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Vol. IX, No. 1 ~ EINet News Briefs ~ Jan 13, 2006


*****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:
- Pan-Asia: Japan-WHO joint meeting on early response to potential influenza pandemic
- OIE's participation at the International Pledging Conference on Avian and Human Pandemic
- Turkey: 2 Additional human cases of avian influenza infection
- Turkey: Analyses of viruses from the first two fatal human cases from Turkey
- Turkey: Official expert agencies express concern about avian influenza situation
- Turkey: Possible influence of Tamiflu and weather on avian influenza; Unique epidemiology
- Romania: New suspected avian influenza cases in poultry; Regional preparedness
- Ukraine (Crimea): Avian influenza outbreak in 3 poultry farms
- Eurasia: Cumulative number of human cases of avian influenza A/(H5N1)
- China: Eighth human H5N1 avian influenza case
- China (Sichuan, Guizhou): New avian influenza outbreaks; economic impacts
- Japan (Saitama and Ibaraki): World’s first confirmed human cases of H5N2 infection
- Indonesia: New suspected human cases of avian influenza infection
- Russia: Update on avian influenza situation and preparedness
- New Zealand (Christchurch): Hepatitis A outbreak
- Russia (St. Petersburg): Typhoid fever outbreak
- Hong Kong: Additional cases of Typhoid fever
- Indonesia: Update on polio outbreak
- USA: States to share $100 million for pandemic planning
- USA: USDA experts part of U.S. avian influenza team to Turkey
- Mexcio (Chiapas): Avian influenza H5N2 outbreak controlled
- Peru (Amazonas): Outbreak of Yellow Fever
- USA (Oklahoma): At least 45 begin rabies treatments
- USA (Nebraska): 2 Cases of tularemia prompt health warning

1. Updates
- Influenza
- Dengue

2. Articles
- Viet Nam: Human cases of avian influenza may be more common and less lethal
- Bioterrorism — Preparing to Fight the Next War

3. Notifications
- Business Planning for Pandemic Influenza: A National Summit
- Public Health Preparedness Database
- Recommended Childhood and Adolescent Immunization Schedule--United States, 2006
- Toxoplasma & Food Safety Meeting, 8-10 May 2006
- CDC’s Global Communications Center opens
- APEC Support Fund Receives Contribution from Chinese Taipei

4. APEC EINet activities
- APEC EINet pandemic influenza videoconference

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Pan-Asia: Japan-WHO joint meeting on early response to potential influenza pandemic
Anti-bird-flu drugs should be stockpiled at the disease's frontline in Asia, ready to be shipped to threatened populations in the critical first 2 weeks of an outbreak, WHO said. Asia was "still the epicentre of the threat to global health posed by this virus", said the regional director of WHO, Shigeru Omi, at a 2-day meeting of Asian countries and international organisations on bird flu in Tokyo. 21 countries and organizations are holding talks there to discuss what measures to take should the virus mutate into a form that could be transmitted from human to human. Stockpiles are only now being built up but are in Europe and the US. 1 or 2 stockpiles should be located in Asia, where they could be drawn on in an emergency, Omi said. All countries need a rapid reaction plan or the only feasible approach to the disease, containment, would fail, according to a WHO official, who said a global influenza taskforce would be set up within weeks. But the logistics of managing an outbreak in Asia remain complex. Laos said it had neither the pathology laboratories to quickly confirm an outbreak nor the trucks to deliver medicine.

Doctors need to speed up testing for bird flu and governments must jointly stockpile supplies to prevent the virus from taking a greater toll. Hitoshi Oshitani, a doctor on the WHO's bird flu task force, said it takes nearly 17 days on average for suspected bird flu cases to be confirmed locally and by WHO. "It would be too late for containment," Oshitani said. He called for a streamlining of procedures to verify bird flu cases, but acknowledged that a lack of lab space and specialists was an impediment. "One of the essential requirements in rapid response and containment, I think, is participation of all countries," said another WHO medical expert, Keiji Fukuda. "As this kind of rapid movement requires a great deal of resources and expertise, we see that training, working on the development and building stockpiles both at the regional and international level is necessary," he said. Narongsakdi Aungkasuvapala, deputy permanent secretary at Thailand's ministry of public health, said that "improving measures to detect bird flu is the most important issue" facing his country. "A large part of the population raises chickens in their households, so it is essential for us," he said. Rapid diagnosis is and has always been an important veterinary need. Speed in diagnosis has a massive impact on the efficiency of stopping any epidemic. But vaccination depends on the national budget and veterinary services efficiency in the field. Too often it is invoked after things have got out of hand. And with avian influenza it merely stops the birds demonstrating clinical signs. The risk of disease spread is only decreased, not eliminated.

WHO’s rationale for the meeting:
In the early stages of the emergence of a potential pandemic strain of the virus, it may be possible to avert further spread by implementing rapid response and containment measures, including large-scale administration of antiviral drugs to the population in the affected areas together with additional public health measures such as quarantine and social distancing. If such rapid interventions are successful, it offers the possibility of preventing hundreds of millions of cases of serious illness and millions of deaths and minimizing the social and economic impact of a future pandemic. However, it must be stressed that containment can succeed only if the earliest sign of a potential influenza pandemic is detected very rapidly and containment measures are fully implemented within a very short period. To enable this, the challenges are considerable and many issues have to be addressed. Japan and WHO are organizing this meeting to discuss the issues and challenges of responding rapidly to a potential influenza pandemic and to explore solutions. The specific objectives of the meeting are: (1) to discuss the early response measures that should be implemented, if and when a potential human pandemic strain emerges; (2) to discuss and recommend regional and international mechanisms, including early detection and reporting of events with pandemic potential, stockpiles of antivirals and other supplies, and operational support for early response efforts in Asia; and (3) to recommend necessary actions to address major issues and challenges associated with implementing early-response measures at country level, particularly those related to early detection and reporting, and the implementation of containment measures. (Promed 1/12/06; WHO 1/12/06 http://www.wpro.who.int/sites/csr/meetings/mtg_20050112-13.htm )

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OIE's participation at the International Pledging Conference on Avian and Human Pandemic
The Global Influenza Meeting jointly held by WHO/FAO/OIE/WORLD BANK in Nov 2005 identified the strategies and the resources needed to control avian influenza in animals and simultaneously limit the threat of a human influenza pandemic. The International Pledging Conference on Avian and Human Pandemic Influenza to be held 17-18 January 2006 in Beijing aims at setting up financial commitments and appropriate mechanisms for all potential donors to assist the international community in addressing the socioeconomic, animal and human health challenges posed by avian influenza. The Director General of the OIE, Dr. Bernard Vallat, will participate in the meeting and will present 2 strategic contributions, one about a new tool allowing internal and/or external evaluations of Veterinary Services to verify their compliance with OIE standards on quality for the prevention or the efficient control of animal diseases, and a second one which will be presented together with the Food and Agriculture Organisation (FAO) on the good governance needed to address emerging and re-emerging animal disease threats. Both these documents are key elements in the fight against Avian Influenza at its animal source worldwide.

