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Vol. VIII, No. 26 ~ EINet News Briefs ~ Dec 16, 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: Sanofi says H5N1 vaccine with adjuvant may go further
- Romania: Avian influenza cases in birds outside Danube delta
- Ukraine: Avian influenza spreads in poultry
- Libya: Official documents show avian influenza in farms
- East Asia: Cumulative number of human cases of avian influenza A/(H5N1)
- China: Additional human case of avian influenza infection; preparedness
- Taipei: Low pathogenic H7N3 and H5N2 in migratory bird droppings
- Indonesia: Additional fatal human case of avian influenza; more suspected cases
- Viet Nam: Additional outbreaks of avian influenza in poultry; new website launched
- Thailand: Contacts of latest human avian flu infection case test negative
- Russia (Altai): Trichinellosis situation worsening
- Russia (Orenburg): Total deaths from HFRS in Orenburg reach 6
- Australia (Tasmania): Salmonellosis outbreak associated with raw eggs
- Australia (South Australia): Meat recalled after 2 hospital deaths
- Canada (British Columbia): Farms declared free of bird flu
- USA: FDA Acts to Protect Public from Fraudulent Avian Flu Therapies
- USA (Minnesota): Pandemic preparedness road show begins
- USA: FDA Warns Consumers to Avoid Drinking Raw Milk
- USA/Japan: Japanese market now open to U.S. beef products

1. Updates
- Influenza
- Dengue
- Viral gastroenteritis
- West Nile Virus

2. Articles
- Influenza--interpandemic as well as pandemic disease
- Influenza-associated deaths among children in the United States, 2003-2004
- West Nile Virus Activity--United States, January 1-December 1, 2005
- Brief Report: Respiratory Syncytial Virus Activity--United States, 2004--2005
- Outbreak of cutaneous Bacillus cereus infections among cadets in a university military program--Georgia, August 2004
- Late Relapse of Plasmodium ovale Malaria--Philadelphia, Pennsylvania, November 2004
- Measles--United States, 2004
- Adverse events associated with smallpox vaccination in the United States, January-October 2003

3. Notifications
- Winter brings new health challenges for people in Pakistan earthquake zone
- New tuberculosis therapy offers potential shorter treatment
- WPRO publication: Tuberculosis Control in South-East Asia and Western Pacific Regions
- WHO Food Safety
- Ninth Annual Conference on Vaccine Research, May 8-10, 2006
- Epidemiology in Action Course and Intermediate Methods
- Epi Info: A Course to Develop Public Health Software Applications
- FDA Approval of Havrix (Hepatitis A Vaccine, Inactivated) for Persons Aged 1--18 Years

4. APEC EINet activities
- APEC EINet pandemic influenza videoconference

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Global: Sanofi says H5N1 vaccine with adjuvant may go further
Sanofi Pasteur announced preliminary trial results suggesting that using an additive to boost the immune response may help to stretch the supply of a vaccine for H5N1 avian influenza by a modest amount. Previous results had indicated that an H5N1 vaccine without an immune-boosting adjuvant would have to contain 12 times as much antigen as seasonal flu vaccines do. In the new results announced, it took 4 times as much antigen as in a seasonal flu vaccine to induce an adequate immune response—an improvement, but far from what is needed to remedy the global shortage of vaccine production capacity.

Sanofi tested an H5N1 vaccine it is making for the French government on 300 volunteers, using 3 different doses: 7.5, 15, and 30 micrograms. The volunteers were divided into 6 groups, and each group received 2 doses of vaccine with or without alum, an adjuvant used in many vaccines, according to Len Lavenda, US spokesman for Sanofi. The shots were given 3 weeks apart. "A 30-microgram dose with an adjuvant in a 2-dose regimen demonstrated an immune response at levels consistent with requirements of regulatory agencies for licensure of seasonal influenza vaccine," the company said. "The 7.5- and 15-microgram studies provided results that were not as high as the 30, but we are continuing to study that data and we expect to publish the full set within a few months," Lavenda said. Seasonal flu vaccines typically contain 15 micrograms of antigen, the active ingredient, for each viral strain covered. The amount that proved adequate in the Sanofi trial was 60 micrograms (two 30-microgram doses), 4 times as much. H5N1 vaccines are being developed in the hope that they will be protective if the H5N1 virus evolves into a pandemic strain. But even if the current experimental vaccines turn out be effective, the world's current production capacity is far too small to provide enough vaccine for everybody. Researchers hope that dose-sparing tools such as adjuvants will help stretch the supply. Sanofi called the new trial results "a sign of progress" that will help guide further development of a pandemic flu vaccine. (CIDRAP 12/15/05 http://www.cidrap.umn.edu/index.html )

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Romania: Avian influenza cases in birds outside Danube delta
Romania has found new cases of avian flu in fowl in a region west of the Danube delta, where the strain of the virus was first isolated Oct 2005, officials said 12 Dec 2005. Bird flu has been found in birds in 14 villages in and around the Danube delta, Europe's largest wetlands, which lie on a major migratory route for wild birds. 4 outbreaks have been confirmed as the highly pathogenic H5N1 strain, the most recent showing that the virus appears to be edging west towards more populated areas. "We detected the H5 type in several hens and turkeys from a small Gypsy (Roma) community, 1 km from the village of Braesti (in the county of Buzau)," director of the Animal Health and Diagnosis Institute Nicolae Stefan said. "The H5 type of virus was also confirmed in the village of Padina," Stefan added. On 11 Dec 2005, the official said 5 new suspected cases of avian flu in domestic birds had been discovered in Padina in the same county of Buzau. The samples from birds would be sent to a laboratory in Britain to see whether it was H5N1. He said authorities culled all the birds from the small Roma community. Romania has no capabilities to test for H5N1. Also on 12 Dec 2005, the country's chief veterinarian Ion Agafitei said that veterinarians discovered 3 suspected bird flu cases in hens in Braila county, which borders the delta. (Promed 12/13/05)

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Ukraine: Avian influenza spreads in poultry
Avian influenza, including the H5N1 strain, has spread to new villages in Ukraine's Crimea peninsula, officials said. Both Belarus and Bulgaria across the Black Sea slapped bans on imports, adding to measures put in place by Russia and Kazakhstan. But Prime Minister Yuri Yekhanurov said he hoped emergency measures invoked to contain the outbreak could be repealed by the New Year. Instances of bird flu had now been detected in 25 villages in Crimea, with the H5N1 strain confirmed in 11. Nearly 54 000 birds had been destroyed in affected villages and 513 residents remained under medical observation. Ukraine has so far based its data on tests by Russian laboratories. Officials are awaiting further confirmation of the presence of H5N1 from a British lab. WHO experts have arrived to examine the situation and to assist in efforts to stop the infection's spread, the Health Ministry said. There have not been any human cases of bird flu in Ukraine.

Belarus's top veterinarian said his country's ban applied to all farm goods from Crimea and 5 adjoining regions. Bulgaria banned import and transit of poultry meat, eggs and live birds from throughout Ukraine. Russia and Kazakhstan imposed similar bans this month. The first discovery of bird flu late Nov 2005 prompted President Viktor Yushchenko to invoke a state of emergency in several villages, with slaughter of birds and imposition of exclusion zones patrolled by police. But villagers complained that birds had been falling ill since September with officials taking no action. About 22 million domestic birds live in Crimea--of 190 million in Ukraine. Poultry producers say the outbreak has had no effect on annual consumption of 1 million tonnes. Yekhanurov said the measures undertaken in Crimea, a major stopping point for migratory birds heading south for the winter, were containing the outbreak. He proposed lifting the state of emergency, imposed for the first time since Ukraine won independence in 1991.

