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Vol. VIII, No. 27 ~ EINet News Briefs ~ Dec 30, 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, Turkey: Avian influenza reported in birds
- Global: FAO veterinarian dismisses fish farming as avian influenza risk
- East Asia: Cumulative number of human cases of avian influenza A/(H5N1)
- China: Additional case of human infection with H5N1 avian influenza virus
- China: Information-sharing and farming practices
- China: Claims better antiviral and avian vaccine
- China-Hong Kong (Rural districts): 9 typhoid fever reports probed
- Russia (Novgorod): Outbreak of infection due to Yersinia pseudotuberculosis
- Philippines: WHO provides emergency assistance for floods
- USA: Tamiflu approved for prevention of influenza in children under age 12
- USA (Washington, Oregon): E coli outbreak blamed on raw milk

1. Updates
- Influenza
- West Nile Virus

2. Articles
- CDC EID Journal, Volume 12, Number 1-January 2006
- Outbreaks of Escherichia coli O157:H7 Associated with Petting Zoos--North Carolina, Florida, and Arizona, 2004 and 2005
- Mycobacterium tuberculosis Transmission in a Newborn Nursery and Maternity Ward--New York City, 2003
- Pertussis--United States, 2001--2003

3. Notifications
- Resumption of U.S. beef trade with Hong Kong
- Public health notification regarding Ralstonia associated with Vapotherm Respiratory Gas Administration Devices--United States, 2005
- FDA reaffirms worth of DoD anthrax vaccine
- Supplemental testing for confirmation of reactive oral fluid rapid HIV antibody tests
- Sexual and reproductive health of adolescents and youths in the Western Pacific Region

4. APEC EINet activities
- APEC EINet pandemic influenza videoconference

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Romania, Turkey: Avian influenza reported in birds
New outbreaks of avian influenza in birds were reported this week in Romania and Turkey. Reportedly, tests in Britain detected H5N1 viruses in 7 samples sent from 4 areas in southeastern Romania. Authorities had ordered the precautionary culling of birds in the affected areas after initial tests pointed to an H5 virus. Reportedly, the virus has now been detected in 22 Romanian localities since early Oct 2005. More than 100,000 poultry and other birds have been slaughtered to contain the disease since the first case was discovered on 7 Oct 2005.

In Turkey, less than a month after declaring its territory free of the virus, poultry in the eastern province of Igdir, near the Armenian border, tested positive for an H5 virus, but it was reportedly not yet known whether it was the H5N1 strain. About 1,200 birds died in the area in mid-Dec 2005, and another 350 were culled as a precaution. The Agriculture Ministry said it had imposed quarantine in the affected area of Igdir. Igdir is a remote rural area where farming and animal husbandry are the main means of livelihood. But poultry are mostly raised by people for their own consumption. The ministry said it believed migratory birds may have brought the virus to Igdir from the Caucasus region. Reportedly, samples from the latest outbreak had been sent to Britain for testing. If confirmed, the latest finding would represent Turkey's second outbreak of H5N1. The first one was discovered Oct 5, 2005 on a turkey farm in Balikesir province in western Turkey.

The following, received by OIE 27 Dec 2005 from Dr. Nihat Pakdil, General Director of Protection and Control, Ministry of Agriculture and Rural Affairs, Ankara, is available at http://www.oie.int/Messages/051228TUR.htm. Avian influenza due to virus subtype H5 was reported in 4 backyard flocks in the village of Kopruler, Aralik, Igdir province. Date of confirmation of the event: 26 Dec 2005 (virus isolation). Number of susceptible animals in the outbreak: 1559 poultry. Number of cases: 1200. Number of deaths: 1200. Number of animals destroyed: 359. Source of outbreak or origin of infection: under investigation. Control measures undertaken: Stamping out policy. All carcasses were buried with lime in 3 pits dug in situ; Quarantine; Movement control inside the country; Disinfection of infected premises/establishments; National and Local Disease Control enters were activated; Protection and surveillance zones were established; Clinical surveillance has been continuing; Biosecurity measures have been increased; Public awareness is being raised and training sessions are being conducted. (CIDRAP 12/30/05 http://www.cidrap.umn.edu/index.html ; Promed 12/25/05, 12/28/05)

