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Vol. VIII, No. 21 ~ EINet News Briefs ~ Oct 07, 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:
- Southeast Asia: ASEAN works on avian influenza preparedness
- Indonesia: Finds H5N1-infected but healthy chickens
- Indonesia: Avian influenza human case count update
- South East Asia: Cumulative number of human cases of avian influenza A/(H5N1)
- East Asia: No new evidence of Tamiflu-resistant H5N1
- Russia: OIE mission to assess the avian influenza situation; bird flu in Urals
- Russia (Nizhniy Novgorod): Hepatitis A epidemic affects 1438 Persons
- Russia (Rostov): Crimean-Congo hemorrhagic fever cases
- Indonesia: Poliomyelitis update
- South Korea: 2 women contract HIV via blood transfusion
- USA (Washington D.C.): Tularemia detection by BioWatch; not a threat
- USA: Alert on Menactra Meningococcal Vaccine and Guillain Barre Syndrome
- USA: FDA Proposes Additional BSE Safeguards
- USA (Minnesota): Infection with polio virus reported in infant; public not at risk
- USA (Wisconsin): Salmonellosis linked to county fair
- Canada/France: Trichinellosis, black bear consumption
- Canada (Nunavut): Outbreak of HTLV-1 Infection
- Canada (Ontario): Legionnaires' Disease deaths confirmed

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

2. Articles
- The 1918 flu virus is resurrected
- Researchers map 209 flu virus genomes
- Neuraminidase inhibitors for influenza
- Incidence of Adamantane Resistance among Influenza A (H3N2) Viruses Isolated Worldwide from 1994 to 2005: a cause for concern
- Bats Are Natural Reservoirs of SARS-Like Coronaviruses
- Infectious Disease and Dermatologic Conditions in Evacuees and Rescue Workers After Hurricane Katrina--Multiple States, August--September, 2005
- Laboratory Surveillance for Wild and Vaccine-Derived Polioviruses, January 2004--June 2005
- Outbreak of Pruritic Rashes Associated with Mites--Kansas, 2004

3. Notifications
- Australia Leads Regional Response to Avian Influenza
- WHO: Partners meeting on avian influenza and human pandemic influenza
- PAHO To Assist Member Countries with Pandemic Planning
- A Warning Shot Influenza and the 2004 Flu Vaccine
- National STD Prevention Conference
- WHO: Immunization maintains strong performance made in last quarter century
- The use of malaria rapid diagnostic tests

4. APEC EINet activities
- Pandemic influenza preparedness and response: Information sharing through a virtual symposium

5. To Receive EINet Newsbriefs
- APEC EINet email list


Asia
Southeast Asia: ASEAN works on avian influenza preparedness
Southeast Asian agriculture ministers agreed on a plan to fight avian flu over the next 3 years. Ministers from the Association of Southeast Asian Nations approved a plan covering 8 "strategic areas". The areas include surveillance, an alert system, vaccination, improving diagnostic capabilities, and setting up a disease-free zone. A task force, led by Malaysia, has been assigned to develop detailed action plans and find donors for a proposed animal health trust fund. $2 million has already been pledged. The ASEAN plan complements a 3-year plan drafted by the WHO, FAO, and OIE in May 2005. Finland is also working on preparedness--it has told drug companies in Europe it wants to buy 5.2 million doses of an avian flu vaccine, enough to protect its whole population. The Finnish government has asked legislators to provide 21 million euros ($25 million) for the vaccine stockpile. Finland had an avian flu scare Aug 2005, when a flu virus was found in some gulls. But it turned out to be a low-pathogenic strain. (CIDRAP 9/30/05 http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/sep3005avian.html)

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Indonesia: Finds H5N1-infected but healthy chickens
Indonesian authorities have found chickens which tested positive for the H5N1 but which appear to be healthy. Some species of waterfowl are natural hosts of H5N1 and do not fall ill from it. But the virus has always been known to be virulent in chickens. Hong Kong's Health Minister York Chow said, "As the virus may have spread so widely (in Indonesia), chickens have now become hosts. . .We are worried that if there are infected chickens which don't show any symptoms, then if we are in close contact with them, the chances of humans getting infected will be higher." Leo Poon, a microbiologist at the Chinese University in Hong Kong, said, "We don't have all the information, and they could have just found a low pathogenic strain of H5N1 in the chickens. Or this could be a highly pathogenic strain but which has adapted itself in chickens or turned less virulent," Poon said. "But the more chickens are infected, the higher the chance of the virus spilling over to humans," he said. It is not clear which test has been carried out in the "asymptomatic chickens which tested positive for the H5N1 bird flu”. In case the test was a serological one, there could have been various reasons for the lack of clinical symptoms: a low-pathogenic virus, natural resistance of the birds, or their immunity. Such an immunity could have been established also by a heterologous H5 virus, either a wild one or a vaccine strain (mass vaccinations are reportedly being carried out in Indonesia). (Promed 10/5/05)

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Indonesia: Avian influenza human case count update
Indonesian officials said 6 Oct 2005 that 2 young men, including one who died a week ago, had proved positive for avian influenza virus. I Nyoman Kandun, Head of disease control at the Health Ministry, said specimens had been sent to a WHO-designated reference laboratory for further testing. The 2 patients were identified as a 21-year-old resident of Lampung who had been treated at the Abdul Moeloek general hospital and a 23-year-old resident of Bogor, who died at the Sulianti Saroso hospital. Quoting the results of the Reverse Transcription-Polymerase Chain Reaction test of the Research and Development Agency at the Health Ministry and Jakarta-branch Naval Medical Research Unit, Kandun said the 2 patients were positively infected with H5N1 virus. He said a team of the Health Ministry and the US CDC were conducting investigation in Lampung.

Indonesia's Health Minister lowered the country's number of confirmed human deaths from bird flu to 3 on 6 Oct 2005, in line with figures from the WHO. There had been confusion surrounding Indonesia's toll from bird flu since its first death was reported July 2005. (Until 6 Oct 2005, Indonesia had reported 6 fatalities from the virus). There have been 3 WHO confirmed fatal cases of avian H5N1 infection in Indonesia and 1 confirmed non-fatal case; there is still a large number of suspected cases (variously given by Indonesia sources as up to 75, 85, and 90), which have yet to be confirmed by WHO. Indonesia received 60 000 doses of Tamiflu for human use, mostly aid from Australia. Tamiflu will be distributed to 44 designated hospitals. In Jakarta alone, at least 20 people were treated at Sulianto Saroso hospital as suspected cases as of 4 Oct 2005; many of them had become sick after visiting the Ragunan Zoo.