It will cost international donors about UDS 1.4 billion to finance the next phase of the global campaign against the virus, including gearing up veterinary services and preparing expert teams for quick deployment to outbreaks, a senior UN expert said. Dr. David Nabarro, U.N. senior coordinator for avian influenza, said he was confident delegates to the Beijing conference would pledge the needed amount. The EU announced its intention to grant up to 80 million euros (about $100 million) to help developing countries fight avian flu. The pledge is to be formally announced in Beijing. The Turkish agriculture minister said his country would receive $35 million under a World Bank Program to improve its "technical capacity" for fighting avian flu. (Promed 1/11/06; OIE 1/13/06 http://www.oie.int/eng/press/en_060113.htm ; CIDRAP 1/13/06 http://www.cidrap.umn.edu/ )

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Turkey: 2 Additional human cases of avian influenza infection
Laboratory tests conducted in Turkey have confirmed detection of the H5 subtype of avian influenza virus in samples from an additional 2 patients. The patients are residents of Sanliurfa Province, near the southern border with Syria, and Siirt Province. Human cases have now been reported from 9 of the country's 81 provinces. Both patients are young children, aged 4 and 6 years, and both have a documented history of direct contact with diseased birds. In Sanliurfa Province, outbreaks in backyard poultry are now thought to date back to late Nov 2005. Altogether, officials have confirmed poultry outbreaks in 11 provinces and are investigating possible outbreaks in an additional 14 provinces across the country.

Laboratory tests completed in 12 Jan 2006 in Turkey have detected the H5 virus subtype in post-mortem specimens taken from a 12-year-old girl, from Agri Province, who died 7 Jan 2006. The child was the sibling of 2 other patients who died earlier. Their infection with the H5N1 virus was subsequently confirmed by a WHO collaborating lab in the UK. The Ministry of Health is now reporting 18 laboratory-confirmed cases, of which 3, all from the same family, have been fatal. Arrangements have been made to send specimens from several patients to the UK collaborating lab for further analysis. The head of the collaborating lab is now in Ankara to support diagnostic work at the country's national influenza centre. Ways are being sought to expedite the testing of patient samples. High awareness of the disease in the Turkish population, combined with almost daily reports of poultry outbreaks in new areas, has resulted in a large number of people concerned about exposure and seeking reassurance.

The Turkish government has launched an intensive public awareness campaign. Better public understanding of the disease, supported by more complete data on disease activity in birds, could help to reduce the risk of additional human cases, pending control of the disease in birds. As the majority of confirmed cases and persons under investigation are children, it is particularly important that messages about high-risk behaviours reach children. Some 100 000 treatment courses of oseltamivir (Tamiflu) arrived in Turkey 6 Jan 2006. This supply is being used for both the treatment of patients and prophylaxis of persons at risk. WHO has organized additional support for laboratory diagnostic work. "All of the cases confirmed by the laboratory are people who had close contact with infected, sick or dead poultry. The major point now is to control the outbreak in poultry as it is the source of infection in humans," Guenael Rodier, a senior specialist for communicable diseases with WHO, said.

The rapid assessment of patients with a possible exposure history is providing a unique opportunity to learn more about the disease in humans. It is also generating data that can be used to assess the efficacy of antiviral drugs, as most people with an exposure history or respiratory symptoms are receiving oseltamivir either prophylactically or very early after the onset of symptoms. International teams are working with local experts to plan relevant studies. These studies should deepen understanding of the epidemiology of the disease, including the possibility that any human-to-human transmission may have occurred, the vulnerability to infection of health care workers and other occupationally-exposed groups, and the possibility that milder forms of the disease might be occurring in the general population. All available evidence indicates that no sustained human-to-human transmission has occurred. As in Asia, contact with infected birds is the principal source of infection. The risk of infection for travellers to Turkey is negligible provided direct contact with dead or diseased domestic and wild birds is avoided.

An interactive map of the officially reported Avian Influenza outbreaks in Turkey can be seen at http://poultrymed.com/files/index.html (go to "maps"). Map of avian flu outbreaks, along with human cases, in Turkey is also available from the European Commission Joint Research Centre: http://disasters.jrc.it/AvianFlu/Turkey/. (Promed 1/8/06, 1/9/06, 1/10/06, 1/12/06)

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Turkey: Analyses of viruses from the first two fatal human cases from Turkey
The WHO Collaborating Centre for Reference and Research on influenza in UK has completed genetic and antigenic analyses of viruses recovered from the first two fatal human cases in the Turkish outbreak. Information provided to WHO indicates that these viruses are very similar to current avian H5N1 viruses isolated from birds in Turkey. They are also closely related to viruses isolated from the large outbreak in migratory birds that occurred at the Qinghai Lake nature reserve in China, in April 2005. These analyses indicate that the Turkish viruses are sensitive to both classes of antiviral drugs, including oseltamivir and amantadine. WHO and collaborating experts will review the data on amantadine sensitivity. Oseltamivir remains the drug of first choice recommended by WHO.

Virus from one of the patients shows mutations at the receptor-binding site. One of the mutations has been seen previously in viruses isolated from a small outbreak in Hong Kong in 2003 and from the 2005 outbreak in Viet Nam. Research has indicated that the Hong Kong 2003 viruses bind preferentially to human cell receptors more so than to avian cell receptors. Researchers at the current UK laboratory anticipate that the Turkish virus will also have this characteristic. Interpretation of the significance of this finding for human health will depend on clinical and epidemiological data now being gathered in Turkey. The present WHO level of pandemic alert remains at phase 3: human infections with a new virus subtype are occurring, but the vast majority of these infections are acquired directly from animals. (Promed 1/12/06)

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Turkey: Official expert agencies express concern about avian influenza situation
OIE, FAO and the EU sent an expert from the OFFLU (OIE/FAO laboratory network for Avian Influenza) to be part of the WHO/FAO/OIE/EU/ECDC team currently assessing the situation in Turkey. As of 8 Jan 2006, a total of 13 AI (H5) outbreaks have been confirmed by virus isolation in 8 provinces (Igdir, Erzurum, Sanli Urfa, Erzincan, Agri, Bitlis, Yozgat, Ankara), mostly in backyard flocks. Within the Ankara region, AI (H5) virus was isolated in 1 wild duck.

Turkey should consider poultry vaccination in addition to culling to control its bird flu outbreak if the number of cases in animals continues to rise, the head of the world animal health body (OIE) said 11 Jan 2006. "They must act quickly as soon as new cases emerge to stamp out the virus. The problem now is that there are cases throughout the country," OIE Director General Bernard Vallat said. "If cases continue to come to light, the second option is to use vaccination in the area around detected outbreaks. Of course, sick animals must still be culled," he added. "The idea is that you create a protective area around an outbreak through vaccination. This could involve an entire province," Vallat said. The international community should provide logistical support and vaccine stocks if Turkey took this option. The OIE is concerned about the very bad weather conditions in eastern Turkey that make any technical intervention very difficult and that also favor a longer survival of the animal virus in the environment.

