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Vol. VIII, No. 23 ~ EINet News Briefs ~ Nov 04, 2005


*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:
- Global: OIE launches appeal for application of international standards of quality
- Romania: H5N1 confirmed in dead heron; additional H5-positive bird case
- Croatia: Official OIE Follow-up report; additional H5N1 positive swan suspected
- Turkey: Official OIE Follow-up report
- United Kingdom/Taipei: Report on HPAI detected in an import quarantine unit
- Iraq, Greece: Samples test negative for avian influenza H5N1
- Macedonia: First test clears bird of avian influenza
- South East Asia: Cumulative number of human cases of avian influenza A/(H5N1)
- China: 2 suspected human cases of avian influenza under investigation
- Viet Nam: 2 more fatal suspected cases of avian influenza
- Thailand: Bird flu spreads, fighting cocks blamed
- Thailand: Woman tests positive for avian influenza
- Japan (Ibaraki): Bird flu suspected at farm; findings presented in interim report
- Japan (Osaka): New bird flu outbreak (H4) confirmed
- Russia: Bird flu confirmed in 10 rural communities
- Hong Kong: Man reportedly died of pig-borne disease
- Philippines (Cebu): At least 2 deaths due to typhoid fever
- Russia (Nizhniy Novgorod): Another 42 suspected hepatitis A cases
- Russia (Moscow): Q fever associated with contaminated wool
- Russia (Khabarovsk and Orenburg): Outbreaks of HFRS
- Russia (Mordovia): 2 additional cases of rabies
- New Zealand (South Island): Legionellosis associated with potting soil
- Pakistan: Tetanus, earthquake-related
- Canada (British Columbia): Avian influenza H5 found in wild birds
- USA: HHS releases new pandemic flu plan
- USA: Chiron wins H5N1 vaccine contract
- USA: Disease experts warn against hoarding Tamiflu
- Canada (Ontario): Legionellosis at long-term care facility
- USA (South Dakota): Source of Legionnaires' outbreak identified
- USA (Oregon): E. coli O157 cases at restaurant
- USA (South Carolina): Human case of eastern equine encephalitis

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

2. Articles
- Global Measles and Rubella Laboratory Network, January 2004--June 2005
- Ralstonia Species Associated with Vapotherm Oxygen Delivery Devices--United States, 2005

3. Notifications
- Avian influenza updates
- International Congress on Infectious Diseases
- National Viral Hepatitis Prevention Conference
- Field Guidelines for Measles Elimination
- Availability of Maxi-Vac Alternative
- The Population Leadership Program at the University of Washington

4. APEC EINet activities
- Pandemic influenza preparedness and response videoconference

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Global: OIE launches appeal for application of international standards of quality
The avian influenza virus strain that appeared in South-East Asia about 2 years ago is currently circulating endemically in several Asian countries that lack the tools and resources needed to implement the appropriate eradication measures. The virus rarely occurs in commercial farms, which now know how to protect themselves. Its favourite targets are to be found in villages, in family-run backyard poultry flocks. Faced with this situation, the World Organisation for Animal Health (OIE) is issuing a fresh reminder of the urgent need to take into account the control of the disease at its animal source. The OIE considers that the action plan developed jointly by the FAO and the OIE, emphasising the importance of taking measures to reduce the presence and circulation of the virus in animals worldwide, is a priority.

"For example, for developing countries clearly experiencing serious difficulties in controlling the animal disease once it has become endemic, we are calling upon the international community to help them vaccinate all their poultry populations", says Dr Bernard Vallat, Director General of the OIE. "Furthermore, the OIE is also advocating a series of medium-term measures that will be relatively simple to implement with private sector support, such as training livestock producers and local veterinarians so as to ensure early detection of the virus at the farm level". The application of OIE standards on the quality of the public and private sector components of the Veterinary Services is of crucial importance to ensure early detection and a rapid response in the event of outbreaks.

***For a similar article, see “How to Stop Bird Flu”, by Jacques Diouf, FAO Director-General: http://www.fao.org/newsroom/en/news/2005/1000105/index.html (OIE 11/4/05 http://www.oie.int/eng/press/en_051104.htm)

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Romania: H5N1 confirmed in dead heron; additional H5-positive bird case
A heron found dead recently in Romania in an uninhabited area near the border with Moldova has tested positive for H5N1 virus, the Agriculture Ministry said. Earlier this month, Romania became the first European mainland country to detect H5N1 in birds in 2 villages in the Danube delta. "Yesterday, the laboratory in Britain confirmed the presence of the H5N1 virus in the heron found in Vaslui county, diagnosed with bird flu on 21 Oct 2005," the ministry said. Authorities in Vaslui county told people to keep chickens indoors to avoid the virus spreading to domestic birds. The ministry said more than 500 tests were conducted in the past 2 weeks on birds in the southeast of the country and all were negative for bird flu. H5N1 was first found in samples taken from 2 villages in the Danube delta. More than 21 000 domestic birds in the 2 villages were killed and the villages were placed under quarantine.

A case of H5-potivie bird has also been found. "We found a wild goose near the village of Vadu Oii and a swan next to the Razim lake, which were tested positive for H5," Chief veterinarian Ion Agafitei said. The areas will not be quarantined as the birds were found at least 1 mile from the nearest human settlement, and no poultry will be culled. He said it had not yet been decided whether to send the samples to the UK to see whether they had the H5N1 strain. In a separate newswire from Slovenia, it was announced that tests ruled out bird flu virus in a suspected swan.

OIE Follow-up report
Information received 22 Oct 2005. Precise identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of start of the outbreak: 21 Oct. 2005. Description of affected population in the new outbreak: a heron was found dead in an unpopulated area, at a distance of about 700 m from Prut River, close to the international border with Moldavia; the heron may have belonged to a flock of migratory birds. Source of new outbreak: unknown or inconclusive. (Promed 10/28/05, 10/31/05)

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Croatia: Official OIE Follow-up report; additional H5N1 positive swan suspected
Information received 27 Oct 2005. Updated information about the examination of samples taken from dead swans on the territory of Zdenci municipality: Precise identification of agent: influenza virus type A, subtype H5N1. (Disease never reported before in Croatia). About 1500 swans arrived 19 Oct 2005 at the location of the fresh water fish farm Grudnjak' in Zdenci municipality. 15 swans died but only 6 of them were available for testing. Control measures undertaken: quarantine; movement control inside the country; screening; zoning; disinfection. Control measures to be undertaken: control of wildlife reservoirs; stamping out.

A swan that flew into Croatia from Hungary carried the H5N1 strain, the agriculture ministry said 2 Nov 2005. The swan, shot down in the area where 8 swans had already tested positive for H5N1, was ringed in Hungary, but ornithologists there insisted the bird was healthy when marked. Hungary has reported no bird flu cases. Hungary's Agriculture Ministry said it was not planning to increase the number of tests on birds nor introduce new preventive measures beyond those already in place. Tests on about 1000 wild and domestic birds have been negative for bird flu and the country plans to tests about 10 000 more by the end of the year. Croatian authorities believe all the swans belonged to the same flock, which came from Hungary. The region has already been disinfected and all domestic poultry there culled. Croatian has so far tested about 1500 birds found dead across the country; none had been sick with bird flu. (Promed 10/28/05, 11/2/05)

