Vol. XIV No. 21 ~ EINet News Briefs ~ Oct 14, 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: Cuba, Southeast Asia among active spots for influenza
- Global WHO keep current strains in 2012 Southern Hemisphere flu vaccine
- Iran: Reports H5N1 avian influenza outbreaks in ducks
- Indonesia: Three new H5N1 influenza deaths include two siblings

2. Infectious Disease News
- WHO warns of consequences of underfunding tuberculosis
- Australia: Measles cases double in 2011
- New Zealand (Auckland): Update on measles cases
- New Zealand (Bay of Plenty): Measles cases spur vaccine check
- New Zealand (Waikato): Measles cases tied to Te Awamutu College
- Philippines (Iloilo): Health office reports clustering measles cases
- Russia (Astrakhan): Recorded outbreak of measles
- Canada (New Brunswick): Salmonella outbreak in nursing home
- Mexico (Guanajuato): 19 cases of hepatitis A reported
- USA: Multistate outbreak of listeriosis linked to whole cantaloupes from Jensen Farms, Colorado
- USA (Alaska): Listeria concerns prompt romaine lettuce recalls
- USA (California): Mumps outbreak on University of California at Berkeley campus
- USA (California): Osamu Corporation recalls frozen ground tuna
- USA (Utah): Botulism suspected in alcohol brew

3. Updates

4. Articles
- Chikungunya in Southeast Asia: understanding the emergence and finding solutions
- Incidence and seroprevalence of dengue virus infections in Australian travellers to Asia
- The economic disease burden of measles in Japan and a benefit cost analysis of vaccination, a retrospective study
- Post-Tsunami Outbreaks of Influenza in Evacuation Centers in Miyagi Prefecture, Japan
- Hand, foot, and mouth disease in china: patterns of spread and transmissibility
- Foot-and-Mouth Disease Control and Eradication in the Bicol Surveillance Buffer Zone of the Philippines
- Indications that Live Poultry Markets are a Major Source of Human H5N1 Influenza Virus Infection in China
- Mortality Burden of the A/H1N1 Pandemic in Mexico: A Comparison of Deaths and Years of Life Lost to Seasonal Influenza
- Household transmission of pandemic (H1N1) 2009 virus, Taiwan
- Pandemic (H1N1) 2009 among quarantined close contacts, Beijing, People’s Republic of China
- Seroconversion to pandemic (H1N1) 2009 virus and cross-reactive immunity to other swine influenza viruses
- Notes from the Field: Q Fever Outbreak Associated with Goat Farms --- Washington and Montana, 2011

5. Notifications
- Emergence of Infectious Diseases, Environments and Biodiversity
- Sixth TEPHINET Southeast Asia and Western Pacific Bi-regional Conference
- EPIDEMICS³ - The Third International Conference on Infectious Disease Dynamics

1. Influenza News

2011 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Bangladesh / 2 (0)
Cambodia / 8 (8)
Egypt / 32 (12)
Indonesia / 8 (6)
Total / 50 (26)

***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: 566 (332) (WHO 10/10/2011)

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 9/12/11):


Global: Cuba, Southeast Asia among active spots for influenza
Though influenza activity is low in most nations, some are seeing active transmission, including Cuba, Bolivia, Cameroon, and parts of Southeast Asia, the World Health Organization said on 7 October 2011.

Cuba and El Salvador have reported increasing circulation of influenza A (H3N2), a strain that peaked in Honduras in the middle of August 2011.

In tropical areas of South America, most countries are reporting little flu transmission, except for Bolivia, which recently cited in increase in 2009 H1N1 activity, which followed an earlier wave of H3N2 infections, mainly in La Paz. South America's temperate regions are reporting decreases in flu activity, returning to baseline levels.

In Africa, flu activity is continuing in Cameroon, with most of it influenza B, though 2009 H1N1 isolates have increased in recent weeks, the WHO reported.

Tropical countries in Asia that are seeing moderate flu activity, such as Singapore and Thailand, are primarily finding the H3N2 strain. Laos reported a marked increase in flu activity in early September, predominantly H3N2, while Vietnam and Cambodia are experiencing sustained transmission of the 2009 H1N1 virus.

Flu activity in Australia, which peaked in early August 2011, is decreasing in most states except for the Northern Territory. Most states and territories are seeing mostly 2009 H1N1, with co-circulation of influenza B.

In temperate Northern Hemisphere areas, flu activity is low or undetectable, according to the WHO.

The US Centers for Disease Control and Prevention (CDC) on 7 October 2011 said the nation's markers for flu activity are below their baselines. Respiratory specimens that have recently tested positive for influenza show that influenza B and H3N2 strains are circulating, with lower numbers of 2009 H1N1.

No pediatric flu deaths were reported, keeping the 2010-11 season total at 116.

Canada's Public Health Agency said flu activity continues at low interseasonal levels, with only two regions of Quebec and one region of Alberta reporting sporadic activity.
(CIDRAP 10/7/2011)


Global WHO keep current strains in 2012 Southern Hemisphere flu vaccine
A run of stability in the makeup of seasonal influenza vaccines continued as the World Health Organization (WHO) recently recommended using the same three flu strains in 2012’s Southern Hemisphere vaccine as are in the current Northern Hemisphere vaccine and were used 2010 in southern countries. The recommendation means the WHO has seen little evidence of changes in circulating flu strains that would make the vaccines now in use a poor match for them.

The WHO experts recommended keeping the pandemic 2009 strain for the influenza A/H1N1 component of the vaccine, along with a Perth 2009 strain of A/H3N2 and a Brisbane 2008 strain of influenza B. Officially, the agency advises using strains similar to:

A/Perth/16/2009 (H3N2)

The new recommendation means the WHO has chosen the same three strains for the Southern Hemisphere three years in a row, as the agency first picked them in September 2009 for the 2010 season. That was when the WHO first chose the pandemic 2009 H1N1 strain for the vaccine on the expectation—which proved correct—that it would replace the previous seasonal H1N1 strain.

