Vol. XV No. 1 ~ EINet News Briefs ~ Jan 06, 2012

*****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: WHO confirms H5N1 influenza deaths in Egypt and China
- Australia: Tamiflu-resistant pH1N1 influenza reportedly on rise
- USA: Novel flu cases prompt new CDC guidance

2. Infectious Disease News
- China (Shandong): Hantavirus infection
- Chinese Taipei: Culls 1,000 pigs in FMD outbreak
- Philippines: Leptospirosis outbreak declared in Cagayan de Oro
- Russia: One third of all cases of measles in Russia registered in Dagestan
- Mexico: Alert for an outbreak of Rickettsia in Michoacán
- Mexico: Five die, dozens sickened, after eating poisoned soy sausage at a drug rehab center
- USA: CDC and FDA says infant formula not tainted

3. Updates

4. Articles
- Use of Lean response to improve pandemic influenza surge in public health laboratories
- Timeliness of contact tracing among flight passengers for influenza A/H1N1 2009
- Transmission of pandemic influenza H1N1 (2009) in Vietnamese swine in 2009–2010
- Differential mortality rates by ethnicity in 3 influenza pandemics over a century, New Zealand
- Community Transmission of Oseltamivir-Resistant A(H1N1)pdm09 Influenza
- Malaria in pregnancy in the Asia-Pacific region
- Burden of rotavirus gastroenteritis and distribution of rotavirus strains in Asia: A systematic review
- Field application of a recombinant protein-based ELISA during the 2010 outbreak of foot-and-mouth disease type A in South Korea
- Effect of an integrated control strategy for schistosomiasis japonica in the lower reaches of the Yangtze River, China: An evaluation from 2005 to 2008

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)
China / 1 (1)
Egypt / 38 (15)
Indonesia / 11 (9)
Total / 60 (33)

***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: 576 (339) (WHO 1/5/2012)

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 2/12/2010): http://gamapserver.who.int/mapLibrary/Files/Maps/Global_H5N1Human_2010_FIMS_20100212.png

WHO’s timeline of important H5N1-related events (last updated 11/7/2011): http://www.who.int/influenza/human_animal_interface/avian_influenza/H5N1_avian_influenza_update.pdf


Global: WHO confirms H5N1 influenza deaths in Egypt and China
The World Health Organization (WHO) on 5 January 2012 announced the deaths of two men from H5N1 avian influenza, one from Egypt and another from China whose death was reported earlier.

The patient from Egypt, a 42-year-old from Menofia governorate, got sick on 16 December 2011 and was admitted to a hospital in critical condition and treated with oseltamivir (Tamiflu) on 21 December 2011, the WHO said. The man died on 22 December 2011, raising Egypt's official H5N1 infection total to 157 and the number of deaths from the disease to 55. Of those, 38 cases and 15 deaths occurred in 2011.

Egypt's Central Public Health Laboratories confirmed the H5N1 virus on 24 December 2011. An investigation into the man's illness revealed that he had been exposed to sick and dead poultry, according to the WHO.

The man from China, a 39-year-old from Shenzhen in Guangdong province, came down with flu symptoms on 21 December 2011 and was hospitalized in critical condition on 25 December 2011. He died on 31 December 2011, pushing China's WHO-confirmed H5N1 cases to 41 and its deaths from the virus to 27. His H5N1 case and death, however, are the country's first in 2011.

Guangdong lab officials diagnosed the man's infection on 30 December 2011, and the Chinese government lab confirmed it the following day, the WHO reported. Earlier media reports suggested the man had no known exposure to live poultry, and the WHO said an investigation into his exposure to the virus is ongoing. Health authorities are monitoring his close contacts, and so far all are well, according to the WHO.

The two infections and deaths push the WHO global H5N1 count to 576 cases and 339 deaths. According to WHO records, the number of H5N1 cases and deaths reported in 2011 so far are modestly higher than 2010 (60 cases versus 48, and 33 deaths versus 24).

