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Vol. XV No. 10 ~ EINet News Briefs ~ May 11, 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
- Bhutan: Eleventh H5N1 avian influenza outbreak in 2012
- India: H5N1 avian influenza strikes poultry farm
- Indonesia: H5N1 avian influenza situation update

2. Infectious Disease News
- India: NTI confirms tuberculosis cases fully drug resistant
- Malaysia: Selangor records highest number of dengue cases
- Singapore: Hand, foot and mouth disease cases rise to new high
- Canada: New Brunswick officials hunt for source of E. coli outbreak
- Canada: Pertussis outbreak in Yukon
- USA: 50 new pertussis cases in New York and national update
- USA: USDA quarantines second farm in BSE investigation
- USA: Multistate outbreak of human Salmonella Infantis infections linked to dry dog food
- USA: Multistate outbreak of Salmonella Bareilly and Salmonella Nchanga infections associated with a raw scraped ground tuna product
- USA: Multistate outbreak of Salmonella Bareilly and Salmonella Nchanga infections associated with a raw scraped ground tuna product
- USA (North Carolina): Update on Salmonella Paratyphi B outbreak associated with tempeh
- USA (North Carolina): Asheville area Salmonella cases jump 30%
- USA (Colorado): Pueblo health department shuts down caterer
- USA (California): Providence Tarzana Medical Center reports two cases of measles
- USA (New York): Lyme disease cases increasing

3. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA
- RABIES

4. Articles
- Research priorities for global measles and rubella control and eradication
- Increased Population Prevalence of Low Pertussis Toxin Antibody Levels in Young Children Preceding a Record Pertussis Epidemic in Australia
- The epidemiology of travel-related Salmonella Enteritidis in Ontario, Canada, 2010-2011
- A Point-Source Norovirus Outbreak Caused by Exposure to Fomites
- Strongyloides, dengue fever, and tuberculosis conversions in New Zealand police deploying overseas
- Community-Based Control of Aedes aegypti By Using Mesocyclops in Southern Vietnam
- Epidemiological, virological, and entomological characteristics of dengue from 1978 to 2009 in Guangzhou, China
- Transmission dynamics, border entry screening, and school holidays during the 2009 influenza A (H1N1) pandemic, China
- Characteristics of a widespread community cluster of H275Y oseltamivir-resistant A(H1N1)pdm09 influenza in Australia

5. Notifications
- International Environment and Health Conference (IEHC2012)
- 15th International Congress on Infectious Diseases
- 6th Ditan International Conference 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 / 2 (2)
China / 1 (1)
Egypt / 9 (5)
Indonesia / 6 (6)
Viet Nam / 4 (2)
Total / 25 (16)

***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: 603 (356) (WHO 5/2/2012)
http://www.who.int/influenza/human_animal_interface/EN_GIP_20120502CumulativeNumberH5N1cases.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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Asia
Bhutan: Eleventh H5N1 avian influenza outbreak in 2012
On 20 April 2012, the Royal Kingdom of Bhutan reported a new outbreak of highly pathogenic avian influenza to the World Organisation for Animal Health (OIE), bringing Bhutan's total to 11 outbreaks as of 3 May in 2012, the USDA reported.

The outbreak occurred in a backyard poultry flock in Yangbari village, Mongar district. This was previously reported on 11 April 2012.

On 9 March 2012, Bhutan reported its tenth outbreak to the OIE. The outbreak occurred in a backyard poultry flock in the Burkey area of Chhukha district. One bird was reported dead, and 131 birds were destroyed. Chhukha district has experienced more HPAI findings than any other Bhutanese district.

The government of Bhutan is taking measures to contain spread of avian influenza. These include quarantine, movement control, clean-up and disinfection of the contaminated premises, and culling.

According to USDA, as of 20 April 2012, the 11 outbreaks in Bhutan had involved 7,133 birds, of which 370 had died and 5,642 were culled. The presence of the H5N1 sub-type of the virus has been confirmed in each outbreak.
(ProMED 5/4/2012)

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India: H5N1 avian influenza strikes poultry farm
Animal health officials in India reported an H5N1 avian influenza outbreak at a district poultry farm in Tripura state, according to the World Organization for Animal Health (OIE) on 7 May 2012. The outbreak began on 18 April 2012, killing 3,168 of 4,668 susceptible birds. All domestic poultry in a three-km radius around the outbreak site are being culled, and an intensive surveillance campaign, poultry market closure, and poultry movement ban are underway in a ten-km radius around the zone. Earlier in 2012, H5N1 outbreaks struck two other farms in Tripura state, which is located in northeast India and shares a border on three sides with Bangladesh.
(CIDRAP 5/9/2012)

