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Vol. VIII, No. 15 ~ EINet News Briefs ~ Jul 15, 2005


*****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:
- South East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
- Viet Nam: 2 more deaths from avian influenza
- Philippines (Bulacan): Low pathogenic H5 bird-flu virus in Calumpit
- Thailand (Suphanburi): New bird flu outbreaks discovered
- Indonesia (Jakarta): Avian Influenza Suspected as Cause of 3 Recent Deaths
- Japan (Ibaraki): Fresh case of H5N2 strain bird flu
- Indonesia: Poliomyelitis update
- Russia: Crimean-Congo Hemorrhagic Fever in Stavropol and Rostov region
- Russia: Rabies, human and animal, Russia overall and Lipetsk region
- Russia (Krasnoyarsk): Tick-borne encephalitis data
- Russia (Rostov): Botulism cases, canned food
- Australia (Queensland): Outbreak of Salmonella among traveling US students
- USA: USDA clears BSE cow's herd of disease
- USA/Canada: Agriculture Secretary announces next steps for importing Canadian cattle
- USA (Massachusetts): Landscaper contracts tularemia
- USA (Minnesota): Children sickened by E. coli outbreak
- USA (New York): 3 cases of Listeriosis
- USA (Multistate): Salmonellosis, unpasteurized orange juice alert
- Note

1. Updates
- Influenza
- Cholera, diarrhea & dysentery
- Dengue
- West Nile Virus

2. Articles
- Prevention and Control of Influenza: Recommendations of ACIP
- Highly Pathogenic H5N1 Influenza Virus Infection in Migratory Birds
- Isolation of a genotypically unique H5N1 influenza virus from duck meat imported into Japan from China
- Rapid Assessment of Influenza Vaccination Coverage Among HMO Members--Northern California Influenza Seasons, 2001--02 Through 2004--05
- Using climate to predict disease outbreaks: a review
- Update: Syringe Exchange Programs--United States, 2002

3. Notifications
- International Symposium on Veterinary Epidemiology and Economics
- 2005 Annual Conference on Assessment Initiative--September 20--22, 2005
- Webcast on Human Papilloma Virus
- A Wealth of Knowledge Free to the World: JHSPH OpenCourseWare
- Public health and medical experts to hold meeting in Macau
- Codex commission adopts code of practice to minimize antimicrobial resistance

4. APEC EINet activities
- EINet distance-learning course to be launched in Aug 2005

5. To Receive EINet Newsbriefs
- APEC EINet email list


Asia
South East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
Cumulative number of confirmed human cases of avian influenza A/(H5N1), 16 Dec 2004 to present:

Economy / Unofficial (Official) Cases / Unofficial (Official) Deaths
Indonesia / 1 (0) / 0 (0)
Cambodia / 4 (4) / 4 (4)
Thailand / 0 (0) / 0 (0)
Viet Nam / 64 (60) / 20 (18)
Total / 69 (64) / 24 (22)

Cumulative number of confirmed human cases of avian influenza A/(H5N1), 3 Dec 2003 to present:
113 (108) / 56 (54)
(CIDRAP 7/14/05 http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/case-count/avflucount.html)

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Viet Nam: 2 more deaths from avian influenza
2 Vietnamese citizens have died from respiratory illness, one of whom was infected with avian influenza, local newspaper Pioneer reported, quoting Vietnam's Preventive Medicine Department. The 2 people died at the Institute of Tropical Diseases in Hanoi. Specimens from a patient tested positive for avian influenza virus strain H5, and the testing of the other patient gave unclear results. The institute is now treating 18 local people, 3 of whom have been confirmed to have contracted H5 virus, and the rest are suspected to be infected with it. One patient is in need of respiratory assistance.

Since 4 Jun 2005, Viet Nam has reported no new human cases of avian influenza virus infection. The department confirmed that a total of 60 local people from 23 localities have been infected with avian influenza since late Dec 2004, of whom 19 died. The department also confirmed that there is no evidence of human-to-human transmission. WHO has recently taken 50 specimens from suspected cases of avian influenza virus infection among people and poultry for testing in the US, Japan and Viet Nam. Viet Nam will start vaccinating fowl against avian influenza virus infection in northern Nam Dinh province and southern Tien Giang province on a trial basis in Aug 2005, and then do the same in other localities with high risks of outbreaks in October. The country has so far in 2005 detected bird flu outbreaks in 35 cities and provinces, which have killed or led to the forced culling of 1.5 million fowl. (Promed 7/14/05)

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Philippines (Bulacan): Low pathogenic H5 bird-flu virus in Calumpit
The Bureau of Animal Industry [BAI] announced 8 Jul 2005 the detection of a low-risk flu strain in ducks in Calumpit, Bulacan, but said there is no cause for alarm. In a routine testing done on samples collected from a small farm in Calumpit, a low pathogenic H5 avian influenza virus was detected in ducks using hemagglutination inhibition and PCR. Samples are being sent to the OIE Reference Laboratory for avian influenza in the Australian Animal Health Laboratory for confirmation of the specific strain involved. All ducks in the farm are apparently healthy with no mortalities, and all the native chickens in the same farm have tested negative. The Department of Agriculture and the Department of Health jointly assured people that the flu strain poses no risk to humans and other animals.

Control measures included: ban of movement and sale of live poultry within a 3 km radius of the affected farm for one week; affected flocks will be culled immediately; sustained surveillance and testing of all poultry farms in nearby areas. Jose Molina, the BAI director, said his office has intensified surveillance and testing of all poultry farms in nearby areas. He said the BAI is carefully monitoring 20 major critical areas in the country and has poured around PHP 20 million [USD 335 600] to fund bird-flu prevention and surveillance programs. The government is set to release an additional PHP 50 million [USD 889 000]. Meanwhile, Imelda Palabyab, president of the Philippine Association of Broiler Integrators, said her group volunteered to temporarily suspend poultry shipments to Japan until the country is cleared of the infection. Government records showed the Philippines has shipped around 3000 tons of chicken to Japan as of June 2005, or 500 tons a month. The country is hoping to export 10 000 tons of chicken to Japan this year, a small share of the 300 000 tons that make up the Japanese annual requirement.