The virus has spread to 22 provinces out of 33 in Indonesia, killing more than 10 million poultry since late 2003. One of the difficulties in controlling the disease is that many people in both rural and urban areas keep a few chickens and other livestock. Health Minister Siti Fadillah Supari said chickens without symptoms had been found among those kept in backyards, while commercial chickens usually died quickly when they contracted the disease. The country has come under fire for reluctance to carry out mass culling of chickens in infected areas. (Promed 10/6/05)

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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 / 8 (4) / 6 (3)
Cambodia / 4 (4) / 4 (4)
Thailand / 0 (0) / 0 (0)
Viet Nam / 68 (64) / 23 (21)
Total / 80 (72) / 33 (28)

Cumulative number of confirmed human cases of avian influenza A/(H5N1), 3 Dec 2003 to present:
124 (116) / 65 (60)
(CIDRAP 10/5/05 http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/case-count/avflucount.html)

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East Asia: No new evidence of Tamiflu-resistant H5N1
It appears a misunderstanding, not a mutation, is behind recent reports suggesting the H5N1 avian flu strain is developing resistance to Tamiflu. The professor of pharmacology from Hong Kong University quoted as warning of an emerging resistant strain of the virus says he was citing old data, not new evidence. He was trying to urge GlaxoSmithKline to reintroduce an injectable form of their rival flu drug, Relenza. The resulting report suggested Tamiflu was becoming less useful, a claim that was widely repeated. "My point is to emphasize on the introduction of injectable drugs. But they use a headline 'Resistant H5N1 appears in Vietnam," Dr. William Chui said. Chui says he was citing medical literature, including a recent New England Journal of Medicine article on human cases of avian influenza that made reference to an H5N1 isolate from Viet Nam shown to be partially resistant to oseltamivir. That discovery was made public May 2005 by WHO. When the reports quoting Chui started to circulate, flu experts sent out urgent e-mails trying to find out who had found new evidence of resistance.

Except for that one partially resistant H5N1 isolate from Viet Nam, no researchers have reported new discoveries of Tamiflu-resistant viruses isolated from human cases of H5N1, both the WHO and Tamiflu's manufacturer, Hoffman-La Roche, confirm. "There is a network of laboratories that has been set up to follow antiviral resistance among influenza strains," says Michael Perdue, a scientist in the WHO's global influenza program. "One of the first things they look at (when they get new viral isolates) is the antiviral sensitivity and resistance. And the papers that have been published thus far have shown all the strains to be sensitive." Oseltamivir is one of only 2 drugs thought to be effective against H5N1; Relenza is the other. Governments around the world have been rushing to stockpile the easier-to-administer Tamiflu as a hedge against a possible pandemic. (Tamiflu is sold in pills; Relenza is inhaled like an asthma drug.)

Everyone, including Roche, expects some resistance to Tamiflu to develop if it becomes widely used. In fact, studies have shown just that in Japan, the only market to date which has embraced Tamiflu in a serious way for seasonal influenza. Dr. Frederick Hayden of the University of Virginia says a recent study of Japanese children showed about 16 per cent developed resistance to the drug. "That's one in 6. So I would anticipate that in H5N1-infected persons that the frequency would certainly be no less," says Hayden, co-chair of an international network of scientists who monitor for resistance to neuraminidase inhibitors. But even when resistance develops, evidence suggests it may not spread easily. In the lab, viruses that develop resistance to oseltamivir pay a price; they are less fit than non- resistant viruses. That suggests it might be difficult for a resistant strain to emerge and claim dominance over non-resistance strains. So far the evidence that resistance strains are less fit has been shown only with human flu strains. Studies should be done to see if the same holds true with H5N1 viruses, he insists. (Promed 10/7/05)

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Russia: OIE mission to assess the avian influenza situation; bird flu in Urals
At the request of the OIE delegate of Russia, the OIE started on 3 Oct 2005 its expert's mission to assess the avian influenza situation of wildlife in Russia and the national measures to be taken to minimize the risk of international spread of the disease. The reference laboratory of the country and, if possible, other laboratories will be visited to assess the conditions for the laboratory in Vladimir to be part of the world wide network of OIE reference laboratories. Samples from wild birds will be collected to try to verify whether they carry H5N1. The relevant species of wild birds will also be listed in order to identify their migration routes and thus to allow the countries receiving these birds to be prepared to develop surveillance activities. This mission will be the first of a series of missions in which the OIE will offer the necessary technical and scientific collaboration to Russia needed in combating and/or preventing the disease. To see the mission goals, visit: http://www.oie.int/eng/press/en_051004.htm.

Russia's Agriculture Minister Alexei Gordeyev said 5 Oct 2005 that the situation with bird flu has stabilized. Avian flu, blamed on wild migratory birds from Southeast Asia, was first detected in Siberia July 2005 and has since spread to at least 5 other provinces. No human cases have been registered in Russia. The Minister said preventive measures were still needed. The number of towns and villages affected by the outbreak have fallen from 50 to 7. Investigators are conducting tests in 19 other settlements suspected to have bird flu cases. The latest outbreak was recorded in the Kurgan region in southern Siberia. The outbreak at the Utyatskaya farm in the Kurgan region was the first to be recorded in the region. More than 1/5 of the farm's 460 000 birds have died and authorities will likely cull the rest. The farm stopped sales 28 Sep 2005 when the first birds died. (Promed 10/5/05, 10/6/05; OIE 10/4/05 http://www.oie.int/eng/press/en_051004.htm)

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Russia (Nizhniy Novgorod): Hepatitis A epidemic affects 1438 Persons
According to the Department of Public Health of the Nizhniy Novgorod region, as of 3 Oct 2005, the number of cases of hepatitis A has risen to 1438. The number of children who have fallen ill since the beginning of outbreak 5 Sep 2005 now exceeds 200. The Nizhniy Novgorod city administration and medical services are continuing to undertake preventative measures to contain the outbreak. During the final week of Sep 2005, 600 shops in all 8 districts of the city have been closed. Some 300 homeless persons have been detained, 10 of whom were found to be suffering from hepatitis A infection. In addition, about 64 000 people have received hepatitis A vaccination. Preliminary reports on the source of the epidemic point to defects in the region's sewer system as the probable cause of the outbreak. (Promed 9/29/05, 10/3/05)

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Russia (Rostov): Crimean-Congo hemorrhagic fever cases
16 cases of Crimean-Congo hemorrhagic fever (CCHF) have been recorded in the Rostov region since the beginning of 2005. One resident of the region has died from CCHF. 38 cases of CCHF have been recorded in the Stavropol region, 37 in the Astrakhan region and about 30 in the Volgograd region. Since 1999, when 26 persons were diagnosed with CCHF in Oblivskaya village, and 6 persons died from this disease, there have been only 6 to 9 cases recorded annually in the Rostov region. Predominantly, these cases have occurred in the southeastern districts of the region. More than RUB 2.5 million [USD 872 000] have been allocated for diagnostic procedures and for preventive measures. Measures taken to control the tick population of the area have been relatively successful in containing the disease and identifying foci of infection. However, despite tick control measures, the presence of CCHF virus antigen has been detected in almost all southeastern districts of the region and also close to the regional center [Rostov-on-Don]. (Promed 10/3/05)

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Indonesia: Poliomyelitis update
11 new poliovirus cases were confirmed from Banten, Lampung and Central Java provinces. The total number of poliovirus cases is now 251. Lampung and Central Java provinces were not included in 2 emergency vaccination campaigns held 31 May and 28 Jun 2005. The first round of the National Immunization Days was held 30 Aug 2005; the second round was conducted 27 Sep 2005, targeting each time 24.4 million children less than 5 years of age throughout the country. Prior to this outbreak caused by an importation of type 1 wild poliovirus, Indonesia had not had a wild poliovirus case since 1995. According to the WHO South East Asian Regional Office, there have been a total of 271 cases reported in Indonesia in 2005 of which 20 are type 1 Vaccine-Derived Polioviruses (VDPV) from Madura Island <http://w3.whosea.org/EN/Section1226.asp>. (the total number of cases of 251 above excludes the 20 cases associated with VDPV). The remaining isolates identified have been wild poliovirus type 1. This report suggests that there was continued circulation of wild poliovirus on the islands of Java and in the southeasternmost province of Sumatra (Lampung). (Promed 9/30/05)

