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Vol. VIII, No. 25 ~ EINet News Briefs ~ Dec 02, 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:
- Romania: Avian influenza threat returns
- East Asia: Cumulative number of human cases of avian influenza A/(H5N1)
- Viet Nam: Culling of birds for avian influenza control
- China: Additional avian influenza outbreak; WHO to help investigations
- China: Fake avian influenza vaccines; development of new vaccine for birds
- Indonesia: Additional confirmed case and suspected cases of human bird flu
- Indonesia (West Java; Sulawesi): Anthrax outbreaks
- Indonesia (West Nusa Tenggara): Outbreak of malaria
- Russia (Nizhniy Novgorod): Viral hepatitis A outbreak continuing
- Russia (Orenburg): Hemorrhagic fever with renal syndrome outbreak
- USA: CDC updating disease-control rules affecting travelers
- USA: FDA approves West Nile test to screen blood
- Canada: Sprouts blamed in big Ontario Salmonella outbreak
- USA/Canada: USA to ease restriction on Canadian poultry

1. Updates
- Influenza
- Dengue
- West Nile Virus

2. Articles
- CDC EID Journal, Volume 11, Number 12-December 2005
- Severe Clostridium difficile--Associated Disease in Populations Previously at Low Risk--4 States, 2005
- Early-Onset and Late-Onset Neonatal Group B Streptococcal Disease--United States, 1996-2004
- Screening HIV-Infected Persons for Tuberculosis--Cambodia, January 2004--February 2005
- East Asia: Many H5N1 cases clustered in families
- Prior H1N1 influenza infection and susceptibility of Cleveland Family Study participants during the H2N2 pandemic of 1957: an experiment of nature
- Effects of local variation, specialty, and beliefs on antiviral prescribing for influenza
- Annual universal influenza vaccination: ready or not?
- New genotype of avian influenza H5N1 viruses isolated from tree sparrows in China
- USA: Produce linked to more disease cases than poultry

3. Notifications
- World AIDS Day --- December 1, 2005
- Conclusions and Recommendations of the Advisory Committee on Poliomyelitis Eradication--Geneva, Switzerland, October 2005
- Licensure of a Combined Live Attenuated Measles, Mumps, Rubella, and Varicella Vaccine

4. APEC EINet activities
- APEC e-Health seminar; Pandemic influenza videoconference

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Romania: Avian influenza threat returns
Virus H5, responsible for the development of avian influenza, was found following tests run on samples from a turkey in the village of Scarlatesti, the commune of Ciresu, Braila County. This focus of avian flu adds to those already found at Ceamurlia de Jos, Maliuc and Caraorman, Tulcea County in Oct 2005. The infected samples at Scarlatesti will be sent for further testing at a UK laboratory. Braila Prefect Nicolae Mitroi ordered that grade one quarantine be immediately enforced in the village of Scarlatesti. Manned road blocks consisting of gendarme and police crews prevent humans, animals and poultry from leaving the village of Scarlatesti until the avian flu focus has been completely eradicated, and entry into the focus area is only allowed after the individuals concerned have been briefed accordingly. The population is also instructed on the danger posed by avian influenza. Authorities at Ciresu take measures aimed at ensuring a steady supply of foodstuffs and other bare essentials, the supplies being ferried without allowing any access to the isolated area. Local measures have been taken to isolate the virus. Experts with the Braila Sanitary Veterinarian and Food Safety Department are attempting to eliminate the focus of the viral infection at Scarlatesti. The vaccination of the local populace began 27 Nov 2005, and so did the killing of the fowl in the village, with compensation. Given that the closest populated location is 3 km away from the village of Scarlatesti, bird killings only apply within the radius of the village. Scarlatesti has nearly 400 homesteads, with an estimated 15 000 fowl.

The European Union maintains the restrictions on imports of poultry from 6 counties in eastern Romania: Tulcea, Constanta, Galati, Braila, Ialomita and Calarasi, but will lift the ban for the other regions starting 1 Dec 2005, the National Sanitary Veterinarian and Food Safety Authority says. However, the ban on imports of live fowl from Romania is still in force. According to the official notifications to the OIE, the vaccination of poultry against avian influenza is not prohibited in Romania. However, no avian vaccination has been reported. Romania has not reported any cases of bird flu in humans so far.

OIE avian influenza H5 report
The following [abridged] report was received from Prof. DR. Predoi Gabriel, CVO, Sanitary Veterinary General Directorate, Romania: Description of affected population: Wild migratory birds found dead in Danube Delta, in Sulina District and Caraorman District: 1) 7 swans, found dead in Tulcea County, Sulina District, Musura bay, N-NE zone; 2) 1 water hen, found dead in Tulcea County, Caraorman District, Obretinul Mic Lake. Diagnosing laboratory: Institute for Diagnostic and Animal Health (National Reference Laboratory). Results: Positive for avian influenza, subtype H5. For full OIE report view: http://oie.int/downld/AVIAN%20INFLUENZA/Romania%20Follow%20up%20No10.pdf (Promed 11/27/05, 11/28/05, 11/29/05)

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Asia
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 / Cases (Deaths)
Indonesia / 12 (7)
Cambodia / 4 (4)
Thailand / 4 (1)
Viet Nam / 66 (22)
China / 3 (2)
Total / 89 (36)

Total number of confirmed human cases of avian influenza A/(H5N1), 26 Dec 2003 to present: 133 (68)
(WHO 11/29/05 http://www.who.int/csr/disease/avian_influenza/country/en/index.html )

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Viet Nam: Culling of birds for avian influenza control
China has provided Viet Nam with non-refundable aid worth 1.5 million Yuan (USD 185 650) to combat bird flu, which had spread to 21 cities and provinces. It also subsidized the cost of transporting vaccines to Ho Chi Minh City. The Vietnamese Animal Health Department said that 21 out of the total 64 localities across Viet Nam have confirmed the outbreak of avian influenza. Southern metro Ho Chi Minh City has strengthened control at checkpoints and outlying districts as the city closed its gates to fowls from other provinces. Military personnel have been deployed to help mobile patrol and market monitor teams. Recently, authorities have seized more than 8000 ducks and chickens and 280 000 eggs at the gates and destroyed them. There are still around 1462 pigeons, 1544 ornamental birds, and 70 ostriches in the city. Officials have told the people to move them out of the city. The Prime Minister issued a ban on poultry trading, breeding, and transport in urban areas from early Nov 2005.