"There is a possibility that the strain was carried to the area by migratory birds," Dr. Hayashi Carillo said, noting the Candaba Swamp is regularly visited by migratory birds from different parts of Southeast Asia. Authorities in the neighboring province of Pampanga have also started taking measures to prevent the entry of bird flu in the bird sanctuary in Candaba. Mayor Jerry Pelayo of Candaba said he has established checkpoints to stop the transportation of poultry into the town as a precautionary measure. (Promed 7/10/05, 7/11/05)

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Thailand (Suphanburi): New bird flu outbreaks discovered
New cases of avian influenza have been detected in Thailand's central Suphanburi province. Bird flu outbreaks have been confirmed at 5 spots in Suphanburi's Sam Chuk district, where more than 450 fowl have been destroyed, said Nirandorn Uangtrakoolsuk, head of the Disease Control and Veterinary Service Bureau of the Livestock Department. Movements of fowl have been banned within a 10 km radius around the area, and necessary measures have been put in place to control the outbreak. More than 450 fowl in the area have been destroyed. Before the detection of the fresh bird flu case, the Agriculture Ministry had planned to declare the country "bird flu-free" 12 Jul 2005, 90 days after the last recorded bird flu case in Lopburi province.

Nirandorn called on farmers to help the authorities by immediately alerting relevant officials to any cases of fowl dying en masse. His additional advice to farmers was that they should use disinfectant spray to protect their farms, as well as any equipment used to raise their fowl, and to stop allowing their fowl to roam freely, as they could catch the disease from wild birds. Nirandorn said the department was checking on whether the mass deaths of fowl in Pathum Thani, Chachoengsao, Prachin Buri, Kalasin, Lampang and Phetchabun recently were also related to bird flu. Nirandorn said the Agriculture Ministry would also have to shelve its campaign to promote fresh chicken from Thailand. The campaign was expected to boost the country's poultry exports in the latter half of 2005.

Cases of avian influenza may occur year round, but there is a seasonal pattern, since the survival and the viability of influenza A virus are known to increase at lower environmental temperatures. Such an upsurge is expected towards summer's end. For instance, since 2001, H5N1 viruses have continued to circulate in mainland China with a seasonal pattern, peaking from October to March, when the mean temperature is below 20 C. See Li, Guan et al, 2004: "Genesis of a highly pathogenic and potentially pandemic H5N1 influenza virus in eastern Asia," Nature 430, 209-213. (Promed 7/11/05)

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Indonesia (Jakarta): Avian Influenza Suspected as Cause of 3 Recent Deaths
A man and his 2 daughters have died of suspected avian influenza in Indonesia, authorities said 15 Jul 2005, and initial investigations showed they had no contact with poultry. The victims, a 38-year-old man and his 2 daughters, ages 9 and one, would be the country's first human fatalities linked to the virus. They lived in a suburb of Jakarta and all died in the last week and a half, Health Minister Siti Fadilah Supari said. "These are suspected avian influenza cases," Supari said. "We have sent specimens to Hong Kong to confirm the results, which will take 7 to 10 days." All were suspected of catching the deadly H5N1 strain of avian influenza virus, she said. Dr. Georg Petersen, a WHO representative, said that while the 3 Indonesian family members had no known contact with poultry, a more thorough investigation could turn up evidence to the contrary. Supari said the man's wife, his son, and their 2 maids have shown no symptoms of the disease; tests have been carried out on more than 300 people who were in contact with the family. In June 2005, the government announced its first bird flu case, saying a farm worker in South Sulawesi Province had been exposed to avian influenza but did not develop symptoms of infection.

The situation regarding the 3 fatalities in a single family in Indonesia has become confused. The deaths were initially attributed to bacterial infection, and avian influenza denied as a possible cause. 24 hours later this opinion was reversed and avian influenza became the presumptive diagnosis on the basis of undisclosed diagnostic tests. Later it was indicated that confirmation of the suspected diagnosis would not be available for several days until further tests had been completed in Hong Kong. Also, the age of one of the daughters is given variously as one or 10 years. The family is reported to have travelled abroad, but this has been denied by a relative. The family is reported to have had no contact with poultry, but this is still being investigated. Further information is awaited. (Promed 7/15/05)

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Japan (Ibaraki): Fresh case of H5N2 strain bird flu
A fresh case of bird flu has been confirmed on a chicken farm neighboring earlier outbreaks discovered in eastern Japan late June 2005. An official with Ibaraki prefecture said tests had confirmed an outbreak of bird flu, which was likely to be the same weak strain found a few weeks earlier. The less virulent H5N2 strain was first found at a chicken farm in Ibaraki, 26 Jun 2005.He said the latest case shares many similarities with the earlier outbreaks, which saw no drastic rise in fowl deaths that would have indicated the presence of a virulent disease. The government has ordered all 8500 chickens at the farm in the latest case culled. It was the first case of the H5N2 strain discovered in Japan. The government restricted the movement of chickens in a 5 km radius around the farm. It is located about 1.25 km from the first outbreak. The virulent H5N1 strain was found in previous avian flu outbreaks in Japan early 2004. (Promed 7/11/05)

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Indonesia: Poliomyelitis update
22 new polio cases were confirmed in Indonesia, bringing the total number of cases to 122. The new cases are from West Java province. Recently confirmed cases in Sumatra and Central Java occurred outside the area where two emergency vaccination campaigns were held 31 May and 29 June 2005. A large outbreak response immunization targeting 78,000 children aged less than five years was held from 26 June around the case in Central Java. Sumatra and Central Java will be included in the next phase of the large-scale immunization campaigns, which will start August 2005. More information on the epidemiology of this ongoing outbreak (epidemiologic curve by date of onset and province of residence, information on the vaccination histories of the cases) would be of use in assessing the efficacy of the ongoing control measures as well as the overall epidemic situation. (Promed 7/8/05; WHO 7/8/05 http://www.who.int/csr/don/2005_07_08/en/index.html)

