Vol. XIV No. 17 ~ EINet News Briefs ~ Aug 19, 2011

*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:

1. Influenza News
- 2011 Cumulative number of human cases of avian influenza A/H5N1
- Global: Avian influenza hits birds in Vietnam, South Africa
- Australia: Sees continued high influenza levels
- Australia: CSL addresses influenza vaccine regulatory concerns, febrile seizure probe
- Egypt: Girl contracts H5N1 influenza

2. Infectious Disease News
- Australia (New South Wales): Urged to get vaccinated after measles outbreak in Sydney
- China (Liaoning): Two more anthrax cases reported in China
- New Zealand: Increased incidences of legionellosis
- New Zealand (Auckland): 94 measles cases confirmed in region
- Philippines (Capiz): Upsurge in measles cases
- Russia (Stavropol): 19 cases of Crimean-Congo hemorrhagic fever reported
- Viet Nam: Anthrax cases reported in northern provinces
- Viet Nam: Hand, foot, and mouth diseases death toll climbs to 81
- Canada: Certain grain fed veal liver may contain E.coli 0157:H7 bacteria
- Canada: Diarrheal shellfish poisoning alert, recall
- Canada (Ontario): Cases of mumps confirmed
- Mexico (Guanajuato): First case of measles in state reported
- USA (CDC): Investigation update, multistate outbreak of human Salmonella Heidelberg infections linked to turkey
- USA (Michigan): Ground beef recall
- USA (Minnesota): Officials confirm case of inhalational anthrax
- USA (Oregon): Cases rise in E. coli strawberry outbreak
- USA (Pennsylvania): Yersiniosis in pasteurized milk
- USA (Pennsylvania): 13 cases of measles confirmed
- USA (Pennsylvania): E.coli infections prompt lake closure
- USA (Washington State): Vibrio parahaemolyticus outbreak linked to raw oysters

3. Updates

4. Articles
- Antibiotic-Resistant Phenotypes and Genotypes of Neisseria gonorrhoeae Isolates in Japan: Identification of Strain Clusters With Multidrug-Resistant Phenotypes
- Monovalent Rotavirus Vaccine Provides Protection Against an Emerging Fully Heterotypic G9P[4] Rotavirus Strain in Mexico
- Latent tuberculosis infection in a migrant agricultural community in baja california, Mexico
- Randomized trials of artemisinin-piperaquine, dihydroartemisinin-piperaquine phosphate and artemether-lumefantrine for the treatment of multi-drug resistant falciparum malaria in Cambodia-Thailand border area
- A systematic review of the evidence on the effectiveness and risks of inactivated influenza vaccines in different target groups
- Serious adverse events following receipt of trivalent inactivated influenza vaccine in Korea, 2003–2010
- Avian influenza A(H5N1) in humans: new insights from a line list of World Health Organization confirmed cases, September 2006 to August 2010
- Effectiveness of Non-Adjuvanted Pandemic Influenza A Vaccines for Preventing Pandemic Influenza Acute Respiratory Illness Visits in 4 U.S. Communities

5. Notifications
- Influenza 2011: Zoonotic Influenza and Human Health
- 5th Vaccine and ISV Annual Global Congress
- Emergence of Infectious Diseases, Environments and Biodiversity
- Sixth TEPHINET Southeast Asia and Western Pacific Bi-regional Conference

1. Influenza News

2011 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Bangladesh / 2 (0)
Cambodia / 7 (7)
Egypt / 32 (12)
Indonesia / 7 (5)
Total / 48 (24)

***For data on human cases of avian influenza prior to 2011, go to:

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 564 (330) (WHO 8/9/2011)

Avian influenza age distribution data from WHO/WPRO (last updated 2/7/2011):

WHO's map showing world's areas affected by H5N1 avian influenza (status as of 2/12/10):

WHO’s timeline of important H5N1-related events (last updated 5/2/11):


Global: Avian influenza hits birds in Vietnam, South Africa
Outbreaks of H5N1 avian influenza have struck poultry flocks in five villages in Vietnam's Nghe An province, national agriculture officials said 4 August 2011. Nghe An is on Vietnam's north central coast. The outbreaks were detected between 17 and 27 July 2011 and killed nine birds while sickening 1,494 more. Authorities culled 2,517 more to control the outbreaks. The source of the virus has not been found. In other avian flu developments, South African officials reported 5 August 2011 nine more highly pathogenic H5N2 outbreaks at ostrich farms in Western Cape province, which has been battling the strain since it reemerged in ostrich flocks in February. The virus was detected during routine surveillance. In the latest round of outbreaks the virus sickened 1,706 birds, and 1,186 more were slaughtered to curb the disease.
(CIDRAP 8/5/2011)


Australia: Sees continued high influenza levels
Flu activity in Australia continues to increase, with rising case numbers not confined to Queensland, New South Wales, and South Australia states, which have been the hot spots over the past several weeks, according the country's Department of Health and Aging on 16 August 2011. Its latest surveillance report covers the week ending 5 August 2011. Most virus detections have been the 2009 H1N1 strain, but influenza B is circulating and has been dominant in some areas, such as Tasmania. Flu activity in four areas—Australian Capital Territory, New South Wales, Queensland, and Tasmania—has surpassed 2010 peaks. Nationally, the weekly number of confirmed cases is above annual peaks for previous years, except for 2009. The health department said the reason for the unusually high activity isn't clear, but the numbers don't appear to be only a reflection of increased testing. The flu season in the Southern Hemisphere typically runs from May through October.
(CIDRAP 8/16/2011)


Australia: CSL addresses influenza vaccine regulatory concerns, febrile seizure probe
Australian flu vaccine maker CSL is still working on addressing concerns raised by the US Food and Drug Administration (FDA) in March regarding manufacturing processes at its plant in Melbourne where the vaccine is made, the Australian Associated Press (AAP) reported 17 August 2011. CSL's managing director, Brian McNamee, said that the company responded in detail to the FDA's concerns and that so far the FDA is satisfied with the progress. But we accept this is a journey and we have to continue to update our systems and procedures, he said. McNamee said the company has improved its management systems for compliance and is bringing in new staff. In June 2010 the company withdrew its Fluvax seasonal flu vaccine after hundreds of children under age five experienced febrile seizures following vaccination. Australian drug regulators confirmed the link. McNamee said CSL's own investigation found that the reactions were caused by a surprise interaction between the flu strains that were in the 2010 vaccine. He said scientists still don't know what caused the interaction between the strains.
(CIDRAP 8/17/2011)


