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Vol. XIV No. 25 ~ EINet News Briefs ~ Dec 09, 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: Influenza virus activity in the world
- Global: H5N1 avian influenza hits poultry in Vietnam, Nepal
- Global: New details emerge in novel H3N2 influenza reports
- Egypt: Woman on ventilator with H5N1 influenza infection
- Nepal: Reports another H5N1 avian influenza outbreak
- USA: Vaccine virus for novel H3N2 influenza based on 2010 swine influenza strain
- USA: CDC sees improving influenza vaccine uptake in kids, health workers

2. Infectious Disease News
- Australia (Australian Capital Territory): Measles outbreak at Orana school
- China (Anhui Province): Dirty needle suspected in outbreak of hepatitis
- Japan: Radioactive cesium found in Meiji baby formula
- Malaysia: 24 trainee commandos in hospital for suspected leptospirosis infection
- Russia (Buryatia): Adverse reactions to brucella vaccine
- Canada (Alberta): Measles update, number of measles cases stands at one
- Canada (Ontario): Milford Bay Trout Farm Inc. Smoked Trout Filet may contain dangerous bacteria
- USA: Who should pay to make ground beef safe from E. coli?
- Canada (Ontario): Certain Domaine de L'oulivie Brand Lucque Olives de Pays may contain dangerous bacteria
- Chile (Bio Bio): Fatal pertussis cases
- USA: Exemptions to childhood vaccines grow
- USA: New England sees puzzling rise in Legionnaires' disease

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

4. Articles
- Eurasian Tree Sparrows, Risk for H5N1 Virus Spread and Human Contamination through Buddhist Ritual: An Experimental Approach
- Swine influenza surveillance in East and Southeast Asia: a systematic review
- New Variants and Age Shift to High Fatality Groups Contribute to Severe Successive Waves in the 2009 Influenza Pandemic in Taiwan
- Varicella in Infants After Implementation of the US Varicella Vaccination Program
- Tuberculosis mortality differentials in Indonesia during 2007-2008: evidence for health policy and monitoring
- Bacterial stress response to environmental radiation relating to the Fukushima radiation discharge event, Japan: Will environmental bacteria alter their antibiotic susceptibility profile?
- The epidemiology of human salmonellosis in New Zealand, 1997-2008
- Temporal trend and climate factors of hemorrhagic fever with renal syndrome epidemic in Shenyang City, China
- Rodent-Borne Hantaviruses in Cambodia, Lao PDR, and Thailand
- Dengue-1 Virus Clade Replacement in Thailand Associated with Enhanced Mosquito Transmission

5. Notifications
- 2nd International Symposium on Zoonoses & Emerging Infectious Diseases
- 30th Annual UC Davis Infectious Diseases Conference
- 2012 Australasian Society for Infectious Diseases Scientific Meeting


1. Influenza News

Global
2011 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Bangladesh / 2 (0)
Cambodia / 8 (8)
Egypt / 34 (12)
Indonesia / 11 (9)
Total / 55 (29)

***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: 571 (335) (WHO 11/29/2011)
http://www.who.int/influenza/human_animal_interface/EN_GIP_20111129CumulativeNumberH5N1cases.pdf

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 9/12/11): http://www.who.int/influenza/human_animal_interface/avian_influenza/H5N1_avian_influenza_update.pdf

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Global: Influenza virus activity in the world
During 6 to 19 November 2011, laboratory confirmed influenza virus detections in general remained sporadic in most parts of the world.

In the northern hemisphere overall influenza activity was low with a number of countries in Europe and North America reporting sporadic detections of influenza A(H1N1)pdm09, A(H3N2) and influenza B. The only country in Europe reporting local outbreaks of influenza was the Netherlands, where A(H3N2) and B viruses co-circulated. In Asia, regional activity of influenza A(H1N1)pdm09 and B viruses continued to persist in Cambodia. Elsewhere in Asia, influenza virus activity of A(H1N1)pdm09, A(H3N2) and B was low.

In Central America, influenza activity was low in general with the exception of Nicaragua which continued to report outbreaks due to co-circulation of A(H1N1)pdm09 and A(H3N2) viruses.

In the southern hemisphere, local outbreaks of A(H1N1)pdm09, influenza A(H3N2)and B continued to be reported in Cameroon. Otherwise sporadic detections of influenza A(H1N1)pdm09, A(H3N2) and B viruses continued to be reported in Africa, Oceania and South America.

Three cases of human infection with a novel influenza A virus in children were recently reported by the United States of America. The virus is a reassortant between the swine-origin Influenza triple reassortant A(H3N2) viruses circulating in the swine population in the United States of America since 1998 and the A(H1N1)pdm09 virus (M gene only). Sequences of whole genomes of the three viruses have been uploaded in GISAID. A candidate reassortant vaccine virus developed from A/Minnesota/11/2010 is available. The WHO Global Influenza Surveillance and Response System (GISRS) has been informed and guidance to laboratories using CDC real-time RT-PCR diagnostic kits to detect this new reassortant virus has been issued.
(WHO 12/2/2011)

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Global: H5N1 avian influenza hits poultry in Vietnam, Nepal
Avian flu has been confirmed in flocks of ducks and chickens in Vietnam and Nepal. Local officials in Dak Lak province in Vietnam's central highlands destroyed a flock of more than 1,300 domestic ducks and 9,800 duck eggs after H5N1 affected an unspecified number of the birds, reported on 29 November 2011. Local agriculture authorities also sanitized the farm and surrounding areas. The outbreak began after the farmer bought ducks from another farm in the province that had an unreported H5N1 outbreak earlier in November 2011. The earlier outbreak resulted in the death of more than 5,000 ducks.

In Nepal, more than 500 ducks and chickens were culled after an avian flu outbreak on a farm in Bhaktapur district, reported 29 November 2011. Lab results on samples tested in the United Kingdom confirmed avian flu after preliminary tests in Nepal. The story did not specify the number of poultry affected, but the Nepal-based Daily Kantipur reported that 35 chickens died on the farm earlier in November 2011. In July the country had been declared free of avian flu.
(CIDRAP 11/29/2011)

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Global: New details emerge in novel H3N2 influenza reports
New details about the three most recent human infections with a novel swine-origin influenza virus have emerged over the past few days, along with a preliminary report of similar viruses in a few pigs.