The WHO's experts make their recommendations for the makeup of Southern Hemisphere flu vaccines in September to allow time to prepare the vaccine viruses and grow them in eggs, which takes several months. The recommendation for the Northern Hemisphere is usually made in February.

The WHO says 2009 H1N1 viruses co-circulated in varying proportions with H3N2 and type B viruses from February to September 2011, with widespread activity in many countries. But compared with previous years, activity was generally low or moderate. No isolates of the previous seasonal H1N1 vaccine were found.

The full article may be accessed at http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/oct0311fluvax.html
(CIDRAP 10/3/2011)


Europe/Near East
Iran: Reports H5N1 avian influenza outbreaks in ducks
Iran's agriculture ministry on 13 October 2011 reported two H5N1 avian influenza outbreaks in the country's Mazandaran province, according to the World Organization for Animal Health (OIE). The locations are villages in two different counties, Jooybar and Savadkooh. The province is in northern Iran on the coast of the Caspian Sea. The outbreaks, the first reported from Iran since August 2008, began 13 September 2011 and have sickened 535 birds and killed 343 more. Officials culled the remaining 2,337 birds to control the spread of the virus. An investigation into the source of the virus is under way. The H5N1 findings were confirmed at Iran's Central Veterinary Lab on 15 September 2011 and at the Reference Laboratory for Avian Influenza in Padova, Italy, on 10 October 2011.
(CIDRAP 10/13/2011)


Indonesia: Three new H5N1 influenza deaths include two siblings
Three Indonesian children have recently died from H5N1 avian influenza infections, including two siblings from the island of Bali, according to the World Health Organization (WHO) on 10 October 2011.

The WHO confirmed one of the deaths on 10 October 2011, and its verification of the two from Bali would push Indonesia's H5N1 total to 181 cases, including 149 fatalities. The country has the most WHO-confirmed H5N1 cases and deaths in the world.

The first case involves a one-year-old girl from the West Jakarta district of DKI Jakarta province, who died on 25 August 2011, the WHO said on 10 October 2011. She got sick and was treated at a healthcare facility on 8 August 2011 then admitted to a private hospital on 15 August 2011.

An investigation into the source of her infection found that one of the girl's family members is a caterer who routinely processes poultry, including slaughtering, according to the WHO. Poultry was kept in the girl's neighborhood, but no chicken deaths had been reported within the 14 days before her illness.

Meanwhile, a hospital in Bali said 9 October 2011 that two children, a ten-year-old boy and his five-year-old sister, died on 9 October 2011 after a two-day hospitalization.

The two children were admitted to Sanglah General Hospital in Denpasar on 7 October with H5N1 symptoms and placed in isolation. Though tests at the hospital were positive for the H5N1 virus, further tests are being conducted at Udayana University and at Indonesia's health ministry.

An official from the hospital said the children had direct contact with dead poultry in their home and had been treated at a local clinic before they were hospitalized.

Puto Sumantra, who heads Bali's animal health agency, said that a team dispatched to investigate the poultry deaths found no sign of the virus on preliminary tests, though some of the carcasses have been sent for further lab tests. He added that the area has been disinfected and that samples have been taken from the childrens' family members.

The infections and deaths are Indonesia's first since early June 2011 and the first to strike the resort island of Bali since 2007. In August 2007, the WHO reported that the virus killed two women, ages 28 and 29. The younger woman was a poultry trader.

The virus was suspected in the death of the other woman's 5-year-old daughter, who had died about two weeks earlier.

WHO confirmation of the two infections and deaths of the Bali children would raise the global H5N1 total to 568 cases, including 334 deaths.
(CIDRAP 10/10/2011)


2. Infectious Disease News

WHO warns of consequences of underfunding tuberculosis
WHO reports for the first time that the number of people falling ill with tuberculosis (TB) each year is declining. New data, published 11 October 2011 in the WHO 2011 global tuberculosis control report, also show that the number of people dying from the disease fell to its lowest level in a decade. Yet, current progress is at risk from underfunding, especially efforts to combat drug-resistant TB.

The full article may be accessed at http://www.who.int/mediacentre/news/releases/2011/tb_20111011/en/index.html
(WHO 10/11/2011)


Australia: Measles cases double in 2011
Australia has experienced almost double the number of measles cases for 2011 compared to 2010, hampering plans to eliminate the disease. Dr. Robert Menzies, deputy director at the National Centre for Immunisation Research and Surveillance, Sydney, said the outbreaks were due to poor vaccination coverage among young adults, a cohort with a high rate of overseas travel and pockets of low coverage in some communities.

Between January and September 2011, 136 measles cases were notified in Australia, compared to 70 cases in 2010. Some 61% of cases (82 individuals) were unvaccinated, including nine children aged younger than 12 months.

Lots of countries overseas have outbreaks, and it is setting back our plans to eliminate measles, Dr. Menzies said. We're aiming to eliminate it in the western Pacific by 2012, but those plans are not going to come to fruition.

Australians born in the 1970s and '80s when only one vaccine dose was given were of concern, as they had low coverage and were also likely to be travelers, he said. We do encourage people to be vaccinated if they are going to travel overseas if they haven't already received two doses of measles vaccine, he said. Despite widespread global outbreaks, experts believed it was unlikely measles would take off in Australia and cause an epidemic. Although in 2011 there have been more outbreaks, our modeling is telling us that our coverage is high enough. We're at about 90% of kids getting two doses, he said.

So far in 2011, NSW has had 71 cases, Victoria 31, Queensland 16, Western Australia nine, Northern Territory three, South Australia three, Australian Capital Territory two, and Tasmania one.
(ProMED 10/2/2011)


New Zealand (Auckland): Update on measles cases
Auckland Regional Public Health Service can report that 11 new cases of measles across the Auckland region have been confirmed since 23 September 2011. As of this 27 September 2011, the cumulative totals are: 179 people have been confirmed as having measles since 30 May 2011; 17 people are in quarantine; two people were in a hospital over the weekend, bringing the total number of people hospitalized since the outbreak began to 26.
(ProMed 10/2/2011)


New Zealand (Bay of Plenty): Measles cases spur vaccine check
Two of nearly 30 suspected cases of measles in the Bay of Plenty have been confirmed. Toi Te Ora Public Health is urging people to check on their vaccinations following the spate of cases in New Zealand, which until now have mainly been in the Auckland, Waikato and Hawkes Bay regions.

