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Vol. VIII, No. 20 ~ EINet News Briefs ~ Sep 23, 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:
- Netherlands: Lifts ban on avian influenza preventive measure
- South East Asia: Cumulative number of human cases of avian influenza A/(H5N1)
- Pan-Asia: Asia must change age-old farming practices to stop disease
- Indonesia: FAO concerned about bird flu spread in Indonesia
- Indonesia: 15 blood samples declared free of avian influenza virus
- Indonesia: Jakarta closes zoo
- Indonesia: Avian influenza suspected in 3 Jakarta zoo workers
- Indonesia: WHO Avian influenza situation update
- Indonesia: Poultry culling; suspected cases of avian influenza
- Viet Nam: Additional fatal case of avian influenza confirmed
- China: OIE report regarding Streptococcus suis; porcine and human infection
- Philippines (Pangasinan): Typhoid worries
- Russia (Astrakhan): West Nile virus outbreak
- Russia (Nizhniy Novgorod): Hepatitis A outbreak
- Russsia (Perm Region): 4 tickborne encephalitis deaths
- USA (Golf States): Norovirus outbreak among evacuees contained
- USA (Golf States): Post-hurricane Vibrio infections
- USA: Pushes international efforts to thwart flu pandemic
- USA: Boosts medical stockpile for flu pandemic
- USA (Wisconsin): 3 Cases of La Crosse encephalitis
- USA (New Hampshire): Death of Eastern Equine Encephalitis Patient

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

2. Articles
- CDC EID Journal, Volume 11, Number 10-Oct 2005
- Vibrio Illnesses After Hurricane Katrina--Multiple States, August--September 2005
- Serological analysis of serum samples from humans exposed to avian H7 influenza viruses in Italy between 1999 and 2003.
- Influenza Activity--US and Worldwide, May 22--Sep 3, 2005, and 2005--06 Season Vaccination Recommendations
- Influenza Vaccination Coverage Among Persons Aged 50--64 Years Enrolled in Commercial Managed Health-Care Plans--United States, 2003--04 and 2004--05 Influenza Seasons
- Direct and Indirect Effects of Routine Vaccination of Children with 7-Valent Pneumococcal Conjugate Vaccine on Incidence of Invasive Pneumococcal Disease--United States, 1998--2003

3. Notifications
- Avian influenza updates
- Avian Influenza Protection Measures Endorsed by APEC Senior Officials
- Fifty-sixth session of the WHO Regional Committee for the Western Pacific
- WHO/DFID-AHP Meeting on Control of Zoonotic Diseases
- Forum on Microbial Threats workshop - "Foodborne Threats to Health," Oct. 25-26, 2005
- 12th International Congress on Infectious Diseases
- Symposium on relating microbiological testing and microbiological criteria to public health goals

4. APEC EINet activities
- APEC Meeting in Korea; recommendations receive endorsement

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Netherlands: Lifts ban on avian influenza preventive measure
The Dutch government has decided to lift a ban on keeping poultry outdoors. 5 million free-range chickens were moved indoors after news that the disease had spread to Russia led to fears of infection from wild birds. The Dutch reversed the decision after advice from migration experts. The European Commission said the risk of infection from wild birds was not sufficient to justify a ban on Europe's outdoor poultry business. The Dutch government was also warned that their eggs and meat could not be labeled as free-range if the ban continued beyond 6 weeks. The Dutch agreed to targeted "farm-by-farm" measures, including temporary roofing for holdings on bird migration routes. The Netherlands is one of the world's biggest meat exporters. Poultry farmers in the EU should get ready to act against bird flu, stepping up surveillance and preparing for mass vaccinations or culls if the disease takes hold, the EU's food safety agency said. The European Food Safety Authority (EFSA) said the biggest risk of a major bird flu outbreak was if low pathogenic strains of the virus mutated into a more dangerous version and then spread throughout Europe. EFSA said 2 of those strains, H5 and H7, should now also be controlled due to the risk of mutation. EFSA also called for greater controls on the use of poultry faeces as manure. Estimates of the risk of a bird flu outbreak in the EU vary, but the UN FAO said migratory birds could bring the virus with them. EU commissioner for health and consumer protection Markos Kyprianou said the EU should take a coordinated approach to the disease and not impose piecemeal national measures. (Promed 9/22/05)

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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 / 6 (3) / 4 (2)
Cambodia / 4 (4) / 4 (4)
Thailand / 0 (0) / 0 (0)
Viet Nam / 68 (64) / 23 (21)
Total / 78 (71) / 31 (27)

Cumulative number of confirmed human cases of avian influenza A/(H5N1), 3 Dec 2003 to present:
122 (115) / 63 (59)
(CIDRAP 9/22/05 http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/case-count/avflucount.html)

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Pan-Asia: Asia must change age-old farming practices to stop disease
Asia must change age-old farming practices to reduce contact between people and poultry to limit avian influenza and prevent new animal diseases infecting humans, WHO said 21 Sep 2005. In launching a 5-year plan to combat emerging diseases in the Asia-Pacific region, WHO said on average one new disease had occurred every year for the past 20 years, mainly in Africa and Asia, and eventually one will become a pandemic. "Even if you control avian influenza, the next one is coming," said Dr Shigeru Omi, WHO's regional director for the Western Pacific. "In my view, this is connected to the differences in the farming practices. In the West, farming practices are well controlled: ducks, chickens, and humans do not mingle together," Omi said. He said the spread of avian flu in Asia over the past 2 years was related to areas of high population and high human-to-poultry contact. "If you look at the poultry density for Asia, southern China, Viet Nam, and Cambodia have very dense populations. In the past 2 years, outbreaks of avian influenza correspond to where poultry population density is very high," he said. Cambodia and Viet Nam, where poultry is farmed in backyards and where farmers live in close proximity to chickens and ducks, have borne the brunt of avian flu deaths. Western Europe had equally dense poultry populations but did not experience the same level of diseases as Asia.

WHO said 75 per cent of infectious diseases in the past 30 years originated from animals, and the Asia-Pacific was "the epicenter for such epidemics." Dengue fever, Japanese encephalitis, leptospirosis, Nipah virus and drug-resistant malaria are some of the diseases now entrenched in the region. Omi said globalization and common borders had also contributed to the spread of diseases like SARS and avian influenza. "There is an urgent need to strengthen inter-country and bioregional collaboration," he said. WHO's "Asia-Pacific Strategy for Emerging Diseases" plan launched 21 Sep 2005 calls for greater cooperation between Asia-Pacific nations to ensure early detection and rapid response to emerging diseases. The plan said that although most countries had surveillance systems for communicable diseases, they were not capable of being used as early warning systems.

