Login   

Vol. VIII, No. 19 ~ EINet News Briefs ~ Sep 09, 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: Acambis hopes to build a flu vaccine that lasts
- Global: Wild birds expected to spread bird flu virus further
- Finland: Seagull had low pathogenic avian influenza, H13
- South East Asia: Cumulative number of human cases of avian influenza A/(H5N1)
- Thailand: Outbreak of avian influenza, H5N1
- Viet Nam: Probable human case of avian influenza
- Viet Nam: 3 Civets infected with H5N1
- Russia (Siberia, Urals): Avian influenza update
- Japan (Ibaraki, Saitama): 1.5 million chickens being culled due to bird-flu outbreak
- Mongolia: Avian Influenza, migratory birds, H5N1
- Thailand (Kanchanaburi): Brucellosis, humans and goats
- Russia (Dagestan): 7 cases of Brucellosis
- Russia (Tatarstan): 23 cases of Hemorrhagic fever with renal syndrome
- Russia (Chechnya): Leptospirosis outbreak
- Russia: Tularemia cases in Nizhny Novgorod, Voronezh, Moscow, and Vladimir regions
- Russia (Ekaterinburg): Tularemia outbreak reported in village of Volini
- USA (Gulf States): First deaths from tainted water due to Vibrio vulnificus
- USA (Maryland): Shore fisherman dies from Vibrio vulnificus
- USA: Prospects for seasonal flu vaccine supply improving
- USA: Probe fails to pinpoint cause of BSE case
- USA: USDA allows use of certain cattle-derived material in human foods and cosmetics
- USA: USDA’s key component of animal ID system
- USA (New York; Kentucky and Ohio): Cryptosporidiosis outbreaks
- USA (New Hampshire): New EEE cases suspected in Concord, Manchester
- USA (Massachusetts): 2 deaths linked to EEE virus infection
- USA (Alaska): Botulism, fermented salmon
- USA (Washington): 7 cases of Tularemia
- Canada (Ontario): Baylisascaris, fatal; first known human case in Canada
- USA: Recall of Medline brand of alcohol-free mouthwash and hygiene kits containing mouthwash

1. Updates
- Influenza
- Dengue
- West Nile Virus

2. Articles
- CDC EID Journal, Volume 11, Number 9-Sep 2005
- Influenza vaccine supply and recommendations for prioritization during 2005-06 influenza season
- Avian Influenza (H5N1) Viruses Isolated from Humans in Asia in 2004 Exhibit Increased Virulence in Mammals
- Detection of prions in blood

3. Notifications
- WHO: Responding to the avian influenza pandemic threat. Recommended strategic actions
- Hurricane Katrina response and guidance for health-care providers, relief workers, and shelter operators
- Syndromic Surveillance: Reports from a National Conference, 2004

4. APEC EINet activities
- APEC Meeting in Korea; EINet course

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Global: Acambis hopes to build a flu vaccine that lasts
The British biotechnology firm Acambis announced its launching of a quest for a vaccine that would protect people from the flu virus for years and perhaps even stave off future pandemic strains. With current technology, flu vaccines have to be retooled every year to cope with mutations that enable the flu virus to avoid quick detection by the immune system. But a vaccine based on parts of the virus that stay the same could eliminate the need to bring out a new model every year. Acambis announced that it was collaborating with Belgium's Flanders Interuniversity Institute for Biotechnology. "The aim of the research collaboration would be to generate a 'universal' vaccine candidate that would protect against both A and B strains of influenza and, more importantly, would not require annual changes to the formulation," the company said. The company hopes that such a vaccine could also protect people from a pandemic flu virus. However, availability of such a vaccine is, at best, years away.

The frequent minor changes in flu viruses involve the proteins hemagglutinin and neuraminidase. Current vaccines target these highly mutable proteins, making it necessary to adjust the vaccines each year. "A major component of the new [vaccine] candidates," the company said, "will be M2e, the extracellular domain of the ion channel protein M2, which is specific to influenza A. Being highly conserved, M2e is intended to elicit protective immune responses against all strains of influenza A. . . . " Ashley Birkett, Acambis's director of viral immunology, said the company is working on a separate technology for type B influenza. If the type A and B vaccines both prove effective, combining the two into 1 shot "would give us a truly universal vaccine," he said. The A type vaccine would potentially protect people against pandemic flu, since previous known pandemic strains were type A. Since the vaccine wouldn't have to be changed each year, manufacturing could be continuous. With year-round manufacturing, people could be immunized any time of year, and vaccine could be stockpiled, Birkett said.

Acambis's experimental vaccine is manufactured with a "recombinant bacterial fermentation technology," in which bacteria are used to make selected viral proteins, rather than whole virus. With this technique, the production time for a batch of vaccine is "a matter of weeks," as compared with 6 months for egg-based vaccine. Acambis said its initial vaccine candidate is "in pre-clinical development" and has been tested successfully in animals. Two recent articles describe successful tests of various versions of the vaccine in mice. The reports, published in Virus Research and Virology, say that M2e generates only a weak immune response during flu infection and when used in a conventional vaccine. But when it is linked to an appropriate carrier, such as hepatitis B virus core (HBc) particles, it induces a strong antibody response. When various versions of the M2e-HBc combination were used with an adjuvant, they fully protected mice from a potentially lethal flu infection.

Theoretically, a perennial flu vaccine is a great concept, said Gregory Poland, MD, a vaccine expert at the Mayo Clinic. But Poland was cautious: ". . . I do think it's theoretically possible. From an immunologic point of view, the key will be choosing the right antigen [viral protein] and knowing that the antigen is displayed early in the infection, so that an immune response can be generated early enough to abort the infection. My concern is if you find antigens that are displayed late in the infection, you may generate an immune response too late to do much good." Birkett acknowledged that the experimental vaccine targets the virus later in its life cycle than conventional vaccines do. "But if you want a universal vaccine, you have to target a component that develops later in the life cycle," he said. The National Institute of Allergy and Infectious Diseases is supporting efforts by several other researchers on the same problem. (CIDRAP 8/25/05)

^top

Global: Wild birds expected to spread bird flu virus further
The deadly strain of avian influenza that has hit several countries in Asia is likely to be carried over long distances along the flyways of wild birds to the Middle East, Europe, South Asia and Africa, FAO warned. Birds flying from Siberia, where the H5N1 virus has been detected, may carry the virus to the Caspian and Black Sea. The Balkans could become a potential gateway to central Europe for the virus. "FAO is concerned that poor countries in southeast Europe, where wild birds from Asia mingle with others from northern Europe, may lack the capacity to detect and deal with outbreaks of bird flu," said Joseph Domenech, FAO's Chief Veterinary Officer. Bird migration routes also run across Azerbaijan, Iran, Iraq, Georgia, Ukraine and some Mediterranean countries, FAO said. India and Bangladesh are also considered to be at risk. Bangladesh, and to a lesser extent India, harbor large numbers of domestic ducks and are situated along one of the major migratory routes.

FAO urged countries at risk, especially along the routes of migrating birds, to step up surveillance of domestic poultry and wild birds. Countries should prepare national emergency plans. Close contacts between humans, domestic poultry and wildlife should be reduced and monitored. On farms and in markets, domestic birds should be strictly separated from wild animals. Vaccinating poultry could also be considered in at-risk situations. FAO called upon affected countries and the international community to battle the bird flu virus at its origin, in poultry. "As long as the H5N1 virus circulates in poultry, humans continue to be at risk. This is why we have set up several regional networks in Asia to improve the cooperation between countries," Domenech said. FAO and the OIE have also developed a strategy for the control of avian influenza that will cost over $100 million to support surveillance, diagnosis and other control measures, including vaccination. So far, donors have pledged around $25 million.

