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Vol. VIII, No. 17 ~ EINet News Briefs ~ Aug 12, 2005


*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:
- Global: No change in influenza A/H5N1 human vaccine prototype strains
- Global: A Vaccine for all types of influenza
- Global: Avian influenza vaccine called effective in human testing
- South East Asia: Cumulative number of human cases of avian influenza A/(H5N1)
- Indonesia: Route of transmission of infection to family in Jakarta unresolved
- Russia: Highly pathogenic avian influenza reported in bird populations
- Russia and Kazakhstan: EU bans import of feathers and live birds; economic implications
- Viet Nam: Begins mass vaccination of poultry
- Viet Nam: New human cases of avian influenza
- China: Pig disease associated with Streptococcus suis kills 39 persons
- China: Bans reporters from sites of pig disease outbreak; farmers ignore hygiene orders
- China: Vaccines to combat pig disease delivered
- China: Multi-organ failure increases mortality of pig-borne disease; questions remain
- Hong Kong: Pig disease infects eighth victim
- China: Anthrax kills one person
- Taiwan: 7 dead in southern Taiwan from Melioidosis
- Russia (Southern Federal District): 4 fatal cases of Crimean-Congo hemorrhagic fever
- Indonesia: Polio outbreak infects over 200 children
- USA: Non-definitive test result found BSE negative; Philippines lifts ban on U.S. beef products
- USA (Colorado): 13 cases of Q Fever confirmed

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

2. Articles
- Computer modeling suggests global influenza pandemic stoppable
- Studies of H5N1 influenza virus infection of pigs by using viruses isolated in Vietnam and Thailand in 2004
- Tiered use of inactivated influenza vaccine in the event of a vaccine shortage
- Multiple diagnostic techniques identify previously vaccinated individuals with protective immunity against monkeypox
- Multidrug-resistant tuberculosis in Hmong refugees resettling from Thailand into US, 2004-2005
- Interim guidance for minimizing risk for human LCMV infection associated with rodents

3. Notifications
- Consultation on Avian Influenza and human health: FAO/OIE/WHO report
- FDA withdraws use of Baytril in poultry
- Webcast: Public-health consequences of disasters
- Vector-borne exotic diseases meeting
- Applied epidemiology competency development
- Small grants program
- International HIV/AIDS clinical training program
- National Immunization Awareness Month

4. APEC EINet activities
- Emerging Infections of International Public Health Importance

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Global: No change in influenza A/H5N1 human vaccine prototype strains
WHO has decided to stick with the strains of H5N1 avian influenza virus it chose in April 2004 for use in developing human vaccines against the virus, which many fear will trigger a flu pandemic. WHO stated 20 Jul 2005 that analyses of 2004 and 2005 human and animal strains of H5N1 viruses from affected countries "did not provide any convincing evidence to change" the strains previously recommended as vaccine prototypes. The announcement comes after a team of experts reported that the virus had not recently improved its ability to spread from birds to humans or from humans to humans. WHO said that it would "continue to monitor the antigenic and genetic changes in circulating A/H5N1 viruses, especially in humans…For research purposes, WHO Collaborating Centres will develop experimental prototype vaccine strains from recent human influenza A/H5N1 viruses." (Promed 8/1/05; http://www.who.int/csr/disease/avian_influenza/statement_2005_07_20/en/index.html)

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Global: A Vaccine for all types of influenza
Scientists are making a vaccine that could give lifelong protection against all types of flu in a single jab. Currently, at risk people in the UK need annual flu jabs, and there is no jab available yet guaranteed to beat avian influenza. Biotechnology firm Acambis in UK says it hopes its jab will target numerous mutations that presently allow flu to evade attack. However, the work is very early and is years off being tested in humans. Globally, between 500 000 and one million people die each year from flu. If the avian influenza virus currently circulating in Asia were to mutate and spread person to person, it could kill as many people as the 1918 Spanish flu, which claimed between 20 and 40 million lives. Current influenza vaccines work by giving immunity to 2 proteins called hemagglutinin and neuraminidase. However, these proteins keep mutating. Scientists at Acambis' laboratory in the US, together with Belgian researchers at Flanders Interuniversity Institute for Biotechnology, are focusing their efforts on a different protein, called M2, which does not mutate, as well as other technology. If successful, a single shot of the vaccine could protect a person against all strains of influenza virus, they believe. Dr. Thomas Monath, chief scientific officer at Acambis, said: "We aim to avoid the need for annual re-engineering and manufacture of the new product, something that is not yet possible with existing vaccines. The need to develop a new vaccine each time a different influenza strain emerges often results in long delays before a population can be protected. The technology also has special importance as a potential means of protecting human populations against pandemic influenza strains.” So far, the vaccine has only been tested in animals. (Promed 8/7/05)

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Global: Avian influenza vaccine called effective in human testing
Government scientists say they have successfully tested in people a vaccine they believe can protect against avian influenza. The Director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony S. Fauci, said that while the vaccine that has undergone preliminary tests could be used on an emergency basis, it would still be months before that vaccine is tested further and, if licensed, offered to the public. He cautioned: "We don't have all the vaccine we need to meet the possible demand. The critical issue now is, can we make enough vaccine, given the well-known inability of the vaccine industry to make enough vaccine." Dr. Fauci has said that tests so far have shown that the new vaccine produced a strong immune response among the small group of healthy adults under age 65 who volunteered to receive it, although the doses needed were higher than in the standard influenza vaccine. The vaccine was developed with genetic engineering techniques. Further tests are expected to be conducted in people 65 and older and children. Because the vaccine is made in chicken eggs, "a potential major stumbling block" to successful mass production is the number of eggs farmers can supply to vaccine manufacturers.

Additional tests are needed to determine the optimal dose of vaccine; how many shots people will need; and whether adding an adjuvant to the vaccine could raise the potency of lower doses, stretching the number of people that could be protected. Even when these tests are completed, more time will be needed before the vaccine can be licensed and determined when and how it should be administered. The vaccine was produced by Sanofi-Pasteur. The government could decide to release the product under emergency conditions if an A(H5N1) influenza pandemic struck before the testing was completed. Dr. Fauci said that the initial test findings have given the government enough confidence to start the process of adding millions more doses of the vaccine to the 2 million it has bought. The A(H5N1) vaccine is a primary immunization because, having had no exposure to that virus, people lack immunity to the strain. The US is thought to be the only country that has produced a human vaccine against A(H5N1). Scientists from Australia, Canada, France, Japan and the UK are trying to develop human avian influenza vaccines. NIAID also contracted with Chiron to make another A(H5N1) vaccine. NIAID has 8000 doses of the Chiron vaccine and hopes to start testing it in volunteers. The approach is still disadvantaged by the lapse of time between choice of vaccine strain and appearance of a pandemic virus which may have diverged by mutation, or may even have acquired non-homologous H or N antigens by reassortment. (Promed 8/7/05)