In addition, the world animal health body OIE said its $100 million strategy to boost veterinary defences against bird flu was the best way to limit the threat of a human pandemic of the deadly disease. With governments spending hundreds of millions of dollars on stocks of anti-viral drugs for use in case the virus mutates to pass easily between humans, it said some of the funds should be spent on animal surveillance and disease control at source. OIE director-general Bernard Vallat said, "If you took 10 per cent of the money being spent on anti-viral medicines and used it on building measures to stamp out the disease, now that would be a good investment." The OIE, along with the UN's FAO, launched its strategy recently and is seeking pledges of $100 million. While most European countries have veterinary systems in place to deal effectively with an outbreak of bird flu, many in places such as Africa need funds to build their defences. Vallat said they would seek pledges from the World Bank, European Commission and US. Vallat said the OIE had sent a team to Siberia to study the wild birds there with the virus to determine if they could spread the disease to Europe. Experts will examine how certain infected wildfowl can live with the disease and if they are able to fly thousands of miles. (Promed 9/22/05)

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Indonesia: FAO concerned about bird flu spread in Indonesia
FAO is concerned about the spread of avian influenza in Indonesia and has offered further assistance to the country. "Avian influenza has become endemic in Indonesia and it is continuing to spread," said FAO's Chief Veterinary Officer Joseph Domenech. The fight against bird flu should become a national priority and veterinary and civil authorities should be provided with the full power to enforce control measures. Local veterinary services should be strengthened to enable them to discover disease outbreaks at a very early stage and to immediately carry out control measures such as culling and targeted vaccination in high risk areas. The national vaccination strategy should be reviewed to ensure that only quality vaccines are used, in accordance with the OIE standards. More financial resources should be made available for the control of bird flu in animals. 4 people have died of bird flu in Indonesia and others are suspected of having the virus. The involvement of around 30 million backyard village households keeping around 200 million chickens would be a major challenge. Major public awareness campaigns should be launched to inform farmers about risks and control strategies. The spread of the virus through marketing channels should be further investigated. Together with the Indonesian government, FAO is developing a national avian influenza control project that will require around $11 million. (FAO 9/22/05 http://www.fao.org/newsroom/en/news/2005/107810/index.html)

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Indonesia: 15 blood samples declared free of avian influenza virus
15 blood samples taken by a Health Ministry team from the relatives and neighbors of an avian influenza victim have tested negative for the virus. "An examination conducted by the Health Ministry's research and development unit on samples of the blood of the woman's relatives and neighbors on 13 Sep 2005 has shown them to be free of the virus," Budihardja, head of the Central Java Health Office, said. The 37 year old woman died at the Bintaro International Hospital in South Jakarta 10 Sep 2005. Tests done on samples of her body fluids at the WHO laboratory showed she had carried the avian influenza virus. Budihardja said the 15 blood samples included those taken from 3 people who had helped to bury the woman. In July 2005, a cluster of 3 deaths in one family was investigated. H5N1 infection was confirmed in the 38-year-old father but laboratory test results for his 2 daughters did not meet criteria for acute H5N1 infections (WHO reports only laboratory-confirmed cases). Investigation of the July family cluster was unable to determine the source of exposure--testing and monitoring of more than 300 close contacts failed to detect any further cases. The virus has spread to 22 provinces out of 33 in the Indonesia, killing more than 9.5 million poultry since late 2003. (Promed 9/16/05, 9/19/05)

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Indonesia: Jakarta closes zoo
The Indonesian Government has closed down the Ragunan Zoo for 21 days from 19 Sep 2005, after 19 birds were confirmed to have contracted avian flu. The order to close the zoo was made by Jakarta Governor Sutiyoso, after 19 of the 27 samples taken from the birds tested positive for bird flu, including peacocks, mynahs, wild ducks, pigmy chickens, eagles, and herons. It is not known how the zoo birds became infected. A complete sterilization of the area and treatment of infected animals will be completed. Some 2,100 birds in the zoo's collection will be tested for the virus. Any bird found carrying the virus would be killed if it is not a protected species. Captive animals have reportedly been affected by the H5N1 virus in 2 Thai zoos in 2004. Health Minister Siti Fadilah Supari said her ministry would increase its surveillance, focusing more on non-chicken birds, especially reared and caged birds and water birds. This report underscores the importance of including zoos in a comprehensive surveillance strategy for avian influenza and other diseases.

In addition, Governor Sutiyoso said 16 Sep 2005 that all poultry farms in Jakarta should relocate to outside the city in order to stop the spread of avian influenza in the capital. Sutiyoso said he had told the City Agriculture, Livestock and Maritime Agency to find suitable places to relocate the poultry farms. Minimizing unnecessary mixing between people and domestic poultry, in order to limit the exposure of humans to zoonotic infections, is epidemiologically compelling. (Promed 9/18/05, 9/19/05)

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Indonesia: Avian influenza suspected in 3 Jakarta zoo workers
3 workers from Jakarta's Ragunan Zoo have been hospitalized with suspected H5N1 avian influenza. The ailing zoo workers include a 28 year old guide and a 39 year old vendor. Another report said a third person from the zoo, also a food worker, was hospitalized. On 16 Sep 2005, officials confirmed that the death of a 37 year old woman from Jakarta was due to H5N1 avian influenza virus infection. As of 19 Sep 2005, 4 children had been hospitalized with suspected cases. They included 2 girls, aged 3 and 6; a 7 year old; and a 9 year old boy who is related to the 37 year old victim. Initial lab tests on 2 children were positive for H5N1. On 19 Sep 2005, the government declared that the avian flu situation was an "extraordinary" health incident. That declaration, which expires in 21 days but can be renewed, allows for forced hospitalization of people who have possible avian flu symptoms. 44 hospitals have been designated to treat avian flu patients. Of the 500 Ragunan Zoo employees, 143 have been identified as being at high risk for exposure to the virus. Of 27 samples from various birds, 19 tested positive. Besides the 37 year old woman, the other confirmed reported cases of avian flu in Indonesia include a 38 year old man and his 2 daughters, who died July 2005, plus a farm worker who tested positive for antibodies to the virus last March, though he had not been sick. However, WHO recognizes only the 37 year old woman and 38 year old man as laboratory-confirmed cases. (Promed 9/20/05, 9/21/05)

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Indonesia: WHO Avian influenza situation update
The Ministry of Health in Indonesia has confirmed a further human case of highly pathogenic H5N1 avian influenza. The case, in an 8-year-old boy, was confirmed as positive for H5N1 infection by a WHO reference laboratory in Hong Kong. The boy remains in hospital for observation and treatment. Prior to the new case announced, 2 human cases of H5N1 infection in Indonesia have been laboratory confirmed, one in July and another in September. All 3 cases have been investigated by the Indonesia health authorities, with WHO support, and searches for further cases have been conducted. As investigations have produced no evidence that the H5N1 virus is spreading easily person to person, WHO has not raised its current level of pandemic alert. WHO will, however, continue to monitor the situation closely. Given the experience of other H5N1 affected countries in Asia, the detection of further human cases in Indonesia or elsewhere would not be surprising. Laboratory confirmation of cases in Indonesia has led to heightened public concern, intensified surveillance for further cases, and strengthened government commitment to contain the disease. As a result, several patients with respiratory symptoms and a history of possible exposure to the avian virus are being evaluated. Samples from these patients have also been sent for analysis by the WHO reference laboratory. In all affected countries, most human cases of H5N1 infection have been linked to contact with poultry. In a few instances, limited human-to-human transmission of the virus may have occurred following close contact with a patient during the acute phase of illness. In all known instances, such transmission has been limited and has not led to larger outbreaks, indicating that the virus does not currently spread easily among people. WHO has sent all countries a document outlining recommended strategic actions for responding to the avian influenza pandemic threat. Recommended actions aim to strengthen national preparedness, reduce opportunities for a pandemic virus to emerge, improve the early warning system, and accelerate vaccine development. (Promed 9/22/05)