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South Korea: 2 women contract HIV via blood transfusion
2 South Korean women have been infected with the AIDS virus after receiving a transfusion of HIV-tainted blood, South Korean Red Cross confirmed. The women, both in their 30s, caught the virus through transfusion of blood donated by a 23-year-old man, in August 2003. (AIDS_ASIA@yahoogroups.com 9/29/05 http://au.news.yahoo.com/050929/3/w5g9.html)

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Americas
USA (Washington D.C.): Tularemia detection by BioWatch; not a threat
Small amounts of a bacterium that causes tularemia were found on Washington's National Mall 24-25 Sep 2005. CDC said several environmental air monitors in the Mall area detected low levels of Francisella tularensis. Public health agencies had no reports of any related human or animal illnesses caused by the bacteria. CDC issued an alert 30 Sep 2005 as a precaution so medical personnel were aware of the situation and could report any suspected cases. Tularemia does not transmit from person to person and can be effectively treated with available medicines. Symptoms usually appear 3 to 5 days after exposure, but in rare cases can take up to 2 weeks. Symptoms of the disease include sudden fever, chills, headaches, conjunctivitis, diarrhea, muscle aches, joint pain, dry cough and progressive weakness.

Health officials said 1 Oct 2005 that the detected bacteria is not harmful and probably occurred naturally. The Department of Homeland Security delayed in alerting CDC because subsequent tests were not conclusively positive, said Richard Besser, who directs the CDC's coordinating office for terrorism preparedness and emergency response. CDC was not contacted for at least 72 hours. Testing never identified all the definitive markers, and officials were wary of issuing a false alarm. Besser acknowledged that the 2 agencies need to review their protocol. Besser said that if the initial evaluation had revealed true positives, the lab would have immediately contacted Homeland Security, which would have immediately brought CDC and local agencies into the discussion. It appears from this report that confirmatory tests were positive, although the levels detected were rather low to be considered a threat.

A similar incident occurred in Texas in October 2003, when 2 air sensors detected fragments of tularemia bacteria. There were no human cases of tularemia reported after the incident, and some experts in the bioterror field said they believe the incident was actually spurred by a strain of the bacterium that does not affect humans. Although not many human cases are reported in the USA each year, almost every state has reported cases. People can get tularemia by being bitten by an infected tick, deerfly or other insect, handling infected animal carcasses, eating or drinking contaminated food or water or breathing in the organisms. For more information on BioWatch: http://www.fas.org/sgp/crs/terror/RL32152.html#_1_3. (Promed 10/5/05)

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USA: Alert on Menactra Meningococcal Vaccine and Guillain Barre Syndrome
The Food and Drug Administration and CDC are alerting consumers and health care providers to 5 reports of Guillain Barre Syndrome (GBS) following administration of Meningococcal Conjugate Vaccine A, C, Y, and W135 (trade name Menactra), manufactured by Sanofi Pasteur. It is not known yet whether these cases were caused by the vaccine or are coincidental. GBS is a serious neurological disorder that can occur, often in healthy individuals, either spontaneously or after certain infections. GBS typically causes increasing weakness in the legs and arms that can be severe and require hospitalization. Meningococcal infection, which Menactra prevents, is a major cause of bacterial meningitis, affecting approximately one in 100 000 people annually. 10-14 percent of cases are fatal and 11-19 percent of survivors may have permanent disability. There are no changes in recommendations for vaccination; individuals should continue to follow their doctors' recommendations. FDA and CDC are not able to determine whether any or all of the cases were due to vaccination. One possibility to consider is whether the syndrome was related to an infection caused by Campylobacter. In the US, Campylobacter is linked to up to 40 percent of GBS cases. FDA and CDC are asking any persons with knowledge of any possible cases of GBS occurring after Menactra administration to report them to the Vaccine Adverse Event Reporting System (VAERS: http://www.vaers.hhs.gov; 1-800-822-7967).

All 5 patients were 17 or 18 years of age and developed weakness or abnormal sensations in the arms or legs 2-4 weeks after vaccination. All individuals are reported to be recovering or to have recovered. More than 2.5 million doses of Menactra vaccine have been distributed to date. The rate of GBS based on the number of cases reported following administration of Menactra is similar to what might have been expected to occur by coincidence. However, the timing of the events is of concern. Also, vaccine adverse events are not always reported to FDA, so there may be additional cases unreported at this time.

Information on the background incidence of meningococcal meningitis in the US can be found in the 27 May 2005 Recommendations and Reports Issue of MMWR Vol. 54 (RR07): 1-21, Prevention and Control of Meningococcal Disease Recommendations of the Advisory Committee on Immunization Practices http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5407a1.htm. In 1976, there was an outbreak of GBS in the USA following administration of the Swine Flu vaccine. A good review of this episode and on GBS (and other suspected neurologic events associated with receipt of Influenza vaccine) can be found in the Institute of Medicine's publication Immunization Safety Review: Influenza Vaccines and Neurological Complications http://www.nap.edu/catalog/10822.html?onpi_newsdoc0309090865.

*** CDC MMWR has posted a Dispatch regarding these 5 cases:
Guillain-Barré Syndrome Among Recipients of Menactra Meningococcal Conjugate Vaccine--United States, June-July 2005. October 6, 2005 / 54(Dispatch);1-3 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm54d1006a1.htm
(FDA http://www.fda.gov/bbs/topics/NEWS/2005/NEW01238.html; Promed 10/2/05)

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USA: FDA Proposes Additional BSE Safeguards
The Food and Drug Administration announced new measures to help further protect consumers against the agent thought to cause bovine spongiform encephalopathy. The Agency is proposing to amend its animal feed regulations to prohibit from use in the food or feed of all animals certain high risk cattle materials that can potentially carry the BSE-infectious agent. All of the proposed prohibitions, except for those related to tallow, have already applied to cattle feed since 1997. These high risk cattle materials prohibited in the proposed rule include: the brains and spinal cords from cattle 30 months of age and older; the brains and spinal cords from cattle of any age not inspected and passed for human consumption; the entire carcass of cattle not inspected and passed for human consumption if the brains and spinal cords have not been removed; tallow that is derived from the materials prohibited by this proposed rule if the tallow contains more than 0.15 percent insoluble impurities; mechanically separated beef that is derived from the materials prohibited by this proposed rule.