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Indonesia: H5N1 avian influenza situation update
The Indonesian IHR National Focal Point of the Ministry of Health has notified WHO of a new case of human infection with avian influenza A(H5N1) virus. The case is a two year-old male from Riau Province. He developed fever on 17 April 2012 and was hospitalized on 21 April 2012, but he died on 27 April 2012. Epidemiological investigation is ongoing. Preliminary findings indicate that the case’s parents are quail egg vendors. The case was confirmed by the National Institute of Health Research and Development (NIHRD), Ministry of Health. As of 2 May 2012, of the 189 cases reported in Indonesia since 2005, 157 have been fatal
(WHO 5/2/2012)

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2. Infectious Disease News
India: NTI confirms tuberculosis cases fully drug resistant
The National Tuberculosis Institute (NTI), Bangalore has validated Hinduja Hospital's study that confirms drugs resistance to all the known TB drugs (first and second line) in eight patients whose samples were re-tested.

On 6 January 2012, Hinduja Hospital had announced that they had detected 12 totally drug resistant (TDR) TB cases, a terminology that was not accepted by the World Health Organization (WHO). Drugs resistance is developed because of mismanagement of multi-drug resistant tuberculosis (MDR-TB). They had published the study in the scientific publication Clinical Infectious Diseases on 21 December 2011.

However, after the Central Tuberculosis Division (CTD), with their team of experts including NTI, arrived in Mumbai to take stock of the situation, they said that the patients suffered from XXDR-TB, which in medical literature is extremely drug-resistant tuberculosis. Of the 12 cases, eight samples were then sent for re-testing to NTI.

"Of the eight samples sent, two patients died early this year (2012). The other six patients live in Mumbai, one of who is a 15-year-old. Five of these patients are undergoing treatment with the Revised National Tuberculosis Control Programme (RNTCP) for extensively drugs resistant (XDR) TB, while one is being treated at the Hinduja Hospital," said Dr. Minni Khetarpal, city TB officer, Brihanmumbai Municipal Corporation.

"The NTI has confirmed the Hinduja report. We will place this report on record before the Directly Observed Treatment Shortcourse (DOTS) committee and figure out the future line of treatment that could be offered to these patients now," said Dr P.Y. Gaikwad, state TB officer.

However, Dr Gaikwad added that two of these patients are sensitive to one second-line drug. "All the other patients are doing well. It shows that immunity of the host (patient) also matters, not just the drug sensitivity to the bacteria. Many of these patients are working for a living," said Dr Gaikwad.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120501.1119816
(ProMED 5/1/2012)

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Malaysia: Selangor records highest number of dengue cases
Selangor recorded the highest number of dengue cases as of 25 April in 2012, with 3,615 and nine deaths up until 24 April 2012, Deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin said. Kuala Lumpur and Putrajaya recorded 868 cases with three deaths, while Perak registered 563 cases with one death. Between January and 24 April in 2012, 18 deaths from 8,052 dengue cases were reported nationwide, up from 6,594 cases with 12 deaths during the same period in 2011.
(ProMED 4/30/2012)

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Singapore: Hand, foot and mouth disease cases rise to new high
The number of hand, foot and mouth disease (HFMD) cases saw a 14% spike, even as efforts have been stepped up to curb the current epidemic.

The Ministry of Health's (MOH) latest statistics showed that the number of cases rose to 1,590 during the last week of April 2012, breaking the four-year high of 1,394 cases seen in the week of 16 April 2012. Inspections have been intensified at pre-schools and spot checks will be done at enrichment centres, said MOH.

Noting that the reported HFMD cases so far have been mild, a MOH spokesperson added high standards of hygiene are also being reinforced in primary schools and childcare centres.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120505.1123951
(ProMED 5/5/2012)

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Americas
Canada: New Brunswick officials hunt for source of E. coli outbreak
Health officials in New Brunswick say they have some leads in their search for the source of an E. coli outbreak that they believe has left people ill in three communities. However, a spokeswoman for the Health Department said there is, "still no clear evidence of the source of the outbreak." Jennifer Graham says that 27 cases of bloody diarrhea suspected to be caused by E. coli have been reported since 1 May 2012.

The first person began showing symptoms on 23 April 2012 and as of 4 May 2012, 23 cases were reported in Miramichi, two in Saint John and two in Bathurst.

As of 5 May 2012, 11 cases have tested positive as E. coli O157, a severe strain that can cause serious illness and sometimes lead to kidney failure.

Ms. Graham says officials are unsure if the Saint John cases are linked to the Miramichi cases, or if they are from a different source. She said 14 people have been hospitalized, eight of whom remain in hospital. New Brunswick gets an average of 12 cases of this infection per year.
(ProMED 5/8/2012)

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Canada: Pertussis outbreak in Yukon
Yukoners are being asked to keep an eye out for pertussis (whooping cough) after five cases have been confirmed in the territory.