Avian influenza OIE report
(Disease never reported before in Ukraine)
Information received 5 Dec 2005 from Dr Petr I Verbytskiy, head, State Department for Veterinary Medicine, Ministry of Agricultural Policy, Kiev: Identification of agent: influenza virus subtype H5. Date of first confirmation of the event: 2 Dec 2005. Date of start of the event: 25 Nov 2005. Nature of diagnosis: clinical, postmortem, and laboratory. Details of outbreaks: http://www.oie.int/cartes/TABA18_49UKR.pdf . Description of affected population: chickens and geese. Samples will be sent to an OIE Reference Laboratory for highly pathogenic avian influenza to confirm the diagnosis. Source of outbreaks or origin of infection: contact with wild birds. Control measures undertaken: control of wildlife reservoirs; stamping out in progress; quarantine; movement control inside the country; screening; zoning; disinfection of infected premises/establishments. Vaccination prohibited. (Promed 12/12/05, 12/13/05, 12/15/05)

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Libya: Official documents show avian influenza in farms
Although Libyan authorities repeatedly denied the presence of the bird flu virus in Libya, Libyan media sources on 9 Dec 2005 disclosed that they have a copy of documents which prove that the Libyan security ministry and senior officials of the Inspection and Control Department were aware and admitted to the Libyan prime minister, Dr Shukri Ghanim, that the bird flu virus is widespread in a number of Libyan poultry farms in the Benghazi region (north east Libya). "Information reaching us has shown that the Benghazi division of the anti-poultry diseases committee has conducted routine checks on the poultry farms in the area, took and thoroughly scrutinized blood samples taken from those farms. They later sent them on 9 Oct 2005 to a special laboratory in the United Kingdom for another lab test. The result, which came by fax, confirmed that all the samples are positive. This shows the prevalence of the bird flu virus in the eastern part of the country," the Libyan security minister, Nasr Al Mabrouk, said in a letter to the prime minister. A copy of the result was attached to the letter. Al Mabrouk complained bitterly against the agriculture ministry, which he accused of doing nothing to stave off the disease from entering the country, while chicken and live birds continue to be sold on the market with no concern. (Promed 12/12/05)

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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), 2005:
Economy / Cases (Deaths)
Indonesia / 14 (9)
Cambodia / 4 (4)
Thailand / 5 (2)
Viet Nam / 61 (19)
China / 6 (2)
Total / 90 (36)

Total number of confirmed human cases of avian influenza A/(H5N1), 26 Dec 2003 to present: 139 (71)
(WHO 12/16/05 http://www.who.int/csr/disease/avian_influenza/country/en/index.html )

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China: Additional human case of avian influenza infection; preparedness
The Ministry of Health in China has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case is a 35-year-old man from the south-eastern province of Jiangxi. It is in a province that hasn't identified human cases before but it is somebody who seems to have a history of exposure to poultry. He developed symptoms of fever on 4 December followed by pneumonia. He remains hospitalized and is receiving intensive care. Agricultural authorities have confirmed the presence of the H5 virus subtype in ducks in the vicinity of the patient's residence. Family members and close contacts have been placed under medical observation. This is China's sixth laboratory-confirmed human case. Of these cases, two have been fatal. To date, China has reported human cases in five provinces and regions: Hunan, Anhui, Guangxi, Liaoning, and Jiangxi.

Also, China, which has reported some 30 outbreaks of bird flu in 2005, said the country could see more of the disease as transport of live poultry increases over the Lunar New Year holidays (end of January). Jia Youling, director-general of the Agriculture Ministry's veterinary bureau, said no new cases of the H5N1 virus have been reported for 15 days after a rash of outbreaks in the past 2 months, but he cautioned against complacency. Beijing has pledged openness in fighting bird flu after it was widely criticised for its cover-up of the SARS, but Health Minister Gao Qiang has said rural doctors might be ill-equipped or ill-trained to detect cases. China has announced plans to vaccinate billions of birds to contain the virus and has launched a campaign to encourage farmers and local officials to report new cases. China has been scrambling to curb outbreaks with mass vaccinations of its 14 billion poultry and with an education campaign to encourage farmers and local officials to report new cases. China was trying to guard against that with stepped-up vaccination efforts, more frequent inspections, curbing the slaughter of live chickens in markets, he said. Reportedly, Anhui province--which has reported 2 human cases of bird flu--lifted a ban on the slaughtering of live poultry in all markets, claiming that the H5N1 strain of the disease had been brought under control. Live poultry dealers were encouraged to resume operations, according to the province's headquarters for bird flu prevention. However, local officials would tighten supervision and quarantine procedures over live poultry markets after the lifting of the ban. Jia reiterated the government's stance that it has not covered up any bird flu outbreaks, and said in fact it was facing the opposite problem--farmers were falsely reporting the virus in hopes of receiving compensation. Reportedly, the State Forestry Administration has established an arm to monitor bird flu among migratory and wild birds. (Promed 12/15/05, 12/16/05)

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Taipei: Low pathogenic H7N3 and H5N2 in migratory bird droppings
Taiwan has discovered low-pathogenic H7N3 and H5N2 strains of the avian flu in migratory bird droppings on the outskirts of Taipei, the agriculture department said. Like the H5N1 strain of bird flu, the H7N3 strain can infect humans. But the H5N2 strain, which can be lethal for birds, is not dangerous to humans. In regular monitoring of migratory birds, the viruses were detected in marshlands on the outskirts of the capital, the Council of Agriculture (COA) said. There are no poultry farms within a radius of 3 km of the droppings, so the council said there was no risk of broader infection, although it still urged nearby residents to be vigilant. The COA has already contacted the Center for Disease Control, the Department of Health and the Wild Bird Federation regarding the result of the tests. The council urged poultry farmers to put up wire fencing to keep migratory birds from mixing with their own birds and so minimize the risk of bird flu spreading. The council said many migratory birds fly to Taiwan on their southward journey during the cold winter months. This is the third time Taiwan has discovered the H7N3 strain in 2005, after detecting the virus in November and previously in April. The H7N3 strain was first detected in turkeys in Britain in 1963 and made one of its last known appearances in poultry in Canada in April and May 2004, according to the WHO and World Organisation for Animal Health. An outbreak of the less virulent H5N2 strain of bird flu in Taiwan in 2004 led to the culling of hundreds of thousands of fowl. Taiwan has not experienced a major outbreak of H5N1. In October, the island found only its second case of the deadly strain since 2003, in birds smuggled in a container ship from China. (Promed 12/15/05, 12/16/05)

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Indonesia: Additional fatal human case of avian influenza; more suspected cases
The Ministry of Health has confirmed a further case of human infection with the H5N1 avian influenza virus. The case occurred in a 35 year old man from West Jakarta. He developed symptoms of fever, cough, and breathing difficulty 6 Nov 2005, was hospitalized 9 Nov 2005, and died 19 Nov 2005. Family members and close contacts were placed under observation and tested for possible infection. No evidence of additional cases has been detected. Investigations have been undertaken to determine the source of the man's exposure. While he did not keep poultry in his household, chickens and other birds were found in his neighbourhood. The Ministry of Health's director general of disease control I Nyoman Kandun said the man had been in contact with chickens that carried the H5N1 virus. "He was building his house and around it there were many chickens and birds running free. Researchers tested those birds and they tested positive for the H5N1 virus," Kandun said. WHO stated, however, that samples from these birds are still undergoing tests to determine whether they may have been the source of infection. The newly confirmed case is the 14th in Indonesia, the world's fourth-most populous nation. Of these cases, 9 have been fatal.