"The highly pathogenic avian influenza virus H5N1 could become endemic in Turkey," FAO said. Juan Lubroth, senior FAO animal health officer, said the virus may be spreading despite the measures already taken to combat it. Turkey needed to apply "a centrally coordinated and countrywide control campaign based on efficient local actions carried out in a transparent manner." FAO urged neighboring countries such as Armenia, Azerbaijan, Georgia, Iraq, Iran and Syria to be on high alert, apply surveillance and control measures and ensure that the public is fully informed about the bird flu risk. Experts also warned the public to be cautious during the 4-day Eid al-Adha, the Muslim Feast of Sacrifice that began 10 Jan 2006 and sees the faithful sacrifice sheep and cows often brought from rural areas to cities for sale. Although sheep and cattle are not affected by avian influenza, doctors say animals that have lived in close proximity with infected poultry could carry the virus on their skin or hooves. (Promed 1/11/06)

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Turkey: Possible influence of Tamiflu and weather on avian influenza; Unique epidemiology
H5N1 has rapidly infected birds in about 30 out of 81 provinces in Turkey, including Ankara, Istanbul and the tourism region near the Aegean coast. "Compared to the numbers in Asia, we do not have too many deaths at the moment," said Dr. Guenael Rodier, head of the WHO mission to Turkey. "We need to investigate this and to see if the use of Tamiflu has played a role in the (smaller) numbers," he said. Also, winter weather is almost certainly playing a role, experts agree. Influenza and similar viruses always become more common in winter. At temperatures of 4C and below, influenza virus could exist in the environment for a month. Authorities believe many poor families in eastern Turkey brought their sick birds into houses when winter hit, increasing chances of infection. Turkey’s agriculture ministry is expected to submit an urgent proposal to parliament to ban the keeping of all backyard poultry in the country. Recep Akdag, the Turkish health minister, reportedly said: "Our people should definitely abandon backyard poultry. From now on, the notion of backyard eggs should be history." For many rural households in Turkey, particularly in its eastern parts where poverty and a lack of development remain major issues, backyard fowl are a key source of livelihood. Turkish health workers have killed more than 300 000 domestic birds across the country since late Dec 2005.

The avian influenza outbreaks and infections in this country have perplexed international scientists on many fronts. Turkey is the first country outside eastern Asia to have human cases, and the first one anywhere to have so many separate animal outbreaks simultaneously. In one week, Turkey announced 15 confirmed human cases of A(H5N1); Asia has seen only about 140 in the space of 5 years. In that same week, Turkish agriculture authorities announced bird outbreaks in 16 cities, from Aydin on the West coast to Van in the far east; in Asia, outbreaks have occurred more sporadically. (Promed comment: A provisional assessment of these observations might be that, in Turkey, exposure to H5N1 avian influenza virus infection may be more widespread than previously supposed and that the virus may be less virulent in humans than inferred from the East Asian experience. Perhaps the heightened awareness of the population in Turkey, combined with a heightened awareness of the health sector, and the capacity of the health sector to conduct more extensive laboratory testing is leading to the identification of much milder expressions of human disease related to H5N1 infection.) (Promed 1/10/06, 1/11/06, 1/12/06)

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Romania: New suspected avian influenza cases in poultry; Regional preparedness
Romania has found new suspected cases of bird flu in poultry in a region west of the Danube delta, where the virulent virus was first detected Oct 2005, the farm ministry said 11 Jan 2005. The country has found the highly pathogenic avian flu in 26 villages in and outside the Danube delta, Europe's largest wetlands and a major migratory route for wild birds. "Preliminary tests taken from domestic birds in the villages of Ciresu and Dudesti in Braila county showed potential signs of the H5 type," the Agriculture Ministry said. It said the villages would be quarantined and all domestic birds will be culled. The ministry also said it had intensified surveillance on birds and domestic animals around affected areas and was monitoring people entering and leaving the country.

Also, authorities in the Bulgarian capital Sofia banned the sale of livestock as a precaution against bird flu. The city would close its 4 livestock markets. Following reports of unwillingness to report outbreaks in poultry in other countries, Bulgaria said it would pay farmers twice the market value of their domestic birds in the event they had to be culled. The virus had not yet been detected in Bulgaria. Georgia has tightened controls on goods crossing the border and Iran has decided to cull poultry within 15 km of the Turkish frontier. Iran has also imposed tight controls on its border with Turkey, banning one-day trips to Turkey from its Bazargan border area. It has also joined the rest of Turkey's neighbours in banning its poultry imports. Ukraine, which has reported outbreaks among poultry in the Crimea region, said it had stepped up monitoring at its Black Sea ports. The EU has banned imports of live birds and risky poultry products such as fresh meat and untreated feathers from affected areas. Moscow raised the prospect of economic damage to Turkey's vital tourist industry, warning Russians against traveling to Turkey. (Promed 1/10/06, 1/11/06, 1/12/06)

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Ukraine (Crimea): Avian influenza outbreak in 3 poultry farms
The last several hundred chickens with avian flu have been slaughtered at 3 poultry farms on the Crimean Peninsula, Ukraine's autonomy. A total of 100 000 domestic fowl have been slaughtered in Crimea's Primorskoye village. Damage is estimated at about $400 000. Ukrainian Agrarian Policy Minister Oleksandr Baranivsky said grave violations of sanitary rules were to blame for the bird flu outbreak. Chickens were given water from open water reservoirs that lie on migrating birds' way. Mass fowl deaths were reported in Primorskoye 28 Dec 2005. Several days later the Vektor virology center confirmed the H5N1 bird flu strain. The strain of bird flu found in the Crimea is highly contagious for chickens but presents less danger for people, an expert from the virology center reportedly said. The virus has so far been identified in 14 Crimean villages and authorities have culled more than 70 000 domestic fowl. There has been no report of human infection by the virus in Ukraine yet. (Promed 1/10/06, 1/12/06)

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Asia
Eurasia: 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)
Cambodia / 4 (4)
China / 8 (5)
Indonesia / 16 (11)
Thailand / 5 (2)
Viet Nam / 61 (19)
Total / 94 (41)

Cumulative number of confirmed human cases of avian influenza A/(H5N1), 2006:
Economy / Cases (Deaths)
Turkey / 4 (2)
Total / 4 (2)

Total number of confirmed human cases of avian influenza A/(H5N1), 26 Dec 2003 to present: 147 (78)
(WHO 1/10/06 http://www.who.int/csr/disease/avian_influenza/country/en/index.html )

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China: Eighth human H5N1 avian influenza case
The Ministry of Health in China has confirmed the country's eighth case of human infection with the H5N1 avian influenza virus. The patient is a 6-year-old boy from Guiyang county, Hunan Province. He developed symptoms of fever and pneumonia 24 Dec 2005 and is presently hospitalized in stable condition. Chinese authorities have also reported that 2 cases, previously announced, have subsequently died. The deaths occurred in a 10-year-old girl from the Guangxi region, reported 7 Dec 2005, and a 35-year-old man from Jiangxi Province, reported 16 Dec 2005. Of the 8 confirmed cases in China, 5 have now died. Initial investigation of the newly confirmed case has identified recent poultry deaths in the family flock as the likely source of exposure, though no poultry outbreaks have been officially reported in the area. Close contacts have been placed under medical observation and none has shown symptoms of infection to date. This is the second confirmed case from Hunan Province. The earlier Hunan case, which was one of the first 2 reported in China in mid-Nov 2005, lived around 300 km away from the present case. In addition to Hunan, provinces and regions reporting human cases of H5N1 infection include Anhui, Guangxi, Liaoning, Jiangxi, and Fujian. (Promed 1/9/06, 1/10/06)

