Vol. XIV No. 26 ~ EINet News Briefs ~ Dec 23, 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 watchdogs report few hot spots
- Egypt: Mother and child contract H5N1 influenza
- Egypt: Man dies of H5N1 avian influenza
- New England: Seal deaths caused by H3N8 influenza
- China: H5N1 influenza hits flock of Tibetan poultry
- Hong Kong: Raises alert level after H5N1 influenza confirmed in poultry
- USA: Novartis says cell-based H5N1 influenza vaccine facility ready to produce

2. Infectious Disease News
- China: Scarlet fever in an elementary school in Shanghai
- China: Polio cases reach 20 in Xinjiang
- Japan: Osaka Prison food poisoning sickens 1,000 inmates
- Russia: Brucellosis situation threatens to spiral out of control in Dagestan
- Viet Nam: Hand, foot and mouth disease
- Canada: Cases of hepatitis A continue to rise
- Mexico: Hepatitis A outbreak in Veracruz
- USA: Multistate outbreak of E. coli O157:H7 infections linked to romaine lettuce
- USA: Two more sickened in ground beef Salmonella outbreak
- USA (Kentucky): Foodborne illness at Zappos

3. Updates

4. Articles
- Cost Comparison of 2 Mass Vaccination Campaigns Against Influenza A H1N1 in New York City
- Antiviral resistance during the 2009 influenza A H1N1 pandemic: public health, laboratory, and clinical perspectives
- Changing Perceptions: of Pandemic Influenza and Public Health Responses
- Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: a population-based study
- Mapping of mosquito breeding sites in malaria endemic areas in Pos Lenjang, Kuala Lipis, Pahang, Malaysia
- Adverse Events following 12 and 18 Month Vaccinations: a Population-Based, Self-Controlled Case Series Analysis
- Integrated surveillance and potential sources of Salmonella Enteritidis in human cases in Canada from 2003 to 2009
- Completeness and timeliness of tuberculosis notification in Taiwan
- Detecting and controlling foodborne infections in humans: lessons for China from the United States experience

5. Notifications
- 30th Annual UC Davis Infectious Diseases Conference
- 2012 Australasian Society for Infectious Diseases Scientific Meeting

1. Influenza News

2011 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Bangladesh / 2 (0)
Cambodia / 8 (8)
Egypt / 36 (13)
Indonesia / 11 (9)
Total / 57 (30)

***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: 573 (336) (WHO 12/15/2011)

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


Global: Influenza watchdogs report few hot spots
Flu activity remained low in the Northern Hemisphere the week of 12 December 2011, with only a few countries, such as Costa Rica and Cameroon, reporting spikes in the number of cases, the World Health Organization (WHO) said on 16 December 2011.

Costa Rica is the only tropical country in the Americas to report increasing numbers of cases, which are primarily influenza A/H3N2, the WHO said.

Another hot spot is Cameroon, where H3N2 infections seem to be peaking. The WHO said Cameroon's rise in H3N2 was preceded by an increasing number of 2009 H1N1 infections, which peaked in early November 2011.

Tropical parts of Asia are reporting localized areas of transmission, with India citing areas of influenza B circulation and Laos reporting H3N2 transmission.

In temperate parts of South America, Australia, and New Zealand, flu activity has returned to inter-seasonal levels, the WHO said. However, as was true to 2010, Australia is reporting persistent low-level H3N2 and influenza B transmission.

Flu levels remained low in the Northern Hemisphere's temperate countries, with only sporadic activity reported in Canada, the United States, and some European countries.

The full article may be accessed at http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/dec1611flu-br.html
(CIDRAP 12/16/2011)


Europe/Near East
Egypt: Mother and child contract H5N1 influenza
The Ministry of Health and Population of Egypt has notified WHO of two cases of human infection with avian influenza A (H5N1) virus.‬‪

The two cases are a mother and her young child from Dakahlia Governorate. Both developed symptoms on 26 November 2011.‬‪The mother was admitted to a Hospital on 1 December 2011 and received oseltamivir on admission. The child was hospitalized on 2 December 2011 and received oseltamivir on admission. The mother was 24 weeks pregnant. She died on 3 December 2011. The child is in stable condition.‬‪

Investigations into the source of infection indicate that both cases had exposure to sick and dead backyard poultry (chicken and turkeys).‬‪

The case was confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Centre of the WHO Global Influenza Surveillance Network, on 3 December 2011.‬‪ Of the 155 cases confirmed to date in Egypt, 53 have been fatal.‬‪
(WHO 12/15/2011)