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Turkey: Official OIE Follow-up report
Information received on 21 Oct 2005. Precise identification of agent: highly pathogenic avian influenza virus type A, subtype H5N1. Based on the initial test results from the national reference laboratory, the local Veterinary Service quarantined the affected holding 6 Oct 2005. At that moment, 1700 of the 1800 birds had died. It was decided to cull immediately the 100 remaining live (and mainly sick) birds. All carcasses were buried that same day with lime in 2 pits within the grounds of the farm. In addition, the local Crisis Centre ordered the culling of: the 2684 free-range turkeys located about 1 km from the outbreak (direct contact); backyard poultry in the protection zone (within a 3-km radius). A total of 10 147 backyard poultry were culled. All poultry were in good condition and no clinical problems were detected during the culling. In the surveillance zone, a surveillance programme was put into place for all poultry farms. All commercial and backyard flocks are clinically controlled every 2 days. Hunting of wild birds is forbidden throughout the country. Further information: http://www.kkgm.gov.tr. (Promed 10/28/05)

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United Kingdom/Taipei: Report on HPAI detected in an import quarantine unit
Highly pathogenic avian influenza serotype H5N1 has been detected in a quarantine establishment in Essex, England. 2 consignments of birds were sharing the unit. The first was a consignment of 148 psittacines imported from Surinam 16 Sep 2005. The second was a mixed consignment of non-psittacines imported from Taipei 26 Sep 2005. The birds were housed in a number of separate but adjacent pens in the same airspace. Sentinel chickens were also present in the unit during the quarantine period. There were a number of deaths during the quarantine period. 2 carcasses from the Surinam consignment were examined post-mortem; virological tests were negative. 2 further dead birds were submitted for examination; a pooled sample was confirmed as H5N1. The closest match is a strain identified in ducks in China earlier this year. It is not so similar to the strains from Romania and Turkey. Working hypothesis: an infection in the birds from Surinam is likely to have arisen in the quarantine system, most likely in the facility in Essex where the Surinam birds shared airspace with the birds from Taipei. All remaining birds in the quarantine unit were killed. Movements on and off the premises have been investigated and no evidence of disease spread has been found. No live birds were removed from the quarantine unit during the quarantine period. Further investigations are continuing. This incident occurred in an officially approved quarantine unit and there is no indication that biosecurity has been breached.

Following this detection in the UK, Taipei responded that it is free of avian influenza. The 185 birds exported from Taipei to the UK were healthy and in compliance with the quarantine requirement of the UK, Taipei reported. Taipei had dispatched animal health workers 22 Oct 2005 to the farm of origin. All birds on the farm were healthy. Throat and cloacal swabs from the birds on the farm were tested for avian influenza 25 Oct 2005. The RT-PCR tests for H5N1 gave negative results. (Promed 10/28/05)

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Iraq, Greece: Samples test negative for avian influenza H5N1
Final tests showed a turkey in Greece suspected of bird flu did not carry the disease. The Greek Agriculture Ministry reportedly announced that as a result, all poultry trade restrictions on Chios and Oinousses, where the suspected case appeared, were now lifted. Greece had banned the export of all live birds and their products from the area of Chios, when preliminary tests had showed the turkey on the islet of Oinousses was positive for the H5 avian flu strain. News of the suspected case caused concern among the public, which reduced poultry consumption dramatically. Greece is on the path of migratory birds making their way to warmer southern climates this time of year (The suspicion of HPAI in Greece dates back to 17 Oct 2005). Also, 2 chickens in the Kurdish region of northern Iraq have been found to have a strain of avian flu but experts said it was not H5N1. Azad Ezzidin, agriculture minister for the Kurdistan region, said 2 suspected cases had been investigated and the dead birds sent to Cairo for tests by the WHO, where they tested negative. Migrating wildfowl can carry the virus and they are believed to be the cause of H5N1's spread into Europe. Iraq said 27 Oct 2005 it was banning imports of poultry and poultry products from 20 countries as bird flu fears rise after cases were confirmed in Turkey. (Promed 10/29/05)

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Macedonia: First test clears bird of avian influenza
A bird that died in Macedonia about 2 weeks ago has tested negative for avian influenza in an initial British lab screening. Sloboden Cokrevski of Macedonia's Veterinary Directorate said the results were "not final, and we cannot be 100 percent sure, but so far, no type of H virus has been found" in the suspect bird, which was sent to Britain for testing October 2005. The domestic fowl was among some 1000 other chickens and turkeys found dead in the villages of Mogila and Germijan, about 200 km southwest of the capital Skopje, in mid-October 2005. In response, Macedonian health authorities destroyed thousands of chickens, roosters and turkeys amid fears that a deadly variant of the bird flu had hit the country. According to Cokrevski, more dead birds had been found in the past few days but this outbreak has been initially diagnosed as Newcastle disease. The Macedonian report to the OIE, 19 Oct 2005, said: "As part of the increased danger of avian influenza outbreaks, and in relation to the time period, which poses greater danger of introducing AI virus via migratory birds, as well as for differential diagnosis, all sera were tested with an antibody test kit for AI virus strains H7N2, H1N7, H7N3, H13N6, H5N9, H11N6, H3N8, H9N2, H5N2, H4N8, H10N7, H2N2, H8N4, H14N5, H6N5 and H12N5. 1 serum gave a positive result to the serological test. In the meantime, the control measures imposed remain in force”. Apparently, the antibody test kit did not include virus strain H5N1, nor any N1. (Promed 11/2/05)

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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 / 10 (7) / 6 (4)
Cambodia / 4 (4) / 4 (4)
Thailand / 3 (3) / 1 (1)
Viet Nam / 68 (64) / 23 (21)
Total / 84 (78) / 34 (30)

Cumulative number of confirmed human cases of avian influenza A/(H5N1), 3 Dec 2003 to present:
129 (122) / 66 (62)
(CIDRAP 11/1/05 http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/case-count/avflucount.html)

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China: 2 suspected human cases of avian influenza under investigation
The government is set to backpedal on the pledge by health minister York Chow Yat-ngok that the borders will be sealed if a bird flu pandemic knocks on the door of Hong Kong. This follows what a government source said 27 Oct 2005 was local and international concern about the enormous social and economic effects of such a move. It also follows a denial by the Ministry of Health of a statement by Vice-Minister of Health Huang Jiefu, who said earlier China would seal its borders if there was even one case of human-to-human transmission of bird flu.

The latest moves came as access remained highly controlled to the Hunan village where a girl died, although authorities said initial tests showed she did not have the H5N1 virus. Despite the controls -- with entrances to the village tightly guarded to prevent outsiders, including reporters, from entering -- chickens and ducks were still running freely inside the village and dead fowl could be seen lying in the field. Inner Mongolia, Anhui and Hunan have all reported bird flu outbreaks of different scales within a week. The authorities have vowed to cull all poultry within 1 km from the affected area. China insisted there had been no documented human cases of bird flu in the country despite the 3 outbreaks. WHO asked China 28 Oct 2005 to investigate media reports of 2 human cases of bird flu. Chinese authorities had told WHO that a team from the central health ministry was dispatched to the region to investigate. China has had 7 outbreaks of avian influenza in poultry so far this year. Experts have warned that a swift and transparent response is needed to any human cases of bird flu to prevent the virus turning into a pandemic strain. (Promed 10/28/05)

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Viet Nam: 2 more fatal suspected cases of avian influenza
2 people showing symptoms of avian influenza virus infection have died, where the disease has already killed 41 people, a hospital official said 29 Oct 2005. Reportedly, the hospital in Quang Binh province said the victims, a 14-year-old girl and a 26-year-old man, had eaten duck and a chicken's egg around a week before they became ill. The girl was admitted to hospital 21 Oct 2005 and died 23 Oct 2005, and the man died 26 Oct 2005. He said the victims were not related and from different towns in the province. Reportedly, both patients had severe respiratory problems, fever and lung infection. Dr Nguyen Ngoc Tai, the Director of the Vietnam-Cuba Hospital in Dong Hoi, said another suspected case (27-year-old man) with symptoms of the disease had been sent to a better-equipped hospital for treatment. These are the first human cases of avian influenza to be reported from Viet Nam since the end of August 2005. It seems that the deaths of these 2 patients have been attributed to H5N1 infection on the basis of clinical assessment alone, and that no lab test has been undertaken. Thus, the status of these cases remains "suspected". (Promed 10/29/05)

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Thailand: Bird flu spreads, fighting cocks blamed
The illegal movement of infected poultry, especially fighting cocks and ducks, has helped spread the bird flu virus to 7 provinces in Thailand, officials said 2 Nov 2005. In the latest outbreak of the H5N1 virus, laboratory results confirmed the virus in chickens and pigeons in the central province of Ang Thong. 6 of the 7 infected provinces were clustered in central Thailand, with the other, Kalasin, in the northeast, where fighting cocks might have caught the disease from those in the infected central region. 34 villagers from Kalasin, including a 4-month-old baby, have been put under close observation after they developed flu-like symptoms. Despite a monitoring system involving one million volunteers who educate farmers and villagers with backyard flocks about the virus and alert officials in cases of suspicious deaths, illegal movements were hard to stop, Livestock Department chief Yukol Limlaemthong said.