In addition, the European Centre for Disease Prevention and Control (ECDC) on 29 November 2011 issued a risk assessment for the new virus, saying the threat to Europe is low, though the events underscore the need for better influenza surveillance in both pigs and humans.

The US Centers for Disease Control and Prevention (CDC) reported details about the recent cases in three Iowa children, along with their contacts with each other, in a Morbidity and Mortality Weekly Report (MMWR) dispatch. The World Health Organization (WHO) reported additional details about the patients on 24 November 2011. Earlier in 2011, seven similar but isolated infections were reported in Indiana, Maine, and Pennsylvania.

All three Iowa children were infected with a swine-origin triple-reassortant H3N2 (S-OtrH3N2) that includes the matrix gene from the 2009 H1N1 virus. Of the ten cases that have been reported in the United States in 2011, the three Iowa cases are the most recent and the first known to involve limited human-to-human spread.

The first child, a girl, got sick during the second week of November 2011. Three days later, she was seen by her healthcare provider, who obtained a respiratory sample and conducted a rapid diagnostic test, according to the CDC. Based on surveillance routines, the provider forwarded the sample to the University of Iowa Hygienic Laboratory. Her brother had a flu-like illness one day before she did, and her father had one two days after he had contact with her, but neither was tested for flu. None of the family members reported exposure to pigs, though the girl who tested positive had attended a small gathering with other children the day she got sick.

The other two children are brothers who got sick one and two days after they were exposed to the young girl. Both were seen by a healthcare provider two days after the first brother got sick. Their positive influenza samples were forwarded to the state health lab. The boy's mother said no other family members had been sick, and none had been exposed to pigs before the first boy got sick.

An investigation by Iowa health officials found that the two families had not traveled recently or attended any community events. No other illnesses or swine exposures were identified in the adults or children who were in the setting where the kids were exposed to each other. The WHO said the children were exposed to each other at a daycare site and listed their ages as 11 months, two years, and three years. It added that none of the children were hospitalized and that all three have recovered.

Iowa has enhanced its surveillance for flu-like illnesses in the communities where the patients live and has asked health providers who treat patients with suspected flu to obtain samples and forward them to the state health lab.

The CDC said its complete genome sequencing confirmed that all three specimens were S-OtrH3N2 viruses that had the M gene from the 2009 H1N1 virus. It said little is known about the virus's ability to transmit between humans and from swine to humans, because of the unusual gene combination.

So far there is no sign of ongoing human-to-human transmission, the CDC said, though the situation bears watching, in case the novel virus gains the ability to spread more easily. It urged clinicians to consider swine-origin influenza in people with febrile respiratory illnesses who have had contact with pigs. It added that enhanced surveillance is under way in Iowa and surrounding states.

The full article may be accessed at http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/nov2911swine-br.html
(CIDRAP 11/29/2011)

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Europe/Near East
Egypt: Woman on ventilator with H5N1 influenza infection
The Ministry of Health and Population of Egypt has notified WHO of one case of human infection with avian influenza A (H5N1) virus. The case is a 31 year-old female from Meet Salseel district, Dakahlia governorate. She developed symptoms on 10 November 2011 and was hospitalized on 16 November 2011. She is in critical condition and is provided with ventilation support. Investigations into the source of infection revealed that the case had exposure to sick and dead poultry in her backyard. The case was confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network on 21 November 2011. Of the 153 cases confirmed as of 29 November 2011 in Egypt, 52 have been fatal.
(WHO 11/29/2011)

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Asia
Nepal: Reports another H5N1 avian influenza outbreak
Officials in Nepal have culled hundreds of chickens and domestic ducks after an outbreak of H5N1 avian flu killed 90 chickens on a farm in Kathmandu, the first avian flu outbreak in the nation's capital, reported 1 December 2011. "Over 500 chickens and ducks have been slaughtered in the last three days. We also destroyed dozens of eggs and several kilos of poultry feed," Nepalese health official Narayan Prasad Ghimire said. He added that a rapid response team was operating on the outskirts of the city to prevent disease spread and that poultry production has been halted in the affected area. H5N1 was confirmed in the dead chickens by a UK lab, the story said. Earlier this week more than 500 birds were culled in nearby Bhaktapur district after 35 farm chickens died from avian flu. The country experienced its first avian flu outbreak in January 2009.
(CIDRAP 12/1/2011)

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Americas
USA: Vaccine virus for novel H3N2 influenza based on 2010 swine influenza strain
The Centers for Disease Control and Prevention (CDC) got a head start on preparing a vaccine against the novel swine-origin influenza strain recently found in four states by using a slightly different swine-origin strain that cropped up in 2010, CDC officials said on 2 December 2011

Since early September 2011, the CDC has reported ten infections with a swine-origin H3N2 reassortant strain that includes the M gene from the 2009 pandemic H1N1 (pH1N1) virus. On 22 November 2011, the CDC reported that it had prepared a vaccine virus and was providing it to vaccine manufacturers as a precaution in case the novel virus spreads.

The World Health Organization (WHO) on 2 December revealed that the vaccine virus is based on an isolate that was collected in Minnesota in 2010. A CDC official said that the isolate is from a pair of swine-origin H3N2 infections that occurred in Minnesota in November 2010. Those cases were among five swine-origin H3N2 cases reported in three states during the 2010-11 flu season.

The 2010 strain is not an exact match for the recent novel H3N2 isolates, but it is close enough to be the basis for a vaccine, said Michael Shaw, PhD, associate director for laboratory science in the CDC's Influenza Division.

"Since we were seeing these cases popping up sporadically, over the summer the decision was made to go ahead and try to make a high-yield reassortant for a vaccine, and it turned out to be a good decision, to have it in reserve," Shaw said.

He said it takes several weeks to prepare a flu vaccine virus. In the case of the 2009 pandemic, the task took about six weeks, which was considered fast, he noted.

The full article may be accessed at http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/dec0211vaccine-jw.html
(CIDRAP 12/2/2011)

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USA: CDC sees improving influenza vaccine uptake in kids, health workers
Officials from the US Centers for Disease Control and Prevention (CDC) said on 5 December 2011 they see promising signs of increased flu vaccine uptake in children and healthcare workers so far in 2011, adding that they hope to boost less impressive numbers in adults and those with chronic medical conditions.

They unveiled the early vaccination findings at a press conference on 5 December 2011 to mark the start of National Influenza Vaccination Week, an annual event designed to promote flu vaccination before the holiday season and into the new year.

