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Vol. XV No. 6 ~ EINet News Briefs ~ Mar 16, 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: WHO issues technical report on February 2012 meeting on H5N1 influenza research
- Global: Research on contagious H5N1 influenza viruses, space suits needed?
- Global: Israel, Bhutan, and Hong Kong report H5N1 avian influenza outbreaks
- Global: H5N1 influenza strikes poultry in India and Nepal
- Bangladesh: H5N1 avian influenza situation update
- Indonesia: H5N1 avian influenza situation update
- Viet Nam: H5N1 avian influenza situation update
- Viet Nam: Another H5N1 avian influenza case
- USA (Maryland): Tests confirm MRSA in fatal influenza cases

2. Infectious Disease News
- Chinese Taipei: Reports 2012's first imported measles case
- Indonesia: Rabies outbreak kills 50 in Maluku province
- Philippines: Nearly 1,000 show signs of typhoid
- Russia: Measles epidemic began in Chechnya
- Viet Nam: Cases of hand, foot and mouth disease hit record levels
- Canada: Catering firm drops meat lasagna and tacos after Salmonella outbreak
- Chile (Santiago): Fifth fatal case of hantavirus in 2012
- Chile (Araucania region): Young girl dies of hantavirus infection
- Chile (O'Higgins region): Young man infected with hantavirus
- USA: Multistate outbreak of shiga toxin-producing Escherichia coli O26 infections linked to raw clover sprouts at Jimmy John's restaurants
- USA (New Mexico): 12 people treated in Eddy County rabies outbreak
- USA (Indiana): New measles case confirmed in Adams County
- USA (Illinois): 313 whooping cough cases confirmed in McHenry County
- USA (New York): Commack district reports fifth whopping cough case
- USA (Washington): Pertussis spreading in Clark County
- USA (Wisconsin): Whooping cough confirmed at Southview

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

4. Articles
- Survey of national immunization programs and vaccine coverage rates in Asia Pacific countries
- The Highly Virulent 2006 Norwegian EHEC O103:H25 Outbreak Strain Is Related to the 2011 German O104:H4 Outbreak Strain
- The antibiotic resistance characteristics of non-typhoidal Salmonella enterica isolated from food-producing animals, retail meat and humans in South East Asia
- Molecular Epidemiology and Nasal Carriage of Staphylococcus aureus and Methicillin-Resistant S. aureus among Young Children Attending Day Care Centers and Kindergartens in Hong Kong
- Antimicrobial drug resistance in Peru
- Factors contributing to the high prevalence of multidrug-resistant tuberculosis: a study from China
- Commercial Serological Tests for the Diagnosis of Active Pulmonary and Extrapulmonary Tuberculosis: An Updated Systematic Review and Meta-Analysis
- Modeling Seasonal Rabies Epidemics in China
- Prevalence and associated psychosocial factors of increased hand hygiene practice during the influenza A/H1N1 pandemic: findings and prevention implications from a national survey in Taiwan
- Telephone Triage of Influenza-like Illness during Pandemic 2009 H1N1 in an Obstetric Population

5. Notifications
- German-Singaporean Symposium on Pathogenic E. coli
- 9th Asia Pacific Travel Health Conference
- 1st Asian Conference on Hepatitis B & C, HIV and Influenza
- International Environment and Health Conference (IEHC2012)
- 15th International Congress on Infectious Diseases


1. Influenza News

Global
2012 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Bangladesh / 3 (0)
Cambodia / 1 (1)
China / 1 (1)
Egypt / 5 (2)
Indonesia / 4 (4)
Viet Nam / 4 (2)
Total / 18 (10)

***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: 596 (350) (WHO 3/12/2012)
http://www.who.int/influenza/human_animal_interface/EN_GIP_20120301CumulativeNumberH5N1cases.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 1/25/2012): http://www.who.int/influenza/human_animal_interface/H5N1_avian_influenza_update.pdf

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Global: WHO issues technical report on February 2012 meeting on H5N1 influenza research
The World Health Organization (WHO) has published a technical report on the 16-17 February 2012 meeting at which influenza experts and public health officials discussed the two controversial unpublished studies describing lab-derived H5N1 viruses with increased transmissibility in ferrets. The five-page report offers no surprises but gives a few more details than were provided in a press conference and a press release issued after the meeting. At that point the WHO said a majority of participants had agreed that a current 60-day moratorium on research involving lab-derived H5N1 viruses should continue, that a public education campaign about the importance of the research should be launched, that biosafety and biosecurity issues raised by the research should be reviewed, and that the two studies should be published in full at a later date—contrary to the December recommendation from the US National Science Advisory Board for Biosecurity. Among other details, the new technical report says the sets of mutations that were associated with increased transmissibility differed between the two studies. It describes the studies as "proof-of-principle experiments" that "were not designed to elucidate the pathogenciity or degree of transmissibility" of the lab-modified viruses. The report also states, "It was not believed that any purpose would be served by destroying these laboratory modified viruses, given their utility for future research and public health surveillance."

The full WHO technical report may be accessed at http://www.who.int/influenza/human_animal_interface/mtg_report_h5n1.pdf
(CIDRAP 3/9/2012)

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Global: Research on contagious H5N1 influenza viruses, space suits needed?
Using the highest level of safety precautions for research on H5N1 viruses that can spread in mammals may slow the advance of science, but it's worth it in view of the grave risks involved, say some commentators writing on 6 March 2012 in mBio, a journal of the American Society for Microbiology (ASM).

But another commentator writing in the same journal says that using the strictest precautions, biosafety level 4 (BSL-4), would encumber research without making the work any safer than doing it in enhanced BSL-3 conditions, the next highest safety level.
The debate was sparked by the current controversy over whether two studies involving lab-derived H5N1 viruses that spread in ferrets via respiratory droplets should be published in full or edited to remove details that could allow others to generate the viruses.

In December 2011, the National Science Advisory Board for Biosecurity (NSABB) took the latter course, out of a concern that bioterrorists or other malefactors could exploit the information. A heated debate among scientists, public health officials, biosecurity experts, and others has raged ever since.

The two journals involved, Science and Nature, have said they are willing to go along with the NSABB recommendation if a way can be found to provide the crucial details to scientists with a legitimate need for them.