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China (Sichuan, Guizhou): New avian influenza outbreaks; economic impacts
Dazhu County, the latest bird flu outbreak site in southwest China's Sichuan Province, has shut down all its 54 live poultry markets amid efforts to prevent the spread of the epidemic. Sales of poultry, eggs and related products have been banned in the county since 3 Jan 2006 when the Ministry of Agriculture announced that bird flu had broken out in Dazhu, said Yang Yue, deputy director of the Sichuan Provincial Bureau for Industry and Commerce. "If no new bird flu outbreak is reported in Dazhu within 21 days, the live poultry markets can be reopened," Yang said. The Municipal Bureau for Industry and Commerce of Dazhou City has banned sales of live poultry in all its counties. Hong Kong has decided to suspend imports of live poultry and poultry meat from Sichuan, the Health, Welfare and Food Bureau of the Hong Kong said 4 Jan 2006. Between 22 and 25 Dec 2005, 1800 chickens and ducks died in 3 households in Yangjia Town's Liuyan Village. Nobody has been infected with the H5N1 virus in Dazhu, as the blood tests of all the 16 people in close contact with the dead poultry have proved negative, said Su Lin, chief of the Emergency Response Office in the Sichuan Provincial Department of Health. Su said that Dazhu is where migratory birds from North China stop before flying further south to spend winter. The Ministry of Agriculture had sent an expert team to Dazhu to direct control efforts.

China also reported a new outbreak of avian influenza in quails in the southern province of Guizhou, according to the Ministry of Agriculture's website, 10 Jan 2005. About 16 000 quail died between 1 and 6 Jan 2006 at a farm in Guiyang city's Wudang area. The infection was confirmed by China's National Avian Influenza Reference Laboratory 10 Jan 2005 as having been caused by the H5N1 strain of bird flu. The local government's veterinarian department culled 42 000 quail at the infection site 6 Jan 2006. The outbreak is reportedly "under control". China, the world's second-biggest poultry meat producer, is vaccinating all 14.2 billion farm poultry in the country to prevent fresh outbreaks of avian influenza from increasing the risk of avian flu spreading to humans and potentially mutating into a pandemic influenza.

The Agriculture Ministry has warned that the risk of the virus spreading could be higher during the Chinese Lunar New Year (late Jan 2006), as meat consumption and the transport of live poultry increases. China's poultry industry, which state media says lost 60 billion yuan (USD 7.44 billion) alone in the fourth quarter of 2005, is gearing up for more losses, according to one senior official. "Prices of chicks have fallen 80 percent, and the price of chicken in the markets is down 20 percent," Deng Fujiang, vice chairman of the China Meat Association, said. Less severe poultry outbreaks in 2004 cost the industry an estimated 30 billion yuan (USD 4 billion), and the final figure for 2005 was likely to be far higher, he said. China has been strictly controlling the movement of poultry around the country since Autumn 2005, even going as far as to set up special quarantine stations outside major cities to ensure no live birds get in. It has done little to boost consumer confidence. "In our surveys, 40 percent of people said they are either eating less poultry, or have stopped altogether," Deng said. (Promed 1/7/06, 1/11/06)

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Japan (Saitama and Ibaraki): World’s first confirmed human cases of H5N2 infection
The world's first confirmed human cases of less pathogenic avian influenza virus infection are too "risky to ignore," even though none of those affected have had health problems, Japanese officials warned. The H5N2 strain [serotype of avian influenza virus], a milder form than the H5N1 serotype, needs global attention, because it could mutate, they said 11 Jan 2006. "In the past, there was a case where a mild strain [i.e. a LPAI (low pathogenic avian influenza) virus] eventually transformed to a lethal one for chickens [i.e. a HPAI (highly pathogenic avian influenza) virus]," warned a researcher at the National Institute of Infectious Diseases.

The Japanese government said that 77 farm workers had been infected with H5N2, after tests on 350 workers and their families at affected chicken farms. The workers are the world's first to test positive for the mild strain. Chickens at some 40 farms in Ibaraki Prefecture have been infected with H5N2 since June 2005. The human infections probably took place before the infections were detected in chickens in the areas. The people were probably exposed to the virus while dealing with chickens and their excrement without taking proper preventive measures. The Health Ministry said it asked the Agriculture, Forestry and Fisheries Ministry and local governments to adopt preventive measures such as advising workers at chicken farms to put on masks at work even if no abnormalities have been found in chickens.

According to WHO, an H5N2 epidemic in birds in 1983-1984 in the USA originally caused little death, but within 6 months reached a mortality rate of 90 percent. Japan, which has stockpiled Tamiflu in case of an avian influenza pandemic, designates all H5 [serotype] strains as avian influenza, requiring the killing of the infected chicken. "If a patient with conventional human influenza is infected by mild bird flu, it could create a new type of human influenza strain for which no vaccine or medicine are prepared," the institute's scientist said. "Because it is winter, and it is the season for influenza, the authorities should keep their eyes on even the milder avian influenza viruses," he said. Japan's Health and Welfare Ministry instructed poultry workers to take preventive measures, such as wearing masks and washing their hands frequently. "Workers who were infected with human influenza should avoid working in poultry farms," the Ministry said. But no one has been found to fall ill from the mild strain. Japan is the only country to treat H5N2 as an infectious disease, the researcher said. "I hope these cases provide a warning whistle to countries worldwide," he said. "Scientists only found in 1997 that avian influenza is infectious for human beings, and now we know that a milder [form] of the avian virus, which is hard to detect because it doesn't [produce] any physical symptoms, can infect human beings," he said.

“Interim Report on a Serological Survey for [Human] Antibodies to the Highly Pathogenic Avian Influenza Virus in Ibaraki and Saitama Prefectures” (10 Jan 2006) is available at the Ministry of Health, Labour and Welfare website: http://www.mhlw.go.jp/houdou/2006/01/h0110-4.html (in Japanese). (Promed 1/8/06, 1/10/06, 1/11/06, 1/12/06)

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Indonesia: New suspected human cases of avian influenza infection
Indonesian doctors said 8 Jan 2006 that they were treating a 29-year-old woman believed to be suffering from avian influenza. The patient was admitted to Jakarta's Sulianto Saroso hospital 8 Jan 2006 after falling ill with pneumonia-like symptoms 5 Jan 2006, said hospital spokesman Ilham Patu. Patu said that the woman had been in contact with her neighbor's chickens in her east Jakarta home earlier. Doctors were conducting tests to determine whether she was carrying the H5N1 virus. Patu also said local tests on a man who died early Jan 2006, which confirmed that he had died of bird flu, were to be sent to a WHO laboratory 9 Jan 2006. If the case is confirmed by the WHO laboratory, the man would be Indonesia's twelfth fatality from the H5N1 virus. At least 11 people have died of avian influenza in Indonesia. 6 other human cases have been confirmed as H5N1-virus-infected, but the patients have either recovered or are still being treated. Most victims in the archipelago nation have so far hailed from densely populated Jakarta and its surrounds, where many people live in close proximity to poultry, providing ideal conditions for the virus to pass to humans. (Promed 1/8/06)

