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Vol. XV No. 4 ~ EINet News Briefs ~ Feb 17, 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: Experts say dual-use H5N1 influenza studies may not hasten pandemic response
- Global: Undetected H5N1 influenza cases seem few, but questions persist
- Bhutan: Reports H5N1 influenza poultry outbreak
- Hong Kong: Swine sampling finds human influenza hybrids
- India: Finds more H5N1 influenza in poultry
- India: Confirms four H5N1 influenza outbreaks in crows
- Nepal: Reports H5N1 influenza poultry outbreaks
- Viet Nam: H5N1 avian influenza situation update
- Viet Nam: H5N1 avian influenza strikes more poultry

2. Infectious Disease News
- Global: WHO says India, Russia must step up MDR-TB surveillance
- Australia: Outbreak of cryptosporidiosis in Cairns, Queensland
- Australia: Melioidosis alert as record numbers fall ill
- Malaysia: 22 students, lecturers of private college contract chikungunya
- New Zealand: Porirua measles cases prompt alert
- Russia: Measles outbreak in St. Petersburg
- Russia: A measles outbreak has affected 100 people and caused one death
- Chile: Hantavirus update
- Mexico: Hepatitis A outbreak among school children
- Mexico: Food poisoning affecting more than 700 people
- USA: 71 Ill with Campylobacter from raw milk dairy
- USA: Multistate outbreak of shiga toxin-producing Escherichia coli O26 infections linked to raw clover sprouts at Jimmy John’s Restaurants
- USA (New York): Legionnaire's hits six at hotel in Albany
- USA (South Dakota): Clostridium causes sickness outbreak in Pierre
- USA (Indiana): Two measles cases confirmed

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

4. Articles
- Development of temporal modeling for prediction of dengue infection in Northeastern Thailand
- Rapid Diagnostic Test-Based Management of Malaria: An Effectiveness Study in Papua New Guinean Infants With Plasmodium falciparum and Plasmodium vivax Malaria
- Vaccine-associated paralytic poliomyelitis in Japan
- Etiology and epidemiology of viral diarrhea in children under the age of five hospitalized in Tianjin, China
- Soil-transmitted helminthiasis: a critical but neglected factor influencing school participation of Aboriginal children in rural Malaysia
- Current epidemiological profile and features of visceral leishmaniasis in People's Republic of China
- Emerged HA and NA Mutants of the Pandemic Influenza H1N1 Viruses with Increasing Epidemiological Significance in Taipei and Kaohsiung, Taiwan, 2009–10
- Effects of School Closure on Incidence of Pandemic Influenza in Alberta, Canada
- Transmission of influenza A(H1N1) 2009 pandemic viruses in Australian swine

5. Notifications
- 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)
China / 1 (1)
Egypt / 1 (0)
Indonesia / 1 (1)
Viet Nam / 2 (2)
Total / 6 (5)

***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: 584 (345) (WHO 2/8/2012)
http://www.who.int/influenza/human_animal_interface/EN_GIP_20120208CumulativeNumberH5N1cases.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: Experts say dual-use H5N1 influenza studies may not hasten pandemic response
International experts say that, while experiments on H5N1 avian flu transmission in mammals are important, publishing full details of such "dual-use" studies likely will not speed up the vaccine response in a pandemic, according to Nature on 8 February 2012.

"I think the research is important, but not for vaccine purposes," said Richard Webby, PhD, of St. Jude Children's Research Hospital in Memphis, Tenn. \ He was referring to two now-famous studies, led by Ron Fouchier, PhD, of the Netherlands and Yoshihiro Kawaoka, DVM, PhD, of the University of Wisconsin, that involved engineering an H5N1 virus and an H1N1-H5N1 hybrid that were transmissible in ferrets via airborne droplets. The Fouchier H5N1 virus was lethal in ferrets, but the Kawaoka hybrid was not.

The studies are slated to be published in Science and Nature, respectively. However, in December the National Science Advisory Board for Biosecurity (NSABB), which advises the US Department of Health and Human services and other agencies, recommended against publishing full details of the studies because of bioterrorism concerns. ("Dual-use" generally signifies research that can be used for both good and bad ends.) The US government agreed with the NSABB, and a maelstrom has ensued over unfettered scientific expression versus concern over public health.

The Nature News said that H5N1 mutation studies could benefit flu surveillance in the long term, according to flu experts, if genetic variations detected in nature are similar to those produced in the lab. Scientists underscored, however, that current flu surveillance systems are sorely lacking, and that a pandemic strain might derive from an entirely different series of mutations.

Another hurdle is economic and political: Governments are unlikely to invest in a vaccine based on strains that might one day cause a pandemic. "Nobody is going to ramp up production of a pre-pandemic vaccine based on these two experimental viruses. That's 100% sure," said Webby. Bram Palache, global government affairs director for vaccines at Abbot Biologicals in Weesp, the Netherlands, agreed that industry will wait for a pandemic strain to be identified and governments to order doses. Albert Osterhaus, PhD, a co-author on Fouchier's study, also agreed that industry will wait for the strain to be identified. But he said screening for mutations could detect variants that could be used to make new seed strains for vaccines, which could help during initial pandemic response.

However, Italian avian flu researcher Ilaria Capua, DVM, PhD, said, "The antigenicity of the virus depends less on any mutations than on where the HA and NA come from," referring to hemagglutinin and neuraminidase, the flu virus's surface proteins.

Jeremy Farrar, MD, PhD, director of the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam, said that officials should focus resources on developing a vaccine that can be produced more quickly than the six months it now takes and on developing a universal flu vaccine. He said the two unpublished studies have underscored the pandemic potential of H5N1.

The full article may be accessed at http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/feb0812dualuse.html
(CIDRAP 2/8/2012)

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Global: Undetected H5N1 influenza cases seem few, but questions persist
The fatality rate for officially confirmed human cases of H5N1 avian influenza infection is a stunningly high 59% (345 deaths in 584 cases). But the current controversy over publishing data about transmissible H5N1 viruses has revived a debate about whether the virus is as lethal as those numbers say.

Some proponents of publishing the full details of two studies involving H5N1 viruses that spread by airborne droplets in ferrets say the true case-fatality proportion is probably much lower, because, they suspect, many mild or asymptomatic cases have gone undetected.