The acting chief medical officer of health, Dr. Sharon Lazeo, said all five cases link back to the Yukon Native Hockey Tournament, which took place in late March 2012. All those who are ill were either participants in the tournament or family members of participants. The outbreak is also directly linked to the current outbreak in British Columbia where there is a confirmed case.

[ProMED note: The increasing susceptibility in older children and adults to pertussis, usually manifesting as chronic cough without the typical "whoop," after appropriate primary immunization continues to be increasingly reported. Waning immunity is generally thought to be the cause of the problem, but it is increasingly clear that Bordetella pertussis clones are being selected by the acellular vaccine, against which we are no longer as well protected with the current vaccines.]
(ProMED 5/2/2012)

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USA: 50 new pertussis cases in New York and national update
The Centers for Disease Control's (CDC) release on 10 May 2012 with data through 5 May 2012, places New York again in the number three spot nationally for reported whooping cough cases. Fifty new cases were added to the total. New York City has reported 153 pertussis cases in 2012 and New York outside of the city has reported 730. The total number of pertussis cases reported in the state through 5 May 2012 is 883 while there were only 144 cases reported for the same period in 2011.

Nationally, 8,159 pertussis cases have been reported to the CDC. Wisconsin has the most reports of whooping cough, with 1,207. The state of Washington is second in the CDC data, with 1,110 reported pertussis cases. The Washington Department of Health reports a total of 1,284 whooping cough cases in the state. The difference reflects reporting delays between local and state public health agencies and the CDC.

Illinois and Pennsylvania swapped fourth and fifth place. Illinois reported 177 new pertussis cases for a total for 2012 of 551. Pennsylvania ranks fifth nationally, having reported 461 whooping cough cases for 2012.

Twenty-one states have reported over 100 pertussis cases in 2012. Two states, Oklahoma and Minnesota, continue to report no new cases. An infant died from whooping cough the week of 7 May 2012 in San Miguel County, New Mexico. A nine week old infant died from the illness the week of 7 May 2012 in Idaho. Other infant deaths from whooping cough were reported earlier in 2012. Infants are at highest risk from the illness since they have not received suggested immunizations due to their age.
(Examiner 5/10/2012)

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USA: USDA quarantines second farm in BSE investigation
In an update on the latest US case of bovine spongiform encephalopathy (BSE or mad cow disease), the US Department of Agriculture (USDA) said that a second dairy farm in California has been quarantined and that a calf of the infected cow tested negative for the disease. The nation's fourth BSE case and first since 2006 was reported 24 April 2012 in a ten-year-old California dairy cow, which was culled for lameness and was held out of the food and feed supplies. The case was detected through routine BSE testing at a rendering facility where the cow had been taken. On 2 May 2012, the USDA said a hold order has been placed on cattle at a dairy farm that is associated with the BSE cow's farm. The California Department of Food and Agriculture (CDFA) has inventoried both farms and was checking records to determine if any at-risk cattle are present. Also under investigation is a calf ranch where the BSE cow was raised ten years ago, the USDA said. The agency also reported that one offspring of the sick cow was found in another state and euthanized and that testing showed it did not have BSE. A second progeny of the BSE cow was stillborn. The cow's illness has been described as "atypical" BSE, possibly caused by a random mutation rather than by eating contaminated feed, the usual cause of the disease.
(CIDRAP 5/4/2012)

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USA: Multistate outbreak of human Salmonella Infantis infections linked to dry dog food
A total of 14 individuals infected with the outbreak strain of Salmonella Infantis have been reported from nine states.

The number of ill persons identified in each state is as follows: Alabama (1), Connecticut (1), Michigan (1), Missouri (3), North Carolina (3), New Jersey (1), Ohio (2), Pennsylvania (1), and Virginia (1).
Among the 9 patients with available information, 5 (56%) were hospitalized. No deaths have been reported.

Multiple brands of dry pet food produced by Diamond Pet Foods at a single manufacturing facility in South Carolina have been linked to some of the human Salmonella infections.

Consumers should check their homes for recalled dog food products and discard them promptly. People who think they might have become ill after contact with dry pet food or with an animal that has eaten dry pet food should consult their health care providers.

The full article may be accessed at http://www.cdc.gov/salmonella/dog-food-05-12/index.html
(USCDC 5/3/2012)

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USA: Multistate outbreak of Salmonella Bareilly and Salmonella Nchanga infections associated with a raw scraped ground tuna product
Based on an epidemiologic link and results of laboratory testing, CDC has combined this Salmonella Bareilly investigation with an ongoing multistate outbreak investigation of Salmonella serotype Nchanga infections. The two associated PFGE patterns have been grouped together as the "outbreak strains."