Egypt: Man dies of H5N1 avian influenza
A 29-year-old Egyptian man has died from H5N1 avian flu, the World Health Organization (WHO) said 21 December 2011. The man, from Dakahlia governorate, developed symptoms on 8 December 2011, was admitted to a hospital on 15 December 2011, and died 19 December 2011 after being listed in critical condition, according to the country's health ministry. He received oseltamivir (Tamiflu) upon admission. He had exposure to backyard poultry, according to the WHO. Egypt has now confirmed 156 H5N1 cases, 54 of them fatal. Local media reported that the man is the brother of the last confirmed Egyptian case-patient, a pregnant woman from Dakahlia governorate who died 3 December 2011. The woman's child also contracted H5N1 flu but did not succumb, the WHO said on 15 December 2011.
(CIDRAP 12/21/2011)


New England: Seal deaths caused by H3N8 influenza
Scientists studying a string of deaths in 162 seals since September 2011 off the New England coast have confirmed H3N8 influenza in five of the dead seals, according to the Northeast Regional Office of the National Oceanic and Atmospheric Administration (NOAA) on 20 December 2011. "This H3N8 virus is usually associated with wild birds, and a separate group of H3N8 infects horses and dogs," said Dr. Hon Ip, of the US Geological Survey's (USGS's) National Wildlife Health Center. "This is the first time that a virus which is similar to the H3N8 avian influenza virus has been associated with a large-scale mortality in marine mammals." Dr. Teri Rowles, coordinator of the Marine Mammal Health and Stranding Program for NOAA Fisheries Service, added, "We are now conducting tests on additional animals to learn more about the role this virus may have played in the die-off and to better understand the virus itself." In the meantime, the agency warned people to stay away from seals in distress, keep pets away, and call an NOAA hotline.
(CIDRAP 12/20/2011)


China: H5N1 influenza hits flock of Tibetan poultry
China has confirmed an outbreak of H5N1 avian flu in a village flock on the Tibetan plateau near Lhasa, according to the World Organization for Animal Health (OIE) on 12 December 2011. Of a flock of 1,865 poultry in Sangda village, 290 died from the disease and the rest were killed to prevent its spread. Authorities have disinfected the area and controlled movement of birds in the region. H5N1 was confirmed by polymerase chain reaction and other tests. An official with China's Ministry of Agriculture said the outbreak is under control and no signs or symptoms of avian flu have been detected in people who had close contact with the dead birds.
(CIDRAP 12/12/2011)


Hong Kong: Raises alert level after H5N1 influenza confirmed in poultry
Hong Kong has changed its avian flu response level from "alert" to "serious" after three birds tested positive for H5N1 avian flu, including a dead chicken from a marketplace, reported 20 December 2011. Authorities will cull 17,000 chickens in response to the positive test. "With a heavy heart, I announce that the dead chicken has been tested positive for the H5N1 strain of virus after a routine check by the agriculture, fisheries and conservation department today (20 December 2011)," Hong Kong's health chief York Chow said. Officials also banned all live poultry imports. The other two birds that tested positive for H5N1 were an Oriental magpie robin and a black-headed gull. The "serious" response level covers two scenarios, the less serious of which involves a highly pathogenic avian flu outbreak in the environment of or among poultry, as is the case on 20 December 2011. (The second scenario involves a human case with no evidence of person-to-person transmission.) Hong Kong was the site of the first known outbreak of H5N1 in people in 1997, when 18 were infected and six died.
(CIDRAP 12/20/2011)


USA: Novartis says cell-based H5N1 influenza vaccine facility ready to produce
Novartis's new cell-culture based influenza vaccine factory in North Carolina has begun making a prepandemic H5N1 flu vaccine and is ready to start producing vaccines for a real pandemic when needed, the company and federal health officials announced 12 December 2011.

The facility in Holly Springs, N.C., billed as the first of its kind in the United States, was dedicated on 12 December 2011 after a long testing process.

As part of the testing, the week of 5 December 2011 the plant produced two lots of "prepandemic" H5N1 flu vaccine for the Strategic National Stockpile, and another lot will be completed the week of 12 December 2011, for a total of 6.5 million doses, said Liz Power, a spokeswoman for Novartis Vaccines and Diagnostics, Cambridge, Mass.

"The dedication signals that in an influenza pandemic the facility can produce cell-based influenza vaccine that could be authorized by the US Food and Drug Administration for use during the emergency," the US Department of Health and Human Services (HHS) said.

Dr. Robin Robinson, director of HHS's Biomedical Advanced Research and Development Authority (BARDA), called the plant's dedication "a major milestone" in national pandemic preparedness. "Today we're marking the first change in influenza vaccine manufacturing in the United States in 50 years," he said.

Cell-based vaccine production involves growing flu viruses in mammalian cell cultures instead of in chicken eggs, the conventional method. It is regarded as more flexible and somewhat faster than egg-based production. No cell-based flu vaccine has yet been approved by the FDA, though such vaccines, including one made by Novartis, are licensed in Europe.

In a flu pandemic, the Novartis plant may be able to produce up to 25% of the vaccine doses needed in the United States, HHS said. The facility is designed to produce 150 million doses of a monovalent vaccine within six months after declaration of a pandemic, according to Power.

