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Vol. XV No. 7 ~ EINet News Briefs ~ Mar 30, 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: Influenza surveillance lacking
- Egypt: H5N1 avian influenza situation update
- Netherlands: Avian influenza on Dutch turkey farm was H5N2
- Bangladesh: Ten H5N1 avian influenza outbreaks affect 49,000 poultry
- Chinese Taipei: Confirms latest outbreak of high-pathogenic H5N2 avian influenza
- India: Reports 12 recent H1N1 influenza deaths
- Indonesia: H5N1 avian influenza situation update
- Nepal: Reports two H5N1 avian influenza outbreaks
- USA: USCDC confirms H3N2 influenza with MRSA in Maryland cluster

2. Infectious Disease News
- Global: WHO suggests that simple methods could thwart tuberculosis in children
- Global: Drug resistant malaria takes new ground, raising fears of spread
- Australia: Ross River virus on the rise
- Chinese Taipei: Taipei City reports five enterovirus 71 cases in 2012
- Hong Kong: CHP investigating suspected ciguatoxin poisoning cases
- Malaysia (Sarawak): New hand-foot-mouth disease cases shoot up two-fold to 109
- Philippines (Cebu): Tuburan typhoid cases down, but Alegria reports 11
- Canada (Ontario): Tests link Salmonella outbreak to school lunch caterer
- Canada: Measles case has Edmonton health officials warning of possible exposures
- Chile: Hantavirus infection cases update
- Chile: Trichinellosis from contaminated pork
- USA (Washington): Possible measles exposure at Skamania Lodge
- USA (California): Recall of raw milk products from San Benito County farm

3. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA
- DENGUE
- PERTUSSIS

4. Articles
- The epidemiology of published norovirus outbreaks: a review of risk factors associated with attack rate and genogroup
- Imported malaria and dengue fever in returned travelers in Japan from 2005 to 2010
- Epidemiology and seasonality of respiratory viral infections in hospitalized children in Kuala Lumpur, Malaysia: a retrospective study of 27 years
- Burden and transmission of zoonotic foodborne disease in a rural community in Mexico
- Risk factors for scabies in Taiwan
- Combination Antiviral Therapy for Influenza: Predictions from Modeling of Human Infections
- Community responses to communication campaigns for Influenza A (H1N1): a focus group study
- Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public's perspectives
- Interspecies interactions and potential Influenza A virus risk in small swine farms in Peru
- Notes from the Field: Severe Hand, Foot, and Mouth Disease Associated with Coxsackievirus A6 — Alabama, Connecticut, California, and Nevada, November 2011–February 2012

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 / 6 (3)
Indonesia / 5 (5)
Viet Nam / 4 (2)
Total / 20 (12)

***For data on human cases of avian influenza prior to 2012, go to: http://depts.washington.edu/einet/humanh5n1.html

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 598 (352) (WHO 3/26/2012)
http://www.who.int/influenza/human_animal_interface/avian_influenza/EN_GIP_20120326CumulativeNumberH5N1cases.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: Influenza surveillance lacking
When researchers created strains of the H5N1 avian influenza virus that could spread easily between mammals, they argued that their work would aid in surveillance, by identifying mutations to watch for in the wild.

But an analysis by Nature paints a dire picture of how animal flu viruses are being monitored. In 2010, the world’s poultry population was estimated at 21 billion, yet only around 1,000 flu sequences from 400 avian virus isolates were collected — and many countries that are home to billions of farmed chickens, ducks and pigs contributed few or none.

In addition, the surveillance is typically not sustained, but instead is ad hoc and reactive, and is largely in response to disease outbreaks or temporary research projects. But a flu virus that emerges anywhere, at any time, can threaten the entire planet. The Nature analysis “highlights a global problem: lack of data”, says Ian Brown, head of avian virology and mammalian influenza at the Animal Health and Veterinary Laboratories Agency lab in Weybridge, UK.

Timely global surveillance of animal flu viruses is crucial not just for identifying pandemic threats, but also for detecting outbreaks, monitoring how viruses are evolving, understanding risk factors that enable them to spread and keeping animal vaccines and diagnostics up to date.

The full article may be accessed at http://www.nature.com/news/flu-surveillance-lacking-1.10301
(Nature News 3/28/2012)

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Europe/Near East
Egypt: H5N1 avian influenza situation update
The Ministry of Health and Population of Egypt has notified WHO of a new cases of human infection with avian influenza A (H5N1) virus. The case is a 40 year-old female from Dakahlia Governorate. She developed symptoms on 6 March 2012, was hospitalized on 12 March 2012. She was in critical condition and received oseltamivir upon admission. She died on 15 March 2012. The case was laboratory confirmed by the Central Public Health Laboratories (NIC). Investigations into the source of infection indicate that the case had exposure to sick backyard poultry. Of the 164 cases confirmed to date in Egypt, 58 have been fatal.
(WHO 3/19/2012)

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Netherlands: Avian influenza on Dutch turkey farm was H5N2
The low-pathogenicity avian flu virus found on a Dutch turkey farm was an H5N2 strain, Dutch officials said to the World Organization for Animal Health (OIE), not H7 as mentioned on 19 March 2012. The virus infected 200 turkeys but caused no deaths, and it prompted the culling of all 44,500 turkeys on the farm, according to the OIE. Because low-pathogenicity H5 and H7 avian flu viruses can mutate into highly pathogenetic forms, they must be reported under European regulations. The source of the virus was listed as unknown. All commercial poultry in a three-kilometer zone around the affected farm will be screened, the report said.
(CIDRAP 3/20/2012)