Ho Chi Minh City has begun poisoning pigeons and other wild birds as it moves to prevent avian flu from spreading into the city, an official said 25 Nov 2005. The virus has this week also surfaced in the south where Ho Chi Minh City is located. "We will make sure that no birds are left in the city to minimize the risk of bird flu," Huynh Huu Loi, Director of Ho Chi Minh City's Animal Health Department, said. Loi said beside the poisoning campaign, authorities would also move pet birds outside the city until Vietnam is free of bird flu. Ho Chi Minh has banned poultry farming even though it has had no human cases since Dec 2004. Most of the outbreaks in recent weeks have been in the north. But the virus has spread to the south with the province of Long An reporting its first flu outbreak in poultry.

A "stamping out" policy might, at times, become a controversial issue, especially when protected species or rare animal breeds may be affected. The U.N. FAO says controlling avian influenza in poultry is the most effective public health measure. Juan Lubroth, an FAO officer in charge of infectious animal diseases, said culling wild birds is likely to be ineffective. "Wild bird species found in and around cities are different from the wetland waterfowl that have been identified as carriers of the avian influenza virus," Lubroth said. FAO recommends improved veterinary services, emergency response and the culling of domesticated fowl exposed to the disease as the most effective means of controlling bird flu. (Promed 11/25/05, 11/30/05)

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China: Additional avian influenza outbreak; WHO to help investigations
China's Ministry of Agriculture confirmed a bird flu outbreak in Zalantun city in Inner Mongolia, 25 Nov 2005, bringing to 23 the number of outbreaks of the disease. Reportedly, a state avian flu lab confirmed that 246 fowl which died in Zalantun had highly pathogenic H5N1. Local veterinary departments have culled 16 567 poultry within 3 km of the affected area. China has already culled more than 20 million birds this year to contain the spread of avian influenza. A look at the map http://www.flu.org.cn/map/MapBrowser.aspx?reportId=18 shows that the outbreaks that have recently been reported span the width and breadth of China. The 3 outbreaks in Xinjiang autonomous region are located north of Tibet. The outbreak in Yunnan is in south-central China bordering Burma and Viet Nam. Hubei and Shanxi provinces are in central China.

At the invitation of the Chinese Ministry of Health, WHO is participating in a joint mission to Anhui Province to investigate circumstances surrounding the recent detection of 2 human cases of H5N1 infection in that province. Both fatal cases, which were confirmed by laboratory tests, occurred in female farmers aged 24 and 35 years. The team will be gathering information about the sources of exposure in these 2 cases and will also assess the effectiveness of public health measures introduced in the areas. The 2 cases lived some distance apart; no link between the 2 cases is thought to exist. China has recently experienced a recurrence of outbreaks of highly pathogenic H5N1 avian influenza in poultry. Beginning in mid-October 2005, officials have reported 25 fresh outbreaks in poultry in 9 provinces. To date, the country has reported 3 laboratory-confirmed cases of human infection, of which 2 were fatal. (Promed 11/25/05, 11/26/05, 11/29/05)

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China: Fake avian influenza vaccines; development of new vaccine for birds
Reportedly, 9 people have been arrested for selling fake bird flu vaccines that are suspected to have contributed to an outbreak of the disease in Liaoning province. Police have arrested officials of the Jinyu Group, a company based in Inner Mongolia that produces medicines, and of the Inner Mongolian Biological Medical Products Factory. After a 20-day investigation covering 4 provinces and regions, police found the 2 companies had manufactured and sold 200 000 vials of 12 different kinds of bird flu vaccine nationwide. With 29 outbreaks of the disease discovered so far this year, China is seeking to vaccinate its estimated 5.2 billion farm-raised birds, but requires manufacturers to have a license to produce the vaccines. Police said that the Jinyu Corporation failed to apply for a license from the state to manufacture bird flu vaccines for poultry, but labeled its products with fake government licensing numbers. Investigators found the fake vaccines were used on farms in Liaoning's Jinzhou region, where an outbreak of bird flu occurred in mid-October 2005. Some 2.5 million farm raised birds were culled in the Jinzhou region following the outbreak, devastating the livelihood of farmers in the region.

The UN said 23 Nov 2005 that it supports China's massive animal vaccination programme to combat bird flu, but cautioned that quality control on vaccines must be assured. Joseph Domenech, chief veterinary officer of the UN FAO, said agency officials would be among those visiting Chinese laboratories. China’s State Council asked local governments to support and supervise designated vaccine producers, and strike hard at those manufacturing fakes. Separately, China has developed a new vaccine for use on birds against the avian influenza strain, media reports said. The vaccine reportedly has the advantage of fighting another common bird disease, as well as the H5N1 influenza strain. It identified this as avulavirus APMV-1, also known as Newcastle disease. "What's more, the new vaccine is safer, more convenient to use and cannot kill newborn chicks," it said. The new vaccine can apparently be applied by spraying. "In addition, the cost of the new vaccine in mass production is only 1/5 that of the previous vaccine." The country was preparing to put the vaccine into mass production. (Promed 11/26/05, 12/1/05)

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Indonesia: Additional confirmed case and suspected cases of human bird flu
The Ministry of Health in Indonesia has confirmed a further case of human infection with the H5N1 avian influenza virus. The case is a 16-year-old boy from West Java Province. He developed symptoms of fever and cough 6 Nov 2005, followed by breathing difficulties a few days later. He was hospitalized 16 Nov and remains in stable condition. A field investigation of this case determined that 2 siblings had died 5 days before his hospitalization. His 2 brothers, aged 7 and 20 years, had onset of illness 3 Nov 2005 and died 11 Nov, following symptoms of fever and breathing difficulty. The presumptive diagnosis was typhoid fever. No samples were taken before burial, which precludes definitive diagnosis. No other cases of influenza-like illness were detected in the 80 households of the village. The field investigation found that chickens in the family household had died during the 2 weeks preceding onset of illness in the deceased brothers. Samples from animals have been collected and the investigation continues.

A 25-year-old Indonesian woman who died has tested positive for avian influenza, a senior researcher at the Health Ministry said 30 Nov 2005. Endang Mamahit said the woman had been treated at the Sulianto Saroso Hospital, Jakarta's hospital for treating avian influenza patients. She died 29 Nov 2005. "We have conducted [a] test and the [result is] positive," Mamahit said, adding that the result had to be confirmed by a WHO laboratory. The woman had reportedly been in contact with dead chickens before being admitted to the hospital 24 Nov 2005. In addition, health officials are waiting for WHO confirmation of local tests which showed that a 35-year-old man who died 19 Nov 2005 was the country's eighth fatality. Indonesia has had 7 deaths from avian influenza confirmed by the WHO laboratory. Another 5 people have been confirmed to have contracted the virus but have survived. Most human bird flu cases in Asia have been blamed on direct or indirect contact with infected poultry.