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Global: FAO veterinarian dismisses fish farming as avian influenza risk
The widespread use of poultry excrement to fertilize fish farms does not greatly increase the risk of bird flu, a senior UN expert said 28 Dec 2005. Joseph Domenech, chief veterinary officer at the U.N. Food and Agriculture Organization, dismissed a wildlife group's claim that using animal feces to boost fish farming was a serious danger. Global environmental group Birdlife International (an umbrella body for bird protection groups in 100 countries) said wild birds have been unfairly blamed for the virus. It says human practices like the trade in poultry and wild birds, and modern agricultural methods, probably play a major role in spreading the virus. The FAO, which is monitoring the global spread of bird flu, supports the practice whereby feces from farm animals are used to boost fish production. The excrement is used to boost nutrients in water for the organisms the fish feed on (a practice now routine in Asia). Domenech said there was a theoretical risk of fish farms becoming a source of infection if excrement from infected poultry were poured into the ponds. It could create "an infection outbreak in the environment, in the water, which can be the source of contamination of other birds which come to drink there." FAO’s 2003 report, Integrated Livestock Fish Farming Systems, noted: "Recently, livestock and fish have been implicated in the irregular occurrence of influenza pandemics; the global impacts on public health of promoting livestock and fish integration are huge if these claims are substantiated." This report includes a reference to a paper published in Nature in 1988, titled Fish Farming and Influenza Pandemics. It said that bringing together fish farms with farm livestock "may well be the creation of a considerable human health hazard." Various countries have banned, or significantly restricted, the recycling of poultry excreta to food animals and, in particular, to ruminants.

Domenech added, however, that as long as the correct surveillance was in place, infection should not happen, or could be dealt with quickly if it did. "To ban these systems of raising livestock, which are extremely efficient and irreplaceable to feed the populations in those countries, would be like banning the raising of ducks because ducks are considered one of the main sources." He also said, "Today, it's impossible to say that wild birds are not playing a role. We hope in 3 to 4 months, at the end of this migration period, we will see better." (Promed 12/28/05)

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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 / 16 (11)
Cambodia / 4 (4)
Thailand / 5 (2)
Viet Nam / 61 (19)
China / 7 (3)
Total / 93 (39)

Total number of confirmed human cases of avian influenza A/(H5N1), 26 Dec 2003 to present: 142 (74)
(WHO 12/30/05 http://www.who.int/csr/disease/avian_influenza/country/en/index.html )

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China: Additional case of human infection with H5N1 avian influenza virus
The Ministry of Health of China has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case is a 41-year-old woman from Fujian province. She developed symptoms of fever followed by pneumonia 6 Dec 2005, and was admitted to hospital 2 days later. The patient died 21 Dec 2005. On 13 Dec 2005, initial laboratory tests on samples from the patient tested negative for H5N1 virus. But further tests on 23 Dec 2005 showed positive results. The virus was also isolated from the patient. Reportedly, close contacts who have been placed under medical observation have not displayed any symptoms. Agricultural authorities so far have not been able to confirm the presence of the H5 virus subtype in poultry in the vicinity of the patient's residence or place of work. Investigators have not been able to confirm any direct contact between the patient and poultry prior to the onset of illness. The investigation, however, is continuing. This is China's seventh laboratory-confirmed human case. Of these cases, 3 have been fatal (including this latest case). To date, China has reported human cases in 6 provinces and regions: Hunan, Anhui, Guangxi, Liaoning, Jiangxi and Fujian.