In a related development, the European Centre for Disease Prevention and Control (ECDC) today issued a rapid risk assessment regarding China's H5N1 fatality, based on a request from the European Commission.

The ECDC said the case is not part of a cluster and that the virus that infected the man is closely related to strains recently found in Hong Kong's wild birds. The findings suggest the patient was infected from an avian source rather than a human one. Sporadic human infections in countries where the virus is endemic in birds aren't unexpected, and the latest Chinese case doesn't change the risk to human health, which for EU countries is very low, the ECDC report said.

Meanwhile, South Korean officials yesterday advised people traveling to China to take precautions, based on the man's H5N1 infection. The Korea Centers for Disease Control and Prevention has also stepped up monitoring of travelers arriving from China by checking their body temperatures and having them fill out questionnaires.
(CIDRAP 1/5/2012)


Australia: Tamiflu-resistant pH1N1 influenza reportedly on rise
Australian researchers on 29 December 2011 reported on increased transmission of oseltamivir (Tamiflu)-resistant 2009 H1N1 in a New South Wales community during the past Southern Hemisphere's flu season. They detailed their findings in a letter in the New England Journal of Medicine, after an initial report of 25 viruses appeared in August 2011. 29 (16%) viruses containing the H275Y substitution were found during an analysis of 182 patients who were treated for 2009 H1N1 infections in the Hunter New England region between May and August 2011. All were resistant to adamantanes as well as oseltamivir but sensitive to zanamivir (Relenza). Genetic analysis of the strains found they were similar to the vaccine strain and closely related, suggesting transmission of a single variant, the group reported. Only one of the 29 patients had been treated with oseltamivir. Most of the patients lived within a 30-mile radius of Newcastle, and some were household contacts or shared a short car ride. The authors urged clinicians in the Northern Hemisphere to be on guard for similar clusters.

The New England Journal of Medicine letter may be accessed at http://www.nejm.org/doi/full/10.1056/NEJMc1111078
(CIDRAP 12/29/2011)


USA: Novel flu cases prompt new CDC guidance
Alongside the confirmation of another novel flu infection with an H3N2 variant, the US Centers for Disease Control and Prevention (CDC) launched a series of documents to advise health and lab workers on how to identify and report new cases.

On 23 December 2011 the CDC confirmed two more novel flu infections, including in a West Virginia child with a swine-origin H3N2 reassortant strain (H3N2v) that includes the M gene from the 2009 H1N1 virus. The youngster was a daycare contact of an H3N2v case reported on 9 December 2011, and the newly confirmed case pushed the nation's H3N2v total to 12 so far.

The other novel flu infection involved a swine-origin H1N1 variant (H1N1v) that had also acquired the M gene from the 2009 H1N1 virus. The CDC said the patient, an adult from Wisconsin who had occupational exposure to swine, was the first detection of the H1N1v strain in a human.

On the same day the CDC announced the two novel flu cases, it released documents that address preventing seasonal and H3N2v in healthcare settings, interim guidance on H3N2v specimen collection and testing, and interim case definitions for investigating H3N2v infections.

Most H3N2v infections have been mild, and only three of the 12 patients were hospitalized, the CDC said. Though it's not clear if cases will become more common, it's possible that healthcare providers will care for patients who have H3N2v infections, it added.

So far there is no evidence that H3N2v transmission characteristics are different from seasonal flu, so the CDC advises that facilities use the same infection control procedures as for seasonal flu to help guard against the spread of H3N2v, including the vaccination of healthcare workers. However, it added that the seasonal flu vaccine may provide limited protection against H3N2v in adults and no protection in children.

The full article may be accessed at http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/dec2811guidance.html
(CIDRAP 12/28/2011)


2. Infectious Disease News

China (Shandong): Hantavirus infection
Rats are blamed for spreading the virus that caused 24 confirmed deaths in 2011 in Shandong province from viral hemorrhagic fever (VHF), according to figures released by the provincial health bureau on 31 December 2011.