Toi Te Ora Medical Officer of Health Dr. Jim Miller said it appeared the two Bay of Plenty cases were likely to have been acquired out of the area. The best way for us to avoid further cases of this potentially serious infection is for everyone to again ask themselves: Is my family protected? Dr Miller said. With the school holidays and families travelling around New Zealand and overseas, it's important to ensure that you and your children are up to date with immunizations in general and the measles, mumps and rubella (MMR) vaccine in particular. Measles immunization provides effective protection, and the vaccine is completely free for children and adults. MMR is given in two doses, normally at 15 months and four years.
(ProMED 10/9/2011)


New Zealand (Waikato): Measles cases tied to Te Awamutu College
Waikato health authorities are bracing for more confirmed cases of measles they say are inevitable due to the region's less than adequate immunization rate. Parents from a Hamilton daycare centre were advised 29 September 2011 that one of the children was being tested for measles after presenting with a rash, but Waikato DHB medical officer of health Dr Anita Bell said it was just one of many unconfirmed cases being investigated.

There have been 24 confirmed cases of measles in people aged between 7 and 31 in Waikato. Of those tested, Dr. Bell said all were unimmunized except for one who had received one of the two recommended doses. All but two of the cases have links back to Te Awamutu College, where the initial Waikato outbreak began early August 2011.

A public health bulletin sent to all GPs and medical centers from Dr. Bell and Dr. Felicity Dumble September 2011 states that although several incubation times have elapsed since the last confirmed Waikato case, it is inevitable that reintroduction will occur, and given our community's less-than-adequate immunization rate, more cases must be expected.

More than 100 Waikato children are being tested for measles as health authorities take every precaution against the highly contagious disease. The problem is there are over 100 cases in the Waikato, where children are presenting with rashes; but this can occur with many different conditions like parvo, but it's a case of testing everything to be absolutely certain, she said. Dr. Bell said that while very few of the cases tested were positive, increased awareness and vigilance are necessary. The good thing is we are getting children tested immediately, and results are coming back straight away, she said.

Population Health has also recorded nine confirmed cases of meningococcal disease in 2011 resulting in two deaths. The deaths in April and August 2011 were both due to the meningococcal C bacteria, though Dr. Bell said there were no plans to offer free vaccinations in the region.
(ProMED 10/2/2011)


Philippines (Iloilo): Health office reports clustering measles cases
The Iloilo Provincial Health Office (IPHO) has recommended a massive measles vaccination of children aged from 6 to 11 months of age in four barangays (communities) of Batad, in Iloilo, after it noted a clustering of measles cases in the area. The office also recommended the conducting of random throat swabbing of patients in order to identify the strain. Earlier, IPHO warned of a clustering of measles cases in the municipality of Batad.

Provincial Health Officer Dr. Patricia Grace Trabado reported to Governor Arthur Defensor Sr. that during 1-7 September 2011, the staff of Batad Rural Health Unit confirmed five measles cases from Barangays Tanao and Binon-an in Batad. Blood serum taken from a 7-month-old boy and a 12-year-old girl in Barangay Binon-an, and 7-, 15- and 29-year-old patients in Barangay Tanao, was confirmed to be positive for measles IgM.

IPHO traced the occurrence of measles cases in Batad to a 23-year-old woman from Pasig City who arrived in Barangay Tapian on 4 May 2011. This woman, who was suspected to have measles, stayed in Barangay Tapi-an for ten days. In June 2011, the 29-year-old woman resident in Barangay Tapi-an suffered from high-grade fever, productive cough, conjunctivitis and gradual appearance of maculopapular rashes. She was suspected to have measles, and a blood sample was collected, and the blood serum was sent to Iloilo Provincial Epidemiology and Surveillance Unit, which subsequently sent the samples to the Research Institute for Tropical Medicine (RITM) in Manila for laboratory confirmation. The results released on 28 June 2011 confirmed that the woman had measles.

On 28 September 2011, IPHO sent a team led by Dr. Maria Socorro Quinon to Barangays Tanao, Binon-an and Tapi-an to investigate the reported measles cases. The team found that a nine-month-old baby had measles, and they also saw an eight-month-old baby manifesting signs and symptoms of measles, thereby confirming that there is a clustering of measles cases in the area.
(ProMED 10/9/2011)


Russia (Astrakhan): Recorded outbreak of measles
Since 2009, Astrakhan has been considered to be a measles-free region, with no confirmed case recorded. The situation has now changed. According to Alexandr Burkina, the Director of the Regional Infectious Disease Hospital, the majority of the new cases are residents of the Leninskii region of Astrakhan.

The Director stated that previously, measles in our region had been imported from other regions, but now there are cases of indigenous measles among local residents. This is a consequence of the fact that many children have not been vaccinated against the disease as a result of problems in our Outpatients Service, whereby children in the 14-month age group have not been vaccinated against any disease.

The confirmed measles cases comprise nine children and eight adults. Measles can be a serious disease, particularly if contracted in adulthood, and every unvaccinated person should attend his or her local clinic for vaccination.
(ProMED 10/9/2011)


Canada (New Brunswick): Salmonella outbreak in nursing home
Six patients and an employee at the Kenneth E. Spencer Memorial Home in Moncton have been infected with salmonellosis in an outbreak that started 18 September 2011 at the facility. A resident has died.

Someone did die. They did have salmonellosis but at the particular time they had multiple diagnoses, said Barbara Tremble Cook, the nursing home's executive director. So I guess we can't say with certainty that would have caused their death, but it could have been a contributing factor. Cook said the resident received proper assistance. When they were not responding to treatment, they were transported to hospital and saw medical assistance there, she said. She added that the facility's kitchen has been found clear of any trace of salmonella.

