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Vol. XIV No. 20 ~ EINet News Briefs ~ Sep 30, 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
- Egypt: Stronger vet measures needed against H5N1 avian influenza
- Bangladesh: H9N2 avian influenza virus shared with the United States
- USA: Most adults say they intend to get influenza vaccine

2. Infectious Disease News
- China: WHO reports polio outbreak in China, warns of spread
- Indonesia (Bali): Rabies still a threat in Denpasar and Gianyar
- New Zealand (Northland): Meningococcal disease outbreak, 38,000 to be vaccinated
- New Zealand (Bay of Plenty): Measles outbreak spreads
- Canada: Tricky new superbug making inroads, Montreal hospital battled outbreak
- Canada: More than 700 cases of measles
- USA: Multistate outbreak of listeriosis linked to whole cantaloupes from Jensen Farms, Colorado
- USA (Illinois): Mumps outbreak reported on QU campus
- USA (California): Measles cases hit a ten-year high
- USA (Wisconsin): Measles cases traced to unvaccinated tot

3. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA
- VECTOR-BORNE DISEASE

4. Articles
- Vaccine effectiveness for laboratory-confirmed influenza in children 6–59 months of age, 2005–2007
- Hospitalization of pregnant women with pandemic A(H1N1) 2009 influenza in Canada
- A Pre-Pandemic Outbreak of Triple-Reassortant Swine Influenza Virus Infection Among University Students, South Dakota, 2008
- Autopsy series of 68 cases dying before and during the 1918 influenza pandemic peak
- Iquitos Virus: A novel reassortant Orthobunyavirus associated with human illness in Peru
- Risk of Buruli ulcer and detection of Mycobacterium ulcerans in mosquitoes in southeastern Australia
- A hidden markov model for analysis of frontline veterinary data for emerging zoonotic disease surveillance
- Additional recommendations for use of tetanus toxoid, reduced-content diphtheria toxoid, and acellular pertussis vaccine (Tdap)
- Poliovirus
- Tuberculous peritonitis: Analysis of 211 cases in Taiwan
- A statewide outbreak of Cryptosporidium and its association with the distribution of public swimming pools
- Future Infectious Disease Threats to Europe
- Rabies surveillance in the United States during 2010
- Enhancing the role of veterinary vaccines reducing zoonotic diseases of humans: Linking systems biology with vaccine development
- Humans infected with relapsing fever spirochete Borrelia miyamotoi, Russia
- Notes from the Field: Measles Among U.S.-Bound Refugees from Malaysia --- California, Maryland, North Carolina, and Wisconsin, August--September 2011
- Clusters of Acute Respiratory Illness Associated with Human Enterovirus 68 --- Asia, Europe, and United States, 2008--2010

5. Notifications
- 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

Global
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:
http://depts.washington.edu/einet/humanh5n1.html

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 564 (330) (WHO 8/9/2011)
http://www.who.int/csr/disease/avian_influenza/country/cases_table_2011_08_09/en/index.html

Avian influenza age distribution data from WHO/WPRO (last updated 2/7/2011):
http://www.wpro.who.int/sites/csr/data/data_Graphs.htm

WHO's map showing world's areas affected by H5N1 avian influenza (status as of 2/12/10):
http://gamapserver.who.int/mapLibrary/Files/Maps/Global_H5N1Human_2010_FIMS_20100212.png

WHO’s timeline of important H5N1-related events (last updated 7/14/11):
http://www.who.int/csr/disease/avian_influenza/H5N1_avian_influenza_update.pdf

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Europe/Near East
Egypt: Stronger vet measures needed against H5N1 avian influenza
Highly pathogenic avian influenza A(H5N1) infections are continuing to occur in poultry and humans in Egypt, and there is now a concern that the veterinary control measures may be insufficient to keep a check on the continuing outbreaks in poultry, with potential implications for human health in Europe. However, ECDC concludes in its rapid risk assessment, that there is no evidence of a significant change in the pattern of human illness and deaths related to A(H5N1) virus infections, and there are certainly no epidemiological data or analyses consistent with adaptation of these viruses to humans in Egypt. Although some limited virological analyses carried out may indicate that the risk of an A(H5N1) pandemic emerging could be higher in Egypt than other countries, the implications of these analyses are difficult to interpret.

The first human cases in Egypt occurred in 2006. The risk of pandemic A(H5N1) viruses emerging in Egypt cannot be excluded and the continuing transmission of the virus among domestic poultry and on to humans in Egypt from 2006 through 2011 is worrying. Egypt’s proximity to EU/EEA countries makes this more concerning since a pandemic strain and if it would emerge it would presumably spread to Europe very quickly. Despite the lack of evidence that the risk might be increasing, intensification of veterinary control measures in Egypt should take place because of concerns over both human and animal health. Constant vigilance should be maintained for any enlargement in human A(H5N1) cluster size, other changes in the behavior of the virus and for individual human cases outside of countries like Egypt where the virus is recognized as being entrenched in domestic poultry.
(EDCD 9/15/2011)

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Asia
Bangladesh: H9N2 avian influenza virus shared with the United States
Bangladesh is sharing an H9N2 avian influenza virus with the United States, which will use it to make a seed strain for a possible pandemic vaccine. Health secretary Muhammad Humayun Kabir stated that the US Centers for Disease Control and Prevention (CDC) confirmed and sequenced the strain, influenza A/Bangladesh/0994/2011 (H9N2), which the country's Institute of Epidemiology Disease Control and Research (IEDCR) had detected during surveillance. Though the virus causes mild disease, it could pose a potential pandemic threat and could mutate with H5N1, which also circulates in Bangladesh. The virus is being shared through protocols developed by the World Health Organization. Mahmudur Rahman, director of the IEDCR, said Bangladesh would get access to affordable vaccines produced from the viruses, along with other technical support.
(CIDRAP 9/18/2011)

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Americas
USA: Most adults say they intend to get influenza vaccine
Almost two thirds of US adults intend to get vaccinated against influenza this 2011-12 season, and 70% of parents plan to have their children vaccinated, according to survey data presented by health officials in Washington, DC, 21 September 2011.

At an annual press conference hosted by the National Foundation for Infectious Diseases (NFID), Tom Frieden, MD, director of the US Centers for Disease Control and Prevention (CDC), said flu activity is at very low levels in the United States so far and that early reports suggest that all three seasonal strains are circulating and are a good match with the strains included in the vaccine for the upcoming season. He said so far about 90 million doses of flu vaccine have been distributed to outlets such as doctor's offices and pharmacies, with manufacturers expected to produce a record 170 million doses for the 2011-12 flu season.

