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Vol. XV No. 2 ~ EINet News Briefs ~ Jan 20, 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
- 2012 Cumulative number of human cases of avian influenza A/H5N1
- Global: An engineered doomsday
- Global: Three countries report H5N1 influenza cases, deaths
- Bhutan: H5N1 avian influenza strikes backyard farm
- Cambodia: Finds first case of H5N1 influenza infection in human in 2012
- Hong Kong: Black-headed gulls test positive for H5N1 influenza virus
- Hong Kong: Lowers avian influenza alert level
- India: H5N1 influenza detected in poultry
- Indonesia: Man dies from H5N1 influenza
- Pakistan: Reports H5N1 avian influenza in zoo peacocks
- USA: HHS orders novel H3N2 influenza vaccine for clinical trials
- USA: Recent cases prompt CDC updates on swine-related influenza variants
- USA: Avian influenza and the future of biosecurity

2. Infectious Disease News
- Australia: Whooping cough cases on the rise
- Australia: Ten people monitored after Hendra death
- India: Reports new tuberculosis strain resistant to all drugs
- Indonesia (Jakarta): First Lady treated for typhoid
- Philippines: Typhoid cases in Leyte alarming
- Philippines: Leptospirosis outbreak feared
- Viet Nam: Doctors warn of contagious encephalitis
- USA (Kansas): Measles cases confirmed
- USA (Massachusetts): Rabies victim in critical condition
- USA (Michigan): EHEC E. coli O157 transmitted by food handler

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

4. Articles
- Zoonotic Viruses Associated with Illegally Imported Wildlife Products
- Controlling disease outbreaks in wildlife using limited culling: modelling classical swine fever incursions in wild pigs in Australia
- A Multistate Outbreak of Hepatitis A Associated With Semidried Tomatoes in Australia, 2009
- Non-O157 Shiga toxin–producing Escherichia coli associated with venison
- Economic Evaluation of the National Immunization Program of Rotavirus Vaccination for Children in Korea
- Assessing trends and predictors of tuberculosis in Taiwan
- Rethinking immigrant tuberculosis control in Canada: from medical surveillance to tackling social determinants of health
- Pathogenic responses among young adults during the 1918 influenza pandemic
- Changing Perceptions: of Pandemic Influenza and Public Health Responses
- Pandemic (H1N1) 2009 virus circulating in pigs, Guangxi, China

5. Notifications
- 30th Annual UC Davis Infectious Diseases Conference
- 2012 International Conference on Emerging Infectious Diseases (ICEID)
- 2012 Australasian Society for Infectious Diseases Scientific Meeting
- 9th Asia Pacific Travel Health Conference


1. Influenza News

Global
2012 Cumulative number of human cases of avian influenza A/H5N1
Cambodia / 1 (1)
Egypt / 1 (0)
Indonesia / 1 (1)
Total / 3 (2)
***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: 581 (342) (WHO 1/19/2012)
http://www.who.int/influenza/human_animal_interface/EN_GIP_20120119CumulativeNumberH5N1cases.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 2/12/2010): 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

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Global: An engineered doomsday
Scientists have long worried that an influenza virus that has ravaged poultry and wild birds in Asia might evolve to pose a threat to humans. Now scientists financed by the National Institutes of Health have shown in a laboratory how that could happen. In the process they created a virus that could kill tens or hundreds of millions of people if it escaped confinement or was stolen by terrorists.

We nearly always champion unfettered scientific research and open publication of the results. In this case it looks like the research should never have been undertaken because the potential harm is so catastrophic and the potential benefits from studying the virus so speculative.

Unless the scientific community and health officials can provide more persuasive justifications than they have so far, the new virus, which is in the Netherlands, ought to be destroyed. Barring that, it should be put in a few government-controlled laboratories with the highest containment rating, known as biosafety level 4. That is how the United States and Russia contain samples of smallpox, which poses nowhere near the same danger of global devastation.

In the future, it is imperative that any such experiments be rigorously analyzed for potential dangers — preferably through an international review mechanism, but also by governmental funding agencies — before they are undertaken, not after the fact as is happening in this case.

The full editorial may be accessed at http://www.nytimes.com/2012/01/08/opinion/sunday/an-engineered-doomsday.html?_r=1
(New York Times 1/7/2012)

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Global: Three countries report H5N1 influenza cases, deaths
The World Health Organization (WHO) on 19 January 2012 confirmed three new H5N1 avian influenza cases from Indonesia and Egypt, one of them fatal, a day after Vietnam's health ministry announced a death from the disease, its first in nearly two years.

Indonesia's newest case-patient is a 5-year-old girl from Jakarta province who died from her infection and is a family member of a man who died from H5N1 on 7 January 2012, the WHO reported. The girl's illness was detected on 7 January 2012 during surveillance as part of the investigation into the man's infection. She was referred to a hospital and began having breathing difficulties on 13 January 2012. The girl's condition worsened and she died on 16 January 2012. The WHO said the girl had been exposed to the same pigeons implicated in the man's death and shared the same household environment. Surveillance of the patients' contacts hasn't found any more H5N1 infections. The girl's illness and death raise Indonesia's H5N1 total to 184 cases, including 152 fatalities. The country leads the world in both categories.