Public health officials continue to monitor the outbreak. The facility remains open to visitors as the investigation continues. Spencer's is home to about 200 people and employs about 230 staff.
(ProMED 10/6/2011)


Mexico (Guanajuato): 19 cases of hepatitis A reported
Health authorities in the state of Guanajuato, Mexico have reported the occurrence of 19 cases of hepatitis A virus infection in the towns of Leon and Dolores Hidalgo. The health secretary, Ector Jaime Ramirez Barba, confirmed the detection of 18 of these cases in the municipality of Leon. They were recorded in the primary schools, S. Lira and Emiliano Zapata, in the district of Jacinto Lopez. As a consequence, the education authorities announced that those children affected must not return to school for at least 15 days.

Meanwhile, Modesto Vazquez Alvarez, in charge of Sanitary District I, announced that a single case had been detected in the jail of the municipality of Dolores Hidalgo. Both of these officials confirmed that no cases of hepatitis A virus infection had been identified in Guanajuato, the capital of Guanajuato state.

Ramirez Barba assured the public that cases of hepatitis A virus infection are not unusual and everything is being done to control the outbreak and that the situation is under control. The Health Secretary emphasized that this type of hepatitis infection is very common and can be caused by poor personal hygiene and consumption of contaminated food and/or water.
(ProMED 10/5/2011)


USA: Multistate outbreak of listeriosis linked to whole cantaloupes from Jensen Farms, Colorado
As of 6 October 2011, a total of 109 persons infected with any of the four outbreak-associated strains of Listeria monocytogenes have been reported to CDC from 24 states. All illnesses started on or after 31 July 2011. The number of infected persons identified in each state is as follows: Alabama (1), Arkansas (1), California (1), Colorado (32), Idaho (1), Illinois (1), Indiana (2), Iowa (1), Kansas (7), Maryland (1), Missouri (3), Montana (1), Nebraska (6), New Mexico (13), New York (1), North Dakota (1), Oklahoma (11), Oregon (1), South Dakota (1), Texas (16), Virginia (1), West Virginia (1), Wisconsin (2), and Wyoming (3).

Twenty-one deaths have been reported: five in Colorado, one in Indiana, two in Kansas, one in Maryland, one in Missouri, one in Nebraska, five in New Mexico, one in New York, one in Oklahoma, two in Texas, and one in Wyoming. In addition, one woman pregnant at the time of illness had a miscarriage.

On 14 September 2011, FDA issued a press release to announce that Jensen Farms issued a voluntary recall of its Rocky Ford-brand cantaloupes after being linked to a multistate outbreak of listeriosis.

Although Jensen Farms issued a voluntary recall of Rocky Ford-brand cantaloupes on 14 September 2011 and the recalled cantaloupe should be off store shelves, more ill persons may be reported because of the time lag between diagnosis and laboratory confirmation and also because up to two months can elapse between eating contaminated food and developing listeriosis.

CDC recommends that consumers not eat whole or pre-cut Rocky Ford-brand cantaloupe from Jensen Farms. This is especially important for older adults, persons with weakened immune systems, and pregnant women. 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.
(USA CDC 10/6/2011)


USA (Alaska): Listeria concerns prompt romaine lettuce recalls
Alaska officials say bags of chopped romaine lettuce are being recalled over concerns of potential listeria contamination. Meanwhile, a California farm said 29 September 2011 it was voluntarily recalling bags of chopped romaine lettuce because of possible contamination, though no illnesses have been reported.

The Alaska Department of Conservation has confirmed that the two-pound bags of chopped romaine lettuce from True Leaf Farms of Salinas, Calif., which have a use-by date of 29 September 2011, were distributed in Alaska by Church Brothers, LLC.

There have been no reported illnesses, but listeria can be fatal and is particularly dangerous to people with weakened immune systems, including infants, the elderly and people with HIV or those who are undergoing chemotherapy. Listeria rarely shows up in produce, but an outbreak linked to cantaloupe from a Colorado farm has caused at least 72 illnesses, including up to 16 deaths, in 18 states.

The full article may be accessed at http://www.cbsnews.com/stories/2011/09/30/health/main20113757.shtml
(CBS News 9/30/2011)


USA (California): Mumps outbreak on University of California at Berkeley campus
At least 7 mumps cases have been confirmed at the University of California (UC) at Berkeley, according to reports on 6 October 2011.

Mumps is a disease generally associated with small children and causes fever, aches, weakness, and headaches. It is spread via saliva or mucus from the mouth, nose, or throat.

Cases of mumps at the campus have risen sharply after it was first discovered in four people on 30 September 2011. There hasn't been an outbreak in at least five years, Kim LaPean, a spokesperson with Berkeley's health center. There are 13 more suspected cases. According to the university, school officials are working with the state to limit the spread of the disease.
(ProMED 10/7/2011)


USA (California): Osamu Corporation recalls frozen ground tuna
Osamu Corporation of Gardena, California, is recalling up to 1,800 cases, lot number7013, of frozen ground tuna because the FDA found decomposition in several samples of the product and also found elevated histamine levels in samples taken from a retail location. Osamu Corporation is recalling the product in an abundance of caution since decomposed product may promote formation of histamine. Histamine consumed in food can cause reactions that exhibit symptoms of tingling or burning sensation in the mouth, facial swelling, rash, hives and itchy skin, nausea, vomiting or diarrhea. However, individuals may experience symptoms differently. Persons developing these symptoms should seek medical attention.

The frozen ground tuna was shipped to three distributors from 18 August 2011 to 8 September 2011. The distributors have removed the product from the marketplace and are destroying any remaining product.

The three distributors are AFC Corporation, Red Shell Foods, and Pacific Fresh Fish Company. Two of these distributors have sushi franchises located in grocery stores. Stores and locations to which this product was shipped are listed at the bottom of this announcement. One, Pacific Fresh Fish Company of Los Angeles, is a cash and carry establishment.