If the real number of infections—the denominator—is much higher, the percentage of fatal cases drops. Some have suggested that the real fatality rate is "orders of magnitude" lower. This argument, however, swims against the tide of scientific findings.

The primary way to detect asymptomatic or subclinical cases is to conduct seroprevalence studies—to look for H5N1 antibodies in people who weren't sick but may have been exposed to the virus, such as contacts of confirmed case-patients, poultry cullers, or residents of a village where poultry outbreaks occurred.

This has been done a number of times, and in nearly all the studies conducted since 2003, the researchers found very few people who had H5N1 antibodies, if any. For example, in a systematic review published in January 2011, Maria D. Van Kerkhove, PhD, and colleagues listed 20 seroprevalence studies, and in the 17 studies conducted since 2003, the proportion of seropositive subjects ranged from 0 to 2.8%, with most of them reporting none.

However, experts say the data are clouded by several uncertainties. One is that researchers differ in their methods and in the antibody titer levels they use to define a positive finding. Another problem is that it's not clear how long H5N1 antibodies persist in the blood. If the antibodies wane with time, a person who is tested months to years after exposure to the virus may test negative even though he or she might have carried antibodies in the past.

Still another difficulty is that if someone had an H5N1 infection and is later tested with an assay based on a different clade (strain) of the virus, the test might not detect the antibodies, experts say.

"There are many, many uncertainties," said Tim Uyeki, MD, MPH, MPP, deputy chief for science in the Epidemiology Branch of the Influenza Division at the US Centers for Disease Control and Prevention (CDC), who has been involved in many clinical studies of H5N1 patients and H5N1 epidemiologic investigations in various countries.

Even with all the unanswered questions, though, most experts seem to think it's unlikely that the number of undetected H5N1 infections is very large.

The full article may be accessed at http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/feb0912subclin.html
(CIDRAP 2/9/2012)

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Asia
Bhutan: Reports H5N1 influenza poultry outbreak
Animal health authorities in Bhutan reported on 16 February 2012 an H5N1 outbreak that killed 87 backyard birds near the southern border town of Phuntsholing. Authorities killed the remaining 27 birds and burned three coops. Earlier in 2012 the virus struck poultry in Bhutan's Thimphu and Chukha districts, according to earlier reports.
(CIDRAP 2/16/2012)

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Hong Kong: Swine sampling finds human influenza hybrids
Officials said 27 of 1,500 samples from the most recent round of testing contained genes from human swine influenza viruses, according to the government's Food and Environmental Hygiene Department (FEHD). The surveillance program at Sheung Shui Slaughterhouse is conducted by Hong Kong, and the results from 14 February 2012 cover tests conducted from mid October 2011 to January 2012. One sample was positive for the 2009 H1N1 virus. Malik Peiris, PhD, who leads the program, said that the finding isn't surprising and is likely to turn up again, given the virus' wide transmission in humans. Of the 27 samples that had human swine influenza genes, two involved H3N2 and 25 were H1N2. The FEHD said the previous two rounds of sampling also detected evidence of swine influenza that contained genes from human strains. Peiris said similar findings have been reported from other parts of the world and that the positive findings don't pose a major human health risk and aren't a food safety threat.
(CIDRAP 2/14/2012)

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India: Finds more H5N1 influenza in poultry
India reported another H5N1 outbreak in Odisha (Orissa) state, where the virus recently recurred. The virus struck a government poultry farm, killing 5,015 of 34,857 susceptible birds, according to the OIE on 4 February 2012. All domestic poultry within a three-kilometer radius of the farm are being culled to control the spread of the disease.

In late January 2012, India's Tripura state, located in northeastern India on the border with Bangladesh, also reported that the virus hit birds at a poultry research farm. Odisha is on India's east coast by the Bay of Bengal.
(CIDRAP 2/6/2012)

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India: Confirms four H5N1 influenza outbreaks in crows
India on 7 February 2012 confirmed four recent outbreaks of highly pathogenic H5N1 avian flu that killed more than 1,100 crows, according to the World Organization for Animal Health (OIE). The first and by far the largest was in Jharkhand state from 30 October to 12 December 2011 and involved 1,143 dead crows. The mass crow deaths were reported in 2011. The report also details two outbreaks that started on 3 January 2012, each involving five dead crows. One was in Maharashtra state and ended 10 January 2012; the other was in Orissa state and ended 11 January 2012. Finally, an outbreak in Bihar state lasted from 10 January through 3 February 2012 and involved six crow fatalities. H5N1 was confirmed in each outbreak at the High Security Animal Disease Laboratory in Bhopal.
(CIDRAP 2/7/2012)

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Nepal: Reports H5N1 influenza poultry outbreaks
Animal health authorities in Nepal reported fresh outbreaks of H5N1 avian influenza in poultry. In Nepal, the virus struck four more sites, including a commercial farm and two villages in the Jhapa district of Mechi zone and a commercial farm in the Sunsari district of Koshi zone, according to the World Organization for Animal Health (OIE) on 15 February 2012. Both zones are located in eastern Nepal. The four outbreaks killed 6,094 birds, and 6,120 more were culled to control the spread of the virus. The outbreak report is Nepal's second of 2012.
(CIDRAP 2/16/2012)

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Viet Nam: H5N1 avian influenza situation update
The Ministry of Health (MoH) has announced a confirmed case of human infection with avian influenza A (H5N1) virus.

The case was a 26 year-old pregnant female from Soc Trang province. She developed symptoms on 23 January 2012, and was admitted to hospital on 25 January 2012. She was treated with Oseltamivir on 27 January 2012, she died on 28 January 2012. Confirmatory test results for influenza A (H5N1) were obtained on 30 January 2012 by Pasteur Institute, the WHO National Influenza Centre in Ho Chi Minh City, Viet Nam. Samples from the newborn infant of the fatal case tested negative for H5N1.

The case had slaughtered and eaten sick chickens. MoH, the local health sector and Pasteur Institute in Ho Chi Minh City are conducting epidemiological investigation and strengthening surveillance and response activities. Close contacts of the fatal case have received prophylaxis and are being monitored; as of 8 February 2012 all remain well. The Department of Animal Health is collaborating with the human health sector.