So far, however, the new outbreaks are many fewer than at the same time in 2004, when 44 of Thailand's 76 provinces had reported fresh outbreaks. The government has imposed strict measures to try to curb the spread of bird flu, including restricting movements of fighting cocks and eliminating a traditional way of raising ducks. Fighting cocks and ducks were more resilient to the virus than farmed chickens and could pass on the disease without showing symptoms, Yukol said. The government had set a Mar 2005 deadline for halting the large-scale movement of 3700 flocks of ducks that owners moved around to new feeding grounds, but extended it to Dec 2005 after owners protested, and might extend it again, officials said. Yukol said rural livestock officials faced tough battles to restrict movements of fighting cocks, as many are owned by influential local figures. Fighting cocks can sell for 100 000 baht (USD 2450). He estimated there were around 1 million fighting cocks in Thailand, 300 000 of them involved in fights regularly, but only 40 000 had been issued a "passport," which must be shown to officials when they are moved. Owners often hide their fighters, as the government pays only 75 percent of the market rate for ordinary chickens culled, no matter what their attributes, and nothing if they did not report suspicious deaths. Thailand's policy regarding HPAI control is based upon stamping out; vaccination is prohibited.

OIE Follow-up report
Information received 25 October 2005. Source of new outbreaks: unknown or inconclusive. Control measures undertaken: stamping out; quarantine; movement control inside the country; screening; zoning; disinfection of infected remises/establishments. Thailand has been conducting the current nationwide surveillance since 1 Jul 2005. In this third wave to date, there have been 64 confirmed outbreaks in 8 provinces, since the second wave of HPAI reoccurrence that occurred from 3 Jul 2004 to 12 Apr 2005. All cases involved either free-range poultry or poultry raised in farms with traditional husbandry practices with poor sanitation and insufficient biosecurity. (Promed 10/28/05, 10/31/05, 11/2/05)

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Thailand: Woman tests positive for avian influenza
A 50-year-old woman, who became the latest case of human bird-flu, contracted the H5N1 virus from the environment rather than from birds, the Public Health Ministry said. Dr. Thawat Suntharachan, director-general of the Ministry's Disease Control Department, said the woman was confirmed 31 Oct 2005 as the 20th case of bird flu in Thailand since 2003. He said the victim was the eighth person to contract the virus without touching a dead chicken. The 7 previous cases were reported 2004. Dr. Kumnuan Ungchusak, head of the Bureau of Epidemiology, said 6 of those were children who might have caught the virus while playing near infected chicken feces or fluids. The adult who caught the virus in 2004 without coming into contact with dead chickens was infected in the same way as the latest case, he said.

The latest victim lived in Bangkok, but she was believed to have contracted the virus in Nonthaburi, where her husband raised poultry that had fallen sick. Thawat said the woman did not touch any dead chickens while she was in Nonthaburi. She was hospitalized 29 Oct 2005 and remains hospitalized in satisfactory condition. Her husband said he raised about fighting cocks and bantams. When some of them died, he decided to cull the rest because he suspected that they might have been infected with the avian-flu virus. He said he did not report the deaths to authorities as required because he thought culling and burying them properly was enough. He said he wrapped his hands in plastic bags before touching the dead animals. Although he was in good health, doctors prescribed 10 anti-viral Tamiflu tablets. Dr. Kumnuan said it was very likely that the woman contracted the virus either through exposure to infected feces or from eating fruit that she had picked up off the ground. 2 other patients are also suspected of contracting the virus, including a 4-year-old girl who tested positive 1 Nov 2005 to H3N2 virus of human influenza.

The woman is the third confirmed case reported in Thailand in the past month. These cases coincide with a recurrence of H5 outbreaks in poultry in 6 provinces. The route of transmission of H5N1 virus to the small number of people who have contracted overt symptoms of infection, remains conjectural. It is likely that lapses in hygiene and sanitation may play a major role, since the disease mainly afflicts people in domestic surroundings and not those involved in commercial poultry husbandry. There is a lack of information concerning the number of infected, but asymptomatic, individuals in exposed communities. (Promed 11/1/05, 11/2/05)

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Japan (Ibaraki): Bird flu suspected at farm; findings presented in interim report
Authorities have detected signs of bird flu at a farm in Japan and plan to kill 82 000 chickens. The farm in Ibaraki prefecture, just northeast of Tokyo, was already inside a quarantined area because of past outbreaks, Kyodo News reported 31 Oct 2005. Kyodo said 1.5 million birds had already been culled in the area because of bird flu fears. Authorities found signs of the disease in 7 farms in the area late Aug 2005. In 31 Oct 2005, antibody tests showed the chickens may be infected with a virus from the H5 family, Ibaraki officials said. Signs of the antibodies means the chickens were infected in the past but had survived. Officials said the strain involved in the recent outbreaks is less virulent than the H5N1 variety in Southeast Asia. Japan reported its first outbreak of avian flu in 79 years early 2004, when it found chickens infected with H5N1 strain. Japan also confirmed a human case of bird flu, but no deaths have been reported. An outbreak in June 2005 forced the culling of about 94 000 birds at another farm outside Tokyo. It was caused by the H5N2 bird flu strain, a variety not known to infect humans.

The weak strain of avian influenza that infected chickens on poultry farms in Ibaraki likely was spread by a mobile meat processor, according to a draft interim report compiled by an advisory body to the Agriculture, Forestry and Fisheries Ministry. The report says illegal vaccines brought into the country most likely are responsible for the outbreak. The strain of bird flu was detected in 30 poultry farms in Ibaraki Prefecture and 1 poultry farm in Saitama Prefecture. The virus was found to have a genetic makeup 97 percent identical to a virus detected between 2000 and 2002 in Guatemala. No officially authorised and commercially available AI vaccine is known to include this strain. It might be concluded that the vaccine, illegally applied in Japan, might have been an unauthorised one, produced abroad and smuggled into Japan. The vaccine involved included a live H5N2 virus, which means a deficient inactivation process. According to the report, a meat processor visited all the infected farms to collect chickens on the same day. The virus might have spread to other poultry farms when he made his rounds to those farms, causing cross contamination. As it is unusual for the Central American virus, which has not been detected elsewhere in Northeast Asia, to be found in poultry farms only in Ibaraki, the report says it is highly likely the virus was brought into the country.