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Asia
Bangladesh: Ten H5N1 avian influenza outbreaks affect 49,000 poultry
Bangladesh has confirmed ten H5N1 avian flu outbreaks on commercial poultry farms in several divisions that killed 2,886 birds and required 46,359 additional poultry to be culled to prevent disease spread, according to the World Organization for Animal Health (OIE). Flocks varied in size from 150 to more than 22,000 poultry, and the start dates for the outbreaks ranged from 19 January to 2 March 2012 . Six of the outbreaks were in Dhaka division (all in separate districts), two in Rajshahi, and one each in Khulna and Chittagong. On 15 January 2012, Bangladesh reported three H5N1 outbreaks from late December 2011 and early January 2012—two in Dhaka and one in Khulna division—that affected 43,849 poultry. And on 21 December 2011 the country reported four November and December 2011 outbreaks that affected 14,885 poultry, with two outbreaks in each of those two divisions.
(CIDRAP 3/21/2012)

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Chinese Taipei: Confirms latest outbreak of high-pathogenic H5N2 avian influenza
Chinese Taipei has confirmed its third outbreak of highly pathogenic H5N2 avian flu in commercial poultry in past weeks, according to the OIE on 19 March 2012. The three outbreaks combined have killed 1,548 birds and led to the culling of 21,564 others to prevent disease spread. All began February 2012 but were reported to the OIE after delays of varying lengths. The most recent report describes an outbreak in a flock of 8,647 poultry that killed 426 birds in Chu-Tang Township of Changhua County. A 10 March 2012 report detailed 318 deaths in a flock of 9,625 in Fang-Yuan Township in the same county, and a 3 March 2012 report confirmed 804 H5N2 deaths in a flock of 4,804 birds in Liou-Jia District of Tainan County. All remaining birds in the three flocks were culled. In January 2012, Taiwan reported to the OIE that a November 2011 avian flu outbreak killed 200 birds on a commercial farm in Fang-Yuan, and the remaining 52,800 poultry were culled. That outbreak, however, was attributed to low-pathogenic H5N2, even though all infected birds died. The H5N2 outbreaks have led to charges of a government cover-up.
(CIDRAP 3/20/2012)

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India: Reports 12 recent H1N1 influenza deaths
A rise in pandemic 2009 H1N1 (pH1N1) flu infections in India has led to 12 deaths in March 2012. Half of those deaths were in the western state of Maharashtra, with Rajasthan, Andhra Pradesh, and Karnatak also reporting pH1N1 deaths, according to Health Secretary P. K. Pradhan. Nearly 130 people have become infected in the country, with many of them hospitalized. In Pune, Maharashtra's second-largest city after Mumbai, hospitals are seeing new pH1N1 patients every day.
(CIDRAP 3/26/2012)

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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 17 year-old male from Nusa Tenggara Barat Province. He developed fever on 28 February 2012 and sought treatment on 1 March 2012. His condition deteriorated and he was admitted to a referral hospital but he died on 9 March 2012. Epidemiological investigation conducted by a team from the health office indicated that there were sudden poultry die-offs in his neighborhood. As of 26 March 2012, of the 188 cases reported in Indonesia since 2005, 156 have been fatal.
(WHO 3/26/2012)

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Nepal: Reports two H5N1 avian influenza outbreaks
Livestock officials in Nepal confirmed two more H5N1 outbreaks in poultry, according to the World Organization for Animal Health (OIE) on 26 March 2012. The virus struck two sites in Bagmati province where commercial farms are located. One is a layer farm in Kathmandu where ducks, quails, and pigs are raised separately at the same facility. The other location comprises two adjoining poultry farms that have layers in two sheds and broilers in another. The outbreaks killed 21,806 birds, and the remaining 3,014 were culled to control the spread of the virus. The virus has hit other farms in the same province over the past few months.
(CIDRAP 3/27/2012)

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Americas
USA: USCDC confirms H3N2 influenza with MRSA in Maryland cluster
The Centers for Disease Control and Prevention in the United States (USCDC) has confirmed reports from Maryland officials that a recent cluster of four severe influenza cases in the state involved a seasonal H3N2 strain, complicated in at least two cases by drug-resistant bacterial infections.

The case cluster in a rural community involved an 81-year-old woman and three of her adult children; the mother and two of her children died.

The CDC said genetic sequencing showed that the H3N2 strain in the cluster was more than 99% similar to other H3N2 isolates submitted by Maryland health officials this season. Although full antigenic testing is pending, the viruses "are close to the H3N2 component of the 2011-2012 seasonal vaccine such that vaccination should offer protection against these viruses," the CDC said on 16 March 2012. Earlier, a local health official said that the elderly woman had received a seasonal flu vaccine but her children had not, according to previous reports.

The CDC also confirmed the state's earlier report that at least two of the cases involved co-infections with methicillin-resistant Staphylococcus aureus (MRSA). Testing of the MRSA isolates is continuing, "but preliminary results indicate that some of the MRSA isolates from Maryland are pulsed-field types USA300," the CDC said. "Strains from the USA300 MRSA pulsed-field type can cause community MRSA infections including outbreaks of skin infections."

The full article may be accessed at http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/mar1912cluster.html
(CIDRAP 3/19/2012)

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2. Infectious Disease News

Global
Global: WHO suggests that simple methods could thwart tuberculosis in children
Serious illness and death from tuberculosis (TB) could be prevented in many of the half million children who become ill from the disease each year if better access to health services were available and health workers were better trained to recognize it, the World Health Organization (WHO) said on 21 March 2012. The disease often goes undiagnosed and untreated in babies and children simply because it isn't looked for; most youngsters with TB catch it from infected parents, but such simple steps as evaluating the children of TB patients are too often not taken, the agency said. The WHO's Stop TB Partnership suggests three low-cost actions to improve TB care in this age-group: Examine children from households where TB is present and begin treatment immediately if they are very ill or have HIV, provide isoniazid to all children who are at risk for TB but have no symptoms, and train health workers who care for pregnant women, babies, and children to check for TB and refer suspected patients as necessary. Lucica Ditiu, MD, executive secretary of the Stop TB Partnership, said, "Two hundred children die from TB every day. Yet it costs less than three cents a day to provide therapy that will prevent children from becoming ill with TB and 50 cents a day to provide treatment that will cure the disease." Children under three and those with malnutrition or compromised immune systems are at greatest risk for TB, and children are at special risk for severe forms of TB, the agency said.
(CIDRAP 3/21/2012)

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Global: Drug resistant malaria takes new ground, raising fears of spread
In Southeast Asia, drug-resistant falciparum malaria may have evolved resistance to another frontline therapy and established itself in new territory in western Thailand, according to the World Health Organization. The new area in Thailand joins previous hot spots in Cambodia, Vietnam, and Myanmar, with the latter being badly equipped to stanch further spread. Despite containment efforts, the possibility this strain may spread to Africa, which has the most significant malaria burden, remains very real.