***A world map of H5N1 outbreaks in 2005 and major flyways of migratory birds is available at: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. A video with statement by FAO Animal Production and Health Director, S. Jutzi is also available at this site. FAO’s latest documents regarding avian influenza can be accessed at: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. (FAO 8/31/05 http://www.fao.org/newsroom/en/news/2005/107405/index.html)

^top

Finland: Seagull had low pathogenic avian influenza, H13
Tests have shown that a Finnish seagull suspected of having a deadly strain of bird flu had a "mild," type of the virus. "The Finnish chief veterinary officer said this is not the H5N1 virus," European Commission spokesman Philip Tod said. "This is a mild, low-pathogenic strain of avian influenza [LPAI] that is commonly found in wild birds." The Finnish case poses a minimal risk to poultry and humans, he said. Finland's Ministry of Agriculture and Forestry said that tests on the seagull were carried out in the northern Finnish town of Oulu, 26 Aug 2005. Finland has never had a case of H5N1. On 2 Sep 2005, the EU avian influenza reference laboratory in UK reported the virus isolated in Oulu to be H13 and low pathogenic. Further characterization of the virus isolated is pending. LPAI is not uncommon and can be found in as many as 30 percent of wild birds, experts say. Veterinary experts from the EU said bird flu in Central Asia was "not a direct threat for Europe and there is no need for general emergency actions". The Finnish ministry said it had been improving disease protection for poultry facilities "systematically over several years". The import of live birds and poultry products from areas stricken by bird flu is banned. (Promed 8/26/05, 8/27/05, 8/30/05, 9/2/05)

^top


Asia
South East Asia: Cumulative number of human cases of avian influenza A/(H5N1)
(No update since 12 Aug 2005 EINet Newsbrief).
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)

^top

Thailand: Outbreak of avian influenza, H5N1
Local authorities have acted promptly to contain a new bird flu outbreak in Kamphaeng Phet,. The provincial governor and local officials visited Ban Sabmanao in Klongthalung district to cull chickens and spray disinfectant after chickens in the village were found to be infected with H5N1. Provincial animal husbandry officials said that the province has enforced preventive measures to ban moving poultry in the 4 affected districts. The cause of the outbreak may be the movement of fighting cocks from other areas where they had contracted the disease. There is no report of the disease in chickens raised in closed farming systems or free-range ducks. The poultry have been under close surveillance and free-range ducks are registered with the authorities. The findings resulted from a nationwide active surveillance campaign conducted since 1 Jul 2005. As a result of this 2-month campaign, 29 new outbreaks have been confirmed in 4 provinces. All cases involved either free-range poultry or poultry raised in farms with traditional husbandry practices with poor sanitation and insufficient biosecurity. Thailand seems to have successfully eradicated the disease in commercial flocks, without vaccination, in an effort to restore exports (applying the zoning/compartmentalisation principles, this might be achieved). The struggle to control the continued infection in small holdings has to be continued. For more information on the surveillance campaign and the follow-up report of the recent outbreaks: http://www.oie.int/eng/info/hebdo/aIS_55.htm#Sec3. (Promed 9/3/05)

^top

Viet Nam: Probable human case of avian influenza
A patient in Hanoi who died late Aug 2005 has been confirmed to have been infected with avian influenza virus strain H5, the newspaper Young People reported 1 Sep 2005. Further tests are needed to ascertain if the virus was H5N1. The 58-year-old patient from the rural district of Soc Son died 28 Aug 2005. Viet Nam has culled over 1300 fowl in 8 localities of Dong Thap, Ben Tre, Can Tho, Tra Vinh, Yen Bai, Ha Giang, Bac Ninh and Hanoi since April 2005. The country is conducting bird flu vaccination for domestic fowl in 47 out of 64 cities and provinces. The total fund for vaccinating over 200 million fowl in the 2005-2006 period is estimated at 700 billion Vietnamese dong (44.3 million USD). Agriculture and Health Ministry officials have been finalizing details of an emergency plan to tackle a flu pandemic. Viet Nam, which has had more human deaths from the H5N1 virus than anywhere else, has been preparing plans for various scenarios, Tien Phong newspaper reported. "Vietnam is vaccinating poultry, [as] there is a great infection risk involving the H5N1 virus jumping from poultry to humans," the newspaper quoted the Health Ministry as saying. There have been no reports so far of people contracting the virus from vaccinated poultry. Animal health officials are meeting to review the vaccination campaign in Nam Dinh and Tien Giang. This month, the government will expand the vaccination campaign to target 60 million fowl at small-scale farms nationwide. The government aims to complete vaccinations by 15 Nov 2005. (Promed, CIDRAP 9/1/05)

^top

Viet Nam: 3 Civets infected with H5N1
Bird flu has killed 3 civets born in captivity, marking the first time the virus has been reported in the species, officials said 26 Aug 2005. The rare Owston civets died late June 2005 at the Cuc Phuong National Park. Samples sent to Hong Kong lab came back positive for the H5N1 virus, said Scott Roberton, technical adviser for the civet conservation program at the park. He said other animals at the park have been tested--chickens, rats and other birds--but none have tested positive for the virus. He said, "No animals are ill, no people are ill. We're still trying to figure out where the source was. The civets were not fed any type of poultry, and 20 other civets of the same species in adjacent cages did not become sick", he said. "The WHO and Viet Nam health officials are expected to test staff and animal keepers to determine [whether] anyone caring for the civets has been infected with bird flu," he said. Civets are captured in the wild and served as a delicacy in Viet Nam and China. Scientists suspect that SARS, which killed nearly 800 people in 2003, was passed to humans from civets and other animals sold in food markets in China. Peter Horby, an epidemiologist for the WHO, said the development would not make people more susceptible to bird flu, because humans have less contact with civets than with poultry. Bird flu had previously been found in other mammals, such as cats and tigers. Studies of H5N1 infection of pigs using viruses isolated in Viet Nam and Thailand have recently been published (Young Ki Choi, Tien Dzung Nguyen et al. Journal of Virology, August 2005, p. 10821-10825 Vol. 79, No. 16). (Promed 8/26/05)

^top

Russia (Siberia, Urals): Avian influenza update
Bird flu has been confirmed in 46 Russian settlements and suspected in another 80, the Rosselkhoznadzor Federal Service for Veterinary and Phytosanitary Inspection reported as of 29 Aug 2005. Veterinary services lifted quarantine from 3 settlements. The Novosibirsk region reported 2 new settlements where bird flu infection is suspected and a new suspected settlement in the Omsk region. In the Tyumen region, quarantine was lifted from 2 settlements in 2 districts. Bird flu has hit another district in the Tyumen region. 57 infected birds were slaughtered in the village of Sladkovo, and measures were being taken to stop the spread of the disease. The first cases of death were reported in the region 26 Jul 2005. Quarantine was imposed 1 Aug 2005 when lab tests conducted in Novosibirsk confirmed bird flu. About 30 500 infected birds have been slaughtered in the region so far. Bird flu was earlier reported in 7 settlements in the region's 3 districts. Regional authorities have allocated 6.2 million rubles (about USD 218 000) to curb the spread of the virus. The previous 3 AI-affected districts in Tyumen are Berdyuzh, Armizonskoye, and Kazanskoye. A map can be accessed at http://www.oie.int/cartes/RUS050826.jpg. EU-sponsored map "Outbreaks of avian influenza (A/H5N1) in animals and man reported from Asia since December 2003": http://www.europa.eu.int/comm/health/ph_threats/com/Influenza/ai_recent_en.htm. Cases of avian influenza in humans who have been in contact with dead birds have not been recorded. (Promed 8/26/05, 8/30/05)