Control of production, testing, and distribution of animal vaccines is an essential part of animal disease control programmes; governments are responsible for their approval and certification. The specific requirements for each vaccine are laid down in OIE's Manual of Diagnostic Tests and Vaccines for Terrestrial Animals; see http://oie.int/eng/normes/mmanual/A_00037.htm. In view of the vital role vaccines play in disease control and the risks related to the use of unauthorised vaccines, intensification of law enforcement, coordinated internationally, deserves prioritisation. Since 27 Jun 2005, Japan has sent 4 reports to the OIE on the identification of a low-pathogenic H5N2 A influenza virus on poultry farms. Since then, 31 additional farms have been officially reported as infected by the same LPNAI virus, as apparent from the 3 follow-up reports to the OIE: 1) 28 Jul 2005, 7 farms in Ibaraki prefecture; 2) 23 Aug 2005, 2 farms in Ibaraki prefecture, one farm in Saitama prefecture; 3) 16 Sep 2005, 21 farms in Ibaraki prefecture; The last follow-up report, No. 3, was sent 23 Sep 2005. (Promed 10/29/05, 10/31/05)

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Japan (Osaka): New bird flu outbreak (H4) confirmed
Authorities have confirmed a new bird flu outbreak at a farm in Osaka. Tests by Japan's National Veterinary Institute confirmed that 10 ducks of the farm have been infected with the H4 strain of avian influenza, which has yet to be transmitted to humans. Experts are conducting more tests on 47 other ducks of the farm, after initial tests showed that some of them might catch the disease. If they test positive for the H5 or H7 virus, the remaining 780 ducks of the farm will be culled. Workers have checked the farm and 8 nearby poultry farms as well. This case seems to be unrelated to the outbreak of low-pathogenic H5N2, which has been simmering in Ibaraki since Apr 2005, probably caused by an illegal vaccine. In contrast to the H5 and H7 strains, H4 is not an OIE-notifiable animal influenza (NAI) strain. However, if found highly pathogenic by means of the prescribed pathogenicity tests, it will become notifiable. (Promed 11/2/05)

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Russia: Bird flu confirmed in 10 rural communities
Suspected cases of avian influenza have now been confirmed in 10 rural communities across Russia and are being verified in 19 others, the Agriculture Ministry said 31 Oct 2005. The confirmed outbreak sites are in the central regions of Tula and Tambov, as well as in the Urals province of Chelyabinsk and in Omsk and Altai, in Siberia. Russia's Kurgan region is the worst affected, with 3 confirmed outbreak sites and 3 suspected. In the Novosibirsk province, 16 communities are currently under suspicion. "Mass deaths of migrant birds have been registered outside Yekaterinburg, the Urals, a spokesman for the local consumer protection service said 31 Oct 2005. Russia has been fighting bird flu since mid-July 2005 and has culled more than 600 000 domestic fowl. (Promed 10/28/05, 10/31/05)

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Hong Kong: Man reportedly died of pig-borne disease
A Hong Kong man who died in hospital earlier October 2005 had a pig-borne infection due to Streptococcus suis, the government said 24 Oct 2005, citing lab tests. The man was the twelfth person from Hong Kong to be infected with the bacterium in 2005. The disease has killed around 40 people in mainland China. The 43-year-old, who had no recent travel history, was admitted to the hospital 13 Oct 2005 and died the same day, and his family was placed under observation. Most of the more than 200 people reported to have caught the disease on the mainland became sick after slaughtering, handling or eating infected pigs. In August 2005, the Hong Kong government temporarily banned imports of pork from the Sichuan province. S. suis human infection occurs in Hong Kong each year. Whether this case reflects the underlying endemicity of this infection or was related to the recent cluster of cases is unclear. It is not stated whether the individual had direct contact with swine. (Promed 10/24/05)

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Philippines (Cebu): At least 2 deaths due to typhoid fever
At least 2 persons died while more than 250 others (mostly children) were brought to hospital for treatment due to the outbreak of typhoid fever and diarrhea in the towns of Borbon and Sibonga in Cebu province. Renan Cimafranca, head of the Regional Epidemiology Unit of the Department of Health regional office recently confirmed the outbreak of typhoid fever in Borbon. According to Cimafranca, they confirmed that people suffering from typhoid fever were found with Salmonella typhi, the bacterium which causes the disease, in blood cultures of the patients. However, Cimafranca said they are still waiting for the results of tests from water samples taken from wells to pinpoint the source of the disease. How many of the more than 200 cases are actually due to typhoid fever is not clear. Classically, typhoid is not associated with much diarrhea but rather a febrile, systemic illness. (Promed 10/27/05)

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Russia (Nizhniy Novgorod): Another 42 suspected hepatitis A cases
The local office of the Russian (Health) Protection Agency (Rospotrebnadzor) confirmed 24 Oct 2005 that recently 42 people have been admitted to hospitals in Nizhniy Novgorod city as suspected cases of hepatitis A. In total, 2217 cases of hepatitis A have been recorded in Nizhniy Novgorod since 5 Sep 2005. This number includes 349 children under the age of 14. In total, 1512 patients have been discharged from Nizhniy Novgorod hospitals, and another 637 remain in hospital. So far, 69 140 persons have been vaccinated against hepatitis A in Nizhniy Novgorod City. Rospotrebnadzor stated that vaccination and preventative measures are continuing. It is now believed that transmission is mainly by contact. (Promed 10/24/05)

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Russia (Moscow): Q fever associated with contaminated wool
As reported by the Territorial management of the Russian (Health) Protection Agency (Rospotrebnadzor), Q fever, was not diagnosed in Moscow in 2004. In 2005, Q fever has already been diagnosed in 5 persons. All of them worked in the Peter Alekseev weaving mill. The first person fell ill in the spring of 2005, the second person in the summer, and now 3 more persons with similar symptoms, have been hospitalized in autumn 2005. The reason for the human infection is thought to be contaminated sheep's wool. Both carders and spinners worked with the wool. (The method of diagnosis is not stated). Coxiella burnetii is the causative agent of Q fever. Cattle, sheep, and goats are the primary reservoirs of C. burnetii. Organisms are excreted in milk, urine, and feces of infected animals. Contact with contaminated wool is known to be a mode of transmission. The organisms can be resistant to heat, drying, and many common disinfectants. These features enable the bacteria to survive for long periods in the environment. The Q fever organism is a Category B bioterrorism agent. Infection of humans usually occurs by inhalation of these organisms from air that contains airborne dust contaminated by dried placental material, birth fluids, and excreta of infected herd animals. Humans are very susceptible to the disease, and very few organisms may be required to cause infection. (Promed 10/25/05)

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Russia (Khabarovsk and Orenburg): Outbreaks of HFRS
6 cases of hemorrhagic fever with renal syndrome (HFRS) have been registered in the Khabarovsk region. Cases of HFRS disease have been encountered in the districts of Bikinskiy, Vyazemskiy and Khabarovsk. During the whole of 2004, only 16 cases of HFRS were recorded in Khabarovsk. Reportedly, 50 percent of rodents in Khabarovsk are infected with the virus causing HFRS. HFRS can be propagated by droplet transmission and by detritus from rodent habitats. On average, the number of HFRS cases recorded in the Khabarovsk region annually ranges from 20 to 100 cases. Also, an outbreak of HFRS has been reported in the Orenburg region. In total 90 people are now receiving treatment in hospitals. Since the beginning of 2005, 300 people have been admitted to hospital with symptoms of HFRS, 2 of whom have died. The symptoms have been high temperature, headache and fever. The situation is exacerbated by the lack of an appropriate vaccine at the present time. The death rate from HRPS world-wide is estimated to be about 12 percent of symptomatic cases. During the first 6 months of 2005 only 35 cases of HFRS were registered, which is 7.6 times fewer than in the first 6 months of 2003, when there were 4 fatalities among 270 cases. (Promed 10/26/05, 11/3/05)

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Russia (Mordovia): 2 additional cases of rabies
Another 2 cases of rabies have been reported in Saransk, the capital city of the Republic of Mordovia. 3 residents of Saransk are now receiving anti-rabies vaccination. 2 cats in 2 different homes have also died, where diagnoses of rabies were confirmed. Epidemiologists will interview the 2 families where animals have died to establish possible contacts with the diseased cats. Reportedly, 3 fatal human cases of rabies have occurred in the past one and a half years. Since the beginning of 2005, 43 cases of human exposure to rabies have been recorded in the Republic of Mordovia, compared with 35 cases in 2004. (Promed 10/28/05)