Meanwhile, health minister Siti Fadilah Supari said that the mass production of Tamiflu in the country would start in 3-5 months. The minister said the government would appoint state-owned pharmaceutical companies to make Tamiflu under the generic name oseltamivir phosphate. Siti said Indonesia had obtained permission from the distributor of Tamiflu, Roche AG, to produce the drug only for the domestic market. The government will produce about 20 million Tamiflu tablets. "The drug will only be produced according to our needs or a minimum of 10 percent of the country's population (of around 220 million people). At present, we have 800 000 tablets provided by donor countries such as Australia, Japan and Singapore," Siti said. Siti said her office had discussed with India, China and South Korea the possible provision of raw materials for Tamiflu production here. (Promed 11/29/05; 11/30/05)

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Indonesia (West Java; Sulawesi): Anthrax outbreaks
An anthrax outbreak near Bogor, West Java has reportedly claimed 6 lives and hospitalized 8 people since 16 Oct 2005. Anthrax may have affected as many as 65 people. Ministry of Health officials report that infected goat meat was the cause. To stem the spread of the infection, the Government of Indonesia has ordered a quarantine of the affected villages, as well as the slaughter of all goats and goat pens in the district. Officials say they are tightening controls on livestock shipped to Jakarta-area slaughterhouses. Anthrax is endemic to nearly all of Indonesia. However, it is particularly common to this sub-district in West Java. Since 2001, the Bogor Health Agency has recorded 47 cases of anthrax infection and 11 fatalities. Health minister Dr Siti Fadilah Supario warned the public to report immediately any evidence of anthrax symptoms in people or livestock. Agriculture minister Apriyanto ordered the distribution of 300 000 doses of anthrax vaccine across the country. He also directed the Bogor district government to isolate and ban inter-regional transportation of livestock from the affected sub-district. Bogor agriculture officials have ordered locals to slaughter and burn all goats and goat pens in the sub-district. The Agriculture Ministry's director of Vectorborne Disease Eradication also deployed an investigation team to the area. The regional disease prevention health office has placed warning signs within the endemic area. Additionally, the regional livestock office is vaccinating other cattle not yet infected by anthrax. The National Institute of Health has asked the US Mission's Naval Medical Research Unit (NAMRU-2) to confirm the presence of anthrax in 5 samples taken from the affected area. NAMRU-2 is currently testing those samples. The Bogor Health and the Bogor Husbandry Agencies will increase monitoring by coordinating with community health centers (Puskesmas) and integrated health service posts (Posyandu), the head of prevention and eradication of infectious diseases and community health of the Health Agency, Eulis Wulantari, said. Eulis said that anthrax infection usually happens at the start of the rainy season.

Separately, health officials in the South Sulawesi city of Makassar carried out house-to-house checks for signs of anthrax infections in humans. Makassar's health office head Naisah said that after the first case of animal anthrax infection was confirmed 11 Nov 2005, authorities set up a centre to deal with the outbreak at Tamangapa village, with more than 200 people appearing for checks. She said health officials had taken blood samples from 11 people. 4 of them showed superficial symptoms of anthrax and the rest were people with a high susceptibility to the disease because of their work. More than 20 cows and water buffalos were believed to have died of anthrax although only 4 cases were confirmed. A ban on the movement of livestock in and out of the area was being enforced, while officials were gearing up for a massive vaccination campaign, with 65 000 doses being prepared for distribution. Sick animals were being treated with antibiotics. (Promed 11/18/05, 11/27/05)

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Indonesia (West Nusa Tenggara): Outbreak of malaria
Reportedly, at least 6 people have died and 266 others have been treated at local hospitals and community health centers in the Indonesian town of East Lombok since a malaria outbreak was first detected in the regency late Oct 2005. The outbreak struck 3 subdistricts in the regency in the eastern province of West Nusa Tenggara. The local government has alerted health centers to prepare more medicines and import doctors and nurses. Regional administrations are also making efforts to reduce the number of malaria-carrying mosquitoes. Officials called for residents to quickly bring their children to hospitals if they had high fevers or showed other malaria symptoms. West Nusa Tenggara Health Office chief of disease eradication Thamrin Hijaz said while malaria was endemic in East Lombok regency every wet season, he was surprised at the high numbers of cases this year. Thamrin blamed the increase on poor sanitation. Meanwhile, the Ministry of Health reportedly donated thousands of mosquito nets to the residents in the affected areas. Malaria is well known on Lombok Island, and outbreaks have been reported in 1997 and 2002. Both P. falciparum and P. vivax malaria are found on Lombok, and chloroquine resistance has been reported. Travelers should be advised to use malaria prophylaxis when visiting Lombok. (Promed 11/21/05)

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Russia (Nizhniy Novgorod): Viral hepatitis A outbreak continuing
21 more people with symptoms of viral hepatitis A virus infection were hospitalized in Nizhniy Novgorod 29 Nov 2005, the regional Emergency Situation Authority said 30 Nov 2005. There remain 426 patients in medical institutions, 60 of them children and teenagers. The hepatitis rate in the city is 2-3 times higher than the regional average. Since the beginning of the epidemic,3053 persons, 644 of them children, have been admitted to hospital. The outbreak began 5 Sep 2005, and as of 29 Nov 2005 the total number of cases has reached 3053 persons including 644 children. This represents an increase of 836 cases (including 295 children) sine the last report from the city dated 24 Oct 2005. The outbreak is far from over and must be one of the largest outbreaks of hepatitis A recorded in recent years. The predominant mode of transmission of infection is now thought to be person-to-person contact. (Promed 11/18/05, 12/1/05)

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Russia (Orenburg): Hemorrhagic fever with renal syndrome outbreak
The Sanitary Department of the Orenburg Regional Office of the Russian (Health) Protection Agency (Rospotrebnadzor) announced that 5 fatal cases of hemorragic fever with renal syndrome (HFRS) had occurred in the Orenburg region during autumn 2005. Since the beginning of Sep 2005, 239 cases of HFRS had been diagnosed in Orenburg by 18 Nov 2005, whereas only 17 cases were recorded during the same period of 2004. This year on average 5 HFRS patients per day had been admitted to the City Infectious Diseases Hospital. On 28 Nov 2005, a special commission was convened, and the need for implementation of rodent control measures in farmyards and their surroundings were emphasized. However, not all farmstead owners were prepared to pay the 167 rouble cost [USD 5.80] from their own resources. The commission recommended implementation of an educational campaign. During the last 9 years scientists have been studying rodent populations in Orenburg and established that 6 - 33 percent were carriers of the virus responsible for HFRS. Outbreaks of disease were associated with the onset of colder weather, when mice sought refuge in human habitations. Medical practitioners consider that expenditure of 167 roubles is a small price to pay for protection of families from the scourge of HFRS. (Promed 11/29/05)

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Americas
USA: CDC updating disease-control rules affecting travelers
Federal officials proposed rule changes to make it easier for public health authorities to keep travelers from bringing infectious diseases into the US or spreading them between states. The changes would require airlines and ship operators to report passengers who have certain signs of illness and to keep lists of passengers for at least 60 days after arrival, CDC announced. The proposed rules also expand the definition of ill travelers to include those with influenza-like illness, and they provide more specific legal protections for people placed in quarantine. The Department of Health and Human Services has authority to use isolation and quarantine to keep people with any of 9 infectious diseases out of the country. Pandemic influenza was added to the list this year; the others are cholera, diphtheria, tuberculosis, plague, SARS, smallpox, yellow fever, and viral hemorrhagic fevers. The proposed rule changes are largely a result of the SARS experience in 2003, when the CDC had a lot of trouble tracking down and alerting passengers who had been on flights with suspected SARS case-patients, officials said.