^top

Japan (Ibaraki, Saitama): 1.5 million chickens being culled due to bird-flu outbreak
The Ministry of Agriculture, Forestry and Fisheries has announced plans to cull 1.5 million chickens following an outbreak of avian flu at poultry farms in Ibaraki and Saitama prefectures. Officials said it was a relatively weak strain of bird flu and that 504 000 chickens had already been destroyed. An additional 1.024 million birds are to be killed. The area of infection has 30 farms with 4.14 million hens. The ministry said there is a strong possibility that the infection was caused by the use of an unauthorized and defective vaccine that contained an active virus. Officials are scrambling to pinpoint the source of the outbreak, because even a weak strain of avian flu virus can quickly become highly virulent. The attenuated strain of avian flu was first detected 26 Jun 2005 at a chicken farm in Mitsukaido, Ibaraki Prefecture. Chickens at a total of 30 farms in the prefecture and Saitama Prefecture have since been confirmed to be infected. All of the chickens at the infected farms were being raised for egg-laying. In Ibaraki, chickens at farms hit by avian flu account for a third of all hens in the prefecture. The ministry speculated that some farm operators had used an unauthorized vaccine to quell infection. Ministry officials suspect that some viruses may have survived a viral inactivation treatment for vaccine production. As a result, any virus that survived the treatment could have been active and transmitted from bird to bird, the officials said. The DNA sequence of the flu virus was almost identical to those that were confirmed in Mexico, Guatemala and El Salvador between 1995 and 2002. Even so, ministry officials said it was highly unlikely that avian flu was carried by migratory birds. Aside from the huge distance between Central America and Japan, no trace of birds infected with the virus had been imported to Japan.

The Japan Poultry Association, meanwhile, disavowed any knowledge of the use of illegal vaccines. To prevent a massive outbreak of bird flu in Japan, the farm ministry maintains a stockpile of vaccine for about 7 million chickens. According to Japan's recent update to the OIE, sent 23 Aug 2005, 3 newly detected foci in Saitama and Ibaraki have been caused by low pathogenic avian influenza virus subtype H5N2. The affected populations showed little or no clinical signs of the disease. (Promed 9/3/05, 9/6/05)

^top

Mongolia: Avian Influenza, migratory birds, H5N1
Mongolian officials said tests have detected an H5N1 avian influenza virus in several wild birds, confirming earlier indications that the virus had reached the country. Mongolian officials told the OIE 19 Aug 2005 that an H5 virus had been found in 3 wild birds. Also, preliminary testing by the US Department of Agriculture detected an H5N1 virus in 1 of about 100 birds found dead at Erhel Lake. Last spring the virus killed several thousand birds in the Qinghai Lake in north-central China, which borders Mongolia. Mongolia's follow-up report of 27 Aug 2005 to OIE relates to samples from Lake Erhel, which were sent by the Mongolian authorities to the OIE Reference laboratory in Hokkaido, Japan. Results on 4 of them, 1 Bar-headed goose (Anser indicus) and 3 whooper swans (Cygnus cygnus), were received 24 Aug 2005, and identified as H5N1; the laboratory is expected to further study the isolate, particularly comparing it with previous isolates from the region. This finding is in line with a report obtained 19 Aug 2005 from the Wildlife Conservation Society, notifying the identification of H5N1 in 1 dead whooper swan collected at the same site and tested in USDA's Poultry Research Laboratory. The WCS posting also provided other important results: 30 live whooper swans living at the same site and also a nearby lake were negative for the virus. Samples collected from other live birds at the 2 sites, including 60 ruddy shelducks, 24 bar-headed geese, and 25 black-headed gulls, were found to be negative for the virus. It has been argued that these (and observations in Qinghai Lake) may indicate that the waterfowl species identified in recent outbreaks appear to be victims rather than effective carriers of the disease.

This event reflects an exemplary proactive, transparent attitude of the Mongolian authorities and a commendable cooperative effort of international experts. The challenge now is to gather information and understand the epidemiology in the newly established geographic location. Foremost among these unanswered questions is the prevalence of infection in the migratory bird population. Comprehensive surveillance is key--surveillance should not be limited to wildlife populations. (Promed 8/31/05, 9/2/05)

^top

Thailand (Kanchanaburi): Brucellosis, humans and goats
Infections in 19 farm workers have prompted the large mass-culling of goats. 2000 goats will be culled at the country's biggest goat farm, in Kanchanaburi province, to prevent the spread of brucellosis. Samart Jaralyanon, provincial chief for livestock development, said the culling at Mahboonkrong Dairy Goats Co will be the first time animals are culled in such large numbers. The transport of all of the farm's products, such as live goats, dairy products and meat, were banned. Samart said goat dairy products already available on the market were safe, because of pasteurization. More than 700 goats had been killed at the farm since the bacterial disease was discovered Mar 2005. The farm was declared an epidemic control zone 1 Sep 2005. Humans can be infected through direct contact with secretions of infected goats. Samart said only goats raised for meat would be culled, because there were no reports of infection among the farm's 2500 dairy goats. 12 men and 7 women who worked at the farm have so far been infected with the disease. Dr Thawat Suntrajarn, director-general of the Disease Control Department, said it was not necessary for infected humans to be quarantined, because there were no reports of human-to-human transmission. A special team was sent to the farm to find out how the workers became infected. Brucellosis is a zoonotic infection that can be spread by direct contact with the animal carrier and by ingestion of unpasteurized dairy products. The infection is also known as undulant fever, related to the occurrence of 1-3 week febrile periods separated by 1-3 days of afebrility. This occurs more likely with B. melitensis (acquired from goats) as compared to B. abortus (cattle) and B. suis (swine). (Promed 9/7/05)

^top

Russia (Dagestan): 7 cases of Brucellosis
In the Akushinskiy district of Dagestan, 7 workers from the agricultural co-operative Akushinskiy were infected with brucellosis. They were thought to have been infected from cattle. Now actions for the localization of outbreak are being carried out in the area, and export of meat and dairy products to other areas of republic is suspended. Brucella is often transmitted to humans through unpasteurized dairy products; cattle, swine, and goats are the major reservoirs. (Promed 8/26/05)

^top

Russia (Tatarstan): 23 cases of Hemorrhagic fever with renal syndrome
Since 19 Aug 2005, 23 cases of hemorrhagic fever with renal syndrome (HFRS) have been registered in the Republic of Tatarstan. A precise diagnosis has not yet been confirmed in all cases. 1 case occurred in the District of Naberezhnye Chelny, 1 in Zelenodolsk, 2 in Rybnoslobodsky, 2 in Kukmorsky, 3 each in Sabinsky and Alkeeevsky, 4 in Nizhnekamsk, and 7 in Bavlinsky. 1 of those infected in the Bavlinsky District has died. HFRS is endemic in the region. It is caused by one or more species of hantavirus. (Promed 8/29/05)

^top

Russia (Chechnya): Leptospirosis outbreak
65 children have been hospitalized with a diagnosis of leptospirosis, according to Chief Physician of the Central District Hospital Idris Baysultanov. The outbreak occurred in the village of Ilishan Yurt in the district of Gudermes. The source of infection is thought to be the Michik River, where the children were swimming. According to Baysultanov, the water is the source of infection, since the decomposing carcass of an animal was discovered upstream (the presence of a decomposing animal may have nothing to do with this cluster). The children are experiencing muscle pain and fever. The river water is used by local people for cooking. Measures have been instituted by officials to identify infected people, and swimming is forbidden. There is the danger that disease could spread, because the Michik flows into the Gums River. Serious, potentially life-threatening complications of leptospirosis include renal failure, liver disease, and pneumonia. Although leptospirosis is usually acquired by exposure to water contaminated with infected rodent urine, the reservoir may also be larger animals, including livestock. (Promed 8/30/05)