The case is the 121st person in Viet Nam to become infected with the H5N1 virus. As of 8 February 2012, 61 of these cases have died from complications of the disease.
(WHO 2/8/2012)

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Viet Nam: H5N1 avian influenza strikes more poultry
Vietnam reported four more H5N1 avian flu outbreaks in poultry, according to the country's agriculture ministry, bringing the country's 2012 outbreaks to 17. The disease struck backyard poultry near Hai Phong, the country's third largest city, and two villages in Ha Tinh province, according to the World Organization for Animal Health (OIE) on 14 and 15 February 2012. The four outbreaks killed 1,425 birds, and 2,675 more were culled to control the spread of the virus. They began 10, 11, and 14 February 2012. Hai Phong is a northeastern port city, and Ha Tinh province is on the north central coast.
(CIDRAP 2/15/2012)

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2. Infectious Disease News

Global
Global: WHO says India, Russia must step up MDR-TB surveillance
The World Health Organization (WHO), in a new report on multidrug-resistant tuberculosis (TB), urged all countries to employ nationwide surveillance but homed in on India and Russia, two of the three nations with the highest burden of MDR-TB, reported 6 February 2012. Only 34 countries have a system to routinely test all patients who have MDR-TB for second-line drug resistance. "Whereas China has been able to conduct a nationwide survey, India and the Russian Federation—the other two large countries that, with China, contribute to more than 50% of the estimated global burden of MDR-TB—have only produced reliable sub-national level data to date," states the WHO report, which was published 4 February 2012. An Indian health ministry official said no plans are in the works to develop a nationwide surveillance program. The ministry said a large number of TB cases are diagnosed but are not conveyed to the Revised National TB Control Programme. The WHO report said MDR-TB has been reported in 80 countries.

The WHO report may be accessed at http://www.who.int/bulletin/volumes/90/2/11-092585/en/index.html
(CIDRAP 2/6/2012)

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Asia
Australia: Outbreak of cryptosporidiosis in Cairns, Queensland
Families have been warned to take extra vigilance with hygiene and watch for signs of illness after the outbreak of a serious and highly contagious children's stomach infection. Queensland Health said the number of cases of the cryptosporidiosis intestinal disease had reached 51 in a month when the usual number of yearly cases was below 20.

Cryptosporidiosis, or crypto for short, is an infection caused by a microscopic parasite that is a common cause of acute diarrhea in young children. "If you've got 51 cases confirmed in a lab, chances are there are hundreds out there," Public Health medical officer Dr. Steven Donohue said.

Cairns and Hinterland Health District recorded 51 lab-tested cases of crypto in January 2012, Dr. Donohue said. "In a normal year you might get 10 or 20 cases," he said, adding the last outbreak in Cairns was in 2008. Dr. Donohue sent a warning letter to day care centers to alert them to the outbreak of crypto.

Dr. Donohue instructed day care centers to exclude children with diarrhea until they have not had symptoms for 48 hours. He also recommended that swimming pools at day care centers be disinfected with adequate chlorination or refilled after each session.

Queensland Health is also in the process of notifying swimming pool operators about the health risk, Dr. Donohue said. "We're not blaming the pools but they are a known factor in magnifying the outbreak," he said. "The pool operators should be very careful to make sure children with diarrhea or dirty nappies are not in pools." Dr. Donohue said children who have had diarrhea should not swim in a public pool for at least two weeks after symptoms stop. Cairns Regional Council pools are tested regularly and would continue to be monitored closely, a spokeswoman said.

In May 2010, the parasite that causes crypto was detected in southern Cairns' water supply, prompting warnings at that time for thousands of residents to boil their drinking water. A council spokeswoman yesterday said the drinking water supply is regularly tested and there was no sign of the parasite that causes crypto in the water.

While crypto is generally not serious for most people, those with weakened immune systems could develop severe and long-lasting illness, which may contribute to death. The best protection from crypto is thorough hand washing before eating and after using the toilet, Dr. Donohue said.
(ProMED 2/5/2012)

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Australia: Melioidosis alert as record numbers fall ill
People living in the Top End of the Northern Territory are being warned to protect themselves against the deadly tropical disease melioidosis. The Centre for Disease Control (CDC) says 54 people have contracted the soil-borne disease wet season 2012, and three of them have died. It is the largest number of cases recorded this early in the year.

CDC director Vicki Krause says the disease is contracted when bacteria enter the body via cuts, sores, or inhalation. The risk of melioidosis will continue for several months, and people need to protect themselves. Dr. Krause says people who have underlying conditions like cancer and lung disease should stay indoors during heavy wind or rain. Waterproof footwear and gloves should be worn when handling soil or mud-soaked items.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120214.1041303
(ProMED 2/14/2012)

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Malaysia: 22 students, lecturers of private college contract chikungunya
Malaysia: 22 students, lecturers of private college contract chikungunya
Director-General of Health Datuk Seri Dr. Hasan Abdul Rahman said on 12 February 2012 that 22 students and lecturers of a private college in Selangor have tested positive for chikungunya virus infection after returning from a course on Pangkor island in Perak.

He said they suffered from fever, headache, cough and pain in the body and joints a week after their return to Kuang. Dr. Hasan said they were among 53 students and lecturers of the college whose blood samples were taken for tests after they complained of the symptoms. He said, "22 of the cases were confirmed as chikungunya virus infections, two tested negative and the remaining 29 are awaiting the test results." adding that they were treated at Universiti Malaya Medical Centre.

So far in 2012, 23 people have contracted chikungunya virus infections, he said, adding that the first case was reported in Johor on 11 February 2012. The symptoms of chikungunya virus infections are similar to those of dengue, but the disease does not result in deaths like dengue, he said. In 2011, 30 cases of chikungunya were reported compared to 804 in 2010, he added.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120212.1040110
(ProMED 2/12/2012)

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New Zealand: Porirua measles cases prompt alert
Wellington health officials have issued an alert after seeing three cases of measles in Porirua already in 2012. Regional Public Health medical officer Margot McLean said general practitioners had been warned about measles in the area and asked to be extra vigilant to avoid a community spread.