The proposed regulation builds on a series of firewalls that include FDA's 1997 feed regulation which prohibits the use of certain mammalian-origin proteins in ruminant feed, but allows these materials to be used in feed for non-ruminant species. The removal of high-risk materials from all animal feed -- including pet food -- will protect against the transmission of the agent of BSE that could occur either through cross-contamination of ruminant feed with non-ruminant feed or feed ingredients during feed manufacture and transport, or intentional or unintentional misfeeding of non-ruminant feed to ruminants on the farm. Comprehensive information about FDA's work on BSE and links are available at http://www.fda.gov/oc/opacom/hottopics/bse.html. (FDA 10/4/05 http://www.fda.gov/bbs/topics/news/2005/new01240.html)

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USA (Minnesota): Infection with polio virus reported in infant; public not at risk
The Minnesota Department of Health (MDH) is investigating a reported case of infection with the polio virus in an infant. The infant, who had previously been diagnosed with immune system problems, does not have symptoms of the paralytic illness that can result from a polio infection. The infant is currently hospitalized. Health Department officials emphasize that only people who have had direct contact with the infant -- including un-immunized health care providers and family members -- are at any risk of illness in connection with this case. At this time, no additional cases have been reported in connection with the infant. The general public is at no risk. This is the first case of polio infection reported in the U.S. since 2000, when use of live-virus oral polio vaccine (OPV) was discontinued in the U.S. All polio vaccinations in the U.S. are now done with an inactivated poliovirus vaccine. Before use of OPV was discontinued, it caused about 8 cases of paralytic polio a year in the U.S. The last case of infection with the wild poliovirus and not a vaccine derived virus in the U.S. was reported in 1979. Naturally-occurring polio is considered to be eradicated in the western hemisphere.

MDH says the virus strain found in the infant appears to be a variant of the strain used in the oral vaccine, which is still used in parts of the world. It is unknown how the infant became infected, but the virus is transmitted through direct contact with the stool or oral secretions of an infected person. OPV has been associated with rare cases of vaccine associated paralytic poliomyelitis (VAPP) in individuals who have directly received the vaccine and in those who have had contact with recently vaccinated individuals. In addition, there have been reports of cases of paralytic poliomyelitis associated with circulating vaccine derived polioviruses (cVDPV) where there has been a reversion to neurovirulence of the involved circulating vaccine derived virus. MDH officials say this unusual case should serve as a reminder to make sure that all of your immunizations are current and that children receive immunizations as recommended. (Promed 10/2/05)

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USA (Wisconsin): Salmonellosis linked to county fair
Walworth County health officials have identified and linked at least a dozen cases of salmonella poisoning to the Walworth County Fair. The minor outbreak was traced back to the swine barn, said Pat Grove, health officer with the Walworth County Health and Human Services Department. Since the discovery, samples of pig feces were analyzed as a possible source of the bacteria. All tests returned negative--the barns had been cleaned before the testing, and samples were limited. All 12 of the infected people, including an adult and 11 children between ages 4 and 17, have recovered. 1 victim was hospitalized and since has been released. Grove doesn't expect any other cases to be directly linked to the fair because the disease's incubation period has passed. These were the first reports of salmonella poisoning linked to the fair since it started 156 years ago. The fair has taken significant safety precautions: Anti-bacterial hand-washing stations are set up at many of the animal barn entrances, and signs encourage fairgoers to wash after leaving animal barns. No food is allowed inside animal barns. (Promed 10/1/05)

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Canada/France: Trichinellosis, black bear consumption
The French National Reference Center on trichinellosis was informed 23 Sep 2005 of suspected cases of trichinellosis in a group of 10 hunters returning from a trip in Canada. On 30 Aug 2005, these hunters ate barbecued meat from a black bear killed the same day in Northern Quebec. The first signs and symptoms (fever, myalgia, facial edema, increased levels of muscular enzymes in the serum, high levels of blood eosinophils) were observed 10-15 days after the consumption of the meat in 9 hunters. 2 hunters brought back bear meat that was shared with relatives. One meal involved, 2 Sep 2005, 9 consumers (including 3 hunters previously contaminated); 3 additional patients acquired the disease during this meal. A second meal involved, 6 Sep 2005, 8 consumers (including 1 hunter previously contaminated); these consumers are still symptom-less and were informed of the potential risk of trichinellosis. Biological tests are in progress, and their physicians were advised to give them a prophylactic regimen of albendazole. So far, 12 patients (of whom 7 are hospitalized) have typical symptoms. Epidemiological and biological investigations are in progress in the 11 other consumers.

Organized travel for hunting in northern Canada are becoming more and more popular. Participants in such travels should be informed of the risk of acquiring trichinellosis by consuming raw or rare meat of wild carnivores. Trichinellosis in northern Canada is particularly frequent, and black bear meat is a frequent source. A particular feature of Trichinella infection is the widespread distribution of cases seen when meat is transported from one country to another or sent to others by mail. (Promed 9/27/05)

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Canada (Nunavut): Outbreak of HTLV-1 Infection
Nunavut health officials have begun a territory-wide search for people infected with a rare cancer-causing blood virus, after discovering an outbreak of HTLV-1 [human T-lymphotropic virus 1] infection. Dr. Isaac Sobol, Nunavut's Chief Medical Officer of Health, said, "So far, we've identified several people -- less than 20 -- who test positive." HTLV-1 is a retrovirus in the same family as HIV. The vast majority of people infected with HTLV-1 show no symptoms, said Dr. Sobol. But for about 5 percent of those infected, the virus can cause degenerative nerve disease leading to loss of control of the legs and bladder. It can also cause leukemia and non-Hodgkin's lymphoma. Like HIV, it is most commonly spread through unprotected sex and blood-to-blood contact, such as sharing needles. An infected woman can also pass it on to her fetus, as well as to her child during breast-feeding.

There is no cure for HTLV-1 infection. Symptoms take between 10 to 20 years to appear. Nunavut's first case of HTLV-1 was discovered June 2005 in a person with leukemia. Sobol said he doubts there have been any new infections. “We’ve been doing intensive work with the individuals involved, and we've been doing our contact tracing. I believe we've taken all reasonable steps to protect the public at this time." Since the virus was found, all blood samples taken in Nunavut have been tested for HTLV-1. That testing will continue until officials can properly assess its prevalence in the territory. Confidential, free tests will be available to anyone in Nunavut who asks for one. HTLV-1 is very rare in Canada that it's not a reportable disease in many Jurisdictions. The Canadian Blood Service, which has screened for HLTV-1 since 1990, reports that, out of roughly 900 000 blood donations received every year, only 10 or 12 are found contaminated with HLTV-1. The virus is endemic in Southern Japan, the Caribbean, Papua New Guinea and parts of Africa. In Nunavut, providers have been briefed to give blood tests and advice. HTLV-1 testing will be added to prenatal screening tests. (Promed 10/2/05)

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Canada (Ontario): Legionnaires' Disease deaths confirmed
The mystery disease that has killed 16 people at a Toronto nursing home has been identified. 3 of the 16 people who died at the 7 Oaks Home for the Aged tested positive for Legionnaires' Disease, Dr. David McKeown, Toronto's medical health officer, said. Dr. McKeown said there have been no new deaths and it appears that the cases have been waning. The bacteria that cause the illness are found in water. Legionellosis is not an airborne disease. Toronto Mayor David Miller emphasized that the city's general population has never been at risk. All 16 people who died of the illness that surfaced 25 Sep 2005 were elderly and frail. The latest victims were 3 men, who were 75, 84 and 89, and 3 women, who were 85, 92 and 96. In all, 70 residents were affected, along with 13 staff members and 5 visitors. Since the until-now mystery illness appeared, officials have emphasized that it is in no way comparable to SARS in 2003 that killed 44 people in the city. Toronto's economy was hit hard following the SARS outbreak. Ontario Premier Dalton McGuinty insisted that medical experts have concluded that the bacterium was contained and that it posed no threat of spreading. Earlier tests had shown that samples were negative for key respiratory pathogens (e.g. influenza viruses, SARS, other common respiratory pathogens) and the attack rate and mortality rate were not out of the expected range for long-term care facility outbreaks. (Promed 10/5/05, 10/6/05)

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1. Updates
Cholera, diarrhea & dysentery
Seasonal influenza activity for the Asia Pacific and APEC Economies, 1 September 2005
Influenza activity was low during weeks 34-37

Australia. Influenza A activity declined further since week 34. Sporadic activity reported in week 37.