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Russia: Crimean-Congo Hemorrhagic Fever in Stavropol and Rostov region
In Stavropol the diagnosis of Crimean-Congo hemorrhagic fever (CCHF) has increased since April 2005. So far in 2005, 28 people have been diagnosed with this disease according to the Russian Department of Consumer Needs Surveillance. At present, 19 people are getting treatment in hospital, 6 of whom have been laboratory-confirmed with CCHF. 6500 citizens of Stavropol have sought medical care after tick bites due to concern about infection with hemorrhagic fever. In comparison, during 2004, 4500 sought medical care. Tick activity is very high this year, and more than 10 million dollars have been allocated for the purposes of prevention and treatment of hemorrhagic fever. About 4.9 million rubles [USD 170 000] have been allocated to disinfest rest areas and summer camps. This money was also used to prepare hospitals to admit patients with hemorrhagic fever and inform the population. CCHF is endemic in this part of Russia. In the Stavropol area, the CCHF seasonal epidemic seems to peak around April and May. The CCHF virus circulates between ticks and small vertebrates in the wild, and eventually a mature infected tick feeds on humans (with a fatality rate of approximately 30 percent).

13 cases of CCHF have been recorded 7 Jul 2005 in the Rostov Region. According to the Rostov Region Administration, that is almost 25 percent more than for the whole of 2004. The largest number of cases has been recorded in the Salskiy and Orlovskiy Districts of the region. The recent decline in incidence of CCHF is a result of greater awareness among regional and city hospital staff of the consequences of outbreaks of serious diseases such as CCHF. In particular, training of medical staff responsible for implementing primary anti-epidemic measures has been improved. The Rostov Region has a common border with the Stavropol Region. Only 9 cases of CCHF were recorded in the Rostov Region in 2004, giving a morbidity index of 0.02 per 100 000 inhabitants. (Promed 7/8/05, 7/10/05)

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Russia: Rabies, human and animal, Russia overall and Lipetsk region
About 3000 cases of rabies among animals have been registered during the first 5 months of 2005 in Russia and there were 9 fatal cases among people who had contact with infected animals. In the village of Krasnoye in the Lipetsk region, a sick dog bit 5 children, all of whom have been taken to the regional hospital. Since the beginning of 2005, 1500 persons have presented themselves for consultation and medical aid in Lipetsk. Recently, a man has died from rabies in Moscow after visiting relatives in the Zadonskiy district of the Lipetsk region. In June 2005, in the forest near Zadonskiy, he killed and skinned a fox, when he was probably infected. The man felt discomfort when he returned to Moscow, but he sought medical aid too late. Preventive vaccination has been given to all members of his family, including relatives in the Lipetsk region. Already in 2005, 120 cases of rabies have been registered in the Lipetsk region (most in Lipetsk and Dolgorukovsky districts; there were only 60 in all of 2004). 65 percent of the infected animals are foxes, 18 percent are dogs, almost 14 percent are domestic cattle. Already 228 persons are in a high-risk group--they have been bitten by or had contact with sick animals. 3 of them have refused to undergo vaccination. (Promed 7/8/05)

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Russia (Krasnoyarsk): Tick-borne encephalitis data
The number of people hospitalized with Tick-borne Encephalitis is increasing in the Krasnoyarsk area. 121 people, including 13 children, were hospitalized during 26 Jun - 2 Jul 2005. Half of those admitted are inhabitants of the Krasnoyarsk area. Tick activity does appear to be decreasing in the region. (Promed 7/14/05)

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Russia (Rostov): Botulism cases, canned food
15 cases of botulism have been reported in Rostov. 2 women have died from botulism in Sholohovo rayon. Botulism is a serious intoxication generally associated with ingestion of food products that are contaminated with the serotype of Clostridium botulinum that produces toxin. The oblast (province) sanitary epidemiological surveillance center is currently checking sale points and the food industry. Physicians are recommending people not to eat food from cans that have swollen and are also recommending greater care during the process of food canning. Most of the cases of botulism related to canned food are due to improper home canning, but commercially canned food has been implicated on occasion. Spores of C. botulinum are quite ubiquitous in the environment and may cause botulism through in situ growth and toxin formation, as occurs in the intestinal tract of infants (infant botulism) or adults (adult colonization botulism) or a contaminated wound (wound botulism). Additionally, botulism is a category A bioterrorism disease, and the toxin can even be aerosolized. (Promed 7/12/05)

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Australia (Queensland): Outbreak of Salmonella among traveling US students
Queensland Health and OzFoodNet are continuing to investigate a recent outbreak of Salmonella enterica serotype Typhimurium infection among visiting students aged 10 to 13 years and teachers from southeastern Virginia and North Carolina, USA. In total, 31 students and 3 teachers were affected from the touring group of 44, who had been traveling through Queensland by bus and have now returned to the USA. The epidemiological investigation has identified that infection was probably foodborne, and the most likely vehicle of transmission was an egg-based dessert served at one of the restaurants the group attended. 28 of the 34 cases were hospitalized, and 19 cases were laboratory-confirmed as Salmonella Typhimurium (phage type pending). This appears to be an isolated incident. Assessment of recent Queensland data has not indicated an increase in serotype Typhimurium cases. Queensland Health has been working with the restaurant owners and produce suppliers to investigate the reasons the contamination occurred. The investigation into the source of the contamination is continuing. (Promed 7/13/05)