Dr. Howard Koh, assistant secretary for health at the US Department of Health and Human Services, said the CDC and its state and local partners hope to use the event to raise awareness that flu remains a serious and unpredictable disease, especially for high-risk groups such as pregnant women and those with underlying diseases such as asthma. The United States is entering the second year of a universal flu vaccination recommendation; the CDC recommends the vaccine for anyone age six months and older.

Koh said the CDC hopes to keep up the momentum that was generated with flu vaccine uptake least season, when nearly half of all pregnant women were immunized, along with almost half of all children, with no racial disparities seen among the youngsters. "It's critical to continue the progress," he said.

Though vaccine effectiveness can vary from year to year and some people, such as seniors, have lower levels of protection, public health experts have said the vaccine is still the best defense against the flu, until a better one can be developed.

The full article may be accessed at http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/dec0511flu.html
(CIDRAP 12/5/2011)

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2. Infectious Disease News

Asia
Australia (Australian Capital Territory): Measles outbreak at Orana school
A student from the Orana Steiner School has been admitted to a hospital with measles, and at least three of his classmates have been diagnosed with the illness. Australian Capital Territory Chief Health Officer Paul Kelly has written to parents at the school 23 November 2011, saying, "We are asking parents of students at Orana School to be alert to measles symptoms. The Health Protection Service has begun contacting people believed to have been exposed, recommending post exposure prophylaxis in line with national guidelines. Priority has been given to contacting the households and those most recently exposed contacts at GP surgeries and the Canberra Hospital. The guidelines require the measles mumps and rubella vaccine to be given within three days or normal human immunoglobulin within six days." Parents of any unvaccinated students in the same class as the students with measles are being asked to exclude their child from school until 4 December 2011.

Orana deputy director Marie-Anne Gigon said the school was working closely with the Health Directorate to halt the spread of measles through the school.
(ProMED 11/23/2011)

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China (Anhui Province): Dirty needle suspected in outbreak of hepatitis
An outbreak of hepatitis C among 56 children is thought to have been caused by the use of unsterilized syringe needles at a private clinic in central China's Henan Province.

The infected children, from Dacheng Town in neighboring Anhui Province, all received injections at Miaoqian Village clinic, according to a preliminary investigation by the Anhui health administration, reported 28 November 2011. Angry parents claimed doctors used a single syringe needle for dozens of children without sterilizing it.

Several villages in Guoyang County, Anhui, use the clinic, which is on the border between the provinces, the mother of a two-year-old infected boy stated. A five-year-old child was the first to be diagnosed with hepatitis C after a routine check-up on 15 November 2011. He was transferred to a hospital in the provincial capital, Hefei on 22 November 2011. His father said the boy could not sleep and cried at night. "His hands have swelled up with days of drips," he added. The infected children are being treated at hospitals in Hefei, Beijing, Shanghai and Nanjing.
(ProMED 11/29/2011)

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Japan: Radioactive cesium found in Meiji baby formula
Radioactive cesium of up to 30.8 becquerels per kilogram has been found in infant formula produced and sold by Meiji Co., the major food company said 6 December 2011, citing an internal examination.

The company suspects a link with the radioactive leaks from the Fukushima Daiichi nuclear power plant damaged by the 11 March 2011 earthquake and tsunami, saying ingredients for its Meiji Step milk powder may have come into contact with airborne radioactive cesium when they were being dried at a plant in Kasukabe, Saitama Prefecture, between 14 and 20 March 2011.

Radioactive cesium has been found in baby formula for the first time since the March disaster, prompting the Health, Labor and Welfare Ministry to begin looking into the matter.

The levels of cesium-134 and cesium-137 contained in the product remain below the government-set allowable limit of 200 becquerels per kilogram. A radiation expert said the reading was not at levels that would have an immediate impact on human health. The company nonetheless plans to offer customers free replacements, affecting around 400,000 850-gram cans of the Meiji Step formula.

Amid concern that babies are more susceptible to the harmful effects of radioactive materials than adults, the ministry has planned to set a new limit for food products for babies. The company will offer replacement products for batches with recommended consumption dates of 3, 4, 5, 6, 21, 22, 23 and 24 October 2012, according to the manufacturer. The dates are printed on the bottom of the cans.

Of the 23 samples with recommended consumption dates ranging from September to November 2012, four contained radioactive cesium of between 21.5 and 30.8 becquerels per kg. The formula in question came from milk produced before the March disaster, according to the company.

"Because the cesium is diluted to three to four becquerels (per kg) when the powders are added to hot water, we don't think it will have an impact on health. But we still want to address the anxieties of those who bought the product by providing replacements," a public relations official of the company said.

The full article may be accessed at http://mdn.mainichi.jp/mdnnews/news/20111206p2g00m0dm142000c.html
(The Mainichi Daily News 12/6/2011)

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Malaysia: 24 trainee commandos in hospital for suspected leptospirosis infection
The Bukit Jugra RMAF base is under lockdown after 24 trainee commandos were admitted for suspected leptospirosis infection. Health Ministry officials descended on the army base on 31 November 2011 to ensure there is no outbreak.

The trainees have been quarantined in the maternity ward of the Banting Hospital. Two of them are in critical condition, with one trainee transferred to the Kuala Lumpur Hospital. The condition of the remaining 22 trainees was reported to be stable. They will be released only after tests are complete — expected to be in a few days. The patients were brought there on the evening of 1 December 2011 for food poisoning. A security guard said family members and friends of the trainees, who turned up at the hospital earlier in the day, were not allowed to enter the ward.

“They just sat here and waited for hours. All they wanted was to see the trainees, but no one was allowed to go in. They left after talking to doctors on duty,” he said.

The guards said they were given strict orders by the hospital management not to allow anyone to enter. A hospital staff stated that they were given strict orders by hospital management and military commandants to keep the situation under wraps. Hospital Banting director Dr. Rozita Mohamed confirmed the commandos were admitted there but declined to comment further.

A hospital staff said there were two maternity wards and whenever a high number of patients were admitted with the same problem, they were kept at one of the wards, also known as “Ward 2”. A nurse, who declined to be identified, said as patients were quarantined, they had to be housed in a separate ward.

“The hospital is taking precautionary measures as the disease may be contagious.” Defence Minister Datuk Seri Zahid Hamidi confirmed 1 December 2011, that the soldiers were infected by leptospirosis, which is commonly associated with rat’s urine.