Hong Kong. Low Influenza activity continued during weeks 34–37.

New Zealand. Influenza B activity declined further and sporadic activity was reported during weeks 34 and 37 with ILI consultation rates similar to those at the same time last year.

Other reports. During weeks 34–37, low influenza activity was detected in Canada (H1 and H3), Japan (H3), Mexico (H3), Peru (H1, H3 and A), and Thailand (H3 and B). Philippines reported no influenza activity. (WHO 10/3/05 http://www.who.int/csr/disease/influenza/update/en/ )

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Dengue
Singapore
The death toll from Singapore's worst dengue fever outbreak on record has risen to 11 with total cases in 2005 now approaching 11 000. A 39-year-old mother of 3 suffering from diabetes became the eleventh fatality from the disease this year. Singapore has launched an all-out campaign to eradicate mosquito breeding grounds. A total of 714 new cases were reported in the week ending 24 Sep 2005, on top of 10 200 cumulative cases previously reported. Singapore authorities have engaged foreign and local experts to study the crisis and advise the government on the best strategy. Singapore has 4.2 million people and imposess penalties for failing to remove stagnant water in private homes. The government is spending 30 million Singapore dollars (18 million US) to fight dengue and has been waging a "search and destroy" campaign against potential mosquito breeding areas. Construction sites used to be the main source of dengue-carrying mosquitoes, but homes are now the main culprit. (Promed 9/27/05)

Malaysia (Penang)
A Malaysian housewife pregnant with twins has died after contracting dengue fever, pushing the nationwide death toll from dengue this year to 70. The 26-year-old woman died at a hospital in the northern Penang state. Her 7-month twin fetuses also did not survive. She was the third person to die from the virus in 2005 in Penang. In southern Negeri Sembilan state, 5 people have so far died due to dengue fever and more than 42 cases were detected last week, a 2-fold increase compared to the preceding week. Dengue has infected more than 7000 people across the country so far this year. Negeri Sembilan's chief minister Mohamad Hassan said villagers and farmers failed to keep abandoned buildings and mosques clean. The US CDC has called dengue this year's "most important mosquito-borne viral disease affecting humans"--ahead of malaria and encephalitis--with an estimated 2.5 billion people at risk worldwide. WHO said Vietnam, Malaysia, Thailand, the Philippines, and Singapore all had a large number of dengue cases this year and have scrambled to curtail the spread of the disease. (Promed 9/27/05)

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Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies
Influenza activity was low during weeks 34-37

Australia. Influenza A activity declined further since week 34. Sporadic activity reported in week 37.

Hong Kong. Low Influenza activity continued during weeks 34–37.

New Zealand. Influenza B activity declined further and sporadic activity was reported during weeks 34 and 37 with ILI consultation rates similar to those at the same time last year.

Other reports. During weeks 34–37, low influenza activity was detected in Canada (H1 and H3), Japan (H3), Mexico (H3), Peru (H1, H3 and A), and Thailand (H3 and B). Philippines reported no influenza activity. (WHO 10/3/05 http://www.who.int/csr/disease/influenza/update/en/ )

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West Nile Virus
Canada
During week 38 (18 Sep - 24 Sep 2005), 16 West Nile virus (WNV) clinical cases [New Brunswick (1), Quebec (1),Ontario (7), Manitoba (4), and Saskatchewan (3)] were reported in Canada . As of 24 Sep 2005, 203 WNV clinical cases and 10 asymptomatic infections have been reported to the Public Health Agency of Canada. Of the 203 clinical cases, 42 (21 percent) were reported as West Nile Neurological Syndrome, 149 (73 percent) were reported as West Nile Non-Neurological Syndrome, and 12 (6 percent) were Unclassified/Unspecified. To date, there have been 9 deaths [Saskatchewan (1), Manitoba (1), Ontario (6) and Quebec (1)] in patients with WNV infection. (Promed 10/1/05)

USA
As of 4 Oct 2005, 41 states have reported 2,016 cases of human WNV illness in 2005. By comparison, in 2004, a total of 1,865 WNV cases had been reported as of October 5, 2004. A total of 1,058 (57%) of the 1,865 cases for which such data were available in 2005 occurred in males; the median age of patients was 51 years (range: 3 months--98 years). Date of illness onset ranged from January 2 to September 29; a total of 55 cases were fatal. A total of 345 presumptive West Nile viremic blood donors (PVDs) have been reported during 2005. Of these, 3 persons aged 53, 56, and 72 years subsequently had neuroinvasive illness; 7 persons (median age: 25 years) subsequently had other illnesses; and 76 persons (median age: 46 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/mm5439a8.htm (MMWR October 7, 2005 / 54(39);999)

West Nile Virus Infections in Organ Transplant Recipients--New York and Pennsylvania, August--September, 2005
“In September 2005, West Nile virus infection was confirmed in three of four recipients of organs transplanted from a common donor. Two recipients subsequently had neuroinvasive disease, one recipient had asymptomatic WNV infection, and a fourth recipient apparently was not infected. This report summarizes the ongoing investigation. Clinicians should be aware of the potential for transplant-associated transmission of infectious disease. . . . This report describes the second report of WNV transmission associated with organ transplant. . . ” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm54d1005a1.htm (MMWR October 5, 2005 / 54(Dispatch);1-3)

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2. Articles
The 1918 flu virus is resurrected
The recreation of one of the deadliest diseases known could help us to prevent another pandemic. Or it might trigger one, say critics. In this issue of Nature, scientists publish an analysis of the full genome sequence of the 1918 human influenza virus. And in this week's Science, researchers describe how they used that sequence to recreate the virus and study its effects in mice. Some scientists have already hailed the work as giving unprecedented insight into the virus. Working out how it arose and why it was so deadly could help experts to spot the next pandemic strain and to design appropriate drugs and vaccines in time, they say. But others have raised concerns that the dangers of resurrecting the virus are just too great.

Jeffery Taubenberger of the Armed Forces Institute is the lead author of the sequencing study. He says the work was necessary and the risks were low. The full sequence is strong evidence that the 1918 flu virus is derived wholly from an ancestor that originally infected birds. In contrast, the viruses that caused the flu pandemics of 1957 and 1968 arose when human and avian flu viruses infected the same person at the same time, allowing their genes to mix. All 8 of the genome segments from the 1918 virus differ in important ways from other human flu sequences, suggesting that none of the genome came from a strain that had previously infected people. Pinpointing exactly which genetic mutations allowed the virus to jump to humans will enable scientists to recognize other bird viruses that could trigger a pandemic. Taubenberger's team has already identified 25 changes in the protein sequences of the 1918 strain that have been present in subsequent human flu viruses. One such change was found in the virus isolated from the only human fatality in a 2003 outbreak of H7N7 bird flu in the Netherlands.