Also on 29 Dec 2005, China's Foreign Ministry spokesman Qin Gang pledged at a regular press briefing that China will continue to strengthen its cooperation with the world community to deal with the challenge of bird flu. China has reported 31 bird flu outbreaks in poultry this year. Reportedly, China's home-made human vaccine begun human trials on 21 Dec 2005 with 6 volunteers receiving the shots. The whole trials will need 9 months of tests, but initial results are expected within the first 3 months. (Promed 12/30/05)

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China: Information-sharing and farming practices
A WHO official recently urged China to share more information on avian influenza outbreaks in poultry and to change farming practices to help prevent the disease. Shigeru Omi, the WHO's Western Pacific regional director, talked about Chinese information-sharing and farming practices during his recent visit to China. Omi praised China for sharing some data on recent human cases of avian flu but reportedly said data on more than 30 outbreaks in poultry had not been divulged. "Human H5N1 viruses are only part of the story," Omi said. "To fully understand how this virus is evolving, we need viruses from outbreaks in animals." Omi reportedly said Chinese officials shared data on the H5N1 flu outbreak in wild birds at Quinghai Lake and also shared 5 virus isolates from animal last year. He said China was not hiding cases, but a lack of surveillance and awareness in rural areas prevents quick and efficient reporting of outbreaks. Julie Hall, a WHO expert on the virus, said WHO has agreed to share virus isolates from 2 of its 6 human cases and to provide viral genetic sequence information for 2 more cases. Omi reportedly said China's common practices of raising different kinds of animals together and living close to them need to change. But he acknowledged that this can't be achieved "overnight," given China's huge poultry population.

Omi said, “The strongest weapons in this war are collaboration, cooperation and the sharing of information. Accurate and complete reporting about outbreaks in animals and about human cases is vital. The sharing of information must be timely, regular and global.” One of the major challenges in fighting the disease in China is that about 70 percent of its poultry throughout the country are spread across backyard farms, meaning a massive effort would be required to educate villagers throughout the country. Most of China's human bird flu cases were also not treated with Tamiflu, the frontline anti-viral drug, either because it was not available quickly enough to be effective or because the cases were not identified soon enough. The drug is most effective within the first 48 hours of illness. (CIDRAP 12/27/05 http://www.cidrap.umn.edu/index.html ; Promed 12/23/05)

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China: Claims better antiviral and avian vaccine
A claim about a new and better anti-flu drug came from Chinese scientist Li Song of the Academy of Military Medical Sciences, according to a report published on the China Daily Web site. The new drug is a neuraminidase inhibitor, like the existing antivirals oseltamivir (Tamiflu) and zanamivir (Relenza), Li said. "We have completed clinical experiments, and find it is more effective on humans than Tamiflu," Li said of the new drug. Li said the drug would be produced by Chinese companies and would cost only a quarter to a third as much as oseltamivir costs in China. The story mentioned no published scientific reports on the drug. A WHO spokesman in China said he had no information on it.

A report of a new avian flu vaccine for poultry came in another China Daily story. Jia Youling, China's chief veterinary officer, said scientists have developed a live-virus vaccine that protects poultry from both avian flu and Newcastle disease (Newcastle infections are endemic to many countries, and is also a highly-contagious viral disease affecting both domestic poultry and wild birds). The combination vaccine can be administered orally, nasally, or by spray, as well as by injection, Jia said. He asserted that the former techniques would save labor and confer increased immunity. Moreover, he said, the vaccine's production cost is only about a fifth as high as that of other vaccines on the market. The vaccine is the product of 4 years of development at the Harbin Veterinary Research Institute, Jia reported. Bu Zhigao, a chief scientist on the vaccine project, said the vaccine can protect mammals, such as mice, from avian flu. The China Daily story mentioned no published scientific reports on the vaccine. The government expedited approval of the recombinant bivalent vaccine after its safety and efficacy were demonstrated, Jia said. Reportedly, authorities approved mass production of the vaccine Dec 23, 2005 and 1 billion doses would be produced by the end of this month, and be used alongside existing vaccines from 2006.