It was believed the commandos could have been infected from the food or water they consumed. Health Ministry officers are conducting checks at the RMAF base, including scouring the Bukit Jugra jungle area where the victims are believed to have undergone final training. The health officers are also inspecting the airbase’s water tanks and water outlets to see if the food or water source could have been contaminated.

The full article may be accessed at http://www.mmail.com.my/content/86869-lockdown-rmaf-base
(The Malay Mail 12/2/2011)

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Russia (Buryatia): Adverse reactions to brucella vaccine
More than 50 meat-processing plant workers in the town of Mykolayiv region of Buryatia Tarbagatai sought medical help after the company required them to be vaccinated against brucellosis, six of them were hospitalized. At the same time, 52 employees entered the plant with a vaccine strain of brucellosis, administered at an excessive dose. The following day, workers began to turn to doctors complaining of fever. All were hospitalized in infectious diseases hospitals.

Employees Rospotrebnadzor for Buryatia has found that a rural paramedic vaccinated slaughterhouse workers against brucellosis in violation of the essential requirements. "The management has purchased the vaccine without the consent of the district hospital. Also, CRH has not concluded contracts for carrying out vaccination," added the department. Proceedings of Inquiry have been sent to the prosecutor's office in Buryatia.

Immunization against brucellosis was held in the "Eco-Food" company in the village of Nikolaevsk on 23 November 2011. The manual mill is not authorized to use the vaccine in an accelerated mode to obtain permission from the Rosselkhoznadzor for purchase of imported meat.

These inoculations were made illegally, stressed the chief epidemiologist of the Ministry of Health of the Republic, Kolmakova Victoria. Now the victims complain of large blisters on their hands, talk about high blood pressure and pain in the liver; similar symptoms appeared in all 52 inoculated plant workers. As of 1 December 2011, six patients were hospitalized with post-vaccinal reaction. “The dynamics of patients and vaccinated individuals are not getting worse," noted the department. All the victims will be under the scrutiny of physicians until January 2012.
(ProMED 12/1/2011)

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Americas
Canada (Alberta): Measles update, number of measles cases stands at one
It turns out some suspected cases of measles were just that -suspected, and not the real infection. As reported 16 November 2011, Alberta Health Services (AHS) was awaiting test results of potential secondary cases of the measles, after one person tested positive for it. Alberta Health Services confirms test results from all three cases have come back negative.

One person did test positive for measles, prompting AHS to send out a warning to those who may have come into contact with that person at Manulife Place, between 7am-9pm, 1-3 November 2011; the Synergy Fall Social Event at Sutton Place Hotel, 3 November 2011, 5pm-9pm; or the emergency room at University Hospital, 8 November 2011, 7:30pm and 9 November 2011, 4:30am. Measles is highly contagious, and potentially deadly if you haven't been immunized against it.
(ProMED 11/23/2011)

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Canada (Ontario): Milford Bay Trout Farm Inc. Smoked Trout Filet may contain dangerous bacteria
The Canadian Food Inspection Agency (CFIA) and Milford Bay Trout Farm Inc. are warning the public not to consume the Milford Bay Trout Farm Inc. Smoked Trout Filet, described below, because this product may be contaminated with Clostridium botulinum. Toxins produced by these bacteria may cause botulism, a life-threatening illness.

The affected product, Milford Bay Trout Farm Inc. Smoked Trout Filet, is sold vacuum packed at various weights. All best before dates and lot codes are affected. The package bears no UPC. This product has been distributed in Ontario. There have been no reported illnesses associated with the consumption of this product.

Food contaminated with Clostridium botulinum toxin may not look or smell spoiled. Consumption of food contaminated with the toxin may cause nausea, vomiting, fatigue, dizziness, headache, double vision, dry throat, respiratory failure and paralysis. In severe cases of illness, people may die.

The manufacturer, Milford Bay Trout Farm Inc., Bracebridge, ON, is voluntarily recalling the affected product from the marketplace. The CFIA is monitoring the effectiveness of the recall.

The CFIA Health Hazard Alert may be accessed at http://www.inspection.gc.ca/english/corpaffr/recarapp/2011/20111127e.shtml
(CFIA 11/27/2011)

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USA: Who should pay to make ground beef safe from E. coli?
Food safety experts say that a vaccine and probiotics are available to combat dangerous Escherichia coli in beef at a cost of only about a penny a burger, but the question of who will pay for early interventions remains a major hurdle. The vaccine was introduced by Pfizer Animal Health in 2010, costs $4 to $6 per animal, and is said to eliminate O157:H7 E. coli in 85% of cattle and reduce levels shed in manure by 98%, according to Pfizer. Other vaccines are in the works as well. Probiotics are beneficial bacterial cultures added to feed that out-compete harmful E. coli in cattle's digestive tract. An effective dose costs $2 to $4 per animal. Consumers are willing to pay one to two cents per pound for safer beef. "The question is no longer, ‘Can we get the technologies?’ We've got them, or they're soon to arrive. The question is ‘How do we implement?’” said Guy Loneragan, professor of food safety at Texas Tech University in Lubbock. The major obstacle may be determining who foots the bill for preventive steps taken long before slaughter. Cattle growers and feedlots are in a position to use the tools but wouldn't benefit. And food companies would place themselves at an economic disadvantage if they demanded the steps while others didn't. So far only two small operations in Kansas have added the steps, but if a mega corporation like McDonald's or Wal-Mart were to adopt the practices, "the industry will turn around on a dime," according to one industry executive.

The full article may be accessed at http://www.usatoday.com/money/industries/food/story/2011-12-01/safe-meat/51447546/1
(USA Today 11/28/2011)

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Canada (Ontario): Certain Domaine de L'oulivie Brand Lucque Olives de Pays may contain dangerous bacteria
The Canadian Food Inspection Agency (CFIA) and Marché Transatlantique Inc. are warning the public not to consume the Domaine de l'Oulivie brand Lucque Olives de Pays described below because the product may be contaminated with Clostridium botulinum. Toxins produced by these bacteria may cause botulism, a life-threatening illness.

The affected product, Domaine de l'Oulivie brand Lucque Olives de pays, was sold in bottles of 340 g net weight bearing UPC 3 760121 190437. All codes are affected by this alert. This product has been distributed in Quebec. There have been no reported illnesses associated with the consumption of this product.