Sanofi Pasteur recently began shipping its newly approved intradermal influenza vaccine for adults aged 18 through 64, which raises the number of vaccine types to four, including the standard intramuscular injection, the nasal spray for ages 2 through 49, and a high-dose injectable vaccine for people 65 and older. William Schaffner, MD, president of NFID and chairman of the Department of Preventive Medicine at Vanderbilt University School of Medicine, unveiled the results of two surveys conducted on flu vaccine perceptions, one on consumers and one on parents. Each was conducted from 11- 14 August 2011.

The consumer survey, conducted via telephone by Caravan, included 1,006 adults age 18 and older. The parent survey was self-selected and included 1,000 parents age 18 and older who had children between ages 2 and 17. It was conducted by ORC International. Schaffner said one finding was that the repeat inclusion of the 2010-11 season’s three strains in the 2011-12 season's vaccine doesn't appear to be dampening parents' intent to have their children vaccinated, as 56% said knowing the strains are the same didn't affect their vaccination intentions. For adult consumers in general, 79% said the repeat of the strains will not change their intent to get vaccinated. According to the surveys, overall interest in vaccines remains high. For parents, 70% said they definitely or probably will get their children vaccinated. For adult consumers, that level was 63%, up from 57% in 2010. More health providers seem to be encouraging their patients to get vaccinated, Frieden said. The survey found 68% of adults received a recommendation from a health professional in 2011, up from 58% in 2010.

However, for both survey groups, NFID found that some see annual flu vaccination as optional. For example, 40% of parents said annual flu vaccination was a priority for their children, but 20% said they see it as a decision to make each year. Of the 36% who said they didn't intend to be vaccinated, more than two-thirds said they could be motivated to change their minds, according to the survey results. The top three factors included seeing a family member or friend get very sick with the flu, receiving a recommendation from a healthcare provider, and receiving reassurance that the vaccine is safe.

The 2010-11 flu season presents a relatively rare situation in that the three strains in the vaccine are the same as the 2009-10 season. Repeating flu vaccines strains have occurred eight times in the past 42 years, according to background information from the NFID. The CDC estimates that 8 million more people received the flu vaccine during the 2010-11 season than were immunized during the 2009-10 season, Frieden said. But we're not seeing that progress in young adults with underlying medical conditions, he said, noting that only 47% of people aged 18 to 64 who have risk factors for flu complications received the vaccine in 2010.

This same risk group could also be missing out on getting the pneumococcal vaccine, which can help prevent pneumonia, a potential serious complication of influenza, he said. He estimated that about 73 million people who are targeted for the pneumococcal vaccine—adults 65 and older and those over 18 with certain medical conditions—have not received it.
(CIDRAP 9/22/2011)

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2. Infectious Disease News

Asia
China: WHO reports polio outbreak in China, warns of spread
Polio has broken out in China for the first time since 1999 after being imported from Pakistan, and there is a high risk of the crippling virus spreading further during the annual Haj pilgrimage, the World Health Organization said on 20 September 2011.

Nine cases have been confirmed in China and polio is now considered to have spread nationwide in Pakistan, mainly due to insecurity that has halted vaccination campaigns in areas including the Khyber tribal region, a WHO spokesman said.

The WHO rates as 'high' the risk of further international spread of wild polio virus from Pakistan, particularly given the expected large-scale population movements associated with Umra and the upcoming Haj in the coming months, the Geneva-based body said.

Haj is the main annual Muslim pilgrimage to Mecca in Saudi Arabia, which is due to start in November. Umra refers to other pilgrimages to Mecca, which can take place any time of the year.
(Reuters 9/20/2011)

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Indonesia (Bali): Rabies still a threat in Denpasar and Gianyar
Rabies continues to be a risk in the resort island’s capital, Denpasar, and its neighboring regency Gianyar, underlining the persistence of the deadly epidemic that has haunted Bali since late 2008.

Yes, the two regions still have an active status and we ask the public not to transport dogs into or out of those regions, provincial husbandry agency head I Putu Sumantra said.

The cited infection rate classification standard groups infected areas into “very active”, “active”, “six months” and “12 months”, referring to the time between reports of infections. Any area that has had a case of rabies reported within a month is defined as “very active”, and a case within three months warrants an “active”.

In the last three months we have found rabies in dogs in those two regions, Sumantra said. He said that 22 villages in Badung, Buleleng, Jembrana, Karangasem and Klungkung were now listed as “six months”. The only regency listed as “12 months” is Tabanan.

The fight against the epidemic is apparently far from over. Sumantra revealed that this year rabies has infected 18 new villages, bringing the total number of infected villages to 282. We have set a target that by early next year the epidemic will not be able to infect a single new village, he said.

Provincial health agency head I Nyoman Sutedja said that as of August 2011, the epidemic had killed 18 people, far less than 2010, when 86 people died of rabies. The number of bite cases is still very high; up to 150 cases per day. Yet, most of the bites do not result in fatalities because a large number of the dogs have been inoculated and the bite victims have managed to immediately get proper medical treatment, including antirabies vaccines, he said.

As of 12 September 2011, the second phase of the island-wide mass vaccination program, targeting pet and stray dogs, has covered 4,350 banjar (traditional neighborhood organizations) or 99% of the targeted 4,370 banjar. The agency estimated that 77% of the island’s total dog population of 302,000 had been inoculated.
(ProMED 9/23/2011)

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New Zealand (Northland): Meningococcal disease outbreak, 38,000 to be vaccinated
Health officials hope a mass vaccination program aimed at 44,000 people aged between one and twenty will prevent the spread of the deadly meningococcal C disease in Northland after two deaths in August 2011.

Two Northlanders have died from meningococcal C disease, a one-year-old from Ruakaka and another person from Whangarei, and four other people have been confirmed as having type C, while two others had type B meningococcal disease.

Northland medical officer of health Clair Mills said the situation was now a community outbreak and that concern over the spread of the disease and its random nature -- there are no known links between any of the cases -- had prompted the mass vaccination campaign.

Dr. Mills said the program would target the highest risk group of those aged between one and twenty, with the most at risk, high school children, to be the first to receive the free meningococcal C vaccination.

Those out-of-school-aged under 20 will be able to get the vaccine from their GP, or attend special clinics in their area, as soon as vaccine becomes available. The District Health Boards (DHB) will liaise with community groups, employers and tertiary institutions to get to that group.

Initially, the program will be offered to high school students in the highest risk areas progressively over the two weeks from 26 September 2011, Dr Mills said. With exams coming up, it's important to get that group vaccinated before the exam season starts.

Dr. Mills said there are usually between zero to two cases of type C per year in Northland, while in previous years, meningococcal type B disease was the most common type in the region. The current situation is, therefore, consistent with a community outbreak. Following expert advice and in consultation with the Ministry of Health, we have decided to launch a vaccination campaign to help control this outbreak and prevent more cases of disease, she said.