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Americas
USA: USDA clears BSE cow's herd of disease
The US Department of Agriculture (USDA) says it has found no more cases of bovine spongiform encephalopathy (BSE) in the Texas cattle herd that the nation's second BSE-infected cow came from. The agency announced 10 July 2005 that 67 cattle culled from the herd had all tested negative. A hold order on the herd, which has not been identified, was lifted. Officials had said earlier that they would test all cattle in the herd that were born within a year before or after the 12-year-old Brahma cross beef cow that tested positive for BSE in June 2005, plus any offspring of that cow born in the past 2 years. The agency said it was continuing to trace cattle from the infected cow's birth cohort that are no longer part of the same herd. USDA spokesman Larry Cooper said there are no rules about how long markets must keep sale documents, but he expressed confidence that "a good number" of the cattle could be traced. The infected cow had spent its entire life on the same ranch. Officials suspect that it contracted BSE by eating contaminated feed, since it was born well before the government banned feeding of cattle protein to cattle in 1997. The cow arrived dead at a slaughterhouse Nov 2004 and was then shipped to a pet food company in Texas. The carcass was kept out of the food and animal feed chains. The Texas cow was the first known case of BSE in a US-born animal. The nation's first case, detected in Dec 2003, involved a Canadian-born dairy cow in Washington State. (CIDRAP 7/12/05 http://www.cidrap.umn.edu/cidrap/content/other/bse/news/july1205bse.html)

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USA/Canada: Agriculture Secretary announces next steps for importing Canadian cattle
Agriculture Secretary Mike Johanns today outlined the steps necessary to reopen the U.S. border to Canadian cattle under 30 months of age and other ruminants. "We will move as expeditiously as possible to begin importing Canadian cattle, but we will do so very carefully to ensure the minimal risk rule criteria are clearly met," Johanns said. "We are coordinating very closely with other U.S. and Canadian government agencies to make certain the correct procedures are in place to properly inspect shipments and verify that our criteria are met." USDA's Animal and Plant Health Inspection Service (APHIS) will issue Standard Operating Procedures to their field offices, the Canadian Food Inspection Agency and U.S. Customs and Border Protection offices. USDA's Food Safety and Inspection Service (FSIS) will issue an updated list of approved products that will be allowed across the border. The agency will also issue instructions to FSIS personnel who will inspect cattle received for immediate slaughter. The process for importing shipments of live cattle and other ruminants, once the preparatory steps are complete, will begin in Canada. The Canadian Food Inspection Agency will issue health certificates to verify the age and identification of the animal and ensure it meets the minimal risk rule criteria. Once verified, U.S. Customs and Border Protection will review the documentation and confirm the shipments are appropriate for entry into the US. The animals will then be released to APHIS veterinarians at border inspection facilities who will inspect the cattle and validate the Canadian certification. Additionally, FSIS inspection personnel will verify U.S. requirements are met at the point of slaughter. (USDA 7/15/05 http://www.usda.gov/)

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USA (Massachusetts): Landscaper contracts tularemia
The Vineyard's first tularemia case of 2005, a 50-year-old male landscaper, may have contracted the potentially fatal disease after handling a dead rabbit he found while working in Edgartown, state public health officials said early July 2005. The latest case, which was confirmed June 2005, is also notable because it was an oropharyngeal brand of tularemia, indicating that the affected glands were in the man's throat. All but 7 of the 30 cases confirmed on the Island since the outbreak began in summer 2000 have been the pneumonic form, leading medical investigators to advance the theory that people have inhaled airborne particles contaminated with the tularemia bacterium. Epidemiologists at the state department of public health (DPH) now believe that the latest victim also inhaled the bacteria. Nearly all the victims of the tularemia outbreak have been landscapers or people who worked predominantly outdoors. The outbreak claimed the life of one victim, killing a 43-year-old man August 2000.

Tularemia is a powerful but rare bacterial disease. Rabbits are the most common carriers, in addition to rodents, but a bite from a dog tick is the most typical way the disease is transmitted to people. On the Vineyard, though, the pneumonic cases have dominated, making the Island the only place in the US to experience an outbreak of pneumonic tularemia. DPH officials said there are no other confirmed or probable cases of tularemia on the Island. They have analyzed about a dozen blood samples from landscapers on the Vineyard who have been sick, possibly with tularemia, but only this one has turned up positive for the disease so far. Tularemia affects about 200 people a year nationwide. Alfred DeMaria, the director of communicable disease control at the DPH, said doctors are treating landscapers who become sick with antibiotics before there is concrete evidence of tularemia infection. The CDC has advised landscapers to wear dust masks as a measure of protection from inhaling tularemia bacteria. (Promed 7/11/05)

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USA (Minnesota): Children sickened by E. coli outbreak
An E. coli outbreak in Anoka County has affected children who went swimming on Coon Lake Beach, 21-23 Jun 2005, the Minnesota Department of Health said. There were 4 confirmed E. coli O157:H7 infections associated with the outbreak among children ranging in age from 2 to 13 years. 2 were hospitalized and released. The children showed symptoms of infection between 1 and 5 days after swimming in the lake. Symptoms included stomach cramps and diarrhea. Anoka County closed the beach 8 Jul 2005. It will reopen when water tests indicate it is safe, health officials said.

In the summer, it often happens that cases of O157:H7 disease are associated with poorly cooked hamburger (or sometimes other food contaminated with cattle feces) or related to a petting zoo, but water--either drunk or swum in--may also be a vehicle for transmission. A 6 Jun 2005 article in the journal Pediatrics reported that early recognition of infection with E. coli O157:H7, with the use of intravenous plasma expansion with fluids, could lower the risk of developing hemolytic uremic syndrome: Ake JA, Jelacic S, Ciol MA, et al: Relative nephroprotection during Escherichia coli O157:H7 infections: association with intravenous volume expansion. Pediatrics 2005; 115:673-80. (Promed 7/12/05)

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USA (New York): 3 cases of Listeriosis
Health officials are investigating whether 3 women with a rare bacterial infection ate recalled food. The Syracuse area residents have been diagnosed with listeriosis, which is a potentially fatal bacterial disease caused by eating contaminated food. Onondaga County health officials say the 3 women, ages 48, 70, and 77, were hospitalized. The USA Food and Drug Administration announced 28 Jun 2005 a recall of Golden Taste Tuna Deluxe, Scallion Tuna Deluxe, and White Fish Salad because they may be contain Listeria monocytogenes, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people and others with weakened immune systems. Although healthy persons may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, listeria infection can cause miscarriages and stillbirths among pregnant women. Golden Taste, Inc. also recalled Golden Taste Baked Salmon Salad 7 Jul 2005 due to listeria contamination (Promed 7/8/05; FDA 7/7/05 http://www.fda.gov/oc/po/firmrecalls/goldentaste07_05.html)