Egypt: Girl contracts H5N1 influenza
A 6-year-old girl in Egypt has contracted H5N1 avian flu, marking the country's 32nd confirmed H5N1 case in 2011, the World Health Organization (WHO) reported 9 August 2011. Citing the Egyptian Ministry of Health, the WHO said the girl, from Beheira governorate, developed symptoms 12 July 2011 and was hospitalized. After completing a course of oseltamivir (Tamiflu), she was discharged from the hospital on 30 July 2011. Egyptian Central Public Health Laboratories confirmed her H5N1 diagnosis, and investigations indicated that she had been exposed to poultry suspected to have avian influenza. Of the 32 Egyptian cases in 2011, 12 have resulted in death. Since 2006 the country has confirmed 151 H5N1 cases, including 52 deaths. The global total now stands at 564 cases and 330 deaths.
(CIDRAP 8/10/2011)


2. Infectious Disease News

Australia (New South Wales): Urged to get vaccinated after measles outbreak in Sydney
The Australian New South Wales (NSW) health authorities on 12 August 2011 issued a measles vaccination reminder following a spike in the number of cases in Sydney.

NSW director of health protection Dr. Jeremy McAnulty said seven cases of measles have been reported in NSW since the start of July 2011. All seven cases were acquired in the Sydney metropolitan region, where several adults in their 20s and 30s were infected, he said.

The rash of cases has puzzled doctors who are unable to pinpoint precisely the source of the current outbreak. This is a little unusual as most cases in NSW tend to be seen in unvaccinated or partially vaccinated people who have recently returned from travel overseas. The original source of their infection is unknown, McAnulty said.

Some 56 measles cases have been recorded in NSW so far in 2011. That compares to a total of 26 in 2010, 19 in 2009, 39 in 2008, and three in 2007.
(ProMED 8/12/2011)


China (Liaoning): Two more anthrax cases reported in China
Another two cutaneous anthrax infections were reported in northeast Liaoning Province, bringing the total number of people who were hospitalized for the disease to 32, health authorities said Tuesday, 16 August 2011. The two cases were found 15 August 2011 in Donggang City, more than 100 km away from the city where the disease was first reported, the Liaoning Provincial Health Department said. Health experts noted that all the cases originated from the same source.

As of 8 p.m. Monday, 15 August 2011, four cases have been confirmed while 28 others were still being investigated, according to the health department. An initial investigation by local health authorities showed that the patients contracted the disease after direct contact with diseased cattle.

The government of Liaoning has since killed or disinfected more than 400 heads of cattle in the province and carried out a survey among over 20,000 people.

Cutaneous anthrax is an infection of the skin caused by direct contact with infected animals or animal products. It is rarely fatal if treated.

A total of nine more people are suspected of being infected with cutaneous anthrax in northeast China's Liaoning Province, bringing the total number of reported cases to 30, local health authorities said on12 August 2011.
(ProMED 8/16/2011)


New Zealand: Increased incidences of legionellosis
Health experts are baffled by New Zealand's accelerating rates of legionellosis -the disease commonly known as legionnaires' disease. A recently released report prepared for the Health Ministry revealed a 141% rise in the number of cases of the illness reported between 2009 and 2010.

Historically the pneumonia-like infection has been caught by inhaling potting mix or exposure to contaminated water in plumbing systems, air conditioning units, or cooling towers. Of 178 reported cases of the disease in 2010 there were five related deaths and 136 hospitalizations. The disease has continued to develop with 89 cases reported from January-June 2011. For January-June 2010, 63 cases were reported.

The full article may be accessed at http://www.promedmail.org/pls/apex/f?p=2400:1001:2565082643394824::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1010,89657
(ProMED 8/5/2011)


New Zealand (Auckland): 94 measles cases confirmed in region
The Auckland Regional Public Health Service (RPHS) has confirmed 94 cases of measles in the Auckland region as of 1 August 2011; eight contacts are in quarantine and five cases have required hospitalization during this outbreak. Most cases have occurred in West Auckland with some spread to Central Auckland, North Shore, and Manukau.

Update. As of 12 August 2011, there are now 104 confirmed cases of the illness. Richard Hoskins says health agencies have seen 10 to 14 new cases each week for the since July 2011. Dr Hoskins says it is not an epidemic yet, but there is a strong possibility that numbers will increase dramatically.

Waikato also has a spate of measles cases, with 12 confirmed cases.

The full article may be accessed at http://www.promedmail.org/pls/apex/f?p=2400:1001:858336402234826::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1010,89789
(ProMED 8/12/2011)


Philippines (Capiz): Upsurge in measles cases
Health officials are stepping up efforts to curb an upsurge in measles cases in Capiz. Provincial Health Information Officer Joeffry Espiritu said that Dr. Renelyn Reyes, Expanded Program on Immunization coordinator of the Department of Health in Western Visayas, was here to take part in formulating measures to curb the increasing measles cases in Capiz. Espiritu revealed that as of 29 July 2011, Capiz had 43 recorded measles cases. 41 of the patients were Capicenos, while the two others came from Aklan and Iloilo, but were confined in the hospitals here.

He added that of the total cases, 22 are from Roxas City, followed by Dao with four cases, three cases each in Pilar and Panay, two cases each in Ivisan and Jamindan, and one case each in Dumalag, Mambusao, Panitan, President Roxas and Sigma. The highest number of cases was registered in June 2011, numbering 25, followed by May 2011 with nine cases, and three cases each in January, February and April 2011, Espiritu said.

Among the measures to be undertaken are mapping activities for children who missed the recently conducted measles immunization campaign, Dr. Reyes said. He added that the mapping-out activity will employ a house-to-house review to ensure that all those children are immunized.