A total of 258 persons infected with the outbreak strains of Salmonella Bareilly (247 persons) or Salmonella Nchanga (11 persons) have been reported from 24 states and the District of Columbia. 32 ill persons have been hospitalized, and no deaths have been reported.

Collaborative investigation efforts of state, local, and federal public health agencies indicate that a frozen raw yellowfin tuna product, known as Nakaochi Scrape, from Moon Marine USA Corporation is the likely source of this outbreak. Consumers should not eat the recalled product, and retailers should not serve the recalled raw Nakaochi Scrape tuna product from Moon Marine USA Corporation.

The full article may be accessed at http://www.cdc.gov/salmonella/bareilly-04-12/index.html
(USCDC 5/2/2012)

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USA: Multistate outbreak of Salmonella Bareilly and Salmonella Nchanga infections associated with a raw scraped ground tuna product
Based on an epidemiologic link and results of laboratory testing, CDC has combined this Salmonella Bareilly investigation with an ongoing multistate outbreak investigation of Salmonella serotype Nchanga infections. The two associated PFGE patterns have been grouped together as the "outbreak strains."

A total of 258 persons infected with the outbreak strains of Salmonella Bareilly (247 persons) or Salmonella Nchanga (11 persons) have been reported from 24 states and the District of Columbia. 32 ill persons have been hospitalized, and no deaths have been reported.

Collaborative investigation efforts of state, local, and federal public health agencies indicate that a frozen raw yellowfin tuna product, known as Nakaochi Scrape, from Moon Marine USA Corporation is the likely source of this outbreak. Consumers should not eat the recalled product, and retailers should not serve the recalled raw Nakaochi Scrape tuna product from Moon Marine USA Corporation.

The full article may be accessed at http://www.cdc.gov/salmonella/bareilly-04-12/index.html
(USCDC 5/2/2012)

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USA (North Carolina): Update on Salmonella Paratyphi B outbreak associated with tempeh
On 4 May 2012, Buncombe County Department of Health received additional test results from the North Carolina Department of Public Health laboratory confirming that the bacteria found in the tempeh is a match to the S. Paratyphi B that is making people sick in the current disease outbreak.

Health officials confirm that people are infected with this type of infection in one of three ways: direct consumption of the tempeh, exposure to food items contaminated by uncooked tempeh, or contact with someone who is ill with the infection.

Lab tests on 3 May 2012 confirm that S. Paratyphi B associated with this outbreak causes a non-typhoidal salmonellosis; which means it causes symptoms that can be severe but not as severe as the other strain of S. Paratyphi B, which lab tests initially indicated.

The test results subsequently confirmed that the tempeh is associated with this outbreak, however cases are continuing to be reported. As of 3 May 2012, Buncombe County Environmental Health specialists have contacted all food establishments under the jurisdiction of the Buncombe County Department of Health to verify that the recalled tempeh has been removed.

As of 4 May 2012, the latest information about the outbreak is as follows:
- 46 cases
- 7 hospitalizations
- age range of those getting ill is 4 - 79 with a median age is 34
- 60% of cases are female

The full article may be accessed at http://www.buncombecounty.org/common/health/BCDH_newsrelease_5-4-12.pdf
(Buncombe County Department of Health 5/4/2012)

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USA (North Carolina): Asheville area Salmonella cases jump 30%
The number of cases of a bacterial infection that have sickened Buncombe County residents and visitors jumped up by more than 30% over 5-6 May 2012. The total number of salmonella cases reported since March 2012 has risen by 14, from 46 to 60, county health officials said 7 May 2012.

The rare type of Paratyphi B salmonella was traced to a locally made tempeh, a fermented bean product. Smiling Hara Tempeh made in Candler was pulled from stores and restaurants in April 2012. That means the disease is now likely spreading person-to-person.

The full article may be accessed at http://www.promedmail.org/direct.php?id=20120509.1127709
(ProMED 5/9/2012)

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USA (Colorado): Pueblo health department shuts down caterer
The Pueblo City-County Health Department has temporarily closed All Seasons Catering, citing a variety of violations found after 35 people were sickened by food the company served at a luncheon on 24 April 2012. The health department said the illness was caused by Clostridium perfringens toxin found in a stool sample submitted by one of the sickened individuals.

Based on interviews with everyone who became ill, the department found a statistical association in several foods that could have been the culprit: a beef-and-gravy dish, butter, tomatoes, and lettuce the caterer served during Pueblo Community Health Center's annual meeting and luncheon during the week of 23 April 2012. 80 people attended the event. All were interviewed about what they ate that day.

Although the bacterium is present in small amounts in most healthy individuals' intestinal tracts, C. perfringens can produce a toxin that causes diarrhea and intestinal cramping when consumed in larger amounts. The resulting illness may lead to serious complications among the elderly and very young.