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USA (Multistate): Salmonellosis, unpasteurized orange juice alert
The Food and Drug Administration (FDA) is issuing a nationwide warning to consumers against drinking unpasteurized orange juice products distributed under a variety of brand names by Orchid Island Juice Company of Florida because they have the potential to be contaminated with Salmonella enterica serotype Typhimurium and have been associated with an outbreak of human disease caused by this organism. Salmonellosis can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Otherwise healthy individuals may suffer short-term symptoms such as high fever, severe headache, vomiting, nausea, abdominal pain and diarrhea. Long-term complications can include severe arthritis. To date, there have been reports of 15 cases of a matching strain of illness directly linked to a history of consumption of Orchid Island Juice from mid-May to Jun 2005 in Michigan, Ohio and Massachusetts. In addition, at least 16 other states have reported cases of serotype Typhimurium infection that match this specific strain. Further investigations are underway to determine if these infections are also related to these products or not.

The unpasteurized product comes in a variety of containers distributed to retail stores and restaurants under various brand names. The products are identified on the labels as freshly squeezed or fresh orange juice. The following labels are involved: Nino Salvaggio's, Westborn Market, and Natalie's Orchid Island Juice. These products do not bear a warning label that the juice is unpasteurized. Such warning labels do appear on many unpasteurized juice products, so consumers should not assume these products are safe to consume simply because they do not bear the "unpasteurized" warning label. (Promed 7/9/05; FDA 7/8/05 http://www.fda.gov/bbs/topics/NEWS/2005/NEW01203.html)

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Note
***This is not an Alert. However, APEC EINet is distributing this Newsbrief early as several avian influenza events have occurred this week. We hope you find this information helpful and timely***

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1. Updates
Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies, 11 July 2005
In week 25, an increase in influenza B activity continued to be observed in New Zealand, causing widespread outbreaks in children and young adults, while in Australia influenza A activity increased and caused a regional outbreak. In other parts of the southern hemisphere activity remained low. In the northern hemisphere, activity was also low, except in Hong Kong, where medium-to-high levels of influenza A(H3N2) activity continued for the 15th week.

Australia. Influenza A activity continued to increase during week 25 but remained within normal seasonal limits. Influenza A(H3N2) was predominant followed by influenza B and lesser numbers of A(H1) virus. The majority of influenza B viruses are B/Shanghai/361/2002-like with small numbers of B/Hong Kong/330/2001-like strains.

Cambodia. An outbreak of respiratory disease in children occurred in Phnom Penh Cambodia. Preliminary results suggested that the outbreak was associated with influenza B and RSV.

Hong Kong. Although the number of influenza viruses isolated still remained high for the 15th week, signs were noticed that influenza activity was gradually easing since week 24 In week 25, a total of 459 influenza viruses were isolated, most of which were influenza A(H3N2) viruses.

New Zealand. Influenza B virus continued to cause widespread outbreaks in children and young adults. The consultation rate of influenza-like illness continued to increase during week 25 and was higher compared to the same period last year.

Other reports. During week 25, low influenza activity was detected in Japan (H3), Mexico(A and B). Philippines reported no influenza activity. (WHO 7/11/05 http://www.who.int/csr/disease/influenza/update/en/)

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Cholera, diarrhea & dysentery
Korea/Philippines
Quarantine officials announced 3 Jul 2005 that a Korean man who returned from the Philippines was found to be infected with cholera, calling for more stringent hygienic rules. "A Korean male tourist, who is in quarantine now, has shown some symptoms of cholera such as diarrhea and high fever when he returned home on 30 Jun 2005," said Park Sun-hee of the Korea Center for Disease Control and Prevention (KCDC). The patient in his 30s has almost completely recovered. KCDC is conducting an epidemiological test of the germ carrier as well as the tourist's family members. Officials are also trying to find the source of the virus. KCDC is in the process of testing 234 passengers and crew members still in Korea who were on the same flight. No additional cholera patient has been reported, but people who are traveling to Southeast Asia should remain on alert. The agency advised people to drink boiled water, eat well-cooked food and wash hands before having meals to avoid cholera infection. (Promed 7/8/05)

Taiwan (Tainan)
Following the release of test results which show a marked increase of non-toxigenic Vibrio cholerae, the bacterium that causes cholera, in the environment, the Taiwan CDC noted 6 Jul 2005 that regional sanitation in southern counties had taken a turn for the worse since widespread flooding in Jun 2005. Tainan County and Tainan City, where Taiwan's 2 confirmed indigenous cholera cases surfaced in Jun and Jul 2005, have both seen a deterioration in sanitation conditions, said CDC division director Yang Kuo-hsi. However, the CDC currently has no evidence to link the rise in bacteria levels and the cases. Even though both confirmed cholera cases were caused by the more harmful toxigenic Vibrio cholerae Ogawa O1 strain and probably have no direct link to the flooding, the public should still take precautions against infection from the non-toxigenic Vibrio cholerae, said Yang. The CDC speculates that proliferation of the non-toxigenic bacterium was a result of the flooding in southern counties in Jun 2005, when water in fishponds and septic tanks overflowed into the surrounding environment. The public should pay greater attention to food hygiene in the summer period, the CDC urged.