The bureau said most of the cases were recorded after October 2011, and the number of deaths is 11 more than 2010. The bureau recorded a total of 938 VHF infection cases in 2011, which is 1.88% lower than that of 2010. Among the 24 fatal cases, 13 were reported in Qingdao, a port city in Shandong.

Fan Tianli, a doctor at the Qingdao Hospital of Infectious Diseases, said the VHF patients were all from rural areas. They had either contact with infected rats, eaten food contaminated by rats, or been bitten by mites that had also bitten rats, before showing symptoms of fever and bleeding disorders. The provincial health bureau has organized vaccinations in the epidemic-affected areas and mobilized campaigns to kill rats.

The bureau's figures showed that 1.5 million people in Shandong have received VHF vaccinations since 2008, which has been attributed to effectively curbing the mass spread of the disease.

Outbreaks of VHF had been reported in the 1980s and 1990s in the province, when more than 10,000 people were infected on average each year, but no exact number of deaths was recorded. Disease control experts say the epidemic is likely to break out in winter and spring when rats lack food in the wild and turn to rural homes and garbage heaps.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20111231.3728
(ProMED 12/31/2011)


Chinese Taipei: Culls 1,000 pigs in FMD outbreak
Taiwanese authorities said 22 December 2011 they had slaughtered nearly 1,000 pigs following the island's worst outbreak of foot-and-mouth disease (FMD) in more than 14 years.

The pigs were culled earlier the week of 19 December 2011 at a farm in the southern city of Tainan after showing symptoms of the disease. Altogether 983 out of the 2,667 pigs on the farm were culled and the rest were vaccinated, the Bureau of Animal and Plant Health Inspection and Quarantine said.

No FMD symptoms have been found so far in animals at 11 other farms within a 3-km (1.8-mile) radius of the affected farm, it said. More than three million pigs were slaughtered in 1997 in the wake of a FMD epidemic.

The highly contagious virus affects cattle, pigs, sheep and other cloven-hoofed livestock. It is not usually fatal, but an outbreak leads to losses in the production of meat and milk.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20111224.3667
(ProMED 12/24/2011)


Philippines: Leptospirosis outbreak declared in Cagayan de Oro
A leptospirosis outbreak has been declared in Cagayan de Oro after 200 people were diagnosed to have leptospirosis. Two of the victims have been confined at the hospital for four days due to leptospirosis. The two survived the floods in Barangay Bulalang in Cagayan de Oro but they could not escape the disease, which is transmitted through floodwaters contaminated by urine from rats and other animals.

"I had a fever after two days. The fever goes away and comes back. I had a headache and I vomited," one of the hospitalized patients said. The Cagayan de Oro City Health Office has already recorded 200 cases of leptospirosis infection, with five deaths. Dr. Jaime Bernadas, regional director of the Department of Health (DOH), said 99% of the patients failed to get enough medicine.

The disease has an incubation period of five to 21 days. The DOH, which declared the outbreak, fears the number of cases could still rise in the coming days.
(ProMED 1/3/2012)


Russia: One third of all cases of measles in Russia registered in Dagestan
In 2011, 222 cases of measles in 24 Russian regions were registered. According to the Dagestan office of the Russian Federal Consumer Rights Protection and Human Health Control Service (Rospotrebnadzor), from July till December 2011, 68 laboratory confirmed cases of measles were recorded in eight administrative districts of Dagestan.

According to the results of epidemiologic investigations, the measles cases were found mainly among those not vaccinated or those who could give no information about their vaccination status. "Also, there are cases of refusal to vaccinate" -- the Office management officials stated.