Science intends to publish a study by Ron Fouchier, PhD, and colleagues of Erasmus Medical Center in the Netherlands. Using a combination of genetic engineering and passaging through ferrets, they generated an H5N1 virus that spread from ferret to ferret without direct contact. Accounts of the virus's lethality have differed somewhat, but apparently it was lethal to ferrets at least with deliberate tracheal inoculation at high doses.

Nature is looking to publish a study led by Yoshihiro Kawaoka, DVM, PhD, of the University of Wisconsin, Madison. His team combined the hemagglutinin from an H5N1 virus with other genes from an H1N1 virus and found that the hybrid could spread in ferrets via respiratory droplets, though it did not kill any of them.

Ferrets are generally considered the best animal models for how flu behaves in humans. Since the case-fatality rate (CFR) for confirmed human H5N1 cases is about 59%, the studies have raised the concern that unleashing a virus with increased human transmissibility could lead to a catastrophic pandemic.

The Fouchier and Kawaoka studies were conducted in "BSL-3 enhanced" conditions. BSL-3 is intended for pathogens that cause serious or potentially fatal disease and spread by the respiratory route, though vaccines or treatments may be available. Safety features include such things as controlled access, entry through an airlock, decontamination of all waste and lab clothing, use of biosafety cabinets when manipulating agents, and negative air flow into the lab.

BSL-4 precautions are intended for aeorosol-transmitted agents that often cause fatal illness and for which there are no vaccines or treatments. Workers in BSL-3 labs must either wear a pressurized suit or else work in a Class III biosafety cabinet, among many other precautions. The facility must be a separate building or an isolated zone of a building, with dedicated ventilation and decontamination systems.

The full article may be accessed at http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/mar0612biosafety.html
(CIDRAP 3/6/2012)

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Global: Israel, Bhutan, and Hong Kong report H5N1 avian influenza outbreaks
Israel's agriculture ministry on 9 March 2012 announced that H5N1 avian flu outbreaks have been detected at two turkey farms in Hadarom, also known as the country's Southern District, according to the World Organization for Animal Health (OIE). The outbreaks began on 7 March 2012, striking a facility near Beersheva that housed 12-week-old turkeys and another near Ashkelon where 8-week-old turkeys were being raised. The virus killed 10,500 of 51,000 susceptible birds, and the remaining ones were culled to control the spread of the disease. An investigation is ongoing, and so far the source of the virus is unknown. Israel's last H5N1 outbreak was reported in April 2011. In other developments, officials in Bhutan announced another H5N1 outbreak in backyard poultry in Chhukha district, according to the OIE on 9 March 2012. The report is the country's sixth of the year, and all of the outbreaks have occurred in the same district. Elsewhere, veterinary officials in Hong Kong said that they have detected H5N1 in two more wild birds that were found dead, collected, and tested. One was a black-headed gull, a common winter visitor to the area, and the other was a peregrine falcon, a rare winter visitor.
(CIDRAP 3/9/2012)

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Global: H5N1 influenza strikes poultry in India and Nepal
Veterinary officials in India and Nepal reported fresh H5N1 outbreaks in poultry. The outbreak in India occurred at a government poultry farm in Tripura state, reported on 10 March 2012. Teams were on standby to begin culling at the farm, which housed 3,871 birds. In January 2012 an outbreak was detected at another government poultry farm located about 12 miles from the latest outbreak site.

Elsewhere, livestock authorities in Nepal reported three more H5N1 outbreaks in backyard birds, according to the World Organization for Animal Health (OIE) on 11 March 2012. The outbreaks occurred in two districts that reported outbreaks earlier in 2012, Mechi and Koshi. The three latest outbreaks killed 326 birds, and 142 more were destroyed to control the spread of the virus.
(CIDRAP 3/12/2012)

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Asia
Bangladesh: H5N1 avian influenza situation update
The Ministry of Health and Family Welfare, Bangladesh has confirmed two new cases of human infection with highly pathogenic avian influenza A(H5N1) virus in the country. These are the fifth and sixth cases reported in the country since 2008.‬‪ These two cases, 26 year-old and 18 year-old males, presented with history of cough, and both have recovered. They were identified in the same live bird market surveillance site in Dhaka City as the fourth case recently reported, and were confirmed by the National Influenza Centre (NIC) of the WHO Global Influenza Surveillance and Response System (GISRS) in Bangladesh.‬‪

Epidemiological investigation and follow-up is being conducted by National Rapid Response teams of the Institute of Epidemiology, Disease Control and Research (IEDCR) and the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B).‬‪
(WHO 3/7/2012)

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Indonesia: H5N1 avian influenza situation update
The Ministry of Health of Indonesia has notified WHO of a new case of human infection with avian influenza A(H5N1) virus. The case is a 24 year-old female from Bengkulu Province. She developed fever on 23 February 2012 and was hospitalized on the following day. She had breathing difficulty, her condition deteriorated and she died on 1 March 2012.

Epidemiological investigation conducted by a team of public health and animal health authorities indicated an exposure to a potentially contaminated environment where sudden deaths of poultry had recently occurred. The case was confirmed by the National Institute of Health Research and Development, Ministry of Health.

As of 12 March 2012, of the 187 cases reported in Indonesia since 2005, 155 have been fatal.
(WHO 3/12/2012)

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Viet Nam: H5N1 avian influenza situation update
The Ministry of Health has reported a confirmed case of human infection with avian influenza A (H5N1) virus. The case is a 22 year-old male from Thanh Hoa province who lived and worked in Binh Duong province. He developed symptoms on 17 February 2012 and first sought medical care on 21 February 2012. He was admitted to the intensive care unit of the Hospital for Tropical Diseases on 23 February 2012 and received Oseltamivir upon admission. He is currently still in hospital.

Confirmatory test results for influenza A (H5N1) were obtained on 25 February 2012 by the Pasteur Institute Ho Chi Minh City, a WHO National influenza Centre. Epidemiological investigation indicates that the man was involved in the slaughter and consumption of ducks. Pasteur Institute in Ho Chi Minh City and the local health sector are conducting the investigation and response. Close contacts of the case with fever have received prophylaxis and are being monitored; all have been confirmed as negative for H5N1 by PCR.
(WHO 3/5/2012)

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Viet Nam: Another H5N1 avian influenza case
The Ministry of Health, Viet Nam has reported a confirmed case of human infection with highly pathogenic avian influenza A(H5N1) virus in the country. The case is a 31 year-old male from Dak Lak province. He developed symptoms on 29 February 2012 and sought health care on the same day. On 4 March 2012, he was admitted to a hospital and was diagnosed with viral pneumonia. He was transferred to a referral hospital on 5 March 2012, where he is currently being treated.