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Asia
South East Asia: Cumulative number of human cases of avian influenza A/(H5N1)
Cumulative number of confirmed human cases of avian influenza A/(H5N1), 16 Dec 2004 to present:
Economy / Unofficial (Official) Cases / Unofficial (Official) Deaths
Indonesia / 4 (1) / 3 (1)
Cambodia / 4 (4) / 4 (4)
Thailand / 0 (0) / 0 (0)
Viet Nam / 68 (63) / 23 (20)
Total / 76 (68) / 30 (25)

Cumulative number of confirmed human cases of avian influenza A/(H5N1), 3 Dec 2003 to present:
120 (112) / 62 (57)
(CIDRAP 8/9/05 http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/case-count/avflucount.html)

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Indonesia: Route of transmission of infection to family in Jakarta unresolved
Indonesia's search for the source of the avian influenza virus that killed 3 people near Jakarta has ended in failure, the Health Minister Siti Fadillah Supari said 10 Aug 2005. Health experts said they could not pinpoint the source and decided to end the investigation into how a man and his 2 young daughters contracted H5N1 influenza virus infection July 2005. They were the country's first human casualties of the virus. Experts had said locating the source of the infection would be key to preventing further deaths. Supari said there were no fresh human cases reported, after authorities tested more than 300 people who had contact with the family. She also said tests on several people were negative. "The Ministry will increase alertness through surveillance, monitoring and technical preparedness at hospitals and ports," said Supari. Indonesia has prepared 44 hospitals for the treatment of possible outbreaks of avian influenza in human patients. In Indonesia, the virus has spread to 21 provinces out of 33 since 2003, killing around 9.5 million fowl. The virus jumped species into pigs in Java early 2005. In an effort to help the industry, the government has launched a campaign to raise awareness that poultry is safe to eat if cooked properly. A lack of funds to compensate farmers has seen Indonesia vaccinate healthy animals in affected areas rather than use mass culling. Most human cases of avian influenza elsewhere in East Asia have been attributed to consumption of diseased poultry. It may be that the deceased members of the Indonesian family had contracted the infection from inadequately cooked poultry products. (Promed 8/10/05)

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Russia: Highly pathogenic avian influenza reported in bird populations
Highly pathogenic avian influenza virus type A(H5N1) has infected bird populations in Russia, according to the World Organisation for Animal Health (OIE). The disease has been reported in 13 villages in the Novosibirsk region, and was first detected 18 Jul 2005. Russia officially notified the OIE 5 Aug 2005 that the avian influenza virus type A from Novosibirsk was H5N1. Cases of avian influenza have been registered in the Novosibirsk, Omsk, Tomsk, and Tyumen Regions and the Altai Territory of Russia. The virus may have spread to 2 more districts of the Kurgan region where bird flu was confirmed in wildfowl. The virus is believed to have been transmitted to domestic poultry from wild waterfowl from China. Infection of domestic birds in all the affected localities, some of which are up to 600 km apart, occurred simultaneously. In all cases, the source of infection was wild waterfowl in lakes frequented by domestic birds. There are controls on the movement of poultry, and many other bird populations in the region are being screened. Affected farms are being disinfected. Reportedly the disease has not affected any humans so far. Officials said mass deaths among farm birds largely stopped 8 Aug 2005 in the worst-affected, quarantined areas of Novosibirsk. The Russian Emergencies Ministry said 8 Aug 2005 that a total of 5573 domestic and wild birds had been affected in the Novosibirsk, Omsk and Tyumen regions. In Tyumen, more than 12 000 chickens, ducks and geese had been killed.

In Europe, there has been concern that the A(H5N1) virus could be carried in by birds. Avian influenza in wild birds has also been reported in Mongolia and in domestic poultry in Kazakhstan. The H5N1 virus was detected in Xinjiang, China Jun 2005. The Russian veterinary service said that the virus apparently had been brought by birds migrating from Southeast Asia. Chinese researchers called Qinghai Lake "a breeding center for migrant birds that congregate from Southeast Asia, Siberia, Australia, and New Zealand." In Kazakhstan, the Agriculture Ministry confirmed that the virus found in birds was the H5N1 strain. The ministry, which reported an outbreak of avian flu 4 Aug 2005, said a quarantine was in place in the affected area in the Pavlodar region. The agriculture ministry said, "As of 9 Aug 2005, there have been no reports of new outbreaks of the disease among poultry or wildfowl in the republic." A quarantine was also in place in the village of Vinogradovka, where bird flu was earlier reported. (Promed 7/30/05, 8/1/05, 8/8/05, 8/9/05, 8/10/05, 8/11/05)

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Russia and Kazakhstan: EU bans import of feathers and live birds; economic implications
The EU Commission has asked Member States to implement a ban on all imports of feathers and live birds from Russia and Kazakhstan, due to confirmed outbreaks of Avian Influenza (AI) in these countries. Russia and Kazakhstan have been added to the list of countries (Thailand, Cambodia, Indonesia, Laos, China, Vietnam, North Korea, Pakistan and Malaysia) not allowed to export birds, their meat or products to the EU because of AI. The ban on the import of poultry and poultry farming products from Russia will cause no negative effects on domestic producers because the export of these items from Russia is very insignificant. In addition to the EU, Azerbaijan, Ukraine, Kyrgyzstan, Tajikistan and Hong Kong also banned poultry products from Russia. The Russian poultry farming industry has been growing steadily for the past few years, as domestic demand has soared and import quotas restricted import. Russia annually consumes more than 2 million tonnes of poultry meat and imports more than half its needs from the US, Brazil and other countries. Russia's growing bird flu crisis could drive up imports of poultry. (Promed 8/9/05)

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Viet Nam: Begins mass vaccination of poultry
Viet Nam began administering early August 2005 the first of 20 million shots to the poultry stock, in the largest-scale bird flu vaccination program ever conducted here. Viet Nam will buy 415 million doses of avian influenza vaccine from China and the Netherlands for use in poultry. The Chinese vaccine is for the H5N1 virus, while the Dutch vaccine is for H5N2. Poultry within 3 km of flu outbreaks will receive emergency inoculations. Officials will have to overcome logistical hurdles for the program to succeed: the vaccine must be kept cool, and millions of chickens running freely must be caught by hand twice, once for the initial injection and 3 to 4 weeks later for booster shots. To Long Thanh, vice director at the National Center for Veterinary Diagnosis, said that if all goes well, the program could be expanded to nearly all provinces. Workers began giving 30 Jul 2005 91 000 injections in parts of Tien Giang province and will vaccinate another 2.9 million birds. Nam Dinh province was set to begin its trial vaccinations 4 Aug 2005 and will immunize 4.2 million birds next week.