Meanwhile, Sulianti Saroso Hospital spokesman Ilham Patu said that 5 new suspected avian influenza patients were admitted 12-13 Dec 2005 from several areas of Jakarta. "We now have a total of 6 patients being treated for suspected avian influenza infections," Patu said. Reportedly, the government is expected to vaccinate 47 million people who have direct contact with birds across the country against regular human influenza. This would reduce the opportunity for H5N1 to interact by genetic reassortment with the ordinary human flu virus. The cost of the vaccination drive, however, is estimated at Rp 5 trillion (US$500 million), which the state budget cannot afford. WHO has recommended the mass culling of poultry to contain the spread of the virus, but the government said it lacked the funds. Jakarta is preparing an early bird flu warning system aimed at reaching remote areas to speed up reporting of any outbreaks. The "village preparedness policy" involves local governments setting up health posts in all villages, where personnel including doctors would be alert to flu cases in birds and humans.

On 16 Dec 2005, local tests confirmed that a 36 year old man who died 2 days ago in a Jakarta hospital had avian influenza. Health officials are still waiting for the results to be confirmed by a WHO laboratory, but if the man, who lived in South Jakarta, is confirmed to have died from avian influenza, he would be the tenth fatality in Indonesia from the virus. Reportedly, investigation of the history of the man's contacts with chickens is ongoing. The patient died 3 days after he was admitted to the Sulianti Saroso infectious disease hospital with symptoms of H5N1 virus infection. Positive test results by local laboratories in Indonesia are usually confirmed by WHO. Bird flu has spread to at least 23 of Indonesia's 33 provinces since late 2003, killing more than 9.5 million poultry. (Promed 12/13/05, 12/14/05, 12/16/05)

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Viet Nam: Additional outbreaks of avian influenza in poultry; new website launched
Bird flu has been reported in 2 more provinces; Yen Bai Province in the northern region and Quang Tri in the centre, the Animal Health Department reported 8 Dec 2005. The latest outbreak killed 500 ducks in a household in Quang Tri's Gio Linh District late Nov 2005, forcing the farmer to cull 5000 birds. Later tests confirmed that the ducks had H5N1 virus. The department also said that avian flu has been detected in a number of poultry farms in Son La, Thanh Hoa and Ninh Binh provinces, all previously hit by outbreaks. The outbreak has now affected 15 provinces and cities in Vietnam, while 5 provinces have since been declared free of bird flu after not seeing outbreaks for 21 days. Outbreaks have been reported in almost 1/3 of the country since Oct 2005, and more than 3 million birds have been culled nationwide. WHO in Vietnam launched a website on bird flu (http://www.un.org.vn/who/avian ), providing updated information in Vietnamese and English on national and global statistics as well as protection and control measures. "A lack of information on avian influenza is helping fuel the spread of the virus in Vietnam," said Dr Hans Troedsson, WHO Representative in Vietnam. "The website provides an important 24-hour link to information and will help people take measures to control the spread of the virus and protect themselves, their families and communities from this very serious threat." The website also provides links to other sites for information, including the Ministry of Health, the Ministry of Agriculture and Rural Development, FAO, WHO (Geneva and Manila), the World Organisation for Animal Health, the US CDC, Ministry of Public Health in Thailand, and the Centre for Health Protection in Hong Kong. (Promed 12/9/05, 12/10/05; WHO/WPRO 12/14/05 http://www.wpro.who.int/ )

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Thailand: Contacts of latest human avian flu infection case test negative
Initial tests on people who had been in contact with the country's latest human case of avian influenza have cooled fears of a human-to-human outbreak, though it remains unclear how the infection was transmitted. None of the blood samples drawn from people who had contact with the 5 year old boy from Nakhon Nayok who died last week has tested positive. The boy tested positive for H5N1 avian influenza virus, said Dr Phaijitr Varachit, director-general of the Medical Sciences Department. A total of 27 people who had physical contact with the boy are still under observation. They include the boy's parents, doctors, and friends who had played with him before he fell ill, said Dr Sompong Boonsuepchat, health chief officer of Nakhon Nayok. For the moment, all of them appear to be in good health, he said. Phaijitr said the department was unlikely to conduct another blood test to detect H5N1 antibodies. The doctor conceded, however, that it usually takes 2-3 weeks to detect whether a person has contracted H5N1 virus infection. Only the parents, especially the mother, were considered potentially high-risk cases. So far, the mother appeared to be healthy, Sompong said.

Nakhon Nayok's public health office had ordered all private clinics to contact state hospitals quickly about suspected cases and refrain from attempting to treat them. The boy victim had been taken to 2 private clinics that mistook his symptoms for something else. Meanwhile, the Livestock Development Department said it would track the cause of the boy's infection. It found no signs of the virus in the poultry near the victim's house. Sompong said pigeons might be the source of the infection, dismissing the possibility of human-to-human transmission. There were many pigeons around the boy's house and [H5N1 avian influenza virus] might have been present in the birds' feces, he said. (Promed 12/15/05)

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Russia (Altai): Trichinellosis situation worsening
Epidemiologists fear that trichinellosis is worsening in the Altai region. According to experts, up until 7 Dec 2005, 46 persons have been diagnosed with trichinellosis in the region this year. For all of 2004, the number was 33 cases. A principal cause of disease is the use of badger, pork or dog meat not boiled thoroughly and used in shish kebab and sausages. Trichinellosis is frequent in Russia. Only health education can prevent infection by Trichinella from wild animals. (Promed 12/7/05)

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Russia (Orenburg): Total deaths from HFRS in Orenburg reach 6
As of 7 Dec 2005, 6 persons in the Orenburg Oblast (Region) have died as a result of hemorrhagic fever with renal syndrome (HFRS) since the beginning of Oct 2005, according to Marina Sherstneva of the Orenburg Regional Office of the Russian (Health) Protection Agency (Rospotrebnadzor). She stated that since the beginning of 2005, a total of 1158 suspected cases of HFRS had been recorded in the region. Of these, 16 were children under 14 years of age. By Nov 2005, 758 of the suspected cases of HFRS had been confirmed. Sherstneva said, "The very warm and dry autumn weather had been responsible for an increase in the rodent population, which has resulted in an enhancement of seasonal HFRS disease.” This year, the autumn population of field voles was the highest for 9 years. Furthermore, between 6 and 33 percent of these animals were carriers of the virus responsible for HFRS. Sherstneva declared that 70 percent of HFRS infections were contracted during outdoor activities. The virus is transmitted also by inhalation of murine detritus during agriculturally-related activities. In 2004 there were 383 confirmed cases of HFRS, including 5 fatal cases, in Orenburg. (Promed 12/7/05)