In the past, passenger lists often have been purged within 48 hours, and if a disease threat emerged after the fact, it became very difficult to recover passenger names and contact information and seating charts, Dr. Marty Cetron, director of the CDC Division of Global Migration and Quarantine, explained. The proposal also calls for airlines to ask passengers to provide post-arrival contact information for potential use by public health officials, though this would be voluntary. CDC is "hopeful and optimistic" that most people would accept assurances that the information would not be used for other than public health purposes, Cetron added. The updated regulations also require the pilot or ship captain to report to the CDC any passenger who has certain signs and symptoms suggesting 1 of the 9 diseases of concern, Cetron said. As things stand now, he explained, sick travelers are not usually reported until well after their trip and generally are identified through traditional public health surveillance. The new regulations also include more detailed due-process rules for people placed in quarantine because of exposure to a disease, Cetron said. The proposed rules empower authorities to hold a person for 3 days, after which a formal decision must be made whether to quarantine or not. In addition, there must be an opportunity for a hearing before an independent arbiter. Also included in the proposed changes is "explicit authority to offer vaccination, prophylaxis, and other appropriate medical interventions on a voluntary basis" to people in quarantine. The CDC will accept comments on the proposed rules for 60 days. (CIDRAP 11/22/05)

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USA: FDA approves West Nile test to screen blood
A test to screen blood and organ donors for West Nile virus (WNV) has won approval by the Food and Drug Administration after 2 years of trial use. The FDA announced approval of the Procleix West Nile virus assay, developed by Gen-Probe Inc., and marketed by Chiron Corp. The test detects West Nile RNA in blood. The test has been used to screen more than 29 million units of donated blood since June 2003 and has detected the virus in more than 1,500 cases, preventing transfusion of contaminated blood into as many as 4,500 people, Gen-Probe officials said. The test is intended to help protect recipients of donated blood and organs from the virus. The FDA said there have been 30 cases in which people probably acquired WNV from a blood transfusion, and 9 of the patients died. Another blood test is available to help doctors diagnose WNV, but it must be used in tandem with other tests. Procleix is the first approved test that stands alone, making it suitable for use by blood banks. Another WNV blood test, developed by Roche Molecular Systems, Inc., is still being used experimentally. An FDA official said the agency is allowing Roche to use the test on a trial basis until it has enough data to apply for approval. Efforts to develop a WNV blood test began in 2002 when it was discovered that the virus could be transmitted in blood. With help from the FDA and other federal health agencies, biotechnology firms developed investigational tests that were quickly adopted on a trial basis. A total of about 1,600 infected donations were detected by the investigational tests, the FDA said. Close to 20,000 cases of WNV illness, with 762 deaths, have occurred in the US since the virus first arrived in 1999, the FDA said. FDA news release: http://www.fda.gov/bbs/topics/NEWS/2005/NEW01266.html (CIDRAP 12/2/05 http://www.cidrap.umn.edu/cidrap )

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Canada: Sprouts blamed in big Ontario Salmonella outbreak
Close to 400 people in Ontario have gotten sick in a Salmonella outbreak blamed on contaminated mung bean sprouts. Toronto's health department ordered Toronto Sun Wah Trading Nov 25, 2005 to stop distributing mung bean sprouts because of possible contamination with Salmonella. Dr. Sheela Basrur, Ontario's chief medical officer of health, said 379 cases of salmonellosis have been confirmed in the province. The report said 26 of 36 regional health agencies in Ontario had reported cases linked with eating sprouts. "We expect that there are many hundred more people who have Salmonella poisoning that have not yet come to our attention," Basrur said. The outbreak began early Nov 2005. Normally about 20 to 25 cases of salmonellosis per month are reported at this time of year, the ministry said. The ministry statement did not spell out the evidence linking the cases with sprouts from Sun Wah Trading. In a Nov 24, 2005 statement, the Canadian Food Inspection Agency (CFIA) said Sun Wah mung bean sprouts have been sold in packages of various weights and under various store names or without the Sun Wah name. Officials did not mention any distribution of the products outside Ontario.

Salmonella bacteria are found in the intestines of animals and can contaminate raw produce that have been in contact with impure water, animal manure, or an infected food handler. Symptoms of infection usually begin from 12 to 36 hours after a person consumes a contaminated food. The recommended safety step of soaking seeds in a calcium hypochlorite solution is not completely effective, the agency said. To reduce the risk of illness, the US Food and Drug Administration advises consumers to cook all sprouts thoroughly before eating them and to ask that raw sprouts not be added to restaurant sandwiches and salads. Most cases of Salmonella infection resolve without medical treatment, but the pathogen can cause serious and sometimes fatal illness in children, elderly people, and those with weak immune systems. (CIDRAP 12/1/05 http://www.cidrap.umn.edu/cidrap/ )

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USA/Canada: USA to ease restriction on Canadian poultry
The US lifted a week-old ban on poultry from British Columbia after concluding that the strain of avian flu found in two ducks on farms east of Vancouver posed no threat to human health. The ban will remain in effect for poultry on farms within 3 miles of where the 2 infected ducks were found. Dr. Con Kiley of the Canadian Food Inspection Service said the virus found at the first farm was identified as an H5N2 strain, and the same result was expected at the second farm. The farms are near Chilliwack. The US had banned all live poultry and raw poultry products from British Columbia Nov 21, 2005. About 58,000 ducks on the 2 affected farms were killed as a precaution. (CIDRAP 11/29/05 http://www.cidrap.umn.edu/cidrap )

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1. Updates
Influenza
USA
During week 47 (Nov 20 – Nov 26, 2005), influenza activity occurred at a low level in the US. 22 (1.8%) specimens tested by U.S. WHO and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories were positive for influenza. The proportion of patient visits to sentinel providers for influenza-like illness (ILI) and the proportion of deaths attributed to pneumonia and influenza were below baseline levels. 23 states, New York City, the District of Columbia, and Puerto Rico reported sporadic influenza activity, and 27 states reported no influenza activity. (CDC 12/2/05 http://www.cdc.gov/flu/weekly/ )