The recent cases mark the first time in 5 years that Taiwan has recorded indigenous outbreaks of cholera. The second case was reported to the CDC after the patient fell ill 26 Jun 2005. The victim was quarantined and is currently being treated in Chi-Mei Hospital, the same facility where the first reported cholera sufferer was treated. After the 6 Jul 2005 inspection, Yang said, "They were hospitalized in different sickrooms. Our investigation suggests that there should be no relation between the 2 cases." The CDC had reported both cases to the WHO, and said it is "fulfilling its duty as a member of the international community." CDC deputy director Shih Wen-yi disclosed, however, that the WHO had no record of receiving the first report of indigenous cholera from Taiwan that was sent 23 Jun 2005. (Promed 7/8/05)

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Dengue
Philippines
The North Cotabato provincial dengue control and prevention division has urged town mayors to help in their campaign against dengue. Dra. Perlita Albano, the health officer of Kidapawan City, has attributed the increase of dengue cases in the city to the lack of cooperation among residents, especially the implementation of 4 o'clock habit in their areas (i.e. cleaning surroundings, draining of water accumulated in tires, bottles, flower vases, and roof gutters to prevent mosquitoes from breeding). Dept of Health records show that 673 cases of confirmed dengue patients were admitted in 5 government hospitals from January to June of the 2005. Kidapawan City ranked number one within the province, with total cases of 189 cases, with 2 fatalities. The city's private hospitals reported 32 dengue patients in June 2005, and the majority came from Barangays Poblacion, Nuangan and Ilomavis. Councilor Jonares John Amador passed a resolution asking City Mayor Rodolfo Gantuangco to allocate funds for the massive campaign. His resolution said the city would tap non-government organizations, public and private schools, barangay officials and all media organizations in the city to help educate the residents on how to combat dengue.

Health Secretary Francisco Duque III has said that there were 5396 dengue patients in various government hospitals nationwide from Jan to 15 Jun 2005. There were 77 fatalities nationwide. Duque attributed the increase to the onset of rainy season. He said that the participation of the local authorities would significantly reduce dengue cases. Sec. Duque said the regions with the highest number of dengue cases were Northern Mindanao with 1 242 cases, National Capital Region with 965 cases, Caraga with 683 cases, and Central Luzon, with 603, and Central Visayas with 579 cases. Dengue fever is a disease spread by the mosquito Aedes aegypti. Symptoms of dengue include fever, rashes, severe headache, muscle and joint pains, loss of appetite and vomiting. (Promed 7/8/05)

Viet Nam
At least 10 000 people in Vietnam's southern Mekong Delta have been infected with dengue fever so far in 2005, of whom 13 died. From 6 Jun to 7 Jul 2005, the country detected some 3 300 dengue fever patients, including 10 fatalities, according to newspaper Saigon Liberation 8 Jul 2005. Most of local sufferers are from southern localities such as the provinces of Soc Trang, Dong Thap, Hau Giang and Bac Lieu, whose weather is most favorable for the development of mosquitoes. To minimize the number of new infections, local health workers are encouraging residents to kill mosquitoes and their larvae. More pesticides are given to the residents. Vietnam reported 73 300 cases of dengue fever infections, including 101 fatalities in 2004, up 108 percent and 74 percent against the year earlier, respectively. (Promed 7/8/05)

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West Nile Virus
USA
As of July 12, 2005, eleven states have reported 25 cases of human WNV illness in 2005. Nineteen (79%) of the 24 cases for which such data were available occurred in males; the median age of patients was 45 years (range: 17--80 years). Date of illness onset ranged from May 14 to June 30; one case was fatal. Seven presumptive West Nile viremic blood donors (PVDs) have been reported in 2005. Of these, 5 were reported in Texas, and 2 in Arizona. In addition, 281 dead corvids and 96 other dead birds with WNV infection have been reported from 16 states during 2005. WNV infections have been reported in horses in 11 states. WNV seroconversions have been reported in 40 sentinel chicken flocks in five states (Arizona, Arkansas, California, Florida, and Minnesota). A total of 439 WNV-positive mosquito pools have been reported in 13 states. For more information visit: http://www.cdc.gov/ncidod/dvbid/westnile/index.htm and http://westnilemaps.usgs.gov. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5427a3.htm (MMWR July 15, 2005 / 54(27);678-679)

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2. Articles
Prevention and Control of Influenza: Recommendations of ACIP
Summary: “This report updates the 2004 recommendations by the Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine and antiviral agents (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2004;53[No. RR-6]:1--40). The 2005 recommendations include new or updated information regarding 1) vaccination of persons with conditions leading to compromise of the respiratory system; 2) vaccination of health-care workers; 3) clarification of the role of live, attenuated influenza vaccine (LAIV) in vaccine shortage situations; 4) the 2005--06 trivalent vaccine virus strains: A/California/7/2004 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like, and B/Shanghai/361/2002-like antigens (for the A/California/7/2004 [H3N2]-like antigen, manufacturers may use the antigenically equivalent A/New York/55/2004 virus, and for the B/Shanghai/361/2002-like antigen, manufacturers may use the antigenically equivalent B/Jilin/20/2003 virus or B/Jiangsu/10/2003 virus); and 5) the assessment of vaccine supply, timing of influenza vaccination, and prioritization of inactivated vaccine in shortage situations. A link to this report and other information can be accessed at http://www.cdc.gov/flu.” http://www.cdc.gov/mmwr/preview/mmwrhtml/rr54e713a1.htm (MMWR July 13, 2005 / 54(Early Release);1-40)

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Highly Pathogenic H5N1 Influenza Virus Infection in Migratory Birds
Liu J et al. Science. 2005 Jul 6
Abstract: “H5N1 avian influenza virus (AIV) has emerged as a pathogenic entity for a variety of species, including humans, in recent years. Here we report an outbreak among migratory birds on Lake Qinghaihu, China, in May and June 2005, in which hundreds of thousands of birds were affected. Pancreatic necrosis and abnormal neurological symptoms were the major clinical features. Sequencing of complete genomes of four H5N1 AIV strains isolated revealed to be reassortants related to a peregrine falcon isolate from Hong Kong and showed known "highly pathogenic" characteristics. Experimental animal infections reproduced typical highly pathogenic AIV-infection symptoms and pathology.”