C. perfringens is one of the most common causes of foodborne illness in the USA, and is commonly found on raw meat and poultry and in food that is prepared too far in advance of consumption and kept at improper temperatures, according to the health department.
(ProMED 5/2/2012)

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USA (California): Providence Tarzana Medical Center reports two cases of measles
Two patients were recently treated for measles at Providence Tarzana Medical Center, hospital officials said 26 April 2012.

The cases are significant because one patient was an adult and the other a child. "It is believed the source was a traveler from abroad who was visiting the younger patient's family," according to Providence Tarzana officials. The cases were reported to the Los Angeles County Department of Public Health. An investigation is ongoing, but it is believed neither patient was vaccinated. "Providence Tarzana is complying with a directive from the department to alert anyone who might have been exposed at the hospital," Providence officials said.

Measles is a contagious respiratory disease caused by a virus. Those with measles can suffer fever, runny nose, cough and a rash all over the body, according to the U.S. Centers for Disease Control and Prevention. For every 1,000 children who get measles, one or two will die, according to the CDC. At least one case of measles has been reported each year in L.A. County since 2005, although there was a spike beginning in 2010, when there were eight cases, said Dr. Nelson El Amin, medical director for the county immunization program. "There was a definite overseas or foreign born linkage," El Amin said. The numbers were almost similar in 2011, he said. "Usually, two cases at the same time is rare," El Amin said.
(ProMED 4/30/2012)

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USA (New York): Lyme disease cases increasing
With national attention fixed on the dramatic upswing in the number of Lyme disease cases in Pennsylvania and New Jersey, little attention has been focused on New York State. Yet, the latest data from the Centers for Disease Control reveals that New York ranks third in the nation in the number of reported cases. 357 cases of Lyme disease have been diagnosed in New York through the report's cutoff data of 28 April 2012.

New York has reported 8.2% of all the Lyme disease cases in the period 1 January through 28 April 2012. 357 cases of the illness have been diagnosed in 2012, an increase over the 339 cases reported in the same period in 2011. Only four cases have been found in New York City, though last year there were 143.

New Jersey leads the nation with 1,677 cases of Lyme disease in 2012, followed by Pennsylvania with 969. New York borders both states, which may help account for the higher number of cases in the state in 2012. Nine states have over 100 cases, mostly in New England or the Mid-Atlantic.
(ProMED 5/6/2012)

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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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RABIES
USA (North Carolina, Zebulon)
A fox carrying rabies was killed in Zebulon after acting strangely during a direct encounter with several people and a dog. Animal Control responded at Wakelon Park on Pippin Road and the fox was taken to the state lab in Raleigh for testing.

Three people who were exposed have begun a series of treatments for rabies exposure. The process will require four treatments over 14 days. The dog that encountered the fox was vaccinated for rabies and required a booster vaccine. State law requires potentially rabid pets to be destroyed unless owners agree to support a six-month quarantine.

"We don't want to alarm residents in Zebulon, but they should be aware of these cases, and of the potential for exposure to themselves, family members and their pets," said Sue Lynn Ledford, community health director for Wake County. "Rabies vaccination is critical to help to prevent the spread of disease, and rabies vaccination is required by law. This is a great opportunity to remind everyone of the importance of rabies vaccinations for their pets."

The last reported case of rabies in Wake County was in November 2011 in Raleigh, according to Wake County Animal Control.
(ProMED 5/6/2012)


USA (Maryland, Cecil County)
Cecil County health officials say rabies has been found in a sickly stray cat that scratched five people in downtown Port Deposit. The vie people were scratched 20 April 2012. The cat was captured and euthanized at a veterinarian's office and tested. The five people have been urged to seek treatment.

The cat is described as a small- to medium-sized yellow tabby. Anyone exposed to the animal in the past 10 days should go to an emergency room. Officials say this is the first domestic animal that has tested positive in Cecil County in 2012. The previous cases were in four raccoons and a skunk.
(ProMED 5/6/2012)

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4. Articles
Research priorities for global measles and rubella control and eradication
Goodson JL, Chu SY, Rota PA, et al. Vaccine. 28 April 2012. doi:10.1016/j.vaccine.2012.04.058.
Available at http://www.sciencedirect.com/science/article/pii/S0264410X12005944

Abstract. In 2010, an expert advisory panel convened by the World Health Organization to assess the feasibility of measles eradication concluded that (1) measles can and should be eradicated, (2) eradication by 2020 is feasible if measurable progress is made toward existing 2015 measles mortality reduction targets, (3) measles eradication activities should occur in the context of strengthening routine immunization services, and (4) measles eradication activities should be used to accelerate control and elimination of rubella and congenital rubella syndrome (CRS). The expert advisory panel also emphasized the critical role of research and innovation in any disease control or eradication program. In May 2011, a meeting was held to identify and prioritize research priorities to support measles and rubella/CRS control and potential eradication activities. This summary presents the questions identified by the meeting participants and their relative priority within the following categories: (1) measles epidemiology, (2) vaccine development and alternative vaccine delivery, (3) surveillance and laboratory methods, (4) immunization strategies, (5) mathematical modeling and economic analyses, and (6) rubella/CRS control and elimination.