Experts say cell-based production is expected to shave a few weeks off the time it takes to produce a vaccine for a novel flu virus. The six-month goal cited by Novartis sounds fairly similar to the timing with egg-based vaccine production.

With the traditional technology, it typically takes four to six months to start producing a vaccine in quantity for a novel flu virus. In the case of the 2009 H1N1 pandemic, the virus was identified in mid-April, and supplies of vaccine began reaching providers in early October, though supplies remained short until December.

The full article may be accessed at http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/dec1311novartis.html
(CIDRAP 12/13/2011)


2. Infectious Disease News

China: Scarlet fever in an elementary school in Shanghai
More than 40 pupils at an elementary school in a suburban area are suspected of having contracted scarlet fever, parents claimed 10 December 2011. At least 39 children in a grade two class at the Mingqiang Elementary School are feared to have the disease, they said. One parent said the school gathered parents on 7 December 2011 to inform them that an initial test indicated 39 out of 48 children had the disease. Parents also said six pupils in a grade three class are suspected to have the disease.

Some parents claim the first case emerged the week of 27 November 2011 and accused the school --which has hundreds of pupils -- of not acting quickly enough. They say it should have isolated sick children and canceled all classes to sterilize classrooms.

According to a 2005 directive by Shanghai's education department, a school where a case of an unidentified contagious disease is discovered should report to authorities and cancel classes involved. "The school has put all the children at the risk of catching the disease," claimed one parent. The Mingqiang Elementary School has only canceled lessons for the grade two class but other parents are taking their children to hospital for tests, said the parent, whose child tested negative.

The first parent claimed school outings had continued the week of 4 December 2011. "I don't understand how the school could organize for a class to visit a city attraction as group activity on Monday (5 December 2011), when it didn't know how many children may have this contagious disease," he said.

School staff declined to comment on 10 December 2011, saying top officials were at an emergency meeting. Earlier, a teacher at the school said that parents' accusations were untrue as only one or two students were confirmed to have scarlet fever and had been isolated.

The city's health authority said it is normal to see an increase of scarlet fever at this time of year, but didn't have a figure. An official, surnamed Liu, with Fudan University's Children's Hospital confirmed they have received children with scarlet fever between 27 November and 10 December 2011, but said their condition was not serious. Liu did not give a figure.
(ProMED 12/11/2011)


China: Polio cases reach 20 in Xinjiang
The number of polio cases recorded in northwest China's Xinjiang Uygur Autonomous Region since an outbreak was confirmed in August 2011 has reached 20, local health officials said on 14 December 2011.

The Chinese Center for Disease Control and Prevention had been testing samples taken from patients in the region diagnosed with Acute Flaccid Paralysis (AFP), a common indicator of polio, to check for the disease. On 5 December 2011, the tests uncovered two new polio cases, said the officials.

One of the samples was taken from a 53-year-old patient from Aksu prefecture who died on 23 October 2011, taking the confirmed number of deaths from polio in the Xinjiang outbreak to two.

Poliomyelitis, or polio, is a viral disease of the brain and spinal cord that mainly affects children under five years of age. One in 200 infections leads to irreversible paralysis, usually in the legs. AFP is a sudden onset of weakness or paralysis, as is commonly found with polio.

Local health officials said the first three cases of 2011¡¦s polio outbreak came from abroad. Xinjiang neighbors three of the four polio-endemic countries in the world: Afghanistan, India, Nigeria and Pakistan.

The local government has conducted large-scale vaccinations in response to the region's polio epidemic that started in August, when the first cases of the disease in China since 2000 were discovered.

Health authorities said four regions in Xinjiang -- the prefectures of Hotan, Kashgar, Bayingolin and Aksu -- were classified as epidemic zones.
(Shanghai Daily 12/14/2011)


Japan: Osaka Prison food poisoning sickens 1,000 inmates
A bout of food poisoning sickened 1,074 inmates at Osaka Prison in Sakai, Osaka Prefecture, from 13-14 December 2011 forcing it to serve preserved food stored for emergency use, prison and local health officials said.

The inmates began complaining of food poisoning symptoms starting Tuesday night, 13 December 2011, prompting the prison to report the matter to the health center the next morning. The inmates were treated at the prison.

Osaka Prison holds around 2,500 male inmates. Their meals are cooked in the prison's kitchen by about 40 inmates who undergo sanitary inspections each month.

The health center closed the kitchen for three days starting 15 December 2011, and the prison is now serving preserved food for use in emergencies.
(Japan Times 12/16/2011)


Russia: Brucellosis situation threatens to spiral out of control in Dagestan
On 8 December 2011, in Makhachkala the deputy prime minister Murat Shikhsaidov held a meeting on the epizootic situation in the republic. The ministers, heads of responsible departments, and the heads of cities and districts were invited to the meeting. According to Murat Shikhsaidov, if drastic measures are not undertaken in the near future, the situation of brucellosis in the country will spiral out of control.