^top

Russia: Tularemia cases in Nizhny Novgorod, Voronezh, Moscow, and Vladimir regions
334 people with symptoms of tularemia, including 54 cases of children, have been reported in the Nizhny Novgorod, Voronezh, Moscow, and Vladimir regions. The diagnosis has been lab-confirmed in 128 persons. 135 people with such symptoms, including 26 children, have been registered in the Moscow region. All the affected have been hospitalized. In 33 persons, the diagnosis has been lab-confirmed. 99 people with symptoms of tularemia have been registered in the Nizhny Novgorod region, 17 of whom are children. 66 are inhabitants of Dzerzhinsk, and 33 are from Nizhny Novgorod. The diagnosis has been lab-confirmed in 43 people, including 18 children. 82 cases have been reported in Gorohovetskiy district of the Vladimir region; 12 of these people were believed to have been infected in the Nizhny Novgorod region; 3 in the Ryazan and 2 in the Ivanovo region. 67 people with symptoms of tularemia have been registered Jul-Aug 2005 in the Ryazan area, including 5 children. 50 have been hospitalized. In 25 people from the Klepikovsky district, the diagnosis has been lab-confirmed. 28 people with symptoms of tularemia have been detected in the Voronezh region, including 6 children. In 22 patients the diagnosis has been lab-confirmed. Infection in urban dwellers occurred during visits to rural areas. All affected people have recalled bites by horseflies or other blood-sucking insects, or bathing in open reservoirs. (Promed 8/31/05)

^top

Russia (Ekaterinburg): Tularemia outbreak reported in village of Volini
As of 30 Aug 2005, 15 people have been confirmed with tularemia in the village of Volini. They are from the Staroutkinskiy rayon and from Ekaterinburg. According to the deputy chief of the sanitary department of the Ekaterinburg region, Andrey Yurovskih, 4 people were admitted to the infectious department of the regional hospital in late August 2005. 3 of these people were hospitalized; 1 of them chose to get treatment at home. Physicians and epidemiologists from Pervouralsk city checked local people and visitors (20 in all) for the disease. 11 of them were confirmed with tularemia, none was hospitalized. (Promed 9/5/05)

^top


Americas
USA (Gulf States): First deaths from tainted water due to Vibrio vulnificus
To date, 7 people in the area affected by Hurricane Katrina have been reported to be ill from Vibrio vulnificus infection. 4 have died. V. vulnificus can cause an infection of the skin when open wounds are exposed to warm seawater. People at greatest risk for illness from V. vulnificus are those with weakened immune systems and the elderly. CDC and other response agencies are working with health departments in affected states to help identify persons who might be at increased risk for V. vulnificus and recommend appropriate treatment for them. V. vulnificus is a bacterium that is a rare cause of illness in the US. The illness is different from cholera, which is caused by Vibrio cholerae. V. vulnificus infections do not spread directly from person to person, and are a serious health threat predominantly to persons with underlying illness. The organism is a natural inhabitant of warm coastal waters. Infection can occur after a wound is exposed to warm coastal waters where V. vulnificus is growing. Infection may also be acquired by eating raw or undercooked seafood from those waters. CDC receives reports of over 400 Vibrio illnesses each year. Of those, about 90 are due to V. vulnificus. Symptoms of infection with V. vulnificus include acute illness, with a rapid decline in health. If exposed by contamination of an open wound, increasing swelling, redness, and pain at the site of the wound can occur. Illness typically begins within 1-3 days of exposure, but begins as late as 7 days after exposure for some cases. Other symptoms include: fever; swelling and redness of skin on arms or legs, with blood-tinged blisters; low blood pressure and shock. Overall, V. vulnificus infections are fatal about 40 per cent of the time. Wound infections with V. vulnificus are fatal about 20 per cent of the time, and aggressive surgical treatment can prevent death.

After a coastal flood disaster, large numbers of persons with illnesses that affect their resistance to infection may be exposed to seawater. Wounds exposed to seawater should be washed with soap and water as soon as possible, infected wounds should be evaluated and monitored by clinicians. V. vulnificus infection is treated with antibiotics. V. vulnificus can be present in non-contaminated waters as a normal inhabitant of salt water; acquisition, therefore, does not mean contact with coliform-containing water.

CDC Director Dr. Julie Gerberding also said that CDC would be encouraging flu shots for hurricane evacuees as part of efforts to protect them from diseases. "Already, Sanofi [Sanofi Aventis] is making 200,000 of the first doses available to these evacuees so we can protect them while they're in the shelters." Sanofi is the leading supplier of flu vaccine in the US. (Promed 9/8/05)

^top

USA (Maryland): Shore fisherman dies from Vibrio vulnificus
An Eastern Shore Maryland fisherman died from a rare bacterial blood infection caused when an open wound on his body came in contact with saltwater. Dr Ann H Webb, deputy health officer for Talbot County, said that the fisherman was healthy until a skin abrasion became infected while he was fishing in July 2005 on the Chesapeake Bay. "It's very rare, and it shouldn't cause any panic," Webb said. "But we'd like to make people aware that when the Bay temperature rises, they should not eat raw seafood. And, if they go swimming, they should not have any open lesions, and they should rinse themselves off well after they leave the water." The last confirmed death from vibrio in Maryland occurred more than a quarter-century ago. Although fatal, vibrio infections are rare in the Chesapeake region. Vibrio is commonly found in the Gulf of Mexico and other warm bodies of saltwater, reproducing more as temperatures rise. (Promed 9/5/05)

^top

USA: Prospects for seasonal flu vaccine supply improving
Prospects for an adequate supply of seasonal influenza vaccine this year brightened with federal approval of a new flu vaccine and a report of progress in fixing problems at Chiron's flu vaccine plant. The Food and Drug Administration announced approval of GlaxoSmithKline's Fluarix vaccine for use in adults. In addition, the FDA said Chiron has made "significant progress" in addressing problems at its flu vaccine plant, where contamination last year forced the company to scrub the sale of about 48 million doses of vaccine. Referring to both developments, Curtis Allen, who works in the CDC's National Immunization Program, said the CDC currently estimates the US flu vaccine supply for this season will range from about 79 million to 87 million doses. That includes 50 million doses from Sanofi Pasteur, 3 million doses from MedImmune, 8 million from GSK, and 18 - 26 million from Chiron.

The FDA said Fluarix, which contains inactivated flu virus, is the first vaccine to gain approval under the agency's accelerated approval process. The process allows the FDA to license products on the basis of results that are "reasonably likely to predict ultimate clinical benefit". GSK showed that Fluarix generated levels of protective antibodies that are likely to be effective in preventing flu, the FDA said. The agency said it evaluated data from 4 clinical studies involving about 1,200 adults, as well as data from post-marketing reports from other countries where the vaccine is used. Officials said they would also require the company to conduct further clinical studies. Fluarix has been in use since 1992 and is currently distributed in 92 countries. The report on progress at Chiron's British plant came after an FDA inspection in July and subsequent communications between Chiron and the FDA. Dr. Jesse Goodman of the FDA said, "The letter that we issued to them this week is a positive development and shows significant progress on their part. However, additional work is needed to determine the amount of vaccine Chiron may be able to supply the U.S. market for the upcoming flu season. FDA will evaluate the implementation and effectiveness of their corrective actions going forward. In addition, any vaccine produced must pass all tests for safety and potency before it can be marketed in the U.S." (CIDRAP, FDA 8/31/05 http://www.fda.gov/bbs/topics/news/2005/NEW01227.html)