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New Zealand (South Island): Legionellosis associated with potting soil
Authorities in Christchurch are dismissing the coincidence of 2 outbreaks of legionnaires' disease in the city in 2005. An elderly man has died and 3 others have contracted the disease from potting mix and compost bags. This latest occurrence is not connected to the outbreak earlier in 2005 which left 3 people dead and was linked to cooling towers. Medical Officer of Health Dr Alistair Humphrey says the first outbreak was unusual, but cases linked to potting mix are nothing new. Gardeners need to take extra care when opening potting mixes or compost bags. The death of a man from bacteria inhaled from common gardening potting mix has prompted a nation-wide warning. Health officials say dust from potting mix and even garden compost can cause infection and should be treated carefully. Officials say they've also treated 3 other people who've been in contact with potting mix who are now recovering satisfactorily. ". . .We usually get between about 5 and 8 cases per year and a lot of those are Legionella longbeachae which is most of these cases," Dr. Humphrey said. L. longbeachae, has been associated with lower respiratory infection in normal and immunocompromised individuals. The organism, especially in Australia, appears to be associated with pneumonia after exposure to soil. The organism has been found in soil and potting mixes from Australia but not from potting mix made in Europe. Cases of L. longbeachae associated with potting soil have been described in the USA and Japan as well. Additionally, a presumed outbreak of hospital-related L. longbeachae infection has been reported from Australia. The presumed source may have been related to demolition of a building adjacent to the health care facility. (Promed 10/27/05)

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Pakistan: Tetanus, earthquake-related
There have been 111 tetanus cases since the quake struck, of which 22 were fatal, and lack of food or shelter could threaten thousands more survivors of the earthquake unless there is a huge injection of aid before winter closes in, UN officials said 27 Oct 2005. Donors, including Pakistan's rival India, have pledged $580 million, but UN said more resources were needed to save between 2 million and 3 million lives. The 8 Oct 2005 quake is believed to have killed nearly 80 000 people and left more than 3 million homeless. There are huge logistical constraints and many of the tens of thousands of people injured in the temblor waited at least a week for medical treatment. Infected wounds have become rife. WHO and Pakistani officials described the case fatality rate to be low under the circumstances. All hospitalized patients were receiving a preventive serum against tetanus. When a natural disaster occurs, survivors who suffer physical trauma are at risk for tetanus if they are not adequately immunized. In the developing world, where the percentage of the population who have not received even a primary sequence of tetanus immunization--let alone boosters every 10 years--is higher, this risk is more substantial.

The disease is produced by the introduction of environmental spores of the bacillus Clostridium tetani into a wound. CDC recently produced information regarding tetanus prevention in relationship to Hurrican Katrina: http://www.bt.cdc.gov/disasters/hurricanes/katrina/tetanus.asp Tetanus in the USA is most commonly reported in older persons who are less likely to be adequately vaccinated than younger persons. Older women are especially susceptible. Diabetics are at increased risk.

***For more information on the Pakistani earthquake disaster, visit: http://www.who.int/hac/crises/international/pakistan_earthquake/en/index.html. (Promed 10/28/05)

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Americas
Canada (British Columbia): Avian influenza H5 found in wild birds
An H5 avian flu virus has been found in wild birds in British Columbia, after nearly 3 dozen birds were reported to have the virus in Quebec and Manitoba. The provinces chief veterinarian Dr. Ron Lewis said the result doesn't hike the risk to commercial poultry farmers; rather, it serves as a reminder of the threats carried by wild birds. None of the birds tested is sick, and none was associated with any commercial poultry operations. Lewis expects further tests to show that there is no evidence of the H5N1 strain. Tests have determined about 174 ducks were positive for the H5 virus from more than 700 samples that were taken from young ducks in Merritt, BC, Aug 2005. Lewis said 75 of those samples were weak or slightly positive and are being tested again. ". . . We’ve never tested birds in this flyway before, so we really don't have any idea whether this is a normal factor or whether these are increased numbers or whether they're decreased numbers. It is just a snapshot surveillance at one particular point in time." The results provide no insight on what viruses may be carried by wild fowl in the Fraser Valley, where poultry operations are concentrated. It was in this area in 2004 that avian influenza spread, likely from wild birds, to commercial poultry barns, forcing the slaughter of 17 million birds. In the end, only about 3 million birds were found to be diseased, and the rest were allowed to be sold to consumers. Farmers should focus their efforts on maintaining strict biosecurity to keep their chickens from being exposed to wild birds, Lewis said. This study is the first national survey of influenza in migratory birds in Canada and will serve as a benchmark in future years. 6 provinces are involved in testing wild waterfowl in Canada. Even if the viruses turn out to be H5N1, that doesn't mean they are closely related to the Asian strain. Experts say typically there is little mingling of avian flu viruses from the flyways of Eurasia and the Americas.

Also, Canadian pharmacists halted cross-border sales of Tamiflu 31 Oct 2005 to relieve public concern that there may be a shortage in the country if there's an outbreak, the Canadian International Pharmacy Association said. There's no evidence of a shortage of the drug, the group said. WHO recommends that governments stockpile antiviral drugs should an outbreak occur. (Promed 10/31/05, 11/2/05)

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USA: HHS releases new pandemic flu plan
US officials focused largely on expanding supplies of vaccines and antiviral drugs as they rolled out a lengthy plan for responding to an influenza pandemic that could kill an estimated 1.9 million Americans under worst-case assumptions. The HHS Pandemic Influenza Plan released by the Department of Health and Human Services assumes that a pandemic flu virus would sicken about 30% of the population, or 90 million people. Depending on the virulence of the virus, anywhere from 865,000 to 9.9 million people could be hospitalized. The release of the plan followed President Bush's speech outlining his administration's strategy for countering the threat posed by the avian flu virus. Bush asked Congress to provide about $7.1 billion for vaccines, antiviral drugs, surveillance, foreign aid, and emergency plans. HHS said a pandemic would require a coordinated response from all levels of government along with individuals and the private sector. The plan calls for vastly improving the nation's capacity to produce flu vaccines and for stockpiling enough antiviral medication to treat 81 million people, or 25% of the population. The vaccine now being tested is based on the current strain of the H5N1 virus. HHS is aiming to acquire enough doses of it to immunize 20 million people.

In the event of an influenza pandemic, medical and public health personnel and workers who make critical vaccines and drugs would have first call on scarce doses of vaccine, under the plan. People at high risk for dying of flu rank second among the vaccination priority groups recommended in the plan. They are followed by pregnant women, household contacts of certain vulnerable people, public health emergency response workers, and key government leaders. The plan also lists priority groups for treatment with the limited supplies of antiviral drugs that would be available if a pandemic erupted. First on that list are hospitalized flu patients, followed by healthcare workers who provide direct patient care, including emergency medical service providers, and then highest-risk outpatients. Next come pandemic response workers, public safety personnel, certain other outpatients, and nursing home residents.