During the first 11 months of 2011, brucellosis has been diagnosed in 1,620 head of cattle and in 826 sheep and goats. Brucellosis is a dangerous disease transmitted via animals to humans. According to the National Center for Infectious Diseases, for the first 11 months of 2011, 248 local residents fell ill with brucellosis, 138 of them with the acute form of the disease.

According to the chairman of the Committee on Veterinary R&D, Mahomed Gazimahomedov, the numbers of animals annually examined for brucellosis in the country are 600,000 cattle, 300,000 sheep and goats, 6,000 horses and 500 dogs.

The main problem, as noted by the speakers, is the lack of sanitary slaughter sites. For this reason, cattle are often slaughtered in backyards without complying with basic veterinary and sanitary regulations, adversely affecting the epizootic situation and facilitating the spread of brucellosis. Another problem is the uncontrolled importation of cattle from other regions of the country infected with brucellosis.

Speakers offered to establish permanent and mobile veterinary inspection posts on the border of Dagestan with the Stavropol Territory and Kalmykia which, in tandem with the law enforcement agencies, are expected to inspect the cattle trucks that enter the republic.
(ProMED 12/11/2011)


Viet Nam: Hand, foot and mouth disease
The Vietnamese Ministry of Health has confirmed an outbreak of hand, foot and mouth disease (HFMD) attributed to human enterovirus 71 (EV71). The outbreak is concentrated in the southern part of the country, but cases have been reported from all regions.

Cities and provinces with the highest numbers of HFMD deaths are Ho Chi Minh City, Dong Nai, Binh Duong, Long An, Ba Ria-Vung Tau, Bac Lieu, Dong Tap, Tien Giang, and Quang Ngai.

As of mid-October 2011, Viet Nam had reported 80,000 cases of HFMD and 137 deaths. As in other outbreaks of EV71-associated HFMD reported in Southeast Asia since 1997, a small proportion of children with the disease have developed severe, often fatal complications, including encephalitis.

[ProMED note: As of the end of October 2011, HFMD in Viet Nam was considered still to be under control according to Health Minister Nguyen Thi Kim Tien, despite a rising number of new HFMD cases. So far in 2011, HFMD has killed 137 people, mostly children, out of 77,895 infections in the 63 cities and provinces of Viet Nam. Travelers to or through Viet Nam, especially if accompanied by children, should heed this travel alert.]
(ProMED 12/14/2011)


Canada: Cases of hepatitis A continue to rise
As of 13 December 2011, a total of 91 persons have been identified with acute hepatitis A, 60% under the age of 20 and equally distributed between gender. The increase in hepatitis A illness commenced in October 2010, with maximum incidence having occurred in late January 2011. Since September 2011, continued incident cases at a rate of about one per week have persisted. Most but not all cases are linked to a cultural grouping on Vancouver Island with large social gatherings and extended family involvement. Control efforts have included immunization of some 10,000 persons as of 13 December 2011. More details are posted at http://www.viha.ca/mho/disease/hepA.htm

[ProMED note: Clearly, the outbreak on Vancouver island is mediated by person-to-person transmission, and infection is not food or water borne.]
(ProMED 12/14/2011)


Mexico: Hepatitis A outbreak in Veracruz
A hepatitis A outbreak in communities in Veracruz has just been reported. Nearly 100 children have been infected because of lack of preventive measures and appropriate public health services. Poor sanitary conditions, together with deficient or non-existent municipal public services and lack of preventive measures are the causes of these outbreaks of hepatitis A in Chumatlan communities, in the central area of the state (Veracruz). The outbreak is affecting more than 100 children, particularly students from three schools in the Lazaro Cardenas and Santa Ana communities.

During the last few weeks, cases from Emiliano Zapata kindergarten and elementary school have been reported, specifically 40 children and also some additional cases were reported form Jaime Sabines high school.

The Health Department has established a sanitary cordon and undertaken a census involving every household, in order to detect any infected persons. Dr. Pablo Anaya-Rivera, Health Secretary, said that proper sanitary measures had already been taken and epidemic emergency units had already been deployed in the affected areas. He also admitted that as well as seasonal factors there had been deficiencies in public services and poor waste disposal facilities, both of which were contributing to the spread of the disease. Dr. Anaya-Rivera declined to give exact figures for the number of infected persons 'in order not to generate alarm', but residents of Santa Ana and Lazaro Cardenas declared that there may be one hundred infected persons.

The residents in these communities complained that municipal authorities gave some families small amounts of lime powder for use in their septic tanks, but less than half of families where hepatitis A cases had been reported had received this disinfectant. Dr. Anaya-Rivera stated that his office is complying with its responsibilities, and indicated that public services, such as supply of potable water, adequate sewage systems and other facilities are the responsibility of the local communities.