One of Egypt's cases is in a 2-year-old girl from Cairo governorate who was treated for flulike symptoms as an outpatient at a hospital on 30 October 2011, according to the WHO. Her H5N1 infection was detected by Egypt's Central Public Health Laboratory during periodic screening of respiratory samples collected from outpatient surveillance sites. An investigation into the source of her infection found she had been exposed to backyard poultry. The WHO said samples have been sent to the US Naval Medical Research Unit 3 (NAMRU 3) for further sequencing.

Egypt's other case is a 31-year-old man from Fayoum governorates who got sick on 1 January 2012, was treated with oseltamivir (Tamiflu) on 14 January 2012 and is still hospitalized in critical condition, the WHO said. He also had been exposed to backyard poultry.

The two new infections push Egypt's H5N1 total to 159 cases, which include 55 deaths. Egypt has the world's second-highest H5N1 case count and third-highest fatality total, behind Vietnam.

Meanwhile, a provincial health official in Vietnam said an 18-year-old man from Kien Giang province has died of an H5N1 infection, reported 19 January 2012. The official said that the man, a worker on a duck farm, died on 16 January 2012, a day after he was hospitalized for fever and breathing difficulties. Kein Giang province is in southern Vietnam's Mekong Delta region. Neither of the two farms where the man worked had recently reported sick or dead poultry. Authorities are monitoring the man's contacts and collecting poultry samples. Vietnam's last H5N1 death was reported in April 2010, according to previous WHO reports. If the WHO confirms this case, the global H5N1 tally would rise to 582 cases and 343 deaths.
(CIDRAP 1/19/2012)

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Asia
Bhutan: H5N1 avian influenza strikes backyard farm
Officials in Bhutan have culled 395 chickens and destroyed 447 eggs after an avian flu outbreak in Tsimasham in Chukha district, reported a story on 6 January 2012. On 30 and 31 December 2011, 87 birds died on a backyard farm, and authorities culled birds on that and nearby farms 4 and 5 January 2011 after Bhutan's national center for animal health confirmed avian flu. The story, which said local officials were awaiting official confirmation from the World Organization for Animal Health (OIE), did not specify the strain of avian flu. Bhutan's last H5N1 avian flu outbreak was in the same district in March 2010, according to OIE data.
(CIDRAP 1/6/2012)

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Cambodia: Finds first case of H5N1 influenza infection in human in 2012
The Ministry of Health (MoH) of the Kingdom of Cambodia has announced a confirmed case of human infection with avian influenza A (H5N1) virus.

The case was a two year-old male from Banteay Meanchey Province. He developed symptoms on 3 January 2012 and was admitted to hospital on 9 January 2012. He is on Tamiflu and has been ventilated.

There have been reports that the boy was exposed to sick poultry in his village. He is the 19th person in Cambodia to become infected with the H5N1 virus; as of 16 January 2012, 16 of these cases have died from complications of the disease.

The National and local Rapid Response Teams (RRT) are conducting outbreak investigation and response following the national protocol. Hospital staff who had contact with the case have been offered oseltamivir. As of 16 January 2012, none of the human contacts have tested positive for A (H5N1).
(WHO 1/16/2012)

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Hong Kong: Black-headed gulls test positive for H5N1 influenza virus
Hong Kong has confirmed that the avian flu strain that killed two black-headed gulls 30 December 2011 and 2 January 2012 was H5N1. Earlier the week of 2 January 2012, Hong Kong's Agriculture, Fisheries and Conservation Department reported that preliminary tests revealed an H5 virus but did not specify the exact subtype. On 6 January 2012, the government confirmed H5N1 in the wild birds, found in Tuen Mun and Lantau.
(CIDRAP 1/6/2012)

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Hong Kong: Lowers avian influenza alert level
Hong Kong has moved its avian flu warning level back to "alert" after it raised it to "serious" on 20 December 2011 upon detection of H5N1 in a chicken at a live bird market and in two wild birds, as reported on 11 January 2012. That clears the way for importing and selling live poultry from mainland China and local farms. In addition, Hong Kong Health Secretary York Chow said the virus in the bird samples has not mutated compared with other samples collected in the region. "There is no significant change in terms of genetic shifting," he said.
(CIDRAP 1/12/2012)

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India: H5N1 influenza detected in poultry
Officials in the eastern Indian state of Odisha alerted authorities statewide after a poultry sample from the Khordha district tested positive for H5N1 avian flu, reported 9 January 2012. After hundreds of crows died in parts of the state, officials tested about 300 birds, mostly crows and poultry. The High Security Animal Disease Laboratory in Bhopal reported 8 January 2012 that a poultry sample tested positive for H5N1. Officials asked all 30 districts to remain alert and take samples from birds that have flu-like symptoms. Less than two weeks ago, India declared itself free of avian flu, according to earlier media reports.
(CIDRAP 1/9/2012)

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Indonesia: Man dies from H5N1 influenza
The Ministry of Health of Indonesia has announced one new confirmed case of human infection with avian influenza A (H5N1) virus. The case is a 23 year-old male from Jakarta Province. He developed symptoms on 31 December 2011, was admitted to hospital on 6 January 2012 and died on 7 January 2012.