^top

USA: Probe fails to pinpoint cause of BSE case
The federal government ended its investigation of the nation's second case of BSE without finding any more cases or learning exactly how the cow was infected. The case, confirmed in Jun 2005, was in a 12-year-old cow that was born and raised in Texas. Officials believe the cow contracted BSE by eating contaminated feed before 1997, when the government banned the use of cattle protein in cattle feed. The US Department of Agriculture said it had removed and tested 67 cattle from the farm the cow came from. Of another 200 animals that had left the farm, most had previously been slaughtered or were presumed dead, though 20 could not be traced. The agency also traced 213 calves in a hunt for 2 that had been born to the infected cow within 2 years before its death. Of these, 208 had "entered feeding and slaughter channels," while 4 were presumed to have gone the same route and 1 was untraceable. The Food and Drug Administration investigated the infected cow's feed history and whether the cow's herd mates were processed at rendering plants that complied with the 1997 ruminant-to-ruminant feed ban. The agency said it found no evidence of feed products used on the farm since 1997 that contained prohibited protein, though it did find 1 feed that contained an unidentifiable animal protein source. Investigators also concluded that all slaughter and rendering plants that processed the cow's herd mates were in compliance with the feed ban. Although investigators could not find a specific feed source likely to have caused the infection, "it is probable that the most likely route of exposure for this animal was consumption of an animal feed containing mammalian protein" before the feed ban took effect, the FDA said. To date, there have been more than 450,000 animals tested in the last 14 months, with 2 BSE positive animals found in US. The Texas cow was the first native-born animal known to have BSE in the US. The nation's first case was identified Dec 2003 in a Canadian-born cow brought into Washington state. For more information: http://www.aphis.usda.gov/lpa/issues/bse/bse.html; http://www.fda.gov/cvm/texasfeedrpt.htm. (USDA 8/30/05; CIDRAP 8/31/05)

^top

USA: USDA allows use of certain cattle-derived material in human foods and cosmetics
The U.S. Food and Drug Administration published several amendments to the July 2004 interim final rule, "Use of Materials Derived from Cattle in Human Food and Cosmetics," that will allow the use of certain cattle-derived material in human foods and cosmetics. The rule prohibits the use of cattle-derived materials that can carry the infectious agent for BSE in human foods, dietary supplements, and in cosmetics. Based on the scientific information provided during the interim final rule's comment period, which demonstrates that a part of the cow's distal ileum can be consistently and effectively removed from the other sections of the small intestine, it is no longer necessary to designate the entire small intestine as a prohibited cattle material. As a result, FDA is amending the rule to allow use of the small intestine in human food and cosmetics, provided that the distal ileum has been removed. The U.S. Department of Agriculture is publishing a similar amendment to its interim final rule on BSE. The amendments also clarify that milk and milk products, hides and hide-derived products, and tallow derivatives are not prohibited for use in human food and cosmetics. FDA has reconsidered the recommended method for determining insoluble impurities in tallow, in response to information submitted to the agency, to cite a method that is less costly to use and requires less specialized equipment. FDA issued the interim final rule to minimize human exposure to materials that studies have demonstrated are highly likely to contain the BSE agent in cattle with the disease. (FDA 9/6/05 http://www.fda.gov/bbs/topics/news/2005/NEW01229.html)

^top

USA: USDA’s key component of animal ID system
Agriculture Secretary Mike Johanns announced the Department of Agriculture's guiding principles for development of a public/private partnership that enables the private sector to maintain animal movement data as part of the National Animal Identification System (NAIS). "We are gratified by the growing support for an animal identification system, with over 100,000 premises now registered," Secretary Johanns said. "We are eager to work closely with industry as they develop and maintain databases that contain animal movement information. After hearing the confidentiality concerns of producers, we envision a system that allows these databases to feed a single, privately held animal-tracking repository that we can access." USDA's 4 guiding principles for the NAIS are as follows:

- The system must be able to allow tracking of animals from point of origin to processing within 48 hours without unnecessary burden to producers and other stakeholders.
- The system's architecture must be developed without unduly increasing the size and role of government.
- The system must be flexible enough to utilize existing technologies and incorporate new identification technologies as they are developed.
- Animal movement data should be maintained in a private system that can be readily accessed when necessary by state and federal animal health authorities.
Once fully implemented, NAIS will enhance U.S. efforts to respond to animal disease outbreaks more quickly and effectively, he said. For more information visit: www.usda.gov/nais. (USDA 8/30/05)

^top

USA (New York; Kentucky and Ohio): Cryptosporidiosis outbreaks
Health officials say the parasitic illness that originated at the Seneca Lake State Park spray-ground has spread to more than 3000 people and could be one of the worst outbreaks of a waterborne sicknesses in the US in a decade. The last time a similar outbreak affected more people, nearly 5500, was in 1995 in Georgia. The State Health Department said the number of reported illnesses possibly linked to the park is now 3131, with 394 cases confirmed as the intestinal illness cryptosporidiosis. Those affected have come from 32 counties across the state, and from several states, Mexico and Canada. Symptoms of the illness include diarrhea, abdominal cramping, nausea, vomiting, fever, headache and loss of appetite. Although the spray park closed 15 Aug 2005, the number of reported cases continues to rise, with increased reporting and the spread of the disease through secondary means, such as contact with an individual carrying the highly infectious disease. Preventative measures include washing hands after using the bathroom and before meals and disinfecting surfaces regularly. Health officials are still investigating how cryptosporidium ended up in 2 storage tanks that supply water to the park.

Also, health departments in Southwest Ohio and Northern Kentucky are investigating an outbreak of about 200 confirmed and probable cases of cryptosporidiosis. Health departments have been working to monitor cases and prevent further spread of the disease. People experiencing diarrhea who visit public pools should not swim. Health departments have asked swimming pool operators to super-chlorinate their pool. The outbreak isn't confined to a particular swimming pool or county. The parasite is endemic in the US; outbreaks of cryptosporidia in the US occur every year in the summer and early autumn. (Promed 8/27/05, 9/3/05)

^top

USA (New Hampshire): New EEE cases suspected in Concord, Manchester
2 new suspected cases of Eastern equine encephalitis were announced by the state Department of Health and Human Services, bringing to 4 the number of human cases of the mosquito-borne virus in New Hampshire. 2 men were hospitalized and are preliminary positive, said John A. Stephen, DHHS commissioner. Stephen announced the 2 additional cases a day after lab tests confirmed that a woman and a 4-year-old boy were infected with EEE. The 2 confirmed cases are the first human cases contracted in New Hampshire. According to the CDC, there have been a total of 200 confirmed cases in the U.S. since 1964, with an average of 4 confirmed cases each year. 6 cases of EEE were reported nationwide in 2004--4 of them occurred in Massachusetts, with 3 of them fatal. DHHS has adopted a consistent mantra for the public at large: prevention. The public should err on the side of caution when seeking treatment for flu-like illness. Using insect repellent containing DEET, wearing protective clothing and eliminating standing water where mosquitoes can breed are the best way to avoid infection, Stephen said. Now, with possible outbreaks in urban settings, the health department is recommending Manchester and Concord to pursue spraying. The department is currently testing mosquitoes for both EEE and West Nile virus and is also working with medical providers and local health officials so they can identify symptoms early. Health officials said mosquitoes will likely remain active through September. HHS has listed prevention methods for stopping mosquito-borne illnesses at http://www.dhhs.nh.go and 1-866-273-6453.