Food contaminated with Clostridium botulinum toxin may not look or smell spoiled. Consumption of food contaminated with the toxin may cause nausea, vomiting, fatigue, dizziness, headache, double vision, dry throat, respiratory failure and paralysis. In severe cases of illness, people may die.

The Importer, Marché Transatlantique Inc., Montréal, QC is voluntarily recalling the affected product from the marketplace. The CFIA is monitoring the effectiveness of the recall.

The CFIA Health Hazard Alert may be accessed at http://www.marketwire.com/press-release/cfia-health-hazard-alert-certain-domaine-de-loulivie-brand-lucque-olives-de-pays-may-1591359.htm
(CFIA 11/25/2011)

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Chile (Bio Bio): Fatal pertussis cases
Jorge Diaz, undersecretary for health, reported an anomalous situation with the detection as of 5 December 2011 of 2,030 cases of whooping cough, or pertussis, which mainly affects infants younger than one year of age. In a normal period 800 cases at most are recorded, a number that has been largely exceeded.

To address this alarming situation, which so far in 2011 has resulted in the deaths of 11 infants in the Bio-Bio Region, the Ministry of Health announced a novel vaccination campaign focused on controlling this disease.

Undersecretary Diaz explained the new "cocoon vaccine" strategy, which consists in vaccinating pregnant mothers and people older than 12 years of age whose families include newborn infants. The reason, according to Diaz, is that "the vaccine confers protective immunity for approximately ten years, therefore, young people and adults are likely to contract the disease and spread it to infants younger than six months of age, who are at the greatest risk."

So far, 11 deaths have been recorded, six of them in the Bio-Bio Region alone. "Children younger than six months of age are at risk of a very serious disease, respiratory distress, and death," said the official.

The cocoon vaccination campaign will begin in Bio-Bio and seeks to address the 209% increase in cases of whooping cough compared to those reported in 2010. "In 2010, we had 794 cases, therefore there is an almost three-fold increase in the numbers of previous years.” While the National Immunization Program permanently vaccinates children against pertussis, this immunity is acquired after one year of age, therefore during the period between birth and the first year there is risk of infection," said Diaz.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20111206.3541
(ProMED 12/6/2011)

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USA: Exemptions to childhood vaccines grow
Rates of exemptions to childhood vaccination have topped 5% in eight states, according to an Associated Press (AP) analysis published 28 November 2011. The states and exemption rates for kindergartners included Alaska, 9%; Colorado, 7%; Minnesota, 6.5%; and Vermont and Washington, 6%. Oregon, Michigan, and Illinois were reported to be "close behind." Mississippi, in contrast, had the lowest rate, at essentially 0%. For its analysis, the AP asked state health departments for kindergarten exemption rates for 2006-07 and 2010-11 and also analyzed data from the Centers for Disease Control and Prevention. The report also cited pockets in some states where exemption rates are much higher, such as some rural counties in northeastern Washington where rates have even hit 50%. "Vaccine refusers tend to cluster," said Saad Omer, an Emory University epidemiologist and vaccine researcher. The AP also found that vaccine exemptions rose in more than half of states, and ten had increases of about 1.5 percentage points or more.

The full article may be accessed at http://www.boston.com/news/education/k_12/articles/2011/11/28/ap_impact_more_kids_skip_school_shots_in_8_states_1322490562/
(Associated Press 11/28/2011)

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USA: New England sees puzzling rise in Legionnaires' disease
Legionnaires' disease, a strain of pneumonia, is on the rise in New England for the year 2011, and the reason for the flare-up remains unexplained, health officials said on 29 November 2011. Total cases confirmed in Maine, Massachusetts and Connecticut have nearly doubled from 2010 while many other northeastern states were also showing sharp increases. States in other parts of the country were not.

Maine's Center for Disease Control and Prevention issued an advisory on 28 November 2011 to all state health care providers to watch for and report Legionnaires' cases after it documented 18 cases so far in 2011, up from 11 in all of 2010.

"This is a spike, and we need to be looking into this and we need to alert people," Maine's state epidemiologist, stated Dr. Stephen Sears. Legionnaires' disease is caused by inhaling an infectious dose of Legionella bacteria, usually found in contaminated water in sources such as cooling towers, whirlpool spas, showers and faucets. The illness, named for a 1976 outbreak at an American Legion convention in Philadelphia, causes pneumonia and kills 5 to 30% of patients; with 8,000 to 18,000 people hospitalized each year. Symptoms can include high fever, chills, chest pain, a cough, and often headaches and muscle aches. It can be treated with antibiotics.

Hard-hit Massachusetts confirmed 211 Legionnaires' disease cases as of 23 November 2011, up from 118 cases in all of 2010, while Connecticut saw 72 cases, versus just 47 in 2010, said Jeff Dimond, a CDC spokesman in Atlanta. In the Mid-Atlantic, populous New York State reported 526 cases for 2011 compared to 379 in 2010, and Pennsylvania saw 450 cases, up from 299 in 2010, the CDC said. By contrast, California, with its 200 cases in 2011, has a mere ten more than it counted during 2010.

Maine epidemiologist Sears has spoken with his Massachusetts and Connecticut counterparts about the jump in scattered individual cases this fall in New England, but they have not yet managed to pinpoint a specific reason for it. Experts were considering possibilities such as an increased awareness of Legionnaires that has led to more testing, changes in climate, more air conditioner usage and an increase in the number of seniors, who are more susceptible to infection.

"We have looked but we haven't found common connections at this point," Sears said. "We've found nothing that tied the people together epidemiologically." The Canadian province of Quebec has issued a similar advisory after a rise in cases there, Sears said.