China is mounting a campaign to vaccine all of its billions of poultry against avian flu. Authorities claimed to have vaccinated 6.85 billion birds as of mid-Dec 2005. By 22 Dec 2005, 30 out of 31 outbreak sites had been lifted out of epidemic isolation, according to ministry sources. [see http://europa.eu.int/comm/health/ph_threats/com/Influenza/ai_recent_en.htm ]. (CIDRAP 12/27/05 http://www.cidrap.umn.edu/index.html ; Promed 12/26/05)

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China-Hong Kong (Rural districts): 9 typhoid fever reports probed
The Centre for Health Protection is reviewing 9 reports of typhoid fever in the past 3 weeks: 7 in Yuen Long, 1 in Sham Shui Po and an imported case. The 7 cases in Yuen Long included 4 children aged 9 to 13 in a single family, a 51-year-old man, and 2 girls aged 8 and 17. The Sham Shui Po case involved a 7-year-old boy. They developed symptoms, including fever, stomach pain and vomiting, between 18 Nov and 6 Dec 2005. All the Yuen Long patients were admitted to Tuen Mun Hospital. The 4 children from the same family and the 17-year-old girl are in stable condition, while the 8-year-old girl and the 51-year-old man have been discharged. The 7-year-old boy in Sham Shui Po was admitted to Caritas Medical Centre and is now in stable condition. Community Medicine Consultant Dr. Thomas Tsang said initial investigations did not reveal a single common food shop or hawker all the patients had patronized. The center is conducting detailed tests to find out whether the cases originated from a common source. More definitive results are expected in about 2 weeks. Typhoid fever is endemic in Hong Kong, Dr. Tsang said, adding there were from 0 to 11 cases reported monthly in the past 2 years. A total of 33 cases have been reported so far in 2005. There were 53 cases in 2004, 49 in 2003, 67 in 2002 and 67 in 2001. Yuen Long district had from 1 to 9 cases each year from 2001 to 2004, Dr. Tsang said. (Promed 12/19/05)

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Russia (Novgorod): Outbreak of infection due to Yersinia pseudotuberculosis
An outbreak of infection due to Yersinia pseudotuberculosis has been recorded among children in a kindergarten of the settlement of Poberezje [Novgorod region]. Valery Pjanyh, deputy head of territorial management of the Russian (Health) Protection Agency (Rospotrebnadzor) for the region, said that the infection has been detected in 24 children within the past 2 days. Reportedly, symptoms of illness in the first children who fell ill with Y. pseudotuberculosis were reminiscent of scarlet fever: acute rise in temperature, a rash, and stomach and joint pains. Single cases of Y. pseudotuberculosis infection have been reported in the region, but an outbreak such as this is the first on record. The source of infection was probably vegetables. Vegetable salads were on the menu of the kindergarten almost daily. Employees of Rospotrebnadzor are now investigating the conditions under which these salads were prepared. Infection with Y. pseudotuberculosis is a zoonosis with reservoirs in many animals. Most individuals affected are children or young adults. The commonest presentation of this infection is mesenteric lymphadenitis presenting with fever and right lower quadrant abdominal pain, which can be confused with acute appendicitis. A febrile gastroenteritis may also occur, which has been described as Izumi syndrome in Japan. Late complications may be a reactive arthritis or erythema nodosum. Diagnosis of infection with this bacterium can be made by isolation of the organism from lymph node or stool. Serological tests can be helpful, but cross-reactions are found between yersiniae and other enteric organisms. (Promed 12/16/05)

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Philippines: WHO provides emergency assistance for floods
WHO has donated an inflatable boat to the Department of Health of the Philippines to provide transportation for mobile health emergency teams in flooded areas in Oriental Mindoro Province, particularly in the city of Calapan. During the first week of December, 3 days of rain destroyed a protective dyke in Calapan, leading to the mass evacuation of more than 1000 families. This was followed a week later by another series of flash floods that forced more than 2000 families to move into evacuation centres. WHO has also donated 2000 bottles of intravenous fluids and intravenous kits. In 2004, the Philippines was also affected by a series of tropical cyclones which led to flooding causing more than 700 deaths. The WHO provided emergency response through a United Nations Flash Appeal. http://www.wpro.who.int/media_centre/press_releases/pr_20051220.htm (WHO/WPRO 12/20/05)