EEE is a rare but serious viral disease. EEE virus can infect several mosquito species. It tends to occur in cycles, with transmission most often detected in swampy, lower-populated areas along the Eastern Seaboard. States with the most confirmed cases historically in: Massachusetts, New Jersey, Florida and Georgia. Birds are the source of infection for mosquitoes, which can sometimes transmit the infection to horses, other animals, and, in rare cases, to humans. Health departments have sometimes used chickens to monitor for this disease. If birds are being found with this disease, horse owners are advised to vaccinate. In addition to vaccination, horse owners should use a recommended equine spray to help control flies and mosquitoes. EEE within the horse population doesn’t increase the risk for human contraction of the disease. Most people have no symptoms; others get only a mild flu-like illness with fever, headache, and sore throat. For people with infection of the central nervous system, a sudden high fever, severe headache, and stiff neck can be followed quickly by seizures and coma. 1/3 of these patients die from the disease. (Promed 8/28/05)

^top

USA (Massachusetts): 2 deaths linked to EEE virus infection
A 5 year old girl from Halifax and an 83 year old man from Kingston have died after being diagnosed with eastern equine encephalitis, bringing the number of human EEE cases in Massachusetts this year to 3. The girl became ill 26 Aug 2005 and died 4 Sep 2005. Lab tests later identified the disease, although final results are pending. The man became ill 21 Aug 2005 and died 5 days later. Tests confirmed the disease. It is not clear how or when the 2 victims contracted EEE virus. During late Aug 2005, the health department announced that a 63 year old woman had contracted the state's first human case of EEE virus infection this summer. The woman was the first case diagnosed and reported. She remains in hospital, in serious condition. As of the final week of Aug 2005, Massachusetts had tested around 120 000 mosquitoes for EEE virus, and only 15 of those insects tested positive for the virus. The Massachusetts Department of Public Health has also confirmed reports of EEE in 2 horses. In 2005, both EEE virus and West Nile virus have been detected in mosquitoes and birds in a number of communities across the state.

In northern regions, human cases of EEE occur in late summer up to the time of the first frosts, whereas cases of infection may occur throughout the year further south. The mosquito Culiseta melanura feeds almost exclusively on birds and is an amplifying host for the virus in spring and summer. A secondary epidemic cycle then occurs involving other species of birds and Aedes spp. mosquitoes. These mosquitoes transmit the virus to horses and humans, both of which are dead-end hosts. There is no vaccine approved for administration to humans. (Promed 9/8/05)

^top

USA (Alaska): Botulism, fermented salmon
The state Division of Public Health has reported 2 recent botulism outbreaks in Interior Alaska villages. Health officials sent nurse practitioners to 2 separate Yukon-Kuskokwim Delta villages 22 Aug 2005. They went to help with 4 people who became ill after eating fermented salmon. Dr. Richard Mandsager, the director of public health, says botulism is not contagious and poses little risk to the public. Since 1995, the state has averaged 8 cases of botulism a year. A description of Arctic marine animal-associated botulism can be found at: http://www.epi.hss.state.ak.us/pubs/botulism/bot_03.htm. The overall case fatality rate in Arctic outbreaks is about 20 percent. Because not all northern Native groups consume traditionally prepared foods, it is difficult to determine true incidence rates of disease. However, using total population as the denominator, Canadian Inuit and Alaska residents had annual incidence rates of 30 cases/100 000 and 8.5 cases/100 000, respectively. These rates compare to 0.43 cases/100 000 in Washington State, the highest rate in the US other than Alaska. All cases in Alaska have been associated with the preparation and storage of traditional native foods. In other parts of the US, foodborne botulism is usually associated with improperly canned foods or with improperly stored unrefrigerated foods. Dried foods, particularly dried fish, have also been implicated in foodborne botulism outbreaks. (Promed 8/29/05)

^top

USA (Washington): 7 cases of Tularemia
Cowlitz County and state officials are alerting residents and health professionals about an increase in cases of a rare disease that is sometimes tied to bioterrorism. There's no need to panic, and the number of cases is still low, but officials want people to be aware and take simple precautions such as not handling dead rodents or other animals and reporting them to the health department. 7 cases of tularemia have been reported in residents of 4 counties in western Washington. In most years, 2-4 cases of tularemia are reported statewide annually. Investigations show that the recent cases are not linked to 1 source and have been contracted naturally. Onset dates for the patients are between 28 May and 2 Aug 2005. The age range is 6 to 66 years old; 5 are male. Most of the exposures occurred in the county of residence, though in 2 cases, there is a possibility of exposure both locally and out of state, and the King county case was contracted in north western Washington. 4 of the cases presented with ulceroglandular tularemia, 1 with meningitis and pneumonia, and 2 with pneumonic tularemia. 2 of the pneumonic tularemia cases were most likely exposed while using power tools to do landscaping; the ulceroglandular cases involved insect bites; 1 of the exposures is still unknown. All 7 of the known Washington patients have recovered. Health advice has been sent to health care providers and veterinarians in western Washington. Tularemia, also called "rabbit fever," is caused by naturally occurring bacteria. There is some evidence the disease has been here for awhile: an unrelated statewide study this winter found that 4.3 per cent of Cowlitz, Clark and Lewis county pets showed exposure to the disease, compared to the state average of 1.9 per cent. (Promed 9/6/05, 9/7/05)

^top

Canada (Ontario): Baylisascaris, fatal; first known human case in Canada
On 25 Aug 2005, Toronto Public Health received notice of a rare human infection with the raccoon roundworm, Baylisascaris procyonis. A 7 year old boy with a history of autism, moderate mental retardation, and attention deficit hyperactivity disorder presented to the emergency department with a 1 to 2 week history of decreased food intake, decreased level of consciousness, and newly onset bed wetting. He was hospitalized with a diagnosis of encephalitis. The boy is still in hospital and in a stable condition after starting treatment, but has shown no recovery to his baseline level. To date, no cases of human neurologic disease caused by B. procyonis have been successfully treated. The infected child has a history of geophagia and was known to play in the yard of his house, which is in an urban area frequented by raccoons. Environmental inspections found an accumulation of fresh and old feces in the yard and roof of the house. Tests for the presence of this roundworm in the raccoon feces were positive. Only 14 probable or confirmed cases of severe or fatal human B. procyonis infection have been found in the literature. This is the first known human case of B. procyonis in Canada. The parasite is known as raccoon roundworm and lives in the digestive tract of raccoons. The eggs are found in raccoon feces. (Promed 9/7/05)

^top

USA: Recall of Medline brand of alcohol-free mouthwash and hygiene kits containing mouthwash
The U.S. Food and Drug Administration is notifying the public of a nationwide voluntary recall of alcohol-free mouthwash and hygiene kits containing mouthwash distributed by Medline Industries, Inc. because of the potential contamination with Burkholderia cepacia. Consumers and health care providers who have Medline brand alcohol free mouthwash should stop using the product immediately and check to see if it is being recalled. CDC has confirmed hospital illness associated with the use of the affected mouthwash in Texas and Florida. For a complete list of admission kits involved, go to www.medline.com or call Medline Industries at 1-800-950-0128. B cepacia is a known cause of infections in hospitalized patients. The effects of B. cepacia on people vary, ranging from no symptoms to serious respiratory infections. B. cepacia poses little medical risk to healthy people. However, people who have certain health problems such as weakened immune systems or chronic lung diseases may be more susceptible to infections with B. cepacia. B. cepacia bacteria are often resistant to common antibiotics. (FDA http://www.fda.gov/bbs/topics/news/2005/NEW01225.html 8/29/05)

^top


1. Updates
Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies, 1 September 2005
Influenza activity was low during weeks 30-33, 2005.

Australia. Influenza A activity started waning since week 30, although activity remained regional in weeks 30–33.

Hong Kong. Influenza activity continued to decline with sporadic activity reported in weeks 30–33.

New Zealand. Influenza B epidemics continued to decline. In week 33, the consultation rate for influenza-like illness dropped to levels similar to those of 2003 and 2004.