Avian/Pandemic influenza updates

- WHO “Influenza pandemic threat: current situation”: http://www.who.int/csr/disease/avian_influenza/pandemic/en/index.html. Comprehensive information on the avian influenza 7-9 Nov 2005 meeting, including presentations, are available at: http://www.who.int/mediacentre/events/2005/avian_influenza/en/index.html WHO recommendations relating to travelers coming from and going to countries experiencing outbreaks of highly pathogenic H5N1 avian influenza: http://www.who.int/csr/disease/avian_influenza/travel2005_11_3/en/index.html. WHO does not recommend any restrictions on travel to any areas affected by H5N1 avian influenza; WHO does not recommend screening of travelers coming from H5N1 affected areas; WHO advises travelers to avoid contact with high-risk environments in affected countries

- WHO/WPRO (Regional office for the Western Pacific) website on avian influenza: http://www.wpro.who.int/health_topics/avian_influenza/overview.htm

- Latest FAO updates on avian influenza: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. Includes maps documenting the latest avian flu outbreaks and an interactive map displaying the timeline of the outbreaks. Documents from the avian influenza meeting (7-9 Nov 2005) are now available.

- Latest OIE updates on avian influenza: http://www.oie.int/eng/en_index.htm. Includes documents from the avian influenza 7-9 Nov 2005 meeting. A press release on the 24th Conference of the OIE Regional Commission for Asia, the Far East and Oceania - Seoul (Republic of Korea) 15-18 November 2005 is also available.

- The CDC website on pandemic influenza: http://www.cdc.gov/flu/pandemic.htm has been updated; for avian influenza (available in Chinese, Korea, Vietnamese, and Japanese): http://www.cdc.gov/flu/avian/ (Key Facts and Q&A updated 25 Nov 2005).

- The US government’s official Web site for pandemic flu: http://www.pandemicflu.gov/.

- Influenza information from the US Food and Drug Administration: http://www.fda.gov/oc/opacom/hottopics/flu.html. Q & A on Using PPE During Influenza Outbreaks, Including Bird Flu: http://www.fda.gov/cdrh/emergency/flu_qa.html.

- PAHO’s latest updates on avian influenza: http://www.paho.org/ Includes press release on the Summit of the Americas.

- American Public Health Association (APHA) information on Influenza (http://www.apha.org/preparedness/influenza.htm) and Avian Influenza (http://www.apha.org/preparedness/avian.htm).

- The American Veterinary Medical Association information on avian influenza: http://www.avma.org/public_health/influenza/default.asp
(WHO; FAO, OIE; CDC; US FDA; CIDRAP; PAHO; APHA; AVMA)

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Dengue
Indonesia
The spread of dengue in Central Java province has reached alarming proportions, with 80 fatalities having been reported since Jan 2005, an official said 15 Nov 2005. The 80 fatalities [a case fatality rate (CFR) of 2.3 per cent or 2265 per 100 000] were out of a total of 3531 dengue cases reported during the same period, said Central Java provincial health office director Budihardja. The dengue cases were spread among all regencies and municipalities in Central Java province, with Semarang being the city with the greatest number of dengue cases: 1340 with 16 fatalities [a CFR of 1.2 per cent]. Budihardja blamed poor sanitation as the chief cause of dengue in the city. Sanitation in the urban area was worse than in the countryside. The number of fatalities caused by dengue this year [2005] was, however, much less than in 2004. While dengue claimed 80 lives up to Nov 2005, in 2004 the disease claimed 163 lives in the whole year. Similarly, the number of dengue cases reportedly fell 3-fold this year. While last year the number of dengue cases numbered 9050, as of Nov 2005, only 3531 had been recorded. The decrease in the number of dengue cases was attributed to the government campaign against the disease. Credit also needed to be given to the people, whose awareness of dengue had increased. Previously, people were often too late in sending ill relatives to hospital due to a lack of knowledge about dengue fever, thus leading to many fatalities. But awareness of dengue symptoms has improved, and they quickly brought ill relatives to the hospital once they detected the symptoms. Budihardja said the government had allocated IDR 1.7 billion [USD 168 843] this year to combat dengue in 9000 subdistricts across the province. Dengue regularly affects some 800 of the 9000 subdistricts in the province, and it was in these 800 subdistricts that the government would focus its efforts.

Meanwhile, the hospitals Pasar Rebo and Budi Asih, both in East Jakarta, have added more beds along their corridors, after dozens of new dengue patients were admitted to the hospitals 24 Nov 2005. At Pasar Rebo hospital, 21 of 72 dengue patients were treated on additional beds along the corridors, while in Budi Asih, 22 of 55 patients were treated along its corridors. Despite the increasing number of people treated for dengue, the city administration has refused to declare the dengue outbreak as an extraordinary occurrence, which would require the city administration to pool its resources to fight the outbreak. Jakarta Health Agency spokesman Evy Zelvino said the number of dengue cases had continued to increase over the last few months as the rainy season approached. Dengue fever is transmitted by the Aedes aegypti mosquito, which is most active during daylight hours. She said that the only way to stop the spread of the disease was to drain receptacles, cover bathing tanks and bury used cans, as there is no vaccine for dengue. According to the Jakarta Health Agency, the capital has recorded 16 840 cases of dengue from January to October 2005, with 74 deaths [a CFR of 439 per 100 000]. Over the last few years, the agency's figures show that the number of cases of dengue fever in greater Jakarta stood at 15 360 in 1998, 3998 in 1999, 8729 in 2000, 8820 in 2001, 5750 in 2002, and 14 071 in 2003. (Promed 11/20/05; 11/30/05)

Hong Kong
The Center for Health Protection has confirmed an imported case of dengue fever in a 24 year old woman, bringing the year's total to 25, all imported. The patient traveled to Indonesia from 24 Oct to 7 Nov 2005. She came down with a fever, cough and sore throat 8 Nov 2005. She has been receiving treatment in hospital since 9 Nov 2005 and is now in stable condition. Her home contacts do not have any symptoms. Travelers should wear long-sleeved tops and trousers and use insect repellent and mosquito screens or nets when rooms are not air-conditioned. For details on dengue fever and its prevention, visit http://www.chp.gov.hk/content.asp?lang=en&info_id=19&id=24&pid=9, where the latest information on dengue fever in other places is also available. (Promed 11/20/05)