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Australia (Tasmania): Salmonellosis outbreak associated with raw eggs
At least 57 people are on the sick list after an outbreak of salmonella in Hobart. The wave of food poisoning is believed to have forced dozens of Tasmanians on to workers' compensation leave while they recover. Of the 22 cases statewide confirmed by testing, 13 were linked to the Hobart outbreak, the Department of Health and Human Services said. But as of 8 Dec 2005, there were 57 people off sick with the symptoms in Hobart. Raw egg has been named the likely culprit for the Hobart attacks; the State Government maintained there was no need to reveal the suspected food business at the heart of the outbreak. There is no information given on the food that the raw eggs were used in. (Promed 12/9/05)

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Australia (South Australia): Meat recalled after 2 hospital deaths
New tests have confirmed that food products from an Adelaide company were contaminated with the same strain of listeria that contributed to the death of a man at the Royal Adelaide Hospital. Another person died in hospital in Gawler, while 2 women are recovering from the illness. The 2 patients who died were already sick in hospital with low immune systems. Listeriosis is a serious infection caught from food contaminated with Listeria monocytogenes, a bacterium widely found in nature and sometimes in raw foods. On 12 Dec 2005, products from Conroy's Smallgoods Bowden factory were recalled. Conroy's is a producer of about 120 meat products. Health Minister John Hill confirmed that 2 products from the company, ham steak and corned beef, tested positive for listeria. "That's the same listeria that was found on equipment in Conroy's plant. It's also the same material that's been found in the Royal Adelaide Hospital," he said. It is still not known if it has the same molecular make-up as the bacteria found in those who died. The CSIRO's Food Science Australia has been appointed to carry out an audit of the way the Health Department handled the outbreak and the way the Royal Adelaide Hospital supplies food to its patients. Conroy's Smallgoods has now removed all its products, except bacon, from sale. (Promed 12/13/05, 12/15/05)

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Americas
Canada (British Columbia): Farms declared free of bird flu
The federal food watchdog has lifted a quarantine on dozens of poultry farms in British Columbia's Fraser Valley, saying they are free of avian influenza. The Canadian Food Inspection Agency officials said 10 Dec 2005 that 21 days of testing turned up no sign of the disease on about 80 poultry farms that had been quarantined. The measure was originally imposed as a precaution after a low-pathogenic strain of the H5N2 virus was detected Nov 2005 at a duck farm near Chilliwack and another near Abbotsford. Canadian Food Inspection Agency officials quickly determined the virus was not the highly pathogenic H5N1 strain. However, they imposed a quarantine on any operation that lay within a 5-km radius of either of the 2 infected BC farms. On 10 Dec 2005, CFIA veterinarian Cornelius Kiley said officials were confident the virus hadn't spread. He said health officials would next focus their energies on trying to get other countries to lift bans on imports of poultry from British Columbia. The US, Japan, Taiwan and Hong Kong had all imposed temporary bans. The 2 farms where the virus was detected will remain under quarantine until the area has been completely disinfected, Kiley said. British Columbia's poultry industry was devastated in 2004 when the highly infectious H7N3 strain of bird flu spread rapidly from barn to barn, leading to a cull of more than 16 million birds in the Fraser Valley. (Promed 12/11/05)

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USA: FDA Acts to Protect Public from Fraudulent Avian Flu Therapies
The U.S. Food and Drug Administration issued warning letters recently to 9 companies marketing bogus flu products behind claims that their products could be effective against preventing the avian flu or other forms of influenza. FDA is not aware of any scientific evidence that demonstrates the safety or effectiveness of these products for treating or preventing avian flu and the agency is concerned that the use of these products could harm consumers or interfere with conventional treatments. Andrew von Eschenbach, MD, Acting FDA Commissioner, said, "The use of unproven flu cures and treatments increases the risk of catching and spreading the flu rather than lessening it because people assume they are protected and safe and they aren't. I consider it a public health hazard when people are lured into using bogus treatments based on deceptive or fraudulent medical claims." 8 of the products purported to be dietary supplements. Examples of the unproven claims cited in the Warning Letters include: "prevents avian flu," "a natural virus shield," "kills the virus," and "treats the avian flu." These alternative therapies are promoted as "natural" or "safer" treatments that can be used in place of an approved treatment or preventative medical product. In the Warning Letters, FDA advises the firms that it considers their products to be drugs because they claim to treat or prevent disease. The Warning Letters further state that FDA considers these products to be "new drugs" that require FDA approval before marketing. The letters also note that the claims regarding avian flu are false and misleading because there is no scientific basis for concluding that the products are effective to treat or prevent avian flu.

The 9 companies are BODeSTORE.com; Chozyn, LLC; Healthworks 2000; Iceland Health Inc.; Melvin Williams; PolyCil Health Inc.; PRB Pharmaceuticals, Inc.; Sacred Mountain Management, Inc.; and Vitacost.com.
(FDA 12/13/05 http://www.fda.gov/bbs/topics/NEWS/2005/NEW01274.html ; CIDRAP 12/13/05 http://www.cidrap.umn.edu/index.html )

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USA (Minnesota): Pandemic preparedness road show begins
National health officials came to Minnesota 14 Dec 2005 to launch what was billed as the first of 50 state pandemic influenza planning meetings, emphasizing the key roles of state and local governments as partners with the federal government. The general theme of the half-day conference was that much, if not most, of the real work of preparing for a pandemic must be done at the local and state levels. HHS and Minnesota officials will conduct a joint tabletop pandemic preparedness exercise sometime in the next 6 months. State and local health officials made clear the need for preparations. It's important for states to contemplate the cascading consequences of pandemic response now: for example, school closures will affect workplaces, movement restrictions will affect trade, and shortages of supplies will mean setting priorities. The federal government's preparations and funding are a step toward the federal fulfillment of its role, Health and Human Services (HHS) Secretary Michael O. Leavitt said. In 5 years, the nation could have new cell-based flu vaccines, end shortages of annual flu vaccine, and develop stockpiles of other medications and supplies.

Jeff Runge, MD, chief medical officer for the US Department of Homeland Security (DHS), emphasized the role of partnerships among federal agencies and between federal, state, and local agencies. Runge also emphasized the importance of developing relationships now. CDC Director Julie Gerberding sketched HHS's preparations involving vaccines and antiviral drugs. The goal is to amass enough of the prototype H5N1 vaccine to protect 20 million people—a tall order, given that it takes a much bigger dose of this vaccine than of ordinary flu vaccine to provide protection. HHS hopes to acquire 81 million treatment courses of antiviral drugs, mainly Tamiflu, but has only about 4.3 million courses on hand now, Gerberding said. Leavitt cautioned people not to pin too much hope on antivirals. He explained that HHS intends to allocate 50 million of the projected 81 million courses of antivirals to the states. A small part of the remainder (previously listed as 6 million doses) will be kept as an emergency reserve to keep the government running. The rest (pegged at 25 million courses) will be distributed to states that are willing to pay 75% of the cost. Also, the USDA has a stockpile of 40 million doses of avian flu vaccines for poultry, including 20 million doses that are effective against the H5N1 Asian strain. (CIDRAP 12/14/05 http://www.cidrap.umn.edu/index.html )