Twice before, drug resistance has appeared first in Southeast Asia then migrated to Africa (which bears a punishing 90% of the world's malaria burden). Malaria intensity at the Thai-Cambodia border is comparatively light, but somehow parasites at this location have managed to evolve a tolerance for some previous frontline drugs, chloroquine and sulfadoxine-pyrimethamine. From 1980 to 2004, malaria deaths increased three-fold to an estimated 1.8 million, according to a study published in The Lancet. Antimalarial drug resistance was "the likely driver" according to the study.

The full article may be accessed at http://arstechnica.com/science/news/2012/03/drug-resistant-malaria-takes-new-ground-raising-fears-of-global-spread.ars
(Ars Technica 3/22/2012)

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Asia
Australia: Ross River virus on the rise
The number of people contracting the mosquito-spread infection has dramatically increased in Western Australia and Tasmania. Although not fatal, many health authorities are warning travelers to be aware of mosquitoes and the Ross River virus (RRV). A significant rise in people contracting the disease has reportedly been caused by recent flooding and consequent swarms of mosquitoes in Western Australia.

The Australian Medical Association (AMA) has already reported 632 cases in Western Australia and Tasmania in 2012 – more than double for the same period in 2011. Due to heavy rainfall in several states and severe flooding in New South Wales and Queensland, vast areas of stagnant water have formed – acting as the perfect breeding grounds for mosquitoes. Health authorities are urging travelers in the affected regions to be vigilant in protecting themselves against mosquito bites.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120325.1079874
(ProMED 3/25/2012)

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Chinese Taipei: Taipei City reports five enterovirus 71 cases in 2012
Taipei city health authorities warned on 19 March 2012 of a rising trend of enterovirus (EV) infection and the likelihood that the virus, a common cause of hand, foot and mouth disease (HFMD) among children, will also attack teenagers. Lin Kuo-ning, deputy chief of the city Department of Health's disease control division, said there have been five cases of enterovirus 71 (EV71) infection reported in 2012, involving one high school student and two junior high school students.

EV71 is a picornavirus associated with HFMD and fatal neurological illness in infants and young children. These cases suggest a rising trend in the age of patients susceptible to EV, Lin said.

According to city health department statistics, as of 10 March 2012, district hospitals in the city had reported a total of 1,182 cases of EV infection, 2.8 times the 417 cases the hospitals reported in the same period in 2011. Meanwhile, schools around Taipei reported a total of 1,384 EV cases from 1 January 2012 to 10 March 2012, some 3.93 times the 352 cases recorded in the same period of 2011. The accumulated number of school classes forced to be suspended due to cluster infections reached 113 classes during this period, that is 3.22 times the 35 classes reported in the same period of 2011, the statistics show.

The city health department reminded the public that infants and toddlers aged under five are at the highest risk of severe EV infection. Children who develop symptoms of extreme sleepiness, unconsciousness, vomiting, persistent fever or seizures should be taken to local clinics or hospitals for medical treatment as soon as possible, the department said.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120319.1074955
(ProMED 3/19/2012)

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Hong Kong: CHP investigating suspected ciguatoxin poisoning cases
The Centre for Health Protection (CHP) of the Department of Health is on 27 March 2012 investigating ciguatoxin poisoning cases affecting five people who have consumed coral reef fish.

The first episode involved three women and a man, aged between 20 and 56, who developed symptoms of ciguatoxin poisoning including abdominal pain, limb numbness, and diarrhea between two to ten hours after eating a fish during dinner at home on 23-24 March 2012. One of them sought medical treatment at Pamela Youde Nethersole Eastern Hospital and required hospitalization. All are now in stable condition. Investigation revealed that the fish was purchased from a market in Ap Lei Chau on 23 March 2012.

The other episode involved a woman aged 48. She developed symptoms of ciguatoxin poisoning including diarrhea, numbness over face and limbs, reversal of sensation of coldness and hotness, and headache three hours after eating a fish at home at midnight of 26 March 2012. She sought medical consultation at United Christian Hospital but did not require hospitalization. She is currently in stable condition. Investigation revealed that the fish was purchased from a market in Tai Po on 24 March 2012.

A CHP spokesman said ciguatera fish poisoning is not uncommon in tropical areas. It is mainly associated with the consumption of big coral reef fish that have accumulated the toxin in the body, in particular in internal organs, through eating small fish that consumed toxic algae in coral reef seas. A larger fish is therefore more likely to carry higher amounts of the toxin. However, it is not easy to tell from the appearance of the fish if it contains toxin.

People affected may show symptoms of numbness of the mouth and the limbs, vomiting, diarrhoea, reversal of sensation of coldness and hotness, and pain in the joints and muscles.

The spokesman said that most people affected by ciguatoxin would recover without long-term health effects. However, if excessive toxin is consumed, the circulatory and nervous systems can be affected. "The toxin cannot be destroyed by cooking," the spokesman said.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120329.1084658
(ProMED 3/29/2012)

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Malaysia (Sarawak): New hand-foot-mouth disease cases shoot up two-fold to 109
The number of hand-foot-mouth disease (HFMD) cases in Sarawak rose sharply on 19 March 2012 to more than double that of 18 March 2012. It went from 44 new cases to 109 new cases on 19 March 2012, according to data the state's Health Department.

The dramatic increase was believed to be due to cases that were detected with the opening of school after a one-week break. "The increase may be due to the fact that most of the clinics as well as child care centres were closed during the weekend and therefore, the majority of cases were only detected on 19 March 2012.”