Experts of the Rospotrebnadzor Dagestan warned that measles is a highly contagious and severe infectious disease. After apparent recovery complications such as blindness, encephalitis, severe diarrhea and associated dehydration may develop. There are also other consequences -- including respiratory infections such as bronchitis and pneumonia. The only effective measure of protection against measles is immunization. Vaccination against measles is mandatory and is included in the national immunization schedule of the Russian Federation.
(ProMED 1/1/2012)


Mexico: Alert for an outbreak of Rickettsia in Michoacán
The Ministry of Health in Michoacán warned on Friday, 30 December 2011, of an outbreak of Rickettsia infection at the port of Lazaro Cardenas. The head of the agency, Guadalupe Hernandez Alcala, announced that so far 25 cases have been confirmed.

Hernandez Alcala pointed out that in total 90 cases were referred to the State Laboratory of Public Health, of which 25 were positive, nine males and 16 females, aged from five to 65 years of age. At the time, he explained, local spraying would be undertaken and relevant epidemiological fences put in place to prevent further spreading of this disease, curable with therapeutic antimicrobial treatment.

The general public is advised to keep their yards and their houses clean, apply ordinary hygiene in the bathroom, and importantly on any suspicion of disease, especially in children and older adults, go to their nearest health center.

[ProMED note: The species of rickettsia here is not specifically mentioned, but Rickettsia rickettsii is known to be endemic in parts of Mexico. R. rickettsii, the cause of Rocky Mountain spotted fever, has been identified in southern Canada, the USA, northern Mexico, Costa Rica, Panama, Brazil, and Argentina. Some synonyms for Rocky Mountain spotted fever in other countries include tick typhus, Tobia fever (Colombia), São Paulo fever and febre maculosa (Brazil), and fiebre manchada (Mexico).]
(ProMED 12/31/2011)


Mexico: Five die, dozens sickened, after eating poisoned soy sausage at a drug rehab center
Medical officials say five recovering drug addicts died and dozens of others were sickened by soy sausage served for Christmas dinner at a rehabilitation center in western Mexico.

Authorities were investigating whether the poisoning at the center in the city of Guadalajara was accidental or intentional. Drug cartels have taken over rehabilitation centers in parts of Mexico, forcibly recruiting addicts as hit men and smugglers. The invasions have led to mass shootings at the centers that have left dozens dead.

Alhy Daniel Nunez is a spokesman for the Red Cross in the western state of Jalisco, where Guadalajara is located. He said on 26 December 2011 that 37 people remained hospitalized, three of them in serious condition.
(Star Tribune 12/26/2011)


USA: CDC and FDA says infant formula not tainted
Four cases of infants sickened by a rare bacteria sometimes linked to powdered formula, including two who died, are not related and parents can continue using the products to feed their babies, two federal agencies announced 30 December 2011.

Scientists with the Centers for Disease Control and Prevention and the Food and Drug Administration tested various types of powdered infant formula and distilled water, known as nursing water, and found no cases of contamination by Cronobacter sakazakii.

Four babies, including one in Missouri and another in Florida who died, were sickened by the bacteria that are found naturally in the environment and in plants such as wheat and rice. Cronobacter also has been traced to dried milk and powdered formula. Two other babies, in Illinois and Oklahoma, were sickened by the bacteria but survived.

The Missouri baby, Avery Cornett of Lebanon, Mo., died earlier in December 2011 after appearing lethargic and displaying what his family said were signs of a stomach ache. Tests at a Springfield hospital showed he had Cronobacter, and he died a few days later after being removed from life support. The infection can be treated with antibiotics, but it's deemed extremely dangerous to babies less than one month old and those born premature.

Avery's death prompted the CDC to ask public health officials from around the country to look for other cases of Cronobacter infection among infants. That request generated reports from three other states about their cases.

Avery's case also prompted Wal-Mart and several other national retailers to pull Enfamil Newborn formula, which Avery had consumed before getting sick, from 3,000 stores until the batches could be tested for contamination. Those tests came back negative, CDC announced 30 December 2011.