All of the Porirua cases were thought to be related to South Auckland. The first case was a teenager who had come back from a holiday in South Auckland in early January 2012, followed by a household member two weeks later. The last case was a child who had not had any obvious contact with the earlier cases, but who Dr. McLean believed was probably related.

The cases follow on from a countrywide outbreak of measles in 2011 that was mainly linked to travel to Auckland, she said. Wellington alone had 14 cases in 2011. Measles had a high rate of complications and more than 10% of those contracting the disease ended up in hospital.

The latest three patients were now recovered, Dr. McLean said. Parents are asked to ensure babies are vaccinated by 12 months old, three months earlier than normal. The next vaccination should be at four years old. Symptoms initially include fever, feeling unwell, coughs and runny noses, followed by a rash that crept from the head down.
(ProMED 2/4/2012)

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Russia: Measles outbreak in St. Petersburg
For the first time in several decades there has been an outbreak of measles in St Petersburg. 26 cases of meals in children and 5 in adults have been diagnosed in the city.

The measles index case came from a different region of Russia. The case was a 16-year-old girl who arrived back in the city after the winter break to continue her studies in one of the colleges of the city. Her infection was diagnosed on 13 January 2012, the day of her return and she was admitted to the St. Petersburg Children's City Hospital No. 1, and later transferred to the Filatov Children's Clinical Hospital.
(ProMED 2/4/2012)

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Russia: A measles outbreak has affected 100 people and caused one death
The areas affected included Volgograd, the Stavropol region, Chechnya and North Ossetia. Six residents of the Volgograd region were hospitalized with a diagnosis of "measles", one of whom -- a child died. In the Chechen Republic 25 cases were registered and 37 in North Ossetia and Stavropol.

Four men and two women were removed from a Nizhnevartovsk-Volgograd train at Volgograd Station-1, after complaint of feeling unwell. They were taken to Infectious diseases hospital No. 1. Their condition was reported to be comfortable. The affected passengers included a 20-year-old man, two brothers aged 19 and 23 years, and a friend who boarded the train at Saratov. Later the hospital received two women from another train, also diagnosed with measles. The relevant carriages of the trains will be treated with disinfectant.

Several young people affected by the infection discharged themselves from hospital without notifying doctors. These people were travelling from a Roma community in Saratov where measles infection was rife. The hospital doctors believe that these fugitives were not aware of the danger and had returned home to the street in Volgograd where they lived. It is expected that they will be returned to the hospital under police escort so that they do not spread infection in their community.

According to the Office of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare in the Volgograd region as a consequence of the epidemic throughout Europe it is likely that measles will spread through neighboring countries.

Unvaccinated people and those not previously exposed to measles are at risk. Measles is particularly dangerous for children under one year of age and the elderly because of the likelihood of complications. A year-old child died on New Year's Eve as a result of complications following measles virus infection. In this instance assistance was sought by Roma parents too late in the progression of the child's illness. In fact it is considered that the Roma community is principally responsible for the spread of the disease.
(ProMED 2/12/2012)

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Americas
Chile: Hantavirus update
In the past five years, there have been 246 cases of hantavirus pulmonary syndrome (HPS) in the country. Of those infected, 58 have occurred in the Bio Bio region, followed by Los Lagos with 42, according to the Ministry of Health.

As of 8 February in 2012, eight cases have occurred, a figure similar to 2011, and the fatality rate reached nationally is 37.5%. That signifies that one in three infected people die of the virus infection. The cases in Bio Bio, which has been on health alert since 6 February 2012, are in La Araucania and Maule.

"If one compares this period over the past five years with the current period, one sees that cases have increased by about 20%. Historically, there have been six, and we have eight; that is an excess of cases in 2012 that have accumulated during the same period," the subsecretary of public health, Jorge Diaz, explained.

The infections of the contract workers of the Sodexo company, who work in the interior of the El Manzano II prison, are yet to be confirmed. These individuals are currently interned in the Clinico del Sur Hospital. The tests administered on them have yielded negative results for the virus. However, definitive confirmation is awaited from the Public Health Institute.

Also, tests have been done on 37 people who were exposed to the prison hantavirus outbreak in order to maintain medical surveillance on them. Of this total, nine have given negative results, and in coming days, the results from the rest of the people tested are awaited.

Up to now, there are three fatal confirmed hantavirus infection cases. Of these, two are inmates of the El Manzano prison. The investigation of these deaths is under way. The third fatal case is of an adult man who died in the Potrero Grande area in Curico while camping in the Las Buitreras sector, with activities in little visited places.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120213.1039499
(ProMED 2/13/2012)

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Mexico: Hepatitis A outbreak among school children
An outbreak of hepatitis A has affected nearly 100 children from zero to 12 years of age, in the "El Colegio" community, Tarimbaro Municipality, Michoacán , Mexico. This occurrence has generated justified anxiety in El Colegio inhabitants.

A woman who has two nieces with hepatitis described the current situation in the community. "Many cases have been observed; my two nieces acquired this disease, and they have just been sent back to school; some other cases occurred in the kindergarten; more than 20 children are affected as far as I know, and many more are being reported; even a baby was said to have acquired this disease."

Mothers are quite concerned, and they claim that some months ago, authorities from the Michoacán Secretariat of Health were informed about this situation, but no action was taken. The mother of a girl who developed hepatitis, declared that: "Too many sick children were seen in this community; nearly 100 cases have been observed; we are sort of scared, since too many children are sick, and we fear there might be fatal cases."

Cases were first reported September 2011 in the local high school, and later cases were detected in the kindergarten and in the elementary school, where cases multiplied in a few weeks. Dr. Veronica Estrada-Pizarro, physician in charge of El Colegio outpatient clinic declared that: "Cases started to occur around September 2011; some of them were directly brought to my office. I requested laboratory tests in order to confirm the diagnosis. Some other cases were seen in Morelia Children's Hospital, and some others were brought to private physicians."

School authorities also said they reported the cases to Morelia officials five months ago, when the number of cases increased markedly. Manuel Ponce-Ramirez, head of the primary school in El Colegio declared that: "Cases were found in my school, and they were reported to Morelia Health center; since then, 20 more cases occurred in one month. They were also reported to the local health center and to Tarimbaro municipality representatives, who once again communicated this occurrence to Morelia authorities."