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Indonesia: Poultry culling; suspected cases of avian influenza
The death of a 5 year old girl and a 2 year old girl from suspected avian influenza fanned worries in Indonesia, as the government promised to destroy infected poultry flocks. 9 people were hospitalized in Jakarta for treatment of suspected avian flu. Indonesia has had 4 deaths attributed to H5N1 avian flu so Far (though WHO has recognized only 2 cases as laboratory-confirmed). The 5 year old died at Jakarta's Sulianti Saroso Hospital. Indonesian Health Minister Siti Fadilah Supari said the girl "most likely" died of avian flu. But she also said an initial local laboratory test on the girl was negative. The 2 year old girl died at Jakarta's Christian PGI Hospital. Sulianti Saroso Hospital had 3 new patients with suspected avian flu. One was a 9 year old girl who visited Ragunan Zoo in Jakarta just before it was closed. The other 2 patients were teenagers who had contact with birds before they fell ill. The government promised to destroy infected poultry flocks, something it has been reluctant to do until now because of cost concerns. Agriculture minister Anton Apriyantono said mass slaughters would be carried out in areas found to be "highly infected," meaning infections in 20 per cent of the poultry.

WHO is prepared to provide the antiviral drug oseltamivir (Tamiflu) if signs of a flu pandemic show up. Shigeru Omi, director for the WHO's Western Pacific Region, said the agency is prepared to send doses to Indonesia "if and when a pandemic starts." A 5-member team of US officials is in Indonesia to find out how the US can help the country battle avian flu. WHO director-general Lee Jong-wook said the agency would not push for a generic version of oseltamivir to increase the supply for people in poor countries. Some countries have suggested that Roche, the manufacturer of oseltamivir, should relinquish its patent so that other companies could produce cheaper versions of the drug. Roche announced in August 2005 it would give 3 million treatment courses of the drug to a WHO-managed international stockpile.

A woman's death from avian influenza in Jakarta has caused considerable alarm there, but genetic tests performed in Hong Kong on samples of the virus from the woman showed that the virus had not yet mutated in ways likely to make it more of a threat to people. The genetic evidence suggests that cases identified so far in Indonesia may be no more dangerous by themselves than the nearly 100 cases recorded since the beginning of 2004 in Thailand and Viet Nam. But the disease remains a potentially serious threat to human health because it could still mutate. (Promed 9/22/05)

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Viet Nam: Additional fatal case of avian influenza confirmed
The Ministry of Health in Viet Nam has retrospectively confirmed an additional fatal case of H5N1 infection that dates back to July 2005. The case, a 35-year-old male farmer from Ben Tre Province, developed symptoms on 25 July and died on 31 July 2005. (Promed 9/19/05)

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China: OIE report regarding Streptococcus suis; porcine and human infection
Information received on 5 Sep 2005 (up to 30 Aug 2005) from Mr Jia Youling, director general, Veterinary Bureau, Ministry of Agriculture, Beijing. A total of 647 pigs have died as a result of Streptococcus suis infection in Sichuan province. The deaths occurred in 149 villages of 88 municipalities in 21 counties of the following 8 regions: Chengdu, Deyang, Luzhou, Mianyang, Nanchong, Neijiang, Zigong, Ziyang. The epizootic began in late June 2005, reached a peak around 20 Jul 2005, and then declined sharply. No new cases have occurred since 6 August 2005. This epizootic was caused by Streptococcus suis type 2. The virulence genes of the bacterium were tested. The results of the tests showed that the virulence of the isolate is not significantly different from that of isolates obtained from other places in the past, and no evidence of genetic variation has been found. The OIE report contains more detail on: Spatial distribution; Temporal distribution; Herd distribution; Control measures and; Vaccination. For more information visit: (Promed 9/11/05)

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Philippines (Pangasinan): Typhoid worries
After dengue, typhoid fever is emerging as the next worry of Dagupenos. The city listed 5 cases of typhoid fever. All barangay health workers were told to double their efforts in monitoring the drinking water in their respective barangays. City Health Officer Leonard Carbonell said typhoid fever comes from dirty water/food. He urged everyone to make sure their food intake is clean and water is free from dirt and disease-causing organisms. Barangay Salisay, the barangay with the largest number of cases, however, reported negative results based on water examination by health officers. (Promed 9/21/05)

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Russia (Astrakhan): West Nile virus outbreak
An outbreak of West Nile fever has been registered in the Astrakhan region [oblast]. As of 9 Sep 2005 60 cases of the disease have been recorded in the region, more than two thirds in the oblast centre. Fatal outcomes have not been observed. Health officials have declared that the situation this year is similar to that observed in 1999, when an abrupt increase in West Nile fever was observed and by the middle of Sep 5 people had died in the Astrakhan region and 53 in the Volgograd region. Disinfection of cellars and reservoirs to prevent an increase in the population of mosquitoes is considered by authorities to be an effective means of limiting the spread of the disease. A sum of 90 000 roubles [USD 3184] has been allocated from the Astrakhan city budget for this purpose. 60 per cent of the city reservoirs have been treated. Beginning in 2006, the treatment of cellars and reservoirs will be included in the city of Astrakhan disinfection plan. Disinfection will be carried out three times a year.