"The FDA tested factory sealed containers of powdered infant formula and nursery water with the same lot numbers as the opened containers collected from Missouri and no Cronobacter bacteria were found," the FDA said.

Powdered infant formula is not sterile, and experts have said there are not adequate methods to completely remove or kill all bacteria that might creep into formula before or during production. The FDA said it gets four to six reports a year of infant infections related to formula and has not found a powder that tested positive since 2002. The CDC said with recent increased awareness of the illness, it has received 12 cases in 2011.

"CDC laboratory tests of samples provided by the Missouri Department of Health and Senior Services found Cronobacter bacteria in an opened container of infant formula, an opened bottle of nursery water and prepared infant formula," the agency said 30 December 2011. "It is unclear how the contamination occurred."

CDC also tested bacteria in the Illinois case and found it differed genetically from that found in the Missouri case. It said bacteria from the Oklahoma and Florida cases were not available for testing.
(Time U.S. 12/31/2011)


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: 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.


Malaysia (Miri, Borneo Island, Sarawak state)
The number of dengue cases in Miri has decreased with less than ten cases being reported each month in 2011, Mayor Lawrence Lai disclosed 8 December 2011. Lai said the dengue situation in Miri is well under control and stated the number of cases reported as of end of November 2011 is 93 compared to 746 in 2010.
(ProMED 1/2/2012)

Mexico (Jalisco state)
Only 168 cases of dengue fever have been registered in the state of Jalisco during 2011, a massive improvement on the official figures of the past three years. The metropolitan area of Guadalajara reported the highest number of cases, (more than 60), followed by Puerto Vallarta (40), noted Leandro Hernandez Barrios of the Jalisco Health Department the week of 19 December 2011. Cases of dengue fever have been reported in 26 of Jalisco's 126 municipalities. At the same time in 2010, the Jalisco Health Secretariat had received confirmed reports of 1,172 cases in the state. Only 12 of the 168 reported cases were DHF.
(ProMED 12/26/2011)


4. Articles
Use of Lean response to improve pandemic influenza surge in public health laboratories
Isaac-Renton JL, Chang Y, Prystajecky N, et al. Emerg Infect Dis. January 2012. doi:10.3201/eid1801.101485.
Available at http://wwwnc.cdc.gov/eid/article/18/1/10-1485_article.htm

Abstract. A novel influenza A (H1N1) virus detected in April 2009 rapidly spread around the world. North American provincial and state laboratories have well-defined roles and responsibilities, including providing accurate, timely test results for patients and information for regional public health and other decision makers. We used the multidisciplinary response and rapid implementation of process changes based on Lean methods at the provincial public health laboratory in British Columbia, Canada, to improve laboratory surge capacity in the 2009 influenza pandemic. Observed and computer simulating evaluation results from rapid processes changes showed that use of Lean tools successfully expanded surge capacity, which enabled response to the 10-fold increase in testing demands.


Timeliness of contact tracing among flight passengers for influenza A/H1N1 2009
Swaan CM, Appels R, Kretzschmar MEE, van Steenbergen JE. BMC Infectious Diseases. 28 December 2011. 11:355. doi:10.1186/1471-2334-11-355.
Available at http://www.biomedcentral.com/1471-2334/11/355/abstract

Background. During the initial containment phase of influenza A/H1N1 2009, close contacts of cases were traced to provide antiviral prophylaxis within 48 h after exposure and to alert them on signs of disease for early diagnosis and treatment. Passengers seated on the same row, two rows in front or behind a patient infectious for influenza, during a flight of [greater than or equal to] 4 h were considered close contacts. This study evaluates the timeliness of flight-contact tracing (CT) as performed following national and international CT requests addressed to the Center of Infectious Disease Control (CIb/RIVM), and implemented by the Municipal Health Services of Schiphol Airport.