An epidemiological investigation conducted by the Ministry of Health and local health officers indicated that he raised pigeons, and there was a sick pigeon he nursed that subsequently died. Laboratory tests have confirmed infection with avian influenza A (H5N1) virus. Of the 183 cases confirmed to date in Indonesia, 151 have been fatal.
(WHO 1/11/2012)

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Pakistan: Reports H5N1 avian influenza in zoo peacocks
Pakistani authorities reported that 15 peacocks at Lahore's Safari Park have died of H5N1 avian flu on 11 January 2012. The deaths occurred over the past seven days. Chickens on nearby poultry farms had previously been found to have the disease.
(CIDRAP 1/11/2012)

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Americas
USA: HHS orders novel H3N2 influenza vaccine for clinical trials
The US Department of Health and Human Services (HHS) is taking steps to prepare for clinical trials of a vaccine targeted to a novel H3N2 influenza strain that has infected at least 12 people, in case one is needed, a department official said on 6 January 2012.

The moves follow the US Center for Disease Control and Prevention (CDC) announcement in November 2011 that it had developed a candidate vaccine virus and provided it to manufacturers. The swine-origin H3N2 reassortant strain (H3N2v) includes the M gene from the 2009 H1N1 virus. The 12 infections were all reported in 2011, occurring mostly in children.

The CDC has said that some of the cases, especially those in children, probably involved limited person-to-person spread of the virus. The current seasonal flu vaccine is thought to provide little protection against the H3N2v strain, though people who were infected with or vaccinated against similar H3N2 strains that circulated in the 1990s might have some protection.

Gretchen Michael, a spokeswoman with the HHS assistant secretary for preparedness and response (ASPR), said that HHS has asked manufacturers to produce enough H3N2v vaccine to launch clinical trials. She said the request to have clinical lots ready is part of its pandemic preparedness program, a strategy that has also been used for other viruses that could have pandemic potential, such as H5N1 and H9N2.

She said HHS has asked Sanofi Pasteur and Novartis to produce the investigational vaccine lots, which would be used in clinical trials by the National Institutes of Health and the manufacturers. The supply of vaccine for the studies will likely be ready by spring 2012, Michael said.

No new novel flu infections were reported on 6 January 2012 in the CDC's weekly flu update. The agency has asked states to increase their surveillance for the new virus.
(CIDRAP 1/6/2012)

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USA: Recent cases prompt CDC updates on swine-related influenza variants
The US Centers for Disease Control and Prevention (CDC) recently updated some of its background documents on swine-origin flu viruses in humans, based on the latest information it has learned about recently detected novel flu infections.

The CDC released the updated information, aimed at both the laypeople and medical audiences, on 6 January 2012. The information covers key facts about swine-origin variant viruses and infections involving the strains in humans, particularly the H3N2 type that has so far infected 12 people in five different states, most of them children. Some of the patients had contact with swine, but other cases likely reflect limited human-to-human transmission, the CDC has said.

The new virus is a triple-reassortant that has acquired the M gene of the 2009 H1N1 virus. The CDC and many of its global partners are referring to the new strain as an H3N2 variant and are using the H3N2v abbreviation.

The CDC has said it's unclear why the number of detections in humans is increasing. It said factors could include better lab capacity to detect novel viruses, changed domestic and international novel flu virus reporting requirements, or a true increase in the number of cases from exposure to swine or through limited human-to-human transmission. Though there's no evidence of sustained transmission, the changing nature of flu viruses means that circulation may become widespread, according to the CDC.

The full article may be accessed at http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/jan0912swine.html
(CIDRAP 1/9/2012)

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USA: Avian influenza and the future of biosecurity
A National Institutes of Health (NIH) official said the US government's goal is to have recommendations for restricting full access to two controversial studies on H5N1 avian flu transmissibility ready in the next couple of weeks, reported 11 January 2012. Amy Patterson, who directs the NIH office that oversees the National Science Advisory Board for Biosecurity (NSABB) said that the Department of Health and Human Services is leading the effort, with help from many other agencies and departments. She said the groups working on the recommendations are receiving input from international partners and are aware of how important it is to share information with H5N1-endemic countries. Patterson also said issues raised by the H5N1 papers have spurred US government work on a draft policy on oversight of dual-use research (that could benefit society but could also be misused), which would also suggest a system for local review at institutions where the research is conducted. She said scientists and members of the public would have a chance to weigh in on the framework, and she predicted that it would be released early in spring 2012. On 20 December 2011 the NSABB asked to redact key information from two studies on the transmissibility of mutant H5N1 strains in ferrets over concern that the information could be misused by bioterrorists. At that time, the NIH said the government was working on a mechanism to share the full study details with scientists who needed them.

A summary of the interview with Amy Patterson may be accessed at http://www.nature.com/news/bird-flu-and-the-future-of-biosecurity-1.9784
(CIDRAP 1/11/2012)

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2. Infectious Disease News

Asia
Australia: Whooping cough cases on the rise
The Department of Health of Western Australia (WA) is encouraging parents of young children to be aware of the symptoms of whooping cough and to ensure their families' vaccinations are up-to-date.

A total of 3,597 cases of whooping cough have been reported to the Department up to 23 December 2011, compared to 1,458 cases for the whole of 2010. Director of Communicable Disease Control Dr. Paul Armstrong said notifications in Western Australia peaked at 704 cases for the month of November 2011, and although there now appeared to be some decrease, whooping cough activity in the community remained high.

"WA's last whooping cough epidemic was in 2004, and we have been overdue for a big year, which typically occurs every three to four years," Dr. Armstrong said. "The increase in WA is consistent with whooping cough activity in other states in recent years.