Other reports. During weeks 30–33, low influenza activity was detected in Canada (A and B), Chile (H3, A and B), Japan (H3), Mexico (H3), and Thailand (H3 and B). (WHO 9/1/05 http://www.who.int/csr/disease/influenza/update/en/)

^top

Dengue
Philippines
The Philippines has reported 197 deaths and 14 738 cases of dengue fever this year. Dr. Eric Tayag of the Department of Health's National Epidemiology Center said the number of reported cases amounted to a 20-percent increase over 2004, and that the death toll had exceeded the 144 registered for 2004. "The health department placed the Philippines on a dengue fever alert last week, and this is likely to stay in force for the remainder of the year," he said. Tayag said hospitals in some areas have become congested with dengue cases. The DOH fears the number of infections could exceed 20 000 by the end of the year, and has ordered fumigation and other measures to prevent the spread of the disease in the worst-affected areas. Health officials have observed a clustering of dengue cases in 117 barangays, prompting them to reiterate calls for a massive environmental cleanup to eliminate the breeding places of mosquitoes. Clustering means 3 or more people falling ill from dengue in the same barangay over a period of 4 weeks. Day-biting Aedes aegypti mosquitoes, which transmit the dengue virus, breed in clean but stagnant water. The DOH said schools should conduct cleanup campaigns regularly. The DOH report showed that 43 percent of the 6384 dengue cases affected children aged 1-9 years. The oldest victim was 95 years old. (Promed 8/31/05)

Philippines (Negros Occidental)
The Negros Occidental Provincial Health Office (PHO) reported that there has been an increase in the number of dengue cases in the province over the past months and requested the Regional Health Center for Health Development 6 to deploy an epidemiological team to affected cities and municipalities for monitoring. Records showed that as of 13 Aug 2005, the number of suspected dengue cases rose to 51 percent. There have been 829 cases recorded so far in 2005, while there were 548 cases in 2004. The PHO currently conducts larviciding in possible mosquito breeding areas. The PHO also echoed the call to the city health units, rural health units, and barangay health units to intensify the environmental sanitation drive and also for the public to continue cleaning their surroundings. During 2004, the most number of dengue cases in the province was noted in Bago City, which had 144 cases. So far in 2005 it was Talisay City, which had 134 cases. (Promed 8/31/05)

Philippines (Valenzuela)
The Valenzuela City government has declared a dengue outbreak in the second district, since 78 percent of 222 people afflicted with the disease in the city came from the area. Dr. Manuel Mapue, the city epidemiologist, said 3 victims have died. There are 9 barangays in the second District but only 5 are being monitored for dengue cases. Most of the dengue patients in the city were confined at the Valenzuela City General Hospital, San Lazaro Hospital, Fatima Medical Center and Calalang General Hospital. Mapue said the declaration of a dengue outbreak in the district has helped in persuading the residents to clean their surroundings. In 2004, Valenzuela had 551 cases of dengue. 3 of the victims died. (Promed 8/31/05)

Singapore
Singapore has reported 8854 cases of dengue fever so far in 2005--nearly double the number from the same period of 2004, when cases rocketed to a 10-year high. The disease has claimed 8 lives [case fatality rate of 904 per 100 000] since the start of 2005. "We have postponed or cancelled 114 non-urgent procedures to meet the demand of in-patient beds," a spokeswoman for Changi General Hospital said. Another public hospital, Tan Tock Seng Hospital, will also delay its non-urgent operations to cope with dengue cases. TTSH, where most dengue patients are admitted, has about 90 to 110 dengue patients staying in its wards each day. Dengue patients now account for about 10 per cent of the hospital's total patient population. Although a raft of measures has been introduced to eliminate mosquito breeding sites, dengue infections have continued to increase. The health ministry said there were 546 new dengue cases reported in the week ending 4 Sep 2005, rising from the 493 cases a week earlier and 414 from 2 weeks ago. WHO issued an alert Sep 2004 after a resurgence of cases in the region. Malaysia, Indonesia and the Philippines, are also struggling to control the disease. (Promed 9/8/05)

Mexico
Dengue fever figures reported for this year in Quintana Roo exceed by 200 percent the number of cases detected in 2004, and health authorities started emergency programs for insecticide spraying, as well as placing Abate in water tanks and promoting the "clean yards" campaign. Jose Joaquin Calderon-Martinez, state director of health services, announced that by epidemiological week No. 32, they have reported 336 cases of dengue fever. 250 of the cases correspond to the classic form and 86 are dengue hemorrhagic fever; for the same time in 2004, the total number of cases was 139, 113 with classic dengue fever and 26 with dengue hemorrhagic fever. City councils with the greatest numbers of dengue fever cases are Othon P. Blanco (210 cases), Benito Juarez (100 cases), and Felipe Carrillo-Puerto (18 cases). The remaining communities report 1-2 cases. In Tamaulipas, 928 cases of dengue fever and 129 cases of dengue hemorrhagic fever have been reported. (Promed 8/31/05)

^top

West Nile Virus
Canada
During week 33 (14 Aug 2005 - 20 Aug 2005), 31 West Nile virus human cases were reported in Quebec (1), Ontario (12), Manitoba (8), Saskatchewan (8), and Alberta (2). As of the 20 Aug 2005, a total of 51 human WNV cases have been reported to the Public Health Agency of Canada. Of the 51 cases, 47 were clinical cases and 4 were asymptomatic. Of the 47 clinical cases, 13 (28 percent) were reported as West Nile Neurological Syndrome, 22 (47 percent) were reported as West Nile Non-Neurological Syndrome, and 12 (26 percent) were Other Clinical/Unspecified. 2 cases are travel-related. (Promed 9/3/05)

USA
As of 6 Sep 2005, 32 states have reported 821 cases of human WNV illness in 2005. By comparison, in 2004, a total of 1,191 WNV cases had been reported as of September 7, 2004. A total of 432 (56%) of the 772 cases for which such data were available occurred in males; the median age of patients was 50 years (range: 3 months--92 years). Date of illness onset ranged from January 2 to August 31; a total of 18 cases were fatal. A total of 163 presumptive West Nile viremic blood donors (PVDs) have been reported during 2005. Of these, 49 were reported from California; 32 from Texas; 22 from Nebraska; 14 from South Dakota; 10 from Louisiana; six from Arizona; 5 from Illinois; 4 each from Kansas and Minnesota; 3 from Iowa; 2 each from Alabama, Colorado, Mississippi, and New Mexico; and 1 each from Michigan, Nevada, North Carolina, North Dakota, Pennsylvania, and Utah. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5435a6.htm (MMWR September 9, 2005 / 54(35);877-878)

^top


2. Articles
CDC EID Journal, Volume 11, Number 9-Sep 2005
CDC Emerging Infectious Diseases Journal, Volume 11, Number 9-Sep 2005 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. The following expedited articles are available online:

- Evolution of H5N1 Avian Influenza Viruses in Asia, WHO Global Influenza Program Surveillance Network
- Atypical Infections in Tsunami Survivors, C. Garzoni et al.
- Melioidosis in Tsunami Survivors, E. Athan et al.

"Evolution of H5N1 Avian Influenza Viruses in Asia": Novel features of this report are the definition of 3 distinct clades by phylogenetic analysis, the complete absence of reassortment of avian and human influenza virus genes, and the first documentation of the occurrence of antigenic drift. Perhaps one of the most significant aspects of this analysis is the finding that antigenic drift is occurring and that some recent isolates are distinguishable from virus isolates that were chosen as the candidate vaccine antigens. This identifies a need for continued surveillance of poultry for the appearance of antigenic variants which may compromise the effectiveness of the current vaccine under development. (Promed 8/27/05; CDC EID)

^top

Influenza vaccine supply and recommendations for prioritization during 2005-06 influenza season
“Influenza vaccine distribution delays or vaccine supply shortages have occurred in the United States in three of the last five influenza seasons. In response, prioritization has been implemented in previous years to ensure that enough vaccine is available for those at the highest risk for complications from influenza. The information in this report updates projections of influenza vaccine supply and previous recommendations for priority use of trivalent inactivated influenza vaccine (TIV) during the 2005--06 influenza season. Four manufacturers now expect to provide influenza vaccine to the U.S. population during the 2005--06 influenza season. Sanofi Pasteur, Inc., projects production of 60 million doses of TIV. Chiron Corporation projects production of 18--26 million doses of TIV. GlaxoSmithKline (GSK), Inc., whose license application was approved by the Food and Drug Administration on August 31, 2005, projects production of 8 million doses of TIV. MedImmune Vaccines, Inc., producer of live attenuated influenza vaccine (LAIV), projects production of approximately 3 million doses. However, because of the uncertainties regarding production of influenza vaccine, the exact number of available doses and timing of vaccine distribution for the 2005--06 influenza season remain unknown.