Methods. Elapsed days between date of flight arrival and the date passenger lists became available (contact details identified - CI) was used as proxy for timeliness of CT. In a retrospective study, dates of flight arrival, onset of illness, laboratory diagnosis, CT request and identification of contacts details through passenger lists, following CT requests to the RIVM for flights landed at Schiphol Airport were collected and analyzed.

Results. 24 requests for CT were identified. Three of these were declined as over 4 days had elapsed since flight arrival. In 17 out of 21 requests, contact details were obtained within 7 days after arrival (81%). The average delay between arrival and CI was 3,9 days (range 2-7), mainly caused by delay in diagnosis of the index patient after arrival (2,6 days). In four flights (19%), contacts were not identified or only after >7 days. CI involving Dutch airlines was faster than non-Dutch airlines (P < 0,05). Passenger locator cards did not improve timeliness of CI. In only three flights contact details were identified within 2 days after arrival.

Conclusion. CT for influenza A/H1N1 2009 among flight passengers was not successful for timely provision of prophylaxis. CT had little additional value for alerting passengers for disease symptoms, as this information already was provided during and after the flight. Public health authorities should take into account patient delays in seeking medical advise and laboratory confirmation in relation to maximum time to provide postexposure prophylaxis when deciding to install contact tracing measures. International standardization of CT guidelines is recommended.


Transmission of pandemic influenza H1N1 (2009) in Vietnamese swine in 2009–2010
Trevennec K, Leger L, Lyazrhi F, et al. Influenza Other Respi Viruses. 30 December 2011. doi:10.1111/j.1750-2659.2011.00324.x.
Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1750-2659.2011.00324.x/abstract

Background. The pandemic of 2009 was caused by an H1N1 (H1N1pdm) virus of swine origin. This pandemic virus has repeatedly infected swine through reverse zoonosis, although the extent of such infection in swine remains unclear.

Objective. This study targets small and commercial pig producers in North Vietnam, in order to estimate the extent of H1N1pdm infection in swine and to identify the risk factors of infection.

Methods. Virologic and serologic surveillance of swine was carried out in 2009–2010 in pig farms (38 swabs and 1732 sera) and at a pig slaughterhouse (710 swabs and 459 sera) in North Vietnam. The sera were screened using a influenza type A-reactive ELISA assay, and positive sera were tested using hemagglutination inhibition tests for antibody to a panel of H1-subtype viruses representing pandemic (H1N1) 2009 (H1N1pdm), triple reassortant (TRIG), classical swine (CS), and Eurasian avian-like (EA) swine lineages. Farm-level risk factors were identified using a zero-inflated negative binomial model.

Results. We found a maximal seroprevalence of H1N1pdm of 55•6% [95% CI: 38•1–72•1] in the slaughterhouse at the end of December 2009, 2 weeks after the peak of reported human fatalities with H1N1pdm. Farm-level seroprevalence was 29% [95% CI: 23•2–35•7]. In seropositive farms, within-herd seroprevalence ranged from 10 to 100%. We identified an increased risk of infection for farms that specialized in fattening and a decreased risk of infection in farms hiring external swine workers.

Conclusions. Our findings suggest extensive reverse-zoonotic transmission from humans to pigs with subsequent onward transmission within pig herds.


Differential mortality rates by ethnicity in 3 influenza pandemics over a century, New Zealand
Wilson N, Barnard LT, Summers JA, et al. Emerg Infect Dis. January 2012. doi:10.3201/eid1801.110035.
Available at http://wwwnc.cdc.gov/eid/article/18/1/11-0035_article.htm

Abstract. Evidence suggests that indigenous populations have suffered disproportionately from past influenza pandemics. To examine any such patterns for Mâori in New Zealand, we searched the literature and performed new analyses by using additional datasets. The Mâori death rate in the 1918 pandemic (4,230/100,000 population) was 7.3× the European rate. In the 1957 pandemic, the Mâori death rate (40/100,000) was 6.2× the European rate. In the 2009 pandemic, the Mâori rate was higher than the European rate (rate ratio 2.6, 95% confidence interval 1.3–5.3). These findings suggest some decline in pandemic-related ethnic inequalities in death rates over the past century. Nevertheless, the persistent excess in adverse outcomes for Mâori, and for Pacific persons residing in New Zealand, highlights the need for improved public health responses.