Laboratory tests were confirmed by the Pasteur Institute Ho Chi Minh City, a WHO National influenza Centre. Epidemiological investigation indicates that the man was involved in the slaughter and consumption of sick poultry. Pasteur Institute Ho Chi Minh City and the local health sector are conducting further investigation and providing appropriate response. No close contacts of the case have reported respiratory symptoms.

As of 12 March 2012, of the 123 confirmed cases reported in Viet Nam, 61 have been fatal.
(WHO 3/12/2012)

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Americas
USA (Maryland): Tests confirm MRSA in fatal influenza cases
Maryland health officials on 9 March 2012 confirmed that at least two of four members of a Calvert County family who had severe influenza were co-infected with methicillin-resistant Staphylococcus aureus (MRSA).

On 9 March 2012, the Maryland Department of Health and Mental Hygiene (MDHMH) confirmed what some health officials had already suspected. It also said the state lab has confirmed that all four patients were infected with the H3N2 strain, which is circulating in Maryland and has been the nation's dominant strain during the 2011-2012 flu season. Earlier, the department had confirmed seasonal H3N2 in two of the patients.

The MDHMH, along with county health officials, has been investigating the cluster of severe respiratory infections that led to the deaths of an 81-year-old woman from Lusby and two adult children who cared for her after she got sick and until she died on 1 March 2012. Another of the woman's daughters is hospitalized with similar symptoms.

As of 9 March 2012, no other related severe respiratory illnesses have been confirmed, and no similar clusters have been identified, the MDHMH said.

In its confirmation of the two MRSA co-infections, the department said that S aureus infection is a known complication of influenza infection.

Officials warned that flu season can last as late as May and said seasonal flu vaccination is the best way to prevent flu and related complications that can be severe. The DHMDH also urged Maryland residents to take basic flu precautions, such as hand washing and staying home when sick.
(CIDRAP 3/9/2012)

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2. Infectious Disease News

Asia
Chinese Taipei: Reports 2012's first imported measles case
The Centers for Disease Control (CDC) in Chinese Taipei has confirmed Taiwan's first imported measles case in 2012, which involves a Taiwanese American man who traveled from India to Taiwan for a family reunion in February 2012. The 21-year-old university student in India flew to Taiwan on 22 February 2012 on a Thai Airways flight he boarded in Bangkok, the transit stop of his journey from India to Taiwan, according to CDC on 9 March 2012. The man came down with a fever on 23 February 2012, and then started to notice a skin rash. It was confirmed he had contracted measles on 8 March 2012. The man has now recovered.

Quarantine inspectors believed that the man had been infected with the measles virus in India. CDC deputy director general Chow Jih-haw said the CDC had contacted three passengers who had been sitting close to the patient on the Thai Airways flight, 25 medical personnel, and people the patient had come into contact with while undergoing emergency medical treatment, as well as the patient's family members. So far none of the people had developed any symptoms of measles, he said.

However, because measles is more highly contagious than influenza, the CDC has warned the relevant health authorities to pay attention to the condition of the travelers who had been sitting close to the student when they reached their final destination, Chow added.

Meanwhile, the CDC is monitoring the health of a Thai traveler who is now still in Taiwan, he said. In addition, the CDC also found that the Taiwanese American patient boarded an express train bound for Kaohsiung at 4 p.m. on 24 February 2012 in Taipei, and disembarked at a station in Yunlin County. People who had also taken the train are reminded to monitor their health and be on the alert for a possible infection. A self-examination period of 18 days (to end on 13 March 2012) is recommended, the CDC said.
(ProMED 3/11/2012)

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Indonesia: Rabies outbreak kills 50 in Maluku province
At least 50 people have died of rabies in the recent weeks in a reported outbreak in the south west district of Indonesia's Maluku province, local officials said on 5 March 2012. "Rabies has killed at least 50 people, and hundreds of others have been exposed to the risk of the disease," Bernabas Orno said, adding that the outbreak has been reported to Maluku governor Karel Albert Ralahalu.

The deadly virus has hit this remote province hard in recent weeks. The rabies virus is spread through contact with infected animals, who carry the virus in their saliva. Those bitten by an infected animal can avoid contracting the deadly disease if they clean the wound and receive a rabies vaccination within hours of contact. But rabies vaccine supplies in the remote Southwest Maluku district have run out, Barnabas said. No hospitals in the district have the vaccine, and efforts to control the spread of the virus have failed to make an impact, he added. "We are badly in need of the provincial government's help," Barnabas said. Without help, Barnabas feared that the rabies epidemic in the Southwest Maluku district would only get worse.

"We are afraid the number of fatalities will continue to increase if the provincial government fails to send the anti-rabies vaccine.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120306.1061764
(ProMED 3/6/2012)

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Philippines: Nearly 1,000 show signs of typhoid
The number of suspected typhoid fever cases in Tuburan town, north west Cebu Province has risen to more than 800 patients, said a Department of Health (DOH)-Central Visayas official. The province's count is even higher: chief of the Integrated Provincial Health Office (IPHO) Dr. Cristina Giango said on 6 March 2012, that there were 999 suspected typhoid cases, including outpatients.

Neighboring towns, the provincial government and line agencies are pitching in to contain the outbreak, from cleaning up the water supply to distributing medicine, relief goods and pledges to pay for hospital bills. Provincial social welfare officer Marivic Garces told the governor that 50 sacks of rice and 30 cartons of canned goods were already delivered and distributed to the affected residents.

Rennan Cimafranca, DOH-Central Visayas epidemiologist, said the cases were identified based on the clinical manifestations of the patients whom health officials examined. These manifestations include fever, headache, stomach ache, distended stomach, joint pains, and lack of appetite. Cimafranca said the typhoid outbreak has not yet been contained and may take some time.

Cimafranca also said the health agency has distributed medicines, such as antibiotics and antipyretics for those with fever, and sent 5 blood samples for confirmatory typhoid testing at the Research Institute for Tropical Medicine (RITM) in Manila.