The local outpatient clinic diagnosed nearly half of all the cases, and the remaining cases were detected in Morelia Children's Hospital, but local health authorities did not develop a program for stopping the transmission (of hepatitis A), so local inhabitants took actions together with school teachers and the local outpatient clinic.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120208.1036246
(ProMED 2/8/2012)

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Mexico: Food poisoning affecting more than 700 people
The Health Secretariat of Guerrero established, according to preliminary results, that the bacterium Staphylococcus aureus which was found in the food taco rice with egg, was what caused the poisoning of 709 people from 16 communities belonging to the municipality of Chilapa, and consumed after attending a meeting of former mayor and licensed and a congressional candidate for the PRI, Sergio Dolores Flores.

The health secretary, Lazaro Mazon Alonso, said it was in the preparation of food originated as food contamination with Staphylococcus aureus, but additional analysis to confirm cases will be ready the week of 13 February 2012. He revealed that the presence of the bacteria might be the cause of the poisoning to 709 people whose symptoms manifested by nausea, vomiting, diarrhea, abdominal pain and dehydration, however, are only preliminary results, he reiterated.

Doctors of the State Health Laboratory performed further sampling in other vomit and fecal sample to confirm the cause of the poisoning.

Health Secretary welcomed the attention of the City of Chilpancingo, the Chilapa and authorities of the Red Cross that cared for affected persons and that so far all were discharged.

Lazaro Mazon said 709 people were poisoned, including children, elderly and adults, of the approximately 4,000 people who attended the rally, are safe and at home.

He announced that those attending the meeting were given as a pancake breakfast prepared with ham, vegetables and mayonnaise. The event ended at 13:00 and for the trip back to the towns the participants were provided with rice tacos with green sauce and egg.
(ProMED 2/12/2012)

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USA: 71 Ill with Campylobacter from raw milk dairy
The Pennsylvania Department of Health has added another six cases to the ongoing Campylobacter outbreak linked to raw milk from Your Family Cow dairy in Chambersburg, PA, bringing the number of confirmed infections to 71. At least nine individuals have been hospitalized. The current age range of those sickened is from two to 74 years old, with 24 of the victims (34%) under the age of 18. The latest breakdown of cases by state is as follows: Pennsylvania (62 illnesses), Maryland (4), West Virginia (3), and New Jersey (2).

After making improvements to equipment and passing a health inspection, the dairy was cleared to resume production early the week of 6 February 2012.

The sale of unpasteurized milk is legal in Pennsylvania. Since 2007, the state has had at least seven disease outbreaks linked to raw milk, resulting in 288 confirmed illnesses:

2007 - Salmonella (29 illnesses)
2007 - Campylobacter (7)
2008 - Campylobacter (72)
2008 - Campylobacter (68)
2009 - Campylobacter (9)
2010 - Campylobacter (22)
2012 - Campylobacter (71 thus far)

In that time, the state's department of health has tracked an additional nine clusters of five or fewer illnesses that have been linked to raw milk.

The Pennsylvania Department of Health plans to update its outbreak information as new cases of infection are confirmed.

[ProMED note: The update does not state whether the additional cases had dates of illness onset after 1 February 2012, the latest date of onset reported, but does break down the ages of those affected. A full third of cases have occurred in minors fed the inherently unsafe product by their parents.]
(ProMED 2/15/2012)

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USA: Multistate outbreak of shiga toxin-producing Escherichia coli O26 infections linked to raw clover sprouts at Jimmy John’s Restaurants
A total of 12 persons infected with the outbreak strain of STEC O26 have been reported from five states. The number of ill persons identified in each state is as follows: Iowa (5), Missouri (3), Kansas (2), Arkansas (1), and Wisconsin (1). Two ill persons have been hospitalized, and no deaths have been reported.

Preliminary results of the epidemiologic and traceback investigations indicate eating raw clover sprouts at Jimmy John's restaurants is the likely cause of this outbreak.

FDA's traceback investigation is ongoing. Traceback information on sprouts has identified a common lot of clover seeds used to grow clover sprouts served at Jimmy John's restaurant locations where ill persons ate.

The full article may be accessed at http://www.cdc.gov/ecoli/2012/O26-02-12/index.html
(USCDC 2/15/2012)

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USA (New York): Legionnaire's hits six at hotel in Albany
Six cases of Legionnaire's disease have been linked to the Best Western Sovereign Hotel at 1228 Western Ave., Albany, New York, the New York State Department of Health said 2 February 2012.

The guests who became ill stayed at the hotel between September and December 2011, according to Peter Constantakes, a health department spokesman. Tests confirmed 30 January 2012 that higher than normal levels of Legionella bacteria were present in the hotel's water system, Constantakes said. "We are fully cooperating with the Department of Health on this matter, and have taken all recommended steps to eliminate the bacteria," said Phoenix-based Best Western International. "Of note, the Department of Health has not closed the hotel, which means that the Department of Health has determined that current guests are not at risk based upon the remedial measures we have taken. In addition, we have provided a list of recent guests to the Department of Health for monitoring. We consider guest safety most important, and we have and we will do everything we can to address the matter."

The six Best Western guests who became ill have recovered. It was New York state epidemiologists who tracked the illness back to the hotel. Water tests were conducted at the hotel on 24 January 2012 and the results were confirmed on 30 January 2012. Best Western Sovereign will flush its water system on 5 February 2012 under the supervision of county officials, said Mary Rozak, spokeswoman for Albany County Department of Health.

The state and county health departments also have instructed the hotel to inform current and prospective customers about the problem, and the county is contacting guests who have recently stayed at the hotel. The hotel also has raised the temperature of the water to help kill off the bacteria. "The bottom line is everyone has recovered," said Rozak. "This is not an outbreak or a crisis. This has been identified and it is being acted upon."