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Russia: Update on avian influenza situation and preparedness
Almost 715 000 birds have died from bird flu in Russia since July 2005 or been culled in an effort to stem the spread of the virus, Russia's Emergency Situations Ministry said 12 Jan 2006. The first wave of avian flu swept through 6 Russian regions of the Volga and Urals federal districts from 21 Jul to 29 Sep 2005. The second outbreak was registered 14 Oct 2005 in 5 regions of the Central, Volga, Urals and Siberian federal districts. The ministry said it was currently controlling the situation in the south of Russia to prevent the virus from spreading. Controls in other Russian regions have been lifted following the end of the standard 21-day quarantine period, the ministry added. Reportedly, Russian Flu Research Center’s director Oleg Kiselyov said that Russia could begin large-scale production of a vaccine to prevent bird flu by April 2006. The Russian Ministry of Agriculture has been coordinating the production of 100 million doses of the vaccine for domestic fowl in Siberia, and regions of the Urals Federal District, which are close to stopover sites used by migrating birds, according to Federal Consumer Rights and Welfare Service chief Gennady Onishchenko. Vaccinations will begin in spring, when young birds appear, he added. Reportedly, the Russian government would allocate more than 1 billion rubles (USD 35 million) in 2006 to vaccinations against bird flu, and Parliament's budget and tax committee would also discuss using reserve funds to help control the spread of the virus, using measures such as border controls. (Promed 1/12/06)

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New Zealand (Christchurch): Hepatitis A outbreak
There is an unusual outbreak of hepatitis A virus infection in Christchurch. 3 new cases on Tuesday takes the total in the city to 10. There are normally only 2-3 cases of the viral illness each year in Canterbury and less than 100 nationwide. 2 of those infected were admitted to hospital, however most of the cases are described as mild to moderate. Health officials suspect raw foods could be the cause of the outbreak. Since Christmas 10 people have been diagnosed with hepatitis A virus infection, and Health Official Dr Mel Briesman says its a big concern: "...Because it suggests that some food or some food premises have a problem and it may be a continuing problem," he says. Water contamination, restaurants and cafes are all being ruled as unlikely sources because too many different areas of the city are involved. So authorities are left with the scenario that they are dealing with the contamination of a single food source. Briesman says it means the possibility of further exposure. "For example if it turned out to be a fruit that gets frozen, that could be in continued supply for some time." And the summer lifestyle doesn't help either says Briesman. "People eat out more and meet with friends more often than they would; all of these confuse the picture and make it more difficult to find the source." Close contacts of these cases are being followed up and may be offered preventive injections of gamma globulin if the exposure has been recent.

Hepatitis A is a viral disease that affects the liver. It is spread either by contamination of food or directly from person to person because of poor hygiene, particularly failure of hand washing. Early symptoms include generally feeling unwell, abdominal discomfort, nausea and fever. Jaundice develops in the later stages of the disease. General practitioners (GPs) have been advised of the outbreak and requested to consider the diagnosis in patients with suggestive symptoms. "The Canterbury DHB (District Health Board) views this outbreak as a serious public health issue and cannot stress enough the importance of hand washing after going to the toilet and before handling food", said Dr Brieseman. (Promed 1/10/06)

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Russia (St. Petersburg): Typhoid fever outbreak
St. Petersburg has been unsuccessful in combating a typhoid fever outbreak. Reportedly, 49 people have been hospitalized in 2005, and 3 of them died. The city had 8 typhoid fever patients in 2004, and the typhoid fever forecast for 2006 was unfavorable. Typhoid fever cases occurred in nearly all population strata, from public utility employees, students and veterinarians to a tourist company manager. Some of the patients came from Central Asia. (Promed 1/10/06)

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Hong Kong: Additional cases of Typhoid fever
The Centre for Health Protection has received 3 more reports of cases of typhoid fever, bringing to 15 the total number since 25 Nov 2005. The 3 cases involve 2 men aged 24 and 25 and a 24-year-old woman. The 3 fell ill 26, 27 and 29 Dec 2005 respectively, with symptoms of fever, abdominal pain and vomiting. The 24-year-old man was admitted to Princess Margaret Hospital 29 Dec 2005 and the 25-year-old man was admitted to the Caritas Medical Centre 31 Dec. The woman was admitted to Tuen Mun Hospital 2 Jan 2006. All are in a stable condition. Among the 14 locally acquired cases, 10 involved residents of Yuen Long district. The Centre and the Food & Environmental Hygiene Department are investigating any possible links between the newly notified case in Yuen Long and previous cases in the district. Preliminary investigation of the other 2 new cases revealed that the patients had not visited Yuen Long district before the onset of symptoms. The centre also pointed out that territory-wide sporadic typhoid fever cases were reported throughout the year. Of the 414 samples taken so far for lab testing, 382 yielded negative results for Salmonella typhi. The remaining samples are being tested. Despite the fact that no common food premises have so far been identified to account for all the cases, investigations focusing on possible common food vehicles or food handlers are continuing. There were 36 cases of typhoid fever in 2005, 53 in 2004, 49 in 2003, 67 in 2002 and 67 in 2001. (Promed 1/10/06)

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Indonesia: Update on polio outbreak
11 new VDPV (Vaccine Derived Poliomyelitis) cases were reported from Madura Island, East Java province. This brings the total number of polio cases to 342 (including 45 type 1 VDPV, under investigation, from Madura Island in East Java province). A total of 10 provinces and 43 districts are affected. In addition to the 2 emergency vaccination campaigns (OPV Mop-ups rounds conducted 31 May and 28 Jun 2005 in West Java, Banten and Jakarta provinces), 3 rounds of National Immunization Days (NIDs) were held 30 Aug, 27 Sep and 30 Nov 2005. Over 24 million children less than 5 years of age were targeted throughout the country. Prior to this outbreak (caused by an importation of type 1 wild poliovirus), Indonesia had been polio free since 1995. (Promed 1/11/06)

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Americas
USA: States to share $100 million for pandemic planning
The federal government announced the release of $100 million appropriated by Congress recently to help states prepare for a potential influenza pandemic. The money is the first installment of $350 million included in the $3.8 billion emergency appropriation for pandemic preparedness that Congress passed in late Dec 2005, said Health and Human Services Secretary Mike Leavitt. "Pandemics happen globally but must be managed at the state and local level, and these funds will help communities meet that responsibility," he said. The $100 million will be divided among the 50 states, the District of Columbia, New York City, Chicago, Los Angeles County, and the 7 US territories. Each state will get $500,000 plus an additional amount based on population. "The remaining $250 million from the appropriation will be awarded later this year in accord with guidance that will require progress and performance," HHS said. The agency said states and cities will use the money to step up their planning and to conduct drills to test the plans. "The focus is on practical, community-based procedures that could prevent or delay the spread of pandemic influenza, and help to reduce the burden of illness communities would contend with during an outbreak," the statement said. The recent appropriation came in response to President Bush's request on Nov 1, 2005 for $7.1 billion for pandemic preparedness. That included $100 million for state and local preparedness, an amount that some public health organizations criticized as too small. The pandemic planning money is in addition to federal funds to help state and local governments prepare for bioterrorism and other public health emergencies. For fiscal year 2006, Congress recently appropriated about $824 million for that purpose, according to the Council of State and Territorial Epidemiologists. (CIDRAP http://www.cidrap.umn.edu/ 1/12/06)