The rise was observed in Kuching as well as in Samarahan, Sri Aman, Betong, Sarikei, Bintulu, Miri, and Limbang. Mukah and Sibu, however, saw a drop in cases, while Kapit had no new cases for the past three consecutive days.

As of 19 March 2012, the department had detected 3,297 cases in the state with 240 admissions. There are no serious cases and no deaths due to HFMD have been reported so far. On 19 March 2012, two schools in Kuching and one in Bintulu were served with closure orders. They were Taska Dirumah Mimi Satok and SK Semerah Padi in Kuching, and Tadika Methodist in Bintulu.

The cumulative number of institutions closed remains at 61. Kuching had 37, Sarikei (9), Betong (6), Samarahan (4), Limbang (3), and Bintulu (2).

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120322.1077794
(ProMED 3/22/2012)

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Philippines (Cebu): Tuburan typhoid cases down, but Alegria reports 11
Even as the Province of Cebu is trying to fight the typhoid menace in the town of Tuburan, another 11 reported cases surfaced in Alegria town. Seven children were brought to Reinhard Wirtgen Memorial Hospital, while four were rushed to the nearby Malabuyoc District Hospital. Most of the cases came from Barangays Legaspi and Poblacion of Alegria. As of 12 March 2012, two patients were discharged from Reinhard Wirtgen Memorial Hospital together with four others in Malabuyoc District Hospital.

Dr. Expedito Medalla, DOH-Central Visayas Health and Emergency Management Staff (HEMS) coordinator, said there is a downtrend of patients in Tuburan. Although there are still people heading to the hospital for consultation, no more serious cases were reported. He said the chlorinator in the water system helped in the decrease of patients.

This is the second time that the town of Alegria was struck by a typhoid outbreak. The first one happened in December of 2010.
(ProMED 3/17/2012)

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Americas
Canada (Ontario): Tests link Salmonella outbreak to school lunch caterer
Lab tests indicate that an outbreak of salmonellosis that has sickened 46 children likely came from food served by a lunch caterer that primarily serves schools, according to the city’s health department.

Samples of frozen ground beef and raw chicken taken from a kitchen belonging to a Lunch Lady franchise on Boyd Avenue tested positive for the same bacterium detected in the children and four adults who’ve been sick enough to seek medical attention since the week of 5 March 2012, the department said on 23 March 2012.

"The results further point to a link between the outbreak and the ground beef prepared at the caterer, but additional testing is still underway.” The beef was tainted with Salmonella enterica serotype Typhimurium and the chicken with S. enterica serotype Heidelberg, two of the many types of the bacterium. The department’s investigation has pointed particularly to Lunch Lady meat lasagna and beef tacos as foods eaten by people who later got sick. The bacterium can be rendered harmless if food is cooked to a high enough temperature.

The challenge now is to determine whether the meat was contaminated when it arrived at the kitchen or became tainted while Lunch Lady workers handled it. The health department "is in communication with the Provincial and Federal Health and Food Safety authorities to assist in the ongoing investigation and response.”.

50 people (46 children and four adults) became sick in cases believed to be connected to this outbreak, which the department revealed at the beginning of the week of 12 March 2012. Known cases have been found in about a dozen elementary schools, a Kanata daycare, and at Merivale High School. In the high school case, an older sibling likely caught the bug from a younger one. To prevent more secondary infections, the health department urges Ottawans to be careful about hygiene, especially when preparing food.

The health department also added three more schools to the list of institutions where related cases have been identified: Featherston Drive Public School in Alta Vista, First Avenue Public School in the Glebe, and Holy Redeemer School in Kanata.
(ProMED 3/24/2012)

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Canada: Measles case has Edmonton health officials warning of possible exposures
Alberta Health Services has confirmed one case of measles in the Edmonton area, and is advising of potential exposures. Officials say anyone who was in five locations in Mill Woods, a neighborhood in southeast Edmonton, at specific times earlier in March 2012, may be at risk of developing the contagious disease, which is spread through the air. The locations are a pharmacy, dental clinic, two medical clinics and a medical lab in Millbourne Shopping Centre.

Health officials say people who haven't been vaccinated against measles or who haven't had the disease are at the highest risk. Symptoms of measles include fever, cough, runny nose or red eyes, and a red blotchy rash that appears three to seven days after fever starts. The rash typically begins behind the ears and on the face, spreading down to the body, and finally to the arms and legs. There is no cure for measles, but it can be prevented with vaccination.
(ProMED 3/24/2012)

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Chile: Hantavirus infection cases update
The Institute of Public Health (ISP) confirmed on 22 March 2012 two new hantavirus infection cases, in the eighth Region and in the Metropolitan Region, bringing to 30 the number of people infected with this disease in the country as of 22 March in 2012.

Of the 30 cases of hantavirus cardiopulmonary syndrome confirmed by the ISP, the Universidad Austral, and the Laboratorio de la Pontificia Universidad Catolica de Chile, eight have died, of which five have been registered in the BioBio region. The other deaths from hantavirus infections have occurred in the Maule, La Araucania, and Metropolitan regions, with one case in each.
(ProMED 3/25/2012)

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Chile: Trichinellosis from contaminated pork
A total of nine persons in Caguach and Achao communities may be affected by the parasitic disease known as trichinellosis. An investigation performed by health authorities found nine cases confirmed in Chiloe by the Public Health Institute (ISP) and with six more suspected cases. The health institution started performing inspections and sanitary education campaigns.

The information was given by Dr. Christian Araneda, Head of Health Authorities in Chiloe, who explained that in Caguach Island eight persons had a confirmed trichinellosis infection, after one person illegally killed a pig and sold the meat to some of his neighbors. "Until now there are no suspicious cases in Caguach and one person is receiving therapy. All of them are in a good condition," Dr. Armeda added.

The health care officer also added that in Achao there is one confirmed case of trichinellosis, and there are three persons considered as suspicious cases, presumably because of having eaten pork from an illegal slaughterhouse. It was also reported that in Castro city there are three additional suspicious cases.