In 2010, there were more than 400 cases of Legionnaire's disease in New York State, including ten in Albany County. The disease is usually mild and most people recover.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120205.1033536
(ProMED 2/5/2012)

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USA (South Dakota): Clostridium causes sickness outbreak in Pierre
Laboratory testing by the Department of Health has identified Clostridium perfringens as the cause of the about 50-person outbreak associated with the Pierre-Mitchell high school boys' basketball game held in Pierre, SD, 31 January 2012. The investigation, which included voluntary questionnaires, implicated tacos as the source food of the outbreak. Of those completing questionnaires, 75% who ate the tacos reported becoming ill.

The Health Department says, the predominant symptoms were diarrhea and cramps lasting less than 24 hours, although the symptoms in some ill persons lasted longer. It was reported 75% of the cases became ill between midnight and 6:00 AM following the game.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120207.1035743
(ProMED 2/7/2012)

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USA (Indiana): Two measles cases confirmed
The State Health Department confirms they have been notified of two cases of measles. One case is in Boone County and the other case is in Hamilton County. According to health officials, one of the infected people was in the crowd during Super Bowl festivities on 3 February 2012. They say that the person did not go into the NFL Experience at the Indiana Convention Center.

Health officials also say they're looking into two additional probable measles cases in Boone County, for a total of four. The Health Department says it's working with local health departments and health care providers to identify additional cases of measles, and to prevent further transmission of the disease. They're also working with the Centers for Disease Control, as well as health officials in New York and Massachusetts.
(ProMED 2/12/2012)

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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 (Jambi province)
In Indonesia's Jambi province, eight people died of dengue fever in January 2012, forcing the local government to extend its alert for the disease, reported on 30 January 2012. At least 118 people were infected by the mosquito-borne disease virus in January 2012 alone.
(ProMED 2/6/2012)


Malaysia
In January 2012, six people, including two students, died of hemorrhagic dengue, Health director-general Datuk Dr. Hasan Abdul Rahman said. Expressing concern, Dr. Hasan said the death toll had doubled from the three cases reported in the same period in 2011. He said of the six victims, between the ages of 9-50, three died in Selangor, another two in Kuala Lumpur, and one in Negri Sembilan. "Five cases were reported in dengue hot spots." Some 1,868 cases were reported since early 2012, compared with 2,048 cases in 2011. Selangor topped the list with 840 cases, followed by Kuala Lumpur (209), Perak (147), Johor Baru (129), Kelantan (82), and Penang (78).
(ProMED 2/6/2012)


Malaysia (Selangor)
Selangor recorded the highest number of dengue cases, with 1,271 reported from January 2012, health minister Datuk Seri Liow Tiong Lai said. This figure was almost half of the 2,854 cases nationwide. As of 13 February 2012, 11 deaths have been reported, he added.
(ProMED 2/14/2012)


Malaysia
Between 29 January and 4 February 2012, four dengue-related deaths in Selangor, Kuala Lumpur and Sabah, and 545 cases nationwide were reported. The figures indicated an increase of 57 cases or 12% compared with the previous week, in which two deaths and 488 cases were recorded, said health director-general Datuk Seri Dr Hasan Abdul Rahman.

He said six states showed an increase in dengue cases compared with the previous week, whereby Selangor recorded 20 cases (9%), Kedah (19 cases or 238%), Kelantan (16 cases or 114%), Sarawak (15 cases or 115%), Johor (12 cases or 57%) and Perlis recorded one case or 50%.
(ProMED 2/14/2012)


Philippines (Zamboanga city, Zamboanga del Sur province, Mindanao Island)
City health officer Dr. Rodelin Agbulos cited the need to step-up public vigilance to avert potential epidemic as he reported an increase in dengue cases in Zamboanga City. Agbulos said from 27 reported cases of dengue on the first week of January 2012, the number climbed to 69, doubling the first mentioned record in two weeks.
(ProMED 2/6/2012)


Thailand
The number of dengue fever cases fell by more than a third in January 2012 in Thailand after 2011's floods interrupted the breeding cycle of the mosquito that carries it, health officials said 3 February 2012. In January 2012, 1,056 cases of dengue hemorrhagic fever and one death were reported at public hospitals, down 36.2% compared with the same period of 2011, the Communicable Disease Control Department said.

Dengue, which is usually pandemic in Bangkok, is transmitted by the Aedes aegypti mosquito, which prefers to lay its eggs in clean, standing water commonly found in urban settings. In October and November 2011, the central plains and parts of Bangkok were hit by the worst floods in five decades, but the resulting inundations were fetid and unsuitable for the A. aegypti to breed. "The floods actually interrupted the mosquito's life cycle and has resulted in a reduction in dengue," said Sanphet Mahamard, a dengue expert at the department.
(ProMED 2/6/2012)


Thailand
According to permanent secretary for public health MD Paijit Warachit, during 1-19 January 2012, there have been 332 patients infected with the dengue virus in Thailand with one death reported, compared with 291 patients and no deaths in the same period of 2011.
(ProMED 2/14/2012)

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4. Articles
Development of temporal modeling for prediction of dengue infection in Northeastern Thailand
Wongkoon S, Jaroensutasinee M, Jaroensutasinee K. Asian Pac J Trop Med. March 2012. 5(3):249-52.
Available at http://www.sciencedirect.com/science/article/pii/S1995764512600340

Objective. To model the monthly number of dengue fever cases in northeastern Thailand using time series analysis.

Methods. Autoregressive Integrated Moving Average (ARIMA) models have been developed on the monthly data collected from January 1981 to December 2006 and validated using the data from January 2007 to April 2010.

Results. The ARIMA (3,1,4) model has been found as the most suitable model with the least Akaike Information Criterion (AIC) of 14.060 and Mean Absolute Percent Error (MAPE) of 7.000. The model was further validated by the Portmanteau test with no significant autocorrelation between residuals at different lag times.

Conclusions. Early warning based on the data in the previous months could assist in improving vector control, community intervention, and personal protection.

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Rapid Diagnostic Test-Based Management of Malaria: An Effectiveness Study in Papua New Guinean Infants With Plasmodium falciparum and Plasmodium vivax Malaria
Senn N, Rarau P, Manong D, et al. Clin Infect Dis. March 2012. 54(5):644-51.
Available at http://cid.oxfordjournals.org/content/54/5/644.long

Background. In malaria-endemic areas it is recommended that febrile children be tested for malaria by rapid diagnostic test (RDT) or blood slide (BS) and receive effective malaria treatment only if results are positive. However, RDTs are known to perform less well for Plasmodium vivax. We evaluated the safety of withholding antimalarial drugs from young Papua New Guinean children with negative RDT results in areas with high levels of both Plasmodium falciparum and P. vivax infections.