"Whooping cough affects people of all ages, but the rise in infections is particularly concerning for children under six months of age, in whom infection can be very severe and even life threatening." There have been four deaths associated with whooping cough in babies in the past four years in WA.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120111.1007036
(ProMED 1/11/2012)

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Australia: Ten people monitored after Hendra death
Ten people are being tested after coming in contact with a horse that died from Hendra virus in north Queensland. The 3-year-old gelding fell ill on a property southeast of Townsville on Tuesday, 3 January 2012.

Queensland chief vet Rick Symons says its condition deteriorated quickly. "A veterinarian was called to a sick horse on 5 January 2012. The horse was apparently blind; it was staggering, and had a nasal discharge," he said. "The veterinarian suspected Hendra virus and took samples and sent them to the lab in Brisbane." The tests confirmed on 4 January 2012 that it was Hendra, and experts from Biosecurity Queensland and Queensland Health went to the site.

The owner, the owner's partner, the vet, and the backhoe driver who buried the dead horse are among those who will be screened for the virus. Five other horses, a dog, and a cat will also be tested, and the site has been quarantined. "There'll be no movement of horses on or off the property or material that could transfer Hendra virus on and off the property," Dr. Symons said. "And we're in the process of talking to neighbors to find out what horses are in the area."

The Hendra virus has a rapid effect and tends to kill animals over a short period of time. More than 20 horses died or were put down during Hendra outbreaks in 2011 across Queensland and northern New South Wales. Authorities say it is unusual for Hendra to surface during summer, with most cases occurring in the July-to-September period.

North Queensland Equestrian Group spokesman Trevor Hyatt says horses must be kept away from trees to stop the virus spreading. "We need to be aware that there are flying foxes that are contributing to this," he said. "We need to keep horses out from underneath the trees. We need to keep our water supply covered so we can help prevent it from spreading." Scientists are preparing to trial a Hendra vaccine, but it is not expected to be on the market until 2013.
(ProMED 1/6/2012)

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India: Reports new tuberculosis strain resistant to all drugs
Indian doctors have reported the country's first cases of "totally drug-resistant tuberculosis," a long-feared and virtually untreatable form of the killer lung disease. It's not the first time highly resistant cases like this have been seen. Since 2003, patients have been documented in Italy and Iran. It has mostly been limited to impoverished areas, and has not spread widely. But experts believe there could be many undocumented cases.

No one expects the Indian TB strains to rapidly spread elsewhere. The airborne disease is mainly transmitted through close personal contact and isn't nearly as contagious as the flu. Indeed, most of the cases of this kind of TB were not from person-to-person infection but were mutations that occurred in poorly treated patients.

What's more, there's a debate within the public health community about whether to even label TB infections as totally drug resistant. The World Health Organization hasn't accepted the term and still considers the cases to be what's now called extensively drug-resistant TB, or XDR. However, Dr. Paul Nunn, a coordinator at the WHO's Stop TB Department in Geneva, said there is ample proof that these virtually untreatable cases do exist.

The Indian hospital that saw the initial cases tested a dozen medicines and none of them worked, a pretty comprehensive assessment. A TB expert at the U.S. Centers for Disease Control and Prevention said they do appear to be totally resistant to available drugs. "It is concerning," said Dr. Kenneth Castro, director of the CDC's Division of Tuberculosis Elimination. "Anytime we see something like this, we better get on top of it before it becomes a more widespread problem."

Ordinary TB is easily cured by taking antibiotics for six to nine months. However, if that treatment is interrupted or the dose is cut down, the stubborn bacteria battle back and mutate into a tougher strain that can no longer be killed by standard drugs. The disease becomes harder and more expensive to treat.

In India, doctors in Mumbai have reported a total of 12 patients who failed initial treatment and also didn't respond to the medicines tried next over an average of two to three years. Three have died. None of the others have been successfully treated.

The full article may be accessed at http://yourlife.usatoday.com/health/story/2012-01-16/India-reports-new-TB-strain-resistant-to-all-drugs/52592516/1

The WHO statement may be accessed at http://www.who.int/tb/challenges/mdr/tdrfaqs/en/index.html
(USA Today 1/16/2012)

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Indonesia (Jakarta): First Lady treated for typhoid
The First Lady of Indonesia is being treated in the hospital after contracting typhoid, a member of the presidential team of doctors said. She was admitted to the Army hospital in Jakarta and was diagnosed as suffering from a bout of typhoid, said Aris Wibudi, a member of the presidential medical team.

"Currently, the First Lady is still suffering from a fever that comes and goes, but clinically she is showing improvements," Aris said at the hospital. He did not say how she contracted typhoid. He also declined to say when she might be released from the hospital.

President Susilo Bambang Yudhoyono, who had been on a visit to Cilacap, Central Java, arrived back in the capital on 5 January 2012 and visited his wife at Gatot Subroto Hospital.
(ProMED 1/10/2012)

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Philippines: Typhoid cases in Leyte alarming
The Department of Health (DoH) in Region 8 is urging the public to keep their surroundings clean after noting the rise in cases of typhoid fever, especially in Leyte province's four towns. DoH 8 Nurse Boyd Cerro said the cases of typhoid fever in the towns of Carigara, Capoocan, Tunga, and Barugo have become alarming, with Carigara registering 102 affected residents.