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USA: USDA experts part of U.S. avian influenza team to Turkey
U.S. Agriculture Secretary Mike Johanns announced USDA is contributing to a team of influenza experts to assess the situation there and offer further support, as part of the US support of Turkey's efforts to manage and prepare for avian influenza. "We recognize the value of partnering and assisting the international community to our hopes of preventing the further spread of avian influenza," said Johanns. The team expects to arrive in Ankara to meet with Turkish government officials and with representatives of international organizations, such as the WHO, the UN Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE) and the European CDC, already working locally on avian influenza. The interagency team will consist of experts in animal and human health surveillance, laboratory capacity, and public health communications from the U.S.D.A., Agency for International Development, Department of Health and Human Services and the Department of State. (USDA http://www.usda.gov/wps/portal/usdahome 1/13/06)

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Mexcio (Chiapas): Avian influenza H5N2 outbreak controlled
Mexican Health Minister Julio Frenk said 6 Jan 2006 that his country had controlled the outbreak of bird flu in Chiapas state on the Guatemala border, adding there was no risk for human health. Frenk said Mexico’s vigilance helped in the early detection of the outbreak which has hit 300 birds. There was little risk that the human population could be infected, unlike with the virus present in Europe and Asia, he said. The Chiapas strain is H5N2. Health authorities in Chiapas had established a quarantine, culled the 300 infected birds, disinfected contaminated areas and compensated affected farmers, Frenk said. Frenk said that there was no risk to people eating Mexican eggs or chicken, and repeated that Latin America was free of bird flu in humans. In Guatemela, 6 Jan 2006, the agriculture authorities said they had increased epidemiological vigilance at the frontier to prevent any possible outbreak. H5N2 is regarded as a low pathogenic strain. Although it can mutate to a much more highly pathogenic strain, this particular case has been depopulated and should put a stop to any opportunity for the virus to mutate. Currently, all outbreaks of the highly pathogenic form have been caused by influenza A viruses of subtypes H5 and H7. (Promed 1/8/06)

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Peru (Amazonas): Outbreak of Yellow Fever
According to the Ministry of Health (MOH), an outbreak of hemorrhagic fever syndrome in Alto Tuntus had its first victim 2 Dec 2005. From 23 Dec 2005 through 28 Dec 2005, 6 more people died. The rate attack is 17.1 percent (73 people); the case fatality rate is 10 percent (7 dead). The main symptoms are fever, headache, general malaise, bilious vomiting and hemorrhagic vomiting. Some patients had bleeding of oral mucosa. Dr. Maguia, an infectious disease specialist from Cayetano Heredia University, suspects an outbreak of Jungle Yellow Fever. Other possible causes are hepatitis D, over Hepatitis B (which is endemic in that area); Leptospirosis; and Arenavirus Hemorrhagic Fever. Alto Tuntus is a very small village located very far away in the department of Amazonas, northeast of Lima. It has 435 inhabitants, all of them from the Aguaruna ethnic group. 2 of 5 patients evacuated to the hospital of Bagua have proteinuria and oligoanuria, symptoms compatible with Yellow Fever.

The existence of this outbreak was first reported in a radio call to a national radio network 26 Dec 2005. A health team reached the village 28 Dec 2005. The health team remains in the area providing care to the people of Alto Tuntus. The Minister of Health, Pilar Mazzetti Soler, confirmed 30 Dec 2005 that the disease affecting the population of the community of Alto Tuntus is yellow fever, according to testing done by National Institute of Health. As soon as the confirmation was made, a team of 24 professionals (physicians, epidemiologists, nurses and health technicians) were flown in by helicopter carrying 2000 doses of yellow fever vaccine to the area to conduct a vaccination campaign in an epidemiologic circle. (Promed 1/1/06)

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USA (Oklahoma): At least 45 begin rabies treatments
The Rogers County Health Department held a special clinic 31 Dec 2005 to begin treating people identified as at risk for contracting rabies after drinking raw milk from a rabid cow. Oklahoma State Department of Health officials announced that people who drank raw, un-pasteurized milk or cream sold by Swan Bros. Dairy in Claremore from 4-19 Dec 2005 may have been exposed. So far, 62 people have begun receiving a regimen of rabies vaccinations. Most healthy people who drank the milk or cream are not at risk for contracting rabies, Rick Garner, a registered nurse for the department's communicable disease division, said. However, people with certain medical conditions, including suppressed immune systems or oral sores, should call the Health Department to determine whether post-exposure treatment is needed. The preventive shots range from USD 2500 - 4000 for the course of treatment.

One cow in the dairy's herd died from rabies, the state Health Department and CDC both confirmed 20 Dec 2005. The infected cow's milk was mixed with the milk of up to 70 other healthy cows, therefore diluting any infected milk that could have been present. Additional tests are being run to determine whether there was any of the virus in the milk. The milk that may have been infected was not pasteurized. Pasteurization, a heating-and-cooling treatment that kills organisms in the milk, would have killed the rabies virus, Garner said. Milk sold at commercial stores and restaurants must be pasteurized. Before this incident the owner did not vaccinate his herd for rabies, but he will start doing so this week. Officials suspect the cow was infected when it was bitten by a rabid skunk, and additional laboratory tests will confirm what type of animal infected the dairy cow.

Rabies, a Lyssavirus, normally affects the neurological tissue. However, the virus is most often transmitted through saliva or contact with oral or gastric mucosa. Additionally, rabies virus also has been detected in the kidney, prostate, pancreas, and other tissues and body fluids. In naturally occurring cases, the proven vehicle for transmission is saliva and neural tissue. Anecdotal reports exist of rabies transmission by ingestion of milk by a nursing lamb from its mother. However, in all of these reports, a bite or mucous membrane exposure could not be ruled out. Transmission of rabies virus in un-pasteurized milk is a theoretical possibility. Another source of exposure have included neural tissues, such as a transplanted corneas, and laboratory aerosols. Recently, the first U.S. instance of human rabies transmission via solid organ transplantation was documented in 3 recipients of a donor unsuspected of having rabies; transmission via organ transplantation has also been documented in other countries. The development of rabies generally takes 10 to 90 days when the virus is transmitted through a bite. (Promed 1/1/06)