Methods. Longitudinal prospective study of children aged 3–27 months visiting outpatient clinics for fever. RDT was administered at first visit. RDT and microscopy were performed if children returned because of persistent symptoms. Outcomes were rates of reattendance and occurrence of severe illnesses.

Results. Of 5670 febrile episodes, 3942 (70%) involved a negative RDT result. In 133 cases (3.4%), the children reattended the clinic within 7 days for fever, of whom 29 (0.7%) were parasitemic by RDT or microscopy. Of children who reattended, 24 (0.7%) presented with a severe illness: 2 had lower respiratory tract infections (LRTIs) with low-density P. vivax on BS; 2 received a diagnosis of P. vivax malaria on the basis of RDT but BSs were negative; 16 had LRTIs; 3 had alternative diagnoses. Of these 24, 22 were cured at day 28. Two children died of illnesses other than malaria and were RDT and BS negative at the initial and subsequent visits.

Conclusion. Treatment for malaria based on RDT results is safe and feasible even in infants living in areas with moderate to high endemicity for both P. falciparum and P. vivax infections.

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Vaccine-associated paralytic poliomyelitis in Japan
Hosoda M, Inoue H, Miyazawa Y, et al. Lancet. 11 February 2012. 379(9815):520.
Available at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60232-3/fulltext

Excerpt. Despite WHO's recommendation to switch the poliomyelitis vaccine from oral polio vaccine (OPV) to inactivated polio vaccine (IPV) in countries where polio elimination has been achieved, Japan has continued to use OPV. In Japan, OPV is given twice to children aged from 3 to 18 months.1 More than 10 years after the elimination of wild polio virus, tragic cases of vaccine-associated paralytic poliomyelitis (VAPP) continue to be reported every year—most recently in May, 2011. The Ministry of Health, Labour and Welfare claims that IPV is still being developed by Japanese vaccine companies and that it will not be available until the end of 2012 at the earliest. The growing tension between the Government, which persists with domestically produced OPV, and the parents, who request IPV to avoid VAPP, has evoked huge media attention.

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Etiology and epidemiology of viral diarrhea in children under the age of five hospitalized in Tianjin, China
Ouyang Y, Ma H, Jin M, et al. Arch Virol. 9 February 2012. doi:10.1007/s00705-012-1235-9.
Available at http://www.springerlink.com/content/173pt4125v1t603w/

Abstract. Viral diarrhea is a great threat to children's health in developing countries. We conducted a prospective surveillance study of acute diarrhea of young children at Tianjin Children's Hospital from April 2008 to April 2009. Viral infections were detected in 356 of the total 766 collected stool specimens (46.48%). Rotavirus infections were the most common (27.94%; predominant type G1), followed by adenovirus infections (17.62%; predominant type Ad41), norovirus infections (5.87%; predominant type GII-4/2006b), and astrovirus infections (3.15%; only HAstV-1). Children younger than 1 year old were the most susceptible population to viral infections (87.9%). Diarrhea, vomiting, and fever were the most frequent clinical symptoms among the infected patients. The viral infections had no age, sex, or regional differences. Most infection rates were higher in the autumn, winter, and spring. This study supported that the rotavirus vaccine should be included in the Expanded Programme on Immunization in China.

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Soil-transmitted helminthiasis: a critical but neglected factor influencing school participation of Aboriginal children in rural Malaysia
Ahmed A, Al-Mekhlafi HM, Azam MN, et al. Parasitology.6 February 2012. :10.1017/S003118201100237X.
Available at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8484735

Abstract. Soil-transmitted helminthiasis (STH), among the most common neglected tropical diseases, is a major public health problem in Malaysia with a possible impact on the nutritional status and school participation of rural children. This study was carried out among Aboriginal schoolchildren, living in an endemic area for STH in Malaysia, to determine the possible relationship between intestinal helminthiasis and school absenteeism. We also evaluated whether successful treatment of the infection will affect school attendance among the subjects. Stool analysis revealed that more than 90% of the subjects were infected with at least 1 helminth species, with Ascaris lumbricoides and Trichuris trichiura infections being most prevalent. Infection of moderate-to-heavy worm burdens, low level of fathers' education and anaemia were identified as the significant predictors of high absenteeism among the subjects (P<0•05). Following treatment of the infected children, it was found that school absenteeism was reduced significantly (P<0•01). In conclusion, STH continues to have significant impacts on public health, particularly in rural communities with a negatively significant effect on the school participation of Aboriginal children. A school-based de-worming programme should be introduced and incorporated in the current educational assistance targeted towards the Aboriginal communities, under the auspices of the government.

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Current epidemiological profile and features of visceral leishmaniasis in People's Republic of China
Wang JY, Cui G, Chen HT, et al. Parasit Vectors. 9 February 2012. 5(1):31. doi:10.1186/1756-3305-5-31.
Available at http://www.parasitesandvectors.com/content/5/1/31/abstract

Background. Visceral leishmaniasis (VL) is still an important public health problem in China. In recent years endemic regions spread, prevalence increased, and even an outbreak of the disease occurred in China due to global warming and population movement. It is essential to elucidate the current epidemic situation and epidemiological characteristics of VL for designing control policy. In the present study we describe the current epidemiological profile and characteristics of VL in China based on retrospectively reviewing of VL cases reported between 2005 and 2010 by a passive surveillance system.

Methods. The present study was a retrospective review of VL cases notified between 2005 and 2010 based on the passive surveillance data. The data were tabulated, diagrammatized and analyzed through descriptive statistics in a Microsoft Excel spreadsheet.

Results. A total of 2450 VL cases were notified, with a mean of 408 cases per year. 61 counties were identified as endemic area with 2224 autochthonous cases, and the other 118 counties as non-endemic areas with 226 imported cases. 97.71% of cases were concentrated in Xinjiang, Gansu and Sichuan Provinces. 9 major counties reported a mean of 10 cases per year, with a total of 1759 cases reported. Different types of VL revealed distinct epidemiological characteristics.