The health department has also noted the rising number of patients with typhoid fever confined in a hospital in Tacloban City, aside from district hospitals in the said four towns. The DoH, however, has not received reports of deaths due to typhoid fever.

Based on the initial investigation launched by the DoH, it was found out that the water sources of the said towns are contaminated with the bacterium causing typhoid fever. Cerro said residents should boil their water before drinking it to prevent getting the disease.
(ProMED 1/10/2012)

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Philippines: Leptospirosis outbreak feared
Hospitals on the island of Mindanao in the Philippines are on alert for cases of leptospirosis, a bacterial disease spread by rodents, following tropical storm Washi.

According to local health care authorities, reports 314 cases and eight deaths in the cities of Cagayan de Oro and Iligan in the archipelago. The Washi storm hit about a million people, and more than 1,250 died and 100 are still missing. In addition, 38,000 people have taken shelter in 54 evacuation centers in the area.

About 80% of reported cases of leptospirosis on the island of Mindanao were among males, median age of 26, who had been working in clean-up details and thus exposed to polluted water. Residents who had not taken shelter in the evacuation centers were particularly vulnerable and cannot be given medication or treatment.

However, despite the outbreak, the levels of leptospirosis are still nowhere near those reported during Typhoon Ketsana in 2009, when there were more than 2,000 cases and 167 deaths reported deaths. According to the Emerging Health Threats for the Philippine National Red Cross (PNRC), the alarm remains high.

The accumulated mud is still a potential source of infection. It may contain bacteria from the carcasses of rodents or their feces and urine that remain in the soil. In addition, the clearing of some areas will remain difficult until the water service is resumed, seriously damaged, in the two cities. Currently only a few pipelines are partially functional. The health department has distributed rapid diagnosis kits to test early symptoms of the disease.
(ProMED 1/14/2012)

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Viet Nam: Doctors warn of contagious encephalitis
Doctors in Ho Chi Minh City (HCMC) have warned of the outbreak of a fatal type of encephalitis that has affected five co-workers. The disease was caused by Neisseria, a large genus of commensal bacteria that colonize in the mucosal surfaces of many animals, and quickly kill the infected body.

HCMC Tropical Diseases Hospital is treating a 29 year old patient with the disease. He was admitted with red spots from subcutaneous bleeding and fever. Nguyen Van Vinh Chau, director of the hospital, said a woman who is a co-worker of the man at a company in District 7 was also received at the hospital around three weeks ago with the disease. Doctors at the hospital suspected the coincidence and contacted the district health authorities, who then confirmed that three other workers from the company had fallen sick with similar symptoms. Authorities are taking steps to quarantine the outbreak.

More information about the pathogen and disease may be accessed at http://www.promedmail.org/direct.php?id=20120117.1012861
(ProMED 1/17/2012)

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Americas
USA (Kansas): Measles cases confirmed
Health officials in Finney County have confirmed two cases of measles. The Finney County Health Department is investigating and contacting all those who might be at risk for the disease.

Because of the widespread use of the MMR vaccine, cases in the US are rare, but it kills 200,000 people worldwide each year. Measles is spread through the air by breathing, coughing, or sneezing. It is so contagious that any person who is exposed to it and is not immune will probably get the disease. Measles can be spread to others from four days before to four days after the rash appears.
(ProMED 1/15/2012)

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USA (Massachusetts): Rabies victim in critical condition
A Cape man diagnosed with rabies the week of 26 December 2011 is alive and fighting the deadly virus, according to health officials. As of 3 January 2012 morning, the unidentified Barnstable man, in his 60s, remained in critical condition at a Boston hospital, said Barnstable Health Director Thomas McKean.

The diagnosis confirmed the first human case of rabies in Massachusetts in more than 75 years. State health officials also confirmed on 3 January 2012 that the man contracted the virus from a species of Myotis bat. The small, brown mammals are common in Massachusetts, said state Department of Health spokesman John Jacob. The man's wife has been released from the hospital following precautionary vaccinations and was staying with friends, McKean said. The man was apparently bitten in the couple's Barnstable home months before exhibiting symptoms.

The Barnstable man is the fourth confirmed human infected by the rabies virus in the United States in 2011, according to statistics from the Centers for Disease Control in Atlanta. A rabies diagnosis is usually considered fatal; however, a treatment developed in the last decade has helped cure a handful of patients. The "Milwaukee protocol" is a pioneering medical procedure in which doctors sedate patients into a coma-like state to give them time to build antibodies to fight the virus. The procedure was developed by Dr. Rodney E. Willoughby, a professor of pediatrics at the Medical College of Wisconsin in Milwaukee. It was first used successfully in 2004 to save a Wisconsin teenager from the almost certainly fatal virus. She was the first person to survive infection without prior immunization, and since then, five more have also been saved.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120106.1002196
(ProMED 1/6/2012)

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USA (Michigan): EHEC E. coli O157 transmitted by food handler
Western Upper Peninsula (Michigan) Health Department is investigating a cluster of cases of Escherichia coli O157:H7 infection who became ill over the Christmas holidays. Initially three local and two non-local cases were identified. Investigation has led to the identification of two additional cases. Four of the cases were hospitalized; no deaths have occurred. The health department has determined that the likely source of the outbreak was an ill food handler at The Ambassador, a Houghton restaurant. The restaurant owner and his staff have been working cooperatively with the health department's environmental health division during the investigation. The restaurant remains open for business and there is no anticipated ongoing risk of illness due to this outbreak.