Since late 2003, about 45 million birds have died or been slaughtered in Viet Nam. The government has not been able to fully compensate them. WHO said it was pleased with Viet Nam's decision to vaccinate, but it warned that healthy birds can still carry the virus. "The vaccination program will need to be accompanied by an intensive surveillance program so that we can continue to monitor the distribution and evolution of the virus once the beacon of large-scale poultry deaths has been switched off," said WHO epidemiologist Peter Horby. The U.N. Food and Agricultural Organization (FAO) also applauded the action. Viet Nam has earmarked USD 37 million for 400 million doses of the vaccine to be used nationally. Early 2005, similar vaccines were tested on a smaller number of poultry in Viet Nam. The results have not been fully analyzed, but reportedly show promise. Avian influenza vaccines also have been used in China, Indonesia, Pakistan and Mexico. (Promed 8/1/05, 8/3/05)

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Viet Nam: New human cases of avian influenza
On 2 Aug 2005, the deputy head of Viet Nam's Preventive Medicine Department under the Health Ministry, Nguyen Van Binh, said the country detected 3 human cases of bird flu infection. A 26-year-old woman from southern Ho Chi Minh City and a 24-year-old man from southern Tra Vinh province have died of the disease (they both showed symptoms of the disease after eating chicken), while a 49-year-old woman from northern Ha Tay province has remained hospitalized. The woman had bought a chicken at a local market and cooked it. Local healthcare agencies have kept close surveillance on areas where she lives and on those who have close contact with her. The Hanoi Animal Health Department also reported bird flu recurrence at a farm in Long Bien district. Department officials culled 1500 ducks, disinfected the site, and sent samples to a test center.

In addition, a 30-year-old man from southern Ben Tre Province, who died late July 2005 has tested positive for the H5N1 virus. The man, from Tan Xuan Commune, died a day after he was admitted to Nguyen Dinh Chieu Hospital with acute pneumonia. His is the first death from avian influenza virus infection in Ben Tre. The man ate sick fighting cocks after slaughtering them. The surroundings of the victim's house have been sprayed with disinfectant [which will have no effect on the virus]. The avian influenza epidemic shows signs of returning, warns the Agriculture and Rural Development Ministry's Animal Health Department deputy director Dau Ngoc Hao. The evidence was signs of a wider distribution of the H5N1 virus in flocks, he said 9 Aug 2005. The Department has required northern cities and provinces to count their poultry flocks in preparation for a vaccination campaign 1-15 Sep 2005. The human death toll from avian influenza virus infection in Viet Nam continues to be associated with consumption of virus-infected poultry. There is still no indication that the virus has acquired an ability to transmit from human to human. (Promed 7/29/05, 8/3/05, 8/5/05, 8/10/05)

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China: Pig disease associated with Streptococcus suis kills 39 persons
On 6 Aug 2005, 2 new infections of Streptococcus suis and 1 new death were reported in Sichuan province. The number of human infections has risen to 214 cases, and the death toll has hit 39. Chengdu city and Pengzhou city each had a case. Chengdu city reportedly had 1 new death, a case who was originally in critical condition. Of the 214 cases, including 44 cases diagnosed by a laboratory, 131 were diagnosed at a clinic, and 39 were suspected cases. Among the 214 infections, 39 have died, 58 were cured and released from the hospitals, and 117 are in the hospitals, with 12 still critically ill. On 5 Aug 2005, WHO urged China to examine the cases of S. suis on a wider scale in order to eliminate other possible pathogenic factors. WHO said the high mortality rate could mean other factors were involved.

This outbreak is thought to be the biggest recorded outbreak of infection from streptococcus suis. The outbreak occurred first in pigs in the Sichuan Province in 8 backyard farms. The province has one of the largest pig populations in China. Investigations conducted by Chinese epidemiologists indicate that the first human cases occurred at the end of June 2005 in Ziyang City, Sichuan Province. From 24 June through 21 July, authorities reported 20 cases of illness, of unknown cause, admitted to 3 hospitals. WHO was officially informed of the outbreak 22 July 2005, at which time 20 cases and 9 deaths had been reported. The date of the first confirmation of the disease was 25 July 2005. The National Animal Exotic Centre and the Harbin Veterinary Research Institute did the differential laboratory diagnosis and excluded Avian Influenza virus and Nipah virus. Most cases reported have occurred in adult male farmers. Close contact with diseased or dead pigs appears to be the principal source of human infection. Symptoms reported include high fever, malaise, nausea, and vomiting, followed by meningitis, subcutaneous haemorrhage, toxic shock, and coma in severe cases. The incubation period is short and disease progression is rapid. Local experts are conducting active searches for further cases. As immediate control measures, stamping out, quarantine, screening, movement control inside the country and zoning were undertaken. To date, Chinese authorities say they have found no evidence of human-to-human transmission. The outbreak in humans has some unusual features and is being closely followed. Diagnostic testing to further characterize the causative agent is recommended to understand this outbreak, ensure its rapid containment, and prevent further deaths.

Streptococcus suis is the causative agent of a wide range of infections in pigs, including meningitis, arthritis, pneumonia, septicemia, endocarditis, encephalitis, polyserositis, and abscesses. The bacterium is endemic in all pig-raising countries world-wide, especially affecting large, intensively managed pig farms. The disease is not regarded to be highly infectious; most outbreaks are limited to the affected farms, and is not notifiable, nationally or internationally. Nevertheless, in the affected farms, significant economic losses may be observed, and antibiotic therapy gives unsatisfactory results. Vaccines have been developed and widely used, but the results of vaccination have been inconsistent. Human infection has generally been known as occupational, affecting farmers and personnel engaged with pig breeding and their handling, including slaughter, not a food-borne disease. (OIE 8/5/05, Promed 8/1/05, 8/2/05, 8/3/05, 8/8/05)

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China: Bans reporters from sites of pig disease outbreak; farmers ignore hygiene orders
Chinese authorities have banned reporters from visiting areas where an outbreak of a pig-borne disease has occurred, ordering newspapers to use dispatches from the state news agency. Sichuan authorities have ordered journalists to stay away from locations where the disease has surfaced, and told newspapers to carry stories as issued by the official Xinhua news agency, Hong Kong's Ming Pao Daily News reported.

Many farmers in southwest China are refusing to bury infected pigs safely, raising fears that the swine flu could spread further. The Beijing News said authorities had blocked inward shipments of about 4000 tons of pork and pork products from Sichuan province up to 31 Jul 2005. Many impoverished Sichuan farmers, having already bought piglets, inoculation and feed, are refusing to spend more on burying sick pigs with disinfectant. Instead, they slaughter them and eat the meat. While most of the infections have been found in Sichuan, cases have also been reported in Guangdong province and Hong Kong. (Promed 8/1/05, 8/2/05)

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China: Vaccines to combat pig disease delivered
To combat the deadly pig-borne disease, the Chinese government airlifted 31 Jul 2005 the first batch of a vaccine for the infection--enough to treat 360 000 pigs--from the Guangzhou to the affected towns. The vaccine's manufacturers say they will be producing enough vaccine to treat 10 million pigs, but vaccines take 3 weeks to produce immunity in the pigs. Health authorities in the province have distributed 2 million notices to educate poor, often illiterate farmers and their children not to slaughter pigs or eat their meat. 39 temporary roadside quarantine stations have been set up to prevent dead pigs from reaching markets; they will be burned instead. China's state-controlled media says the government has brought the disease under control and that no human-to-human transmission of infection has been found. But there has been widespread criticism of the way the situation has been handled, with parallels being drawn to China's handling of SARS and bird flu outbreaks. The authorities knew of the first human cases 24 Jun 2005, but it allowed the news out 25 Jul 2005. (Promed 8/2/05)