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Americas
USA: Tamiflu approved for prevention of influenza in children under age 12
On Dec 21, 2005, the Food & Drug Administration (FDA) approved the use of Tamiflu for prevention (prophylaxis) of seasonal influenza in children 1 to 12 years of age who had close contact with an infected individual. This is the first drug approved for prevention of both influenza A and B in pediatric patients. Tamiflu is an oral anti-viral drug previously approved by FDA for both the prevention and treatment of influenza in adolescents 13 years and older, and in adults. Tamiflu also is approved for treatment of influenza in pediatric patients older than 1 year of age. A study of the spread of flu in households involving over 1100 people included 222 children 1 to 12 years of age. When someone in the household was diagnosed with seasonal flu, other family members received either Tamiflu once a day for 10 days or no Tamiflu at all unless they became ill. The rate of children developing fever and other symptoms confirmed to be flu was reduced from 17% in the group receiving no preventative treatment to 3% in the group that received Tamiflu as a preventative measure. The benefit in children mirrored the benefit seen in older individuals in this and earlier studies. The effective use of Tamiflu to prevent influenza in immunocompromised patients has not been established. In the studies, side effects from Tamiflu, when taken for prevention, were similar to those from patients who took the drug for treatment. The most common side effects were nausea, vomiting, headache and fatigue. Vomiting was reported more frequently in people receiving the twice daily treatment dose compared to once daily prophylaxis. Although no new side effects occurred in these studies, FDA has requested additional postmarket study data from the drug maker to support the long term safety of the drug. A comprehensive review of post-marketing safety reports for Tamiflu indicated rare reports of severe rash and allergic-type skin reactions that may be drug-related. In Nov 2005, FDA required that new safety language regarding serious skin/hypersensitivity reactions be added to the Tamiflu label. (FDA 12/22/05 http://www.fda.gov/bbs/topics/news/2005/NEW01285.html; Promed 12/26/05)

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USA (Washington, Oregon): E coli outbreak blamed on raw milk
An outbreak of Escherichia coli O157:H7 cases in Washington state has sickened up to 18 people, most of them children. A report in the Portland Oregonian newspaper said 18 people, including 15 children younger than 13, are believed to have been infected with E coli O157:H7 after drinking raw milk from Dee Creek Farm near Woodland, Washington. The outbreak was first reported last week. On Dec 15, 2005, the Washington State Department of Health said 5 children had been hospitalized, 3 of them with possible kidney failure. The Oregonian said 2 hospitalized children were continuing to improve "after days in critical condition." Preliminary tests by the Washington State Department of Agriculture revealed E coli O157:H7 in milk from the farm and from a customer's home, the Oregonian reported. Additional testing was needed to determine whether it is the same strain identified in 7 of the 18 patients and whether its DNA fingerprint matches that found in 4 of the confirmed cases. Washington allows limited sales of raw milk, but only by producers and processors who have been inspected and licensed by the state. The milk involved in the cases did not come from a licensed raw-milk dairy. The state stopped the distribution of Dee Creek Farm's milk last week. The outbreak triggered a new warning from the US FDA against drinking raw milk (http://www.fda.gov/bbs/topics/NEWS/2005/NEW01278.html ). FDA said more than 300 people in the US got sick from drinking raw milk or eating cheese made from raw milk in 2001. FDA said pasteurization does not significantly change milk's nutritional value and is the only effective method for eliminating the bacteria in raw milk and milk products. Besides E coli infection, pasteurization of milk can prevent a number of other contagious diseases, such as tuberculosis, diphtheria, polio, Q fever, salmonellosis, strep throat, scarlet fever, and typhoid fever. Federal law requires pasteurization of all milk shipped between states. In 1993, 14 Oregonians became ill with E. coli O157:H7; those cases were traced to unpasteurized milk. In 1999, Oregon outlawed the retail sale of raw milk, with an exception for farms with 3 or fewer cows; however they cannot advertise and buyers must go to the farm to pick up the milk. (CIDRAP 12/21/05 http://www.cidrap.umn.edu/index.html ; Promed 12/16/05, 12/19/05)