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USA: FDA Warns Consumers to Avoid Drinking Raw Milk
Following an outbreak in the state of Washington, the Food and Drug Administration (FDA) is warning the public against drinking raw milk because it may contain harmful bacteria that can cause life-threatening illnesses. Raw milk is not treated or pasteurized to remove disease-causing bacteria. The risk of drinking raw milk was most recently demonstrated in Washington by an outbreak associated with raw milk containing the bacteria Escherichia coli O157:H7. To date, 8 illness have been reported in Washington state, several of which were in children. 2 of the children remain hospitalized. Health authorities have identified locally sold raw milk as a source of the outbreak, and have ordered the unlicensed dairy to shut down. According to CDC, more than 300 people in the US became ill by drinking raw milk or eating cheese made from raw milk in 2001, and nearly 200 became ill from these products in 2002. Symptoms of E. coli O157:H7 illness include stomach cramps and diarrhea, including bloody diarrhea. E. coli O157:H7 disease sometimes leads to hemolytic uremic syndrome (HUS), which can cause kidney failure. People typically become ill 2-5 days after eating contaminated food. Pasteurization is the only effective method for eliminating the bacteria in raw milk and milk products. There is no meaningful difference in the nutritional value of pasteurized and unpasteurized milk. Pasteurization can also prevent such contagious diseases as tuberculosis, diphtheria, polio, Q fever, salmonellosis, strep throat, scarlet fever, and typhoid fever that can be spread by bacteria in milk. (FDA 12/16/05 http://www.fda.gov/bbs/topics/NEWS/2005/NEW01278.html )

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USA/Japan: Japanese market now open to U.S. beef products
Under the agreement announced 11 Dec 2005, the US is able to export beef from cattle 20 months of age and younger to Japan. Japan has lifted its ban on the importation of American beef, nearly 2 years after the discovery of the first US case of bovine spongiform encephalopathy (BSE) triggered the boycott. The US reciprocated by lifting its own ban on Japanese beef, in place since BSE was detected in Japan in Sep 2001 (Before the ban, Japan exported about $800,000 worth of expensive Kobe beef to the US annually). More than 94 percent of total U.S. ruminant and ruminant products, with a total export value of $1.7 billion in 2003, are now eligible for export to Japan. In 2003, the US exported $1.4 billion worth of beef and beef products to Japan. Prior to the Dec 2003 discovery of the first BSE-infected cow in the US, the U.S. exported beef and beef products to 119 countries. With the opening of Japan, 67 countries have now established trade to at least selected U.S. beef and beef products. Economies/countries in Asia whose markets remain closed include: Taiwan, South Korea, Hong Kong, China, and Singapore. (USDA 12/11/05 http://www.usda.gov/wps/portal/usdahome ; CIDRAP 12/12/05 http://www.cidrap.umn.edu/index.html )

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1. Updates
Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies
Influenza activity remained low during week 48

Canada. In week 48, 2 influenza outbreaks were reported from the provinces of Alberta and British Columbia, where overall activity remained localized. Activity remained low in the rest of the country.

During week 48, low influenza activity was detected in Hong Kong (H1 and H3), Japan (H1 and H3), and Russia. Mexico reported no influenza activity. (WHO 12/15/05 http://www.who.int/csr/disease/influenza/update/en/ )

USA. During week 49 (Dec 4 – Dec 10, 2005), influenza activity overall was low. 41 (3.0%) 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. One state reported regional influenza activity; 5 states, and the District of Columbia reported local influenza activity; 30 states and New York City reported sporadic influenza activity; and 13 states reported no influenza activity.

For more detailed information, please read, “Update: Influenza Activity --- United States, October 2--December 3, 2005”, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5449a2.htm. This report summarizes U.S. influenza activity since the beginning of the 2005--06 influenza surveillance season.
(CDC 12/16/05 http://www.cdc.gov/flu/weekly/ ; MMWR December 16, 2005 / 54(49);1256-1259)

Avian/Pandemic influenza updates
- Comprehensive information on the avian influenza: http://www.who.int/csr/disease/avian_influenza/en/index.html. WPRO 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 timeline of the outbreaks. Documents from the avian influenza meeting (7-9 Nov 2005) are also available.
- OIE updates on avian influenza: http://www.oie.int/eng/en_index.htm. Includes documents from the 7-9 Nov 2005 meeting and the 15-18 Nov 2005 Conference of the OIE Regional Commission for Asia, the Far East and Oceania.
- CDC website on pandemic influenza: http://www.cdc.gov/flu/pandemic.htm (includes the new Business Pandemic Plan Checklist and the State and Local Pandemic Influenza Planning Checklist). For avian influenza (available in Chinese, Vietnamese, and Spanish): http://www.cdc.gov/flu/avian/ .
- 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.
- Avian Influenza (Bird Flu): Implications for Human Disease
- Latest CIDRAP updates on avian/pandemic influenza: http://www.cidrap.umn.edu/index.html. A comprehensive overview on avian influenza, updated Dec 15, 2005, is available.
- 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
Semarang Mayor Sukawi Sutarip called for more support from 177 subdistrict heads in the fight against dengue fever, as 24 children have died from the illness in 2005, a much higher number than the 7 fatalities recorded in 2004. "I ask all heads of subdistricts in Semarang to observe all houses and schools in their neighborhoods. On Tuesday morning, all students will take part in an effort to clean their schools to rid them of mosquitoes," Sukawi said. Semarang recorded the highest number of dengue fever cases in Central Java province, with 118 of its 177 subdistricts recording cases. Dengue fever has killed 762 people in Indonesia so far in 2005 and infected some 62 000. The health ministry's director general for infectious disease, I Nyoman Kandun, warned that the toll from the disease could rise considerably in the next few months. Indonesia faces annual outbreaks of dengue. It infected 74 621 people in 2004, killing 862 [a fatality rate of 1155 per 100 000], data from the health ministry show. Kandun said the government was promoting environmental hygiene. (Promed 12/11/05)

Peru (Lima)
The Peruvian Ministry of Health (MINSA) has issued an alert. After a study performed in Lima, MINSA announced that the presence of Aedes aegypti, the vector for dengue fever, has been detected in 112 areas in Lima (19 districts). They warn that there is a high risk for new outbreaks of the disease this summer (mid-Dec to mid-Apr). National Coordinator for the Sanitary Strategy Against Vector-Borne Diseases at MINSA, Dr. Luis Miguel Leon, explained that the lack of drinkable water is the main problem in the fight against dengue fever. It is a very difficult problem to be solved in 2 months. According to MINSA, during 2005, 1200 dengue fever cases were detected in La Libertad area in Comas District. Dr. Leon says that the actual number of cases must be higher than the figures reported. Comas District Mayor, Mr. Julio Saldana, said that he is aware of the risk for his community, since it is an area that has already been affected by the virus. "The first thing we did is to establish the 'Health [Round] Table,' consisting of healthcare networks, the citizens, and the municipality", he informed. Major Saldana emphasized the importance of educating the population. "Saving water in receptacles outside houses and without any sanitary measures is a risk for neighbours", said Dr. Leon. Mr. Saldana also announced that bags containing larvicidal compound are being given out to the residents of the most risky areas. Dr. Leon said that even though no cases have yet been reported yet, there is a high risk. (Promed 12/11/05)

Philippines (Samar and Cantanduanes)
The Department of Health (DOH) said 12 Dec 2005 that contaminated deep wells may have caused an outbreak of diarrhea in Guian, Eastern Samar, which left 3 residents dead. Eric Tayag, head of the DOH's National Epidemiology Center, said that the diarrhea outbreak that started in Oct 2005 was caused by dirty water from deep wells. Tayag said that residents have been advised to boil the water taken from wells and faucets before drinking. He said that 3 residents of the affected barangays have already died of diarrhea, while at least 302 people are still being treated. Most of the victims were children. Tayag also said that the DOH regional office and the provincial government of Eastern Samar have already sent medicine and chlorine tablets to Guian.