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China: Multi-organ failure increases mortality of pig-borne disease; questions remain
Short latent period and multi-organ failure are ultimate causes for the higher-than-expected mortality rate of the pig-borne disease in southwest China's Sichuan Province, a Chinese health specialist said. "Most patients suffered failures in the kidneys, livers, lungs and heart shortly after they were contracted, and some of them died before timely treatment," said Chen Zhihai, head of the expert panel sent by the Ministry of Health to the epidemic-hit regions. Chen said antibiotics are effective in tackling the organism, but not after it has led to multi-organ failure, which is largely to blame for the high morality rate. Earlier symptoms of the disease are similar to those of flu, with high fever, fatigue, nausea and vomiting, but many patients became comatose shortly afterwards and had bruises under their skin. The epidemic broke out in late June 2005, first in Ziyang and Neijiang, and later spread to 10 cities, including Jianyang and the provincial capital Chengdu.

Marcelo Gottschalk, one of the world's leading experts on the disease, said 3 Aug 2005, "We are worried, and we wonder what's happening. We would like to have the strain to identify." Gottschalk works in the world's only reference laboratory for S. suis at the University of Montreal in Canada and says no one in China has contacted him for help since the outbreak was reported. So few people have studied this disease, he is unsure how the Chinese have been able to identify it and what type of vaccine they plan to use, since immunizations typically are not effective. Gottschalk said S. suis usually takes a while to develop in people and often causes meningitis followed by partial or permanent hearing loss. Most people survive after being treated with antibiotics, and cases are typically few and far between; WHO and the UN Food and Agriculture Organization have questioned whether S. suis could possibly have combined with some other disease or bacteria in China. (Promed 8/4/05)

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Hong Kong: Pig disease infects eighth victim
The swine disease that has killed 39 people in Sichuan province infected its eighth victim in Hong Kong. The Centre for Health Protection and the Department of Health received a report that an unnamed 78-year-old woman was diagnosed with the Streptococcus suis disease when she was admitted to Kwong Wah Hospital in Mong Kok 8 Aug 2005. The woman came down with the infection 3 Aug 2005 and was admitted to the hospital with a fever and pain in her right hip. The woman, a resident of Mong Kok, is in stable condition. She had not left Hong Kong, and there are no signs that she has infected anyone in her household. It remains unclear whether the Sichuan outbreak is directly related to the Hong Kong cases, but in those with a clear porcine exposure, contact with pork from the area may need to be seriously considered. On 1 Jul 2005, the Hong Kong authorities said that, to better monitor the situation, they would classify Streptococcus suis as a statutorily notifiable disease, which would require all local doctors to report cases in humans to the government. Shipments of pork from Sichuan, China's top producer, to Hong Kong have been stopped. They also stepped up inspections and quarantine procedures on live pigs and frozen pork imported from mainland provinces and said they would crack down on illegal pork imports. See: http://www.alertnet.org/thenews/newsdesk/HKG69696.htm. Hong Kong health experts have confirmed the bacteria as Streptococcus suis and found no evidence of any mutation. (Promed 8/2/05, 8/4/05, 8/11/05)

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China: Anthrax kills one person
Anthrax has killed one person and infected 12 in northeast China in the latest outbreak of animal-borne disease to hit the country. Anthrax, a disease caused by spore-forming bacteria normally contracted through contact with infected livestock, struck 29 Jul 2005 outside Shenyang, in Liaoning province (see http://www.xinhuanet.com), 7 Aug 2005. By 5 Aug 2005, no new cases had been reported in the town of Damintun for 5 consecutive days. 11 victims had been treated in the hospital and were recovering. Livestock in the affected areas had been inoculated with anti-anthrax vaccine or culled and buried. Officials had checked all local meat sales points and banned people from bringing sick animals to markets. All victims in Damintun were infected through slaughtering, handling or eating infected cows. (Promed 8/7/05)

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Taiwan: 7 dead in southern Taiwan from Melioidosis
One more melioidosis patient died in southern Taiwan 31 Jul 2005, bringing the death toll to 7, with 3 remaining in intensive care units and 9 others in the hospital after contracting the disease in the wake of a recent typhoon and flooding, the Department of Health said. Between 11 and 31 Jul 2005, a total of 19 cases were reported, compared with 22 since early in 2005 (another news report raises the number of cases to 26). Melioidosis is not a notifiable disease but is a category B bioterrorism disease. Melioidosis (Whitmore's disease) is an infectious disease caused by the Burkholderia pseudomallei bacterium. The bacterium is usually found in contaminated water or soil and is spread to humans through direct contact. As the majority of the patients lived along the heavily polluted Erjen Creek that runs through Tainan and Kaohsiung counties, the health department has urged the public to be on guard and avoid contaminated water or soil. Health officials also warned people with diabetes, weak immune systems or open wounds not to expose themselves to polluted water or soil. B. pseudomallei is commonly found in the soil in focal areas of Southeast Asia and northern Australia. Most cases occur during the rainy season. A majority of severe cases of melioidosis occur in diabetes and other immunocompromised groups. (Promed 8/3/05)

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Russia (Southern Federal District): 4 fatal cases of Crimean-Congo hemorrhagic fever
As of 25 Jul 2005, 127 cases of Crimean-Congo hemorrhagic fever (CCHF) had been notified in the Southern Federal District (SFD) since the beginning of 2005. This number is 2.3 times more than during the same period of 2004. 110 patients have been discharged on recovery (compared with 43 during the same period in 2004), and 4 have died (compared with 6 in 2004). In all cases the diagnosis has been confirmed by laboratory testing. CCHF is a severe tick-borne hemorrhagic fever that occurs in rural communities in Africa, the Middle-East, the Balkans, Russia, and northern China. The causative agent is a tick-borne virus belonging to the genus Nairovirus of the family Bunyaviridae. The disease can be contracted directly from infected ticks or from susceptible domestic animals at time of slaughter. Infected domestic animals rarely exhibit symptoms of infection. Nosocomial transmission can occur in hospitals, particularly among those undergoing surgery. The increased number of human cases in the first half of 2005 reflects a corresponding increase in the abundance of ticks over a wide area of southern Russia. (Promed 7/29/05)

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Indonesia: Polio outbreak infects over 200 children
The number of children affected by polio virus in an outbreak in Indonesia has risen to 205. The highest number of cases is in West Java province, with 54; only 1 case can be confirmed in Jakarta. Officials say a second round of a nationwide anti-polio vaccination campaign had fewer takers because of parents' fears of possible harmful side effects. 2 more rounds are scheduled for 30 Aug 2005 and 27 Sep 2005, targeting 24.3 million children. The disease is believed to have returned to Indonesia via Saudi Arabia, either through migrant workers or Muslim pilgrims returning from Mecca. (Promed 8/7/05)

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Americas
USA: Non-definitive test result found BSE negative; Philippines lifts ban on U.S. beef products
The U.S. Department of Agriculture's National Veterinary Services Laboratories determined that the non-definitive test result reported 27 Jul 2005 is negative for BSE. Tests conducted by the Veterinary Laboratories Agency in Weybridge, England, are also negative for BSE. NVSL and Weybridge conducted the additional testing after a non-definitive IHC test result was received. The initial non-definitive result was caused by artifactual (artificial or untrue) staining and this staining did not resemble BSE. The enhanced surveillance program is designed to provide information about the prevalence of BSE in the US.