The DHB hoped to vaccinate about 35,000 of those in the one to twenty age group before 16 December 2011 and was optimistic it would reach this target. Dr. Mills said the disease was serious and had major health implications, and she did not think there would be widespread opposition to the vaccination campaign. The DHB would not say how much the vaccination campaign would cost or who was paying for it -- the DHB or the Ministry of Health -- with discussions between the two organizations over that issue ongoing.

Those outside the targeted age group could buy type C vaccinations from their doctor, but the immunization campaign is likely to take up most of the country's available stock. Once new stock arrives from 6 October 2011, the campaign is expected to be offered to primary schools from the beginning of November 2011.

Vaccination offered through a school-based program is the most effective way of ensuring that as many students as possible are protected against the disease, Dr. Mills said. The vaccination campaign will be launched with extensive media advertising, public relations, a poster campaign and widespread communication with schools, parents and caregivers, students, and health professionals in Northland.
(ProMED 9/18/2011)

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New Zealand (Bay of Plenty): Measles outbreak spreads
Bay of Plenty health officials are urging people to check whether they are immunized against measles, as an outbreak of the disease continues to spread nationally.

During the week of 19 September 2011, there has been a surge in the number of people infected with the disease, with 45 reported cases, including one in the Bay of Plenty, taking the total number of nationally confirmed cases since May 2011 to 167.

Bay of Plenty District Health Board medical officer of health Dr. Phil Shoemack says people should be getting their children immunized and be aware of coming into contact with anyone if they, or their children, are not immunized. Vaccination is the best way to protect against measles with the Measles-Mumps-Rubella (MMR) vaccine available, given in two doses, normally at 15 months and four years of age.

Dr. Shoemack says the immunization rate in the Bay of Plenty is improving, although it has not reached the 95% target.

The number of cases in New Zealand is continuing to grow, particularly in the Auckland region, where 27 contacts are currently in quarantine. Health officials say many people have come into contact with the measles on domestic flights and are warning anyone who is planning to travel to check their immunization status first.

Dr. Shoemack says there has been one confirmed case of the measles in the Bay of Plenty, and that was an overseas visitor who is now back in their home country.
(ProMED 9/25/2011)

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Americas
Canada: Tricky new superbug making inroads, Montreal hospital battled outbreak
A Montreal hospital has been battling since 2010 to extinguish an outbreak with worrisome and highly drug-resistant bacteria. The outbreak at the Jewish General is the first in Canada caused by this strain of the bacteria, a bug that has sparked serious concern because of how easily it spreads and its ability to transfer resistance to other bacteria.

A report on the outbreak was presented in Chicago on 18 September 2011 to the Interscience Conference on Antimicrobial Agents and Chemotherapy, a major annual gathering of infectious diseases specialists. Dr. Mark Miller, head of infection control at the Jewish General, said the outbreak has been brought under control, but a few patients with the bacteria are still being treated in the hospital.

The outbreak was caused by Klebsiella pneumonia, which is normally found in the human intestine. In healthy people, these bacteria can live in the intestine without causing illness. In hospitals, however, they can cause a range of infections, including pneumonia, bloodstream infections, and urinary tract infections.

K. pneumonia traditionally have been treated with antibiotics called carbapenems. But in the last decade or so, a strain of the bacteria has developed that is resistant to this class of drugs. To make matters worse, the genetic component that gives K. pneumonia this resistance has the capacity to transfer into other bacteria, making them resistant to these drugs as well.

The strain with this component is called KPC-producing K. pneumonia, and it has even more tricks in its arsenal. The gene that makes it resistant to carbapenems is packaged in a cassette of genes that confer resistance to a number of other antibiotics. Miller said the version that slipped into his hospital could only be treated with two antibiotics -- an old drug with serious side-effects and a newer drug. He and others worry about the day they will find KPC that responds to no drugs at all.

That has happened. In fact, the Ottawa Hospital had two cases of KPC-producing K. pneumonia in 2008, one of which was resistant to all antibiotics. Microbiologist Marc Desjardins said the Ottawa Hospital was lucky -- the three cases didn't spark an outbreak. (One patient caught the bacteria from one of the other two, but there was no sustained spread in the hospital.) But the patients were hard to treat and for one, nothing worked. The bug was resistant to everything. There was absolutely not a single antibiotic we could give that patient, Desjardins said. The woman, who had other grave health problems, eventually died. Battling bacteria that are not susceptible to any antibiotics is a nightmare scenario, he admitted. At least in serious infections, there is hope to actually treat the infection. With KPCs, if your organism is resistant to everything, currently in our baggage of antibiotics we have nothing available to treat them, Desjardins said. The only thing to do is to use combinations of antibiotics and hope.

The full article may be accessed at http://www.globalnews.ca/canada/tricky+new+superbug+making+inroads+in+canada+montreal+hospital+battled+outbreak/6442484188/story.html
(Global News 9/18/2011)

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Canada: More than 700 cases of measles
For the first time since 2007, Quebec is dealing with a wide scale measles outbreak. More than 700 cases of the potentially deadly disease have been reported in the province in 2011, with the majority of people being infected between April and July 2011, although new infections are still being reported. Most of the people infected live in the Mauricie region of the province, but the most recent cases have been reported in the Eastern Townships.

12% of the infections have been so bad people needed to be hospitalized for treatment. Measles can cause blindness, encephalitis, pneumonia and death. Public health officials suspect the disease was brought into Quebec by European visitors. They are urging parents to get children vaccinated against the disease.

Vaccination rates against measles have dropped since 1998, when a medical researcher faked research and falsely claimed there was a link between a measles vaccine and autism. That research has since been thoroughly discredited; the journal that published the study has apologized, and the doctor involved has been stripped of his medical license.
(ProMED 9/25/2011)

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USA: Multistate outbreak of listeriosis linked to whole cantaloupes from Jensen Farms, Colorado
As of September 26, 2011, a total of 72 persons infected with the four outbreak-associated strains of Listeria monocytogenes have been reported to CDC from 18 states. All illnesses started on or after 31 July 2011. The number of infected persons identified in each state is as follows: California (1), Colorado (15), Florida (1), Illinois (1), Indiana (2), Kansas (5), Maryland (1), Missouri (1), Montana (1), Nebraska (6), New Mexico (10), North Dakota (1), Oklahoma (8), Texas (14), Virginia (1), West Virginia (1), Wisconsin (2), and Wyoming (1).

Thirteen deaths have been reported: two in Colorado, one in Kansas, one in Maryland, one in Missouri, one in Nebraska, four in New Mexico, one in Oklahoma, and two in Texas.