It was reported 6 Dec 2005 that 3 people died of diarrhea in Barangay Cogon in Virac, Catanduanes, prompting the Department of Health (DOH) to investigate the cause of an apparent outbreak among other residents. Dr Ferchito Avelino, assistant regional health director in Bicol, said the cases could be related to a similar incident reported in the municipalities of San Andres and Virac in Sep 2005. "There were 14 confirmed deaths in San Andres and Virac [in Sep 2005] which were caused by water sources contaminated by E. coli bacteria," Avelino said. At least 70 other residents in Cogon were taken to hospitals after showing symptoms of the disease. The apparent outbreak was first reported 30 Nov 2005. A 4 person team from the DOH has been sent to the barangay to investigate the spread of diarrhea. (Promed 12/12/05)

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Viral gastroenteritis
USA (Nebraska)
There is no class at an Omaha, Nebraska school 11 Nov 2005 because of what may be the fourth outbreak of norovirus this fall. The Douglas County Health Department is investigating at Oak Valley Elementary School; 45 students either called in sick or went home sick 10 Nov 2005. The school cancelled classes Friday and workers will clean the school. The school is encouraging students to frequently wash their hands. The school is treating the outbreak as the norovirus, but it will take testing to confirm that. Omaha Public Schools thinks the outbreak is contained to one school. About 40 students at Creighton University have been ill since Friday, and there is speculation that it may be due to norovirus infection. Initially norovirus infection appeared to be associated predominantly with food-borne outbreaks of sudden-onset viral gastroenteritis, but latterly it became apparent that infection can be transmitted directly from person to person. Subsequent reports of norovirus infection included those associated with hotels, cruise ships, hospitals, and sports facilities. It is likely that this progression reflects changes in public awareness rather than fundamental changes in the epidemiology of norovirus infection. (Promed 12/10/05)

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West Nile Virus
USA
As of 6 Dec 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. [a total of 42 states]. Maps detailing county-level human, mosquito, veterinary, avian and sentinel data are available at: http://westnilemaps.usgs.gov/. (Promed 12/12/05)

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2. Articles
Influenza--interpandemic as well as pandemic disease
Dolin R. N Engl J Med. 2005 Dec 15;353(24):2535-7.
Excerpt: “Influenza occurs in both pandemic and interpandemic forms. Fortunately, pandemics, defined as worldwide outbreaks of severe disease, occur infrequently. Interpandemic influenza, although less extensive in its impact, occurs virtually every year. Widespread avian infection with influenza A (H5N1) and associated clusters of human disease have aroused concern about the threat of a pandemic, and attention has been appropriately focused on control measures to deal with such an event. However, interpandemic influenza has a substantial effect, both cumulatively and in individual outbreaks, and has much to teach us about transmission, pathogenesis, and potentially effective control measures. . .” (CIDRAP http://www.cidrap.umn.edu/index.html )

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Influenza-associated deaths among children in the United States, 2003-2004
Bhat N et al. N Engl J Med. 2005 Dec 15;353(24):2559-67.
Abstract: “Background: Although influenza is common among children, pediatric mortality related to laboratory-confirmed influenza has not been assessed nationally. Methods: During the 2003–2004 influenza season, we requested that state health departments report any death associated with laboratory-confirmed influenza in a U.S. resident younger than 18 years of age. Case reports, medical records, and autopsy reports were reviewed, and available influenza-virus isolates were analyzed at the Centers for Disease Control and Prevention. Results: One hundred fifty-three influenza-associated deaths among children were reported by 40 state health departments. The median age of the children was three years, and 96 of them (63 percent) were younger than five years old. Forty-seven of the children (31 percent) died outside a hospital setting, and 45 (29 percent) died within three days after the onset of illness. Bacterial coinfections were identified in 24 of the 102 children tested (24 percent). Thirty-three percent of the children had an underlying condition recognized to increase the risk of influenza-related complications, and 20 percent had other chronic conditions; 47 percent had previously been healthy. Chronic neurologic or neuromuscular conditions were present in one third. The mortality rate was highest among children younger than six months of age (0.88 per 100,000 children; 95 percent confidence interval, 0.52 to 1.39 per 100,000). Conclusions: A substantial number of influenza-associated deaths occurred among U.S. children during the 2003–2004 influenza season. High priority should be given to improvements in influenza-vaccine coverage and improvements in the diagnosis and treatment of influenza to reduce childhood mortality from influenza.” (CIDRAP http://www.cidrap.umn.edu/index.html )

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West Nile Virus Activity--United States, January 1-December 1, 2005
“West Nile virus (WNV) is the leading cause of arboviral encephalitis in the United States. . .During Jan 1--Dec 1, 2005, a total of 2,744 cases of WNV disease in humans were reported in the US, an increase from 2,359 during the same period in 2004. A total of 1,165 cases were WNV neuroinvasive disease (WNND). WNV infections in humans, birds, mosquitoes, and nonhuman mammals are reported to CDC through ArboNET, an Internet-based arbovirus surveillance system managed by state health departments and CDC. During 2005, WNV transmission to humans or animals expanded into 21 counties that had not previously reported transmission and recurred in 1,196 counties where transmission had been reported in previous years. This report summarizes provisional WNV surveillance data through Dec 1, 2005, and highlights the need for ongoing surveillance, mosquito control, promotion of personal protection from mosquito bites, and research into additional prevention strategies. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5449a1.htm (MMWR December 16, 2005 / 54(49);1253-1256)

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Brief Report: Respiratory Syncytial Virus Activity--United States, 2004--2005
“Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections (LRTIs) (e.g., bronchiolitis and pneumonia) among young children, resulting in an estimated 51,000--82,000 hospitalizations annually in the US. RSV also causes severe disease and death among older persons and persons of all ages with compromised respiratory, cardiac, or immune systems and can exacerbate chronic cardiac and pulmonary conditions. In temperate climates, most RSV infections occur during a distinct seasonal peak. This report presents preliminary data from RSV activity reported to the National Respiratory and Enteric Virus Surveillance System (NREVSS) for the weeks ending July 2 through December 3, 2005, indicating the onset of the 2005-06 RSV season, and summarizes trends during July 2004-June 2005. Health-care providers should consider RSV in the differential diagnosis for persons of all ages with LRTIs, implement appropriate isolation precautions to prevent nosocomial transmission, and provide appropriate immune prophylaxis to eligible children, including certain premature infants or infants and children with chronic lung and heart disease. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5449a3.htm (MMWR December 16, 2005 / 54(49);1259-1260)