After the outbreak was reported, Dr. Araneda explained that some measures had been taken. These consist in monitoring the clinical condition of affected persons and performing inspections to butcher shops during next weekend in the affected communities. Also, we will deliver educational lectures using specially designed material, aiming to prevent the occurrence of new cases of trichinellosis", he said.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120323.1079129
(ProMED 3/23/2012)

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USA (Washington): Possible measles exposure at Skamania Lodge
Health officials are warning people who visited Skamania Lodge between 25 February 3 and March 2012 that they may have been exposed to measles. Skamania County health officials learned 3 March 2012 that someone who had visited the lodge recently was later diagnosed with the highly contagious disease.

The person, who was traveling internationally, attended the Open Source Technology Summit at the lodge from 6 March to 9 March 2012. The person began exhibiting symptoms of measles after returning home and was diagnosed positive for measles on 11 March 2012.

Measles is transmitted through small particles in the air so anyone who was at the lodge or attended the summit may have been exposed, health officials said. Those who have been vaccinated against measles, have had measles in the past or were born before 1 January 1957 are protected against measles. People who were exposed can receive protective antibody treatment that can decrease the risk of serious illness if given by 15 March 2012.
(ProMED 3/18/2012)

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USA (California): Recall of raw milk products from San Benito County farm
Raw milk, raw nonfat milk and raw cream produced by Claravale Farm of San Benito County is the subject of a statewide recall and quarantine order announced 23 March 2012, by California State Veterinarian Dr. Annette Whiteford. The quarantine order came following the confirmed detection of Campylobacter bacteria in raw cream.

Consumers are strongly urged to dispose of any product remaining in their refrigerators with code dates of "MAR 27" and earlier, and retailers are to pull those products immediately from their shelves.

On 19 March 2012, Claravale Farm voluntarily ceased distribution of its products after the California Department of Food and Agriculture made a preliminary positive finding of Campylobacter in raw cream. The stoppage of distribution included goat milk, as well. No illnesses have been definitively attributed to the products at this time. However, the California Department of Public Health is conducting an epidemiological investigation of reported clusters of campylobacterosis illness where consumption of raw milk products may have occurred.

[ProMED note: There is not yet either a clear epidemiological association between the human illnesses and the unpasteurized cream and other dairy products, nor genetic fingerprint evidence of identity between the human isolates and Campylobacter strains obtained from the possible vehicle. Despite these, it is more than likely that this is another outbreak of campylobacteriosis caused by unpasteurized milk or milk products.]
(ProMED 3/23/2012)

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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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DENGUE
Australia (Manunda, Queensland state)
In Manunda, three more residents have contracted dengue fever, one month after 2012’s first local outbreak was detected in the community. There have now been six locally acquired cases of the mosquito-borne disease in 2012, Public Health medical officer Richard Gair said.
(ProMED 3/26/2012)


Malaysia (national)
The number of dengue fever cases in the week of 5 March 2012 dropped to 504 cases with no fatalities, compared with 567 cases with two fatalities during the week of 27 February 2012. Director-General of Health Datuk Seri Dr Hasan Abdul Rahman said. However six states showed a rise in the number of cases from the week of 27 February 2012. The six states were Penang, which rose by 12 cases, Perak nine cases, the Federal Territories of Kuala Lumpur and Putrajaya eight cases, Sarawak four cases, Perlis three cases, and Sabah three cases. The number of dengue cases from 1 January - 10 March 2012 rose by 17% or 739 cases to 5,184 cases with 16 fatalities, compared to 4,445 cases with eight deaths during the same period in 2011.
(ProMED 3/19/2012)


Peru (Cajamarca region)
The Regional Health Director's Office of Cajamarca today on 13 March 2012 reported 1,196 dengue cases, with two deaths, as of 13 March 2012 this year. This figure is higher than the 587 cases reported in the same period in 2011.
(ProMED 3/19/2012)


Peru (Jaen, Cajamarca region)
The Director of the Jaen General Hospital, Alberto Sanchez, stated that the virus detected in Jaen province is the Asian-American dengue virus type 2 variant, which is more virulent. As of 13 March 2012 this year, a total of 180 people have been admitted to the Jaen General Hospital for dengue infection. Currently, 36 patients are attended to and monitored in a special area that had to be created due to the high number of cases. Of the patients, 30% are children.
(ProMED 3/19/2012)

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PERTUSSIS
Australia
A spike in whooping cough (pertussis) cases may have been caused by a relatively new strain of the bacterium, (found within the last 10 years, http://www.promedmail.org/direct.php?id=20120322.1078115) that is more resistant to existing vaccines, new research suggests. In 2011, the number of diagnosed whooping cough cases in Australia rose to 38,000, the highest since records began in 1991.

A team of Australian scientists studied samples taken from patients in four states and found the new strain of the bacterium now accounts for 84% of whooping cough cases. Among the recent victims was a five-week-old baby boy who died in an Adelaide hospital 18 months ago. Adults can get whooping cough as well.

Professor Lyn Gilbert, who is the director of the Centre for Infectious Diseases and Microbiology at Sydney's Westmead Hospital, says the strain is breaking through the protection of vaccines. "What we suspect, although it's circumstantial evidence at this stage, is that one of the reasons that there has been a significant increase in Australia and many other countries in the last few years is that this strain is not affected as much by the vaccine as the older strains were," she said. "So that it's been able to break through the protection offered by the vaccines."

Doctor Jeremy McAnulty from New South Wales Health says that does not mean people should not be vaccinated. "Before vaccinations against whooping cough it was a major killer, there were hundreds of deaths," he said. He says even where the vaccine does not prevent the bacteria, it still reduces its severity.
(ProMED 3/21/2012)


USA (New York, Tompkins County)
With a recent increase in whooping cough cases, the Tompkins County Health Department is focusing efforts to educate the public to contain the disease. "There are more cases than we saw in all of 2011," Tompkins County Public Health Director Frank Kruppa said Tuesday, 13 March 2012.