Consumers concerned about whether the sushi they purchased may contain the ground tuna should check with the store where they purchased the sushi. That store will be able to determine if it used the recalled product to prepare the sushi. At this time Osamu does not believe that the recalled product or sushi made with the recalled product is available for purchase by consumers.

Three illnesses due to elevated histamine levels have been reported as of 12 October 2011, all involving sushi purchased at a single location. The cause of the elevated histamine levels found in the ground tuna at that location is presently unknown.

Red Shell Foods has sushi franchises in grocery markets in the state of California in the following cities: Calabasas, Century City, Dana Point, Encino, Hollywood, Irvine, Los Angeles, Marina del Rey, Newport Beach, North Hollywood, Northridge, Pacific Palisades, Pasadena, Santa Barbara, Sherman Oaks, Silverlake, Tarzana, West Hollywood, and Westlake Village.

AFC has sushi franchises at counters in grocery stores in nearly every state.
(ProMED 10/14/2011)


USA (Utah): Botulism suspected in alcohol brew
A dozen inmates were sickened, including three in critical condition, in a suspected botulism outbreak after they drank alcohol brewed inside a prison cell, Utah health officials said 5 October 2011. Eight male prisoners who were hospitalized had exhibited botulism symptoms and preliminary tests were positive for the disease in two of the men, said Dr. Dagmar Vitek, the medical director of the Salt Lake Valley Health Department.

It was not clear where the drink was made, what its ingredients were, or who was responsible for its production. Prison officials believe the inmates drank the cell brew, often referred to as pruno, from 1-2 October 2011, corrections department spokesman Steve Gehrke said.

Vitek said she understood the liquid is typically made with fruit, water, and sugar. Bread and raw potato are other common ingredients, she said. It's obviously considered contraband, said Gehrke, but right now, we're not really focused on the disciplinary aspect of this, we want to focus on the health aspect and to take steps to prevent it from happening again.

It's not uncommon for inmates to make their own alcohol, although it's a violation of prison rules, Gehrke said. Health official are testing samples of the pruno to pinpoint the specific bacteria that triggered the disease, which has seven different strains. Those results are not expected for several days, Vitek said.

Most of the 12 inmates became sick on 1 October 2011, she said. The last illness was reported two days later, and officials believe they have identified everyone who might be at risk, although the incubation period for the disease can be as long as eight days, Vitek said. The eight hospitalized inmates were treated with an antitoxin obtained from the CDC. Three of them remained in critical condition 5 October 2011, while four others were being treated at the prison infirmary, Vitek said.

The disease is rare in Utah, which last reported two cases in 2003. Before that, the last known case was in 1993, Vitek said. Data from the CDC shows an average of 145 cases of botulism are annually reported in the USA, of which 15% are foodborne and typically caused by improper home canning.
(ProMED 10/6/2011)


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.


Chinese Taipei (Penghu county)
The Taiwan Centers for Disease Control (CDC) announced the first batch of confirmed cases of indigenous dengue fever in the offshore Penghu County in a decade. There were a total of 238 confirmed cases of dengue fever affecting seven areas as of 28 September 2011, with Kaohsiung topping the list with 211 cases, followed by Penghu with seven cases.
(ProMED 10/4/2011)

Mexico (Queretaro State)
The Secretariat of Health reported 4 October 2011 that there are 51 confirmed dengue cases in the state along with 114 probable cases, although the situation is considered to be a moderate outbreak and not an epidemic.
(ProMED 10/4/2011)

Mexico (Veracruz State)
Inhabitants of coastal communities in the municipalities of Alto Lucero, Actopan, and Vega de Alatorre are on alert for emergence of a dengue outbreak that has affected more than 45 people.
(ProMED 10/4/2011)

Peru (Piura)
Currently in the Huancabamba Province, Piura Region, there is an outbreak of bartonellosis (Carrion's disease) with severe cases and deaths. Until epidemiological week 26 September - 2 October 2011, the Office of Epidemiology of Piura has reported 74 cases of the infection of which 96% (71/74) are confirmed. 45% (33/74) corresponds to the acute form- Oroya fever, and 55% (41/74) to the chronic form - verruga peruana (Peruvian wart). There have been two deaths attributed to the outbreak.
(ProMED 10/11/2011)

USA (Florida, Hillsborough County)
The Hillsborough County Health Department confirms three cases of dengue fever. All three patients are from the Seminole Heights area. Two are neighbors who traveled to the Caribbean, and were infected there, officials said. The third person lives with one of the two, but got the disease in Florida, most likely through a mosquito bite, according to the health department.
(ProMED 10/4/2011)

USA (Florida, Miami-Dade County)
Miami-Dade County Health Department officials received confirmation of the second locally acquired case of dengue fever for 2011, in a 44 year-old male resident of Miami-Dade County. The individual was diagnosed with dengue fever based on symptoms and confirmed by laboratory tests. The patient fully recovered from his illness.
(ProMED 10/4/2011)

USA (Delaware)
The Delaware Public Health Laboratory confirmed Delaware's first case of tularemia since 2003, in a 45 year-old Kent County man. The man is hospitalized and responding to treatment. Although Delaware has not reported a case of tularemia in eight years, each year an estimated 125 to 150 cases are reported nationwide.

Tularemia is associated with tick bites and is not spread person to person. Domestic cats are very susceptible to tularemia and have been known to transmit the bacteria to humans. Humans can become infected by handling infected animal tissue when hunting or skinning infected rabbits, muskrats and other rodents; by inhaling dust or aerosols contaminated with the bacteria, such as during farming or landscaping activities, especially when tractors or mowers run over an infected animal or carcass. The disease can also be transmitted by drinking untreated water contaminated with the bacteria introduced by animal contact.