So far, four deaths have been recorded since the typhoid outbreak was reported. Garcia said two chlorinators are already operating, with the help of the office of the town mayor and local social welfare office.

Engr. Adolfo Quiroga, Provincial Planning and Development Office (PPDO) head, said they had already inspected Sitio Magdagook of Barangay Calangahan's pipes for any leaks. Water quality continues to be monitored in the town's three water sources in Barangays Marmol, Calangahan, and Alegria. Garcia said these pipes were installed during her second term, from 2007 to 2010. Local officials suspect the connections were damaged by the earthquake that hit Cebu and Negros Oriental on 6 February 2012.

The Philippine Army's 78th Infantry Battalion also put up tents and folding beds in an open area near the hospital, to accommodate the growing number of patients.
(ProMED 3/10/2012)

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Russia: Measles epidemic began in Chechnya
The number of Russians who contracted measles is growing every day. Over 500 cases have been recorded in 13 regions of Russia. It has been reported that the outbreak originated in the Chechen Republic. However, now the epidemic is beginning to decline. Earlier, the World Health Organization (WHO) predicted that by the spring of 2012 measles would have been disseminated throughout Europe. Already, measles has spread to France, Spain, Italy, Romania, Greece and Germany. In 2011, the European Centre for Disease Control and Prevention has reported more than 30 thousand cases of measles. As for Russia, 631 cases of measles have reported as of 1 March 20122. In total 411 cases (65.1%) were registered in November and December 2011. Thus, the incidence of measles, compared with 2010 (127 cases) had increased five-fold.

In January 2012, the spread of measles in the Russian Federation continued. In particular measles cases were recorded in the Volgograd, Belgorod and Novosibirsk regions, the Chechnya Republic and the Stavropol Territory. For the first time in seven years, an outbreak of measles was recorded in North Ossetia (there were 45 cases). In St. Petersburg, according to recent data, there have been 152 cases of measles and around 300 in Moscow.
(ProMED 3/4/2012)

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Viet Nam: Cases of hand, foot and mouth disease hit record levels
Cases of hand, foot and mouth disease (HFMD) have surged, infecting nearly 12,400 children and killing 11 in the first two months of 2012, authorities said 13 March 2012. This figure is 7.5 times higher than the same period in 2011, according to the Health Ministry's preventive medicine department.

Southern provinces account for the majority of patients, with 19 per 100,000 people infected, said Nguyen Van Binh, head of the department. The virus is transmitted through saliva, blister fluid and feces, but it is rare among adults, whose immune systems are generally strong enough to fight it off.

The disease is life-threatening in a small number of cases, owing to complications such as lung hemorrhages and meningitis. In 2011, HFMD killed 166 people in Viet Nam, most of them children. The death toll was ten times higher than the previous year as a more dangerous strain of the virus became more prevalent.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120313.1069657
(ProMED 3/13/2012)

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Americas
Canada: Catering firm drops meat lasagna and tacos after Salmonella outbreak
The investigation of a salmonellosis outbreak in three Ottawa schools and a daycare is focusing on two particular dishes served by a catering company that delivers to all four places.

"Tacos and meat lasagna, which were identified as possible sources, have been removed from our menu, and replaced with vegetarian lasagna," says the man who owns two franchises of The Lunch Lady catering company in Ottawa. Public health investigators are working on tracing the source of contamination that appears to have come from a Lunch Lady kitchen on Boyd Avenue.

Dr. Isra Levy, the city's top public health official, confirmed that as investigators interviewed victims, several said they ate one or both of those dishes. But, he said, there's no scientifically definitive conclusion yet. "People don't really remember what they ate a week ago," Levy said.

The early stages of an investigation are driven "more by instinct and judgment of the on-the-ground investigators," Levy said, which will point them in the direction of foods that seem more likely to be contaminated. Then comes the scientifically rigorous examination, which is really just getting started. Five inspectors and six nurses are working on it.

The investigation's threads are still "diverging rather than converging," Levy said. He's concerned, as well, that identifying these particular foods might influence the memories of people investigators haven't yet reached. The department has taken samples of suspect food at the Lunch Lady kitchen for analysis -- ground beef, cottage cheese, sour cream, and some spices.

Given the facts known so far, there are plenty of plausible explanations for the outbreak, Levy said, from a bad batch of beef to a kitchen worker who didn't wash his/her hands after handling a pet turtle at home (reptiles often harbor Salmonella on their skins).

The department now has 20 lab-confirmed cases of salmonellosis reported since the outbreak was declared, including 16 children and four adults. The schools known to be involved are Steve MacLean Public School, Turnbull Academy, and Jean-Paul II elementary school, plus Tiny Hoppers daycare in Kanata, all of which get hot food delivered by The Lunch Lady.

Schools served by the owner's other kitchen, or by a third Lunch Lady franchise that serves eastern Ottawa, aren't known to have been affected by the outbreak.
(ProMED 3/15/2012)

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Chile (Santiago): Fifth fatal case of hantavirus in 2012
A young man became the fifth fatal victim of hantavirus as of 2 March 2012 this year, confirmed the Subsecretary of Health, Jorge Diaz. "A young man of 22 years resided in the Metropolitan region, but he went to a rural area in the BioBio region, where, according to the investigation, is probably where he was infected," Diaz stated.

The Subsecretary added that the young man was interned in the Davila Clinic, "He arrived in Santiago and presented with symptoms and later he developed a very, very difficult and very complex condition, where all available technology was used, but he could not survive."

The health authority also confirmed that there are a total of 21 hantavirus infection cases in the entire country, mostly concentrated in BioBio.
(ProMED 3/4/2012)

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Chile (Araucania region): Young girl dies of hantavirus infection
A 7-year-old girl became the first fatal hantavirus case in 2012 in the Araucania region. The girl died 7 March 2012 in the Carahue Hospital due to cardio-respiratory insufficiency (HPS) and multi-systemic failure. Hantavirus was confirmed as the cause of death by the Institute of Public Health.

A representative from Araucania Health SEREMI (regional governmental ministerial unit), Gloria Rodriguez, confirmed this situation and said that the initial examination done on the girl did not detect the presence of the virus.
(ProMED 3/14/2012)

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Chile (O'Higgins region): Young man infected with hantavirus
The Institute of Public Health (ISP) confirmed 7 March 2012 a new case of hantavirus infection in the O'Higgins region. The individual is a 19-year-old man who lives in Lolol.