The paper includes a map demonstrating H5N1 AIV prevalence sites during the 2004 outbreak in China and migratory routes of the bar-headed goose to Lake Qinghaihu. The paper does not mention the number of birds sampled. Reportedly the Chinese have vaccinated 2 million chickens in the region following the Qinghai outbreak. The results of this investigation support the conclusion of the authors that this virus has the potential to be a global threat. (Promed 7/14/05)

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Isolation of a genotypically unique H5N1 influenza virus from duck meat imported into Japan from China
Mase M et al. Virology. 2005 Jun 17
“An H5N1 influenza A virus was isolated from duck meat processed for human consumption, imported to Japan from Shandong Province, China in 2003. This virus was antigenically different from other H5 viruses, including the Hong Kong H5N1 viruses isolated from humans in 1997 and 2003. Sequence analysis revealed that six genes (PB1, PA, HA, NA, M, and NS) of this virus showed > 97% nucleotide identity with their counterparts from recent H5N1 viruses, but that the remaining two genes (PB2 and NP) were derived from other unknown viruses. This duck meat isolate was highly pathogenic to chickens upon intravenous or intranasal inoculation, replicated well in the lungs of mice and spread to the brain, but was not as pathogenic in mice as H5N1 human isolates (with a dose lethal to 50% of mice (MLD(50)) = 5 x 10(6) 50% egg infectious doses [EID(50)]). However, viruses isolated from the brain of mice previously infected with the virus were substantially more pathogenic (MLD(50) = approximately 10(2) EID(50)) and possessed some amino acid substitutions relative to the original virus. These results show that poultry products contaminated with influenza viruses of high pathogenic potential to mammals are a threat to public health even in countries where the virus is not enzootic and represent a possible source of influenza outbreaks in poultry.” (Promed 7/14/05)

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Rapid Assessment of Influenza Vaccination Coverage Among HMO Members--Northern California Influenza Seasons, 2001--02 Through 2004--05
“The Vaccine Safety Datalink (VSD) is a collaborative project involving CDC and eight health maintenance organizations (HMOs) in the United States. Computerized data on vaccination, medical outcomes, and patient demographics are collected and linked under a standard protocol at multiple HMOs. Beginning with the 2003--04 influenza season, the VSD team and one of the HMOs, Kaiser Permanente Northern California (KPNC), established an automated system for rapid detection of potentially adverse events after vaccinations among its members. During the 2004--05 influenza season, in response to the influenza vaccine shortfall and resulting prioritization of vaccine distribution, this rapid analysis system also was used to assess influenza vaccination coverage weekly among KPNC members. The results indicated that KPNC followed Advisory Committee on Immunization Practices (ACIP) prioritization guidelines by targeting influenza vaccination to children aged 6--23 months and adults aged >65 years. For the 2005--06 influenza season, the rapid analysis system should be expanded to include data from additional HMOs and more detailed information on vaccinees (e.g., high risk for influenza complications) to better characterize influenza vaccination coverage during the 2005--06 influenza season on a weekly basis….” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5427a2.htm (MMWR July 15, 2005 / 54(27);676-678)

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Using climate to predict disease outbreaks: a review
This document evaluates the current and future potential of climate-based disease early warning as a means of improving preparedness for, and response to, epidemics. Based on the history of Early Warning Systems (EWS) development to date, the authors develop a conceptual framework for constructing and evaluating climate-based EWS. They identify the climate-sensitive diseases of major public health importance and review the current state of the art in climate-based modeling of these diseases, as well as future requirements and recommendations. This document lays the foundation for future development of EWS that capitalize on new knowledge about the interaction between climate and infectious diseases, as well as improved capacity for forecasting climate. No large scale EWS is yet in place but for some diseases, such as malaria and Rift Valley fever, early warnings based on climatic conditions are beginning to be used in selected locations to alert ministries of health to the potential for increased risk of outbreaks and to improve epidemic preparedness. However, the use of such models is just beginning, and experience with their use is limited. A number of models are in the pipeline, although more work is required before climate-based models can realize their full potential. This joint CSR, PHE and RBM publication was prepared with the understanding that climate-based EWS, when fully developed, do have the potential to provide increased lead-times in which to implement epidemic prevention and/or control activities. Therefore their development should be encouraged, and both positive and negative experience of using such systems should be documented. (WHO http://www.who.int/globalchange/climate/en/)

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Update: Syringe Exchange Programs--United States, 2002
“Syringe exchange programs (SEPs) provide sterile syringes in exchange for used syringes to reduce transmission of human immunodeficiency virus (HIV) and other bloodborne infections associated with reuse of contaminated syringes by injection-drug users (IDUs). This report summarizes a survey of SEP activities in the United States for January--December 2002 and compares the results with those of previous surveys. The findings indicate that in 2002, for the first time in 8 years, the number of SEPs, the number of localities with SEPs, and public funding for SEPs decreased nationwide; however, the number of syringes exchanged and total budgets across all programs continued to increase. SEPs can help prevent bloodborne pathogen transmission by increasing access to sterile syringes among IDUs and enabling safe disposal of used syringes. Often, programs also provide other public health services, such as HIV testing, risk-reduction education, and referrals for substance-abuse treatment….” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5427a1.htm (MMWR July 15, 2005 / 54(27);673-676)

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3. Notifications
International Symposium on Veterinary Epidemiology and Economics
You are invited to submit an abstract for the 11th International Symposium on Veterinary Epidemiology and Economics (ISVEE XI). The symposium will be held in Cairns, Australia 6-11 Aug 2006. The Theme will be Innovation: Reshaping Veterinary Epidemiology. ISVEE symposia are held every 3 years, and over 600 delegates are expected at Cairns. 7 themes will run concurrently for the week. Epidemiology and animal health economics are disciplines that depend on integrating expertise from a wide range of people, from virologists to sociologists, from engineers to ecologists. Those who have never attended an ISVEE, in particular those who may not call themselves epidemiologists or economists but who share common interests in epidemiology, are welcome.