West Nile virus was first isolated in the West Nile District of Uganda in 1937 and subsequently has been recorded throughout Africa and Eurasia, probably radiating from Africa northwards to the Mediterranean and southern European regions, eastwards to India, central and southern Asia, and finally to Australia as Kunjin virus. The natural life cycle of this virus involves ornithophilic mosquitoes and birds that migrate between Africa, Europe, and Asia. Infection of humans and mammals in Africa and Eurasia is sporadic and rare. But significant outbreaks, like the current outbreak in Astrakhan, have been recorded. (Promed 9/11/05)

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Russia (Nizhniy Novgorod): Hepatitis A outbreak
As of 20 Sep 2005, 822 people, including 150 children and teenagers, have been treated in hospital on suspicion of hepatitis A virus infection in Nizhniy Novgorod. Another 30 people, including 1 child with this diagnosis, were admitted to hospitals in the city 20 Sep 2005. The majority of the patients are from the Sormovskiy district of the city. The outbreak of hepatitis A in Nizhniy Novgorod was recorded first 5 Sep 2005. In the opinion of physicians, a principal cause of the outbreak is delayed repair of the network of waterpipes in the Sormovskiy district. Anti-epidemic measures are being carried out. As is frequently the case in Russia, inadequacy of the public water supply appears to be responsible for this outbreak. During the first 8 months of 2005 the increase in hepatitis A morbidity in the region was 1.8 times greater than during the same period of 2004, and the morbidity among children under 14 years was 2.5 times greater. The increased incidence indicates that control of hepatitis A virus infection has not made much progress. Although hepatitis A is endemic throughout the world, in many places it is held at bay by judicial use of vaccine and attention to social infrastructure, principally provision of good-quality drinking water and adequate treatment and disposal of waste water and sewage. In many parts of rural and urban Russia these may be deficient, and hepatitis A vaccination is a prudent precaution for travelers. (Promed 9/15/05, 9/21/05)

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Russsia (Perm Region): 4 tickborne encephalitis deaths
4 people have died of tickborne encephalitis in the Perm region of Russia this year. Another 686 people were admitted to hospital with encephalitis during the season of tick activity. Tickborne encephalitis was confirmed in 136 of these cases. Over 24 500 people have applied for medical assistance this year as a result of tick bites. This is 5100 more tick bite cases than during the same period last year. Last year, over 19 000 people were bitten by ticks in the Kama River area, the region with a traditionally high activity of ticks. 3 people died. Tickborne encephalitis is caused by 2 closely related flaviviruses. The majority of infections are a consequence of tick bites, but, rarely, infection has occurred by consumption of infected cow's or goat's milk. Inactivated vaccines are available for protection. (Promed 9/19/05)

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Americas
USA (Golf States): Norovirus outbreak among evacuees contained
Doctors at the complex housing thousands of Katrina evacuees said that they have contained a viral outbreak that caused diarrhea and vomiting. About 700 people have been treated, with 40 still in isolation to contain the virus, said Dr Hermenia Palacio, director of Harris County Public Health and Emergency Services. The evacuees were diagnosed to be suffering from norovirus infection. While the effects of norovirus infection were relatively mild, doctors took the precaution of isolating some people. There have been reports of similar outbreaks at shelters around the country, but norovirus does not appear to be a widespread problem. Palacio said the norovirus outbreak at the Astrodome and Reliant Center in Houston peaked 5 Sep 2005. Such a viral outbreak poses the most serious threat to the oldest and youngest in the evacuee population. While conditions were wretched at first, the American Red Cross, public health agencies, and the homeless themselves have turned 15 sanctioned shelters in the 6-county region of the Mississippi Gulf Coast into safe havens. A survey of the shelters and hospitals by health officials found no unexpected illness during the second week September 2005 and "surprisingly few" cases of gastrointestinal disease, said Mills McNeill, chief epidemiologist for the Mississippi Department of Health. For the latest updates on Katrina visit: http://www.bt.cdc.gov/disasters/hurricanes/index.asp. (Promed 9/11/05)

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USA (Golf States): Post-hurricane Vibrio infections
A Katrina evacuee has been diagnosed with cholera and quarantined at the Tennessee Army National Guard Armory shelter at Smyrna Airport. An adult male evacuee was in isolation 14 Sep 2005, away from other evacuees, emergency responders, and community volunteers at the shelter, said Andrea Turner, Tennessee Health Department public information director. The Smyrna-based evacuee appears in good health and has not required hospitalization. A state health physician said this strain of cholera "poses no threat" to the public, emergency workers, or community volunteers who've been in contact with evacuees. To date, more than 280 hurricane evacuees have passed through the Smyrna shelter since 3 Sep 2005. Turner verified other Vibrio infections have been diagnosed in the USA in the wake of Hurricane Katrina, but only 1 in Tennessee since the evacuation of the Gulf Coast began 29 Aug 2005. There have been 22 confirmed new cases of Vibrio nationally, with 5 deaths in 2 states, but not Tennessee. Only 2 of these infections have been identified as V. cholerae and both were nonepidemic strains. This case is the third documented V. cholerae (non-O1, non-O139) infection related to the hurricane. (Promed 9/16/05)

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USA: Pushes international efforts to thwart flu pandemic
US officials promoted international efforts to prepare for a potential influenza pandemic, announcing an international flu surveillance partnership and promising aid to Vietnam for avian and human flu surveillance. President Bush announced the international partnership when he addressed the UN General Assembly Sep 14 2005. The US ambassador to Vietnam, Michael Marine, said the US would give Vietnam 2.5 million over the next 5 years for flu surveillance. The aid will begin with a $500,000 grant from the CDC to Vietnam's National Institute of Hygiene and Epidemiology. Health and Human Services Secretary Mike Leavitt announced he would lead a US delegation to Thailand, Cambodia, Laos, and Vietnam next month to discuss flu issues. WHO, the UN FAO, and at least 16 countries already have agreed to join the partnership. The countries listed were Argentina, Australia, Britain, Cambodia, Canada, China, India, Japan, Malaysia, New Zealand, Nigeria, Russia, Singapore, Thailand, and Vietnam.

Commenting on the aid to Vietnam, Marine said, "This network focuses on systematic collection of information about influenza, information about what viruses are causing it, how they are being spread, and how fast." The CDC has signed an agreement with Vietnam to provide $500,000 for equipment and laboratory reagents to help improve lab-based surveillance for flu and to develop a flu surveillance network in Vietnam. CDC has assisted Vietnam's National Institute of Hygiene and Epidemiology in Hanoi with human flu–related activities since 1998, providing training, reagents, and specimen testing. The funding is expected to total $2.5 million over the next 5 years but is subject to availability. (CIDRAP 9/16/05 http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/sep1605pandemic.html)

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USA: Boosts medical stockpile for flu pandemic
The federal government is spending about $103 million to boost its small supplies of avian influenza vaccine and antiviral drugs to battle a possible flu pandemic. The Department of Health and Human Services has awarded a $100 million contract to Sanofi Pasteur for an unspecified number of doses of vaccine for the H5N1 strain of avian influenza. Sanofi made 2 million doses of the vaccine under a previous contract with HHS. In addition, HHS said it has paid $2.8 million for enough doses of GlaxoSmithKline's antiviral drug zanamivir (Relenza) to treat 84,300 people. The purchase adds to an existing stockpile of about 4.3 million treatment courses of Roche's oseltamivir (Tamiflu). "These purchases build on the department's plans to buy enough vaccine for 20 million people and enough antivirals for another 20 million people," the HHS announcement said. "These countermeasures provide us with tools that we have never had prior to previous influenza pandemics," HHS Secretary Mike Leavitt said. Sanofi Pasteur won a contract in May 2004 to make about 8,000 doses for clinical trials; in September 2004 it signed a $13 million contract to make 2 million doses for use by health and emergency workers and to prepare for possible mass production. Zanamivir and oseltamivir make up the class of antivirals called neuraminidase inhibitors. In the US, zanamivir is licensed for treatment of flu in people aged 7 years and older; oseltamivir can be used to treat patients from the age of 1 year and can also be used to prevent flu in patients older than 12 years. Disease experts have repeatedly warned that the world's supplies of antivirals and capacity for producing vaccine are far from adequate for coping with a flu pandemic. No decision has been made on whether vaccine or antivirals from the US stockpile could be used to help snuff out an emerging pandemic overseas, should the need arise. (CIDRAP 9/15/05 http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/sep1505hhs.html)