Symptoms of tularemia usually appear three to five days after exposure to the bacteria, but can take as long as 14 days. Symptoms may include: sudden fever, chills, headaches, diarrhea, muscle aches, joint pain, dry cough and progressive weakness. People can also develop pneumonia with chest pain, cough and difficulty breathing. Other symptoms of tularemia depend upon how the person was exposed. These symptoms can include ulcers on the skin or in the mouth, swollen and painful lymph glands, swollen and painful eyes and a sore throat.

Anyone exposed to tularemia should be treated as soon as possible since the disease can be fatal. Because the disease is difficult to diagnose, it is important to share with your health care provider any likely exposures, such as tick and deer fly bites, or contact with sick or dead animals. Blood tests and cultures can help confirm the diagnosis. Delaware laboratories and healthcare providers are required to report any diagnosed case of tularemia to the Division of Public Health's Bureau of Epidemiology.

Preventing tick bites is the best way to protect yourself from tularemia, said Dr. Karyl Rattay, DPH director. Use insect repellent containing DEET on your skin, or treat clothing with repellent containing permethrin, to prevent insect bites. In addition, use care and wear gloves when handling sick or dead animals. Be sure to cook food thoroughly and that your water is from a safe source. Note any change in the behavior of your pets (especially rodents and rabbits) or livestock, and consult a veterinarian if they develop unusual symptoms.
(Delaware Health and Social Services 10/11/2011)

USA (Missouri)
The Missouri Department of Public Health (DPH) has confirmed a resident of that state contracted the mosquito-borne virus eastern equine encephalitis (EEE) in Raynham summer 2011. The CDC (Centers for Disease Control and Prevention) has confirmed a Missouri person did contract EEE while in Massachusetts, said Jacqueline Lapine, spokeswoman for the Missouri DPH.

In Septermber 2011 the Massachusetts DPH sent out a notice of a suspected second case of EEE originating in Raynham. The victim, an elderly Missouri woman, had spent a significant amount of time visiting in Raynham, before returning to her home state in late August 2011 where she developed symptoms of the virus [infection]. Lapine said the victim was still alive and recovering.

Upon hearing of a second case confirmed in his town, Raynham Selectman Joseph Pacheco said, this continues to highlight the need for aerial spraying early in the season. Pacheco said he would lobby hard through the winter to get state officials on board to authorize an aerial spray to prevent further deaths from EEE in 2011.
(ProMED 10/7/2011)


4. Articles
Chikungunya in Southeast Asia: understanding the emergence and finding solutions
Pulmanausahakul R, Roytrakul S, Auewarakul P, Smith DR. Int J Infect Dis. October 2011. 15(10):e671-6.
Available at http://www.sciencedirect.com/science/article/pii/S1201971211001329

Abstract. In the last few years, chikungunya has become a major problem in Southeast Asia, with large numbers of cases being reported in Singapore, Malaysia, and Thailand. Much of the current epidemic of chikungunya in Southeast Asia is being driven by the emergence of a strain of chikungunya virus that originated in Africa and spread to islands in the Indian Ocean, as well as to India and Sri Lanka, and then onwards to Southeast Asia. There is currently no specific treatment for chikungunya and no vaccine is available for this disease. This review seeks to provide a short update on the reemergence of chikungunya in Southeast Asia and the prospects for control of this disease.


Incidence and seroprevalence of dengue virus infections in Australian travellers to Asia
Ratnam I, Black J, Leder K, et al. Eur J Clin Micobiol Infect Dis. 9 October 2011. doi: 10.1007/s10096-011-1429-1 (Epub ahead of print).
Available at http://www.springerlink.com/content/0636t07443345082/

Abstract. The purpose of this study was to estimate the incidence density and prevalence of dengue virus infection in Australian travellers to Asia. We conducted a multi-centre prospective cohort study of Australian travellers over a 32-month period. We recruited 467 travellers (≥16 years of age) from three travel clinics who intended to travel Asia, and 387 (82.9%) of those travellers completed questionnaires and provide samples pre- and post-travel for serological testing for dengue virus infection. Demographic data, destination countries and history of vaccinations and flavivirus infections were obtained. Serological testing for dengue IgG and IgM by enzyme-linked immunosorbent assay (ELISA) (PanBio assay) was performed. Acute seroconversion for dengue infection was demonstrated in 1.0% of travellers, representing an incidence of 3.4 infections per 10,000 days of travel (95% confidence interval [CI]: 0.9-8.7). The seroprevalence of dengue infection was 4.4% and a greater number of prior trips to Asia was a predictor for dengue seroprevalence (p = 0.019). All travellers experienced subclinical dengue infections and had travelled to India (n = 3) and China (n = 1). This significant attack rate of dengue infection can be used to advise prospective travellers to dengue-endemic countries.


The economic disease burden of measles in Japan and a benefit cost analysis of vaccination, a retrospective study
Takahashi K, Ohkusa Y, Kim JY. BMC Health Serv Res. 7 October 2011. 11(1):254 (Epub ahead of print).
Available at http://www.biomedcentral.com/1472-6963/11/254

Background. During 1999-2003, Japan experienced a series of measles epidemics, and in Action Plans to Control Measles and the Future Problems, it was proposed that infants be immunized soon after their one-year birthday. In this study, we attempted to estimate the nationwide economic disease burden of measles based on clinical data and the economic effectiveness of this proposal using the benefit cost ratio.

Methods. Our survey target was measles patients treated at Chiba-Nishi general hospital from January 1999 to September 2001. Two hundred ninety-one cases were extracted from the database. The survey team composed of 3 pediatricians and 1 physician from Chiba-Nishi general hospital examined patient files and obtained additional information by telephone interview. We analyzed data based on a static model, which assumed that the number of measles patients would be zero after 100% coverage of single-antigen measles vaccine. Costs were defined as the direct cost for measles treatment, vaccination and transportation and the indirect cost of workdays lost due to the nursing of patients, hospital visits for vaccination or nursing due to adverse reactions. Benefits were defined as savings on direct and indirect costs. Based on these definitions, we estimated the nationwide costs of treatment and vaccination.