In the paper in Science, Terrence Tumpey and his co-workers have used Taubenberger's sequence to recreate the complete 1918 virus. When they used the strain to infect mice they found it was extremely virulent. The researchers compared the complete 1918 virus with strains in which some genes had been replaced by those of contemporary strains. They found that replacing the haemagglutinin gene, which helps the virus to enter cells, made it unable to kill mice. Replacing all three of the polymerase genes, which allow the virus to replicate, significantly reduced its virulence. The haemagglutinin gene is essential, says Tumpey. "But no single change or gene is the answer," adds Taubenberger. "It's a combination effect." Future research will involve testing reconstructed viruses with and without certain mutations, to see which are the most important for virulence.

But the studies have also sparked fears. Richard Ebright, a bacteriologist at Rutgers University, said, "Tumpey et al. have constructed, and provided procedures for others to construct, a virus that represents perhaps the most effective bioweapons agent now known." "This would be extremely dangerous should it escape, and there is a long history of things escaping," says Barbara Hatch Rosenberg, a molecular biologist and member of the Federation of American Scientists' Working Group on Biological Weapons. Tumpey counters that even if the virus did escape, it wouldn't have the same consequences as the 1918 pandemic. Most people now have some immunity to the 1918 virus because subsequent human flu viruses are in part derived from it. And, in mice, regular flu vaccines and drugs are at least partly effective against an infection with reconstructed viruses that contain some of the genes from 1918 flu. Philip Campbell, editor-in-chief of Nature, and Donald Kennedy, editor-in-chief of Science, agree that the benefits outweigh the risks. The US National Science Advisory Board for Biosecurity reached a similar conclusion. Taubenberger admits there can be no absolute guarantee of safety: "We are aware that all technological advances could be misused. . . .But what we are trying to understand is what happened in nature and how to prevent another pandemic. In this case, nature is the bioterrorist."

The references for the 2 papers published in Nature and Science are the following: Jeffery K. Taubenberg et al. Nature 437, 889-893, 2005; and T. M. Tumpey et al. Science 310, 77 80; 2005. (Promed 10/6/05; Nature http://www.nature.com/news/2005/051003/full/437794a.html)

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Researchers map 209 flu virus genomes
Researchers marked a milestone by publishing a report on the complete genetic mapping of 209 samples of human flu viruses. The report in Nature is one of the first fruits of the Influenza Genome Sequencing Project, which aims to trace the genetic blueprints of thousands of flu viruses. NIAID Director Anthony Fauci said the new information could lead to better vaccines, drugs, and diagnostic tools for flu. Ghedin and colleagues say that until now, scientists had fully mapped and published the genomes of only a few strains of human flu viruses. Most of the published data pertain to short fragments of the genes for the virus's two key surface proteins, hemagglutinin and neuraminidase. The samples analyzed include 207 H3N2 viruses and two H1N2 isolates, which were gathered in New York state from 1998-99 through 2003-04 flu seasons. "Even within a geographically constrained set of isolates, we have found surprising genetic diversity, indicating that the reservoir of influenza A strains in the human population—and the concomitant potential for segment exchange between strains—may be greater than was previously suspected," they write. They detected a number of mutations that occurred during the study period, and also found 3 cases in which strains traded whole gene segments (reassortments). By carefully cataloging mutations and reassortments, "we can begin to get the first real picture of the rate of mutational events underlying influenza A virus evolution," they write. The flu genome sequencing project is now being expanded to include avian flu, in an effort to learn how often avian strains cross into humans.

Reference: Ghedin E, Sengamalay NA, Shumway M, et al. Large-scale sequencing of human influenza reveals the dynamic nature of viral genome evolution. Nature 2005 Oct 5 (advance online publication)
(CIDRAP 10/6/05 http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/oct0605flugenes.html)

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Neuraminidase inhibitors for influenza
Anne Moscona
Introduction: “The impact of influenza infection is felt globally each year when the disease develops in approximately 20 percent of the world's population. In the United States, influenza infections occur in epidemics each winter, generally between late December and early March. Recent events, including human cases of avian influenza, have heightened awareness of the threat of a pandemic and have spurred efforts to develop plans for its control. Although vaccination is the primary strategy for the prevention of influenza, there are a number of likely scenarios for which vaccination is inadequate and effective antiviral agents would be of the utmost importance. During any influenza season, antigenic drift in the virus may occur after formulation of the year's vaccine has taken place, rendering the vaccine less protective, and outbreaks can more easily occur among high-risk populations. In the course of a pandemic, vaccine supplies would be inadequate. Vaccine production by current methods cannot be carried out with the speed required to halt the progress of a new strain of influenza virus; therefore, it is likely that vaccine would not be available for the first wave of spread of virus. Antiviral agents thus form an important part of a rational approach to epidemic influenza and are critical to planning for a pandemic. . . .” (NEJM 9/29/05 http://content.nejm.org/cgi/content/full/353/13/1363)

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Incidence of Adamantane Resistance among Influenza A (H3N2) Viruses Isolated Worldwide from 1994 to 2005: a cause for concern
Rick A Bright et al. Lancet. 2005 Oct 1;366(9492):1175-81. Epub 2005 Sep 22.
Abstarct: “Adamantanes have been used to treat influenza A virus infections for many years. Studies have shown a low incidence of resistance to these drugs among circulating influenza viruses; however, their use is rising worldwide and drug resistance has been reported among influenza A (H5N1) viruses isolated from poultry and human beings in Asia. We sought to assess adamantane resistance among influenza A viruses isolated during the past decade from countries participating in WHO's global influenza surveillance network. We analysed data for influenza field isolates that were obtained worldwide and submitted to the WHO Collaborating Center for Influenza at the US Centers for Disease Control and Prevention between 1 Oct 1994, and 31 Mar 2005. We used pyrosequencing, confirmatory sequence analysis, and phenotypic testing to detect drug resistance among circulating influenza A H3N2 (n=6524), H1N1 (n=589), and H1N2 (n=83) viruses. More than 7000 influenza A field isolates were screened for specific amino acid substitutions in the M2 gene known to confer drug resistance. During the decade of surveillance, a significant increase in drug resistance was noted, from 0.4 percent in 1994-1995 to 12.3 percent in 2003-2004. This increase in the proportion of resistant viruses was weighted heavily by those obtained from Asia, with 61 percent of resistant viruses isolated since 2003 being from people in Asia. Our data raise concerns about the appropriate use of adamantanes and draw attention to the importance of tracking the emergence and spread of drug-resistant influenza A viruses.”

Resistance to amantadine and rimantadine has been recorded previously, but the high frequency of resistant virus where these drugs have been used extensively over a considerable period suggests that their future usefulness will be limited. In places such as China, drug resistance exceeded 70 percent, suggesting that these drugs will probably no longer be effective for treatment or as a preventive in pandemic flu. (Promed 9/30/05)

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Bats Are Natural Reservoirs of SARS-Like Coronaviruses
Wendong Li, et al. Science, page 11183911
http://www.sciencemag.org/cgi/content/abstract/1118391v1?etoc
Abstract: “Severe acute respiratory syndrome (SARS) emerged in 2002-3 in southern China. The origin of its etiological agent, the SARS coronavirus (SARS-CoV), remains elusive. Here we report that species of bats are a natural host of coronaviruses closely related to those responsible for the SARS outbreak. These viruses, termed SARS-like coronaviruses (SL-CoV), display greater genetic variation than SARS-CoV isolated from humans or civets. The human and civet isolates of SARS-CoV nestle phylogenetically within the spectrum of SL-CoVs, indicating that the virus responsible for the SARS outbreak was a member of this coronavirus group.”