A representative from the Health SEREMI, Michael Casson, stated that "the patient has had a frank deterioration of his health and in a few hours has evolved so that support in the intensive care unit is necessary. The Rancagua Regional Hospital and the O'Higgins Health Service are doing everything possible to remedy his situation."

Casson added that "within the scope of Health Action and Public Health, the initial epidemiological work has already been done to determine the areas that the 19-year-old man visited. These are Valdivia, Talca, and Lolol. In Valdivia we have a history that the youth was on vacation in the Niebla area and in Talca in a rural area, which apparently are areas with a certain grade of risk of acquiring a hantavirus infection. But since these are in other jurisdictions, they are not within our areas of responsibility to investigate," he said.

In Lolol, where the youth lives, we have jurisdiction and he frequently visited the Los Robles area, an area where we carry out work to correct environmental factors or behavior of the people. Basically, the idea is to minimize the risks of the people to contact a hantavirus infection," he stated.

The ISP indicated that with this case the reference laboratory confirmed that the number of people infected with the disease virus increases to 22 in the country as of 10 March 2012 this year. In 2012, cases of hantavirus infections have increased by 61% in comparison to 2011.
(ProMED 3/14/2012)

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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 25 individuals infected with the outbreak strain of E. coli O26 have been reported from eight states. The 11 new ill persons have been reported from Alabama, Michigan, and Ohio. Of the 24 ill persons with available information, 21 (87%) reported consuming sprouts at Jimmy John's restaurants in the seven days preceding illness.

Among these 24 ill persons, illness onset dates ranged from 25 December 2011 to 15 February 2012. Ill persons range in age from 9 years to 53 years old, with a median age of 26 years. 88% of ill persons are female. Among the 24 ill persons, 6 (25%) were hospitalized. None have developed HUS, and no deaths have been reported. Illnesses that occurred after 19 February 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

The full article may be accessed at http://www.cdc.gov/ecoli/2012/O26-02-12/index.html
(USCDC 3/8/2012)

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USA (New Mexico): 12 people treated in Eddy County rabies outbreak
State health officials say 12 Eddy County residents have received a series of rabies shots in the most concentrated outbreak of the viral illness in New Mexico in decades. Thirty-two pet dogs have been euthanized in 2012 in the Carlsbad area, most after tangling with rabid skunks. Health officials tell the Albuquerque Journal they have confirmed rabies in 22 skunks and a fox in Eddy County.

Each year, about 50 to 70 New Mexicans receive post-exposure treatment for rabies. But health officials are alarmed by the concentration of 12 treatments in a single county within two months. The cause of the outbreak appears to be a combination of a large skunk population and the region's extended drought forcing skunks to look for food in areas where there are people and pets.

[ProMED note: While this article seems to indicate a bit of alarm about the number of rabies post exposure prophylaxis (PEP) for humans exposed to the disease, there does not seem to be evidence of a rabies drive to vaccinate pets.

Creating a barrier between wildlife and humans is important to reduce the number of rabies PEP. The best way to create that barrier is to protect our pets by vaccinating against rabies. Our pets often come in contact with the rabid animal and then in contact with the owners or other humans. If authorities are alarmed about this situation then perhaps we will hear more about their efforts to mobilize drives to get pets vaccinated against rabies.]
(ProMED 3/3/2012)

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USA (Indiana): New measles case confirmed in Adams County
Indiana health officials have confirmed a new case of measles (the 17th) in the state, and this time it's in northeastern Indiana and unrelated to an outbreak in the Indianapolis metro area.

Spokeswoman Amy Reel of the Indiana State Department of Health says an unvaccinated resident of Adams County south of Fort Wayne was exposed to measles while traveling overseas. She says that person also may have exposed other persons to the highly infectious disease during a trip to the emergency room at Bluffton Region Medical Center on the evening of Monday, 20 February 2012. Bluffton is in Wells County, also south of Fort Wayne.

In central Indiana, 16 linked cases have been confirmed in Boone and Hamilton Counties.
(ProMED 3/4/2012)

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USA (Illinois): 313 whooping cough cases confirmed in McHenry County
313 cases of whooping cough have been confirmed in McHenry County since an outbreak began in August 2011. Health officials say 156 cases involved children aged ten and younger. A pair of two-month-old infants were hospitalized but have recovered.
(ProMED 3/10/2012)

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USA (New York): Commack district reports fifth whopping cough case
A fifth person within the Commack School District has been diagnosed with pertussis, also known as whooping cough, superintendent Donald James confirmed. The individual is from Indian Hollow Primary, and will return to school once they are treated, James said. In February 2012, it was announced an individual at Burr Intermediate had been diagnosed.

In January 2012, a person from Sawmill Intermediate was diagnosed with the disease. The first case was confirmed at Commack High School in December 2011. Though only five cases have been confirmed so far, James noted the disease is highly contagious and may spread. "Pertussis is highly contagious. Therefore, it is possible that subsequent cases will be diagnosed," James said.
(ProMED 3/10/2012)

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USA (Washington): Pertussis spreading in Clark County
Health officials say pertussis, also known as whooping cough, has become widespread in Clark County, Washington. Officials say 18 cases have been recorded throughout the county since January 2012, but there could be quite a few more cases that haven't been reported. The County Public Health Department says at least five school districts have confirmed cases of whooping cough. The Health Department recommends vaccinations as one of the best ways to avoid contracting pertussis.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120310.1066817
(ProMED 3/10/2012)

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USA (Wisconsin): Whooping cough confirmed at Southview
A student at Southview Elementary is the county’s latest confirmed case of whooping cough. The Chippewa County Department of Public Health confirmed to school district parents and employees on Wednesday, 7 March 2012, that the student was infected with the pertussis bacterium, more commonly known as whooping cough.

Neither school district staff nor county public health director Jean Durch would disclose the age or grade level of the infected student, citing the confidentiality of a single case. Durch said this is the fifth case of whooping cough the county has recorded since the beginning of 2012.