According to him, during the last week of August 2011, nurses who were employed under the Registered Nurses for Health Enhancement And Local Service (RN HEALS) program in Roxas city will conduct a rapid coverage assessment to validate mapping out activities in every barangay district. In April to May 2011, a nationwide anti-measles campaign was initiated to free the country from measles cases.
(ProMED 8/6/2011)


Russia (Stavropol): 19 cases of Crimean-Congo hemorrhagic fever reported
The regional service of Rospotrebnadzor (Federal Service for Consumer Protection and Human Welfare) has reported 19 cases of Crimean-Congo hemorrhagic fever (CCHF) in the region (Stavropol territory). Eight of them contracted the infection in the course of their employment in animal husbandry, and the other 11 contracted infection during recreation in the countryside.

Tick-bites were responsible for medical consultation in 8,575 cases, 2,548 of who were children. Employees of the public health advisory service have been issued with protective clothing when spraying tick repellant. The general population is being advised to seek medical treatment immediately if symptoms of fever, muscle aches, and headache are experienced.
(ProMED 8/5/2011)


Viet Nam: Anthrax cases reported in northern provinces
Some mountainous northern provinces including Lai Chau, Dien Bien, and Ha Giang have reported cases of the anthrax disease for the months of July and August 2011.

The Department of Preventive Medicines in Lai Chau has reported 25 anthrax cases in the districts of Than Uyen and Tam Duong. One three-year-old toddler contracted the infection while one resident succumbed to the disease.

People believe that the cause of the disease is exposure to infected goats, cattle, sheep, and horses or by consuming products related to them. Medical workers fret that it is difficult to eradicate the disease because residents' have a nasty habit of exposing themselves directly to infected ruminants during slaughter.

According to deputy health minister Trinh Quan Huan, anthrax can infect humans in three ways. The commonest is through the skin, which causes ugly sores that usually go away without treatment. Dead carcasses of animals left to putrefy in open contaminated areas can be a source of anthrax infestation. Carcasses need to be buried to avoid the spread of the virus to live animals and subsequently to humans.
(ProMED 8/8/2011)


Viet Nam: Hand, foot, and mouth diseases death toll climbs to 81
A health official said 96% of hand, foot and mouth disease (HFMD) fatalities in Viet Nam for 2011 have been of children under five years of age. The death toll for HFMD has climbed to 81 among 32,588 cases reported in 52 cities and provinces, according to the Viet Nam Administration of Preventive Medicine.

Tran Thanh Duong, the agency's deputy chief, stated that fatalities have been reported in 17 cities and provinces, with Ho Chi Minh City having the highest toll at 22, followed by the provinces of Dong Nai, Binh Duong, Long An and Ba Ria-Vung Tau. He added 96% of fatalities were of children under five years of age.

Duong's office has warned the disease may continue to spread to more provinces and claim more lives in the coming months. The risks are higher for children attending kindergartens, since the new school year has already begun. The Ministry of Health has asked the education sector to take active measures to sterilize kindergartens, daycare centers and schools to prevent the spread of the HFMD virus.
(ProMED 8/15/2011)


Canada: Certain grain fed veal liver may contain E.coli 0157:H7 bacteria
The Canadian Food Inspection Agency (CFIA) announced a recall on 10 August 2011 of grain-fed veal liver products produced by White Veal Meat Packers Ltd. of Toronto. The CFIA recall alert did not specify the total amount of recalled product, which includes vacuum-packed and poly-packed veal sold in British Columbia, Ontario, and Quebec. The FSIS said there have been reported illnesses associated with the consumption of this product but did not offer further details.

The full article may be accessed at http://www.inspection.gc.ca/english/corpaffr/recarapp/2011/20110810e.shtml
(CFIA 8/10/2011)


Canada: Diarrheal shellfish poisoning alert, recall
The Canadian Food Inspection Agency (CFIA) is warning the public not to consume the mussels, described below, because they may contain Diarrhetic Shellfish Poisoning (DSP) biotoxin.

The affected mussels were harvested by Island Sea Farms Inc. from the harvest location “Area: BC 13, Sub Area: 15”or “BC 13-15” between 19 July 2 August 2011.

The full article may be accessed at http://www.inspection.gc.ca/english/corpaffr/recarapp/2011/20110806e.shtml
(CFIA 8/6/2011)


Canada (Ontario): Cases of mumps confirmed
Toronto Public Health reports 11 cases of mumps (10 confirmed and 1 probable) since 20 July 2011. The index case for this cluster travelled from Vancouver, where a mumps outbreak that started in Whistler has spread to Toronto on 3 June 2011 and developed symptoms on 9 June 2011. Transmission was initially confined to employees and patrons at the Toronto financial district restaurant where the index case worked, but has now spread to other sites. Currently, all confirmed cases have some link (work, meeting, or other activities) to the downtown financial core of Toronto. A small number of other cases linked to this outbreak have also been reported from other health units within Ontario.

The median age of the 11 cases is 34 years, with a range of 24 to 47 years; 73% of cases are male. One case had received two doses of mumps-containing vaccine, three cases had received a single dose, and the rest had an unknown vaccination history. Reports continue to be received and investigated. Genotyping of all lab-confirmed cases is pending.

Toronto Public Health's response has included: 1) a vaccine clinic for employees of the restaurant, 2) two public health alerts to assist clinicians with diagnosing mumps and infection prevention and control measures for their office, 3) promotion of vaccine messages through media outlets, and 4) the exclusion from work of susceptible employees in a high risk setting (for example, health care workers) for the period 12 to 26 days following their exposure.

One other confirmed case of mumps also travelled to Vancouver during their period of acquisition and was reported before this outbreak. There was no evidence of any further transmission from this case.
(ProMED 8/8/2011)


Mexico (Guanajuato): First case of measles in state reported
Secretary of Health of Guanajuato Jaime Ramirez Barba reported the first case of measles in the state, a man of 45 years in the city of Celaya who had caught the infection on a journey made to the United States and Canada.

The Guanajuato resident acquired measles in transit through New York, Boston and Canada, health officials said. The patient was hospitalized with measles symptoms 3 August 2011 after a private physician notified the Ministry of Health. The victim has been released but remains under medical supervision. Ramirez Barba stated on 5 August 2011. The Federal Ministry of Health has confirmed the diagnosis of measles virus infection. To prevent the spread of the virus, vaccination had been intensified in Celaya, where the victim resided.