Collaborative investigations by local, state, and federal public health and regulatory agencies indicate the source of the outbreak is whole cantaloupe grown at Jensen Farms’ production fields in Granada, Colorado.

On 14 September 2011, FDA announced that Jensen Farms issued a voluntary recall of its Rocky Ford-brand cantaloupes after being linked to a multistate outbreak of listeriosis. CDC recommends that persons at high risk for listeriosis, including older adults, persons with weakened immune systems, and pregnant women, do not eat Rocky Ford cantaloupes from Jensen Farms. Other consumers who want to reduce their risk of Listeria infection should not eat Rocky Ford cantaloupes from Jensen Farms. Even if some of the cantaloupe has been eaten without becoming ill, dispose of the rest of the cantaloupe immediately. Listeria bacteria can grow in the cantaloupe at room and refrigerator temperatures.

Cantaloupes that are known to NOT have come from Jensen Farms are safe to eat. If consumers are uncertain about the source of a cantaloupe for purchase, they should ask the grocery store. A cantaloupe purchased from an unknown source should be discarded: when in doubt, throw it out.
(US CDC 9/27/2011)

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USA (Illinois): Mumps outbreak reported on QU campus
The Adams County Health Department (ACHD) and Quincy University (QU) say several cases of mumps have been reported on the college campus. QU officials said students have received information about mumps and are being given the opportunity to get vaccinations to reduce the risk of contracting the mumps. The department does not consider this cluster of cases will increase risk of mumps disease to the general public since cases are limited to a single localized population.

Jerrod Welch, director of clinical and environmental services for the ACHD, says the number of cases of mumps is believed to be under ten.

Mumps is a disease that by the time you have symptoms, you are no longer contagious or very contagious, Welch said. The symptoms usually resolve themselves within a number of days.

Mumps is an acute viral infection of the salivary glands. Symptoms may include fever, headache, muscle ache and swelling and tenderness of the salivary glands under the ears or jaw on one or both sides of the face. Infection takes place through direct contact with respiratory droplets from the nose or throat, through saliva, coughing, sneezing or from any surface contaminated with mumps virus. Because it's a viral infection, mumps does not respond to antibiotic treatment. QU students and faculty have been provided with a campus contact hotline number for questions or concerns about mumps. Welch urged people who believe they have mumps or any communicable disease to contact their health care provider by phone. The thing we least want to do is expose people by going into a waiting room, Welch said.
(ProMED 9/28/2011)

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USA (California): Measles cases hit a ten-year high
With more parents forgoing measles vaccinations for their children, the number of Californians contracting the highly contagious disease is higher than any time in the last decade.

As of 19 September 2011, there were 28 reported cases of measles in 2011, according to the California Department of Public Health. That is the highest incidence since 2001, when 40 people reported having measles. There were nine cases in all of 2009 and 27 cases in 2010.

Of the cases reported in 2011, 22 of the 28 were not vaccinated or very likely to lack the vaccine. More than half had recently traveled internationally, including to Europe, where vaccination rates have dropped and measles cases have risen.

We are quite concerned in California as is I believe the rest of the country about increasing cases of measles, said Gil Chavez, deputy director of the department’s Center for Infectious Diseases. Even one single case that is acquired oversees can expose a lot of individuals when they come back home and in the airplane.

The high incidence is concerning to health officials, who worry that individual cases could lead to outbreaks in schools and communities. In 2008, a seven-year-old boy who had not been vaccinated triggered an outbreak in San Diego.

The number of non-vaccinated children has continued to grow over the last decade, as parents fear that vaccinations could cause autism, a belief repeatedly disproved in scientific literature. To opt out of the vaccine, parents simply fill out a form.
(Los Angeles Times 9/21/2011)

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USA (Wisconsin): Measles cases traced to unvaccinated tot
The Centers for Disease Control and Prevention says Milwaukee's measles alert began when an unvaccinated 23-month-old refugee from Burma flew to the city from Malaysia. The child flew to Wisconsin on 24 August 2011 and was reported to have laboratory-confirmed measles on 7 September 2011. Since then, measles has been confirmed in two more people in Milwaukee. Paul Biedrzycki, the city's director of disease control and environmental health, says both of those people appear to have acquired the disease through exposure to the refugee patient.
Biedrzycki says Milwaukee health workers are working with refugee resettlement agencies to identify and control the spread of measles.
(ProMED 9/25/2011)

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3. Updates
INFLUENZA A/H1N1
- WHO
Influenza A/H1N1: http://www.who.int/csr/disease/swineflu/en/index.html
Influenza A/H1N1 frequently asked questions:
http://www.who.int/csr/disease/swineflu/frequently_asked_questions/en/index.html
Pandemic Influenza Preparedness and Response - A WHO Guidance Document
http://www.who.int/csr/disease/influenza/pipguidance2009/en/index.html
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:
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/biofacts/swinefluoverview.html
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:
http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/sep0210standards.html
American Academy of Pediatrics Policy Statement: Recommendations for Prevention and Control of Influenza in Children, 2010-2011:
>http://pediatrics.aappublications.org/cgi/content/abstract/peds.2010-2216v1

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AVIAN INFLUENZA
- 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.

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VECTOR-BORNE DISEASE
Mexico
Health authorities have detected two dengue outbreaks, both in the capital of Querétaro state (Santiago de Querétaro), where 13 cases of classical dengue fever were confirmed, with another 35 suspected cases. The disease has also put the health sector of Quintana Roo on alert, where 84 positive cases are reported with one death, as well as in Tamaulipas, with 35 cases and Michoacán with one case, but none of DHF.
(ProMED 9/19/2011)


Thailand (National)
The Ministry of Public Health has urged people in flooded areas to beware of dengue fever infection during the seven to ten days after the water recedes, as the mosquito population is expected to soar.

With concerns over a possible outbreak of dengue fever, the Minister has assigned provincial public health and disease control offices across the country to be on high alert and seek cooperation from local residents in cleaning their homes after the floods and eliminating all stagnant waters within the first week.

According to MD Paijit, there have been 48,760 people infected with dengue fever in Thailand since the beginning of 2011; 35 of them have passed away. The majority of patients are in the central region, followed by the Northeast, the North and the South.
(ProMED 9/19/2011)


Chile (Aysen)
The ninth confirmed case of hantavirus infection was registered 23 September 2011 in the Coyhaique Regional Hospital. The patient is a 44-year-old woman who visited the La Junta area, the same site where a month earlier her husband also was infected with the virus. In both cases, their recoveries were positive so that both the woman and her husband were released from the hospital without serious health consequences.