The Maine CDC Health Advisory may be accessed at http://www.maine.gov/tools/whatsnew/attach.php?id=320713&an=2
(Reuters 11/29/2011)

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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
Peru (Puerto Inca)
Huanuco department (state of province equivalent) confirmed the occurrence of a dengue outbreak. From the initiation of the outbreak 11 September to 22 October 2011, the Huanuco DIRESA (District Health Office) reported 52 dengue cases from the Puerto Inca district. The trend was for an increase to the week of 18 September 2011 and later a decrease in cases.
(ProMED 11/22/2011)


Philippines (Valenzuela City)
The number of dengue cases in Valenzuela City has "dropped significantly" compared with what was recorded in the same period for 2010, a public official said. Ahna Mejia, city chief public information officer, stated that the city had a total of 1,440 partial reports of the disease from 1 January to 19 November 2011. The figure, which lumps together suspected cases of dengue (1,410 cases) and those that had been confirmed (30 cases), is 5% lower than the 1517 suspected and confirmed cases in the same period of 2010, Mejia said.
(ProMED 11/23/2011)


Philippines (Misamis Occidental Province)
The intensified information campaign against dengue conducted by the City Health Offices of Oroquieta and Tangub cities has reportedly paid off. This, as the number of dengue cases in Oroquieta City posted a downtrend, from 69 to 40 cases or down by 42%, and Tangub City, from 86 to 75 cases or down by 13%, as reflected in the Disease Surveillance Report covering the period 1 January to 25 November 2011.
(ProMED 12/2/2011)

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4. Articles
Eurasian Tree Sparrows, Risk for H5N1 Virus Spread and Human Contamination through Buddhist Ritual: An Experimental Approach
Gutiérrez RA , Sorn S , Nicholls JM , et al. PLoS ONE. 2 December 2011. 6(12): e28609. doi:10.1371/journal.pone.0028609.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0028609

Background. The Highly Pathogenic Avian Influenza H5N1 virus has dramatically spread throughout Southeast Asia since its first detection in 1997. Merit Release Birds, such as the Eurasian Tree Sparrow, are believed to increase one's positive karma when kissed and released during Buddhist rituals. Since these birds are often in close contact with both poultry and humans, we investigated their potential role in the spread of H5N1 virus.

Methodology/Principal Findings. Seven series of experiments were conducted in order to investigate the possible interactions between inoculated and exposed birds, including sparrow/sparrow, sparrow/chicken, duck/sparrow. Daily and post-mortem samples collected were tested for H5N1 virus by real-time RT-PCR and egg inoculation. When directly inoculated, Eurasian Tree Sparrows were highly susceptible to the H5N1 virus, with a fatality rate approaching 100% within 5 days post-inoculation. Although transmission of fatal infection between sparrows did not occur, seroconversion of the exposed birds was observed. Up to 100% chickens exposed to inoculated sparrows died of H5N1 infection, depending on the caging conditions of the birds, while a fatality rate of 50% was observed on sparrows exposed to infected ducks. Large quantities of H5N1 virus were detected in the sparrows, particularly in their feathers, from which infectious particles were recovered.

Conclusions/Significance. Our study indicates that under experimental conditions, Eurasian Tree Sparrows are susceptible to H5N1 infection, either by direct inoculation or by contact with infected poultry. Their ability to transmit H5N1 infection to other birds is also demonstrated, suggesting that the sparrows may play a role in the dissemination of the virus. Finally, the presence of significant quantities of H5N1 virus on sparrows' feathers, including infectious particles, would suggest that Merit Release Birds represent a risk for human contamination in countries where avian influenza virus is circulating and where this religious ritual is practiced.

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Swine influenza surveillance in East and Southeast Asia: a systematic review
Trevennec K, Cowling BJ, Peyre M, et al. Anim Health Res Rev. 29 November 2011. doi:10.1017/S1466252311000181. [Epub ahead of print].
Available at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8444070

Abstract. East and Southeast Asia are important pig- and poultry-producing areas, where the majority of production takes place on small-scale farms with low biosecurity levels. This systematic review synthesizes data on swine influenza virology, serology and epidemiology in East and Southeast Asia. A total of 77 research articles, literature reviews and conference papers were selected and analyzed from 510 references retrieved from PubMed and ISI Web of KnowledgeSM. The number of published articles increased in the last 3 years, which may be attributed to improvement in monitoring and/or a better promotion of surveillance data. Nevertheless, large inequalities in surveillance and research among countries are underlined. Virological results represent the largest part of published data, while the serological and epidemiological features of swine influenza in East and Southeast Asia remain poorly described. The literature shows that there have been several emergences of swine influenza in the region, and also considerable evidence of multiple introductions of North American and avian-like European strains. Furthermore, several avian-origin strains are isolated from pigs, including H5 and H9 subtypes. However, their low seroprevalence in swine also shows that pigs remain poorly infected by these subtypes. We conclude that sero-epidemiological investigations have been neglected, and that they may help to improve virological surveillance. Inter- and intra-continental surveillance of gene flows will benefit the region. Greater investment is needed in swine influenza surveillance, to improve our knowledge of circulating strains as well as the epidemiology and disease burden in the region.

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New Variants and Age Shift to High Fatality Groups Contribute to Severe Successive Waves in the 2009 Influenza Pandemic in Taiwan
Yang JR, Huang YP, Chang FY, et al. PLoS ONE. 30 November 2011. 6(11): e28288. doi:10.1371/journal.pone.0028288.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0028288

Abstract. Past influenza pandemics have been characterized by the signature feature of multiple waves. However, the reasons for multiple waves in a pandemic are not understood. Successive waves in the 2009 influenza pandemic, with a sharp increase in hospitalized and fatal cases, occurred in Taiwan during the winter of 2010. In this study, we sought to discover possible contributors to the multiple waves in this influenza pandemic. We conducted a large-scale analysis of 4703 isolates in an unbiased manner to monitor the emergence, dominance and replacement of various variants. Based on the data from influenza surveillance and epidemic curves of each variant clade, we defined virologically and temporally distinct waves of the 2009 pandemic in Taiwan from May 2009 to April 2011 as waves 1 and 2, an interwave period and wave 3. Except for wave 3, each wave was dominated by one distinct variant. In wave 3, three variants emerged and co-circulated, and formed distinct phylogenetic clades, based on the hemagglutinin (HA) genes and other segments. The severity of influenza was represented as the case fatality ratio (CFR) in the hospitalized cases. The CFRs in waves 1 and 2, the interwave period and wave 3 were 6.4%, 5.1%, 15.2% and 9.8%, respectively. The results highlight the association of virus evolution and variable influenza severity. Further analysis revealed that the major affected groups were shifted in the waves to older individuals, who had higher age-specific CFRs. The successive pandemic waves create challenges for the strategic preparedness of health authorities and make the pandemic uncertain and variable. Our findings indicate that the emergence of new variants and age shift to high fatality groups might contribute potentially to the occurrence of successive severe pandemic waves and offer insights into the adjustment of national responses to mitigate influenza pandemics.

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Varicella in Infants After Implementation of the US Varicella Vaccination Program
Chaves SS, Lopez AS, Watson TL, et al. Pediatrics. 28 November 2011. doi: 10.1542/peds.2011-0017.
Available at http://pediatrics.aappublications.org/content/early/2011/11/22/peds.2011-0017.abstract

Objective. To describe varicella disease in infants since implementation of the varicella vaccination program in the United States.