"A majority of those cases have links to Eau Claire," Durch said, citing students open enrolling for Eau Claire schools. But increased whooping cough cases aren’t limited to this region. Durch said the state’s reported cases of whooping coughs have been at their highest levels since 2004.
(ProMED 3/10/2012)

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3. Updates
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 (Jakarta)
Since January until March 2012, 174 dengue fever cases have happened in North Jakarta. Those cases were spread in Koja Sub-District as much as 45 cases, Tanjungpriok Sub-District 41 cases, Penjaringan Sub-District 35 cases, Cilincing Sub-District 30 cases, Pademangan Sub-District 12 cases, and Kelapa Gading Sub-District 11 cases.
(ProMED 3/13/2012)


Malaysia (national)
The death toll due to dengue recorded in the first two months in 2012 has shown a worrying increase with 15 deaths as compared to only eight in the corresponding period in 2011. Director-general of Health Datuk Seri Dr Hasan Abdul Rahman said three of the deaths recorded in 2012 involved children. Dr. Hasan said the number of dengue cases had also increased by 14% to 4,453 during the said period as compared to 3,915 cases previously.
(ProMED 3/6/2012)


Peru (Cajamarca region)
There have been at least 450 cases of the dengue virus infections, in four areas in Cajamarca. The most affected areas are Jaen, Tembladera, Cutervo, and San Ignacio. In late January of 2012, Ucayali was placed under a 60-day state of emergency after the region's epidemiology agency reported three deaths, and 50,000 cases of dengue virus infections since October 2011.
(ProMED 3/6/2012)


Philippines (Bataan)
In Bataan, seven municipalities were tagged as hotspots as dengue cases there have increased by almost 70% compared to 2011. Dr. Rosanna Buccahan, PHO officer-in-charge, said 364 cases of dengue fever were recorded from January - February 2012 compared to 214 for the same period in 2011. No fatality was reported.
(ProMED 3/13/2012)

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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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4. Articles
Survey of national immunization programs and vaccine coverage rates in Asia Pacific countries
Lu CY; APECI members, Santosham M. Vaccine. 16 March 2012. 30(13):2250-5.
Available at http://www.sciencedirect.com/science/article/pii/S0264410X11017075

Abstract. Children in the Asia Pacific region are still suffering from certain vaccine-preventable diseases. The current study surveyed the national immunization programs and vaccine uptake of traditional and newly developed vaccines in 12 countries in this area. The results showed children in most countries were well protected from conventional vaccine-preventable diseases, while immunization programs for certain diseases such as poliovirus or measles should be strengthened in certain countries. Protection against pneumococcus, rotavirus, and human papillomavirus infections were obviously inadequate in most of the countries in the region. Promoting coverage of newly developed vaccines will benefit a great number of children in this area.

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The Highly Virulent 2006 Norwegian EHEC O103:H25 Outbreak Strain Is Related to the 2011 German O104:H4 Outbreak Strain
L'Abée-Lund TM, Jørgensen HJ, O'Sullivan K, et al. PLoS ONE. 5 March 2012. 7(3): e31413. doi:10.1371/journal.pone.0031413.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0031413

Abstract. In 2006, a severe foodborne EHEC outbreak occurred in Norway. Seventeen cases were recorded and the HUS frequency was 60%. The causative strain, Esherichia coli O103:H25, is considered to be particularly virulent. Sequencing of the outbreak strain revealed resemblance to the 2011 German outbreak strain E. coli O104:H4, both in genome and Shiga toxin 2-encoding (Stx2) phage sequence. The nucleotide identity between the Stx2 phages from the Norwegian and German outbreak strains was 90%. During the 2006 outbreak, stx2-positive O103:H25 E. coli was isolated from two patients. All the other outbreak associated isolates, including all food isolates, were stx-negative, and carried a different phage replacing the Stx2 phage. This phage was of similar size to the Stx2 phage, but had a distinctive early phage region and no stx gene. The sequence of the early region of this phage was not retrieved from the bacterial host genome, and the origin of the phage is unknown. The contaminated food most likely contained a mixture of E. coli O103:H25 cells with either one of the phages.

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The antibiotic resistance characteristics of non-typhoidal Salmonella enterica isolated from food-producing animals, retail meat and humans in South East Asia
Van TT, Nguyen HN, Smooker PM, Coloe PJ. Int J Food Microbiol. 15 March 2012. 154(3):98-106.
Available at http://www.sciencedirect.com/science/article/pii/S0168160511007604

Abstract. Antimicrobial resistance is a global problem. It is most prevalent in developing countries where infectious diseases remain common, the use of antibiotics in humans and animals is widespread, and the replacement of older antibiotics with new generation antibiotics is not easy due to the high cost. Information on antibiotic resistance phenotypes and genotypes of Salmonella spp. in food animals and humans in different countries and geographic regions is necessary to combat the spread of resistance. This will improve the understanding of antibiotic resistance epidemiology, tracing of new emerging pathogens, assisting in disease treatment, and enhancing prudent use of antibiotics. However, the extent of antibiotic resistance in food-borne pathogens and humans in many developing countries remains unknown. The goal of this review is to discuss the current state of antibiotic resistance of non-typhoid Salmonella spp. in food-producing animals, retail meat and humans from South East Asia. It is focused on resistance characteristics of traditional and "critically important" antibiotics in this region, and the emergence of multidrug resistant strains and genetic elements that contribute to the development of multidrug resistance, including integrons and the Salmonella Genomic Island (SGI).

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Molecular Epidemiology and Nasal Carriage of Staphylococcus aureus and Methicillin-Resistant S. aureus among Young Children Attending Day Care Centers and Kindergartens in Hong Kong
Ho PL, Chiu SS, Chan MY, et al. J Infect. 9 March 2012. doi:10.1016/j.jinf.2012.02.018.
Available at http://www.journalofinfection.com/article/S0163-4453(12)00064-3/abstract

Objectives. To investigate the prevalence and molecular epidemiology of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) nasal carriage in children.

Methods. We collected nasal and nasopharyngeal swabs from 2211 children aged 2-5 years attending 79 day care centers (DCCs) and 113 kindergartens (KGs) in all 18 geographical districts in Hong Kong.