Marco Acuna, epidemiologist of the Health SEREMI (Regional Ministerial Secretariat) who ratified the ninth case of this infection, said that the woman was again at her home. The woman was hospitalized on 12 September 2011 with febrile symptoms, intense muscle pain and poor general condition, and was hospitalized in the intensive care unit of the Coyhaique hospital, where preliminary tests by the hospital clinical laboratory recorded a hantavirus infection. On 23 September 2011, the positive results were confirmed by the Public Health Institute. The woman recovered favorably and was released on 18 September 2011. With this case, the number of cases of the infection increased to 11 in the Aysen region.

Marco Acuna, provided information about the areas with the greatest concentration of mice and thus the greatest probability of contracting the disease. The information that we have had is that in the most affected areas in the north from Viviana to Lago Verde, the current situation is normal for this time of year, with a significant decline in rodent populations. The important activity is in the barrier between Rio Paloma, Lago Caro, Lago Atravesado, Lago Portales, Lago Riesco, where the concentration of mice was most important two weeks ago and as of 24 September there is a similar notable decline, but there is still an abnormally high population of mice for this time of year.

Finally, Acuna reiterated the call to maintain good cleanliness in the various areas occupied by people, to avoid contracting this virus infection that may be fatal and has taken the lives of three people in 2011.
(ProMED 9/24/2011)


USA (California)
A total of five people in Orange County (O.C.), including one under 18, have been diagnosed with confirmed or probable infections caused by flea-borne typhus since June 2011, the county's Health Care Agency (HCA) reported Wednesday 14 September 2011.

Symptoms include fever, headache, muscle aches and a rash on the chest, back, arms or legs. The disease is treatable with antibiotics, but it can be fatal if left untreated, says Michael Hearst, district manager for the county's Vector Control. The disease, also known as endemic typhus, isn't passed from person to person. Instead, it's transmitted by the bites of infected fleas. In most of the O.C. cases the past few years, people have been infected by a family cat, although other animals can carry the fleas, including rats, opossums and raccoons. Everybody we talked to had adopted a feral cat, or had a cat that was in and out a lot, Hearst said.

Between 1994 and 2005, there were no reported cases of flea-borne typhus in the county. There was one case in 2006, six in 2007, 15 in 2008, and six cases each in 2009 and 2010. We've had more cases in the last three years than in the previous 50, Hearst said. There have been eight reported cases in 2011. Of the five in the last three months, four were adults and one was under 18, HCA said. All live in North County, although infected animals can be found in any part of the county.
(ProMED 9/17/2011)


USA (Oregon)
Umatilla County, Oregon, health officials confirmed 16 September 2011 that a local man was hospitalized with septicemic plague. The man is believed to have been infected while hunting in Lake County, Oregon. He is receiving treatment for the disease.

Plague is spread to humans through a bite from an infected flea, said Genni Lehnert-Beers, Umatilla County public health administrator. Plague is serious but it is treatable with antibiotics if caught early.

Only three human cases of plague have been diagnosed in Oregon since 1995, including two in Lake County in 2010. All three people recovered.

Lehnert-Beers recommends that people stay away from flea-infested areas and learn to recognize plague symptoms. Plague can be cured with antimicrobials, but early treatment is essential. Untreated plague can be fatal. Lehnert-Beers also recommends taking precautions against fleas and flea bites, including using flea treatment on pets, wearing insect repellent, tucking pant cuffs into socks when in areas heavily occupied by rodents and avoiding contact with wildlife.
(ProMED 9/20/2011)

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4. Articles
Vaccine effectiveness for laboratory-confirmed influenza in children 6–59 months of age, 2005–2007
Staata MA, Griffin MR, Donauer E, et al. Vaccine. 21 September 2011. doi:10.1016/j.vaccine.2011.09.037.
Available at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8381397

Abstract. To estimate the effectiveness of influenza vaccine against medical care visits for laboratory-confirmed influenza in young children we conducted a matched case–control study in children with acute respiratory illness or fever from 2005–2007. Influenza vaccine effectiveness (VE) was calculated using cases with laboratory-confirmed influenza and controls who tested negative for influenza. The effectiveness of influenza vaccine in fully vaccinated children 6–59 months of age was 56% (95% CI: 25%–74%); a significant VE was not found for partial vaccination.

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Hospitalization of pregnant women with pandemic A(H1N1) 2009 influenza in Canada
Rolland-Harris E, Vachon J Kropp R, et al. Epidemiology and Infection. 16 September 2011. doi: 10.1017/S0950268811001737.
Available at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8381397

Summary. This article describes the epidemiology of pandemic A(H1N1) 2009 influenza in all Canadian pregnant women admitted to hospital, and compares it with historical inter-pandemic influenza activity. We used weekly hospitalization and death counts of laboratory-confirmed pandemic A(H1N1) influenza cases reported to the Public Health Agency of Canada's (PHAC) 2009–2010 national pandemic influenza surveillance programme. Pregnant women infected and admitted with the pandemic strain were described and compared with: (1) confirmed admissions of all women of reproductive age; (2) all admitted cases reported to PHAC; and (3) to a historical average of inter-pandemic seasonal influenza admissions, and pneumonia and influenza (P&I) admissions for pregnant women. During the pandemic, 263 pregnant women with confirmed infections were admitted; four died in their third trimester. The median age for admitted pregnant cases was 27•5 years, which is consistent with the median age of the 3-year historical inter-pandemic pregnant comparison group. Aboriginal women appeared to be overrepresented but ethnicity was unavailable for 15•2% of all pregnant cases. Overall admission volumes were higher than those for seasonal influenza in the historical comparison group but were lower than those for P&I admissions. Despite increased admission volumes, severe outcomes in pregnant women were proportionally fewer than in all cases admitted for influenza A(H1N1) infection during the pandemic.

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A Pre-Pandemic Outbreak of Triple-Reassortant Swine Influenza Virus Infection Among University Students, South Dakota, 2008
Dawood TS, Dong L, Liu F, et al. J Infect Dis. 2011; 204 (8): 1165-1171. doi: 10.1093/infdis/jir502.
Available at http://jid.oxfordjournals.org/content/204/8/1165.short

Background. After identifying a student with triple-reassortant swine influenza virus (SIV) infection and pig exposure at a livestock event, we investigated whether others were infected and if human-to-human transmission occurred.

Methods. We conducted a cohort study and serosurvey among persons exposed to (1) event pigs, (2) other pigs, (3) the index case, and (4) persons without pig or index case exposure. Confirmed cases had respiratory specimens positive for SIV within 2 weeks of the index case’s illness. Probable and suspected cases had illness and (1) exposure to any pig or (2) contact with a confirmed case preceding illness. Probable cases were seropositive. Suspected cases did not give serum samples.