"Such an investigation is a routine part of health department operations," said Dr. Teresa Frankovich. "The cases came to light earlier in January 2012 and health department staff has been conducting interviews with the ill individuals to look for exposures they might have in common. All of the cases have now been linked through the restaurant."

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120117.1013132
(ProMED 1/17/2012)

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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
Indonesia (Depok)
Residents and health officials fumigated parts of Limo, Depok, on 6 January 2011 after chikungunya fever infected at least 200 people in December 2011. The outbreak was attributed to poor sanitation and poor awareness of the mosquito-borne disease.

There were several new cases in the neighboring districts of Tanah Baru and Pancoran Mas, according to the local health agency.

Councillor Lilis Latifah, who heads the Depok City Council’s Commission D overseeing social welfare, said that residents could prevent the disease by regularly cleaning their neighborhoods. “I hope the voluntary larvae controllers will work harder … There should be incentives for them,” Lilis said after visiting patients in the stricken areas.

The Depok administration is providing free, around-the-clock healthcare for residents with symptoms of the disease. The symptoms chikungunya fever, which is similar to dengue fever, include the abrupt onset of fever, frequently accompanied by joint pain that is often debilitating.

[ProMED note: Within the past three months in Indonesia, there have been cases of chikungunya virus infection in West Sumatra and Central Java. Now there are cases in West Java. A cleanup of water catchment breeding sites should help reduce the population of Aedes aegypti, the likely vector of chikungunya virus in the area. There is no vaccine available to prevent chikungunya virus infections. Control of vector mosquito populations and avoidance of their bites are the only feasible preventive measures.]
(ProMED 1/7/2012)


Malaysia
Director general of Health Datuk Dr. Hasan Abdul Rahman on 12 January 2012 expressed concern over the 26% rise in the number of dengue fever cases in the country in the first week of 2012, up by 90 to 440 compared with the last week of 2011. He said Selangor had the highest number of 61 more cases, with Johor next with 11 more cases, and Perak with 10 more cases. One death from the disease was reported in Selangor in the first week of 2012, he said.
(ProMED 1/16/2012)


Peru (Pasco)
There is a general health alarm in the Pasco region, Constitucion district in the Oxapampa province, where there is a dengue outbreak, considered as such due to the epidemiological index of the health center, which is 1.14 and where 55 probable and 33 positive people who have presented with dengue fever have been registered.
(ProMED 1/16/2012)


Philippines (Cebu city)
On 2 January 2012, the Cebu City Medical Center (CCMC) reported a suspected case of dengue. The child, a resident of Barangay Pahina Central, died that night. "It's not confirmed that it's dengue, they are still investigating it. But once that is confirmed, then it would be the first dengue death for 2012," Macasocol said. In 2011, 13 patients, all of them children, died of dengue fever and at least 1,680 others were hospitalized due to dengue virus infections.
(ProMED 1/9/2012)


Philippines (Cagayan de Oro)
The Cagayan de Oro city government expressed alarm on the possible surge of dengue cases due to the "unpredictable weather". Dante Pajo, chairperson of the City Council's Committee on Health and Sanitation, said on 13 January 2012 that three children were reported to have dengue.
(ProMED 1/16/2012)

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4. Articles
Zoonotic Viruses Associated with Illegally Imported Wildlife Products
Smith KM, Anthony SJ, Switzer WM, et al. PLoS ONE. 10 January 2012. 7(1): e29505. doi:10.1371/journal.pone.0029505.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0029505

Abstract. The global trade in wildlife has historically contributed to the emergence and spread of infectious diseases. The United States is the world's largest importer of wildlife and wildlife products, yet minimal pathogen surveillance has precluded assessment of the health risks posed by this practice. This report details the findings of a pilot project to establish surveillance methodology for zoonotic agents in confiscated wildlife products. Initial findings from samples collected at several international airports identified parts originating from nonhuman primate (NHP) and rodent species, including baboon, chimpanzee, mangabey, guenon, green monkey, cane rat and rat. Pathogen screening identified retroviruses (simian foamy virus) and/or herpesviruses (cytomegalovirus and lymphocryptovirus) in the NHP samples. These results are the first demonstration that illegal bushmeat importation into the United States could act as a conduit for pathogen spread, and suggest that implementation of disease surveillance of the wildlife trade will help facilitate prevention of disease emergence.

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Controlling disease outbreaks in wildlife using limited culling: modelling classical swine fever incursions in wild pigs in Australia
Cowled BD, Garner MG, Negus K, Ward MP. Vet Res. 16 January 2012. 43(1):3.
Available at http://www.ncbi.nlm.nih.gov/pubmed/22243996