Conclusions. The number of VL cases and endemic counties both increased in the period 2005-2010 in China. Different type or sub-type of VL revealed distinct epidemiological characteristics. Therefore, differential control measures must be taken in different endemic areas against incidence increase and endemic area spread.

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Emerged HA and NA Mutants of the Pandemic Influenza H1N1 Viruses with Increasing Epidemiological Significance in Taipei and Kaohsiung, Taiwan, 2009–10
Kao C-L, Chan T-C, Tsai C-H, et al. PLoS ONE. 6 February 2012. 7(2): e31162. doi:10.1371/journal.pone.0031162.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0031162

Abstract. The 2009 influenza pandemic provided an opportunity to observe dynamic changes of the hemagglutinin (HA) and neuraminidase (NA) of pH1N1 strains that spread in two metropolitan areas -Taipei and Kaohsiung. We observed cumulative increases of amino acid substitutions of both HA and NA that were higher in the post–peak than in the pre-peak period of the epidemic. About 14.94% and 3.44% of 174 isolates had one and two amino acids changes, respective, in the four antigenic sites. One unique adaptive mutation of HA2 (E374K) was first detected three weeks before the epidemic peak. This mutation evolved through the epidemic, and finally emerged as the major circulated strain, with significantly higher frequency in the post-peak period than in the pre-peak (64.65% vs 9.28%, p<0.0001). E374K persisted until ten months post-nationwide vaccination without further antigenic changes (e.g. prior to the highest selective pressure). In public health measures, the epidemic peaked at seven weeks after oseltamivir treatment was initiated. The emerging E374K mutants spread before the first peak of school class suspension, extended their survival in high-density population areas before vaccination, dominated in the second wave of class suspension, and were fixed as herd immunity developed. The tempo-spatial spreading of E374K mutants was more concentrated during the post–peak (p = 0.000004) in seven districts with higher spatial clusters (p<0.001). This is the first study examining viral changes during the naïve phase of a pandemic of influenza through integrated virological/serological/clinical surveillance, tempo-spatial analysis, and intervention policies. The vaccination increased the percentage of E374K mutants (22.86% vs 72.34%, p<0.001) and significantly elevated the frequency of mutations in Sa antigenic site (2.36% vs 23.40%, p<0.001). Future pre-vaccination public health efforts should monitor amino acids of HA and NA of pandemic influenza viruses isolated at exponential and peak phases in areas with high cluster cases.

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Effects of School Closure on Incidence of Pandemic Influenza in Alberta, Canada
Earn DJ, He D, Loeb MB, et al. Ann Intern Med. 7 February 2012156(3):173-181.
Available at http://www.annals.org/content/156/3/173.full.pdf+html

Background. Control of pandemic influenza by social-distancing measures, such as school closures, is a controversial aspect of pandemic planning. However, investigations of the extent to which these measures actually affect the progression of a pandemic have been limited.

Objective. To examine correlations between the incidence of pandemic H1N1 (pH1N1) influenza in Alberta, Canada, in 2009 and school closures or weather changes, and to estimate the effects of school closures and weather changes on pH1N1 transmission.

Design. Mathematical transmission models were fit to data that compared the pattern of confirmed pH1N1 cases with the school calendar and weather patterns.

Setting. Alberta, Canada, from 19 April 2009 to 2 January 2010.

Data Sources. 2009 virologic test results, 2006 census data, 2009 daily temperature and humidity data, and 2009 school calendars.

Measurements. Age-specific daily counts of positive results for pH1N1 from the complete database of 35 510 specimens submitted to the Alberta Provincial Laboratory for Public Health for virologic testing from 19 April 2009 to 2 January 2010.

Results. The ending and restarting of school terms had a major effect in attenuating the first wave and starting the second wave of pandemic influenza cases. Mathematical models suggested that school closure reduced transmission among school-age children by more than 50% and that this was a key factor in interrupting transmission. The models also indicated that seasonal changes in weather had a significant effect on the temporal pattern of the epidemic.

Limitations. Data probably represent a small sample of all viral infections. The mathematical models make simplifying assumptions in order to make simulations and analysis feasible.

Conclusion. Analysis of data from unrestricted virologic testing during an influenza pandemic provides compelling evidence that closing schools can have dramatic effects on transmission of pandemic influenza. School closure seems to be an effective strategy for slowing the spread of pandemic influenza in countries with social contact networks similar to those in Canada.

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Transmission of influenza A(H1N1) 2009 pandemic viruses in Australian swine
Deng YM, Iannello P, Smith I, et al. Influenza and Other Respiratory Viruses. 15 February 2012. doi: 10.1111/j.1750-2659.2012.00337.x.
Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1750-2659.2012.00337.x/abstract

Background. Swine have receptors for both human and avian influenza viruses and are a natural host for influenza A viruses. The 2009 influenza A(H1N1) pandemic (H1N1pdm) virus that was derived from avian, human and swine influenza viruses has infected pigs in various countries.

Objectives. To investigate the relationship between the H1N1pdm viruses isolated from piggery outbreaks in Australia and human samples associated with one of the outbreaks by phylogenetic analysis, and to determine whether there was any reassortment event occurring during the human-pig interspecies transmission.

Methods. Real-time RT-PCR and full genome sequencing were carried out on RNA isolated from nasal swabs and/or virus cultures. Phylogenetic analysis was performed using the Geneious package.

Results. The influenza H1N1pdm outbreaks were detected in three pig farms located in three different states in Australia. Further analysis of the Queensland outbreak led to the identification of two distinct virus strains in the pigs. Two staff working in the same piggery were also infected with the same two strains found in the pigs. Full genome sequence analysis on the viruses isolated from pigs and humans did not identify any reassortment of these H1N1pdm viruses with seasonal or avian influenza A viruses.

Conclusions. This is the first report of swine infected with influenza in Australia and marked the end of the influenza-free era for the Australian swine industry. Although no reassortment was detected in these cases, the ability of these viruses to cross between pigs and humans highlights the importance of monitoring swine for novel influenza infections.

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5. Notifications
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