You are invited to submit an abstract to be considered for oral or poster presentation in one of the conference themes outlined on the web site. Abstracts must be submitted by 14 Sep 2005. Abstracts are to be submitted online, via our web site. All necessary details are available in the “call for abstracts brochure”, downloadable from the web site. Authors will be informed of their acceptance and method of presentation by 7 Dec 2005. If you would like to keep up-to-date with ISVEE announcements, including the soon-to-be-announced pre- and post-ISVEE workshops, please register at <http://www.isveexi.org/content.php?page=register>

Further information can be found at: <http://www.isveexi.org> Dr John Morton for the ISVEE XI Organising Committee
Senior Lecturer in Veterinary Epidemiology and Biometry, School of Veterinary Science, University of Queensland 4072, Queensland Australia
Ph: +61 (0)7 3365 2107; Fax: +61 (0)7 3365 1255; Mob: 0407 092 558 j.morton@uq.edu.au (Promed 7/13/05)

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2005 Annual Conference on Assessment Initiative--September 20--22, 2005
The 2005 Annual Conference on Assessment Initiative will be held Sep 20--22, 2005, in Seattle, Washington, USA. The purpose of this meeting is to discuss and share information on innovative systems and methods that improve the way data are used to inform public health programs, services, and policy at the state and local levels. Sessions will cover data dissemination, applied data analysis and presentation techniques, and community health assessment processes and outcomes. The conference is cosponsored by CDC and the National Association for Public Health Statistics and Information Systems. Participants include staff from state and local health departments, federal agencies, and community organizations involved or interested in the collection, analysis, and dissemination of data for community health assessment. Conference attendees can register online at http://www.psava.com/cha2005. The deadline for online registration is Sept 9, 2005. Please visit: http://www.cdc.gov/epo/dphsi/ai/conference_training.htm. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5427a4.htm (MMWR July 15, 2005 / 54(27);679)

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Webcast on Human Papilloma Virus
CDC will present a webcast, "HPV and Cervical Cancer: An Update on Prevention Strategies," on August 9, 2005, 1:00--2:00 p.m. EDT. Genital HPV infection is one of the most common sexually transmitted diseases. New information is available about the natural history of HPV infection, the association of different HPV types with various clinical manifestations, HPV transmission, and methods of HPV prevention. In addition, the Food and Drug Administration recently approved the use of a commercially available HPV DNA test. This new information about HPV might require changes in approaches to cervical cancer screening in primary-care practices and in counseling and educating patients and their sex partners. The webcast will address cervical cancer screening guidelines and strategies for preventing genital HPV infection. Please visit: http://www.phppo.cdc.gov/phtn/hpv-05. Information about registration is also available via telephone 800-418-7246 or 404-639-1292. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5427a5.htm (MMWR July 15, 2005 / 54(27);679)

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A Wealth of Knowledge Free to the World: JHSPH OpenCourseWare
The Johns Hopkins Bloomberg School of Public Health's OpenCourseWare (OCW) project provides access to content of the School's most popular courses. Free public health courses on issues such as refugee health care, family planning, and immunization are available through http://ocw.jhsph.edu/. The project is designed to allow students to learn at their own pace about projects they are interested in. The courses include syllabi, lecture notes, reading lists, and homework assignments. The Bloomberg School's OCW: does not require that participants register; does not grant degrees or certificates and; does not provide access to JHSPH faculty. (JHSPH http://ocw.jhsph.edu/, APHA The Nation’s Health June/July 2005)

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Public health and medical experts to hold meeting in Macau
From: Communicable Disease Division of Surveillance and Epidemiology Branch, Centre for Health Protection, Department of Health (cdss@dh.gov.hk)

A delegation of medical and public health professionals, led by Director of Health, Dr Lam Ping-yan, will attend the Fifth Tripartite Meeting of Guangdong-Hong Kong-Macau Expert Group on the Prevention and Control of Infectious Diseases to be held in Macau July 13 and 14, 2005. During the meeting, experts from the Centre for Health Protection, the Hospital Authority, and Princess Margaret Hospital will discuss issues relating to the overall strategy in the control of communicable diseases and the further co-operation and exchange of medical and public health experts. (Hong Kong Dept of Health, 7/12/05)

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Codex commission adopts code of practice to minimize antimicrobial resistance
The Codex Alimentarius Commission (CAC) adopted more than 20 new and amended food standards during its annual meeting. Among the measures adopted was a code of practice to minimize and contain antimicrobial resistance. Some 120 countries were represented at this year's Codex session, plus the European Community, a member organization. Codex is an international food standards-setting body established by the UN Food and Agriculture Organization (FAO) and the WHO. It has 172 members, all of which are members of FAO or WHO or both.

Codex tentatively agreed to a task force addressing antimicrobial resistance. A formal decision is set for next year. WHO, FAO and the World Organization for Animal Health (OIE) have developed guidelines for the prudent use of antimicrobials in treatment of human illnesses and animal production, which the task force will carry forward to ensure food safety. Antimicrobial resistance had been debated for several years and agreement has been difficult because it involves collaboration from different sectors: animal health and production, human health and drug manufacturing. The new task force will bring all these sectors together and develop a holistic approach to this growing problem. Resistance to antimicrobial drugs, such as antibiotics, is an emerging public heath problem caused by a number of factors, including the inappropriate use of antibiotics in humans; antibiotic treatment of illnesses in animals used for human consumption and, in some cases, to promote faster growth. The use of antimicrobials as pesticides is also a factor in antimicrobial resistance. Resistant microorganisms developed in animals used for human consumption may be transmitted to humans mainly by contaminated food. For example, resistant strains of salmonella and other food-borne microorganisms are now frequently encountered, limiting the effective treatment of human infections, which in some cases can result in death. (WHO 7/12/05 http://www.who.int/mediacentre/news/notes/2005/np17/en/index.html)

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4. APEC EINet activities
EINet distance-learning course to be launched in Aug 2005
The EINet team is planning to launch in August 2005 the updated “Emerging Infections of International Public Health Importance” course on our Website. The course will include new lectures and is being made available without charge by the APEC EINET project. In early December 2005 EINet is planning to host a virtual symposium on biopreparedness. All APEC economies are welcome to participate. Details will be forthcoming.

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5. To Receive EINet Newsbriefs
APEC EINet email list
The APEC EINet email list was established to enhance collaboration among health, commerce, and policy professionals concerned with emerging infections in APEC member economies. Subscribers are encouraged to share their material with colleagues in the Asia-Pacific Rim. To subscribe, go to: http://depts.washington.edu/einet/?a=subscribe or contact apecein@u.washington.edu. Further information about APEC EINet is available at http://depts.washington.edu/einet/.

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 apecein@u.washington.edu