***To see the HHS plan visit: http://www.hhs.gov/pandemicflu/plan/. (CIDRAP 11/2/05, 11/3/05 http://www.cidrap.umn.edu/)

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USA: Chiron wins H5N1 vaccine contract
The US government has awarded Chiron Corp. a $62.5 million contract to make a vaccine for H5N1 avian influenza as part of efforts to prepare for a possible human flu pandemic. Meanwhile, WHO said that recent isolates of the H5N1 virus from birds and humans in Asia show slight genetic changes from the isolate on which current experimental H5N1 vaccines are based. However, the WHO is not recommending changing the prototype strain used for vaccines at this point. Chiron said it would supply the vaccine to the government in 2006. It is not yet known how many people the vaccine would protect, because the dose size has yet to be determined in clinical trials. The Department of Health and Human Services (HHS) has a stated goal of stockpiling enough H5N1 vaccine to vaccinate 20 million people. In Sep 2005 the agency awarded Sanofi Pasteur a $100 million contract to supply an H5N1 vaccine. The dose size for that vaccine also remains to be determined. Chiron won a contract from the National Institute of Allergy and Infectious Diseases (NIAID) in May 2004 to produce small amounts of an H5N1 vaccine for use in clinical trials. NIAID will test various doses and formulations of the vaccine.

Chiron also announced promising preliminary results in a clinical trial of a vaccine for another avian flu virus that has been known to infect humans, H9N2. The virus caused serious illness in 3 people in Hong Kong in 1999 and 2003 and is viewed as capable of evolving into a pandemic strain. 4 different doses of Chiron's experimental H9N2 vaccine were tested in 96 people. Some of the doses contained an adjuvant called MF59. All the formulations containing MF59 generated antibody levels believed high enough to protect a person from the virus, the company said. Vaccine formulations without MF59 generated significantly lower levels of antibodies. Progress on still another avian flu vaccine was reported by the European Union Commission. Researchers developed an experimental vaccine for the H7N1 virus, which is viewed as another potential pandemic strain. H7N1 caused deadly outbreaks in Italian poultry in 1999 and was related to the H7N7 virus, which devastated Dutch poultry flocks in 2003. European researchers reported recently that antibodies to H7 viruses were found in Italian poultry workers in 2003.
(CIDRAP 10/28/05 http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/oct2805chiron.html)

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USA: Disease experts warn against hoarding Tamiflu
Two major organizations of infectious disease experts warned the public against hoarding oseltamivir (Tamiflu). "The threat of a pandemic to the American people is so low right now that it simply doesn't justify personal stockpiles of antivirals," said Leonard Mermel, president of the Society for Healthcare Epidemiology of America (SHEA). "We need this drug to treat sick people who will suffer from human strains of flu this winter." The statement follows recent reports of people trying to stockpile the drug for protection in case a flu pandemic erupts. Governments are stockpiling oseltamivir, but supplies are limited and production is slow. Recently Roche suspended shipments of the drug to US pharmacies in an effort to prevent hoarding and save supplies for those who will need it for seasonal flu. IDSA and SHEA said, "Personal stockpiling would likely lead to inappropriate use and wastage, as well as foster antiviral drug resistance emergence under some circumstances." The groups suggested that healthcare facilities consider building a rotating stockpile containing about 5 times as much oseltamivir and zanamivir as they need in an average flu season. US officials say they currently have a stockpile of about 2.3 million treatment courses of oseltamivir and expect to have about 2 million more by the end of this year. The government's current goal is to have enough to treat 20 million people, which is less than 10% of the population. The IDSA advocates storing up enough to treat 25% to 40% of the population. (CIDRAP 10/31/05 http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/oct3105tamiflu.html)

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Canada (Ontario): Legionellosis at long-term care facility
3 more elderly people have died from an outbreak of Legionnaires' disease that investigators confirmed 21 Oct 2005. Health officials said droplets were distributed into the air by the cooling system on the roof of the Seven Oaks Home for the Aged in Toronto and then sucked into the ventilation system's air intake. "The bacteria causing the disease were spread through a very vulnerable population of elderly residents with tragic results," Dr. David McKeown, Toronto's medical officer of health, said. "From what we know at this point, there's no evidence that the cooling tower was not properly maintained." Health officials ordered the cooling tower shut down 6 Oct 2005 when the disease was detected. "This outbreak stands as one of the most significant events on record involving Legionnaires' disease and we will be very diligent in reviewing our work and identifying important lessons learned." A separate, independent review of the outbreak is also being conducted by Dr. David Walker, who also chaired an expert panel on Toronto's deadly SARS outbreak. Walker will evaluate the city's response to the outbreak and determine whether lessons learned from the 2003 SARS outbreak were applied. So far, 20 people--all of whom were elderly--have died as a result of the outbreak. There have been 127 cases of disease, including 67 residents, 30 staff and 26 visitors. Another 4 people who live or work in close proximity to the facility have also contracted the disease, likely infected by droplets that escaped the building through the cooling tower. (Promed 10/22/05)

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USA (South Dakota): Source of Legionnaires' outbreak identified
An ornamental fountain in a restaurant waiting area has been identified as the source of an outbreak of Legionnaires' disease in Rapid City, officials said 29 Oct 2005. Samples taken from the Casa Del Rey matched the Legionella strain isolated from people who have become sick, state Health Secretary Doneen Hollingsworth said. 2 new cases of Legionnaires' disease have been identified, bringing the total number of Rapid City cases to 15. One person died 1 Jul 2005. 2 people remain hospitalized. Casa Del Rey removed the fountain 26 Oct 2005. The disease can't be transmitted person-to-person but rather by exposure to bacteria in a mist or vapor. This outbreak persisted over many months before the source was found. The USA's Department of Labor's Occupational Health and Safety Administration Technical Manual Section III, Chapter 7 reviews the epidemiology and control of legionellosis http://www.osha.gov/dts/osta/otm/otm_iii/otm_iii_7.html. Water stored below 20 C is generally not a source for amplified L. pneumophila levels. However, high levels of bacteria have been measured in the water supplying ice machines. The source of amplification in this case was thought to be heat from the condenser coil of the ice maker to the cold water supply. However, no cases of Legionnaires' disease have been linked to consumption of ice made from contaminated water. (Promed 10/31/05)

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USA (Oregon): E. coli O157 cases at restaurant
Deschutes County Public Health, Deschutes County Environmental Health, and the Oregon Department of Human Services are investigating an outbreak of E. coli O157:H7 infection with common exposure at McGrath's Fish House in Bend. To date, 18 cases of diarrhea have been reported; 2 have confirmed E. coli O157 infection. The restaurant is fully cooperative and working with the agencies in the investigation. At this point in time no specific food item stands out as a likely source. Dan Peddycord, Deschutes County Health Administrator, cautioned persons with suspected O157 infection to avoid over-the-counter anti-diarrheal agents and antibiotics. E. coli O157:H7 can cause severe illness. E. coli O157:H7 infections may be spread from a variety of food products, most commonly undercooked ground beef, unpasteurized milk and apple cider, other foods cross-contaminated with raw beef, and untreated water. E. coli O157:H7 can also be spread person-to-person, primarily within households. (Promed 10/25/05)

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USA (South Carolina): Human case of eastern equine encephalitis
The South Carolina Department of Health and Environmental Control said Eastern Equine Encephalitis has hit the Pee Dee, with an elderly man becoming the first human case in 2005 of EEE in South Carolina. Although the disease shares a similar transmission process to the West Nile Virus, the 2 are quite different. EEE is relatively rare among people, but there has been an increase in 2005 in confirmed cases of EEE in animals and mosquitoes in South Carolina, according to DHEC. DHEC Commissioner C. Earl Hunter said wearing long sleeves and long pants when outside and using repellents, such as DEET, can help reduce the likelihood of contact. "Continue to look around your home and property, and empty any standing water from containers," he said. EEE virus is transmitted to horses and to humans through the bite of an infected mosquito. Horses can become infected with and die from EEE virus infection. However, the primary EEE transmission cycle is between birds and mosquitoes. Several species of mosquitoes can become infected with EEE virus. The most important mosquito in maintaining the enzootic transmission cycle is Culiseta melanura. Human cases occur relatively infrequently, largely because the primary transmission cycle takes place in swamp areas. States with the largest number of cases are Florida, Georgia, Massachusetts, and New Jersey. About 35 percent of people who survive EEE are left with neurological deficits. There have been about 200 confirmed cases in the US between 1964 and the present. There is an average of 4 cases per year, with a range from 0 to 14 cases. (Promed 10/21/05)

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1. Updates
Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies

Canada. Localized activity of influenza A was reported in Saskatchewan for weeks 40 and 41. Activity remained low in the rest of Canada.