Results. Using our static model, the nationwide total cost for measles treatment was estimated to be US$ 404 million, while the vaccination cost was US$165 million. The benefit cost ratio of the base case was 2.48 and ranged from 2.21 to 4.97 with sensitivity analysis.

Conclusions. Although the model has some limitations, we conclude that the policy of immunizing infants soon after their one-year birthday is economically effective.


Post-Tsunami Outbreaks of Influenza in Evacuation Centers in Miyagi Prefecture, Japan
Hatta M, Endo S, Tokuda K, et al. Clin Infect Dis. 5 October 2011. doi: 10.1093/cid/cir752 (Epub ahead of print).
Available at http://cid.oxfordjournals.org/content/early/2011/09/29/cid.cir752.long

Abstract. We describe 2 post-tsunami outbreaks of influenza A in evacuation centers in Miyagi Prefecture, Japan, in 2011. Although containment of the outbreak was challenging in the evacuation settings, prompt implementation of a systemic approach with a bundle of control measures was important to control the influenza outbreaks.


Hand, foot, and mouth disease in china: patterns of spread and transmissibility
Wang Y, Feng Z, Yang Y, et al. Epidemiology. November 2011. 22(6):781-92.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21968769

Background. There were large outbreaks of hand, foot, and mouth disease in both 2008 and 2009 in China.

Methods. Using the national surveillance data since 2 May 2008, we summarized the epidemiologic characteristics of the recent outbreaks. Using a susceptible-infectious-recovered transmission model, we evaluated the transmissibility of the disease and potential risk factors.

Results. Children ages 1.0 to 2.9 years were the most susceptible to hand, foot, and mouth disease (odds ratios [OR] >2.3 as compared with other age-groups). Infant cases had the highest incidences of severe disease (ORs >1.4) and death (ORs >2.4), as well as the longest delay from symptom onset to diagnosis (2.3 days). Boys were more susceptible than girls (OR = 1.56 [95% confidence interval = 1.56-1.57]). A 1-day delay in diagnosis was associated with increases in the odds of severe disease by 40% (39%-42%) and in the odds of death by 54% (44%-65%). Compared with Coxsackie A16, enterovirus 71 is more strongly associated with severe disease (OR = 16 [13-18]) and death (OR = 40 [13-127]). The estimated local effective reproductive numbers among prefectures ranged from 1.4 to 1.6 (median = 1.4) in spring and stayed below 1.2 in other seasons. A higher risk of transmission was associated with temperatures in the range of 70° F to 80°F, higher relative humidity, lower wind speed, more precipitation, greater population density, and 16 [13-18] periods during which schools were open.

Conclusion. Hand, foot, and mouth disease is a moderately transmittable infectious disease, mainly among preschool children. Enterovirus 71 was responsible for most severe cases and fatalities. Mixing of asymptomatically infected children in schools might have contributed to the spread of infection. Timely diagnosis may be 40 [31-127] key to reducing the high mortality rate in infants.


Foot-and-Mouth Disease Control and Eradication in the Bicol Surveillance Buffer Zone of the Philippines
Windsor PA, Freeman PG, Abila R, et al. Transbound Emerg Dis. October 2011. 58(5):421-33. doi: 10.1111/j.1865-1682.2011.01225.x.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21545690

Abstract. Following the onset of an epidemic of foot and mouth disease (FMD) commencing in 1994 and affecting mainly pigs in the Philippines, a National Plan for the Control and Eradication of the disease was initiated. A disease surveillance buffer zone in the southern Luzon region of Bicol was established to protect the Visayas and Mindanao from infection and enable eventual elimination of the disease in Luzon. With achievement of Office International Epizooties (OIE)-certified FMD freedom with vaccination in the Philippines now imminent, the four components of the disease control strategy are reviewed, including quarantine and animal movement controls, strategic vaccination, surveillance and disease investigation, and enhanced public awareness with school on the air radio programmes. Although numbers of outbreaks declined following widespread vaccination, evaluation of serological responses in vaccinates suggested low levels of immune protection. The cessation of outbreaks was considered more likely a result of animal movement controls, improved surveillance and emergency response capability, and reduction in FMD-risk behaviours by livestock owners, particularly through efforts to enhance public awareness of biosecurity measures by the training of traders, livestock industry personnel and both commercial and smallholder farmers. A two-stage random sampling serosurveillance strategy enabled identification of residual infection that was not detected through opportunistic sampling and negative incident reporting. Intensive investigations of FMD outbreaks, particularly in Albay province in 1999, enabled improved understanding of the risk factors involved in disease transmission and implementation of appropriate interventions. The findings from this review are offered to assist development of FMD control and eradication programmes in other countries in south-east Asia that are now being encouraged to support the OIE goal of FMD freedom with vaccination by 2020.


Indications that Live Poultry Markets are a Major Source of Human H5N1 Influenza Virus Infection in China
Wan XF, Dong L, Lan Y, et al. J Virol. 5 October 2011. doi:10.1128/JVI.05266-11 (Epub ahead of print).
Available at http://jvi.asm.org/cgi/content/short/JVI.05266-11v1

Abstract. Human infections of H5N1 highly pathogenic avian influenza virus have continued to occur in China without corresponding outbreaks in poultry, and there is little conclusive evidence of the source of these infections. Seeking to identify the source of the human infections, we sequenced 31 H5N1 viruses isolated from humans in China (2005-2010). We found a number of viral genotypes, not all of which having similar known avian virus counterparts. Guided by patient questionnaire data, we also obtained environmental samples from live poultry markets and dwellings frequented by six individuals prior to disease onset (2008-2009). H5N1 viruses were isolated from 4 of the 6 live poultry markets sampled. In each case, the genetic sequence of the environmental and corresponding human isolates was highly similar, demonstrating a link between human infection and live poultry markets. Therefore, infection control measures in live poultry markets are likely to reduce human H5N1 infection in China.