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USA (Wisconsin): 3 Cases of La Crosse encephalitis
The first 3 cases of La Crosse encephalitis have been reported, La Crosse County health officials stated 7 Sep 2005. A 2 year old boy from Cashton, Wisconsin contracted the mosquito-borne disease and was hospitalized for 5 days. An 8 year old girl from Westby, Wisconsin was hospitalized for one day. A 57 year old man from Boscobel, Wisconsin also was diagnosed with the disease and hospitalized. Dave Geske, La Crosse County Health Department's mosquito control officer, said initial tests showed all 3 had the La Crosse strain of the disease. Encephalitis-carrying mosquitoes were found in containers or tires near the infected people's homes or places where they often go. The peak time for La Crosse encephalitis is August and September, Geske said, adding that mosquito activity has picked up significantly in the past 2 weeks. The encephalitis-carrying mosquitoes usually remain active until the first couple of killing frosts, Geske added. About a half-dozen encephalitis cases are reported in the La Crosse area each year. La Crosse encephalitis usually affects children ages 6 to 15 and attacks the central nervous system. Symptoms include fever, headaches, stiff neck, with seizures occurring in about half the cases.

La Crosse virus is the leading cause of pediatric arboviral encephalitis in the US. According to CDC, there are about 70 human cases annually. Its main vectors are Aedes triseriatus and small mammals. La Crosse virus is present in the US to the east of the Mississippi river, and serological studies indicate that human infections occur throughout the range of the mosquito vector. The incubation period is about one week, followed by a non-specific febrile period and an acute encephalitis which may last up to 10 days. (Promed 9/9/05)

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USA (New Hampshire): Death of Eastern Equine Encephalitis Patient
State health officials say a 20-year-old Newton woman died 9 Sep 2005 of Eastern equine encephalitis (EEE). This marks the fifth confirmed case of EEE in the state this year but the first time someone has died. The woman was taken to a Boston hospital 3 Sep 2005 with symptoms of the disease. An initial test was inconclusive, but a subsequent test confirmed 10 Sep 2005 that she had the disease, Dr. Jose Montero, the state epidemiologist, said. Montero says testing of mosquitoes in the Kingston-Newton-Plaistow area have made it clear the virus has a foothold there. 4 other confirmed cases of the disease in New Hampshire involved people in Londonderry, Goffstown, Manchester, and Concord. All 4 were hospitalized and have since been released. State health officials continue to advise people to wear bug repellant along with long sleeves and long pants and to empty any standing water on their property where mosquitoes could breed. 2 of 3 patients with the illness in Massachusetts have died this year. (Promed 9/12/05)

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1. Updates
Cholera, diarrhea & dysentery
Philippines (East Nusa Tenggara)
A recent occurrence of children with severe diarrhea in Indonesia's East Nusa Tenggara province has claimed 21 lives, mostly children, over the last month. In the worst-hit area, Timor Tengah Selatan regency, 16 children reportedly died due to the diarrhea -- the cause of which was still unknown. In addition, 851 people were being treated in hospitals and health centers with similar symptoms. In Kupang regency, 5 people have died, with their deaths attributed to complications as a result of the same severe diarrhea. Head of Timor Tengah Selatan regency's Health Office, Markus NG Righuta, said 31 Aug 2005 that 28 children with nearly identical symptoms were still being treated at hospitals and health centers. (Promed 9/10/05)

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Dengue
Malaysia (Kuala Lumpur)
After 4 months of battling to control dengue, Malaysia is back on high alert, as the number of cases soared during the third week of Sep 2005. With the disease claiming 68 lives as of 10 Sep 2005, health authorities are concerned that there may be more casualties. Their worries are growing, as 9540 people in Singapore were reported to be down with the disease as of 12 Sep 2005, surpassing the previous record of 9459 in 2004. An action plan has been activated in Johor to cope with a possible increase n dengue cases following the outbreak in the neighboring republic. All over Asia, governments are scrambling to halt the spread of the disease, with the agenda topped by efforts to educate the public on the disease and control of mosquito-breeding areas, as there is no known cure for dengue. The US CDC has billed dengue as "the most important mosquito-borne viral disease affecting humans -- ahead of malaria and encephalitis -- with an estimated 2.5 billion people at risk worldwide."

Health Ministry Communicable Disease Control division director Dr Ramlee Rahmat said continued monitoring, surveillance, education and co-operation between the public and relevant authorities ensured that the situation was under control, which recorded an average of 600 cases a week. He added that the number of dengue cases had almost doubled, from 507 cases recorded between 28 Aug-3 Sep 2005, to 703 from 4-10 Sep 2005. Dr. Ramlee said that between 1 Jan-10 Sep 2005, authorities were notified of 26 099 suspected cases, with 7604 later confirmed as dengue. He said that 35.7 per cent, or 9313, of the suspected cases were reported in Selangor, followed by Federal Territory with 4072 and Perak with 2164. (Promed 9/19/05)

Malaysia (Penang)
A 46 year old woman died 17 Sep 2005 of dengue hemorrhagic fever and a 21 year old from Kampung Binjal, Bayan Lepas is suffering from the disease and in critical condition in the Penang Hospital, following an outbreak of dengue in several urban areas of the state. The State Health, Welfare and Caring Society Committee chairman P Subbaiyah called for public cooperation to prevent the spread of the disease. He said workers from the local authorities would conduct checks and also spray insecticide in suspected mosquito-breeding areas. Areas where dengue cases have occurred include Sungai Nibong, Bayan Baru, Pantai Jerejak, and Teluk Kumbar. He said people should spray their homes with mosquito repellant, especially at dawn and sunset, and rid their property of mosquito breeding grounds. (Promed 9/19/05)