Abstract. Disease modelling is one approach for providing new insights into wildlife disease epidemiology. This paper describes a spatio-temporal, stochastic, susceptible- exposed-infected-recovered process model that simulates the potential spread of classical swine fever through a documented, large and free living wild pig population following a simulated incursion. The study area (300 000 square kms) was in northern Australia. Published data on wild pig ecology from Australia, and international Classical Swine Fever data was used to parameterise the model. Sensitivity analyses revealed that herd density (best estimate 1-3 pigs per square km), daily herd movement distances (best estimate approximately 1 km), probability of infection transmission between herds (best estimate 0.75%) and disease related herd mortality (best estimate 42%) were highly influential on epidemic size but that extraordinary movements of pigs and the yearly home range size of a pig herd were not. CSF generally established (98% of simulations) following a single point introduction. CSF spread at approximately 9 square kms per day with low incidence rates (< 2 herds per day) in an epidemic wave along contiguous habitat for several years, before dying out (when the epidemic arrived at the end of a contiguous sub-population or at a low density wild pig area). The low incidence rate indicates that surveillance for wildlife disease epidemics caused by short lived infections will be most efficient when surveillance is based on detection and investigation of clinical events, although this may not always be practical. Epidemics could be contained and eradicated with culling (aerial shooting) or vaccination when these were adequately implemented. It was apparent that the spatial structure, ecology and behaviour of wild populations must be accounted for during disease management in wildlife. An important finding was that it may only be necessary to cull or vaccinate relatively small proportions of a population to successfully contain and eradicate some wildlife disease epidemics.

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A Multistate Outbreak of Hepatitis A Associated With Semidried Tomatoes in Australia, 2009
Donnan EJ, Fielding JE, Gregory JE, et al. Clin Infect Dis. 11 January 2012. doi: 10.1093/cid/cir949.
Available at http://www.ncbi.nlm.nih.gov/pubmed/22238166

Background. A large outbreak of hepatitis A affected individuals in several Australian states in 2009, resulting in a 2-fold increase in cases reported to state health departments compared with 2008. Two peaks of infection occurred (April-May and September-November), with surveillance data suggesting locally acquired infections from a widely distributed food product.

Methods. Two case-control studies were completed. Intensive product trace-back and food sampling was undertaken. Genotyping was conducted on virus isolates from patient serum and food samples. Control measures included prophylaxis for close contacts, public health warnings, an order by the chief health officer under the Victorian Food Act 1984, and trade-level recalls on implicated batches of semidried tomatoes.

Results. A multijurisdictional case-control study in April-May found an association between illness and consumption of semidried tomatoes (odds ratio [OR], 3.0; 95% CI 1.4-6.7). A second case-control study conducted in Victoria in October-November also implicated semidried tomatoes as being associated with illness (OR, 10.3; 95% CI, 4.7-22.7). Hepatitis A RNA was detected in 22 samples of semidried tomatoes. Hepatitis A virus genotype IB was identified in 144 of 153 (94%) patients tested from 2009, and partial sequence analysis showed complete identity with an isolate found in a sample of semidried tomatoes.
Conclusions. The results of both case-control studies and food testing implicated the novel vehicle of semidried tomatoes as the cause of this hepatitis A outbreak. The outbreak was extensive and sustained despite public health interventions, the design and implementation of which were complicated by limitations in food testing capability and complex supply chains.

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Non-O157 Shiga toxin–producing Escherichia coli associated with venison
Rounds JM, Rigdon CE, Muhl LJ, et al. Emerg Infect Dis. February 2012. doi: 10.3201/eid1802.110855.
Available at http://wwwnc.cdc.gov/eid/article/18/2/11-0855_article.htm

Abstract. We investigated an outbreak of non-O157 Shiga toxin–producing Escherichia coli at a high school in Minnesota, USA, in November 2010. Consuming undercooked venison and not washing hands after handling raw venison were associated with illness. E. coli O103:H2 and non-Shiga toxin–producing E. coli O145:NM were isolated from ill students and venison.

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Economic Evaluation of the National Immunization Program of Rotavirus Vaccination for Children in Korea
Kang HY, Kim KH, Kim JH, et al. Asia Pac J Public Health. 10 January 2012. doi: 10.1177/1010539511416806.
Available at http://www.ncbi.nlm.nih.gov/pubmed/22234827

Objective. The authors assessed the cost-effectiveness of rotavirus vaccination to develop an evidence-based national immunization program in Korea.

Methods. A Markov model was constructed to compare the costs and clinical outcomes of vaccination versus no vaccination. The birth cohort of 493189 infants in 2007 was followed until the age of 5 years. Korea-specific data for epidemiological characteristics and economic burden of rotavirus diarrhea were used for the modeled estimation. Efficacy of RotaTeq® was based on a recent clinical trial.

Results. Rotavirus vaccination would prevent 181238 symptomatic cases (reduction rate = 63.2%) over 5 years after birth. From the societal perspective, at a vaccination cost of 100000 Korean won (KW; 1 US$ ≈ 1200 KW) per dose, universal vaccination would cost 375620 KW per case averted. The breakeven price of vaccine was 56061 KW.

Conclusions. Rotavirus vaccination would reduce the burden of the disease substantially and be a cost-effective strategy to prevent rotavirus diarrhea in Korea.

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Assessing trends and predictors of tuberculosis in Taiwan
Liao CM, Hsieh NH, Huang TL, et al. BMC Public Health. 12 January 2012. 12(1):29
Available at http://www.biomedcentral.com/1471-2458/12/29/abstract

Background. Variety of environmental and individual factors can cause tuberculosis (TB) incidence change. The purpose of this study was to assess the characteristics of TB trends in the period 2004 - 2008 in Taiwan by month, year, gender, age, temperature, seasonality, and aborigines.

Methods. The generalized regression models were used to examine the potential predictors for the monthly TB incidence in regional and national scales.