In addition the Education Secretary has confirmed that 41 students have been reported to be infected with hepatitis A virus in Coxquihui and Chumatlan municipalities.
(ProMED 12/18/2011)


USA: Multistate outbreak of E. coli O157:H7 infections linked to romaine lettuce
The United States Centers for Disease Control and Prevention (CDC) is collaborating with public health and agriculture officials in Missouri, other states, and the Food and Drug Administration to investigate a multistate outbreak of Escherichia coli serotype O157:H7 infections linked to romaine lettuce. Public health investigators are using DNA "fingerprints" of E. coli O157:H7 bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis (PFGE) to identify cases of illness that may be part of this outbreak. They are using data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

As of 4 December 2011, 60 people infected with the outbreak strain of E. coli O157:H7 have been reported from 10 states. The number of ill people identified in each state is as follows: Arizona (1), Arkansas (2), Georgia (1), Illinois (9), Indiana (2), Kansas (3), Kentucky (1), Minnesota (3), Missouri (37), and Nebraska (1). Among those for whom information is available, illnesses began from 10 October 2011 to 4 November 2011. Patients ranged in age from one to 94 years (median 29 years). 63% were female. Among the 45 patients with available information, 30 (67%) were hospitalized, and two developed hemolytic uremic syndrome (HUS). No deaths have been reported.

The full CDC investigation announcement may be accessed at http://www.cdc.gov/ecoli/2011/ecoliO157/romainelettuce/120711/index.html
(USCDC 12/7/2011)


USA: Two more sickened in ground beef Salmonella outbreak
Two more patients have been sickened in a Salmonella Typhimurium outbreak linked to a grocery store chain's ground beef, raising the total to 16, the US Centers for Disease Control and Prevention (CDC) said on 20 December 2011. On 15 December 2011, Hannaford, a Maine-based chain, recalled an undetermined amount of its fresh, in-store ground beef after epidemiologic investigations into 14 illnesses with the same genetic fingerprint found a link to the products. The CDC said the patients are from seven different states: four each from Maine, New Hampshire, and New York, and one each from Hawaii, Kentucky, Massachusetts, and Vermont. The CDC said initial tests suggest the outbreak strain is resistant to several commonly prescribed antibiotics, which could increase the risk of hospitalization or treatment failure. Among 13 cases with available information, seven patients were hospitalized. No deaths have been reported. Eleven of the 16 patients said they ate ground beef the week before they got sick, and all but one reported buying ground beef from Hannaford stores. The US Department of Agriculture (USDA) has said the company's sparse records were making it difficult to identify the companies that supplied the beef. The company is cooperating with public health officials.

The USCDC investigation announcement may be accessed at http://www.cdc.gov/salmonella/typhimurium-groundbeef/122011/index.html
(CIDRAP 12/20/2011)


USA (Kentucky): Foodborne illness at Zappos
After 60 people went home sick, the Bullitt County Health Department in Kentucky confirms there was a foodborne outbreak at Zappos. The bacteria that caused the sickness is a bacteria called Bacillus cereus, according to Dr. Swannie Jett, Bullitt County public health director.

Health inspectors traced the source to Masterson's Catering. Zappos employees are served a free meal at the workplace. "The outbreak has stopped. The proper controls are in place. Zappos and Masterson's have been very cooperative," Dr. Jett said. In this case, the bacteria has been traced to food not served at the proper temperature.

"Any issues that did arise from maybe the handling have been resolved. So, there will not be any future instance I can see at this point," Dr. Jett said.

Health inspectors traced the sickness to food served to workers during an overnight shift from 4-5 December 2011. More than 1,000 were served the same line of food. Health inspectors say while 60 became ill, and some checked out at area hospitals, this was still an isolated incident.
(WAVE 12/10/2011)


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: http://pediatrics.aappublications.org/cgi/content/abstract/peds.2010-2216v1


- 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:
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:
Read about the latest news on avian influenza H5N1 in wild birds and poultry.


Indonesia (Jakarta)
The Kebayoran Lama district recorded 235 dengue fever cases in 2011 as of 12 December 2011 -- the most in South Jakarta, according to a health official. There have been 1,194 dengue fever cases recorded in South Jakarta, including cases in Pasar Minggu district (194), Tebet (151), Jagakarsa (123), Cilandak (118), Pesanggrahan (93), Kebayoran Baru and Setiabudi (85), Pancoran (61) and Mampang Prapatan (49).
(ProMED 12/13/2011)

An ongoing outbreak of dengue fever in western Indonesia has killed at least 27 people in November and December 2011, officials said on 15 December 2011. Hundreds more have been affected. Health officials on 15 December 2011 confirmed that two more people have died of dengue fever at the Sultan Thaha Saefuddin general hospital in the Tebo district of Jambi province, which is located on the east coast of central Sumatra. Jambi administration spokesman Subhi said that in November and December 2011, the dengue fever endemic has caused at least 27 deaths. The total number of cases has meanwhile increased to around 800, an increase from 700 at the start of December 2011.
(ProMED 12/19/2011)