This is the third confirmed case of measles in Mexico. The other two, identified in the city of Mexico, were a one-year-old girl from France and a young Mexican woman who had arrived from London. The Ministry of Health has reinforced vaccination of children under 12 years of age who had not been vaccinated and people under 39 years, who have not been completely immunized. For this purpose, 57,000 doses were distributed in the eight jurisdictions of the state territory.

At Guanajuato International Airport, a team from the National Epidemiological Surveillance System is on alert for possible cases and will be reporting them immediately and establishing quarantine. Ramirez Barba advised Guanajuato citizens traveling to the United States, Canada and Europe to make sure that they have been adequately vaccinated.
(ProMED 8/6/2011)


USA (CDC): Investigation update, multistate outbreak of human Salmonella Heidelberg infections linked to turkey
CDC is collaborating with public health officials in many states and the US Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS) to investigate a multistate outbreak of Salmonella (enterica serotype) Heidelberg infections that is likely caused by eating ground turkey.

A total of 107 people infected with the outbreak strain have been reported from 31 states between 27 February 2011 and 9 August 2011. The number of patients identified in each state is as follows: Alabama (1), Arkansas (1), Arizona (3), California (6), Colorado (2), Georgia (2), Illinois (13), Indiana (1), Iowa (2), Kansas (1), Kentucky (2), Louisiana (1), Massachusetts (3), Maryland (1), Michigan (12), Minnesota (2), Mississippi (1), Missouri (4), Nebraska (2), Nevada (1), New York (2), North Carolina (3), Ohio (10), Oklahoma (1), Oregon (1), Pennsylvania (5), South Dakota (3), Tennessee (2), Texas (14), Utah (1), and Wisconsin (4).

Among those for whom information is available, illnesses began on or after 27 February 2011. Patients range in age from less than 1 year to 89 years old, with a median age of 21 years old. 55 percent are male. Among the 64 ill people for whom information is available, 25 (39 percent) have been hospitalized. One death has been reported.

The full article may be accessed at http://www.cdc.gov/salmonella/heidelberg/081111/index.html
(US CDC 8/11/2011)


USA (Michigan): Ground beef recall
The US Department of Agriculture's (USDA's) Food Safety and Inspection Service (FSIS) announced 11 August 2011 that McNees Meats and Wholesale LLC., of North Branch, Mich., has expanded its recall of ground beef linked to an E. coli O157:H7 outbreak to 2,020 pounds, up from 360 pounds recalled on 9 August 2011. In addition to the original 10-pound packages recalled earlier, the expanded recall includes 1-pound clear packages labeled McNees Ground Beef Bulk, 1- to 1.5-pound clear plastic bags labeled McNees Ground Beef Bulk, 1-pound packages of McNees Ground Round, and 1- and 2-pound red-and-white packages of McNees Ground Beef Bulk. Each bears the establishment number EST. 33971 within the USDA mark of inspection. The meat has been linked to five confirmed and four suspected E. coli illnesses.
(CIDRAP 8/11/2011)


USA (Minnesota): Officials confirm case of inhalational anthrax
A person hospitalized in Minnesota has contracted inhalational anthrax after traveling in western states, officials from the Minnesota Department of Health (MDH) announced 9 August 2011. The MDH said that the agency and its partners at the US Centers for Disease Control and Prevention (CDC) are investigating the infection, which apparently stemmed from environmental exposure.

The individual is hospitalized in Minnesota after traveling to North Dakota, Montana, Wyoming, and South Dakota. Lab officials in Minnesota confirmed the illness. The MDH did not disclose the patient's name, age, gender, or medical condition, but said he or she is not a Minnesota resident.

Ruth Lynfield, MD, Minnesota state epidemiologist, said evidence suggests the patient was exposed from a natural source. The person had been exposed to soil and animal remains. She added that anthrax disease in hoofed animals occurs annually in certain parts of the country, including the Midwest and West. Animal infections can occur as far south as Texas and as far north as the Canadian border.

Because anthrax is considered a bioterrorism agent, the Federal Bureau of Investigation (FBI) conducted an initial investigation with the MDH, but it found no links to criminal or terrorist activity, the MDH said. The FBI is no longer actively investigating the case.

The rare infection in a human doesn't pose a risk to the public, Lynfield said. Anthrax is not spread from person to person, and it is extremely rare for humans to become sickened with anthrax, especially through inhalation, she said. Human infections occasionally occur from handling contaminated animal hides or meat or from ingesting soil or meat tainted with the anthrax spores.

Officials said they aren't issuing any travel advisories, because infections are rare and Bacillus anthracis, the anthrax bacterium, is naturally found in the environment.

One of the last human anthrax infections in the United States occurred in late 2009 when a New Hampshire woman got sick with the gastrointestinal form of the disease after she participated in an event that involved the use of animal-hide drums. An anthrax bioterror attack on the East Coast in the fall of 2001, involving spores sent through the mail, led to 22 illnesses and five deaths.
(CIDRAP 8/9/2011)


USA (Oregon): Cases rise in E. coli strawberry outbreak
Two new cases of Escherichia coli infection possibly linked to the Oregon outbreak tied to strawberries were reported 10 August 2011 by the Clatsop County Public Health Department (CCPHD), which would bring the outbreak total to 18. County officials said at least one of the people is known to have eaten strawberries traced to Jaquith Strawberry Farms, the source of the tainted berries. Specimens from the two people have been sent to a laboratory for confirmation. Neither required hospitalization. All Oregon cases have been in Clatsop, Washington, and Multnomah counties. Also on 10 August 2011, Oregon Public Health (OPH) officials said they have confirmed the outbreak strain of E. coli O157:H7 in strawberries that were grown in July 2011 on a Jaquith farm in Newberg.
(CIDRAP 8/11/2011)


USA (Pennsylvania): Yersiniosis in pasteurized milk
Officials at the state health department have confirmed that ten people from Beaver and Allegheny counties became sick after consuming milk from a local dairy. Pennsylvania Department of Health spokeswoman Brandi Hunter-Davenport said in an e-mail 4 April 2011 that five individuals in Beaver County and five in Allegheny County in western Pennsylvania were sickened by bacteria after drinking pasteurized, glass-bottled milk from Brunton Dairy in Independence Township.