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1. Updates
Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies
A slight increase of influenza activity was observed for the first time so far this season in several countries in the northern hemisphere during week 49. WHO’s surveillance information has not been updated since the 22 Dec 2005 report. Please see EINet’s 23 Dec 2005 Alert for further details.
(WHO 12/22/05 http://www.who.int/csr/disease/influenza/update/en/ )

USA. During week 51 (Dec 18 - Dec 24, 2005), influenza activity continued to increase in the western US. 155 (13.5%) 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) was above the national baseline. The proportion of deaths attributed to pneumonia and influenza was below the baseline level. 4 states reported widespread influenza activity; 4 states reported regional influenza activity; 5 states reported local influenza activity; 31 states, New York City, and Puerto Rico reported sporadic influenza activity; and 5 states and the District of Columbia reported no influenza activity (CDC 12/29/05 http://www.cdc.gov/flu/weekly/ )

Avian/Pandemic influenza updates
- WHO’s 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.
- OIE updates and documents on avian influenza: http://www.oie.int/eng/en_index.htm.
- 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/. Infection control measures for preventing and controlling flu transmission in long-term care facilities was updated 23 Dec 2005: http://www.cdc.gov/flu/professionals/infectioncontrol/longtermcare.htm.
- 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.
- Latest CIDRAP updates on avian/pandemic influenza: http://www.cidrap.umn.edu/index.html. A comprehensive overview on avian influenza, updated Dec 20, 2005, is available. The article, “H5N1 avian flu viruses: What's in a name?”, clarifies common questions and confusion arising from the nomenclature.
- PAHO’s latest updates on avian influenza: http://www.paho.org/ Includes article “Avian vs. Pandemic Flu: Understanding the Threat”.
- 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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West Nile Virus
USA
As of 20 Dec 2005, human cases of WNV infections 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 published each week on the collaborative USGS/CDC West Nile virus website:http://westnilemaps.usgs.gov/. Of the total 2799 cases reported to CDC between 1 Jan 2005 through 20 Dec 2005, 1168 (42 percent) were reported as West Nile meningitis or encephalitis (neuroinvasive disease), 1472 (53 percent) were reported as West Nile fever (milder disease), and 159 (6 percent) were clinically unspecified at this time. (Promed 12/26/05)

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2. Articles
CDC EID Journal, Volume 12, Number 1-January 2006
CDC Emerging Infectious Diseases Journal, Volume 12, Number 1-January 2006 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. Numerous articles on influenza are on this issue. The following expedited articles is available online: Free-grazing Ducks and Highly Pathogenic Avian Influenza, Thailand, M. Gilbert et al.

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Outbreaks of Escherichia coli O157:H7 Associated with Petting Zoos--North Carolina, Florida, and Arizona, 2004 and 2005
“During 2004--2005, three outbreaks of Escherichia coli O157:H7 infections occurred among agricultural fair, festival, and petting zoo visitors in North Carolina, Florida, and Arizona. One hundred eight cases, including 15 cases of hemolytic uremic syndrome (HUS), were reported in the North Carolina outbreak; 63 cases, including seven HUS cases, were reported in the Florida outbreak; and two cases were reported in Arizona. No fatalities occurred. Illnesses primarily affected children who visited petting zoos at these events. This report summarizes findings from these outbreak investigations, which indicated the need for adequate control measures to reduce zoonotic transmission of E. coli O157:H7. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a1.htm
(MMWR December 23, 2005 / 54(50);1277-1280)