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Increased Population Prevalence of Low Pertussis Toxin Antibody Levels in Young Children Preceding a Record Pertussis Epidemic in Australia
Campbell P, McIntyre P, Quinn H, et al. PLoS ONE. 27 April 2012. 7(4):e35874. doi:10.1371/journal.pone.0035874.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0035874

Background. Cross-sectional serosurveys using IgG antibody to pertussis toxin (IgG-PT) are increasingly being used to estimate trends in recent infection independent of reporting biases.

Methods/Principal Findings. We compared the age-specific seroprevalence of various levels of IgG-PT in cross-sectional surveys using systematic collections of residual sera from Australian diagnostic laboratories in 1997/8, 2002 and 2007 with reference to both changes in the pertussis vaccine schedule and the epidemic cycle, as measured by disease notifications. A progressive decline in high-level (¡Ý62.5 EU/ml) IgG-PT prevalence from 19% (95% CI 16¨C22%) in 1997/98 to 12% (95% CI 11¨C14%) in 2002 and 5% (95% CI 4¨C6%) in 2007 was consistent with patterns of pertussis notifications in the year prior to each collection. Concomitantly, the overall prevalence of undetectable (<5 EU/ml) levels increased from 17% (95% CI 14¨C20%) in 1997/98 to 38% (95% CI 36¨C40%) in 2007 but among children aged 1¨C4 years, from 25% (95% CI 17¨C34%) in 1997/98 to 62% (95% CI 56¨C68%) in 2007. This change followed withdrawal of the 18-month booster dose in 2003 and preceded record pertussis notifications from 2008 onwards.

Conclusions/Significance. Population seroprevalence of high levels of IgG-PT is accepted as a reliable indicator of pertussis disease activity over time within and between countries with varying diagnostic practices, especially in unimmunised age groups. Our novel findings suggest that increased prevalence of undetectable IgG-PT is an indicator of waning immunity useful for population level monitoring following introduction of acellular vaccines and/or schedule changes.

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The epidemiology of travel-related Salmonella Enteritidis in Ontario, Canada, 2010-2011
Tighe MK, Savage R, Vrbova L, et al. BMC Public Health. 26 April 2012. 12(1):310. doi:10.1186/1471-2458-12-310.
Available at http://www.biomedcentral.com/1471-2458/12/310/abstract

Background. Increases in the number of salmonellosis cases due to Salmonella Enteritidis (SE) in 2010 and 2011 prompted a public health investigation in Ontario, Canada. In this report, we describe the current epidemiology of travel-related (TR) SE, compare demographics, symptoms and phage types (PTs) of TR and domestically-acquired (DA) cases, and estimate the odds of acquiring SE by region of the world visited.

Methods. All incident cases of culture confirmed SE in Ontario obtained from isolates and specimens submitted to public health laboratories were included in this study. Demographic and illness characteristics of TR and DA cases were compared. A national travel survey was used to provide estimates for the number of travellers to various destinations to approximate rates of SE in travellers. Multivariate logistic regression was used to estimate the odds of acquiring SE when travelling to various world regions.

Results. Overall, 51.9% of SE cases were TR during the study period. This ranged from 35.7% TR cases in the summer travel period to 65.1% TR cases in the winter travel period. Compared to DA cases, TR cases were older and were less likely to seek hospital care. For Ontario travellers, the adjusted odds of acquiring SE was the highest for the Caribbean (OR 37.29, 95% CI 17.87-77.82) when compared to Europe. Certain PTs were more commonly associated with travel (e.g., 1, 4, 5b, 7a, Atypical) than with domestic infection. Of the TR cases, 88.9% were associated with travel to the Caribbean and Mexico region, of whom 90.1% reported staying on a resort. Within this region, there were distinct associations between PTs and countries.

Conclusions. There is a large burden of TR illness from SE in Ontario. Accurate classification of cases by travel history is important to better understand the source of infections. The findings emphasize the need to make travellers, especially to the Caribbean, and health professionals who provide advice to travellers, aware of this risk. The findings may be generalized to other jurisdictions with travel behaviours in their residents similar to Ontario residents.