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Viral gastroenteritis
Hong Kong
According to researchers, one out of every 10 imported oysters screened in Hong Kong showed evidence of contamination with norovirus. Senior investigator Dr Wilina W L Lim said, "It appears that oysters may be an important vehicle for introducing novel strains of norovirus." Outbreaks of gastric illness caused by norovirus are often linked to eating oysters, and contamination appears to be widespread, noted Lim and colleagues. They found that 10.5 per cent of 507 samples of oysters from 11 countries tested on arrival were positive for norovirus genetic material. In particular, oysters from 6 countries were contaminated, while those from the remaining 5 countries were not--but the team does not say what those countries were. A wide variety of virus strains was found, including 2 novel types. "Given the popularity of consuming raw oysters in many countries, oysters may serve (as) a vehicle for the dissemination of new norovirus strains," Lim's group concludes. Norovirus screening was also conducted following 13 outbreaks of oyster-associated gastroenteritis in hotels or restaurants in Hong Kong. Norovirus sequences were detected in at least one oyster in 6 outbreaks. However, only in one outbreak was there a match between the strains isolated from patients and those found in the oysters. (Promed 9/22/05)

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West Nile Virus
Canada
During week 35 (28 Aug 2005 - 3 Sep 2005), 41 West Nile virus cases were reported in Canada [Quebec (3), Ontario (18), Manitoba (9), Saskatchewan (10) and Alberta (1). As of 3 Sep 2005, a total of 127 human WNV cases have been reported to the Public Health Agency of Canada (PHAC). Of these cases, 119 were clinical cases and 8 were asymptomatic. Of the 119 clinical cases, 27 (23 percent) were reported as West Nile Neurological Syndrome, 66 (56 percent) were reported as West Nile Non-Neurological Syndrome, and 26 (22 percent) were Unclassified/Unspecified. 13 cases are travel-related. To date, there have been 3 deaths [Manitoba (1) and Ontario (2)] related to WNV infection. (Promed 9/17/05)

USA
As of 20 Sep 2005, 38 states have reported 1,512 cases of human WNV illness in 2005. By comparison, in 2004, a total of 1,604 WNV cases had been reported as of September 21, 2004. A total of 780 (56%) of the 1,396 cases for which such data were available occurred in males; the median age of patients was 50 years (range: 3 months--98 years). Date of illness onset ranged from January 2 to September 16; a total of 41 cases were fatal. A total of 268 presumptive West Nile viremic blood donors (PVDs) have been reported during 2005. Of these, two persons aged 53 and 56 years subsequently had neuroinvasive illness; three persons aged 17, 41 and 51 years subsequently had other illnesses; and 61 persons (median age: 47 years [range: 17--78 years]) subsequently had West Nile fever. Additional information about national WNV activity is available from CDC at http://www.cdc.gov/ncidod/dvbid/westnile/index.htm and at http://westnilemaps.usgs.gov.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5436a4.htm (MMWR September 16, 2005 / 54(36);902-903)

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2. Articles
CDC EID Journal, Volume 11, Number 10-Oct 2005
CDC Emerging Infectious Diseases Journal, Volume 11, Number 10-Oct 2005 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. The following expedited articles are available online: Respiratory Infections during SARS Outbreak, Hong Kong, 2003, J.Y.C. Lo et al. (CDC EID October 2005)

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Vibrio Illnesses After Hurricane Katrina--Multiple States, August--September 2005
“Hurricane Katrina made landfall on Aug 29, 2005, with major impact on the US Gulf Coast. During August 29–September 11, surveillance identified 22 new cases of Vibrio illness with five deaths in persons who had resided in two states. These illnesses were caused by V. vulnificus, V. parahaemolyticus, and nontoxigenic V. cholerae. These organisms are acquired from the environment and are unlikely to cause outbreaks from person-to-person transmission. No cases of toxigenic V. cholerae serogroups O1 or O139, the causative agents of cholera, were identified. This report summarizes the investigation by state and local health departments and CDC, describes three illustrative cases, and provides background information on Vibrio illnesses. Results of the investigation underscore the need for heightened clinical awareness, appropriate culturing of specimens from patients, and empiric treatment of illnesses (particularly those associated with wound infections) caused by Vibrio species. No confirmed cases of illness have been identified with onset after September 5; additional Vibrio cases are under investigation. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm54d914a1.htm (MMWR September 14, 2005 / 54(Dispatch);1-4)

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Serological analysis of serum samples from humans exposed to avian H7 influenza viruses in Italy between 1999 and 2003.
Puzelli S, Di Trani L, Faviani C, et al. J Infect Dis 2005; Oct 15.
Abstract: "We evaluated the potential for avian-to-human transmission of low pathogenic avian influenza (LPAI) and highly pathogenic avian influenza (HPAI) H7N1 and LPAI H7N3 viruses that were responsible for several outbreaks of influenza in poultry in Italy between 1999 and 2003. A serological survey of poultry workers was conducted by use of a combination of methods. Evidence of anti-H7 antibodies was observed in 3.8 percent of serum samples collected from poultry workers during the period in 2003 when LPAI H7N3 virus was circulating. These findings highlight the need for surveillance in people occupationally exposed to avian influenza viruses so that they can be monitored for the risk of avian-to-human transmission during outbreaks of avian influenza caused by both LPAI and HPAI viruses. http://www.journals.uchicago.edu/JID/journal/issues/v192n8/34097/brief/34097.abstract.html

The researchers have reported the first evidence that low-pathogenic avian influenza viruses, and not just highly pathogenic strains, can infect humans. The finding, in a study of Italian poultry workers, suggests that avian influenza viruses have more chances than previously suspected to mix with human influenza viruses, potentially creating hybrids that could trigger a human influenza pandemic. The researchers took serum samples from 983 workers at several farms in northern Italy from August 1999 until July 2003. Several avian influenza outbreaks occurred there during that period, including both LPAI and HPAI strains of H7N1 and an LPAI H7N3 strain. All the workers who tested positive had been in close contact with turkeys or chickens in dusty poultry houses. None of the workers reported any flu-like illness at the time of the avian influenza outbreaks, and only one reported symptoms of conjunctivitis. The researchers call for "permanent" surveillance for avian influenza viruses in both animals and humans and also say that poultry workers should be regularly vaccinated against ordinary flu to reduce the risk of gene-swapping between avian and human flu strains. Editorial Commentary by Frederick Hayden and Alice Croisier to the article is also available at the above URL. (Promed 9/18/05)

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Influenza Activity--US and Worldwide, May 22--Sep 3, 2005, and 2005--06 Season Vaccination Recommendations
Influenza A (H3N2) viruses circulated worldwide, and Influenza A (H1) and B viruses were reported less frequently during May 22--Sep 3, 2005. During May 22--Sep 3, 2005 WHO and NREVSS collaborating laboratories tested 14,016 respiratory specimens; 120 (0.9%) were positive for influenza. Of the positive results, 66 (55%) were influenza B viruses, 33 (28%) were influenza A (H3N2) viruses, 1 (0.8%) was an influenza A (H1) virus, and 20 (17%) were influenza A viruses that were not subtyped. The majority (78%) of these isolates were tested from mid-May through late June, during which time 1.3% of specimens tested were positive for influenza. Since July, 0.4% of specimens tested were positive for influenza. During May 22--Sep 3, the weekly percentage of patient visits to sentinel providers for ILI remained below the national baseline of 2.5% and ranged from 0.7% to 1.3%. The percentage of deaths attributable to pneumonia and influenza (P&I) as reported by the 122 Cities Mortality Reporting System remained below the epidemic threshold, and no influenza-related pediatric deaths were reported as occurring during this period.