Other reports. During weeks 40-41, low influenza activity was detected in Chile (B), Hong Kong (H1, H3 and B), Mexico (A), and the USA (H3 and A). (WHO 10/27/05 http://www.who.int/csr/disease/influenza/update/en/)

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Cholera, diarrhea & dysentery
Russia (Chuvashia)
Reportedly, 77 schoolchildren in the Chuvashia village of Vurnary proved to have intestinal infection, and 56 of them are now in a hospital. Reportedly, 48 children aging from 7 through 17 years have dysentery. Doctors say that their condition is not critical. The school is under sanitary treatment. One of the theories is that the children were poisoned with contaminated sausage, so the school canteen is temporary closed. (Promed 10/21/05)

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Dengue
Malaysia
The Aedes mosquito in Malaysia, which carries the dengue virus, has evolved into an extremely hardy insect, with its eggs surviving for up to 6 months without water, a report said. Reportedly, an entomologist specialising in mosquitoes from the Universiti Sains Malaysia, Abu Hassan Ahmad, said research showed that water was needed for the insect's eggs to be laid but they could then survive for months in dry conditions. "Our lab tests have shown that the eggs can survive for 4 months and we are sure they can even last up to 6 months without a drop of water," Abu Hassan was quoted. Malaysia is moving out of the dry monsoon period into a wetter season and the scientist said this would see eggs being hatched. Abu Hassan said "fogging" killed the adult insects but not the eggs. "The eggs are laid in tree crevices, drains and containers when water collects there. It is impossible to destroy the eggs totally," he said. Separate studies by health and environment officials in eastern Sarawak state showed continuous fogging with the same chemical would result in the Aedes mosquito becoming resistant to the poison. (Promed 10/21/05)

Malaysia (Kuala Lumpur)
Cases of dengue fever in the capital city are on the rise, even though the reverse is true in most other States. Health Ministry director of disease control, Dr. Ramlee Rahmat, said suspected dengue cases in Kuala Lumpur rose from 114 to 128 in Oct 2005. However, most States registered a decline: Selangor, Penang, Johor and Perak. States which saw an increase were Sabah, Malacca, Perlis and Putrajaya. Dr. Ramlee said the total fatalities from dengue are 81 in Oct 2005. 1064 suspected dengue cases were reported in the third week of Oct 2005, as compared to 1172 the previous week. The number of dengue cases in the country on 22 Oct 2005 was 32 126. Of this, 9381 were confirmed dengue cases, while another 1634 were dengue hemorrhagic fever cases. Dr. Ramlee urged local councils and the public to step up the fight against dengue by making sure public places, buildings and homes did not become mosquitoes breeding grounds. The Selangor Government allocated RM 20 million [USD 5.3 million] for dengue prevention. This was in addition to the RM 20 million already provided for the task in 2005. (Promed 10/21/05, 10/30/05)

Viet Nam
Many southern provinces are suffering from a dengue fever outbreak and the epidemic is spreading to central and northern provinces. The Ministry of Health reported 3575 dengue fever cases nationwide in the past 2 weeks, including 2 deaths in southern Ca Mau and Long An provinces. This disease has also appeared in central provinces such as Thanh Hoa (245 cases), Ha Tinh (74) and Khanh Hoa. Dr Pham Ngoc Dinh, Deputy Director of the Central Hygiene and Epidemiology Institute, said that the central region is now the hub of dengue fever, especially Khanh Hoa with nearly 4000 patients. He added that the spread of the epidemic could continue until November. According to Dr Dinh, the number of dengue fever patients is low in the North because 18 northern provinces organized effective anti-dengue fever networks while the weather was unfavourable to mosquitoes. (Promed 10/21/05)

Singapore
The official death toll from Singapore's worst dengue fever outbreak has jumped to 19 in 2005 with the number of reported cases now approaching 13 000. The health ministry says 4 men, 3 in their 60s and one aged 49, have succumbed over Oct 2005 to the disease, which continues to infect dozens of people daily in the city-state. The health ministry says it is "hopeful," because the number of new cases appeared to be tapering off from more than 100 a day at the peak of the outbreak. Reportedly, the average number of new cases a day has fallen to 56. Singapore has set aside USD 18 million to battle the outbreak and formed a panel of international experts to advise the government on how to combat a disease normally associated with poorer tropical countries. (Promed 10/30/05)

Brunei (Borneo)
There are 18 cases of dengue fever recorded throughout Brunei in October 2005, with 6 of those cases occurring in the Temburong district, it was reported 27 Oct 2005. The Health Services Department is campaigning to enhance public awareness on dengue fever and its prevention measures. The Department continues to monitor the situation, following the rise in the number of dengue fever cases in the region. Dengue fever is caused by the bite of the Aedes mosquito. Symptoms of the disease are headaches, fever, skin rashes, muscle and joint pains, and pain around the eye sockets. Members of the public, however, should not be unduly alarmed, as preventive measures have been undertaken by the department. They should also help in preventing the spread of dengue fever by keeping a clean environment. (Promed 10/30/05)

USA (Texas)
Over a dozen cases of dengue fever have been reported in 2 south Texas counties. City officials held an emergency meeting 26 Oct 2005 to ask leaders in all Valley cities to take the necessary precautions to prevent further spread. Dengue fever is spread by mosquitoes. Officials believe the disease migrated to the states from across the border. Some symptoms of dengue fever are coughing, fever and body aches. (Promed 10/30/05)

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West Nile Virus
Canada
During week 42 (16-22 Oct 2005), 4 new West Nile virus clinical cases [Ontario (2) and Quebec (2)] were reported. As of 22 Oct 2005, 227 WNV clinical cases and 13 asymptomatic infections have been reported to the Public Health Agency. Of the 227 clinical cases, 51 (22 percent) were reported as West Nile Neurological Syndrome, 167 (74 percent) were reported as West Nile Non-Neurological Syndrome, and 9 (4 percent) were Unclassified/Unspecified. To date, there have been 12 deaths [Saskatchewan (2), Manitoba (1), Ontario (8) and Quebec (1)] reported in patients with WNV infection. (Promed 10/30/05)

USA
As of 1 Nov 2005. 42 states have reported 2,581 cases of human WNV illness in 2005. By comparison, a total of 2,241 WNV cases had been reported as of 2 Nov, 2004. A total of 1,359 (56%) of the 2,419 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). Dates of illness onset ranged from January 2 to October 21; a total of 83 cases were fatal. A total of 374 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: 41 years [range: 17--64 years]) subsequently had other illnesses; and 82 persons (median age: 46 years [range: 17--78 years]) subsequently had West Nile fever. Additional information 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/mm5443a5.htm (MMWR November 4, 2005 / 54(43);1105-1106)