Dengue cases have shown an increase over the last nine weeks, said Health Minister Datuk Seri Liow Tiong Lai. A total of 486 cases were reported between 4-10 December 2011, the highest recorded since February 2011. However, the total number of cases from January-December 2011 was much lower, with 18,371 cases and 34 deaths compared with 44,641 cases and 132 deaths in the same period in 2010. "Statistics also show Malaysia has a decreasing rate of 58% in cases, which is relatively high," said the Health Minister.
(ProMED 12/19/2011)

Mexico (National)
The detection of a new serotype of dengue virus -- DENV-3 -- in Quintana Roo state has put the Health Services of Morelos on alert. In Mexico, DENV-2 has had greatest prevalence, although DENV-3 has been occasionally detected in the country.
(ProMED 12/13/2011)

Mexico (Veracruz state)
The Chief of Health Jurisdiction IV, Amado Meza Angeles, stated that the number of dengue cases in the region during 2011 was 580, with the last one detected in November 2011. There were no deaths.
(ProMED 12/13/2011)


4. Articles
Cost Comparison of 2 Mass Vaccination Campaigns Against Influenza A H1N1 in New York City
Kansagra SM, McGinty MD, Morgenthau BM, et al. Am J Public Health. 15 December 2011. doi:10.2105/AJPH.2011.300363.
Available at http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2011.300363

Objectives. We estimated and compared total costs and costs per dose administered for 2 influenza A 2009 monovalent vaccine campaigns in New York City: an elementary school¡Vlocated campaign targeting enrolled children aged 4 years and older, and a community-based points-of-dispensing campaign for anyone aged 4 years and older.

Methods. We determined costs from invoices or we estimated costs. We obtained vaccination data from the Citywide Immunization Registry and reports from the community points of dispensing.

Results. The school campaign delivered approximately 202 089 vaccines for $17.9 million and $88 per dose. The community campaign delivered 49 986 vaccines for $7.5 million and $150 per dose. At projected capacity, the school campaign could have delivered 371 827 doses at $53 each or $13 each when we excluded the value of in-kind resources. The community points of dispensing could have administered 174 000 doses at $50 each or $24 each when we excluded the value of in-kind resources.

Conclusions. The school campaign delivered vaccines at a lower cost per dose than did the community campaign. Had demand been higher, both campaigns may have delivered vaccine at lower, more comparable cost per dose.


Antiviral resistance during the 2009 influenza A H1N1 pandemic: public health, laboratory, and clinical perspectives
Hurt AC, Chotpitayasunondh T, Cox NJ, et al. The Lancet Infectious Diseases. 19 December 2011. doi:10.1016/S1473-3099(11)70318-8.
Available at http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2811%2970318-8/abstract?rss=yes

Abstract. Influenza A H1N1 2009 virus caused the first pandemic in an era when neuraminidase inhibitor antiviral drugs were available in many countries. The experiences of detecting and responding to resistance during the pandemic provided important lessons for public health, laboratory testing, and clinical management. We propose recommendations for antiviral susceptibility testing, reporting results, and management of patients infected with 2009 pandemic influenza A H1N1. Sustained global monitoring for antiviral resistance among circulating influenza viruses is crucial to inform public health and clinical recommendations for antiviral use, especially since community spread of oseltamivir-resistant A H1N1 2009 virus remains a concern. Further studies are needed to better understand influenza management in specific patient groups, such as severely immunocompromised hosts, including optimisation of antiviral treatment, rapid sample testing, and timely reporting of susceptibility results.


Changing Perceptions: of Pandemic Influenza and Public Health Responses
Kamradt-Scott A. Am J Public Health. January 2012. 102(1):90-98. doi:10.2105/AJPH.2011.300330.
Available at http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2011.300330

Abstract. According to the latest World Bank estimates, over the past decade some US $4.3 billion has been pledged by governments to combat the threat of pandemic influenza. Presidents, prime ministers, and even dictators the world over have been keen to demonstrate their commitment to tackling this disease, but this has not always been the case. Indeed, government-led intervention in responding to the threat of pandemic influenza is a relatively recent phenomenon. I explore how human understandings of influenza have altered over the past 500 years and how public policy responses have shifted accordingly. I trace the progress in human understanding of causation from meteorological conditions to the microscopic, and how this has prompted changes in public policy to mitigate the disease's impact. I also examine the latest trend of viewing pandemic influenza as a security threat and how this has changed contemporary governance structures and power dynamics.


Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: a population-based study
McGready R, Lee SJ, Wiladphaingern J, et al. The Lancet Infectious Diseases. 13 December 2011. doi:10.1016/S1473-3099(11)70339-5.
Available at http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70339-5/abstract

Background. The effects of malaria and its treatment in the first trimester of pregnancy remain an area of concern. We aimed to assess the outcome of malaria-exposed and malaria-unexposed first-trimester pregnancies of women from the Thai—Burmese border and compare outcomes after chloroquine-based, quinine-based, or artemisinin-based treatments.