Results. Of 99 event pig-exposed students, 72 (73%) participated in the investigation, and 42 (42%) provided serum samples, of whom 17 (40%) were seropositive and 5 (12%) met case criteria. Of 9 students exposed to other pigs, 2 (22%) were seropositive. Of 8 index case-exposed persons and 10 without exposures, none were seropositive. Pig-exposed persons were more likely to be seropositive than persons without pig exposure (37% vs 0%, P < .01).

Conclusions. We identified an outbreak of human SIV infection likely associated with a livestock event; there was no evidence of human-to-human transmission.

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Autopsy series of 68 cases dying before and during the 1918 influenza pandemic peak
Sheng ZM, Chertow DS, Ambroggio X, et al. PNAS. 19 September 2011. doi: 10.1073/pnas.1111179108.
Available at http://www.pnas.org/content/early/2011/09/12/1111179108.abstract

Abstract. The 1918 to 1919 “Spanish” influenza pandemic virus killed up to 50 million people. We report here clinical, pathological, bacteriological, and virological findings in 68 fatal American influenza/pneumonia military patients dying between May and October of 1918, a period that includes ∼4 mo before the 1918 pandemic was recognized, and 2 mo (September–October 1918) during which it appeared and peaked. The lung tissues of 37 of these cases were positive for influenza viral antigens or viral RNA, including four from the prepandemic period (May–August). The prepandemic and pandemic peak cases were indistinguishable clinically and pathologically. All 68 cases had histological evidence of bacterial pneumonia, and 94% showed abundant bacteria on Gram stain. Sequence analysis of the viral hemagglutinin receptor-binding domain performed on RNA from 13 cases suggested a trend from a more “avian-like” viral receptor specificity with G222 in prepandemic cases to a more “human-like” specificity associated with D222 in pandemic peak cases. Viral antigen distribution in the respiratory tree, however, was not apparently different between prepandemic and pandemic peak cases, or between infections with viruses bearing different receptor-binding polymorphisms. The 1918 pandemic virus was circulating for at least 4 mo in the United States before it was recognized epidemiologically in September 1918. The causes of the unusually high mortality in the 1918 pandemic were not explained by the pathological and virological parameters examined. These findings have important implications for understanding the origins and evolution of pandemic influenza viruses.

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Iquitos Virus: A novel reassortant Orthobunyavirus associated with human illness in Peru
Aguilar PV, Barrett AD, Mohammad F, et al. PLoS Negl Trop Dis. 20 September 2011;5(9): e1315. doi:10.1371/journal.pntd.0001315.
Available at http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001315

Abstract. Oropouche (ORO) virus, a member of the Simbu serogroup, is one of the few human pathogens in the Orthobunyavirus genus in the family Bunyaviridae. Genetic analyses of ORO-like strains from Iquitos, Peru, identified a novel reassortant containing the S and L segments of ORO virus and the M segment of a novel Simbu serogroup virus. This new pathogen, which we named Iquitos (IQT) virus, was first isolated during 1999 from a febrile patient in Iquitos, an Amazonian city in Peru. Subsequently, the virus was identified as the cause of outbreaks of “Oropouche fever” during 2005 and 2006 in Iquitos. In addition to the identification of 17 isolates of IQT virus between 1999 and 2006, surveys for neutralizing antibody among Iquitos residents revealed prevalence rates of 14.9% for ORO virus and 15.4% for IQT virus. Limited studies indicate that prior infection with ORO virus does not seem to protect against disease caused with the IQT virus infection. Identification of a new Orthobunyavirus human pathogen in the Amazon region of Peru highlights the need for strengthening surveillance activities and laboratory capabilities, and investigating the emergence of new pathogens in tropical regions of South America.

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Risk of Buruli ulcer and detection of Mycobacterium ulcerans in mosquitoes in southeastern Australia
Lavender CJ, Fyfe JA, Azuolas J, et al. PLoS Negl Trop Dis. 5 September 2011;5(9):e1305. Epub 20 September 2011.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21949891

Background. Buruli ulcer (BU) is a destructive skin condition caused by infection with the environmental bacterium, Mycobacterium ulcerans. The mode of transmission of M. ulcerans is not completely understood, but several studies have explored the role of biting insects. In this study, we tested for an association between the detection of M. ulcerans in mosquitoes and the risk of BU disease in humans in an endemic area of southeastern Australia. Methodology/Principal Findings. Adult mosquitoes were trapped in seven towns on the Bellarine Peninsula in Victoria, Australia, from December 2004 to December 2009 and screened for M. ulcerans by real-time PCR. The number of laboratory-confirmed cases of BU in permanent residents of these towns diagnosed during the same period was tallied to determine the average cumulative incidence of BU in each location. Pearson's correlation coefficient (r) was calculated for the proportion of M. ulcerans-positive mosquitoes per town correlated with the incidence of BU per town. We found a strong dose-response relationship between the detection of M. ulcerans in mosquitoes and the risk of human disease (r, 0.99; 95% CI, 0.92-0.99; p<0.001). Conclusions/Significance. The results of this study strengthen the hypothesis that mosquitoes are involved in the transmission of M. ulcerans in southeastern Australia. This has implications for the development of intervention strategies to control and prevent BU.

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A hidden markov model for analysis of frontline veterinary data for emerging zoonotic disease surveillance
Robertson C, Sawford K, Gunawardana WS. et al. PLoS One. 2011; 6(9):e24833. Epub 16 September 2011. Available at http://www.ncbi.nlm.nih.gov/pubmed/21949763

Abstract. Surveillance systems tracking health patterns in animals have potential for early warning of infectious disease in humans, yet there are many challenges that remain before this can be realized. Specifically, there remains the challenge of detecting early warning signals for diseases that are not known or are not part of routine surveillance for named diseases. This paper reports on the development of a hidden Markov model for analysis of frontline veterinary sentinel surveillance data from Sri Lanka. Field veterinarians collected data on syndromes and diagnoses using mobile phones. A model for submission patterns accounts for both sentinel-related and disease-related variability. Models for commonly reported cattle diagnoses were estimated separately. Region-specific weekly average prevalence was estimated for each diagnoses and partitioned into normal and abnormal periods. Visualization of state probabilities was used to indicate areas and times of unusual disease prevalence. The analysis suggests that hidden Markov modelling is a useful approach for surveillance datasets from novel populations and/or having little historical baselines.