Results. The overall carriage rates of S. aureus and MRSA were 27.6% (95% confidence interval [CI], 24.8%-28.5%) and 1.3% (95% CI, 0.8%-1.8%), respectively. Molecular typing (staphylococcal cassette chromosome mec [SCCmec], sequence type [ST], clonal cluster [CC]) showed that all the 28 MRSA isolates had SCCmec IV (n=13) or V (n=15) including 12 isolates with community-associated-MRSA genotypes (ST59-IV/V, ST30-IV, ST88-V), 10 isolates with healthcare-associated-MRSA genotypes (ST45-IV/V, CC5-IV and ST630-V) and six isolates with novel genotypes (ST10-V, CC1-IV). Spa typing indicated that there was some within and between DCCs/KGs transmission of certain MRSA and Methicillin-sensitive S. aureus strains but this was not extensive.

Conclusion. Our findings indicate the potential for DCCs to be a reservoir for emerging MRSA genotypes and highlight the need to enhance education and infection control measures to reduce their cross-transmission in this population.

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Antimicrobial drug resistance in Peru
García C, Horna G, Linares E, et al. Emerg Infect Dis. March 2012.18(3):520-1. doi:10.3201/eid1803.100878.
Available at http://wwwnc.cdc.gov/eid/article/18/3/10-0878_article.htm

To the Editor. In Latin American countries, rates of antimicrobial drug resistance among bacterial pathogens are high. Data on these rates in Peru are incomplete, and no institution in Peru has participated in multinational surveillance studies. To document the antimicrobial drug resistance profile of key pathogens, we organized a surveillance network of clinical laboratories from 9 hospitals (public, general, tertiary care, and quaternary care) in Lima, the capital of Peru. Over a 12-month period (April 2008-March 2009), we consecutively collected positive bacterial blood culture isolates (other than coagulase-negative staphylococci) from each of the 9 hospitals. Only the first isolate per patient was included. Patients' age and hospital ward were recorded. Identification and susceptibility testing were performed at the Institute of Tropical Medicine Alexander von Humboldt (Lima, Peru).

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Factors contributing to the high prevalence of multidrug-resistant tuberculosis: a study from China
Liang L, Wu Q, Gao L, et al. Thorax. 8 March 2012. doi:10.1136/thoraxjnl-2011-200018.
Available at http://thorax.bmj.com/content/early/2012/03/07/thoraxjnl-2011-200018.abstract

Background. The rapid spread of multidrug-resistant tuberculosis (MDR-TB) has attracted global concerns. This study aimed to identify factors contributing to the high prevalence of MDR-TB in China's Heilongjiang province.

Methods. A cross-sectional survey following the WHO/International Union Against Tuberculosis and Lung Disease guidelines was conducted with consecutive recruitment of patients with TB in 30 counties selected at random in Heilongjiang in 2004. A total of 1995 patients were tested for MDR-TB. Factors associated with MDR-TB were identified through multilevel models and traditional logistic regression analysis, along with in-depth interviews with nine patients, five healthcare managers and four doctors.

Results. 241 patients (12%) were identified with MDR-TB. The retreatment patients were 5.48 times (95% CI 4.04 to 7.44) more likely to have MDR-TB than newly diagnosed patients. The patients who were treated with isoniazid and rifampin for >180 days were 4.82 times (95% CI 2.97 to 7.81) more likely to develop MDR-TB than those treated <180 days. Age and delay in initiating TB treatment were associated with MDR-TB. Financial burden, poor knowledge and side effects of TB treatment were perceived by the interviewees as influencing factors. Lack of coordination of services, unsatisfactory supervision of treatment and infection control jeopardized the control of MDR-TB.

Conclusions. Inappropriate treatment is the most important influencing factor of MDR-TB. Increasing people's awareness of TB, early detection and appropriate treatment of patients with TB should become a priority, which requires strong commitment and collaboration among health organizations and greater compliance with TB treatment guidelines by service providers and patients.

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Commercial Serological Tests for the Diagnosis of Active Pulmonary and Extrapulmonary Tuberculosis: An Updated Systematic Review and Meta-Analysis
Steingart KR, Flores LL, Dendukuri N, et al. PLoS Med. 9 August 2011. 8(8): e1001062. doi:10.1371/journal.pmed.1001062.
Available at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001062

Background. Serological (antibody detection) tests for tuberculosis (TB) are widely used in developing countries. As part of a World Health Organization policy process, we performed an updated systematic review to assess the diagnostic accuracy of commercial serological tests for pulmonary and extrapulmonary TB with a focus on the relevance of these tests in low- and middle-income countries.

Methods and Findings. We used methods recommended by the Cochrane Collaboration and GRADE approach for rating quality of evidence. In a previous review, we searched multiple databases for papers published from 1 January 1990 to 30 May 2006, and in this update, we add additional papers published from that period until 29 June 2010. We prespecified subgroups to address heterogeneity and summarized test performance using bivariate random effects meta-analysis. For pulmonary TB, we included 67 studies (48% from low- and middle-income countries) with 5,147 participants. For all tests, estimates were variable for sensitivity (0% to 100%) and specificity (31% to 100%). For anda-TB IgG, the only test with enough studies for meta-analysis, pooled sensitivity was 76% (95% CI 63%–87%) in smear-positive (seven studies) and 59% (95% CI 10%–96%) in smear-negative (four studies) patients; pooled specificities were 92% (95% CI 74%–98%) and 91% (95% CI 79%–96%), respectively. Compared with ELISA (pooled sensitivity 60% [95% CI 6%–65%]; pooled specificity 98% [95% CI 96%–99%]), immunochromatographic tests yielded lower pooled sensitivity (53%, 95% CI 42%–64%) and comparable pooled specificity (98%, 95% CI 94%–99%). For extrapulmonary TB, we included 25 studies (40% from low- and middle-income countries) with 1,809 participants. For all tests, estimates were variable for sensitivity (0% to 100%) and specificity (59% to 100%). Overall, quality of evidence was graded very low for studies of pulmonary and extrapulmonary TB.

Conclusions. Despite expansion of the literature since 2006, commercial serological tests continue to produce inconsistent and imprecise estimates of sensitivity and specificity. Quality of evidence remains very low. These data informed a recently published World Health Organization policy statement against serological tests.