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2. Articles
Global Measles and Rubella Laboratory Network, January 2004--June 2005
“Measles continues to be a leading cause of childhood morbidity and mortality in developing countries and an outbreak threat in the majority of countries. . .In 2001, WHO and the United Nations Children's Fund (UNICEF) developed a 5-year strategic plan. . .to reduce measles mortality by 50% by 2005 (relative to 1999 estimates) and to achieve and maintain interruption of indigenous measles transmission in large geographic areas with established measles elimination goals. This plan included strengthening routine vaccination coverage, providing a second opportunity for measles immunization to children, improving measles case management, and improving surveillance with laboratory confirmation of suspected measles cases. To date, four of six WHO regions have established measles elimination targets: the Americas Region (AMR) by 2000, the European Region (EUR) by 2010, the Eastern Mediterranean Region (EMR) by 2010, and the Western Pacific Region (WPR) by 2012. . .the African (AFR) and South East Asian (SEAR) regions are continuing work toward the measles mortality reduction goal. Likewise, to reduce the burden of disease from congenital rubella syndrome (CRS). . .several countries have developed or continue to develop rubella control programs, and AMR and EUR have established regional rubella elimination and CRS reduction goals, respectively. Because improved global surveillance is essential for monitoring progress toward mortality reduction and elimination of these diseases, WHO established the Measles and Rubella Laboratory Network (LabNet) in 2003 to promote case identification and confirmation. This report provides an update on the development of LabNet. . .and describes the geographic distribution of measles and rubella virus genotypes as of June 2005. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5443a3.htm (MMWR November 4, 2005 / 54(43);1100-1104)

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Ralstonia Species Associated with Vapotherm Oxygen Delivery Devices--United States, 2005
“This report updates information on Ralstonia species associated with Vapotherm oxygen delivery devices. . .CDC has obtained new information from a test developed by CDC and performed by The Children's Hospital of Philadelphia (Pennsylvania) to assess the efficacy of the new chlorine dioxide disinfection protocol recommended by Vapotherm. Although limited, this information suggests that the new protocol for disinfecting Vapotherm devices and cartridges might not achieve sustained bacterial control in certain situations. At this time, the optimal protocol to disinfect machines and cartridges that might contain very heavy biofilms is not known. Before development of the new disinfection protocol in October 2005, certain institutions had reported no growth of Ralstonia spp. in samples obtained from machines and cartridges disinfected according to the previous protocol. In addition, in an experiment conducted by an independent laboratory contracted by Vapotherm, a laboratory-generated biofilm. . .was grown in a Vapotherm device and cartridge for 3 weeks. The device and cartridge were then subjected to the new chlorine dioxide disinfection protocol. Results from this trial revealed no growth during the 4 days after disinfection. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5443a4.htm (MMWR November 4, 2005 / 54(43);1104-1105)

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3. Notifications
Avian influenza updates
- For the latest CDC updates on pandemic influenza:
http://www.cdc.gov/flu/pandemic.htm; for avian influenza: http://www.cdc.gov/flu/avian/. The “Questions & Answers: Vaccine Supply and Prioritization Recommendations for the U.S. 2005-06 Influenza Season” has been updated 10/28/05: http://www.cdc.gov/flu/about/qa/0506supply.htm.

- The US government has developed an official Web site for information on pandemic flu and avian influenza: http://www.pandemicflu.gov/.

- For the latest FAO updates on avian influenza: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html.

- WHO has uploaded a new comprehensive Web page, “Influenza pandemic threat: current situation”: http://www.who.int/csr/disease/avian_influenza/pandemic/en/index.html.

- American Public Health Association (APHA) now has links for Influenza (http://www.apha.org/preparedness/influenza.htm) and Avian Influenza (http://www.apha.org/preparedness/avian.htm).

- The American Veterinary Medical Association has developed a new website with information on avian, canine and equine influenza on one page: http://www.avma.org/public_health/influenza/default.asp

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 (Rome and Bangkok) 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. (Washington Dept of Health 11/2/05; CDC; WHO; APHA; CIDRAP; Promed 11/3/05)

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International Congress on Infectious Diseases
Abstract submissions are now being accepted for the 12th International Congress on Infectious Diseases to be held in Lisbon, Portugal 15-18 Jun 2006. Join your colleagues in an outstanding scientific meeting that covers the breadth and depth of infectious and emerging diseases. An outstanding international faculty will come together to present such topical issues as pandemic influenza preparedness, zoonotic disease surveillance, polio eradication and community acquired MRSA. Advances in HIV treatment in high and low-income settings, the influence of bacterial microevolution and crosstalk on pathogenesis, new insights into tuberculosis control, the latest developments in vaccines for malaria, tuberculosis and HIV, and host genetics in community acquired pneumonia are examples of exciting developments covered in additional sessions. Please visit <http://www.isid.org> for complete information. The Program Committee offers the Chiron Vaccine Award, Sanofi Pasteur Awards and ISID New Investigator Award programs for outstanding abstracts. Members of the ProMED-mail editorial staff also will be at the 12th ICID to meet with subscribers and to discuss new developments in ProMED-mail. (Promed 11/2/05 http://www.isid.org/)

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National Viral Hepatitis Prevention Conference
Capitol Hill, Washington, D.C.; December 5-9, 2005; http://www.nvhpc.com
Prevention of viral hepatitis is a major challenge for the nation’s public health, scientific and medical communities. Acute and chronic liver diseases caused by hepatitis viruses result in substantial morbidity and mortality in the US. The conference focus will be on the prevention of viral hepatitis during all stages of life (perinatal, infancy, childhood, adolescence, and adulthood). Workshops will address a wide spectrum of challenges including perinatal and childhood prevention activities; providing hepatitis prevention services to high-risk individuals; addressing health disparities; designing, implementing, and evaluating successful outreach, education, and counseling activities; and identifying and overcoming barriers to integrating viral hepatitis activities into existing program settings. The conference will provide important scientific and programmatic updates and training for public health and other professionals working with persons in need of viral hepatitis prevention services. (CDC http://www.cdc.gov/ncidod/diseases/hepatitis/conference.htm)

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Field Guidelines for Measles Elimination
Measles is a vaccine-preventable disease that remains a leading cause of death among children in the Western Pacific Region. Therefore, the Western Pacific Region is now moving towards measles elimination. These guidelines provide guidance for countries to implement the Western Pacific Regional Plan of Action for Measles Elimination. This Field Guide will help countries develop and implement national plans based on the Measles Regional Plan’s key strategies: immunization, surveillance, and laboratory diagnosis. The Field Guide provides health workers, immunization programme managers, public health professionals, and policy-makers at national and subnational levels with advice on what needs to be done and how to do it. (WHO/WPRO http://www.wpro.who.int/publications/pub_929061126x.htm)

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Availability of Maxi-Vac Alternative
Maxi-Vac Alternative, a public use software program, is now available. Maxi-Vac Alternative was developed by CDC to help public health officials plan smallpox vaccination clinics in the event of a bioterrorist attack. Maxi-Vac Alternative allows planners to refine human resource allocations at clinics, with the goal of maximizing patient flow-through. Maxi-Vac Alternative is a companion program to Maxi-Vac 1.0, which was released 2003. The two programs differ in terms of the time patients will require at each station (e.g., pre-vaccination screening and vaccination) and the selections the user can make for number of personnel, size of patient pre-vaccination orientation rooms, and the need for vaccination witnesses. Because no one scenario can describe all contingencies of an emergency mass smallpox vaccination campaign, users should examine both versions before deciding which version to use. Both can be downloaded from http://www.bt.cdc.gov/agent/smallpox/vaccination/maxi-vac. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5443a6.htm (MMWR November 4, 2005 / 54(43);1106)

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The Population Leadership Program at the University of Washington
The Population Leadership Program at the University of Washington is now accepting applications for the 2006-2007 academic year. The application deadline is December 15, 2005. This program brings together professionals from around the world to expand their leadership skills, and partners with them to create systemic improvements in population issues, family planning, and reproductive health at the local, national, and international levels. For more information: http://population-leaders.washington.edu . (UW Population Leadership Program October 2005)

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4. APEC EINet activities
Pandemic influenza preparedness and response videoconference
APEC EINet is preparing 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. All APEC members have been invited to participate. Also, South Korea has generously offered EINet their video clip of their preparedness exercise drill. The video can be found in our “About EINet” section, under Library: http://depts.washington.edu/einet/about.html?a=about&sub=docs.

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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