As of 13 March 2011, there were 15 pertussis cases recorded in 2012, two more than in all of 2011. The disease normally occurs more frequently in the winter, although cases can happen any time of year.
(ProMED 3/22/2012)


USA (Texas, Bell County)
More cases of whooping cough have been confirmed in the Bell County area. As of 19 March 2012, there are 14 confirmed cases in both Belton and Temple, with eight probable cases that have yet to be confirmed. The health department is expecting more cases to surface. While the cases are, for the most part, not connected, it is still vital to recognize symptoms early.
(ProMED 3/22/2012)


USA (Washington, Jefferson County)
20 people have been diagnosed with pertussis in Jefferson County as of 12 March in 2012, and one person has been hospitalized in the week of 5 March 2012. In all of 2011, there was only one person in Jefferson County to be stricken with what is more commonly known as whooping cough. The person hospitalized spent one night under observation.

"We really want to make sure infants are protected," Jefferson County Public Health supervisor Julia Danskin said on 13 March 2012. "We've seen grandparents come through wanting to be immunized. So I think we have increased awareness a lot."

80% of the people who contracted pertussis this year have not been fully immunized, Danskin said. But there is no specific school or community that is being hit more than another, she said. Ages of those diagnosed with pertussis range from a 6-month-old child to a 14-year-old and three adults, whose ages were not available.
(ProMED 3/22/2012)


Washington (Benton, Franklin Counties)
Pertussis (whooping cough) cases are on the rise across the state, with almost six times as many cases in the first 11 weeks of 2012 as the same time period in 2011. State health officials have reports of 463 cases through 17 March 2012, compared with 82 by this time in 2011.

Pertussis cases are on the rise in Benton and Franklin counties, which have seen 19 cases as of 25 March in 2012. Dr. Amy Person, health officer for Benton and Franklin counties, said most of the reported Tri-City cases have been schoolchildren or people around them. A small outbreak was reported in some Kennewick schools in February, and Person said she has heard some recent reports of pertussis in Pasco schools.

Person said the increased number of cases in Benton and Franklin counties isn't abnormal, particularly as nearby counties were reporting outbreaks in late 2010. Grant County experienced 57 cases, including one infant death, during a 16-month outbreak that started in late 2010, including one infant death. In the previous five years, Grant County reported one to four cases per year.

Benton County was seeing very few cases during Grant County's outbreak, but now is seeing activity while Grant County has had no reported cases in 2012. "I think it ended up just being our time," Person said. "It ends up being everybody's time at some point."
(ProMED 3/25/2012)

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4. Articles
The epidemiology of published norovirus outbreaks: a review of risk factors associated with attack rate and genogroup
Matthews JE, Dickey BW, Miller RD, et al. Epidemiology and Infection. 26 March 2012. doi:10.1017/S0950268812000234.
Available at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8520331

Abstract. The purpose of this study was to examine global epidemiological trends in human norovirus (NoV) outbreaks by transmission route and setting, and describe relationships between these characteristics, viral attack rates, and the occurrence of genogroup I (GI) or genogroup II (GII) strains in outbreaks. We analysed data from 902 reverse transcriptase–polymerase chain reaction-confirmed, human NoV outbreaks abstracted from a systematic review of articles published from 1993 to 2011 and indexed under the terms ‘norovirus’ and ‘outbreak’. Multivariate regression analyses demonstrated that foodservice and winter outbreaks were significantly associated with higher attack rates. Foodborne and waterborne outbreaks were associated with multiple strains (GI+GII). Waterborne outbreaks were significantly associated with GI strains, while healthcare-related and winter outbreaks were associated with GII strains. These results identify important trends for epidemic NoV detection, prevention, and control.

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Imported malaria and dengue fever in returned travelers in Japan from 2005 to 2010
Mizuno Y, Kato Y, Kano S, Takasaki T. Travel Med Infect Dis. 17 March 2012.
Available at http://www.ncbi.nlm.nih.gov/pubmed/22429753

Abstract. Malaria and dengue are important problems in Japan particularly since international travel to developing countries has become increasingly popular. To describe the clinical features of malaria and dengue cases in Japan, a retrospective study was conducted on 50 malaria cases and 40 dengue cases presented to the National Centre for Global Health and Medicine of Japan between 2005 and 2010. The most frequent area of acquisition for cases of malaria was Africa (76.0%), and for dengue fever was Asia (90.0%). Although the immigrant population is very small in Japan, patients categorized as visiting friends and relatives were relatively high in proportion, which is similar to Western reports. Confirmed cases of malaria and dengue account for less than 10% of the all travelers returning with any health problems according to the National Centre for Global Health and Medicine. Careful observation of symptoms and signs helps the differential diagnosis of malaria and dengue.

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Epidemiology and seasonality of respiratory viral infections in hospitalized children in Kuala Lumpur, Malaysia: a retrospective study of 27 years
Khor CS, Sam IC, Hooi PS, et al. BMC Pediatr. 20 March 2012. 12(1):32. doi:10.1186/1471-2431-12-32.
Available at http://www.biomedcentral.com/1471-2431/12/32/abstract

Background. Viral respiratory tract infections (RTI) are relatively understudied in Southeast Asian tropical countries. In temperate countries, seasonal activity of respiratory viruses has been reported, particularly in association with temperature, while inconsistent correlation of respiratory viral activity with humidity and rain is found in tropical countries. A retrospective study was performed from 1982-2008 to investigate the viral etiology of children ([less than or equal to]5 years old) admitted with RTI in a tertiary hospital in Kuala Lumpur, Malaysia.

Methods. A total of 10269 respiratory samples from all children [less than or equal to]5 years old received at the hospital's diagnostic virology laboratory between 1982-2008 were included in the study. Immunofluorescence staining (for respiratory syncytial virus (RSV), influenza A and B, parainfluenza types 1-3, and adenovirus) and virus isolation were performed. The yearly hospitalization rates and annual patterns of laboratory-confirmed viral RTIs were determined. Univariate ANOVA was used to analyse the demographic parameters of cases. Multiple regression and Spearman's rank correlation were used to analyse the correlation between RSV cases and meteorological parameters.