The full article may be accessed at http://www.promedmail.org/pls/apex/f?p=2400:1001:2565082643394824::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1010,89654
(ProMED 8/5/2011)


USA (Pennsylvania): 13 cases of measles confirmed
For 2011 the state has confirmed 13 cases of measles. There have been six in Perry County, four in Berks County and three in Bucks County. In 2010, only two cases reported in the state.
(ProMED 8/6/2011)


USA (Pennsylvania): E.coli infections prompt lake closure
A rash of Escherichia coli O157:H7 infections has prompted state officials to close a central Pennsylvania lake to recreational activities. The Department of Conservation and Natural Resources says at least six positive cases and three probable infections have been reported by people who swam in the lake at Cowans Gap State Park in Fulton County.

Spokesman Terry Brady says the infection cases involve patients ranging from 2 to 49 years old. One affected child is from Maryland and the rest from central Pennsylvania. Brady says all nine cases involve people who went swimming in the lake in late July 2011.

The lake was closed to swimmers one day in July 2011, following a high E. coli reading, but was reopened after the level dropped within acceptable limits.

(ProMED 8/16/2011)


USA (Washington State): Vibrio parahaemolyticus outbreak linked to raw oysters
At least 22 people have become ill after eating raw oysters in Washington State according to a 4 August 2011 Washington State Department of Health (WSDH) news release. The illnesses, caused by the bacterium Vibrio parahaemolyticus, have been connected to both raw oysters from commercial harvesting and recreational harvesting.
(Examiner.com 8/6/2011)


3. Updates
Influenza A/H1N1: http://www.who.int/csr/disease/swineflu/en/index.html
Influenza A/H1N1 frequently asked questions:
Pandemic Influenza Preparedness and Response - A WHO Guidance Document
International Health Regulations (IHR) at http://www.who.int/ihr/en/index.html.

- WHO regional offices
Africa: http://www.afro.who.int/
Americas: http://new.paho.org/hq/index.php?option=com_content&task=blogcategory&id=805&Itemid=569
Eastern Mediterranean: http://www.emro.who.int/csr/h1n1/
Europe: http://www.euro.who.int/en/what-we-do/health-topics/diseases-and-conditions/influenza/pandemic-influenza
South-East: http://www.searo.who.int/EN/Section10/Section2562.htm
Western Pacific: http://www.wpro.who.int/health_topics/h1n1/

- North America
US CDC: http://www.cdc.gov/flu/swine/investigation.htm
US pandemic emergency plan: http://www.flu.gov
MOH México: http://portal.salud.gob.mx/index_eng.html
PHA of Canada: http://fightflu.ca

- Other useful sources
CIDRAP: Influenza A/H1N1 page:
ProMED: http://www.promedmail.org/
WHO H1N1 pandemic influenza update 115: http://www.who.int/csr/don/2010_08_27/en/index.html
CDC Teleconference results: Healthcare groups need to share emergency plans:
American Academy of Pediatrics Policy Statement: Recommendations for Prevention and Control of Influenza in Children, 2010-2011:


- UN: http://www.undp.org/mdtf/influenza/overview.shtml
UNDP’s web site for information on fund management and administrative services. This site also includes a list of useful links.
- WHO: http://www.who.int/csr/disease/avian_influenza/en/
- UN FAO: http://www.fao.org/avianflu/en/index.html.
View the latest avian influenza outbreak maps, upcoming events, and key documents on avian influenza H5N1.
- OIE: http://www.oie.int/eng/info_ev/en_AI_avianinfluenza.htm.
Link to the Communication Portal gives latest facts, updates, timeline, and more.
- US CDC: Visit "Pandemic Influenza Preparedness Tools for Professionals" at: http://www.cdc.gov/flu/pandemic/preparednesstools.htm.
This site contains resources to help health officials prepare for an influenza pandemic.
- The US government’s website for pandemic/avian flu: http://www.flu.gov/.
“Flu Essentials” are available in multiple languages.
- CIDRAP: Avian Influenza page: http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm.
- Link to the Avian Influenza Portal at: http://influenza.bvsalud.org/php/index.php?lang=en.
The Virtual Health Library’s Portal is a developing project for the operation of product networks and information services related to avian influenza.
- US National Wildlife Health Center: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp
Read about the latest news on avian influenza H5N1 in wild birds and poultry.


Dengue is wreaking havoc in large areas of the Philippines, afflicting more than 46,000 people since January 2011, a top Department of Health (DoH) official reported on 13 August 2011. Dr. Eric Tayag, the chief of the DoH Epidemiology Center, said dengue claimed the lives of 267 people who were mostly children. But even more alarming, was that the 6,000 new patients have been reported since 2 August 2011, with the provinces of La Union and Ilocos Sur in Northern Luzon declaring a state of calamity due to upsurge in the number of dengue cases.
(ProMED 8/14/2011)

The number of weekly dengue cases has taken a dip since fears of a major dengue epidemic surfaced in July 2011. According to numbers from the National Environment Agency, the latest weekly figures of 179 dengue cases as of 5 August 2011 is a drop from the previous number of 263 cases. There were 13 new dengue cases as of 5 August 2011. In comparison, 29 new dengue cases were reported on 4 August 2011.
(ProMED 8/14/2011)

Thailand (Krabi)
Health authorities have highlighted 20 cases of dengue fever on Phi Phi, including some among tourists. There have been 380 dengue fever cases in Krabi province, and some tourists have fallen victim to dengue on Phi Phi and needed treatment at the island hospital. There has been one death on the island in the first six months of 2011, the first since 2010.
(ProMED 8/6/2011)

Viet Nam
Since early 2011, there have been approximately 23,000 cases of dengue fever in the country, causing 22 deaths so far. The General Department of Preventive Medicine reported a total of 5,000 cases in July 2011 alone, including eight fatalities. It said the number of dengue virus infection cases continued rising not only in the south but also in the north.
(ProMED 8/6/2011)

Australia (Kimberley, Pilbara)
More cases of mosquito-borne viruses have been detected in the Western Australia (WA) states of Kimberley and Pilbara regions, more than two months after the virus killed three people.