Methods. We analysed all antenatal records of women in the first trimester of pregnancy attending Shoklo Malaria Research Unit antenatal clinics from May 12, 1986, to Oct 31, 2010. Women without malaria in pregnancy were compared with those who had a single episode of malaria in the first trimester. The association between malaria and miscarriage was estimated using multivariable logistic regression.

Findings. Of 48 426 pregnant women, 17 613 (36%) met the inclusion criteria: 16 668 (95%) had no malaria during the pregnancy and 945 (5%) had a single episode in the first trimester. The odds of miscarriage increased in women with asymptomatic malaria (adjusted odds ratio 2•70, 95% CI 2•04—3•59) and symptomatic malaria (3•99, 3•10—5•13), and were similar for Plasmodium falciparum and Plasmodium vivax. Other risk factors for miscarriage included smoking, maternal age, previous miscarriage, and non-malaria febrile illness. In women with malaria, additional risk factors for miscarriage included severe or hyperparasitaemic malaria (adjusted odds ratio 3•63, 95% CI 1•15—11•46) and parasitaemia (1•49, 1•25—1•78 for each ten-fold increase in parasitaemia). Higher gestational age at the time of infection was protective (adjusted odds ratio 0•86, 95% CI 0•81—0•91). The risk of miscarriage was similar for women treated with chloroquine (92 [26%] of 354), quinine (95 [27%) of 355), or artesunate (20 [31%] of 64; p=0•71). Adverse effects related to antimalarial treatment were not observed.

Interpretation. A single episode of falciparum or vivax malaria in the first trimester of pregnancy can cause miscarriage. No additional toxic effects associated with artesunate treatment occurred in early pregnancy. Prospective studies should now be done to assess the safety and efficacy of artemisinin combination treatments in early pregnancy.


Mapping of mosquito breeding sites in malaria endemic areas in Pos Lenjang, Kuala Lipis, Pahang, Malaysia
Ahmad R, Wan Mohamad Ali WN, Mohamad Nor Z, et al. Malar J. 13 December 2011. 10(1):361. doi:10.1186/1475-2875-10-361.
Available at http://www.malariajournal.com/content/10/1/361/abstract

Background. The application of the Geographic Information Systems (GIS) to the study of vector transmitted diseases considerably improves the management of the information obtained from the field survey and facilitates the study of the distribution patterns of the vector species.

Methods. As part of a study to assess remote sensing data as a tool for vector mapping, geographical features like rivers, small streams, forest, roads and residential area were digitized from the satellite images and overlaid with entomological data. Map of larval breeding habitats distribution and map of malaria transmission risk area were developed using a combination of field data, satellite image analysis and GIS technique. All digital data in the GIS were displayed in the WGS 1984 coordinate system. Six occasions of larval surveillance were also conducted to determine the species of mosquitoes, their characteristics and the abundance of habitats.

Results. Larval survey studies showed that anopheline and culicine larvae were collected and mapped from 79 and 67 breeding sites respectively. Breeding habitats were located at 100-400 m from human settlement. Map of villages with 400 m buffer zone visualizes that more than 80% of Anopheles maculatus s.s. immature habitats were found within the buffer zone.

Conclusions. This study amplifies the need for a broadening of the GIS approach which is emphasized with the aim of rejuvenating the dynamic aspect of entomological studies in Malaysia. In fact, the use of such basic GIS platforms promote a more rational basis for strategic planning and management in the control of endemic diseases at the national level.


Adverse Events following 12 and 18 Month Vaccinations: a Population-Based, Self-Controlled Case Series Analysis
Wilson K, Hawken S, Kwong JC, et al. PLoS ONE. 12 December 2011. 6(12): e27897. doi:10.1371/journal.pone.0027897.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0027897

Background. Live vaccines have distinct safety profiles, potentially causing systemic reactions one to 2 weeks after administration. In the province of Ontario, Canada, live MMR vaccine is currently recommended at age 12 months and 18 months.

Methods. Using the self-controlled case series design we examined 271,495 12 month vaccinations and 184,312 18 month vaccinations to examine the relative incidence of the composite endpoint of emergency room visits or hospital admissions in consecutive one day intervals following vaccination. These were compared to a control period 20 to 28 days later. In a post-hoc analysis we examined the reasons for emergency room visits and the average acuity score at presentation for children during the at-risk period following the 12 month vaccine.

Results. Four to 12 days post 12 month vaccination, children had a 1.33 (1.29¡V1.38) increased relative incidence of the combined endpoint compared to the control period, or at least one event during the risk interval for every 168 children vaccinated. Ten to 12 days post 18 month vaccination, the relative incidence was 1.25 (95%, 1.17¡V1.33) which represented at least one excess event for every 730 children vaccinated. The primary reason for increased events was statistically significant elevations in emergency room visits following all vaccinations. There were non-significant increases in hospital admissions. There were an additional 20 febrile seizures for every 100,000 vaccinated at 12 months.