Philippines (Pangasinan)
A government doctor has confirmed that there are 2 strains of dengue found in Pangasinan patients, based on the blood cultures analyzed so far. Dr. Jesus Canto, chief of the Region 1 Medical Center (R1MC), said the strains were a [non-virulent] type found mostly among patients from western Pangasinan and the virulent type that appeared to afflict those from western Pangasinan. Canto said the [virulent] type of dengue was what attacked 2 patients who died, one of them from western Pangasinan. He added that the boy died a few minutes after arrival, because when he was admitted at R1MC, his platelet count had dropped to as low as 2 to 4, as he already had continuous bleeding. Dengue patients need fresh platelets to replace those destroyed by the virus. Canto said that from 1-27 Aug 2005, a total of 65 dengue patients had already been admitted to R1MC, compared to 60 patients admitted for July 2005. Dengue cases are expected to rise some more over those in Sep 2005, because the rainy season is not yet over. The R1MC is the usual destination of dengue patients in Pangasinan because it is the only hospital in the Ilocos Region that has a blood separator machine. With the blood separator, platelet concentrates are now available any time the patient needs them. (Promed 11/30/05)

Malaysia (Kuala Lumpur)
The number of dengue cases dropped to 649 for the week ending 26 Nov 2005 compared to 814 a week earlier. Of the 649 cases, 22 were hemorrhagic dengue, said the Health Ministry's Disease Control Division, 29 Nov 2005. The number of dengue cases in Putrajaya fell to 1 from 4, Sabah fell to 6 from 20, Perlis fell to 7 from 19, Penang fell to 43 from 85, Melaka fell to 17 from 32, Kelantan fell to 18 from 33, Pahang fell to 31 from 53 (An 11 year old boy from Kuala Medang in Kuala Lipis, Pahang died of dengue 12 Nov 2005), Kedah fell to 26 from 38, Kuala Lumpur fell to 61 from 85, Terengganu fell to 13 from 15, Selangor fell to 204 from 231 and Perak fell to 49 from 231. However, the cases in Negeri Sembilan rose from 20 to 32, and Johor rose from 101 to 113. Cases involving students dropped from 119 to 102, with Selangor recording the highest number, with 38 cases. The Disease Control Division also said that 51 873 premises had been inspected and that 551 of them had been found to breed Aedes mosquitoes. A total of 284 compound fines were issued, and fines worth MYR 43 000 [USD 11 394] were collected over the past week. (Promed 11/20/05; 11/30/05)

Singapore
Singapore has witnessed 13 425 dengue cases so far this year, according to Channel News Asia [14 Nov 2005]. The figure is 42 per cent higher than the 9459 cases recorded for the whole of 2004. The weekly number of cases dropped further to 175 in the week ending 12 Nov 2005, as compared with the 222 cases reported in the previous week. In September 2005, the city state saw a surge in the number of dengue cases, and the weekly number reached a record high of 713 from 18 to 24 Sep 2005. 19 Singaporeans [CFR 142/100 000] have died of the disease in 2005. (Promed 11/20/05)

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West Nile Virus
Canada
To date (6 - 12 Nov 2005, week 45), 225 WNV clinical cases and 14 asymptomatic infections have been reported to the Public Health Agency of Canada. Of the 225 clinical cases, 50 (22 percent) were reported as West Nile Neurological Syndrome, 167 (74 percent) were reported as West Nile Non-Neurological Syndrome, and 8 (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 12/2/05)

USA
As of 29 Nov 2005, human cases have been reported in: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Wisconsin, and Wyoming. Maps detailing county-level human, mosquito, veterinary, avian and sentinel data are available at: http://westnilemaps.usgs.gov/. (Promed 12/2/05)

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2. Articles
CDC EID Journal, Volume 11, Number 12-December 2005
CDC Emerging Infectious Diseases Journal, Volume 11, Number 12-December 2005 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. The following expedited articles on influenza are available online: Making Better Influenza Virus Vaccines, P. Palese; Nonpharmaceutical Interventions for Pandemic Influenza, International Measures, World Health Organization (WHO) Writing Group and; Nonpharmaceutical Interventions for Pandemic Influenza, National and Community Measures, World Health Organization (WHO) Writing Group.

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Severe Clostridium difficile--Associated Disease in Populations Previously at Low Risk--4 States, 2005
“Clostridium difficile is a spore-forming, gram-positive bacillus that produces exotoxins that are pathogenic to humans. C. difficile--associated disease (CDAD) ranges in severity from mild diarrhea to fulminant colitis and death. Antimicrobial use is the primary risk factor for development of CDAD. . .C. difficile typically has affected older or severely ill patients who are hospital inpatients or residents of long-term care facilities. Recently, however, both the frequency and severity of health-care-associated CDAD has increased. . .One possible explanation for these increases is the emergence of a previously uncommon strain of C. difficile responsible for severe hospital outbreaks. . .in 2005, the Pennsylvania Department of Health (PADOH) and CDC received several case reports of serious CDAD in otherwise healthy patients with minimal or no exposure to a health-care setting. An investigation was initiated by the Philadelphia Department of Public Health (PDPH), PADOH, and CDC to determine the scope of the problem and explore a possible change in CDAD epidemiology. This report summarizes the results of the investigation in Pennsylvania and three other states, which indicated the presence of severe CDAD in healthy persons living in the community and peripartum women, 2 populations previously thought to be at low risk. The findings underscore the importance of judicious antimicrobial use, the need for community clinicians to maintain a higher index of suspicion for CDAD, and the need for surveillance to better understand the changing epidemiology of CDAD . . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5447a1.htm (MMWR December 2, 2005 / 54(47);1201-1205)

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Early-Onset and Late-Onset Neonatal Group B Streptococcal Disease--United States, 1996-2004
“In 2002, CDC, the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Pediatrics (AAP) issued revised guidelines for prevention of perinatal invasive group B streptococcal (GBS) disease. These guidelines recommend universal screening of pregnant women for rectovaginal GBS colonization at 35--37 weeks' gestation and administering intrapartum antimicrobial prophylaxis to carriers. To assess the impact of the guidelines on multistate trends in neonatal GBS disease incidence, CDC analyzed data from the Active Bacterial Core surveillance (ABCs) system from 1996--2004. This report summarizes the results of that analysis, which determined that incidence of GBS disease in infants aged 0--6 days (i.e., early-onset disease) in 2004 had decreased by 31% from 2000--2001, the period immediately before universal screening was implemented. Incidence of GBS disease in infants aged 7--89 days (i.e., late-onset disease) remained unchanged during the 9-year period reviewed. Continued monitoring is needed to assess the impact of the 2002 guidelines on early-onset disease and the long-term effect of widespread intrapartum use of antimicrobial agents on neonatal GBS disease. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5447a2.htm (MMWR December 2, 2005 / 54(47);1205-1208)