Results. A total of 2708 cases were laboratory-confirmed using immunofluorescence assays and viral cultures, with the most commonly detected being RSV (1913, 70.6%), parainfluenza viruses (357, 13.2%), influenza viruses (297, 11.0%), and adenovirus (141, 5.2%). Children infected with RSV were significantly younger, and children infected with influenza viruses were significantly older. The four main viruses caused disease throughout the year, with a seasonal peak observed for RSV in September-December. Monthly RSV cases were directly correlated with rain days, and inversely correlated with relative humidity and temperature.

Conclusion. Viral RTIs, particularly due to RSV, are commonly detected in respiratory samples from hospitalized children in Kuala Lumpur, Malaysia. As in temperate countries, RSV infection in tropical Malaysia also caused seasonal yearly epidemics, and this has implications for prophylaxis and vaccination programmes.

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Burden and transmission of zoonotic foodborne disease in a rural community in Mexico
Zaidi MB, Campos FD, Estrada-García T, et al. Clin Infect Dis. 15 March 2012.
Available at http://cid.oxfordjournals.org/content/early/2012/03/13/cid.cis300.long

Background. The foodborne transmission and human health impact of Salmonella and Campylobacter infections have rarely been evaluated at the population level in highly endemic settings.

Methods. A prospective 15-month cohort study of 127 infants and 119 elders was combined with animal and food surveillance to determine the incidence and severity of Salmonella and Campylobacter gastroenteritis in a comparatively prosperous rural community in Mexico.

Results. Salmonella and Campylobacter were isolated in up to 75% and 57%, respectively, of raw retail meat, and up to 4.5% of ready-to-eat foods. Rates of acute gastroenteritis of any etiology in infants and elders were, respectively, 2.1 and 0.7 episodes per person per year. The annual incidence density rate of Salmonella gastroenteritis was 17.8 per 100 infants and 7.9 per 100 elders; the rate of Campylobacter gastroenteritis was 11.7 per 100 infants and 0 per 100 elders. PFGE analysis yielded multiple clusters of human, meat and/or animal Salmonella and Campylobacter isolates with indistinguishable patterns. On average, gastroenteritis episodes with these pathogens lasted 3 days in infants and 2 days in elders. Medical attention was sought in 44% of infant diarrheal episodes and 26% in elders; none required hospitalization. Infants with MDR-Salmonella gastroenteritis had a higher frequency of bloody stools and medical visits (50% vs. 11%, OR= 8.5, p= 0.04) than infants with more susceptible strains.

Conclusions. In this relatively advantaged Mexican rural community, the human health impact of a food chain heavily contaminated with Salmonella and Campylobacter was of low magnitude.

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Risk factors for scabies in Taiwan
Wang CH, Lee SC, Huang SS, et al. J Microbiol Immunol Infect. 21 March 2012.
Available at http://www.ncbi.nlm.nih.gov/pubmed/22444547

Background. Scabies is a global problem. Transmission of scabies is usually due to direct or indirect contact. Delay in diagnosis may result in the spread of the scabies mite. Prompt diagnosis and treatment are important.

Methods. In this study, we collected data from 52 scabies patients and analyzed the risk factors for scabies with the case-control method.

Results. Our study has revealed that the patients who were bedridden [odds ratio (OR) 6.72, p < 0.0001], living in a nursing home (OR 9.89, p < 0.0001), had a higher clinical severity status before admission (OR 1.25, p < 0.0001), and a catheter inserted (including nasogastric tube, Foley catheter, Port-A, or Hickman catheter) (OR 9.05, p < 0.0001) were significantly more likely to acquire scabies infection.

Conclusion. To prevent scabies, proper management of the nursing home setting, including adequate cleaning of the contaminated clothing, bedding and equipment, in combination with treating all suspected scabies patients, and contact isolation are important and necessary.

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Combination Antiviral Therapy for Influenza: Predictions from Modeling of Human Infections
Perelson AS, Rong L, Hayden FG. J Infect Dis. 23 March 2012. doi: 10.1093/infdis/jis265.
Available at http://jid.oxfordjournals.org/content/early/2012/03/22/infdis.jis265.short

Abstract. Emergence of resistance is a major concern in influenza antiviral treatment and prophylaxis. Combination antiviral therapy might overcome this problem. Here, we estimate that all possible single mutants and a sizeable fraction of double mutants are generated during an uncomplicated influenza infection. While many of them may sustain a fitness cost, some variants may confer drug resistance and be selected during therapy. We argue that a triple combination regimen would markedly reduce the risk of antiviral resistance emergence in seasonal and pandemic influenza viruses, especially in seriously ill or immunocompromised hosts.

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Community responses to communication campaigns for Influenza A (H1N1): a focus group study
Gray L, MacDonald C, Mackie B, et al. BMC Public Health. 19 March 2012. doi:10.1186/1471-2458-12-205.
Available at http://www.biomedcentral.com/1471-2458/12/205/abstract

Background. This research was a part of a contestable rapid response initiative launched by the Health Research Council of New Zealand and the Ministry of Health in response to the 2009 influenza A pandemic. The aim was to provide health authorities in New Zealand with evidence-based practical information to guide the development and delivery of effective health messages for H1N1 and other health campaigns. This study contributed to the initiative by providing qualitative data about community responses to key health messages in the 2009 and 2010 H1N1 campaigns, the impact of messages on behavioural change and the differential impact on vulnerable groups in New Zealand.

Methods. Qualitative data were collected on community responses to key health messages in the 2009 and 2010 Ministry of Health H1N1 campaigns, the impact of messages on behaviour and the differential impact on vulnerable groups. Eight focus groups were held in the winter of 2010 with 80 participants from groups identified by the Ministry of Health as vulnerable to the H1N1 virus, such as people with chronic health conditions, pregnant women, children, Pacific Peoples and Maori. Because this study was part of a rapid response initiative, focus groups were selected as the most efficient means of data collection in the time available. For Maori, focus group discussion (hui) is a culturally appropriate methodology.