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Mycobacterium tuberculosis Transmission in a Newborn Nursery and Maternity Ward--New York City, 2003
“Evaluating young children recently exposed to airborne Mycobacterium tuberculosis is a public health priority. If infected, children aged <2 years are at high risk for severe tuberculosis (TB) disease. . .In December 2003, infectious pulmonary TB disease was diagnosed in a foreign-born nurse working in the newborn nursery and maternity ward of a New York City hospital (hospital A); the nurse had declined treatment for latent TB infection (LTBI) after testing positive 11 years earlier. An investigation. . .was conducted by the Bureau of TB Control (BTBC) at the New York City Department of Health and Mental Hygiene, hospital A, and CDC. This report summarizes the results of that investigation, which determined that approximately 1,500 patients had been exposed to the nurse but the majority could not be located for evaluation. Among those who were tested, four infants had positive tuberculin skin test (TST) results, likely attributable to recent transmission of M. tuberculosis. The findings emphasize the difficulty of conducting contact investigations in certain settings and the importance of effective LTBI testing and treatment programs for health-care workers (HCWs) to prevent TB disease and subsequent health-care-associated transmission. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a2.htm
(MMWR December 23, 2005 / 54(50);1280-1283)

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Pertussis--United States, 2001--2003
“. . .In the United States, most hospitalizations and nearly all deaths from pertussis are reported in infants aged <6 months, but substantial morbidity does occur in other age groups. Infant/childhood vaccination has contributed to a reduction of more than 90% in pertussis-related morbidity and mortality since the early 1940s in the United States. Estimates of childhood vaccination coverage with >3 doses of pertussis-containing vaccine have exceeded 90% since 1994; however, reported pertussis cases increased from a historic low of 1,010 in 1976 to 11,647 cases in 2003. A substantial increase in reported cases has occurred among adolescents, who become susceptible to pertussis approximately 6-10 years after childhood vaccination. Recently, booster vaccines for adolescents and adults combining pertussis antigens with tetanus and diphtheria toxoids (Tdap) were approved by the Food and Drug Administration (FDA). On June 30, 2005, the Advisory Committee on Immunization Practices (ACIP) recommended Tdap for all persons aged 11-18 years. This report summarizes national surveillance data on pertussis reported to CDC during 2001-2003 and focuses on pertussis reported among persons aged 10--19 years before implementation of national recommendations for adolescent pertussis vaccination. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a3.htm
(MMWR December 23, 2005 / 54(50);1283-1286)

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3. Notifications
Resumption of U.S. beef trade with Hong Kong
Hong Kong resumed beef trade with the US. The agreement will allow the US to export boneless beef from cattle less than 30 months of age to Hong Kong under the Beef Export Verification Program. In 2003, the US exported $90 million worth of beef and beef products to Hong Kong. It was the fifth largest market for U.S. beef products. Since the closing of many US export markets in Dec 2003, the US has recovered access to markets valued at more than $2.8 billion, or 74 percent of the 2003 export value of $3.9 billion. For more information: http://www.usda.gov/wps/portal/usdahome (USDA 12/29/05)

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Public health notification regarding Ralstonia associated with Vapotherm Respiratory Gas Administration Devices--United States, 2005
This report updates information previously published regarding contamination of Vapotherm respiratory gas administration devices with Ralstonia spp. The Food and Drug Administration has issued an updated Preliminary Public Health Notification, advising health-care providers to use alternative devices until the source of the contamination has been identified. CDC continues to receive information regarding Ralstonia spp. associated with Vapotherm use. 29 institutions in 16 states have reported recovery of Ralstonia spp. from Vapotherm devices and from approximately 40 pediatric patients. The majority of these cases appear to represent colonization, although 1 infection has been reported to CDC and other cases remain under investigation. In addition, the recommended disinfecting protocol has reportedly failed to eradicate Ralstonia spp. in 3 separate tests. Isolates from facilities in 6 states were determined closely related genetically, a finding that suggests intrinsic contamination of some part of the device. Cultures of unused Vapotherm cartridges performed by 2 hospitals have yielded Ralstonia spp. However, cultures of other unused cartridges from some of the same lots did not grow organisms in testing performed by CDC and the cartridge manufacturer. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a4.htm
(MMWR December 23, 2005 / 54(50);1286-1287)