Mortality Burden of the A/H1N1 Pandemic in Mexico: A Comparison of Deaths and Years of Life Lost to Seasonal Influenza
Charu V, Chowell G, Palacio Meijia LS, et al. Clin Infect Dis. 5 October 2011. doi: 10.1093/cid/cir644 (Epub ahead of print).
Available at http://cid.oxfordjournals.org/content/early/2011/09/29/cid.cir644.short?rss=1

Background. The mortality burden of the 2009 A/H1N1 influenza pandemic remains controversial, in part because of delays in reporting of vital statistics that are traditionally used to measure influenza-related excess mortality. Here, we compare excess mortality rates and years of life lost (YLL) for pandemic and seasonal influenza in Mexico and evaluate laboratory-confirmed death reports.

Methods. Monthly age- and cause-specific death rates from January 2000 through April 2010 and population-based surveillance of influenza virus activity were used to estimate excess mortality and YLL in Mexico. Age-stratified laboratory-confirmed A/H1N1 death reports were obtained from an active surveillance system covering 40% of the population.

Results. The A/H1N1 pandemic was associated with 11.1 excess all-cause deaths per 100 000 population and 445 000 YLL during the 3 waves of virus activity in Mexico, April–December 2009. The pandemic mortality burden was 0.6–2.6 times that of a typical influenza season and lower than that of the severe 2003–2004 influenza epidemic. Individuals aged 5–19 and 20–59 years were disproportionately affected relative to their experience with seasonal influenza. Laboratory-confirmed deaths captured 1 of 7 pandemic excess deaths overall but only 1 of 41 deaths in persons >60 years of age in 2009. A recrudescence of excess mortality was observed in older persons during winter 2010, in a period when influenza and respiratory syncytial virus cocirculated.

Conclusions. Mexico experienced higher 2009 A/H1N1 pandemic mortality burden than other countries for which estimates are available. Further analyses of detailed vital statistics are required to assess geographical variation in the mortality patterns of this pandemic.


Household transmission of pandemic (H1N1) 2009 virus, Taiwan
Chang LY, Chen WH, Lu CY, et al. Emerg Infect Dis. October 2011. doi: 10.3201/eid1710.101662.
Available at http://wwwnc.cdc.gov/eid/article/17/10/10-1662_article.htm

Abstract. During August–November 2009, to investigate disease transmission within households in Taiwan, we recruited 87 pandemic (H1N1) 2009 patients and their household members. Overall, pandemic (H1N1) 2009 virus was transmitted to 60 (27%) of 223 household contacts. Transmission was 4× higher to children than to adults (61% vs. 15%; p<0.001).


Pandemic (H1N1) 2009 among quarantined close contacts, Beijing, People’s Republic of China
Pang X, Yang P, Li S, et al. Emerg Infect Dis. October 2011. doi: 10.3201/eid1710.101344.
Available at http://wwwnc.cdc.gov/eid/article/17/10/10-1344_article.htm

Abstract. We estimated the attack rate of pandemic (H1N1) 2009 and assessed risk factors for infection among close contacts quarantined in Beijing, People’s Republic of China. The first 613 confirmed cases detected between May 16 and September 15, 2009, were investigated; 7,099 close contacts were located and quarantined. The attack rate of confirmed infection in close contacts was 2.4% overall, ranging from 0.9% among aircraft passengers to >5% among household members. Risk factors for infection among close contacts were younger age, being a household member of an index case-patient, exposure during the index case-patient’s symptomatic phase, and longer exposure. Among close contacts with positive test results at the start of quarantine, 17.2% had subclinical infection. Having contact with a household member and younger age were the major risk factors for acquiring pandemic (H1N1) 2009 influenza virus infection. One person in 6 with confirmed pandemic (H1N1) 2009 was asymptomatic.


Seroconversion to pandemic (H1N1) 2009 virus and cross-reactive immunity to other swine influenza viruses
Perera RAPM, Riley S, Ma SK, et al. Emerg Infect Dis. October 2011. doi: 10.3201/eid1710.110629.
Available at http://wwwnc.cdc.gov/eid/article/17/10/11-0629_article.htm

Abstract. To assess herd immunity to swine influenza viruses, we determined antibodies in 28 paired serum samples from participants in a prospective serologic cohort study in Hong Kong who had seroconverted to pandemic (H1N1) 2009 virus. Results indicated that infection with pandemic (H1N1) 2009 broadens cross-reactive immunity to other recent subtype H1 swine viruses.


Notes from the Field: Q Fever Outbreak Associated with Goat Farms --- Washington and Montana, 2011
Centers for Disease Control and Prevention. MMWR. 14 October 2011. 60(40):1393.
Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6040a5.htm?s_cid=mm6040a5_w

Abstract. On April 22, 2011, the Q fever bacterium Coxiella burnetii was detected in a goat placenta collected from a farm in Washington, where 14 of 50 (28%) pregnant does had aborted since January. A county health alert advised health-care providers to ask patients with symptoms compatible with Q fever (e.g., fever, headache, chills, and myalgia) about exposure to goats, and the owners of the farm informed purchasers of their goats that C. burnetii had been detected in their herd. On May 25, the county health department reported a symptomatic patient with antibodies to C. burnetii who had purchased goats from the farm in February. On May 27, a report from Montana identified a child seropositive for C. burnetii whose family had purchased goats from the Washington farm in October 2010; one of the goats aborted triplets 2 weeks before the child's May 12, 2011, illness onset. On May 31, five more persons reported onset of symptoms compatible with Q fever from late March to mid-May, following exposure at a Montana farm to goats purchased from the Washington farm at various times during October 2010--January 2011. On June 10, the Washington State Department of Health and Montana Department of Public Health and Human Services requested CDC assistance to characterize the extent of the outbreak, distribute Q fever information, and identify others at risk for infection.


5. Notifications
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/


EPIDEMICS³ - The Third International Conference on Infectious Disease Dynamics
Boston, MA, United States, 29 November to 2 December 2011
Epidemics3 is a wide-ranging conference that broadly deals with infectious disease dynamics; to include field and laboratory studies as well as modeling.
Additional information at http://www.epidemics.elsevier.com/