Results. Thematic analysis of data identified four major themes: personal and community risk, building community strategies, responsibility and information sources. People wanted messages about specific actions that they could take to protect themselves and their families and to mitigate any consequences. They wanted transparent and factual communication where both good and bad news is conveyed by people who they could trust.

Conclusions. The responses from all groups endorsed the need for community based risk management including information dissemination. Engaging with communities will be essential to facilitate preparedness and build community resilience to future pandemic events. This research provides an illustration of the complexities of how people understand and respond to health messages related to the H1N1 pandemic. The importance of the differences identified in the analysis is not the differences per se but highlight problems with a "one size fits all" pandemic warning strategy.

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Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public's perspectives
Silva DS, Gibson JL, Robertson A, et al. BMC Public Health. 26 March 2012. doi:10.1186/1471-2458-12-241.
Available at http://www.biomedcentral.com/1471-2458/12/241/abstract

Background. Pandemic influenza may exacerbate existing scarcity of life-saving medical resources. As a result, decision-makers may be faced with making tough choices about who will receive care and who will have to wait or go without. Although previous studies have explored ethical issues in priority setting from the perspective of clinicians and policymakers, there has been little investigation into how the public views priority setting during a pandemic influenza, in particular related to intensive care resources.

Methods. To bridge this gap, we conducted three public town hall meetings across Canada to explore Canadian's perspectives on this ethical challenge. Town hall discussions group discussions were digitally recorded, transcribed, and analyzed using thematic analysis.

Results. Six interrelated themes emerged from the town hall discussions related to: ethical and empirical starting points for deliberation; criteria for setting priorities; pre-crisis planning; in-crisis decision-making; the need for public deliberation and input; and participants' deliberative struggle with the ethical issues.

Conclusions. Our findings underscore the importance of public consultation in pandemic planning for sustaining public trust in a public health emergency. Participants appreciated the empirical and ethical uncertainty of decision-making in an influenza pandemic and demonstrated nuanced ethical reasoning about priority setting of intensive care resources in an influenza pandemic. Policymakers may benefit from a better understanding the public's empirical and ethical 'starting points' in developing effective pandemic plans.

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Interspecies interactions and potential Influenza A virus risk in small swine farms in Peru
McCune S, Arriola CS, Gilman RH, et al. BMC Infectious Diseases. 15 March 2012. doi:10.1186/1471-2334-12-58.
Available at http://www.biomedcentral.com/1471-2334/12/58/abstract

Background. The recent avian influenza epidemic in Asia and the H1N1 pandemic demonstrated that influenza A viruses pose a threat to global public health. The animal origins of the viruses confirmed the potential for interspecies transmission. Swine are hypothesized to be prime "mixing vessels" due to the dual receptivity of their trachea to human and avian strains. Additionally, avian and human influenza viruses have previously been isolated in swine. Therefore, understanding interspecies contact on smallholder swine farms and its potential role in the transmission of pathogens such as influenza virus is very important.

Methods. This qualitative study aimed to determine swine-associated interspecies contacts in two coastal areas of Peru. Direct observations were conducted at both small-scale confined and low-investment swine farms (n = 36) and in open areas where swine freely range during the day (n = 4). Interviews were also conducted with key stakeholders in swine farming.

Results. In both locations, the intermingling of swine and domestic birds was common. An unexpected contact with avian species was that swine were fed poultry mortality in 6/20 of the farms in Chancay. Human-swine contacts were common, with a higher frequency on the confined farms. Mixed farming of swine with chickens or ducks was observed in 36% of all farms. Human-avian interactions were less frequent overall. Use of adequate biosecurity and hygiene practices by farmers was suboptimal at both locations.

Conclusions. Close human-animal interaction, frequent interspecies contacts and suboptimal biosecurity and hygiene practices pose significant risks of interspecies influenza virus transmission. Farmers in small-scale swine production systems constitute a high-risk population and need to be recognized as key in preventing interspecies pathogen transfer. A two-pronged prevention approach, which offers educational activities for swine farmers about sound hygiene and biosecurity practices and guidelines and education for poultry farmers about alternative approaches for processing poultry mortality, is recommended. Virological and serological surveillance for influenza viruses will also be critical for these human and animal populations.

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Notes from the Field: Severe Hand, Foot, and Mouth Disease Associated with Coxsackievirus A6 — Alabama, Connecticut, California, and Nevada, November 2011–February 2012
Centers for Disease Control and Prevention, United States (USCDC). MMWR. 30 March 2012. 61(12):213-214.
Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6112a5.htm?s_cid=mm6112a5_e

Excerpt. Hand, foot, and mouth disease (HFMD) is a common viral illness caused by enteroviruses that predominantly affects children aged <5 years. In the United States, outbreaks of HFMD typically occur during summer and autumn months. The most common cause of HFMD in the United States has been enterovirus serotype coxsackievirus A16. Most infections are asymptomatic; persons with signs and symptoms typically have a mild febrile illness with rash on the palms of the hands and soles of the feet, and sores in the mouth. HFMD also has been associated, often weeks after initial symptom onset, with nail dystrophies (e.g., Beau's lines or nail shedding).

From November 7, 2011, to February 29, 2012, CDC received reports of 63 persons with signs and symptoms of HFMD or with fever and atypical rash in Alabama (38 cases), California (seven), Connecticut (one), and Nevada (17). HFMD is not a reportable disease in the United States; the cases were identified as unusual by health-care providers or by a department of health that contacted CDC for diagnostic assistance. Clinical specimens were collected from patients in 34 of the 63 cases. Coxsackievirus A6 (CVA6) was detected in 25 (74%) of those 34 patients by reverse transcriptase–polymerase chain reaction and partial sequencing of the VP1 gene at CDC or at the California Department of Public Health. No enteroviruses were detected in the other nine patients.

ProMED note may be accessed at http://www.promedmail.org/direct.php?id=20120329.1084829

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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.
Additional information at http://www.redi.org.sg/E%20coli%20Symposium_Invitation%20Flyer%20final.pdf

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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