Given the uncertainties in doses and distribution, CDC recommends that the following priority groups receive TIV until October 24, 2005: persons aged >65 years with comorbid conditions; residents of long-term--care facilities; persons aged 2--64 years with comorbid conditions; persons aged >65 years without comorbid conditions; children aged 6--23 months; pregnant women; health-care personnel who provide direct patient care; household contacts and out-of-home caregivers of children aged <6 months . . . Beginning October 24, 2005, all persons will be eligible for vaccination. . . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a4.htm (MMWR September 2, 2005 / 54(34);850)

^top

Avian Influenza (H5N1) Viruses Isolated from Humans in Asia in 2004 Exhibit Increased Virulence in Mammals
Maines TR et al.
Abstract: “The spread of highly pathogenic avian influenza H5N1 viruses across Asia in 2003 and 2004 devastated domestic poultry populations and resulted in the largest and most lethal H5N1 virus outbreak in humans to date. To better understand the potential of H5N1 viruses isolated during this epizootic event to cause disease in mammals, we used the mouse and ferret models to evaluate the relative virulence of selected 2003 and 2004 H5N1 viruses representing multiple genetic and geographical groups and compared them to earlier H5N1 strains isolated from humans. Four of five human isolates tested were highly lethal for both mice and ferrets and exhibited a substantially greater level of virulence in ferrets than other H5N1 viruses isolated from humans since 1997. One human isolate and all four avian isolates tested were found to be of low virulence in either animal. The highly virulent viruses replicated to high titers in the mouse and ferret respiratory tracts and spread to multiple organs, including the brain. Rapid disease progression and high lethality rates in ferrets distinguished the highly virulent 2004 H5N1 viruses from the 1997 H5N1 viruses. A pair of viruses isolated from the same patient differed by eight amino acids, including a Lys/Glu disparity at 627 of PB2, previously identified as an H5N1 virulence factor in mice. The virus possessing Glu at 627 of PB2 exhibited only a modest decrease in virulence in mice and was highly virulent in ferrets, indicating that for this virus pair, the K627E PB2 difference did not have a prevailing effect on virulence in mice or ferrets. Our results demonstrate the general equivalence of mouse and ferret models for assessment of the virulence of 2003 and 2004 H5N1 viruses. However, the apparent enhancement of virulence of these viruses in humans in 2004 was better reflected in the ferret.”
J Virol. 2005 Sep;79(18):11788-800: http://jvi.asm.org/cgi/content/abstract/79/18/11788 (CIDRAP)

^top

Detection of prions in blood
Joaquín Castilla, Paula Saá & Claudio Soto
“Prion diseases are caused by an unconventional infectious agent termed prion, composed mainly of the misfolded prion protein (PrPSc). The development of highly sensitive assays for biochemical detection of PrPSc in blood is a top priority for minimizing the spread of the disease. Here we show that the protein misfolding cyclic amplification (PMCA) technology can be automated and optimized for high-efficiency amplification of PrPSc. We show that 140 PMCA cycles leads to a 6,600-fold increase in sensitivity over standard detection methods. Two successive rounds of PMCA cycles resulted in a 10 million−fold increase in sensitivity and a capability to detect as little as 8,000 equivalent molecules of PrPSc. Notably, serial PMCA enables detection of PrPSc in blood samples of scrapie-afflicted hamsters with 89% sensitivity and 100% specificity. These findings represent the first time that PrPSc has been detected biochemically in blood, offering promise for developing a noninvasive method for early diagnosis of prion diseases.” Nature Medicine 28 August 2005; http://www.nature.com/nm/journal/vaop/ncurrent/abs/nm1286.html

The authors have found a way to detect abnormal prion protein in blood, an achievement that could lead to the first practical blood test for BSE and similar diseases in living animals. The test was used successfully to detect a prion disease in hamsters. If it proves effective in cattle and humans, it could help protect the blood supply from BSE, help determine the prevalence of the disease in US cattle, and assist researchers trying to assess how many people are unwittingly infected with variant Creutzfeldt-Jakob disease (vCJD). At present, BSE and related prion diseases can be definitively diagnosed only by examination of brain tissue after death. The authors report that they devised a way to stimulate a tiny, undetectable amount of abnormal prion protein in a blood sample to multiply so that it reaches detectable levels. They suggest that the test could permit the diagnosis and treatment of vCJD early in its course, before the appearance of clinical signs and permanent brain damage. (Promed 8/29/05)

^top


3. Notifications
WHO: Responding to the avian influenza pandemic threat. Recommended strategic actions
This document sets out activities that can be undertaken by individual countries, the international community and WHO to prepare the world for the next influenza pandemic and mitigate its impact once international spread has begun. The objectives of the strategic actions correspond to the principal opportunities to intervene and are likewise phase-wise.

PHASE: pre-pandemic: 1. Reduce opportunities for human infection; 2. Strengthen the early warning system
PHASE: emergence of a pandemic virus: 3. Contain or delay spread at the source
PHASE: pandemic declared and spreading internationally: 4. Reduce morbidity, mortality, and social disruption; 5. Conduct research to guide response measures (WHO http://www.who.int/csr/resources/publications/en/; CIDRAP 9/2/05)

^top

Hurricane Katrina response and guidance for health-care providers, relief workers, and shelter operators
Hurricane Katrina struck the coastal areas of Alabama, Florida, Louisiana, and Mississippi August 29, 2005, causing substantial numbers of deaths among both humans and animals, infrastructure damage, and flooding. Affected areas continue to experience shortages of essential services. CDC/ATSDR, local and state health departments, other federal agencies, and other partners are supporting public health and medical-care functions for persons in affected areas and those displaced. As of Sep 7, 2005, CDC/ATSDR had deployed 182 members of the U.S. Public Health Service Commissioned Corps, CDC Epidemic Intelligence Service officers, and federal civilian personnel to provide technical support and additional personnel for critical public health functions. To protect the public health and safety during recovery operations, CDC has provided guidelines: http://www.bt.cdc.gov/disasters/hurricanes/index.asp. In addition, a new compilation, Natural Disasters, has been added to the M Guide Online Knowledge Centers: http://www.cdc.gov/mmwr. The M Guide provides links to previously published MMWR reports regarding assessment of health needs and surveillance of morbidity and mortality after hurricanes, floods, and the December 26, 2004 tsunami. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5435a5.htm (MMWR September 9, 2005 / 54(35);877)

^top

Syndromic Surveillance: Reports from a National Conference, 2004
The report is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/su5401toc.htm. It includes sections on: Overview, Policy, and Systems; Data Sources; Analytic Methods; Simulation and Other Evaluation Approaches; Practice and Experience and; Abstracts. (MMWR August 26, 2005 / Vol. 54 / Supplement)

^top


4. APEC EINet activities
APEC Meeting in Korea; EINet course
Drs. Louis Fox and Ann Marie Kimball are attending the APEC Health Task Force meeting in Gyeonju, Korea, Sep 7-11, 2005, to discuss EINet’s progress and future efforts. 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."

^top


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/.

^top

 apecein@u.washington.edu