Results. We found that (i) in Taiwan the average TB incidence was 68 per 100,000 population with mortality rate of 0.036 person1 yr1, (ii) the highest TB incidence rate was found in eastern Taiwan (116 per 100,000 population) with the largest proportion of TB relapse cases (8.17%), (iii) seasonality, aborigines, gender, and age had a consistent and dominant role in constructing TB incidence patterns in Taiwan, and (iv) gender, time trend, and 2-month lag maximum temperature showed strong association with TB trends in aboriginal subpopulations.

Conclusions. The proposed Poisson regression model is capable of forecasting patterns of TB incidence at regional and national scales. This study suggested that assessment of TB trends in eastern Taiwan presents an important opportunity for understanding the time-series dynamics and control of TB infections, given that this is the typical host demography in regions where these infections remain major public health problems.

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Rethinking immigrant tuberculosis control in Canada: from medical surveillance to tackling social determinants of health
Reitmanova S, Gustafson D. J Immigr Minor Health. February 2012. 14(1):6-13.
Available at http://www.springerlink.com/content/lv2154rj77671281/

Abstract. Current tuberculosis control strategies in Canada rely exclusively on screening and surveillance of immigrants. This is consistent with current public health discourse that attributes the high burden of immigrant tuberculosis to the exposure of immigrants to infection in their country of origin. The effectiveness of control strategies is questionable given the evidence that many immigrants are at higher risk of tuberculosis reactivation because of risk factors such as poverty, malnutrition and overcrowded housing. This paper argues that the absence of policies that address poverty-related disadvantages among immigrants makes these populations more vulnerable to the reactivation of their tuberculosis long after they have been exposed in their countries of birth. Policies for tuberculosis prevention in the Aboriginal population attend to their poverty and other social determinants of health. Effective health prevention policy for tuberculosis within the immigrant population must take similar direction.

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Pathogenic responses among young adults during the 1918 influenza pandemic
Shanks GD, Brundage JF. Emerg Infect Dis. February 2012. doi: 10.3201/eid1802.102042.
Available at http://wwwnc.cdc.gov/eid/article/18/2/10-2042_article.htm

Abstract. Of the unexplained characteristics of the 1918–19 influenza pandemic, the extreme mortality rate among young adults (W-shaped mortality curve) is the foremost. Lack of a coherent explanation of this and other epidemiologic and clinical manifestations of the pandemic contributes to uncertainty in preparing for future pandemics. Contemporaneous records suggest that immunopathologic responses were a critical determinant of the high mortality rate among young adults and other high-risk subgroups. Historical records and findings from laboratory animal studies suggest that persons who were exposed to influenza once before 1918 (e.g., A/H3Nx 1890 pandemic strain) were likely to have dysregulated, pathologic cellular immune responses to infections with the A/H1N1 1918 pandemic strain. The immunopathologic effects transiently increased susceptibility to ultimately lethal secondary bacterial pneumonia. The extreme mortality rate associated with the 1918–19 pandemic is unlikely to recur naturally. However, T-cell–mediated immunopathologic effects should be carefully monitored in developing and using universal influenza vaccines.

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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.

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Pandemic (H1N1) 2009 virus circulating in pigs, Guangxi, China
Yan J-H, Xiong Y-O, Yi C-H, et al. Emerg Infect Dis. February 2012. doi: 10.3201/eid1802.111346.
Available at http://wwwnc.cdc.gov/eid/article/18/2/11-1346_article.htm

Abstract. Pandemic (H1N1) 2009, caused by a virus usually circulating in pigs in Europe and Asia, is a triple hybrid that contains swine, human, and avian virus gene segments, which further emphasizes that SIVs pose a serious threat to public health. We describe an outbreak of pandemic (H1N1) 2009 virus, which was isolated from a pig farm in Guangxi Province, People’s Republic of China, and report the consequences of subsequent epidemiologic studies. Our findings strengthened previous data by showing that growing and fattening pigs are susceptible to infection of pandemic (H1N1) 2009 virus. Analysis of the complete genome sequence of the subtype H1N1 isolates suggests that no gene reassortment occurred. The results of serologic studies demonstrated that uninfected pig farms are also susceptible to pandemic (H1N1) 2009 virus infection. Our results suggest that the pandemic virus is currently circulating in swine populations and posing a challenge to pigs in southern China. Increasing serologic surveillance of pigs for prevention and better control of pandemic influenza is urgently needed in China.

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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/

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2012 International Conference on Emerging Infectious Diseases (ICEID)
Atlanta, Georgia, United States, 11 to 14 March 2012
The ICEID was first convened in 1998; ICEID marks its eighth occurrence. The conference brings together public health professionals to encourage the exchange of scientific and public health information on global emerging infectious disease issues. The program will include plenary and panel sessions with invited speakers as well as oral and poster presentations on emerging infections. Major topics to be included are current work on surveillance, epidemiology, research, communication and training, bioterrorism, and preventions and control of emerging infectious diseases, both in the United States and abroad.
Additional information at http://www.iceid.org/

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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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9th Asia Pacific Travel Health Conference
Singapore, Singapore, 2 to 5 May 2012
The Asia Pacific Travel Health Conference 2012 is aimed at regional clinicians, physicians and any other healthcare professionals working in the field of travel medicine covering fields such as emerging infectious diseases, preventive medicine, primary health care and vaccinology. The conference will give an opportunity to exchange and get the most up-to-date information on travel medicine in the Asia Pacific region.
Additional information at http://www.apthc2012.org

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 apecein@u.washington.edu