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FDA reaffirms worth of DoD anthrax vaccine
In a new chapter in a 2-year legal battle over the US military's anthrax vaccination program, the Food and Drug Administration (FDA) has reaffirmed its earlier finding that the anthrax vaccine used by the military is safe and effective for preventing all forms of anthrax. DoD has been giving the vaccine, called Anthrax Vaccine Adsorbed (Biothrax), to military personnel on a voluntary basis since Apr 2005. Dr. William Winkenwerder, assistant secretary of defense for health affairs, said, "The military services will continue anthrax vaccinations as they have since Apr 2005 on a voluntary basis for eligible service members with the option to refuse." More than 1.3 million service members have received anthrax shots since 1998. But some have objected to the shots out of concern about side effects. In a lawsuit filed by military and civilian contractor personnel, a federal judge ordered DoD to stop requiring the shots because the FDA, in his view, had never specifically approved the vaccine for inhalataional anthrax. The FDA responded that the vaccine was for safe and effective for all forms of anthrax disease. District Judge Emmet G. Sullivan then lifted his injunction. But in Oct 2004 he stopped the vaccinations again, ruling that the FDA had not followed proper procedures in issuing the new approval. In Jan 2005, the FDA granted DoD's request for emergency authority to resume the vaccination program, but said the shots had to be voluntary. Also in Jan, the FDA proposed a new approval of safety and effectiveness for the vaccine and asked for public comments. Winkenwerder said experts have consistently found the vaccine to be safe and effective. "The threat of anthrax as a weapon remains real," he said. "For people at increased risk of exposure, the benefits of the vaccine far outweigh the risks when all factors are considered. Vaccination against anthrax is the best round-the-clock protection available to protect our forces at risk." (CIDRAP 12/19/05 http://www.cidrap.umn.edu/index.html )

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Supplemental testing for confirmation of reactive oral fluid rapid HIV antibody tests
“In March 2004, the Food and Drug Administration (FDA) approved the OraQuick Rapid HIV-1 Antibody Test. . .for use with oral fluid by trained personnel as a point-of-care test to aid in the diagnosis of infection with human immunodeficiency virus (HIV). In June 2004, FDA approved an added claim for detection of HIV-2 antibodies in oral fluid and a change in the name of the device to OraQuick Advance Rapid HIV-1/2 Antibody Test. A reactive rapid HIV test result is considered preliminary and must be confirmed by supplemental testing. Some false positive rapid test results. . .are to be expected within the range of specificity for the device. However, in late 2005, HIV testing programs in multiple U.S. cities experienced apparent clusters of false-positive rapid HIV test results using oral fluid (but not whole blood) specimens. Counselors at these programs have expressed concern regarding the specificity and positive predictive value of the oral fluid rapid HIV test. The published sensitivity and specificity for the test using oral fluid are 99.3%. . .and 99.8%. . ., respectively. CDC has received multiple inquiries concerning whether its guidelines for confirmatory testing for reactive rapid HIV tests on oral fluid specimens have been modified. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a5.htm
(MMWR December 23, 2005 / 54(50);1287-1288)

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Sexual and reproductive health of adolescents and youths in the Western Pacific Region
There is a large population of young people (age 10-24 years) in the region of Asia and the Pacific. Adjusting to sexual development and protecting their reproductive health are among the greatest challenges for adolescents during this period of transition from childhood to adulthood. The WHO Western Pacific Regional Office supported Cambodia, China, Lao People’s Democratic Republic, Malaysia, Mongolia, Philippines, Republic of Korea and Viet Nam to conduct a literature and programme review on adolescent sexual and reproductive health (ASRH). The objectives of the review are: to identify the extent of ASRH problems in the Western Pacific Region; to examine trends in ASRH in the countries; (c) to assess the needs and gaps in the delivery of ASRH services, and; to assess the evidence on effective policies and interventions and limitations in current policies. The review covered all research and projects conducted on ASRH from 1995 to 2003. (WHO/WPRO http://www.wpro.who.int/publications/pub_929061031X.htm )

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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