Community Transmission of Oseltamivir-Resistant A(H1N1)pdm09 Influenza
Hurt AC, Hardie K, Wilson NJ et al. N Engl J Med. 29 December 2011. 365:2541-2542.
Available at http://www.nejm.org/doi/full/10.1056/NEJMc1111078

Abstract. Oseltamivir-resistant prepandemic seasonal influenza A (H1N1) viruses with a H275Y neuraminidase substitution spread globally in 2008,1 reducing the effectiveness of oseltamivir.2 Although oseltamivir-resistant pandemic 2009 A (H1N1) viruses, now known as A(H1N1)pdm09, have been detected in persons receiving oseltamivir treatment, they have been detected in less than 1% of untreated patients in the community, and transmission has been documented only in closed settings or settings involving close contact with infected persons.3,4

We identified sustained community transmission of oseltamivir-resistant A(H1N1)pdm09 viruses in Australia. Reverse-transcriptase-polymerase-chain-reaction-positive A(H1N1)pdm09 viruses were obtained from 182 patients in emergency departments, intensive care units, and general practitioners' offices in the Hunter New England region of New South Wales, Australia, between May and August 2011.


Malaria in pregnancy in the Asia-Pacific region
Rijken MJ, McGready R, Boel ME, et al. Lancet Infect Dis. January 2012. 12(1):75-88.
Available at http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70315-2/abstract

Abstract. Most pregnant women at risk of for infection with Plasmodium vivax live in the Asia-Pacific region. However, malaria in pregnancy is not recognised as a priority by many governments, policy makers, and donors in this region. Robust data for the true burden of malaria throughout pregnancy are scarce. Nevertheless, when women have little immunity, each infection is potentially fatal to the mother, fetus, or both. WHO recommendations for the control of malaria in pregnancy are largely based on the situation in Africa, but strategies in the Asia-Pacific region are complicated by heterogeneous transmission settings, coexistence of multidrug-resistant Plasmodium falciparum and Plasmodium vivax parasites, and different vectors. Most knowledge of the epidemiology, effect, treatment, and prevention of malaria in pregnancy in the Asia-Pacific region comes from India, Papua New Guinea, and Thailand. Improved estimates of the morbidity and mortality of malaria in pregnancy are urgently needed. When malaria in pregnancy cannot be prevented, accurate diagnosis and prompt treatment are needed to avert dangerous symptomatic disease and to reduce effects on fetuses.


Burden of rotavirus gastroenteritis and distribution of rotavirus strains in Asia: A systematic review
Kawai K, O'Brien MA, Goveia MG, et al. Vaccine. 30 December 2011. doi:10.1016/j.vaccine.2011.12.092.
Available at http://www.ncbi.nlm.nih.gov/pubmed/22212128

Background. Rotavirus is the leading cause of severe diarrhea in children worldwide. We systematically reviewed the burden of rotavirus gastroenteritis (RVGE) and distribution of rotavirus strains in Asia.

Methods. We searched MEDLINE, EMBASE and the World Health Organization (WHO) website for the term "rotavirus" and the name of each country. We included studies that were conducted in children between 2000 and 2011 and that examined the epidemiology, health and/or economic burden of RVGE, and G and P-type distribution in Eastern, South East, Southern and Central Asia. Random effects models were used to pool the proportions of RVGE. We also estimated child mortality due to RVGE using the updated WHO and United Nations Children's Fund's mortality estimates in 2008.