Agriculture Secretary Mike Johanns announced that the Philippines will resume imports of U.S. beef and beef products. US will now be able to export boneless beef from cattle not older than 30 months to the Philippines. The estimated value of the Philippines market reopening to U.S. boneless beef is $2.5 million. In 2003, the US exported $4.9 million of beef and beef products to the Philippines. After the Dec 2003 discovery of the first BSE-infected cow in the US, the Philippines restricted imports of certain types of U.S. beef, while allowing imports of U.S. boneless beef from cattle not older than 30 months with its memorandum order in Jan 2004. In June 2005, the Philippines imposed a temporary ban on beef and beef products from the US following confirmation that a second U.S. cow had tested positive for BSE. (Promed 8/3/05; USDA 8/4/05)

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USA (Colorado): 13 cases of Q Fever confirmed
Q fever has shown up in an unusual number of cases this summer in Colorado. The source is probably diseased livestock. The state health department has confirmed 13 human cases in the state in 2005. In 2004, there were 3 confirmed cases in Colorado. Q fever is a zoonotic disease caused by Coxiella burnetii, a bacterium distributed globally. It builds up in livestock placental tissues, putting veterinarians and farmers at high risk, though it is treatable with antibiotics. In 1999, Q fever became a notifiable disease in the USA, but reporting is not required in many other countries. Cattle, sheep, and goats are the primary reservoirs of C. burnetii. Infection has been noted in a wide variety of other animals. C. burnetii does not usually cause clinical disease in these animals. Organisms are excreted in milk, urine, and feces of infected animals. The organisms are resistant to heat, drying, and many common disinfectants. Infection of humans usually occurs by inhalation of air contaminated by dried placental material, birth fluids, and excreta of infected animals. Ingestion of contaminated milk, followed by regurgitation and inspiration of contaminated food, is a less common mode of transmission. Other modes of transmission to humans, e.g. tick bites and human-to-human transmission, are also rare.

Humans are very susceptible to the disease, but only about half of all people infected with C. burnetii show signs of clinical illness. Most acute cases of Q fever begin with sudden onset of one or more of the following: high fevers, severe headache, general malaise, myalgia, confusion, sore throat, chills, sweats, non-productive cough, nausea, vomiting, diarrhea, abdominal pain, and chest pain. Most patients will recover within several months without any treatment. Only 1-2 percent of acute Q fever cases are fatal. Chronic Q fever, characterized by infection that persists for more than 6 months is uncommon. Since C. burnetii is a highly infectious agent that is rather resistant to heat and drying, it is considered relevant in bioterrorism. A single C. burnetii organism may cause disease in a susceptible person. (Promed 8/10/05)

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1. Updates
Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies, 2 August 2005

Australia. Influenza activity increased significantly in south Australia in weeks 28-29. Influenza A predominated, with roughly equal numbers of A(H1) and A(H3N2) viruses identified. Most influenza B viruses were B/Shanghai/361/2002-like, with smaller numbers of B/Hong Kong/330/2001-like strains.

Chile. Influenza A activity declined in weeks 28–29. Sporadic activity was reported for week 29.

Hong Kong. After 17 weeks of high A(H3N2) activity, influenza activity declined significantly.

New Zealand. Influenza B activity remained widespread in week 28, although the consultation rate for influenza-like illness continued to decline.

Other reports. During weeks 28–29, low influenza activity was detected in Canada (A) and Thailand (H3 and B). Philippines reported no influenza activity. (WHO 8/2/05 http://www.who.int/csr/disease/influenza/update/en/)

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Cholera, diarrhea & dysentery
South Korea
Cholera has been detected in the sewage system of a plane from India at Incheon International Airport, Korea Center for Disease Control and Prevention said 3 Aug 2005. The agency is searching for the 55 people who entered the country after arriving on the flight from Mumbai 30 Jul 2005. The list of passengers was sent to local municipal governments in an effort to determine their whereabouts. The incident is the third of its kind in 2005. (Promed 8/5/05)

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Dengue
Philippines (Manila)
The Department of Health (DoH) reported 16 new dengue fatalities and 1000 more new infections nationwide as cases continue to surge. According to the DoH-National Epidemiological Center (NEC) dengue report, from 29 Jul to 3 Aug 2005, the number of deaths in 2005 has already risen to 159 from 143 and cases went up from 10 977 to 12 308. The total number of cases in 2005 is 15 percent higher compared to the same period in 2004 which saw 10 690 cases. Outbreaks where recorded by the DoH-NEC in 2 provinces: Zamboanga City and Nueva Ecija. The outbreak in Zamboanga is now under control, while cases in Gen. Tinio, Nueva Ecija continue to increase and now stand at 99 cases with 2 deaths. DoH advised parents to protect their kids who go to school against dengue. NEC records reveal that 43 percent of the victims of dengue are children. Most adults are immune to the dengue types circulating in the country. Parents can protect their kids by applying mosquito repellant to their skin. DoH also reminded school officials to engage in clean-up activities at least once a week and pay attention to the removal of possible breeding grounds of mosquitoes such as cans and used tires that can accumulate water. (Promed 8/11/05)

Philippines (Negros Occidental)
Negros Occidental has now had 574 dengue cases from Jan to Jul 2005. Dr. Luisa Efren, provincial health officer, said there has been a 40 percent increase in the number of cases compared to the same period in 2004, which had total of only 373 cases. There were 2 deaths recorded in the latest PHO (provincial health office) monitoring. Efren had raised the dengue alert status in the entire province. She enjoined Negrenses to be advocates of the 4 o'clock habit, a daily regimen that includes the burning of garbage at 4 p.m. to produce smoke that will drive away the mosquito Aedes aegypti. Daily elimination of breeding places is also suggested. Dr. Jovy Vergara, assistant health officer of Bacolod, asked Bacolenos not to kill or gather spiders for spider derby purposes; spiders are predators of mosquitoes. (Promed 8/11/05)

Malaysia
A 10-fold increase in dengue cases within the last 10 years is worrying the government, prompting it to order all relevant agencies to take measures to halt the trend. This should result in closer monitoring, greater enforcement, enhancement of prevention measures, and better public education in schools. A nationwide campaign to clean up schools will be launched Sep 2005 to ensure that schools are Aedes-free. Deputy Prime Minister Datuk Seri Mohd Najib Razak said currently 156.1 out of 100 000 people had dengue, up from 132.5 out of 100 000 people in 2004. "Last year, over 33 000 people were hospitalized with dengue, and the upward trend is continuing this year." (Promed 8/4/05)