Murray Valley encephalitis (MVE) continues to be detected across the state which medical entomologist Sue Harrington said was unusual given it was so far into the dry season. She said it indicated an ongoing and persistent activity of the virus.

One person has died in WA and a further nine people have been found to have contracted the mosquito-borne virus in 2011. Another person was currently being monitored and was believed to be the 11th person with MVE virus infection.

A man died in the north west region of WA in early May 2011 after contracting the virus. Later that month, it also claimed the life of a Canadian tourist who visited the Northern Territory and a South Australian man.

By late May 2011, the Department of Health had issued warnings that the virus may spread much closer to Perth than it had previously, with mosquitoes thriving in the perfect WA conditions. A late onset of winter has allowed the infected mosquitoes to breed for longer and in higher numbers, and they are thriving further south.

MVE has no cure and no vaccine with the only way to avoid infection being the avoiding of mosquito bites. The Department of Health issued a warning to people living and travelling through the Kimberley and Pilbara regions to take care against mosquitoes, especially at sunrise and sunset when they were most active.
(ProMED 8/10/2011)

Chinese Taipei
The Taiwan Department of Health (DOH) on 21 July 2011 reported its first imported case of tularemia since 2007. The patient, a 67-year-old United States citizen from San Francisco, California showed symptoms of fever before flying to Taiwan on 26 June 2011. The man was confirmed to have the disease on 18 July 2011, after being admitted to a Taipei hospital for fever, pneumonia, and a build-up of fluid in his lungs, Centers for Disease Control (CDC) deputy director Shih Wen-yi said. However, he is expected to be released from the hospital soon.
(ProMED 8/12/2011)

Hong Kong
Hong Kong has confirmed its first case of Japanese encephalitis in four years. The patient, a six-year-old girl, was admitted to Tuen Mun hospital with fever and vomiting in July 2011. She is now in stable condition. She had no recent travel history, and four of her family members are under medical surveillance.
(ProMED 8/6/2011)

USA (New Mexico)
A 59-year-old woman from McKinley County is in critical condition at University of New Mexico Hospital in Albuquerque with the state's fifth confirmed case of hantavirus pulmonary syndrome (HPS), the New Mexico Department of Health announced 5 August 2011.

While cases of hantavirus infection are uncommon, the five cases we have had for 2011 serve as a reminder of the importance in following our prevention guidelines to keep all New Mexicans safe and reduce their risk of being exposed to infected mice, Health Secretary Dr. Catherine Torres stated in a news release.

So far in 2011, there have been three fatal cases of HPS: a 51-year-old McKinley County woman whose case was reported in January 2011; a 35-year-old Torrance County man reported in May 2011; and a 23-year-old man from McKinley County reported July 2011, the health department said. A 39-year-old McKinley County man whose case was reported in May 2011 has recovered from the illness, officials said.
(ProMED 8/5/2011)


4. Articles
Antibiotic-Resistant Phenotypes and Genotypes of Neisseria gonorrhoeae Isolates in Japan: Identification of Strain Clusters With Multidrug-Resistant Phenotypes
Tanaka M, Koga Y, Nakayama H, et al. Sex Transm Dis. September 2011. 38(9):871-5.
Available at http://www.ncbi.nlm.nih.gov.offcampus.lib.washington.edu/pubmed/21844744

Objectives. To determine the antibiotic susceptibility and the genotype distributions of N. gonorrhoeae isolates in Fukuoka, Japan, and to evaluate the specific associations between genotypes and antibiotic resistance.

Methods. Antibiotic susceptibility testing and N. gonorrhoeae multiantigen sequence typing (NG-MAST) were performed on 242 and 239 N. gonorrhoeae isolates, respectively, in Fukuoka, Japan in 2008.

Results. No isolates showed resistance to spectinomycin, ceftriaxone, or cefixime, although 34 (14.0%) and 149 (61.6%) isolates displayed decreased susceptibility to ceftriaxone (minimum inhibitory concentration range, 0.06-0.5 mg/L) and cefixime (minimum inhibitory concentration range, 0.06-0.5 mg/L), respectively. Furthermore, 171 (70.7%), 68 (28.1%), 39 (16.1%), and 1 (0.4%) isolates were resistant to ciprofloxacin, tetracycline, penicillin, and azithromycin, respectively. The 239 isolates were divided by NG-MAST into 67 sequence types (STs); the 4 most common STs were ST2958 (20.5%), ST4018 (7.5%), ST1407 (6.7%), and ST4487 (5.9%). ST2958 and ST1407 were characterized by a multidrug-resistant phenotype, whereas ST4018 and ST4487 presented a susceptible phenotype. Interestingly, ST1407, which is now common in Europe and Australia, was identified as a predominant ST in this study.

Conclusions. This is the first report combining N. gonorrhoeae antibiotic susceptibility testing with molecular typing by using NG-MAST in Japan. Although a large diversity in NG-MAST was identified, based on comparisons with the international data, the ST1407 with a multidrug-resistant phenotype currently seems to be circulating worldwide.


Monovalent Rotavirus Vaccine Provides Protection Against an Emerging Fully Heterotypic G9P[4] Rotavirus Strain in Mexico
Yen C, Figueroa JR, Uribe ES, et al. J Infect Dis. September 2011. 204(5):783-786.
Available at http://jid.oxfordjournals.org/content/early/2011/07/28/infdis.jir390.full

Abstract. After the introduction of monovalent rotavirus vaccine (RV1) in Mexico in 2006-2007, diarrhea mortality and morbidity declined substantially among Mexican children under 5 years of age. In January 2010, surveillance identified the emergence of a novel G9P[4] rotavirus strain nationwide. We conducted a case-control study to assess the field effectiveness of RV1 against severe rotavirus gastroenteritis caused by this unusual strain and to determine whether the G9P[4] emergence was related to vaccine failure or failure to vaccinate. RV1 was 94% effective (95% confidence interval, 16%-100%) against G9P[4] rotavirus-related hospitalization, indicating that its emergence was likely unrelated to vaccine pressure.