Patients and Methods. From 1995 to 2008, demographic, clinical, and epidemiologic data on cases of varicella in infants were collected prospectively through a community-based active surveillance project. We examined disease patterns for infants in 2 age groups: 0 to 5 and 6 to 11 months.

Results. Infant varicella disease incidence declined 89.7% from 1995 to 2008. Infants aged 0 to 5 months had milder clinical disease than those aged 6 to 11 months: ¡Ý50 lesions, 49% vs 58% (P = .038); fever (body temperature > 38¡ãC), 12% vs 21% (P = .014); and varicella-related complications, 6% vs 14% (P = .009), respectively. Age was an independent predictor of the occurrence of complications.

Conclusions. The varicella vaccination program has resulted in substantial indirect benefits for infants, who are not eligible for vaccination. Presence of maternal varicella-zoster virus antibodies might explain attenuated disease in very young infants likely born to mothers with history of varicella. Although varicella disease incidence has declined, exposure to varicella-zoster virus continues to occur. Improving varicella vaccination coverage in all age groups will further reduce the risk of varicella exposure and protect those not eligible for varicella vaccination.

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Tuberculosis mortality differentials in Indonesia during 2007-2008: evidence for health policy and monitoring
Rao C, Kosen S, Bisara D, et al. Int J Tuberc Lung Dis. 1 December 2011. 15(12):1608-14.
Available at http://www.ingentaconnect.com/content/iuatld/ijtld/2011/00000015/00000012/art00010?token=005716af0953b7573d2570257070494a2f2d406a765b2b357c4e75477e4324576b6427380459248df0faf6c

Background. Indonesia bears the third highest tuberculosis (TB) burden in the world. Current mortality estimates are based on notification and case fatality rates derived from the National TB Control Programme.

Objective. To report TB mortality measures for 2007-2008 based on death registration systems in selected populations in five provinces of Indonesia.

Methods. Data were compiled from sites in Central Java, Lampung, Gorontalo, West Kalimantan and Papua in 2007-2008, covering 2.5 million people. Overall mortality levels and TB mortality indicators were computed. Data quality was assessed in terms of completeness of death registration and strength of evidence in verbal autopsy questionnaires.

Results. A total of 1547 TB deaths were diagnosed in the five provinces. There was direct or indirect evidence of incomplete death registration at all sites. More than 90% of TB diagnoses from verbal autopsies were based on strong evidence. The results demonstrate high TB death rates in Papua, and significant mortality differentials across provinces.

Conclusions. The measurement of cause-specific mortality is feasible by strengthening death registration in Indonesia. Observed TB mortality rates from five sites are baseline evidence for monitoring TB control programmes. Sustained efforts are required to develop death registration as a routine annual source of mortality data for Indonesia.

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Bacterial stress response to environmental radiation relating to the Fukushima radiation discharge event, Japan: Will environmental bacteria alter their antibiotic susceptibility profile?
Nakanishi S, Moore JE, Matsuda M, et al. Ecotoxicol Environ Saf. February 2012. 76(2):169-74. doi:10.1016/j.ecoenv.2011.09.011. [Epub ahead of print].
Available at http://www.sciencedirect.com/science/article/pii/S0147651311003046

Abstract. Antibiotic resistance in clinical pathogens in humans may be traced back to resistance mechanisms in environmental bacteria and any factors, which are likely to alter (upregulate) resistance in environmental organisms, is of potential and eventual consequence to human pathogens. Furthermore, sublethal doses of gamma radiation to environmental organisms may cause sublethal stress and a selective pressure, which may lead to mutational events that alter the bacterium's susceptibility profile. A gamma (ã) radiation simulation experiment was performed to emulate the exposure of four environmental bacteria, including Listeria innocua, Bacillus subtilis, E. coli and Pseudomonas aeruginosa, to levels of radiation in and around Fukushima, Japan, equating to 1, 10 and 100 years equivalence exposure. Alteration to susceptibility to 14 antibiotics was measured as the primary endpoint. There was no significant alteration in the susceptibility of the Gram-positive organisms, whereas both Gram-negative organisms became slightly more susceptible to the antibiotics tested over time. These data indicate that such radiation exposure will not increase the antibiotic resistance profile of these organisms and hence not add to the global public health burden of increased antibiotic resistance in human bacterial pathogens.

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The epidemiology of human salmonellosis in New Zealand, 1997-2008
Lal A, Baker MG, French NP, et al. Epidemiol Infect. 30 November 2011. doi:10.1017/S0950268811002470. [Epub ahead of print].
Available at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8444473

Abstract. This study describes the epidemiology of human salmonellosis in New Zealand using notified, hospitalized and fatal cases over a 12-year period (1997-2008). The average annual incidence for notifications was 42•8/100 000 population and 3•6/100 000 population for hospitalizations. Incidence was about twice as high in summer as in winter. Rural areas had higher rates than urban areas (rate ratio 1•23, 95% confidence interval 1•22-1•24 for notifications) and a distinct spring peak. Incidence was highest in the 0-4 years age group (154•2 notifications/100 000 and 11•3 hospitalizations/100 000). Hospitalizations showed higher rates for Mâori and Pacific Island populations compared to Europeans, and those living in more deprived areas, whereas notifications showed the reverse, implying that notifications are influenced by health-seeking behaviours. Salmonella Typhimurium was the dominant serotype followed by S. Enteritidis. For a developed country, salmonellosis rates in New Zealand have remained consistently high suggesting more work is needed to investigate, control and prevent this disease.

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Temporal trend and climate factors of hemorrhagic fever with renal syndrome epidemic in Shenyang City, China
Liu X, Jiang B, Gu W, Liu Q. BMC Infect Dis. 2 December 2011. 11(1):331. doi:10.1186/1471-2334-11-331. [Epub ahead of print].
Available at http://www.biomedcentral.com/1471-2334/11/331/abstract

Background. Hemorrhagic fever with renal syndrome (HFRS) is an important infectious disease caused by different species of hantaviruses. As a rodent-borne disease with a seasonal distribution, external environmental factors including climate factors may play a significant role in its transmission. The city of Shenyang is one of the most seriously endemic areas for HFRS. Here, we characterized the dynamic temporal trend of HFRS, and identified climate-related risk factors and their roles in HFRS transmission in Shenyang, China.