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USA (Nebraska): 2 Cases of tularemia prompt health warning
2 cases of a bacterial infection that rarely manifests itself in human beings have been detected in Grand Island, prompting health officials to issue a warning to the community. Tularemia is typically found in animals. The disease naturally exists, but human cases are "very rare in Central Nebraska," according to the Central District Health Department, which issued a warning 29 Dec 2005. "We've had 2 cases in 2 weeks, and that's pretty exceptional," said Michelle Ellermeier, epidemiology nurse at the Health Department. "We usually see 3 to 4 cases a year, so we felt it necessary to let people know it was out there." Ellermeier said it's likely the local rabbit population is the culprit, and during times when hunters are out and when pets might get hold of a rabbit, the public should be on alert. The signs of the disease may include skin ulcers, swollen lymph glands, inflamed eyes, sore throat, mouth sores, diarrhea and pneumonia. Many cases of tularemia involve lymph node infection with (ulceroglandular) or without (glandular) a local skin infection draining to the lymph node. In the winter, infection tends to be associated with rabbit hunting and in the summer, with tick or deer fly bites. Summer cases associated with lawn mowers, as has been described in Massachusetts, are often pneumonic, related to inhalation of bacilli. Unlike human plague infection, pneumonic tularemia does not spread from person to person. (Promed 1/3/06)

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

USA. During week 1 (Jan 1 – Jan 7, 2006), influenza activity continued approximately at the same level as recent weeks in the US. 203 (9.1%) 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. 7 states reported widespread influenza activity; 11 states reported regional influenza activity; 9 states reported local influenza activity; 21 states, New York City, the District of Columbia, and Puerto Rico reported sporadic influenza activity; and 2 states reported no influenza activity.

A comprehensive update on influenza activity in the USA (“Update: Influenza Activity--United States, December 18--24, 2005”) is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5451a3.htm. (MMWR January 6, 2006 / 54(51&52);1305-1307) (CDC 1/13/06 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, including news from Turkey: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html.

- 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 (“Highlights” have been updated Jan 2006). For avian influenza: http://www.cdc.gov/flu/avian/. “Key facts” have been updated 10 Jan 2006.

- The US government’s web site for pandemic flu: http://www.pandemicflu.gov/. New State Summit summaries have been uploaded; On 12 Jan 2006, HHS announced $100 million to accelerate State and Local Pandemic Influenza Preparedness Efforts.

- Influenza information from the US Food and Drug Administration: http://www.fda.gov/oc/opacom/hottopics/flu.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 updates on avian influenza: http://www.paho.org/English/AD/DPC/CD/influenza.htm.

- 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 (Bantul)
Dengue fever has become a threat for people in Bantul regency, Yogyakarta, with the number of people contracting the dengue virus in Dec 2005 reaching 61 people, a 300 percent increase compared to Nov 2005. The number is expected to increase in coming months as rain has started to pound the region, said health officer with Bantul regency administration Gandung Bambang Hermanto. Besides the rainy season, bad sanitation was also blamed for the rising number of people contracting the disease. ". . .the area free of Aedes aegypti mosquito larvae in the regency is only 67 percent of the total area, while in order to be free of dengue the area free of mosquito larvae should reach 95 percent," said Gandung. The rainy season has created puddles in many areas, making ideal breeding grounds for Aedes aegypti mosquitoes, the carrier of dengue fever, said Gandung. In order to prevent the spread, the government has intensified its campaign by calling on the public to clean up the environment. The government also distributed larvicidal powder in order to help destroy mosquito larvae. With the additional 61 persons, the number of people contracting dengue virus in Bantul totaled 195 in 2005. 4 of these people died, according to Gandung. (Promed 1/10/06)

Hong Kong
The Centre for Health Protection has confirmed the first imported case of Dengue fever in 2006. The patient is a 45-year-old man who developed symptoms Dec 22, 2005. He is hospitalized in stable condition. He had travelled to the Mainland and Indonesia 8 - 22 Dec 2005. His home contacts did not have any symptoms. The Centre urges people to guard against the disease and prevent mosquito breeding. (Promed 1/10/06)

Mexico (Oaxaca)
During 2005, Health Services in Oaxaca registered 1076 cases of dengue fever; 910 were classic dengue fever and 166 were hemorrhagic dengue fever [DHF]. No deaths were reported. According to official figures, of the 1076 cases, 536 were found in the Tehuantepec Isthmus, followed by Tuxtepec with 263 cases. The coastal region had 136 dengue fever cases; 107 were classic dengue fever and 29 DHF. Central valleys had 78 cases (69 and 9, respectively); Mixteca, 40 cases (36 and 4), and the highlands reported 23 cases of dengue fever (22 and 1, respectively). Officials said that even though meteorological phenomena such as hurricane Stan severely affected the area, this did not lead to a huge increase in the number of cases of dengue fever, as was the case in Veracruz. On the contrary, they said, the case toll remained stable. Authorities explained that community participation in the fight against the Aedes aegypti mosquito vector, through cleaning their households' backyards and roofs, was fruitful, since no deaths cause by dengue had been recorded. In order to fight the insect, they reported that in August 2005, 5 million Pesos [USD 472 144] were allocated for purchasing materials, and during the contingency provoked by Hurricane Stan, healthcare worker teams were sent to the affected areas. Antivectorial control has been expanded to 489 communities in 166 municipalities. (Promed 1/10/06)

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2. Articles
Viet Nam: Human cases of avian influenza may be more common and less lethal
Human cases of avian influenza may be both more common and less lethal than has been reported, Swedish and Vietnamese researchers reported 9 Jan 2006. A survey of Vietnamese residents shows that people who handled or cared for sick chickens were more likely to report some sort of flu-like illness in 2004. While the study cannot prove these people were infected with avian influenza, it suggests that infections may be going undetected, said Dr. Anna Thorson of the Karolinska Institute in Stockholm. "The verified human cases of highly pathogenic avian influenza in Viet Nam may represent only a selection of the most severely ill patients," Thorson's team wrote in their report. Half of all respiratory deaths are never diagnosed in developed countries, and the numbers are even lower in developing nations.

Thorson's team sent trained interviewers to a rural Vietnamese region with confirmed outbreaks of H5N1 avian influenza among poultry. "We included 45 478 randomly selected inhabitants," they wrote. They found that 8149 people, or close to 18 percent, reported having some sort of flu-like illness and that about 25 percent of all those surveyed lived in households reporting sick or dead poultry. Other exposures to poultry -- such as using bird feces as manure -- were common. "The flu-like illness attributed to direct contact with sick or dead poultry was estimated to be 650 to 750 cases," the researchers said. "Our epidemiological data are consistent with transmission of mild, highly pathogenic avian influenza to humans and suggest that transmission could be more common than anticipated, though close contact seems required," they concluded. "Having poultry in the household was in itself not a risk factor for flu-like illness, but contact with sick or dead poultry was," they added.

They said someone should follow up with blood tests to see if people who reported flu-like illness had antibodies to H5N1, which would indicate they had been infected with the virus at some point. If the virus is circulating more widely among people than believed, this could be dangerous, because it would give the virus more opportunities to evolve into a form that more easily infects humans, the researchers said. (In the absence of supporting serological data, it is premature to conclude that all or any of the symptomatic flu-like illnesses recorded are associated with H5N1 avian influenza virus. There are a diverse range of human respiratory viruses that could account for these findings.)