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Additional recommendations for use of tetanus toxoid, reduced-content diphtheria toxoid, and acellular pertussis vaccine (Tdap)
Committee on Infectious Diseases. Pediatrics. 26 September 2011 [Epub ahead of print].
Available at http://www.ncbi.nlm.nih.gov/pubmed/21949151

Abstract. The American Academy of Pediatrics and the Centers for Disease Control and Prevention are amending previous recommendations and making additional recommendations for the use of tetanus toxoid, reduced-content diphtheria toxoid, and acellular pertussis vaccine (Tdap). Review of the results from clinical trials and other studies has revealed no excess reactogenicity when Tdap is given within a short interval after other tetanus- or diphtheria-containing toxoid products, and accrual of postmarketing adverse-events reports reveals an excellent safety record for Tdap. Thus, the recommendation for caution regarding Tdap use within any interval after a tetanus- or diphtheria-containing toxoid product is removed. Tdap should be given when it is indicated and when no contraindication exists. In further efforts to protect people who are susceptible to pertussis, the American Academy of Pediatrics and Centers for Disease Control and Prevention recommend a single dose of Tdap for children 7 through 10 years of age who were underimmunized with diphtheria-tetanus-acellular pertussis (DTaP). Also, the age for recommendation for Tdap is extended to those aged 65 years and older who have or are likely to have contact with an infant younger than 12 months (eg, health care personnel, grandparents, and other caregivers).

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Poliovirus
Committee on Infectious Diseases. Pediatrics. 26 September 2011 [Epub ahead of print].
Available at http://www.ncbi.nlm.nih.gov/pubmed/21949143

Abstract. Despite marked progress in global polio eradication, the threat of polio importation into the United States remains; therefore, all children should be protected against the disease. The standard schedule for poliovirus immunization remains 4 doses of inactivated poliovirus vaccine at 2, 4, and 6 through 18 months and 4 through 6 years of age. The minimum interval between doses 1 and 2 and between doses 2 and 3 is 4 weeks, and the minimum interval between doses 3 and 4 is 6 months. The minimum age for dose 1 is 6 weeks. Minimal age and intervals should be used when there is imminent threat of exposure, such as travel to an area in which polio is endemic or epidemic. The final dose in the inactivated poliovirus vaccine series should be administered at 4 through 6 years of age, regardless of the previous number of doses administered before the fourth birthday, and at least 6 months since the last dose was received.

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Tuberculous peritonitis: Analysis of 211 cases in Taiwan
Yeh HF, Chiu TF, Chen JC, et al. Dig Liver Dis. 24 September 2011. [Epub ahead of print].
Available at http://www.ncbi.nlm.nih.gov/pubmed/21944948

Background. Tuberculosis infection caused by Mycobacterium tuberculosis or other Mycobacterium species is a major communicable disease worldwide.

Aim. We evaluated the epidemiology of tuberculous peritonitis to determine diagnostic features and factors related to late diagnosis.

Methods. We retrospectively reviewed 211 tuberculous peritonitis cases diagnosed between January 1999 and December 2009. Clinical features, laboratory data, and diagnostic methods were analysed.

Results. Subjects included 115 males (54.5%) and 96 females (45.5%) with median age 61.0 years (range 43-72) and 29.2 days mean duration from symptoms to diagnosis. Disease histories included end-stage renal disease (20.9%), pulmonary tuberculosis (36.0%) and liver cirrhosis (23.7%). Most common symptoms were abdominal distension (80.1%), abdominal pain (68.7%) and weight loss (45.5%). Most common signs were ascites (62.6%) and fever (55.5%). One-year survival rate was 89.9%; 21 patients died during follow-up. Mortality risk was higher in patients with more concomitant diseases, including liver cirrhosis, AIDS, chronic steroid use, alcoholism, GI bleeding, haemoptysis, period from symptom presentation to treatment, secondary bacterial peritonitis requiring emergent operation.

Conclusions. Increased duration between symptoms and definitive diagnosis increases mortality risk. Early diagnosis and prompt initiation of anti-tuberculosis therapy improve prognosis. Neutrophil-predominant ascites influences poor prognosis when correlated with secondary bacterial peritonitis.

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A statewide outbreak of Cryptosporidium and its association with the distribution of public swimming pools
Polgreen PM, Sparks JD, Polgreen LA, et al. Epidemiol Infect. 27 September 2011;1-7. [Epub ahead of print].
Available at http://www.ncbi.nlm.nih.gov/pubmed/21943664

Summary. In order to characterize the association between county-level risk factors and the incidence of Cryptosporidium in the 2007 Iowa outbreak, we used generalized linear mixed models with the number of Cryptosporidium cases per county as the dependent variable. We employed a spatial power covariance structure, which assumed that the correlation between the numbers of cases in any two counties decreases as the distance between them increases. County population size was included in the model to adjust for population differences. Independent variables included the number of pools in specific pool categories (large, small, spa, wading, waterslide) and pool-owner classes (apartment, camp, country club or health club, hotel, municipal, school, other) as well as the proportion of residents aged <5 years. We found that increases in the number of bigger pools, pools with more heterogeneous mixing (municipal pools vs. country club or apartment pools), and pools catering to young children (wading pools) are associated with more cases at the county level.

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Future Infectious Disease Threats to Europe
Suk JE, Semenza JC. Am J Public Health. 22 September 2011. [Epub ahead of print].
Available at http://www.ncbi.nlm.nih.gov/pubmed/21940915

Abstract. We examined how different drivers of infectious disease could interact to threaten control efforts in Europe. We considered projected trends through 2020 for 3 broad groups of drivers: globalization and environmental change, social and demographic change, and health system capacity. Eight plausible infectious disease threats with the potential to be significantly more problematic than they are today were identified through an expert consultation: extensively drug resistant bacteria, vector-borne diseases, sexually transmitted infections, food borne infections, a resurgence of vaccine-preventable diseases, health care-associated infections, multidrug-resistant tuberculosis, and pandemic influenza. Preemptive measures to be taken by the public health community to counteract these threats were identified.

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Rabies surveillance in the United States during 2010
Blanton JD, Palmer D, Dyer J, et al. J Am Vet Med Assoc.15 September 2011; 239(6):773-83.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21916759

Summary. During 2010, 48 states and Puerto Rico reported 6,154 rabid animals and 2 human rabies cases to the CDC, representing an 8% decrease from the 6,690 rabid animals and 4 human cases reported in 2009. Hawaii and Mississippi did not report any laboratory-confirmed rabid animals during 2010. Approximately 92% of reported rabid animals were wildlife. Relative contributions by the major animal groups were as follows: 2,246 raccoons (36.5%), 1,448 skunks (23.5%), 1,430 bats (23.2%), 429 foxes (6.9%), 303 cats (4.9%), 71 cattle (1.1 %), and 69 dogs (1.1 %). Compared with 2009, number of reported rabid animals decreased across all animal types with the exception of a 1 % increase in the number of reported rabid cats. Two cases of rabies involving humans were reported from Louisiana and Wisconsin in 2010. Louisiana reported an imported human rabies case involving a 19-year-old male migrant farm worker who had a history of a vampire bat (Desmodus rotundus) bite received while in Mexico. This represents the first human rabies case reported in the United States confirmed to have been caused by a vampire bat rabies virus variant. Wisconsin reported a human rabies case involving a 70-year-old male that was confirmed to have been caused by a rabies virus variant associated with tri-colored bats (Perimyotis subflavus).