USA (St. Croix)
Dr. Eugene Tull, Health Department epidemiologist, said that lab results have confirmed 25 additional cases of dengue fever in the territory. The confirmed cases were all from St. Croix. The results were from blood specimens collected Jun 24 - Jul 6 2005. Of the additional 25 confirmed cases, 22 occurred in people who had had dengue before. There are 4 types of the dengue virus, which is transmitted to people through the bite of an infected mosquito. Someone who has been infected by 1 of the strains and has developed immunity to it is still vulnerable to the other strains. People who previously have been infected with dengue and are infected again are at higher risk for developing dengue hemorrhagic fever. The number of laboratory-confirmed dengue cases on St. Croix this year is 36. A dramatic increase in reports of suspected dengue on St. Croix followed publicity surrounding the death of a 14-year-old girl Jun 2005. More than 200 suspected cases of dengue fever have been reported on St.Croix. Public concern over the death, combined with the large number of suspected dengue cases on St. Croix and the fact that many have been clustered in certain neighborhoods, prompted the Health Department to identify dengue "hot spots" on St.Croix. Tull said it was not clear whether there are more cases this year, or whether people experiencing symptoms are seeking medical help more quickly. (Promed 7/29/05)

Indonesia (Jakarta)
Out of the 38 635 people who contracted dengue fever throughout the country so far in 2005, 539 have died [a case fatality rate (CFR) of 1395 per 100 000], Minister of Health Siti Fadilah Supari said. "The province with the highest number of dengue fever sufferers is Jakarta with 10 847 and 57 deaths [CFR of 526 per 100 000], followed by East Java with 6007 sufferers and 84 deaths [CFR of 1398]," Siti Fadilah said. The minister explained that the highest incidence of dengue fever was also registered in Jakarta with 96.4 cases per 100 000 people, followed by East Kalimantan with 61.7, North Sumatra with 45.7, Southeast Sulawesi with 35.2 and Bali with 34.8. Compared to the number of dengue fever sufferers in the corresponding period in 2004, this year's incidence fell from 18.8 per 100 000 people to 16.6. The Ministry has taken a number of measures to anticipate a possible major outbreak of the disease by intensifying monitoring of new cases and encouraging hospitals to accommodate an upsurge in the number of patients, Siti Fadilah added. (Promed 8/11/05)

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West Nile Virus
USA (Louisiana)
Mosquito monitoring continues to show an active presence of West Nile virus in the mosquitoes that can transmit the disease to people. The East Baton Rouge Parish Mosquito Abatement and Rodent Control District reported that 41 percent of the 156 samples of mosquitoes submitted to the Louisiana State University Vet School in July 2005 tested positive for West Nile Virus. The samples were collected 12-19 Jul 2005. Mosquitoes get infected by biting and drawing the blood of birds and can then pass on the virus to people or other mammals. "West Nile virus seems to be spreading from wild birds into other mosquito species, and this further increases the potential for human infections," said Matt Yates, director of the control agency. The state has reported only 2 human cases of West Nile in 2005. (Promed 8/5/05)

USA
As of August 9, 2005, twenty-two states (Arizona, Arkansas, California, Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Louisiana, Minnesota, Mississippi, Missouri, Nevada, New Mexico, New York, North Carolina, North Dakota, Ohio, Pennsylvania, South Dakota, and Texas) have reported 187 cases of human WNV illness in 2005. Ninety-eight (57%) of the 171 cases for which such data were available occurred in males; the median age of patients was 47 years (range: 4--85 years). Date of illness onset ranged from May 14 to August 4 2005; 3 cases were fatal. 54 presumptive West Nile viremic blood donors (PVDs) have been reported in 2005. Of these, 25 were reported from California, 18 from Texas, 5 from South Dakota, 3 from Arizona, and 1 each from Iowa, Louisiana, and Mississippi. Of the 54 PVDs, 11 persons (median age: 50 years [range: 17--77 years]) subsequently had West Nile fever. For more information: http://www.cdc.gov/ncidod/dvbid/westnile/index.htm and http://westnilemaps.usgs.gov. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5431a3.htm (MMWR August 12, 2005 / 54(31);769-770)

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2. Articles
Computer modeling suggests global influenza pandemic stoppable
UK and US teams used computer models to work out the scenarios that could occur if the H5N1 avian influenza virus became capable of spreading human to human. The result could be deaths on the scale of the 1918 Spanish flu pandemic. However, surveillance plus targeted use of anti-viral drugs could halt it, they told Nature and Science. The models used by both teams looked at Thailand. Professor Neil Ferguson of Imperial College London and his colleagues found 2 key conditions would have to be met to limit an outbreak of human-transmissible avian influenza to fewer than 200 cases. Firstly, the virus would have to be identified while confined to about 30 people. In addition, antiviral drugs would have to be distributed rapidly to the 20 000 individuals nearest those infected. His group estimated that an international stockpile of 3 million courses of the treatment would be enough to contain an outbreak. But it would mean having to deploy the drug anywhere in the world at short notice. Professor Ferguson said: "It's an enormous undertaking and will require cooperation among governments on a large scale."

Another team from Emory University in USA, led by Dr. Ira Longini, simulated an outbreak in a population of 500 000 in rural Thailand, with people mixed in a variety of settings, including households, schools, workplaces and a hospital. Provided targeted use of antiviral drugs was adopted within 21 days, it would be possible to contain an outbreak, they found, as long as each infected person was not likely to infect more than an average of 1.6 people. If there was more infectivity than this, household quarantines would also be necessary, they said. Co-researcher Elizabeth Halloran said that early intervention could slow the pandemic, helping to reduce mortality until a well-matched vaccine could be produced.

WHO said the models would help to improve pandemic influenza preparedness planning: "National and international stockpiles of antiviral drugs may be an essential component of comprehensive international pandemic preparedness that also includes vaccine development and disease surveillance." While this analysis is encouraging, Thailand has been relatively successful in controlling avian disease, and the majority of the human cases and deaths have occurred in Viet Nam. There have been no human cases or deaths in Thailand since the end of 2004.