Thus study reports that the likely source of SARS is the horseshoe bat. They say the virus may have needed to infect another animal such as the civet before it could transmit to humans. They suggest that live horseshoe bats should be kept out of markets until the transmission path is fully understood. In May 2003, the suggestion emerged that the virus responsible had entered the human population from civets. WHO endorsed this link early in 2004, an announcement which led authorities in China to cull an estimated 10 000 civets killed. But for some time, the prevailing theory has been that civets were not the reservoir. One clue is that they appear to have little immunity, and become seriously ill; whereas species which harbor pathogens for a long period of time usually adapt to them. Civets could be an "amplifier host" for SARS. If they are, one suggestion, according to Peter Daszak, who was also involved in the study, is to keep them away from horseshoe bats. "In the east Asian region, we need to face up to high-risk behaviours," he said, "and in this situation, bringing these species into live markets, butchering and eating them and using them in medicines, is a high-risk behavior. . . These bats have a wide distribution in Europe and Asia, and what we don't know, and need to know urgently, is the distribution of the SARS-like coronavirus in these bats. The last thing we should do is to take it out on the bats, because the evidence suggests that they have carried this coronavirus for thousands, perhaps millions of years; only recently has it emerged in a big way, and it was human behaviours that made the difference." (Promed 9/30/05)

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Infectious Disease and Dermatologic Conditions in Evacuees and Rescue Workers After Hurricane Katrina--Multiple States, August--September, 2005
“On August 29, 2005, Hurricane Katrina struck states along the Gulf Coast of the United States. In the days after the hurricane struck, approximately 750 evacuation centers were established in at least 18 states to accommodate more than 200,000 evacuees. State and local health departments, with assistance from CDC, initiated enhanced infectious disease surveillance and outbreak response activities, implemented by teams of public health and rescue workers, including military personnel. Outbreak monitoring included direct reporting of conditions of public health significance to public health agencies; daily contact between CDC and local public health officials; canvassing of reports from CDC, public health departments, and news media for potential infectious disease outbreaks; and investigation of reports of infectious disease with outbreak potential. This report summarizes infectious disease and dermatologic conditions reported during the first 3 weeks after the hurricane, before effective local surveillance was fully implemented. One outbreak of norovirus was reported among evacuees in Texas; no other outbreaks requiring unusual mobilization of public health resources were reported among evacuees or rescue workers. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5438a6.htm

***For more information on Katrina, visit: http://www.bt.cdc.gov/disasters/hurricanes/index.asp (MMWR September 30, 2005 / 54(38);961-964)

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Laboratory Surveillance for Wild and Vaccine-Derived Polioviruses, January 2004--June 2005
“A global network of 145 virology laboratories has been established by the World Health Organization (WHO) to support surveillance activities of the Polio Eradication Initiative (PEI). The Global Polio Laboratory Network analyzes stool specimens from patients with acute flaccid paralysis (AFP) and environmental samples for the presence of polioviruses. Surveillance systems detect at least one AFP case per 100,000 persons aged <15 years, collect adequate stool samples from patients, and send the samples to network laboratories for analysis. Laboratory data are used to identify locations where wild polioviruses (WPVs) or vaccine-derived polioviruses (VDPVs) are circulating, target supplementary immunization activities (SIAs) to interrupt transmission chains, and investigate genetic relationships among viral isolates. This report updates previous publications and describes the laboratory network's performance during the period January 2004--June 2005. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5438a5.htm (MMWR September 30, 2005 / 54(38);958-961)

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Outbreak of Pruritic Rashes Associated with Mites--Kansas, 2004
“In late August 2004, the Kansas Department of Health and Environment (KDHE) received reports from the Crawford County Health Department (CCHD) of approximately 300 residents of Pittsburg, Kansas (2000 population: 19,243), seeking care for a pruritic rash of unknown etiology. In early September, three neighboring counties in Kansas and two neighboring states (Missouri and Nebraska) also reported such cases. These events prompted KDHE to request assistance from CDC. Additional cases subsequently were reported in Oklahoma and Texas. This report describes the investigation in Crawford County, Kansas, by public health agencies and entomologists to identify the etiology of the pruritic rash and to assess the extent of the outbreak. A microscopic itch mite (Pyemotes herfsi) was identified as the likely cause of the outbreak, which affected an estimated 54% of the Crawford County population (2000 population: 38,242). Entomologists confirmed the return of P. herfsi in Kansas in August 2005 and have recommended prevention measures, such as use of DEET-containing products, to help minimize exposure for persons outdoors. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5438a3.htm (MMWR September 30, 2005 / 54(38);952-955)

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3. Notifications
Australia Leads Regional Response to Avian Influenza
Australia will host a high-level meeting on avian influenza in Brisbane 31 Oct - 1 Nov 2005. This regional initiative will bring together, for the first time, the principal pandemic/disaster management coordinators from APEC economies. The meeting of pandemic and disaster experts will discuss efforts to improve regional coordination of preparedness and response. It highlights Australia's leadership role in providing a strategic and coordinated response approach to the avian influenza threat. It will build on the work undertaken in APEC since 2001 on preparedness for and response to infectious disease threats. It will inform discussion among APEC Leaders and Ministers when they meet in Korea in Nov 2005. The objective is to ensure a swift and co-coordinated regional response to contain any outbreak of avian influenza, by: improving communication between the key personnel leading the fight against avian influenza in the Asia-Pacific region; sharing information about and improving transparency of regional and national strategies for avian influenza preparedness and response; identifying gaps in regional preparedness; and developing mechanisms to better co-ordinate the regional fight against any outbreaks.

The Prime Minister announced a $5 million initiative to combat Avian Influenza at the ASEAN Leaders Meeting Nov 2004. As well as $133 million allocated for prevention and preparedness of a pandemic in Australia, Australia has provided more than $20 million since 2003 to tackle avian influenza and SARS in the region. Emergency coordinators will be joined by health and quarantine colleagues and by representatives of key international organisations including WHO and FAO. (APEC http://www.foreignminister.gov.au/releases/2005/fa124_05.html)

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WHO: Partners meeting on avian influenza and human pandemic influenza
7-9 November 2005; Geneva, Switzerland
WHO, Food and Agriculture Organization, World Organisation for Animal Health (OIE) and the World Bank will cosponsor a partners meeting on avian influenza and human pandemic influenza 7-9 Nov 2005. The meeting will include members of the cosponsoring organizations, country representatives, donor partners, and regional organizations and will enable an examination of integrated national plans to deal with the issue, focusing on affected countries and countries at risk. Overall objectives are:

• To confirm the two-pronged strategy: to control avian influenza at source in animals for the short and medium term and simultaneously prepare for pandemic influenza;
• To support national plans in line with the above strategy through commitment at national, regional and global levels;
• To discuss shared responsibilities of the international community and technical organizations and agencies in assisting affected countries and countries at risk;
• To assess national, regional and global needs with broad indications of resources required in the short and medium term, review current bilateral and multilateral initiatives to avoid duplication and identify potential synergies;
• To discuss and outline coordination mechanisms necessary at national, sub-regional, regional and global levels to ensure effective and rapid mobilization of resources and oversee the impact and progress in implementation;
• To identify key next steps based on an agreed strategy with the political support and backing from the international community.
(WHO http://www.who.int/mediacentre/events/2005/meeting_avian_influenza/en/index.html)