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Outbreak of cutaneous Bacillus cereus infections among cadets in a university military program--Georgia, August 2004
“Although Bacillus cereus is known mainly as an agent of food poisoning, other infections caused by this organism have been documented in immunocompromised patients. . .Certain populations are at increased risk for B. cereus infection, including cancer patients, neonates, intravenous drug users, and patients with a history of trauma, surgery, or catheterization. Primary cutaneous disease attributed to B. cereus in immunocompetent persons or in non--health-care settings rarely has been reported. This report is the first to document such an outbreak. On August 24, 2004, a local health department in Georgia received a call from a university health center describing 90 cadets with nonpruritic, impetigo-like lesions on their scalps; B. cereus was the common organism among the 3 patients whose lesions were cultured. The cases occurred during the freshman military orientation week that preceded the start of the fall term. The Georgia Division of Public Health (GDPH) conducted an investigation to determine the source of the infections, identify associated risk factors, and implement control measures. This report summarizes the results of the outbreak investigation, which identified receiving a short haircut at the start of orientation week, sharing sunscreen during the week, and membership in Company B as strongly associated with having scalp lesions. Recommendations to the university included changing the type of haircut required, increasing time allowed for showering, and issuing individual sunscreen. The results of this investigation underscore the need for military programs to incorporate good hygiene and infection-control measures into school orientation events. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5448a3.htm (MMWR December 9, 2005 / 54(48);1233-1235)

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Late Relapse of Plasmodium ovale Malaria--Philadelphia, Pennsylvania, November 2004
“Approximately 1,300 cases of malaria are reported each year in the United States; nearly all of these cases occur in travelers, many of whom fail to receive or adhere to prescribed chemoprophylaxis or do not follow recommendations for prevention of mosquito bites. Malaria can persist if not treated or if treated incorrectly. . .Although malaria typically becomes clinically apparent within 1 month of infection, cases can occur years after the last presumed exposure. In November 2004, CDC received a report of a late relapse of malaria in a Nigerian man aged 23 years in Philadelphia, Pennsylvania. His malaria was determined to have been caused by Plasmodium ovale, one of the four species of Plasmodium parasite that are transmitted by mosquitoes and cause malaria. The patient had been treated for malaria in Nigeria on multiple occasions, most recently 6 years before onset of his illness in the US. This report describes the Philadelphia case, which underscores the importance of taking a detailed travel and immigration history when evaluating unexplained fever and considering malaria in the differential diagnosis. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5448a2.htm (MMWR December 9, 2005 / 54(48);1231-1233)

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Measles--United States, 2004
“Measles is a highly infectious, acute viral illness that can cause severe pneumonia, diarrhea, encephalitis, and death. During 2004, a total of 37 cases (incidence: <1 case per million population) was reported to CDC by local and state health departments, the lowest number of measles cases ever reported in 1 year in the United States and a decrease of 16% from the previous low of 44 cases in 2002. This report describes the epidemiology of measles in the US in 2004, documenting the absence of endemic measles and the continued risk for internationally imported measles cases that can result in indigenous transmission. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5448a1.htm (MMWR December 9, 2005 / 54(48);1229-1231)

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Adverse events associated with smallpox vaccination in the United States, January-October 2003
Christine G. Casey et al. JAMA. 2005;294:2734-2743. http://jama.ama-assn.org/cgi/content/abstract/294/21/2734
Context: On January 24, 2003, the US Department of Health and Human Services (DHHS) implemented a preparedness program in which smallpox (vaccinia) vaccine was administered to federal, state, and local volunteers who might be first responders during a bioterrorism event. Objective: To describe results from the comprehensive DHHS smallpox vaccine safety monitoring and response system. Design, Setting, and Participants: Descriptive study of adverse event reports from the DHHS smallpox vaccine safety monitoring and response system received between January 24 and October 31, 2003, through the Vaccine Adverse Event Reporting System (VAERS) and the Centers for Disease Control and Prevention. A total of 37 901 volunteers in 55 jurisdictions received at least 1 dose of smallpox vaccine. Main Outcome Measures: Number of vaccinations administered and description of adverse events and reporting rates. Results: A total of 38 885 smallpox vaccinations were administered, with a take rate of 92%. VAERS received 822 reports of adverse events following smallpox vaccination (overall reporting rate, 217 per 10 000 vaccinees). A total of 590 adverse events (72%) were reported within 14 days of vaccination. Nonserious adverse events (n = 722) included multiple signs and symptoms of mild and self-limited local reactions. One hundred adverse events (12%) were designated as serious, resulting in 85 hospitalizations, 2 permanent disabilities, 10 life-threatening illnesses, and 3 deaths. Among the serious adverse events, 21 cases were classified as myocarditis and/or pericarditis and 10 as ischemic cardiac events that were not anticipated based on historical data. Two cases of generalized vaccinia and 1 case of postvaccinial encephalitis were detected. No preventable life-threatening adverse reactions, contact transmissions, or adverse reactions that required treatment with vaccinia immune globulin were identified. Serious adverse events were more common among older revaccinees than younger first-time vaccinees. Conclusions: Rigorous smallpox vaccine safety screening, educational programs, and older vaccinees may have contributed to low rates of preventable life-threatening adverse reactions. Other rare, clinically significant, or unexpected cardiac adverse events were detected by timely review of VAERS data and intensive clinical case investigation. (CIDRAP 12/14/05 http://www.cidrap.umn.edu/index.html )

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3. Notifications
Winter brings new health challenges for people in Pakistan earthquake zone
WHO Director-General Dr LEE Jong-wook is visiting Pakistan to assess the continuing health needs of people affected by the October earthquake. Shelter remains an acute concern. Respiratory infections, hypothermia and water-borne diseases continue to pose urgent health challenges. Dr Lee praised the response of the government and the international community but said WHO still needs US$ 13 million, or almost half, of the US$ 27 million initially requested, to help people survive the winter. For more information, visit: http://www.who.int/hac/crises/international/pakistan_earthquake/en/index.html. (WHO 12/12/05)

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New tuberculosis therapy offers potential shorter treatment
Clinical results on a new combination treatment that could dramatically shorten the length of tuberculosis (TB) treatment were presented at the 45th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington, D.C. The phase II trial results of a gatifloxacin-containing regimen are demonstrating good potential. The regimen is significantly more potent than the currently recommended 6-month regimen of isoniazid, rifampicin, pyrazinamide and ethambutol, and suggests that when gatifloxacin is used instead of ethambutol, the standard 6-month regimen may be shortened to 4 months. "We are working to bring together public and private partners to speed development for this new treatment," says Dr. Robert Ridley, Director of the WHO-based Special Programme for Research and Training in Tropical Diseases (TDR). This is the most advanced shorter TB treatment regimen presently in development, and could be available to the public by the end of 2009 if positive results continue.

Finding options to shorten the length of treatment has been declared a public health priority by the Stop TB partnership. One-third of the world's population is infected with Mycobacterium tuberculosis, the causative agent of TB, with approximately 8 million people developing the active form of the disease every year. The HIV/AIDS pandemic has dramatically increased the incidence of this disease. A shorter TB regime will also help improve treatment adherence and preventing the development of multidrug-resistant TB. The phase II trial was conducted by the South African Medical Research Council in Durban, South Africa, in patients with newly diagnosed pulmonary tuberculosis with and without HIV co-infection. It was designed to measure the anti-tuberculosis activity of the treatment in the first 2 months of therapy when compared to standard WHO recommended treatment and 2 other similar regimens which contained either ofloxacin or moxifloxacin. Treatment with either the gatifloxacin or moxifloxacin containing regimen was shown to be significantly more active than either the standard regimen or the ofloxacin containing regimen after 2 months of treatment. (WHO 12/16/05 http://www.who.int/mediacentre/news/releases/2005/pr71/en/index.html)