Results. The search identified 113 eligible articles. The incidence rates of rotavirus-related hospitalizations in children under 5 years of age ranged from 2.1 to 20.0 cases per 1000 children per year with the highest rates reported in Bangladesh, South Korea, Taiwan, Thailand, and Vietnam. Rotavirus accounted for 37.5% of year-round hospitalized gastroenteritis cases, with higher proportions reported in South East Asia. Rotavirus was associated with approximately 145,000 deaths every year in Asia, with the greatest numbers occurring in India, Pakistan, and Indonesia. The highest annual societal costs of treating RVGE were reported in China (US$365 million), followed by Japan (US$254 million) and India (US$41-72 million). A diversity of rotavirus G and P-types was observed across Asia and the distribution of strains differed by country and year. The most common strains were G1P[8] (23.6%), G2P[4] (11.8%), G3P[8] (18.9%), and G9P[8] (7.4%).

Conclusions. Rotavirus is associated with substantial hospitalizations and deaths among children and causes large healthcare expenditures throughout Asia. Safe and effective rotavirus vaccines could substantially reduce the burden of disease.


Field application of a recombinant protein-based ELISA during the 2010 outbreak of foot-and-mouth disease type A in South Korea
Ko YJ, Lee HS, Park JH, et al. J Virol Methods. January 2012. 179(1):265-268.
Available at http://www.sciencedirect.com/science/article/pii/S016609341100396X

Abstract. A recombinant protein-based enzyme-linked immunosorbent assay (RP ELISA) exists for the detection of antibodies to foot-and-mouth disease virus (FMDV) type A. In this study, the efficacy of the RP ELISA was compared to that of other current tests by examining sera collected in the field during an FMD type A outbreak in South Korea in 2010. The RP ELISA detected early antibodies to FMDV with the same sensitivity as the liquid-phase blocking ELISA (LPB ELISA), identifying FMD farm outbreaks correctly on a herd basis. In addition, the two assays exhibited a high correlation coefficient (ã(2)=0.83) when testing thirty seven sera from one outbreak farm exhibiting various antibody titers. The sensitivity and specificity of the RP ELISA relative to the LPB ELISA were 84% and 97%, respectively, and excellent agreement (kappa=0.82) was observed between the two tests. Taken together, the RP ELISA should be a useful alternative to the LPB ELISA for the detection of early antibodies to FMDV type A during an outbreak.


Effect of an integrated control strategy for schistosomiasis japonica in the lower reaches of the Yangtze River, China: An evaluation from 2005 to 2008
Sun LP, Wang W, Liang YS, et al. Parasit Vectors. 30 December 2011;4(1):243. doi:10.1186/1756-3305-4-243.
Available at http://www.parasitesandvectors.com/content/4/1/243/abstract

Background. Schistosomiasis japonica remains a major public health concern in China. There are many interventions implemented to control the transmission of the disease. The purpose of the present study was to investigate the effects of an integrated control strategy for schistosomiasis control.

Methods. An integrated control strategy for Schistosomiasis japonica with emphasis on removing cattle from snail-infested grasslands, providing farmers with mechanized farm equipment, improving sanitation by supplying tap water and building lavatories and latrines and providing boats with fecal-matter containers was implemented in 107 villages of the lower reaches of the Yangtze River, Jiangsu Province, China, during a 32-month period from May 2005 to 2008, and the effectiveness was investigated.

Results. Following the effects of the comprehensive control, the snail habitat, infected snail habitat, snail infection rate, and S. japonicum prevalence in both humans and livestock all appeared a declining trend year by year, with reductions of 47.88%, 94.29%, 92.55%, 96.94%, and 100% compared with those before the comprehensive control. In addition, all of the 17 counties achieved the infection control in 2007, and 7 reached the criteria of transmission control in 2008. The confirmed snail habitats reduced from 107 to 20, and the acute infections have also been controlled for 2 successive years since 2007.

Conclusions. The integrated control strategy for Schistosomiasis japonica is effective to control the transmission of S. japonicum.


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