During May 22--September 3, influenza A (H3N2) viruses predominated in Asia (China, Hong Kong, Japan, Korea, and Thailand). Influenza A (H3N2) viruses were also identified in Oman and Singapore. Influenza A (H1) viruses were reported in China, Hong Kong, India, Indonesia, Japan, Korea, and Malaysia. Influenza B viruses were reported in China, Hong Kong, Indonesia, Korea, Nepal, Philippines, and Thailand. In Oceania, during the same period, influenza A (H3N2 and non-subtyped) viruses predominated in Australia; influenza B viruses were responsible for outbreaks in New Zealand. Influenza B viruses were also reported in Australia and New Caledonia. In South America, influenza A (H3N2 and non-subtyped) viruses were associated with regional outbreaks in Argentina and Chile during May 22--September 3 and were reported in Brazil, Colombia, Peru, and Uruguay. Influenza B viruses were associated with an outbreak in Colombia in July and also were reported in Argentina, Brazil, Chile, and Uruguay. Influenza A (H1) viruses were reported in Peru. In North America, influenza A viruses (H3N2 and non-subtyped) and influenza B viruses were reported in Canada, Mexico, and the US. For more information see: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5436a3.htm (MMWR September 16, 2005 / 54(36);899-902)

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Influenza Vaccination Coverage Among Persons Aged 50--64 Years Enrolled in Commercial Managed Health-Care Plans--United States, 2003--04 and 2004--05 Influenza Seasons
“To combat an unexpected shortage of influenza vaccine in the fall of 2004, CDC issued guidance to direct available vaccine supplies to persons in designated priority groups (e.g., persons aged >65 years, persons with certain health conditions, health-care workers, and close contacts of persons at high risk for complications from influenza). Analyses of influenza vaccination coverage for the 2004--05 influenza season indicated that coverage levels for adults in priority groups nearly reached the levels of previous years, whereas coverage levels among adults not in priority groups were approximately half the levels of the 2003--04 season. These findings suggested that national public health actions to direct available vaccine supply to persons at high risk for complications from influenza during the supply disruption were successful. To assess influenza vaccination coverage among persons aged 50--64 years for the 2004--05 influenza season relative to the 2003-04 season and to estimate the effect of shortages on selected subgroups, the National Committee for Quality Assurance (NCQA) analyzed data from a survey of persons enrolled in commercial managed care health plans. This report summarizes the findings of that analysis, which indicated that, although vaccination coverage declined substantially from 2003--04 to 2004--05 among all subgroups in this age range, respondents who were older or who reported poorer health status exhibited smaller relative declines in vaccination coverage between the two seasons. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5437a2.htm (MMWR September 23, 2005 / 54(37);921-923)

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Direct and Indirect Effects of Routine Vaccination of Children with 7-Valent Pneumococcal Conjugate Vaccine on Incidence of Invasive Pneumococcal Disease--United States, 1998--2003
“Streptococcus pneumoniae (pneumococcus) is a leading cause of pneumonia and meningitis in the United States and disproportionately affects young children and the elderly. In 2000, a 7-valent pneumococcal conjugate vaccine (PCV7) was licensed in the United States for routine use in children aged <5 years. Surveillance data from 2001 and 2002 indicated substantial declines in invasive pneumococcal disease (IPD) in children and adults compared with prevaccine years. This report updates assessment of the impact of PCV7 on IPD through 2003 by using population-based data from the Active Bacterial Core surveillance (ABCs) of the Emerging Infections Program Network, a cooperative surveillance program conducted by several state health departments and CDC. The results of this analysis indicated that 1) routine vaccination of young children with PCV7 continued to result in statistically significant declines in incidence of IPD through 2003 in the age group targeted for vaccination and among older children and adults, 2) the vaccine prevented more than twice as many IPD cases in 2003 through indirect effects on pneumococcal transmission (i.e., herd immunity) than through its direct effect of protecting vaccinated children, and 3) increases in disease caused by pneumococcal serotypes not included in the vaccine (i.e., replacement disease) occurred in certain populations but were small compared with overall declines in vaccine-serotype disease. Ongoing surveillance is needed to assess whether reductions in vaccine-serotype IPD are sustained and whether replacement disease will erode the substantial benefits of routine vaccination. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5436a1.htm (MMWR September 16, 2005 / 54(36);893-897)

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3. Notifications
Avian influenza updates
A comprehensive review paper titled "Potential risk of HPAI spreading through wild water bird migration", including maps, has been prepared by FAO's avian influenza task force and published in issue No 33 of FAO-AIDE-NEWS update on the avian influenza situation, as of 1 Sep 2005. See http://www.fao.org/ag/againfo/subjects/documents/ai/AVIbull033.pdf. For the latest maps and documents from FAO, visit: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. In addition, OIE recently held a seminar on the "Structure of national Veterinary Services of OIE Member Countries in Europe" in Russia (http://www.oie.int/eng/press/en_050916.htm).

A current episode in PBS (Public Broadcasting Service)’s “Wide Angle” series examines issues surrounding avian influenza’s potential threat to public health. http://www.pbs.org/wnet/wideangle/. (Promed 9/9/05; CDC/PBS)

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Avian Influenza Protection Measures Endorsed by APEC Senior Officials
An APEC Symposium has called on APEC Member Economies to consider specific recommendations to minimize the health and economic consequences of a potential human influenza pandemic. These measures include improving information sharing between economies and fostering greater cooperation with the business sector to deal with potential threats. Other recommendations included responding to the Global Strategy for the Progressive Control of Highly Pathogenic Avian Influenza, encouraging adequate compensation for farmers with potentially infected birds and animals and basing disease-related trade restrictions on recommendations of international organizations. The recommendations were prepared by the APEC Health Task Force 'Symposium on Response to Outbreaks of Avian Influenza and Preparedness for a Human Health Emergency'. The report was presented to APEC Senior Officials meeting in Gyeongju, Korea, by Dr. Amar Bhat, the Chair of the APEC Health Task Force. Dr Bhat said the recommendations were well received by Senior Officials who acknowledged the seriousness of the potential threat posed by avian influenza. "The social and economic implications of an avian influenza pandemic are staggering and would touch people in all corners of the world," Dr. Bhat said, "The Health Task Force is committed to working with APEC officials to ensure that the region is prepared for such an eventuality." The symposium was convened in San Francisco, 28-29 July and called for APEC member economies to play a strong leadership role to avoid a human influenza pandemic by focusing on prevention through preparedness and then having a response plan ready in case there is an outbreak. To download the recommendations report, follow the link at: http://www.apec.org/apec/news___media/media_releases/150905_kor_avianfluprotectmeasuresend.html# (APEC 9/15/05)