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A Point-Source Norovirus Outbreak Caused by Exposure to Fomites
Repp KK, Keene WE. J Infect Dis. 8 May 2012. 205(11):1639-1641. Doi:10.1093/infdis/jis250.
Available at http://jid.oxfordjournals.org/content/205/11/1639.abstract

Abstract. We investigated a norovirus outbreak (genotype GII.2) affecting 9 members of a soccer team. Illness was associated with touching a reusable grocery bag or consuming its packaged food contents (risk difference, 0.636; P < .01). By polymerase chain reaction, GII norovirus was recovered from the bag, which had been stored in a bathroom used before the outbreak by a person with norovirus-like illness. Airborne contamination of fomites can lead to subsequent point-source outbreaks. When feasible, we recommend dedicated bathrooms for sick persons and informing cleaning staff (professional or otherwise) about the need for adequate environmental sanitation of surfaces and fomites to prevent spread.

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Strongyloides, dengue fever, and tuberculosis conversions in New Zealand police deploying overseas
Visser JT, Narayanan A, Campbell B. J Travel Med. 24 April 2012. 19(3):178-82. doi:10.1111/j.1708-8305.2012.00601.x.
Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1708-8305.2012.00601.x/abstract;jsessionid=513F3725F2014AC71AF102EF1AD67411.d02t01

Background. Members of New Zealand Police (NZP) deploy overseas in a variety of roles. There is limited published data on travel-related morbidity in police as a subgroup of travelers.

Methods. An audit of pre- and postdeployment medical files for all NZP personnel deploying overseas during 2004 to 2010 was undertaken. Of all deployments, 58.9% were within Oceania.

Results. Positive Strongyloides stercoralis serology was returned in 6.07% (95% CI: 3.80%-9.13%) at a rate of 9.00/1,000 person deployment months (pdm) (95% CI: 5.57-13.8). Dengue fever seroconversion was recorded in 4.91% (95% CI: 3.40%-6.83%) at a rate of 8.57/1,000 pdm (95% CI: 5.90-12.0). The relative risk of dengue infection was 7.47 for Timor Leste compared to all other deployment destinations. An association between seroconverting for both dengue fever and Strongyloides was found. Tuberculosis conversion was recorded in 1.76% (95% CI: 0.85%-3.21%) at a rate of 2.92/1,000 pmd (95% CI: 1.48-5.375). A single case of human immunodeficiency virus (HIV) seroconversion was recorded. There were no recorded hepatitis C seroconversions.

Conclusions. Police deploying overseas appear to have similar rates of dengue and tuberculosis conversion as other groups of travelers, and they appear to be at low risk of hepatitis C and HIV. Strongyloidiasis appears to be a significant risk; postdeployment prevalence was markedly higher than that reported in a small number of studies.

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Community-Based Control of Aedes aegypti By Using Mesocyclops in Southern Vietnam
Nam VS, Yen NT, Duc HM, et al. Am J Trop Hyg. May 2012. 86(5):850-9. doi:10.4269/ajtmh.2012.11-0466.
Available at http://www.ajtmh.org/content/86/5/850.long

Abstract. We previously reported a new community-based mosquito control strategy that resulted in elimination of Aedes aegypti (Linn.) in 40 of 46 communes in northern and central Vietnam, and with annual recurrent total costs (direct and indirect) of only $0.28–$0.89 international dollars per person. This control strategy was extended to four provinces in southern Vietnam in Long An and Hau Giang (2004–2007) and to Long An, Ben Tre, and Vinh Long (2005–2010). In a total of 14 communes with 124,743 residents, the mean ± SD of adult female Ae. aegypti was reduced from 0.93 ± 0.62 to 0.06 ± 0.09, and the reduction of immature Ae. aegypti averaged 98.8%. By the final survey, no adults could be collected in 6 of 14 communes, and one commune, Binh Thanh, also had no immature forms. Although the community-based programs also involved community education and clean-up campaigns, the prevalence of Mesocyclops in large water storage containers > 50 liters increased from 12.77 ± 8.39 to 75.69 ± 9.17% over periods of 15–45 months. At the conclusion of the study, no confirmed dengue cases were detected in four of the five communes for which diagnostic serologic analysis was performed. The rate of progress was faster in communes that were added in stages to the program but the reason for this finding was unclear. At the completion of the formal project, sustainability funds were set up to provide each commune with the financial means to ensure that community-based dengue control activities continued.