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PAHO To Assist Member Countries with Pandemic Planning
The Pan American Health Organization outlined their plan for a regional approach to influenza pandemic preparedness and response, during the 46th Directing Council meeting. The plan sets forth activities to promote pandemic preparedness among PAHO member countries, to monitor and prevent the spread of avian influenza in the region, and to provide guidance at the regional and country level on what to do should a human flu pandemic erupt. PAHO’s Strategic and Operational Plan for Responding to Pandemic Influenza lays out a multisectoral, phase-specific approach based on the WHO Global Influenza Preparedness Plan. PAHO's top influenza expert, Dr. Otavio Oliva, urged PAHO countries to undertake pandemic planning and said the PAHO plan provides a blueprint for the organization to support the countries in these efforts. In the pre-pandemic phase, PAHO will work with its member countries to:

• Promote the development of national influenza pandemic preparedness plans,
• Strengthen surveillance through early warning systems,
• Ensure local availability of a pandemic vaccine and antiviral drugs,
• Plan for health-care services and infection control,
• Reduce opportunities for human infection,
• Develop pandemic communication plans and raise awareness of the pandemic threat,
• Estimate the potential impact of an influenza pandemic and assess information gaps, and
• Build partnerships and strategic alliances among authorities in health, agriculture, emergency response and other sectors, as well as with civil society and the private sector, to support an effective response to pandemic influenza.

Should a pandemic virus emerge, PAHO will work at the regional and country levels to contain or delay the early spread of the virus. In the event of a full-scale pandemic, PAHO efforts will focus on reducing morbidity, mortality, and social disruption through coordinated action with its member countries and WHO. Assistant Director Carissa Etienne called on all PAHO member countries to undertake pandemic planning and to share their plans with one another to strengthen these efforts. (PAHO 9/29/05 http://www.paho.org/English/DD/PIN/pr050929a.htm)

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A Warning Shot Influenza and the 2004 Flu Vaccine
By Timothy Brookes: A Warning Shot is a story of paradoxes. It is a book about the failure of government regulatory oversight as well as the heroic efforts of public health officials to respond to the crisis. It is the story of catastrophic production failure at one company and the work of others to fill the void. It is a tale about the failure of national leadership to protect our nation’s vaccine supply at a time when many of these same leaders were taking great care to prepare for a potential pandemic influenza. (APHA http://www.apha.org/)

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National STD Prevention Conference
"Beyond The Hidden Epidemic: Evolution or Revolution?"
(May 8-11 2006) Jacksonville, Florida, USA
Call for abstracts submissions; deadline December 9, 2005.
STD rates remain unacceptably high in groups such as adolescents and men who have sex with men. In addition, racial disparities in STD rates remain a challenge. Socio-cultural norms have not been conducive to understanding and addressing sexual risk behaviors. Nevertheless, technological advances ranging from rapid diagnostics and new vaccines to the Internet, along with a more sophisticated understanding of social and behavioral networks, have opened unprecedented opportunities for interventions. Innovative approaches to identify and treat sex partners have also emerged. As we begin the second decade since the IOM’s 1996 call to action, we need to confront the persistent hidden STD epidemics using strategies that are reflective of current and emerging socio-cultural contexts, while taking full advantage of new prevention options. Conference delegates from academia, public health departments, nongovernmental organizations, the private health sector, and policy organizations are invited to explore these issues, share successes, ask and debate new questions, and seek answers that will advance STD prevention. (CDC http://www.cdc.gov/stdconference/)

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WHO: Immunization maintains strong performance made in last quarter century
Immunization at the global level has progressed very well during the past 25 years, but further increases in coverage would save the lives of millions more who do not yet benefit from this protection, said a group of immunization partners at the World Vaccine Congress. WHO and UNICEF, with financial support from the US CDC, conduct world-wide monitoring and work closely with Ministries of Health to produce estimates of immunization coverage each year. Major findings:

• Global immunization coverage with three doses of diphtheria-tetanus-pertussis (DTP3) vaccine has been sustained at 78% for the year 2004.
• 102 countries have reached DTP3 coverage of 90% or more and 80 countries are within the 50-89% range. Ten countries, in Africa, Asia and Central America, have coverage levels below 50%.
• There has been dramatic expansion in the use of hepatitis B and Haemophilus influenzae type b (Hib) vaccines. 153 countries now routinely vaccinate children with hepatitis B vaccine, up from 12 countries in 1990. 92 countries include Hib vaccine in their routine immunization systems, up from four countries in 1991.
• 27 million infants were not immunized with DTP3 in 2004
• China, India, Indonesia, Nigeria and Pakistan each have more than 1 million unvaccinated children accounting for 16.3 million of the world's 27 million unvaccinated children.

Unprecedented new resources for immunization are being made available through the International Finance Facility for Immunization towards which a group of European countries committed nearly USD 4 billion. A revolution is expected in the next decade in the ways that vaccines are designed, manufactured, financed, delivered and administered. 20 new or improved vaccines are anticipated within the next ten years. WHO and UNICEF have produced a new Global Immunization Vision and Strategy for 2006-2015.

At PAHO's Directing Council meeting, Peru's Health Minister said "It is crucial for us in the health sector to strengthen our links with ministers of finance and those responsible for budgets in our countries, because we have very important times ahead of us in terms of new vaccines." From a country perspective, she said, one of the lessons learned is setting priorities for health interventions and protecting the immunization achievements to date, while promoting new alliances and improving efficiency. (WHO http://www.who.int/mediacentre/news/releases/2005/pr48/en/index.html; PAHO 9/29/05 http://www.paho.org/English/DD/PIN/pr050929.htm)

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The use of malaria rapid diagnostic tests
(Document available in PDF: http://www.wpro.who.int/publications/pub_9290610883.htm). Misdiagnosis of malaria results in significant morbidity and mortality. Rapid, accurate and accessible detection of malaria has an important role in addressing this, and in promoting more rational use of increasingly costly drugs, in many endemic areas. Rapid diagnostic tests offer the potential to provide accurate diagnostic to all at-risk populations for the first time, reaching those unable to access good quality microscopy services.

Despite reductions in recent years, malaria still constitutes a public health problem in the Americas, according to a report presented at PAHO meeting. The report shows that of the 21 PAHO Member States where malaria is endemic, 15 reported decreases in the absolute numbers of cases between 2000 and 2004. However, six countries reported increases, including Peru (23%). (WHO/WPRO; PAHO 9/30/05 http://www.paho.org/English/DD/PIN/pr050930.htm)

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4. APEC EINet activities
Pandemic influenza preparedness and response: Information sharing through a virtual symposium
APEC EINet is currently planning for a major video conference on pandemic influenza preparedness in January 19, 2006. The overall aim of this “virtual symposium” is to promote regional information sharing and collaboration to enhance biopreparedness against pandemic influenza and other emergent threats. In order to improve preparedness regionally, it is vital to understand how each economy in the region is undertaking preparedness and response planning. Details will be forthcoming.

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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