Latent tuberculosis infection in a migrant agricultural community in baja california, Mexico
Garfein RS, Burgos JL, Rodriquez-Lainz A, et al. J Immigr Minor Health. October 2011. 13(5):940-947.
Available at http://www.springerlink.com/content/h28q651772783114/

Abstract. The objectives were to estimate the prevalence and identify correlates of latent tuberculosis infection (LTBI) among residents of a migrant agricultural community in San Quintín, Baja-California, Mexico. Residents completed a questionnaire and had their blood tested for LTBI using the QuantiFERON(®)-TB Gold In-Tube (QFT) assay. Among 133 participants, 39.8% (95% CI 31.5-48.7%) tested QFT-positive. Having crossed the U.S.-Mexican border since living in San Quintin (P = 0.03), consuming unpasteurized milk (P = 0.02) and receiving health care at IMSS-Oportunidades in the last 6 months (P = 0.03) were independently associated with QFT-positivity. High LTBI prevalence in this community emphasizes the need for TB education and LTBI treatment for its residents. Association with travel to the U.S. suggests the potential for TB transmission across borders. Higher QFT-positivity among those consuming unpasteurized milk could indicate M. bovis infection, previously reported among Mexican migrants living in U.S. border cities.


Randomized trials of artemisinin-piperaquine, dihydroartemisinin-piperaquine phosphate and artemether-lumefantrine for the treatment of multi-drug resistant falciparum malaria in Cambodia-Thailand border area
Song J, Socheat D, Tan B, et al. Malar J. 10 August 2011. 10(1):231. doi:10.1186/1475-2875-10-231 (Epub ahead of print).
Available at http://www.malariajournal.com/content/10/1/231/abstract

Background. Drug resistance of falciparum malaria is a global problem. Sulphadoxine/pyrimethamine-resistant and mefloquine-resistant strains of falciparum malaria have spread in Southeast Asia at lightning speed in 1980s-1990s, and the Cambodia-Thailand border is one of the malaria epidemic areas with the most severe forms of multi-drug resistant falciparum malaria.

Methods. Artemisinin-piperaquine (AP), dihydroartemisinin-piperaquine phosphate (DHP) and artemether-lumefantrine (AL) were used to treat 110, 55 and 55 uncomplicated malaria patients, respectively. The total dosage for adults is 1,750 mg (four tablets, twice over 24 hours) of AP, 2,880 mg (eight tablets, four times over two days) of DHP, and 3,360 mg (24 tablets, six times over three days) of AL. The 28-day cure rate, parasite clearance time, fever clearance time, and drug tolerance of patients to the three drugs were compared. All of the above methods were consistent with the current national guidelines.

Results. The mean parasite clearance time was similar in all three groups (66.7+/-21.9hrs, 65.6+/-27.3hrs, 65.3+/-22.5hrs in AP, DHP and AL groups, respectively), and there was no remarkable difference between them; the fever clearance time was also similar (31.6+/-17.7hrs, 34.6+/-21.8hrs and 36.9+/-15.4hrs, respectively). After following up for 28-day, the cure rate was 95.1%(97/102), 98.2%(54/55) and 82.4%(42/51); and the recrudescence cases was 4.9%(5/102), 1.8%(1/55) and 17.6%(9/51), respectively. Therefore, the statistical data showed that 28-day cure rate in AP and DHP groups was superior to AL group obviously. The patients had good tolerance to all the three drugs, and some side effects (anoxia, nausea, vomiting, headache and dizziness) could be found in every group and they were self-limited; Patients in control groups also had good tolerance to DHP and AL, there was no remarkable difference in the three groups.

Conclusions. AP, DHP and AL all remained efficacious treatments for the treatment of falciparum malaria in Cambodia-Thailand border area. However, in this particular setting, the AP regimen turned out to be favourable in terms of efficacy and effectiveness, simplicity of administration, cost and compliance. Trial Registration The trial was registered at Chinese Clinical Trial Register under identifier 2005L01041.


A systematic review of the evidence on the effectiveness and risks of inactivated influenza vaccines in different target groups
Michiels B, Govaerts F, Remmen R, et al. Vaccine. 12 August 2011. doi:10.1016/j.vaccine.2011.08.008 (Epub ahead of print).
Available at http://www.sciencedirect.com/science/article/pii/S0264410X11012175

Purpose. To systematically review the evidence regarding the efficacy, effectiveness and risks of the use of inactivated influenza vaccines in children, healthy adults, elderly individuals and individuals with co-morbidities such as diabetes, chronic lung disease, cardiovascular disease, kidney or liver disease and immune suppression.

Methods. The Cochrane database of systematic reviews was searched for relevant reviews and supplemented with searches of the Cochrane Central Register of Controlled Trials database and Medline. Two reviewers independently assessed review and trial quality and extracted data.

Results and conclusions. The inactivated influenza vaccine has been proven effective in preventing laboratory-confirmed influenza among healthy adults (16–65 years) and children (≥6 years) (GRADE A evidence). However, there is strikingly limited good-quality evidence (all GRADE B, C or not existing) of the effectiveness of influenza vaccination on complications such as pneumonia, hospitalisation and influenza-specific and overall mortality. Inconsistent results are found in studies among children younger than 6 years, individuals with COPD, institutionalised elderly (65 years or older), elderly with co-morbidities and healthcare workers in elderly homes, which can only be explained by bias of unknown origin. The vaccination of pregnant women might be beneficial for their newborns, and vaccination of children might be protective in non-recipients of the vaccine of all ages living in the same community (one RCT, Grade B evidence).


Serious adverse events following receipt of trivalent inactivated influenza vaccine in Korea, 2003–2010
Choe YJ, Cho H, Kim SN, et al. Vaccine. 7 August 2011. doi:10.1016/j.vaccine.2011.07.129 (Epub ahead of print).
Available at http://www.sciencedirect.com/science/article/pii/S0264410X11011790

Background. Vaccination is very important for the control and prevention of influenza, yet no vaccine is perfectly safe. Little is known, however, about influenza vaccination-associated serious adverse events following immunization (AEFI). This study aimed to identify background information on influenza vaccination-related serious AEFI in Korea.

Methods. Retrospective review of data from Korea National Vaccine Injury Compensation Program from 2003 to 2010.