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Modeling Seasonal Rabies Epidemics in China
Zhang J, Jin Z, Sun GQ, Sun XD, Ruan S. Bull Math Biol. 1 March 2012. doi:10.1007/s11538-012-9720-6.
Available at http://www.springerlink.com/content/y645727777720384/

Abstract. Human rabies, an infection of the nervous system, is a major public-health problem in China. In the last 60 years (1950-2010) there had been 124,255 reported human rabies cases, an average of 2,037 cases per year. However, the factors and mechanisms behind the persistence and prevalence of human rabies have not become well understood. The monthly data of human rabies cases reported by the Chinese Ministry of Health exhibits a periodic pattern on an annual base. The cases in the summer and autumn are significantly higher than in the spring and winter. Based on this observation, we propose a susceptible, exposed, infectious, and recovered (SEIRS) model with periodic transmission rates to investigate the seasonal rabies epidemics. We evaluate the basic reproduction number R (0), analyze the dynamical behavior of the model, and use the model to simulate the monthly data of human rabies cases reported by the Chinese Ministry of Health. We also carry out some sensitivity analysis of the basic reproduction number R (0) in terms of various model parameters. Moreover, we demonstrate that it is more reasonable to regard R (0) rather than the average basic reproduction number or the basic reproduction number of the corresponding autonomous system as a threshold for the disease. Finally, our studies show that human rabies in China can be controlled by reducing the birth rate of dogs, increasing the immunization rate of dogs, enhancing public education and awareness about rabies, and strengthening supervision of pupils and children in the summer and autumn.

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Prevalence and associated psychosocial factors of increased hand hygiene practice during the influenza A/H1N1 pandemic: findings and prevention implications from a national survey in Taiwan
Miao YY, Huang JH. Trop Med Int Health. 5 March 2012. doi: 10.1111/j.1365-3156.2012.02966.x.
Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2012.02966.x/abstract;jsessionid=060B95D1C94810CB5B55120AE3C17502.d02t02

Objective. To investigate increased hand hygiene practice in response to the pandemic influenza A/H1N1 (pH1N1) and its associated psychosocial factors in the Taiwanese general population.

Methods. A national telephone survey using random digit dialing was conducted on October 28-30, 2009 in Taiwan, resulting in a final sample of 1079 participants aged 15 or older.

Results. Seventy-seven per cent reported that they increased hand hygiene practice during the pH1N1 epidemic. Multivariate logistic regression analysis showed that increased hand hygiene practice was associated with health beliefs that pH1N1 was more transmissible than avian influenza (OR=1.42); that pH1N1 was slightly more severe in Taiwan compared with other countries (OR=1.59); that handwashing was very effective in preventing pH1N1 (OR=3.12), and that handwashing after contact with possibly pH1N1-contaminated objects/surfaces was not very difficult (OR=2.14) or not difficult at all (OR=2.49).

Conclusions. These findings suggest that future campaigns to promote preventive health behaviour in the public should consider communicating evidence-based information concerning the effectiveness of the recommended preventive behaviour, comparing the emerging epidemic with prior local outbreaks, and not overplaying the seriousness of the disease with fear tactics.

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Telephone Triage of Influenza-like Illness during Pandemic 2009 H1N1 in an Obstetric Population
Eppes CS, Garvia PM, Grobman WA. AJOG. 2 March 2012. doi:10.1016/j.ajog.2012.02.023.
Available at http://www.sciencedirect.com/science/article/pii/S000293781200186X

Objective. To determine the safety and efficiency of a telephone-based triage system for influenza-like illness (ILI), during the 2009 pandemic, at our institution.

Study Design. A triage system was implemented that involved initial telephone screening by a provider who determined whether outpatient phone-based care or assessment in a centralized evaluation unit was needed. Those who received outpatient care were empirically treated. Those seen in the evaluation unit were assessed for inpatient admission.

Results. Of the 230 women who were evaluated, 41% were treated as outpatients and 59% were seen in the evaluation unit. Of those treated as outpatients, 9% were eventually seen in the evaluation unit and only 4% were ultimately admitted, with a maximum hospitalization of 4 days. Of the 135 patients initially seen in the evaluation unit, 32% were admitted and 44% had a positive PCR for respiratory pathogens.

Conclusions. This triage system improved efficiency of resource utilization without incurring apparent ILI morbidity.

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5. Notifications
German-Singaporean Symposium on Pathogenic E. coli
Singapore, Singapore, 23 April 2012
The focus of the Symposium is on the 2011 outbreak of enterohaemorrhagic E. coli (EHEC) O104:H4 in Germany that involved more than 4,000 cases and 50 deaths. The theme of the Symposium is: “What can be learnt from the German EHEC outbreak in terms of investigating outbreaks and strengthening outbreak response capacities?" Experts from Germany will provide firsthand accounts of the investigation and response to the 2011 outbreak, and panels of regional experts will discuss the implications of the outbreak for the Asia-Pacific region.

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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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1st Asian Conference on Hepatitis B & C, HIV and Influenza
Beijing, China, 18 to 19 May 2012
This workshop aims at bridging the gap between the knowledge that is shared among experts in the field and the knowledge of researchers and clinicians in daily practice. The format of the workshop will consist of a two-day program.
Additional information at http://www.virology-education.com/index.cfm/t/1st_Asian_Conference_on_Hepatitis_B_and_C__HIV_and_Influenza/vid/E5152F66-A8F0-C451-1E451D27CBA2B0E4

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International Environment and Health Conference (IEHC2012)
Penang, Malaysia, 6 to 7 June 2012
This conference aims to gather all environment and health scientists, policy makers and academicians to pursue their ideas and research findings regarding health issues caused environmental problems such as global warming, pollution, and natural and environmental disasters.
Additional information at http://www.ppsk.usm.my/conference/ehc12.nsf/

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15th International Congress on Infectious Diseases
Bangkok, Thailand, 13 to 16 June 2012
The 15th ICID will be a chance for ongoing collaborative efforts, as well as for individuals, to present and share their experiences fighting infectious diseases. To commemorate the 30th year of our Society we are keen to provide attendees in Bangkok with an outstanding scientific program that will run the spectrum from cutting edge research with clinical implications, to state of the art practices in infectious diseases by a truly international faculty composed of world leaders in their areas. ISID looks forward to working together with our collaborator in Thailand, the Infectious Disease Association of Thailand (IDAT), as well as other organizations to develop 15th ICID.
Additional information at http://www.isid.org/icid/welcome.shtml

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 apecein@u.washington.edu