Conclusions. There are significantly elevated risks of primarily emergency room visits approximately one to two weeks following 12 and 18 month vaccination. Future studies should examine whether these events could be predicted or prevented.


Integrated surveillance and potential sources of Salmonella Enteritidis in human cases in Canada from 2003 to 2009
Nesbitt A, Ravel A, Murray R, et al. Epidemiol Infect. 14 December 2011. doi:10.1017/S0950268811002548.
Available at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8456718

Abstract. Salmonella Enteritidis has emerged as the most prevalent cause of human salmonellosis in Canada. Recent trends of S. Enteritidis subtypes and their potential sources were described by integrating Salmonella data from several Canadian surveillance and monitoring programmes. A threefold increase in S. Enteritidis cases from 2003 to 2009 was identified to be primarily associated with phage types 13, 8 and 13a. Other common phage types (4, 1, 6a) showed winter seasonality and were more likely to be associated with cases linked to international travel. Conversely, phage types 13, 8 and 13a had summer seasonal peaks and were associated with cases of domestically acquired infections. During agri-food surveillance, S. Enteritidis was detected in various commodities, most frequently in chicken (with PT13, PT8 and PT13a predominating). Antimicrobial resistance was low in human and non-human isolates. Continued integrated surveillance and collaborative prevention and control efforts are required to mitigate future illness.


Completeness and timeliness of tuberculosis notification in Taiwan
Lo HY, Yang SL, Chou P, et al. BMC Public Health. 12 December 2011. 11:915. doi:10.1186/1471-2458-11-915.
Available at http://www.biomedcentral.com/1471-2458/11/915/abstract

Background. Tuberculosis (TB) is a notifiable disease by the Communicable Disease Control Law in Taiwan. Several measures have been undertaken to improve reporting of TB but the completeness and timeliness of TB notification in Taiwan has not yet been systemically evaluated.

Methods. To assess completeness and timeliness of tuberculosis notification, potential TB cases diagnosed by health care facilities in the year 2005-2007 were identified using the reimbursement database of national health insurance (NHI), which has 99% population coverage in Taiwan. Potential TB patients required notification were defined as those who have TB-related ICD-9 codes (010-018) in the NHI reimbursement database in 2005-2007, who were not diagnosed with TB in previous year, and who have been prescribed with 2 or more types of anti-TB drugs. Each potential TB case was matched to the national TB registry maintained at Taiwan Centers for Disease Control (CDC) by using national identity number or, if non-citizen, passport number to determine whether the patients had been notified to local public health authorities and Taiwan CDC. The difference in the number of days between date of anti-tuberculosis treatment and date of notification was calculated to determine the timeliness of tuberculosis reporting.

Results. Of the 57,405 tuberculosis patients who were prescribed with 2 or more anti-tuberculosis drugs, 55,291 (96.3%) were notified to National TB Registry and 2,114 (3.7%) were not. Of the 55,291 notified cases, 45,250 (81.8%) were notified within 7 days of anti-tuberculosis treatment (timely reporting) and 10,041(18.2%) after 7 days (delayed reporting). Factors significantly associated with failure of notification are younger age, previously notified cases, foreigner, those who visited clinics and those who visited health care facilities only once or twice in 6 months.

Conclusion. A small proportion of tuberculosis cases were not notified and a substantial proportion of notified tuberculosis cases had delayed reporting, findings with implication for strengthening surveillance of tuberculosis in Taiwan. Countries where the completeness and timeliness of TB notification has not yet been evaluated should take similar action to strengthen surveillance of TB.


Detecting and controlling foodborne infections in humans: lessons for China from the United States experience
Varma JK, Wu S, Feng Z. Glob Public Health. 16 December 2011. doi: 10.1080/17441692.2011.641988.
Available at http://www.ncbi.nlm.nih.gov/pubmed/22175805

Abstract. In the past 50 years, the United States has made major advances in human health surveillance, research and outbreak investigation that have helped reduce microbial contamination of food. In China, food safety has emerged as one of the country's most prominent domestic concerns, but there has been limited investment in surveillance, inter-agency coordination, outbreak investigation and data synthesis. After large outbreaks of Salmonella in the 1960s and E. coli O157:H7 in the 1990s, the United States transformed its approach to detecting and investigating foodborne infections, including deployment of a national, laboratory-based surveillance system that uses molecular subtyping. In China, the absence of a national, laboratory-based surveillance system means that it is difficult to rapidly detect a widely dispersed foodborne infection outbreak or the emergence of new foodborne infections. Based on lessons learned in the United States, we propose policy and administrative changes that China can adopt to strengthen detection and control of foodborne infections.


5. Notifications
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/


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