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Epidemiological, virological, and entomological characteristics of dengue from 1978 to 2009 in Guangzhou, China
Luo L, Liang HY, Hu YS, et al. J Vector Ecol. June 2012. 37(1):230-40. doi:10.1111/j.1948-7134.2012.00221.x.
Available at http://www.ncbi.nlm.nih.gov/pubmed/22548558

Abstract. To understand its unprecedented resurgence, we examined the epidemiological, virological, and entomological features of dengue in Guangzhou during 1978-2009. Cases reported to the Guangzhou Centre for Disease Control and Prevention and data from virological and entomological surveillance were analyzed from three periods: 1978-1988, 1989-1999, and 2000-2009. Although cases decreased over time: 6,649 (1978-1988) to 6,479 (1989-1999) to 2,526 (2000-2009), geographical expansion resulted in districts with an average incidence >2.5/100,000, increasing from five (1978-1988, 1989-1999) to seven (2000-2009). Age distribution (mean age: 34.9 years) provided a trend of increasing dengue incidence among adults, and there was a significantly higher incidence among men with a sex ratio of 1.15:1 (P<0.001). Cases occurred from May through November with a peak between August and October, and a long-term trend was characterized by a three to five-year cyclical pattern. The most frequently isolated serotypes were DENV-2 (1978-1988) and DENV-1 (1989-1999 and 2000-2009). Seasonal fluctuations in immature densities of Aedes albopictus (sole transmission vector in Guangzhou) were consistent with the dengue seasonality. After a 30-year apparent absence, DENV-3 had reemerged in 2009. The current epidemiological situation is highly conducive to periodic dengue resurgences. Thus, a high degree of surveillance and strict control measures in source reduction should be maintained.

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Transmission dynamics, border entry screening, and school holidays during the 2009 influenza A (H1N1) pandemic, China
Yu H, Cauchemez S, Donnelly CA, et al. Emerg Infect Dis. May 2012. doi:10.3201/eid1805.110356.
Available at http://wwwnc.cdc.gov/eid/article/18/5/11-0356_article.htm

Abstract. Pandemic influenza A (H1N1) 2009 virus spread rapidly around the world in 2009. We used multiple data sources from surveillance systems and specific investigations to characterize the transmission patterns of this virus in China during May¨CNovember 2009 and analyze the effectiveness of border entry screening and holiday-related school closures on transmission. In China, age distribution and transmission dynamic characteristics were similar to those in Northern Hemisphere temperate countries. The epidemic was focused in children, with an effective reproduction number of ¡Ö1.2¨C1.3. The 8 days of national holidays in October reduced the effective reproduction number by 37% (95% credible interval 28%¨C45%) and increased underreporting by ¡Ö20%¨C30%. Border entry screening detected at most 37% of international travel¨Crelated cases, with most (89%) persons identified as having fever at time of entry. These findings suggest that border entry screening was unlikely to have delayed spread in China by >4 days.

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Characteristics of a widespread community cluster of H275Y oseltamivir-resistant A(H1N1)pdm09 influenza in Australia
Hurt AC, Hardie K, Wilson NJ, et al. J Infect Dis. 4 May 2012. doi: 10.1093/infdis/jis337.
Available at http://jid.oxfordjournals.org/content/early/2012/05/04/infdis.jis337.short?rss=1

Background. Oseltamivir resistance in A(H1N1)pdm09 influenza is rare, particularly in untreated community cases. Sustained community-transmission has not previously been reported.

Methods. Influenza specimens from the Asia-Pacific region were collected through sentinel surveillance, hospital and general practitioner networks. Clinical and epidemiological information was collected on patients infected with oseltamivir-resistant viruses.

Results. Twenty nine (15%) of 191 A(H1N1)pdm09 viruses collected between May and September 2011 from Hunter New England (HNE), Australia, contained the H275Y neuraminidase substitution responsible for oseltamivir resistance. Only one patient had received oseltamivir before specimen collection. The resistant strains were genetically very closely related, suggesting the spread of a single variant. Ninety percent of cases lived within 50 kilometers. Three genetically similar oseltamivir-resistant variants were detected outside of HNE, including one strain from Perth, approximately 4000 kilometers away. Computational analysis predicted that neuraminidase substitutions V241I, N369K and N386S in these viruses may offset the destabilizing effect of the H275Y substitution.

Conclusions. This cluster represents the first widespread community-transmission of H275Y oseltamivir-resistant A(H1N1)pdm09 influenza. These cases and data on potential permissive mutations suggest that currently circulating A(H1N1)pdm09 viruses retain viral fitness in the presence of the H275Y mutation and that widespread emergence of oseltamivir-resistant strains may now be more likely.

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5. Notifications
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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6th Ditan International Conference on Infectious Diseases
Beijing, China, 12 to 15 July 2012
This year the theme of the Conference is “Integration of Clinical, Research and Administrative Data”. In order to fight again and successfully control the infectious diseases, clinical practice, scientific research and administration policy are the three essential elements. It is important to translate the research data into clinical practice while we accumulating the experience from daily practice. Indeed, the government and hospital administration policy is also playing an key role to facilitate the infection control. We hope this meeting can integrate the three elements together, thus, enhancing the communications among the scientists, physicians and administrators.
Additional information at http://www.bjditan.org/

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 apecein@u.washington.edu