Nature article: Ferguson NM et al. Strategies for containing an emerging influenza pandemic in Southeast Asia. Nature. 2005 Aug 3. http://www.nature.com/nature/journal/vaop/ncurrent/abs/nature04017.html

Science article: Longini IM et al. Containing Pandemic Influenza at the Source. Science. 2005 Aug 3. http://www.sciencemag.org/cgi/content/abstract/1115717 (Promed 8/4/05)

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Studies of H5N1 influenza virus infection of pigs by using viruses isolated in Vietnam and Thailand in 2004
Choi YK et al.
Abstract: “To determine whether avian H5N1 influenza viruses associated with human infections in Vietnam had transmitted to pigs, we investigated serologic evidence of exposure to H5N1 influenza virus in Vietnamese pigs in 2004. Of the 3,175 pig sera tested, 8 (0.25%) were positive for avian H5N1 influenza viruses isolated in 2004 by virus neutralization assay and Western blot analysis. Experimental studies of replication and transmissibility of the 2004 Asian H5N1 viruses in pigs revealed that all viruses tested replicated in the swine respiratory tract but none were transmitted to contact pigs. Virus titers from nasal swabs peaked on day 2, and low titers were detected in the liver of two of the four pigs tested. Our findings indicate that pigs can be infected with highly lethal Asian H5N1 viruses but that these viruses are not readily transmitted between pigs under experimental conditions.” (Journal of Virology, August 2005, p. 10821-10825, Vol. 79, No. 16)

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Tiered use of inactivated influenza vaccine in the event of a vaccine shortage
“The United States has experienced disruptions in the manufacture or distribution of inactivated influenza vaccine during three of the last five influenza seasons. Delays in delivery of influenza vaccine or vaccine shortages remain possible, in part, because of inherent time constraints in manufacturing the vaccine, given the annual updating of influenza vaccine strains and uncertainties regarding vaccine supply (including licensure of new vaccine preparations). Although total vaccine supply for the 2005--06 influenza season is not yet known, the minimum anticipated supply is approximately 58--60 million doses of inactivated vaccine and 3 million doses of live, attenuated vaccine. This estimated supply is similar to that available during the 2004--05 season and would be adequate to satisfy historical demand for influenza vaccine among persons considered by the Advisory Committee on Immunization Practices (ACIP) to be at high risk for serious complications associated with influenza virus infection, health-care workers, and household contacts of children aged <6 months. These groups were prioritized for influenza vaccination in 2004--05. Additional doses of inactivated influenza vaccine might be available for the U.S. market in 2005--06, but this cannot yet be confirmed. Availability of additional vaccine would allow for expansion of the priority groups and, preferably, vaccination of all persons who desire it….” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5430a4.htm (MMWR August 5, 2005 / 54(30);749-750)

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Multiple diagnostic techniques identify previously vaccinated individuals with protective immunity against monkeypox
Erika Hammarlund et al.
Abstract: “Approximately 50% of the US population received smallpox vaccinations before routine immunization ceased in 1972 for civilians and in 1990 for military personnel. Several studies have shown long-term immunity after smallpox vaccination, but skepticism remains as to whether this will translate into full protection against the onset of orthopoxvirus-induced disease. The US monkeypox outbreak of 2003 provided the opportunity to examine this issue. Using independent and internally validated diagnostic approaches with 95% sensitivity and 90% specificity for detecting clinical monkeypox infection, we identified three previously unreported cases of monkeypox in preimmune individuals at 13, 29 and 48 years after smallpox vaccination. These individuals were unaware that they had been infected because they were spared any recognizable disease symptoms. Together, this shows that the US monkeypox outbreak was larger than previously realized and, more importantly, shows that cross-protective antiviral immunity against West African monkeypox can potentially be maintained for decades after smallpox vaccination.”

About half the U.S. adult population has been vaccinated as part of routine efforts that stopped in 1972 for civilians and 1990 for the military. Studies have shown that immunity lasts as long as 75 years. Similarly, Yvette Edghill-Smith et al., in an article published in Nature Medicine 1 Jul 2005, concluded from experiments using a Rhesus macaque model of infection with monkeypox virus that: "Smallpox vaccine-induced antibodies are necessary and sufficient for protection against monkeypox virus." http://www.nature.com/nm/journal/vaop/ncurrent/abs/nm1273.html (Nature Medicine, published online 7 August 2005; Promed 8/8/05)

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Multidrug-resistant tuberculosis in Hmong refugees resettling from Thailand into US, 2004-2005
“In December 2003, the U.S. Department of State initiated a resettlement program for 15,707 Hmong refugees who had been displaced from Laos and were living on the grounds of Wat Tham Krabok, a Buddhist temple in Thailand. In January 2005, reports of tuberculosis (TB) cases among refugees still in Thailand and refugees who had arrived in the United States, including some cases caused by multidrug-resistant (MDR) strains, prompted a 1-month travel suspension. After enhanced screening in Thailand and intensified TB-control measures in the United States, resettlement resumed on February 16. A majority of the Hmong refugees in Thailand and the United States with TB diagnosed were started on treatment and monitored. As of July 15, no additional TB cases had been diagnosed among newly resettled Hmong refugees. U.S. health departments should continue to ensure careful monitoring for TB among this refugee group.…” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5430a1.htm (MMWR August 5, 2005 / 54(30);741-744)

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Interim guidance for minimizing risk for human LCMV infection associated with rodents
“In May 2005, CDC received reports of four organ-transplant recipients with unknown illness. All were discovered to have been infected with lymphocytic choriomeningitis virus (LCMV) via a common organ donor. Epidemiologic investigation traced the source of the virus to a pet hamster purchased by the donor from a local pet store. LCMV testing of other rodents at the pet store revealed three other LCMV-infected rodents (two hamsters and a guinea pig), supplied by a single distributor (distributor A). Preliminary laboratory testing of hamsters from distributor A has identified an infection rate of approximately 3% among the animals sampled. The facility of distributor A is under quarantine until it can be documented as free of LCMV infection. This report provides background information on LCMV and interim guidance for the public on reducing risk for LCMV infection from pet rodents….” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5430a3.htm

Other less well known but possible zoonotic sources of human lymphocytic choriomeningitis virus (LCMV) are marmosets and tamarins, occasionally kept as pets. (MMWR August 5, 2005 / 54(30);747-749; Promed 8/6/05)

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3. Notifications
Consultation on Avian Influenza and human health: FAO/OIE/WHO report
The official report of “Global health agencies have plan to fight avian flu” (see July 8, 2005 EINet Newsbrief) is now available at: http://www.fao.org/ag/againfo/subjects/documents/ai/concmalaysia.pdf. Sections on conclusions and recommendations are particularly valuable and informative. (FAO)

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FDA withdraws use of Baytril in poultry
U.S. Food and Drug Administration (FDA) has announced its final decision to no longer allow distribution or use of the antimicrobial drug enrofloxacin for the purpose of treating bacterial infections in poultry. This ruling does not affect other approved uses of the drug. This animal drug belongs to fluoroquinolones and is marketed under the name Baytril by Bayer Corporation. The FDA began proceedings to withdraw use of this drug in poultry because of data that showed that the use of enrofloxacin in poultry caused resistance to emerge in Campylobacter. Chickens and turkeys normally harbor Campylobacter in their digestive tracts without causing poultry to become ill. Enrofloxacin does not completely eliminate Campylobacter from the birds' intestinal tracts, and those Campylobacter that survive are resistant to fluoroquinolone drugs. These resistant bacteria multiply in the digestive tracts of poultry and are found on chicken carcasses in slaughter plants and retail poultry meats. Campylobacter are a significant cause of foodborne illness in the U.S. Antimicrobial treatment is recommended for people with severe illness as well as the very young, the elderly, and people with certain medical conditions. Fluoroquinolones used in humans are ineffective if used to treat Campylobacter infections that are resistant to them. This failure can significantly prolong the duration of the infections and may increase the risk of complications. The proportion of Campylobacter infections that are resistant to fluoroquinolones has increased significantly since the use of enrofloxacin in poultry was approved in the U.S. For the Final Decision go to www.fda.gov/oc/antimicrobial/baytril.pdf and for the Federal Register documents go to www.fda.gov/ohrms/dockets. (FDA 7/28/05)