The reference for this study is: Thorson A et al. “Is Exposure to Sick or Dead Poultry Associated With Flulike Illness? A Population-Based Study From a Rural Area in Vietnam with Outbreaks of Highly Pathogenic Avian Influenza.” Arch Intern Med. 2006;166: 119-123. http://archinte.ama-assn.org/cgi/content/abstract/166/1/119 (As stated in the CIDRAP article, 10 Jan 2006, recall bias may be a limitation in this study). (Promed 1/10/06; CIDRAP http://www.cidrap.umn.edu/ )

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Bioterrorism — Preparing to Fight the Next War
David A. Relman. N Engl J Med. 2006 Jan 12;354(2):113-5.
“The United States has become preoccupied with the threat of bioterrorism — the potential for the poisoning of the milk supply with botulinum toxin, the hypothetical dissemination of smallpox by self-infected terrorists, the possibility of a massive release of aerosolized anthrax spores in the subway, even the newly raised specter of misuse of a reconstructed 1918 influenza virus. These concerns have had important consequences for the biomedical research agenda, funding priorities, and the regulatory environment. In fiscal year 2003, $1.5 billion was allocated for biodefense research to the National Institutes of Health (NIH). These new research dollars, which have been reallocated yearly, now account for roughly one third of the budget of the National Institute of Allergy and Infectious Diseases (NIAID) at the NIH. . .Government concern about bioterrorism has also led to new federal restrictions on the handling of infectious agents; such rules have hampered both the ability of U.S. researchers to participate in international collaborations and efforts to train foreign scientists in this country. All these changes reflect a radical shift in the political and social climate--a shift highlighted by the incarceration in 2004 in federal prison, on charges of improper handling of Yersinia pestis, of Dr. Thomas Butler, chief of infectious diseases at Texas Tech University and an expert on plague. How well founded is this heightened concern about bioterrorism? If it is justified, how can we best allocate our intellectual, technical, and financial resources, given the imminent dangers from avian influenza and other natural threats? On what principles should we build a biodefense strategy? . .” To read the article: http://content.nejm.org/cgi/content/full/354/2/113 (CIDRAP http://www.cidrap.umn.edu/ )

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3. Notifications
Business Planning for Pandemic Influenza: A National Summit
February 14-15, Minneapolis, Minnesota
The Summit will join leaders in business and government and health experts in a timely and practical discussion of how to effectively and efficiently prepare business for pandemic influenza. Business leaders, government officials, and business-related organization officials should consider attending the Summit. Hosted by the Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota, U.S. Chamber of Commerce, and Minnesota Chamber of Commerce (CIDRAP https://programs.regweb.com/metro/cidrap/1/ )

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Public Health Preparedness Database
RAND’s Public Health Preparedness Database website contains a searchable database of exercises used to evaluate public health preparedness (http://www.rand.org/health/projects/php/index.html ). The materials were designed to help state and local public health officials identify and evaluate exercises to be used in preparedness activities in their local areas. The website is a living tool that will be expanded over the coming months to include additional exercises as they become available and to feature reports, tools, and resources to support preparedness activities. The website contains: searchable database of public health preparedness exercises; public health preparedness tools and documents; and evaluation criteria to be used in evaluating an exercise. (CIDRAP http://www.cidrap.umn.edu/ )

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Recommended Childhood and Adolescent Immunization Schedule--United States, 2006
The Advisory Committee on Immunization Practices (ACIP) periodically reviews the recommended childhood and adolescent immunization schedule to ensure that the schedule is current with changes in vaccine formulations and reflects revised recommendations for the use of licensed vaccines, including those newly licensed. The recommendations and format of the childhood and adolescent immunization schedule and catch-up schedule for Jan--Dec 2006 were approved by ACIP, the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP). The changes to the previous childhood and adolescent immunization schedule, published January 2005 are presented. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5451-Immunizationa1.htm (MMWR January 6, 2006 / 54(52);Q1-Q4)

Also, “QuickStats: Number of Vaccine Doses Provided or Prescribed for Patients Aged <18 Years, by Vaccine and Setting--United States, 2002—2003”, is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5451a4.htm. (MMWR January 6, 2006 / 54(51&52);1308)

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Toxoplasma & Food Safety Meeting, 8-10 May 2006
From Dr Eskild Petersen, Aarhus University Hospital, Denmark, epf@sks.aaa.dk :
Recent studies in Europe have shown the surprisingly small effect of pre- and neonatal screening programmes despite use of considerable resources, and the question is therefore: How to control toxoplasma infections in humans in the future? Risk-factor studies have shown that at least 2/3 of infections in humans in Europe are transmitted through meat and meat products. Recent trends in consumer habits indicate a shift towards consumption of "animal-friendly" or "organic" pigs, which include increased exposure of the pig to the environment, and this will lead to an increased risk of Toxoplasma gondii in products from such animals. The focus of the meeting is control of Toxoplasma gondii infections in humans by providing the consumer with Toxoplasma-free meat and meat products. The meeting aims at bringing together people from academia, public health, agriculture and food manufacturers to discuss whether the provision of Toxoplasma-free food is practical, feasible, and indeed the right direction for future control of Toxoplasma infections in humans.

Location: Palermo, Sicily, Italy
For further information: Dr Aldo Vesco, Istituto Zooprofilattico Sperimentale della Sicilia, Italy vesco@pa.izs.it. Programme and Registration: http://www.pa.izs.it/toxofood/. (Promed 1/10/06)

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CDC’s Global Communications Center opens
CDC’s Global Communications Center (GCC) opened for business October 3, 2005. A state-of-the-art facility built to replace some of CDC’s aging infrastructure, the Global Communications Center houses the agency’s public information center, exhibit/education area, conference center, distance learning facilities, and CDC visitor security processing area. For more information, call 404-639-0830 or e-mail global@cdc.gov. (http://www.cdc.gov/gcc/ )

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APEC Support Fund Receives Contribution from Chinese Taipei
With pandemic health threats and terrorism threatening regional economic security, Chinese Taipei has announced it will generously donate US$ 1 million to APEC institutions to promote cooperation on emergency and disaster preparedness and response. The US$1 million package includes US$500,000 for the APEC Support Fund. The funding will be used to promote cooperation on emergency and disaster preparedness and response. US$500,000 will be directed to the Asian Development Bank (ADB)'s Cooperation Fund for Regional Trade and Financial Security Initiative. This contribution will effectively reinforce counter-terrorism action among APEC members. John Chen, the Senior Official of Chinese Taipei says, "Chinese Taipei is concerned about the threat of avian flu and other new strands that pose potential pandemic threats as top-priority public health concerns. Based on Chinese Taipei's experience in disease control during the 2003 SARS outbreak, we are committed to sharing information about the useful mechanisms we implemented to combat an outbreak, especially as it applies to avian influenza. Chinese Taipei has made every effort to integrate the resources of different ministries and departments for disease control. Fighting such a pandemic requires the close cooperation of every organ of the government.” Chinese Taipei's contribution brings the APEC Support Fund total to US$4 million. It supplements Australia's contribution which was made earlier. (APEC http://apec.org/ 11 Jan 2006)

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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