Results. Distribution of approximately 75 million doses of influenza vaccine by end of 2010 gave rise to 42 potentially serious AEFI. In all, nine Guillain-Barré syndrome, eighteen other neurologic events, eight local events, and seven miscellaneous events were included. 62% of these events were identified to have unlike causal association with the vaccine. The reporting rate of serious AEFI ranged from 0.006 to 0.07 cases per 100,000 distributed doses of the vaccine.

Conclusion. GBS was the most common influenza vaccination-related serious AEFI. Enhancing post-vaccination GBS surveillance may increase public confidence in future routine and pandemic influenza vaccination.


Avian influenza A(H5N1) in humans: new insights from a line list of World Health Organization confirmed cases, September 2006 to August 2010
Fiebig L, Soyka J, Buda S, et al. Euro Surveill. August 2011. 16(32):pii=19941.
Available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19941

Abstract. The threat of avian influenza (AI) viruses to humans in Europe in 2005 prompted the Robert Koch Institute to establish a routine monitoring instrument condensing information on all human AI cases worldwide reported from the World Health Organization (WHO) and other sources into a line list for further analysis. The 235 confirmed AI cases captured from September 2006 to August 2010 had a case fatality rate of 56% (132/235), ranging from 28% (27/98) in Egypt to 87% (71/82) in Indonesia. In a multivariable analysis, odds of dying increased by 33% with each day that passed from symptom onset until hospitalisation (OR: 1.33, p=0.002). In relation to children of 0–9 years, odds of fatal outcome were more than six times higher in 10–19 year-olds and 20–29 year-olds (OR: 6.06, 95% CI: 1.89–19.48, p=0.002 and OR: 6.16, 95% CI: 2.05–18.53, p=0.001, respectively), and nearly five times higher in patients of 30 years and older (OR: 4.71, 95% CI: 1.56–14.27, p=0.006) irrespective of the country, which had notified WHO of the cases. The situation in Egypt was special in that case number and incidence in children were more than twice as high as in any other age group or country. With this study, we show that data from the public domain yield important epidemiological information on the global AI situation. This approach to establish a line list is time-consuming but a line list is a prerequisite to such evaluations. We thus would like to encourage the placing of a publicly accessible line list of anonymised human AI cases, e.g. directly by WHO. This might enhance our understanding of AI in humans and permit the rapid detection of changes in its epidemiology with implications for human health.


Effectiveness of Non-Adjuvanted Pandemic Influenza A Vaccines for Preventing Pandemic Influenza Acute Respiratory Illness Visits in 4 U.S. Communities
Griffin MR, Monto AS, Belongia EA, et al. PLoS ONE. 12 August 2011. 6(8): e23085. doi:10.1371/journal.pone.0023085.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0023085

Abstract. We estimated the effectiveness of four monovalent pandemic influenza A (H1N1) vaccines (three unadjuvanted inactivated, one live attenuated) available in the U.S. during the pandemic. Patients with acute respiratory illness presenting to inpatient and outpatient facilities affiliated with four collaborating institutions were prospectively recruited, consented, and tested for influenza. Analyses were restricted to October 2009 through April 2010, when pandemic vaccine was available. Patients testing positive for pandemic influenza by real-time RT-PCR were cases; those testing negative were controls. Vaccine effectiveness was estimated in logistic regression models adjusted for study community, patient age, timing of illness, insurance status, enrollment site, and presence of high-risk medical conditions. Pandemic virus was detected in 1,011 (15%) of 6,757 enrolled patients. Fifteen (1%) of 1,011 influenza positive cases and 1,042 (18%) of 5,746 test-negative controls had record-verified pandemic vaccination >14 days prior to illness onset. Adjusted effectiveness (95% confidence interval) for pandemic vaccines combined was 56% (23%, 75%). Adjusted effectiveness for inactivated vaccines alone (79% of total) was 62% (25%, 81%) overall and 32% (−92%, 76%), 89% (15%, 99%), and −6% (−231%, 66%) in those aged 0.5 to 9, 10 to 49, and 50+ years, respectively. Effectiveness for the live attenuated vaccine in those aged 2 to 49 years was only demonstrated if vaccination >7 rather than >14 days prior to illness onset was considered (61%: 12%, 82%). Inactivated non-adjuvanted pandemic vaccines offered significant protection against confirmed pandemic influenza-associated medical care visits in young adults.


5. Notifications
Influenza 2011: Zoonotic Influenza and Human Health
Oxford, England, United Kingdom, 7-9 September 2011
The 4th Oxford influenza conference, Influenza 2011, will address most aspects of basic and applied research on zoonotic influenza viruses and their medical and socio-economic impact, and invites proposals for podium and poster sessions in the following general areas: epidemiology and evolution; molecular virology and immunology; host-pathogen interaction - virulence and pathogenecity; mathematical models; national and international surveillance and contingency strategies; antiviral drug development and treatment strategies, including vaccination; and advances in viral detection and identification technologies.
Additional information at http://www.libpubmedia.co.uk/Conferences/Influenza2011/Influenza2011%20Home.htm


5th Vaccine and ISV Annual Global Congress
Seattle, Washington, United States, 2-4 October 2011
The annual Vaccine Congress is the leading global forum for the exchange of new ideas on the development of vaccines for infectious and non-infectious diseases. Now in its fifth year, the annual Vaccine Congress has become the forum for the exchange of ideas to accelerate the rate at which vaccines can come to benefit the populations that need them.
Additional information at http://www.vaccinecongress.com


Emergence of Infectious Diseases, Environments and Biodiversity
Libreville, Gabon, 4-5 November 2011
The Centre International de Recherches Médicales de Franceville and the Gabonese Government invite you to the gathering of all fields of expertise to address emergence of infectious diseases: human health, animal health, ecology, human and social sciences.
Additional information at http://www.cirmf.org/en/symposium


Sixth TEPHINET Southeast Asia and Western Pacific Bi-regional Conference
Bali, Indonesia, 8-11 November 2011
The conference has the theme “Global Surveillance Networking for Global Health” and is organized by the Training Programs in Field Epidemiology and Public Health Intervention Network (TEPHINET). The conference is crucial given the transnational population mobility thanks to modern means of transportation and speedy transnational transmission of communicable diseases. At least 700 participants from more than 40 countries are expected to attend the conference.
Additional information at http://tephinet.fetpindonesia.org/