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Webcast: Public-health consequences of disasters
In September 2005, the University of Pittsburgh will host a Webcast that organizers of the event believe will be the academic lecture with the largest audience in history. The lecture, given by Dr. Eric K. Noji on the topic of the public-health consequences of disasters, will potentially be viewed by as many as one million doctors, students, and others around the world. The lecture will be transmitted live to a number of organizations, including Internet2, Egypt's Library of Alexandria, the Medical Library Association, and UNICEF. Those organizations will then distribute the Webcast on their own networks. Ronald E. LaPorte, a professor of epidemiology at the university, said that disseminating medical research often takes a long time, and part of the goal of the Webcast is to make such information available much more quickly. LaPorte also acknowledged that many developing nations lack the technology infrastructure to support the Webcasts. For them, the university will offer presentation materials from the lecture as well as other resources. http://chronicle.com/prm/daily/2005/07/2005072601t.htm (Edupage, EDUCAUSE 7/27/05)

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Vector-borne exotic diseases meeting
28 Oct 2005; London, UK
The emergence and re-emergence in the EU and US of vector-borne diseases has led to an increased interest in both predicting future viral incursions and in exploring the underlying factors driving those that have already occurred. This meeting will bring together entomologists, mathematical modelers and virologists from the forefront of risk assessment. It presents an overview of the vector-borne diseases and examines the use of mathematical modeling and satellite imagery to assess the risk of incursion of viruses and to plan integrated control measures. The meeting will highlight those entomological and pathogen-based aspects of disease transmission that are driven by climate. The major areas of risk assessment will be explored through examining case-studies of both ongoing epidemics and those pathogens thought to be of immediate risk to the EU. The meeting will provide a condensed briefing for those involved in risk assessment decision making, and promote cross-discipline discussion across the fields of parasitology, virology and mathematical modeling. It will be an interest to those with an interest in the future influence of climate change in public health and the planning of measures to minimize these impacts.

For more information contact:
Ms Laura Milne, Conference Producer
SCI - where science meets business, International Headquarters, 14/15 Belgrave Square
London SW1X 8PS
Tel: 020 7598 1565; Fax: 020 7235 7743; laura.milne@soci.org
Websites: http://www.soci.org/pest; http://www.soci.org/SCI/events/details.jsp?eventID=EV676 (Promed 8/11/05; http://www.soci.org)

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Applied epidemiology competency development
CDC's Office of Workforce and Career Development and the Council of State and Territorial Epidemiologists (CSTE) have convened a panel to define competencies for applied epidemiology for local, state, and federal public health epidemiologists. This panel includes representatives of state and local public health agencies, academia, private industry, and CDC. The draft competency document for Tier 2 (i.e., mid-level) epidemiologists is now available for review and comment at http://www.cste.org/competencies.asp. Practicing epidemiologists can review this document and submit comments online through Sep 16, 2005, at http://www.cste.org/assessment/competencies/index.asp. Persons and organizations employing applied epidemiologists can e-mail comments to competencies@cste.org. Competencies for Tier 1 (i.e., frontline) and Tier 3 (i.e., senior) epidemiologists will be available for comment Oct 2005. The panel will consider all information received and revise the competency documents for publication. Questions regarding competencies for applied epidemiology or the development process can be e-mailed to CSTE at competencies@cste.org. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5430a5.htm (MMWR August 5, 2005 / 54(30);750)

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Small grants program
The Small Grants Program is designed to fund pilot research projects by young investigators in developing countries. The goal is to support and foster the professional development of young individuals in the field of infectious diseases research by helping them to acquire additional skills and data to apply for other grants. Areas of interest include, but are not limited to investigations of the epidemiology, pathophysiology, diagnosis or treatment of infectious diseases, the epidemiology and control of hospital-acquired infections, and modeling of cost effective interventions. Upon completion of the project, a written report of the project must be sent to the Society. Up to 5 grants of up to US $6,000 each will be awarded annually. Deadlines for submission of proposals are April 1 and October 1, 2005. For more information contact: ISID Professional Development Working Group, 181 Longwood Avenue Boston, Massachusetts 02115, USA; Fax: (617) 731-1541; E-mail: info@isid.org (ISID)

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International HIV/AIDS clinical training program
The International HIV/AIDS Clinical Training Program is an annual short course designed to educate infectious disease health care providers from developing and transitional countries in clinical, therapeutic, epidemiological, and public health issues relevant to HIV/AIDS clinical care. Program curricula include formal lectures, case discussions and practical experience in caring for HIV-infected adults and children. Emphasis is on the various presentations of HIV infection, differential diagnosis, patient management and new and experimental protocols for the diagnosis and treatment of HIV-infected individuals with opportunistic infections and HIV-associated neoplasms. The program also covers laboratory experience in procedures used to diagnose HIV infection and AIDS-associated infections. Participants are also given the opportunity to spend time at the public health departments associated with the respective training institutions to learn about AIDS- related public health issues in the U.S. Participants are expected to play an active role in discussions on pressing HIV/AIDS public health issues as well as community and global responses to the epidemic. A modest stipend of $2,500 to help defray travel costs and living expenses is given. There are no course fees or tuition expenses. Community- and academic-based health care providers actively involved in the care of HIV-infected adults and/or children at their home institution may apply. The deadline is October 15. For more information contact: info@isid.org. (ISID)

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National Immunization Awareness Month
August is National Immunization Awareness Month (NIAM). The goal of NIAM is to increase awareness about immunizations across the lifespan, from infants to the elderly. This year’s campaign is focused around the theme, “Are You Up to Date? Vaccinate!,” to remind people of all ages of the importance of immunization. A free NIAM promotional kit offers a variety of template materials, such as brochures and posters, which communities can easily customize and use at or in conjunction with local health screenings, media events and other related immunization outreach efforts. Visit (www.partnersforimmunization.org/niam.html) to view and download the materials. (CDC http://www.cdc.gov/nip/events/niam/)

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4. APEC EINet activities
Emerging Infections of International Public Health Importance
EINet launched its updated course "Emerging Infections of International Public Health Importance" on 5 August 2005. The course materials are offered at no cost and consist of lectures presented by experts in the field, with learning objectives and module questions. The lectures contain updated content and new topics (e.g. SARS). They can be found under "Teaching & Learning" at http://depts.washington.edu/einet/?a=teach. Click on "Emerging Infections of International Public Health Importance Course."

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

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 apecein@u.washington.edu