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Fifty-sixth session of the WHO Regional Committee for the Western Pacific
WHO takes key steps to combat emerging diseases
WHO’s Committee for the Western Pacific endorsed the Asia Pacific Strategy for Emerging Diseases, which is designed to reduce the risk of infectious diseases that could have global consequences. The Asia Pacific region has become the epicentre of such epidemics, prompting the WHO Regional Offices in South-East Asia and the Western Pacific to develop a strategy to provide a regional tactical approach and build new partnerships against emerging diseases. The past few decades have seen emerging infectious diseases arrive with greater frequency and with more virulence. The pattern has changed, with animals now being the principal source of infection. SARS and avian influenza have also heightened awareness about the economic impact of emerging diseases. The Asia Pacific Strategy for Emerging Diseases is a road map to strengthen core capacities required for effective preparedness planning, prevention, surveillance, containment and control of emerging infectious diseases. Dr Shigeru Omi, WHO Regional Director for the Western Pacific, said a well developed plan of action is needed to effectively respond to these diseases. He also stressed the need for resource mobilization and donor coordination. Over 30 new infectious agents have been detected in the last three decades, 75% of which have originated in animals. New pathogens remain unpredictable and continue to emerge and spread.

WHO calls for intensified actions to reduce high infant and under-five mortality
WHO calls for intensified actions to reduce high infant and under-five mortality Some 3 000 children in the Western Pacific Region under five years of age will continue to die every day—mostly from common neonatal conditions, pneumonia and diarrhoea—unless there is greater commitment and resource mobilization by countries and areas in the Region, WHO said. WHO's governing body in the Region urged Member States to place child health higher on their political, economic and health agendas. One of UN's Millennium Development Goals—to cut under-five child mortality by two thirds between 1990 and 2015—will not be met unless there are greater efforts. WHO and UNICEF have developed a joint Regional Child Survival Strategy that aims to reduce inequities in child survival and to accelerate and sustain actions to reduce childhood mortality. The strategy advocates that all children in the Region be given access to an essential package of interventions for child survival, particularly in countries and areas of greatest need.

WHO Regional EPI targets: eliminate measles and control hepatitis B by 2012
The Western Pacific Region has identified 2012 as the target to eliminate measles and control hepatitis B. This will help to avert almost 30 000 measles-related deaths among children and reduce the 350 000 deaths from hepatitis B every year. Apart from disease-specific benefits, the initiative will also contribute to the overall strengthening and sustainability of primary health care services. However, this will need political commitment and substantial and sustained financial commitments from donors. Despite a 95% reduction in measles deaths in the Western Pacific Region since the pre-vaccine era, the illness remains a leading cause of vaccine-preventable deaths among children. In 2002, WHO estimated the measles burden in the Region might be as high as 6.7 million cases, with 30 000 deaths. The Western Pacific Region also has more than 50% of global deaths due to hepatitis B. The disease claims the lives of about 890 people per day, or 20-22 deaths per 100 000 population. The regional goal is to reduce the prevalence rate from the current level of 8%-10% to less than 2% among children under five years old by 2012. WHO is developing an Asian-Pacific Immunization and Measles Elimination partnership, which will include financial support for the less developed areas. (WHO/WPRO http://www.wpro.who.int/)

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WHO/DFID-AHP Meeting on Control of Zoonotic Diseases
With funding provided by the Animal Health Programme of the UK Department for International Development, FOS/SDE is organizing this meeting in Geneva 20-21 September 2005. The meeting will focus on the opportunities which the effective control of zoonotic diseases offer for alleviating poverty in livestock-keeping communities. Zoonotic endanger not only poor people's livelihoods by affecting their livestock, but also compromise their own health and survival. The best-known and most feared of these is rabies; others include brucellosis, bovine tuberculosis, various tapeworms and the zoonotic form of sleeping sickness. The purpose of this meeting is to bring together those involved in both the medical and veterinary aspects, and both in research and development work in the field, to report on recent research findings, especially epidemiological findings, which focus on obtaining more accurate estimates of incidence, calculations of the burden of these diseases in people and their livestock, and analyses of the risk factors which enable populations and regions at risk to be identified. (WHO http://www.who.int/mediacentre/events/2005/zoonotic_diseases/en/index.html)

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Forum on Microbial Threats workshop - "Foodborne Threats to Health," Oct. 25-26, 2005
On behalf of the Institute of Medicine, we are pleased to inform you of an upcoming two-day workshop on Foodborne Threats to Health: The Policies and Practice of Surveillance; Prevention; Outbreak Investigations; and International Coordination. The workshop is sponsored by the Institute of Medicine's Forum on Microbial Threats, chaired by Dr. Stanley Lemon, Director, Institute for Human Infections and Immunity, UTMB. The meeting agenda and a summary of the meeting objectives can be found at http://www.iom.edu/event.asp?id=28584. Register at: http://www8.nationalacademies.org/isc-registration/public/default.asp?event=A71DE0C0. If you cannot attend the workshop, you may participate in the meeting by listening to a live audio webcast and submitting questions using an e-mail form at http://national-academies.org. For more information contact: Kate Giamis, Sr. Program Assistant, The National Academies. Tel: (202) 334-2462; Fax: (202) 334-3861 (The National Academies 9/8/05)

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12th International Congress on Infectious Diseases
15-18 Jun 2006; Lisbon, Portugal
From community-acquired MRSA to hemorrhagic fever outbreaks in low-resource areas, and with internationally recognized speakers from every region of the world, the ICID provides a breadth of infectious disease updates not found in any other congress. The 12th ICID will be an especially exciting occasion, as it marks the 20th anniversary of the International Society for Infectious Diseases, its sponsoring organization. Please visit: http://www.isid.org/12th_ICID/20050811_announce.shtml. Please visit the Congress web site for the latest program updates, to submit an abstract for the scientific program beginning 1 Oct 2005, and to register for the meeting. http://www.isid.org/12th_ICID. Keryn Christiansen, President, International Society for Infectious Diseases (Promed 9/13/05)

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Symposium on relating microbiological testing and microbiological criteria to public health goals
Leading international experts on microbiological food safety testing, criteria, risk assessment and policy will gather in Washington, D.C., to discuss issues surrounding the development of a risk-based approach to the establishment of microbiological criteria and testing to improve public health. For program details, visit http://www.ilsi.org/Events/2005SymposiumDC.htm, e-mail mailto:ilsimeetings@ilsi.org or call (202) 659-0074. (APHA 9/15/05)

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4. APEC EINet activities
APEC Meeting in Korea; recommendations receive endorsement
Drs. Louis Fox and Ann Marie Kimball attended the APEC Health Task Force meeting in Gyeonju, Korea, Sep 7-11, 2005, to discuss EINet’s progress and future efforts. EINet and the Health Task Force’s recommendations regarding avian influenza preparedness received endorsement by the Senior Officials.

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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