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Enhancing the role of veterinary vaccines reducing zoonotic diseases of humans: Linking systems biology with vaccine development
Adams LG, Khare S, Lawhon SD, et al. Vaccine. 22 September 2011; 29(41):7197-206. Epub 2011 Jun 7.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21651944

Abstract. The aim of research on infectious diseases is their prevention, and brucellosis and salmonellosis as such are classic examples of worldwide zoonoses for application of a systems biology approach for enhanced rational vaccine development. When used optimally, vaccines prevent disease manifestations, reduce transmission of disease, decrease the need for pharmaceutical intervention, and improve the health and welfare of animals, as well as indirectly protecting against zoonotic diseases of people. Advances in the last decade or so using comprehensive systems biology approaches linking genomics, proteomics, bioinformatics, and biotechnology with immunology, pathogenesis and vaccine formulation and delivery are expected to enable enhanced approaches to vaccine development. The goal of this paper is to evaluate the role of computational systems biology analysis of host:pathogen interactions (the interactome) as a tool for enhanced rational design of vaccines. Systems biology is bringing a new, more robust approach to veterinary vaccine design based upon a deeper understanding of the host-pathogen interactions and its impact on the host's molecular network of the immune system. A computational systems biology method was utilized to create interactome models of the host responses to Brucella melitensis (BMEL), Mycobacterium avium paratuberculosis (MAP), Salmonella enterica Typhimurium (STM), and a Salmonella mutant (isogenic ÄsipA, sopABDE2) and linked to the basis for rational development of vaccines for brucellosis and salmonellosis as reviewed by Adams et al. and Ficht et al. [1,2]. A bovine ligated ileal loop biological model was established to capture the host gene expression response at multiple time points post infection. New methods based on Dynamic Bayesian Network (DBN) machine learning were employed to conduct a comparative pathogenicity analysis of 219 signaling and metabolic pathways and 1620 gene ontology (GO) categories that defined the host's biosignatures to each infectious condition. Through this DBN computational approach, the method identified significantly perturbed pathways and GO category groups of genes that define the pathogenicity signatures of the infectious agent. Our preliminary results provide deeper understanding of the overall complexity of host innate immune response as well as the identification of host gene perturbations that defines a unique host temporal biosignature response to each pathogen. The application of advanced computational methods for developing interactome models based on DBNs has proven to be instrumental in elucidating novel host responses and improved functional biological insight into the host defensive mechanisms. Evaluating the unique differences in pathway and GO perturbations across pathogen conditions allowed the identification of plausible host-pathogen interaction mechanisms. Accordingly, a systems biology approach to study molecular pathway gene expression profiles of host cellular responses to microbial pathogens holds great promise as a methodology to identify, model and predict the overall dynamics of the host-pathogen interactome. Thus, we propose that such an approach has immediate application to the rational design of brucellosis and salmonellosis vaccines.

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Humans infected with relapsing fever spirochete Borrelia miyamotoi, Russia
Platonov AE, Karan LS, Kolyasnikova NM, et al. Emerg Infect Dis. Oct 2011. [Epub ahead of print]. doi:10.3201/eid1710.101474.
Available at http://wwwnc.cdc.gov/eid/article/17/10/10-1474_article.htm#suggestedcitation

Abstract. Borrelia miyamotoi is distantly related to B. burgdorferi and transmitted by the same hard-body tick species. We report 46 cases of B. miyamotoi infection in humans and compare the frequency and clinical manifestations of this infection with those caused by B. garinii and B. burgdorferi infection. All 46 patients lived in Russia and had influenza-like illness with fever as high as 39.5°C; relapsing febrile illness occurred in 5 (11%) and erythema migrans in 4 (9%). In Russia, the rate of B. miyamotoi infection in Ixodes persulcatus ticks was 1%–16%, similar to rates in I. ricinus ticks in western Europe and I. scapularis ticks in the United States. B. miyamotoi infection may cause relapsing fever and Lyme disease–like symptoms throughout the Holarctic region of the world because of the widespread prevalence of this pathogen in its ixodid tick vectors.

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Notes from the Field: Measles Among U.S.-Bound Refugees from Malaysia --- California, Maryland, North Carolina, and Wisconsin, August--September 2011
Center for Disease Control and Prevention. MMWR. 23 September 2011. 60(37):1281-1282.
Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6037a4.htm

Abstract. On August 26, 2011, California public health officials notified CDC of a suspected measles case in an unvaccinated male refugee aged 15 years from Burma (the index patient), who had lived in an urban area of Kuala Lumpur, Malaysia, which is experiencing ongoing measles outbreaks. Currently, approximately 92,000 such refugees are living in urban communities in Malaysia (1). Resettlement programs in the United States and other countries are ongoing. The health and vaccination status of urban refugees are largely unknown.

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Clusters of Acute Respiratory Illness Associated with Human Enterovirus 68 --- Asia, Europe, and United States, 2008--2010
Center for Disease Control and Prevention. MMWR. 30 September 2011. 60(38):1301-1304.
Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6038a1.htm

Abstract. In the past 2 years, CDC has learned of several clusters of respiratory illness associated with human enterovirus 68 (HEV68), including severe disease. HEV68 is a unique enterovirus that shares epidemiologic and biologic features with human rhinoviruses (HRV) (1). First isolated in California in 1962 from four children with bronchiolitis and pneumonia (2), HEV68 has been reported rarely since that time and the full spectrum of illness that it can cause is unknown. The six clusters of respiratory illness associated with HEV68 described in this report occurred in Asia, Europe, and the United States during 2008--2010. HEV68 infection was associated with respiratory illness ranging from relatively mild illness that did not require hospitalization to severe illness requiring intensive care and mechanical ventilation. Three cases, two in the Philippines and one in Japan, were fatal. In these six clusters, HEV68 disproportionately occurred among children. CDC learned of clusters of HEV68 from public health agencies requesting consultation or diagnostic assistance and from reports presented at scientific conferences. In each cluster, HEV68 was diagnosed by reverse transcription--polymerase chain reaction (RT-PCR) testing targeting the 5'-nontranslated region, followed by partial sequencing of the structural protein genes, VP4-VP2, VP1, or both, to give definitive, enterovirus type-specific information. This report highlights HEV68 as an increasingly recognized cause of respiratory illness. Clinicians should be aware of HEV68 as one of many causes of viral respiratory disease and should report clusters of unexplained respiratory illness to the appropriate public health agency.

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5. Notifications
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

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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

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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/

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 apecein@u.washington.edu