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Screening HIV-Infected Persons for Tuberculosis--Cambodia, January 2004--February 2005
“Worldwide, tuberculosis (TB) is one of the most common causes of death among persons infected with human immunodeficiency virus (HIV). The World Health Organization recommends screening HIV-infected persons for TB disease after HIV diagnosis, before initiation of highly active antiretroviral therapy (HAART), and during routine follow-up care. In 2003, health officials in Banteay Meanchey Province, Cambodia, in conjunction with CDC and the U.S. Agency for International Development (USAID), began a pilot project to increase TB screening among persons with HIV infection. . .CDC analyzed and evaluated data from the first 14 months of the project. This report summarizes the results of that analysis, which determined that, during January 2004--February 2005, among persons with HIV infection at voluntary counseling and confidential testing (VCCT) clinics, 37% were screened for TB disease, and 24% of those screened had TB disease diagnosed. On the basis of these findings, the Provincial Health Department (PHD) took action to increase awareness of the risk for TB among HIV-infected persons. During the 3 months after these measures were implemented, the TB screening rate among persons with HIV infection increased to 61%. Evaluation of projects like the one conducted in Banteay Meanchey Province can help develop an evidence-based approach for removing barriers to screening HIV-infected persons for TB. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5446a2.htm (MMWR November 25, 2005 / 54(46);1177-1180)

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East Asia: Many H5N1 cases clustered in families
More than 1/3 of the human cases of H5N1 avian influenza that occurred over a 19-month period were clustered within families, suggesting the possibility that some family members caught the virus from others, according to a recent report. 41 of 109 cases (38 %) identified between Jan 2004 and Jul 2005 occurred in 15 families, with between 2 and 5 cases per family, according to the report by Sonja J. Olsen et al., published as a letter in the November issue of Emerging Infectious Diseases [Olsen SJ, Ungchusak K, Sovann L, et al. Family clustering of avian influenza A (H5N1). Emerg Infect Dis 2005;11(11):1799-1801 http://www.cdc.gov/ncidod/EID/vol11no11/05-0646.htm].

Most human cases of avian flu are believed to have stemmed from exposure to sick poultry. The virus has not yet shown an ability to spread easily between people. Researchers previously identified 1 cluster, involving a young Thai girl and her mother and aunt in Sep 2004, as the probable result of person-to-person transmission. Too little information is available to conclude whether the virus spread from person to person in any of the other families, the report says. Family clusters don't necessarily mean the virus is spreading from person to person. They may simply mean that relatives were exposed to H5N1-infected poultry at the same time. However, in 3 family clusters, all in Viet Nam, the first and second patients fell ill more than a week apart, which suggests that they probably didn't acquire the virus from the same source at the same time, the report says. The authors also found that family clusters were slightly more common in the period from Dec 2004 through Jul 2005 than they were in the preceding year: 9 clusters in 243 days, or 3.7 per 100 days, versus 6 clusters in 365 days, or 1.6 per 100 days (relative risk, 2.3; 95 percent confidence interval, 0.8 to 6.3). The difference was similar when the researchers compared the period from Dec 2004 through Jul 2005 with the same 8-month period a year earlier.

Although this increase was not significant, the authors write, "We believe any cluster of cases is of great concern and should be promptly and thoroughly investigated because it might be the first indication of viral mutations resulting in more efficient person-to-person transmission." The researchers defined a family cluster as 2 or more family members with lab-confirmed H5N1 avian flu or 2 or more family members with severe pneumonia or respiratory death, when at least 1 member had confirmed H5N1. Of the 41 patients in the 15 family clusters, 25 (61 %) died. Another 4 patients recovered, while 3 were never sick even though they tested positive for the virus. The outcomes for the other 9 patients were unknown. The article says that family clusters are still occurring, but they "do not appear to be increasing as a proportion of total cases." In line with previous reports, the authors also note a decline in the overall death rate for human cases: 32 of 44 cases (73 %) from Dec 2003 through Nov 2004, versus 23 of 65 cases (35 %) from Dec 2004 through Jul 2005. (Promed 11/29/05)

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Prior H1N1 influenza infection and susceptibility of Cleveland Family Study participants during the H2N2 pandemic of 1957: an experiment of nature
Suzanne L. Epstein. J Infect Dis. 2006 Jan 1;193(1):49-53. Epub 2005 Nov 21.
Abstract: “During a pandemic, influenza vaccines that rely on neutralizing antibodies to protect against matched viruses might not be available early enough. Much broader (heterosubtypic) immune protection is seen in animals. Do humans also have cross-subtype immunity? To investigate this issue, archival records from the Cleveland Family Study, which was conducted before and during the 1957 pandemic (during which a shift from subtype H1N1 to H2N2 occurred), were analyzed. Only 5.6% of the adults who had had symptomatic influenza A in earlier study years developed influenza during the pandemic, despite living in households with participants who had influenza. In contrast, 55.2% of the children who had had symptomatic influenza A contracted it again. These findings suggest an impact of accumulated heterosubtypic immunity during a pandemic. Such immunity, as well as its implications for vaccination, should be further investigated.”

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Effects of local variation, specialty, and beliefs on antiviral prescribing for influenza
Rothberg et al. Clin Infect Dis. 2006 Jan 1;42(1):95-9. Epub 2005 Nov 18.
Abstract: “In 2004, we conducted a survey of physician knowledge, attitudes, and practices regarding influenza diagnosis and treatment at Baystate Medical Center in Massachusetts and Scott & White Hospital and Clinic in Texas. Of the 579 physicians we contacted, 336 completed the survey. Sixty-one percent of the respondents prescribed antivirals, and 62% used rapid testing. Prescribing practices were associated with location, practice size, use of rapid testing, and belief in the efficacy of antivirals.” http://www.journals.uchicago.edu/CID/journal/issues/v42n1/37289/brief/37289.abstract.html (CIDRAP http://www.cidrap.umn.edu/cidrap )

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Annual universal influenza vaccination: ready or not?
Abramson JS, Neuzil KM, Tamblyn SE. Clin Infect Dis. 2006 Jan 1;42(1):132-5. Epub 2005 Nov 23.
Abstract: “Influenza causes annual worldwide epidemics of respiratory disease. Currently, the United States and many other countries recommend influenza vaccination for persons who are at high risk for influenza-related complications. This commentary explores the potential benefits of a policy advocating universal annual influenza vaccination and outlines obstacles that need to be overcome to make such a recommendation feasible. The 5-year experience of a free influenza vaccination program for everyone 6 months of age in the Canadian province of Ontario is reviewed.” http://www.journals.uchicago.edu/CID/journal/issues/v42n1/37101/37101.html (CIDRAP http://www.cidrap.umn.edu/cidrap )