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WPRO publication: Tuberculosis Control in South-East Asia and Western Pacific Regions
This featured publication is the first combined biregional report on tuberculosis control in the South-East Asia and the Western Pacific Regions. It presents data on TB epidemiology and gauges the progress being made by national TB control programmes in both regions. It presents the overall success with the strategies adopted to control TB and highlights the similarities and differences between individual countries. For more information visit http://www.wpro.who.int/publications/PUB_9290611960.htm. (WHO/WPRO)

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WHO Food Safety
The Department of Food Safety, Zoonoses and Foodborne Diseases (FOS) strives to reduce the serious negative impact of foodborne diseases worldwide. Food and waterborne diarrhoeal diseases are leading causes of illness and death in less developed countries, killing approximately 1.8 million people annually, most of whom are children. Recent trends in global food production, processing, distribution and preparation are creating an increasing demand for food safety research in order to ensure a safer global food supply. FOS works with other WHO departments, Regional Offices and WHO collaborating centres as well as other international and national agencies. In particular, WHO works closely with the Food and Agriculture Organization of the UN (FAO) to address food safety issues along the entire food production chain--from production to consumption--using new methods of risk analysis. These methods provide efficient, science-based tools to improve food safety, thereby benefiting both public health and economic development. FOS endeavours to help all WHO Member States, both developing and developed, through the approaches outlined in the WHO Global Strategy for Food Safety. For more information, including The FAO/WHO Expert Meeting on the Development of Practical Risk Management Strategies Based on Microbiological Risk Assessment Outputs will take place 31 Jan - 4 Feb 2006 (http://www.who.int/foodsafety/en/). Food safety concerns have also been recently addressed by food safety experts in the Americas: http://www.paho.org/English/DD/PIN/pr051209a.htm and http://www.paho.org/English/DD/PIN/pr051205.htm. (WHO and PAHO)

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Ninth Annual Conference on Vaccine Research, May 8-10, 2006
CDC and 10 other agencies and organizations will collaborate with the National Foundation for Infectious Diseases in sponsoring the Ninth Annual Conference on Vaccine Research, to be held May 8-10, 2006, at Baltimore, Maryland. The conference is devoted exclusively to the research and development of vaccines and related technologies for the prevention and treatment of disease and will bring together human and veterinary vaccinology researchers. 34 speakers will address topics that include tuberculosis vaccines, vaccines in the elderly and adolescents, herd immunity, vaccine constructs based on novel immunologic strategies, veterinary vaccines, adverse reactions, and differing immune responses in developing countries. Oral and poster presentations will be selected through peer review of submitted abstracts. Deadline for submission of abstracts is Feb 3, 2006. For more information: http://www.nfid.org/conferences/vaccine06, and by e-mail (vaccine@nfid.org), fax (301-907-0878), tel (301-656-0003, ext 19), and mail (NFID, Suite 750, 4733 Bethesda Avenue, Bethesda, MD 20814). http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5449a4.htm (MMWR December 16, 2005 / 54(49);1261)

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Epidemiology in Action Course and Intermediate Methods
The Rollins School of Public Health at Emory University and CDC will cosponsor a course, Epidemiology in Action, Mar 27--Apr 7, 2006 at Emory University. The course is designed for state and local public health workers. The course emphasizes the practical application of epidemiology to public health problems and will consist of lectures, workshops, classroom exercises (including actual epidemiologic problems), and roundtable discussions. Topics include descriptive epidemiology and biostatistics, analytic epidemiology, epidemic investigations, public health surveillance, surveys and sampling, Epi Info training, and discussions of selected prevalent diseases. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5448a5.htm

CDC and Rollins School of Public Health will also cosponsor Epidemiology in Action: Intermediate Methods, Feb 27--Mar 3, 2006, at Emory University. The course is designed for practicing public health professionals who have had training and experience in basic applied epidemiology and desire training in additional quantitative skills related to analysis and interpretation of epidemiologic data. The course includes a review of the fundamentals of descriptive epidemiology and biostatistics, measures of association, normal and binomial distributions, confounding, statistical tests, stratification, logistic regression, models, and computers as used in epidemiology. Prerequisite is an introductory course in epidemiology, such as Epidemiology in Action or the International Course in Applied Epidemiology. Application deadline is Jan 27, 2006. For more information: Emory University, Rollins School of Public Health, Global Health Dept (Pia), 1518 Clifton Rd. NE, Rm. 746, Atlanta, GA 30322; telephone, 404-727-3845; by fax, 404-727-4590; online, http://www.sph.emory.edu/epicourses; e-mail, pvaleri@sph.emory.edu.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5448a6.htm (MMWR December 9, 2005 / 54(48);1236)

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Epi Info: A Course to Develop Public Health Software Applications
CDC and Emory University's Rollins School of Public Health will cosponsor "Epi Info: A Course to Develop Public Health Software Applications" Mar 13-15, 2006, at Emory University. The course is designed for practitioners of epidemiology and computing with intermediate-to-advanced computer skills who wish to develop public health software applications using Epi Info for Windows 98, NT, 2000, and XP. The 3-day course covers hands-on experience with the new Windows version of Epi Info, programming Epi Info software at beginning-to-intermediate level, and computerized interactive exercises for developing public health information systems. All Epi Info modules, such as Makeview, Checkcode, Enter, Analysis, Epi Map, and Epi Report, will be covered. Additional information is available from Emory University, Rollins School of Public Health, Global Health Dept (Pia), 1518 Clifton Rd. NE, Rm. 746, Atlanta, GA 30322; by telephone, 404-727-3845; by fax, 404-727-4590; http://www.sph.emory.edu/epicourses; or by e-mail, pvaleri@sph.emory.edu. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5448a7.htm (MMWR December 9, 2005 / 54(48);1236-1237)

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FDA Approval of Havrix (Hepatitis A Vaccine, Inactivated) for Persons Aged 1--18 Years
On Oct 17, 2005, the Food and Drug Administration approved an application to allow use of the pediatric/adolescent formulation of Havrix (hepatitis A vaccine, inactivated) (GlaxoSmithKline Biologicals) for persons aged 1--18 years. Previously, pediatric use of Havrix was approved for use in persons aged 2--18 years. The formulation, dosage, and schedule for Havrix were not changed. Each 0.5-mL dose of pediatric/adolescent Havrix contains 720 enzyme-linked immunosorbent assay units of formalin-inactivated hepatitis A viral antigen adsorbed onto aluminum hydroxide. The pediatric/adolescent formulation of Havrix is indicated for vaccination of persons aged 1--18 years against disease caused by hepatitis A virus. The primary vaccination schedule is unchanged and consists of 2 doses, administered on a 0, 6--12-month schedule. Additional information is available from the manufacturer's package insert and GlaxoSmithKline Biologicals at telephone 888-825-5249. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5448a4.htm (MMWR December 9, 2005 / 54(48);1235-1236)

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4. APEC EINet activities
APEC EINet pandemic influenza videoconference
As EINet celebrates its 10th anniversary of service to the Asia Pacific, we are pleased to host the first APEC Virtual Symposium on Pandemic Preparedness, Friday 20 Jan 2006, 02:00 – 07:00 UTC. A strong alliance of government and academic partners with experts in pandemic preparedness and technology is bringing this innovative effort in real time communications into the fight against regional pandemics. Using state of the art advanced networking we will host economies online to discuss lessons learned with preparedness planning, exercises, stockpiling and other strategic issues. This is an experiment bringing state of the art high speed communications tools into the regional mission of public health. For more information please visit: http://depts.washington.edu/einet/symposium.html.

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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