Methods. The annual and monthly cumulative numbers of HFRS cases from 2004 to 2009 were calculated and plotted to show the annual and seasonal fluctuation in Shenyang. Cross-correlation and autocorrelation analyses were performed to detect the lagged effect of climate factors on HFRS transmission and the autocorrelation of monthly HFRS cases. Principal component analysis was constructed by using climate data from 2004 to 2009 to extract principal components of climate factors to reduce co-linearity. The extracted principal components and autocorrelation terms of monthly HFRS cases were added into a multiple regression model called principal components regression model (PCR) to quantify the relationship between climate factors, autocorrelation terms and transmission of HFRS. The PCR model was compared to a general multiple regression model conducted only with climate factors as independent variables.

Results. A distinctly declining temporal trend of annual HFRS incidence was identified. HFRS cases were reported every month, and the two peak periods occurred in spring (March to May) and winter (November to January), during which, nearly 75% of the HFRS cases were reported. Three principal components were extracted with a cumulative contribution rate of 86.06%. Component 1 represented MinRH0, MT1, RH1, and MWV1; component 2 represented RH2, MaxT3, and MAP3; and component 3 represented MaxT2, MAP2, and MWV2. The PCR model was composed of three principal components and two autocorrelation terms. The association between HFRS epidemics and climate factors was better explained in the PCR model (F=446.452, P<0.001, adjusted R2 =0.75) than in the general multiple regression model (F=223.670, P<0.000, adjusted R2 =0.51).

Conclusions. The temporal distribution of HFRS in Shenyang varied in different years with a distinctly declining trend. The monthly trends of HFRS were significantly associated with local temperature, relative humidity, precipitation, air pressure, and wind velocity of the different previous months. The model conducted in this study will make HFRS surveillance simpler and the control of HFRS more targeted in Shenyang.

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Rodent-Borne Hantaviruses in Cambodia, Lao PDR, and Thailand
Blasdell K, Cosson JF, Chaval Y, et al. Ecohealth. 29 November 2011. doi: 10.1007/s10393-011-0725-7. [Epub ahead of print].
Available at http://www.springerlink.com/content/1844032755662v26/

Abstract. In order to evaluate the circulation of hantaviruses present in southeast Asia, a large scale survey of small mammal species was carried out at seven main sites in the region (Cambodia, Lao People's Democratic Republic, and Thailand). Small scale opportunistic trapping was also performed at an eighth site (Cambodia). Using a standard IFA test, IgG antibodies reacting to Hantaan virus antigens were detected at six sites. Antibody prevalence at each site varied from 0 to 5.6% with antibodies detected in several rodent species (Bandicota indica, B. savilei, Maxomys surifer, Mus caroli, M. cookii, Rattus exulans, R. nitidius, R. norvegicus, and R. tanezumi). When site seroprevalence was compared with site species richness, seropositive animals were found more frequently at sites with lower species richness. In order to confirm which hantavirus species were present, a subset of samples was also subjected to RT-PCR. Hantaviral RNA was detected at a single site from each country. Sequencing confirmed the presence of two hantavirus species, Thailand and Seoul viruses, including one sample (from Lao PDR) representing a highly divergent strain of Seoul virus. This is the first molecular evidence of hantavirus in Lao PDR and the first reported L segment sequence data for Thailand virus.

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Dengue-1 Virus Clade Replacement in Thailand Associated with Enhanced Mosquito Transmission
Lambrechts L, Fansiri T, Pongsiri A, Thaisomboonsuk B, et al. J Virol. 30 November 2011. doi: 10.1128/JVI.06458-11. [Epub ahead of print].
Available at http://jvi.asm.org/content/early/2011/11/23/JVI.06458-11.abstract

Abstract. Dengue viruses (DENV) are characterized by extensive genetic diversity, which can be organized in multiple, genetically distinct lineages that arise and die out on a regular basis in endemic regions. A fundamental question for understanding DENV evolution is the relative extent to which stochastic processes (genetic drift) and natural selection acting on fitness differences among lineages contribute to lineage diversity and turnover. Here, we used a set of recently collected and archived low-passage DENV-1 isolates from Thailand to examine the role of mosquito vector-virus interactions in DENV evolution. By comparing the ability of 23 viruses isolated on different dates between 1985 and 2009 to be transmitted by a present-day Aedes aegypti population from Thailand, we found that a major clade replacement event in the mid-1990s was associated with virus isolates exhibiting increased titers in the vector's hemocoel, which is predicted to result in a higher probability of transmission. This finding is consistent with the hypothesis that selection for enhanced transmission by mosquitoes is a possible mechanism underlying major DENV clade replacement events. There was significant variation in transmission potential among isolates within each clade, indicating that in addition to vector-driven selection other evolutionary forces act to maintain viral genetic diversity. We conclude that occasional adaptive processes involving the mosquito vector can drive major DENV lineage replacement events.

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5. Notifications
2nd International Symposium on Zoonoses & Emerging Infectious Diseases
Kuching, Sarawak, Malaysia, 15 to 16 December 2011
The recent emergence and re-emergence of zoonotic diseases emphasizes the urgent need to identify infective agents in wildlife, study their transmission to human and understand the complex epidemiological and ecological mechanisms that directly impact on the health of wildlife and humans.
Additional information at http://www.frst.unimas.my/2zeid.html

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30th Annual UC Davis Infectious Diseases Conference
Sacramento, California, United States, 10 to 11 February 2012
Infectious disease is an area of medicine that is constantly changing. New pathogens are identified and newer therapeutic strategies are defined. This is an important opportunity to review and update participants on practical info.
Additional information at http://www.ucdmc.ucdavis.edu/cme/conferences/

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2012 Australasian Society for Infectious Diseases Scientific Meeting
Fremantle, Western Australia, 21 to 25 March 2012
The meeting’s focus is to explore what the future holds for infectious diseases. Specific topics will include the origins and spread of new infectious diseases, how host factors may determine outcomes from infection, what tools we can use to predict, diagnose, manage and monitor infections, as well as a range of other topics including malaria, travel-related infections, viral hepatitis, antimicrobial use and abuse, current controversies in infectious diseases and the emergence and spread of multi-resistant organisms in the community.
Additional information at http://www.asid.net.au/Default2.aspx?active_page_id=337

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 apecein@u.washington.edu