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New genotype of avian influenza H5N1 viruses isolated from tree sparrows in China
Kou Z. et al. J Virol. 2005 Dec;79(24):15460-6.
Abstract: “The 2004 outbreaks of highly pathogenic avian influenza H5N1 disease in China led to a great poultry loss and society attention. A survey of avian influenza viruses was conducted on tree sparrows (Passer montanus) collected in China in 2004. Four viruses were isolated from free-living tree sparrows. The results of the whole-genome analysis indicated that an H5N1 virus with a new genotype is circulating among tree sparrows. The hemagglutinin and neuraminidase genes of the new genotype were derived from Gs/Gd/96-like viruses and the nuclear protein gene descended from the 2001 genotype A H5N1 viruses, while the other inner genes originated from an unknown influenza virus. In experimental infection, all four viruses were highly pathogenic to chickens but not pathogenic to ducks or mice. The four tree sparrow viruses were different from the 2003 tree sparrow strain (genotype Z) in Hong Kong. The results suggested that H5N1 viruses might be distributed widely in tree sparrows.” (CIDRAP http://www.cidrap.umn.edu/cidrap )

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USA: Produce linked to more disease cases than poultry
Contaminated produce caused more cases of disease in recent years than poultry, eggs, or other food groups did, according to a report by the consumer group Center for Science in the Public Interest (CSPI). CSPI reported that 554 illness outbreaks totaling 28,315 cases were linked to produce and produce dishes between 1990 and 2003. Poultry, the second largest category, was blamed for 476 outbreaks with 14,729 cases. In particular, fresh produce may be surpassing poultry as a cause of Salmonella infections, according to CSPI. "From 1990 to 2001 poultry accounted for 121 Salmonella outbreaks and produce accounted for 80," the group said. "But in 2002-2003, produce accounted for 31 Salmonella outbreaks and poultry accounted for 29." CSPI compiles foodborne-illness data from the CDC, state health departments, and peer-reviewed journals. The database includes only the outbreaks in which 2 or more people got sick from eating the same food. The group identified a total of 4,486 outbreaks involving 138,622 cases over the 14-year period. Produce-related outbreaks caused an average of 51 cases each. Vegetables were blamed for 205 outbreaks involving 10,358 cases, and fruits for 93 outbreaks with 7,799 cases. Another 10,158 cases were traced to dishes involving more than 1 produce item. Salmonella, noroviruses, and Cyclospora species accounted for most of the produce-related outbreaks.

To limit produce contamination, Caroline Smith DeWaal of CSPI commented, "FDA should require growers to limit the use of manure to times and products where it poses no risk. And packers and shippers should mark packaging to ensure easy traceback when fruits and vegetables are implicated in an outbreak." Seafood was implicated in the largest number of outbreaks, 899, but the outbreaks were relatively small at about 10 cases each, for a total of 9,312 cases. The other leading illness-causing food categories were beef and beef dishes, 438 outbreaks with 12,702 cases, and eggs and egg dishes, 329 outbreaks with 10,847 cases. Another 812 outbreaks totaling 23,126 cases were traced to multiple-ingredient foods, such as pizza and salads. Dairy products were blamed for 153 outbreaks totaling 5,156 cases. Almost a third of the outbreaks (32%) were linked to unpasteurized items. The report says CDC has made several improvements in its foodborne disease surveillance and reporting programs in recent years but needs to do more. The agency "should mandate reporting by states, provide real-time reporting of outbreaks, and organize outbreaks by food hazard [rather than by pathogen] to increase the utility of its information," CSPI asserts. (CIDRAP 12/1/05 http://www.cidrap.umn.edu/cidrap )

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3. Notifications
World AIDS Day --- December 1, 2005
Dec 1 will mark the 18th observance of World AIDS Day. Begun in 1988, this annual worldwide event was established to increase awareness and education regarding HIV infection and AIDS. The 2005 World AIDS Day theme in the US, "Action Makes a Difference," addresses the importance of prevention, testing, treatment, and care programs for persons at risk for or living with HIV/AIDS. At the end of 2003, more than 1 million persons were estimated to be living in the US with HIV infection. Approximately one fourth of these persons were believed to be unaware of their infections underscoring the need for increased efforts to reach populations at-risk with HIV testing and prevention services. Recent data from 33 states indicate that HIV/AIDS diagnoses continue to disproportionately impact non-Hispanic blacks and men who have sex with men regardless of race. For more information about World AIDS Day: http://www.worldaidscampaign.info ; for more regarding other U.S. HIV/AIDS observances: http://www.omhrc.gov/hivaidsobservances/index.html. Information on AIDS is available from the Joint UN Program on AIDS at http://www.unaids.org. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5446a1.htm (MMWR November 25, 2005 / 54(46);1177)

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Conclusions and Recommendations of the Advisory Committee on Poliomyelitis Eradication--Geneva, Switzerland, October 2005
The second meeting of the Advisory Committee on Poliomyelitis Eradication was convened in Geneva, Switzerland, Oct 11--12, 2005, to provide the WHO and the Global Polio Eradication Initiative with advice on program policies for 1) interrupting wild poliovirus (WPV) transmission worldwide, 2) limiting the international spread of circulating polioviruses, and 3) refining the program of work for eventual cessation of immunization with oral poliovirus vaccine (OPV). This report summarizes the results. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5446a5.htm (MMWR November 25, 2005 / 54(46);1186-1188)

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Licensure of a Combined Live Attenuated Measles, Mumps, Rubella, and Varicella Vaccine
On Sep 6, 2005, the Food and Drug Administration licensed a combined live attenuated measles, mumps, rubella, and varicella (MMRV) vaccine (ProQuad, Merck & Co., Inc.) for use in children aged 12 months--12 years. The attenuated measles, mumps, and rubella vaccine viruses in ProQuad are identical and of equal titer to those in the measles, mumps, and rubella (MMR) vaccine, MMRII (Merck). The titer of Oka/Merck varicella-zoster virus is higher in MMRV vaccine than in single antigen varicella vaccine, VARIVAX (Merck), a minimum of 3.13 log10 plaque-forming units (pfu) versus 1,350 pfu (approximately 1.13 log10), respectively. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5447a4.htm (MMWR December 2, 2005 / 54(47);1212-1214)

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4. APEC EINet activities
APEC e-Health seminar; Pandemic influenza videoconference
EINet presented an update of their work and next steps at the e-Health Seminar in Seoul, Korea, 14 Nov 2005, part of the APEC meetings in Korea. EINet is preparing for a major video conference on pandemic influenza preparedness 19 Jan 2006. The goal of this “virtual symposium” is to promote regional information sharing and collaboration to enhance biopreparedness against pandemic influenza. In order to improve preparedness regionally, it is vital to understand how each economy is undertaking preparedness and response planning. South Korea has generously offered EINet their video 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