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Vol. IX, No. 3 ~ EINet News Briefs ~ Feb 10, 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:
- Eurasia: Cumulative number of confirmed human cases of avian influenza A/(H5N1)
- Nigeria: Avian influenza H5N1 infection confirmed in poultry
- Nigeria: FAO concerned with avian influenza in Africa
- Iraq: WHO supports avian influenza response; additional suspected cases
- Turkey: H5 avian influenza outbreak in chickens
- Bulgaria: Swan tests positive for H5 virus; EU prevention plans
- Romania, Georgia: Suspected avian influenza cases in birds
- Iran: Samples from dead swans negative for H5, H9 avian influenza virus
- Indonesia: 4 more human cases of avian influenza infection; additional suspected cases
- China (Fujian): Eleventh confirmed human case of H5N1 infection
- China (Shanxi): 200 000 chickens culled in latest poultry outbreak
- Hong Kong: Avian influenza situation and prevention
- Australia (Victoria): Ross River virus becoming a public health threat
- New Zealand (Dunedin): Suspected Norovirus outbreak
- Russia (Kemerovo): Trichinellosis associated with bear meat
- Chile (Talagante): 2 cases of Hantavirus infection confirmed
- USA: Lymphogranuloma venereum believed spreading among MSM’s
- USA (Florida): Legionnaires’ disease found at resort

1. Updates
- Influenza
- Cholera, diarrhea & dysentery
- Dengue
- Viral gastroenteritis

2. Articles
- Establishment of multiple sublineages of H5N1 influenza virus in Asia: Implications for pandemic control
- Adenovirus vaccines said to offer hope for fighting flu pandemics
- Assessment of health-related needs after tsunami and earthquake--three districts, Aceh Province, Indonesia, July--August 2005
- The role of the airline transportation network in the prediction and predictability of global epidemics
- Epidemiological and genetic correlates of Severe Acute Respiratory Syndrome coronavirus infection in the hospital with the highest nosocomial infection rate in Taiwan in 2003
- Emergence of a new norovirus genotype II.4 variant associated with global outbreaks of gastroenteritis
- Prions in Skeletal Muscles of Deer with Chronic Wasting Disease
- Racial/Ethnic Disparities in Diagnoses of HIV/AIDS--33 States, 2001--2004
- Leptospirosis After Flooding of a University Campus--Hawaii, 2004
- Imported Vaccine-Associated Paralytic Poliomyelitis--United States, 2005
- Human Botulism Immune Globulin for the Treatment of Infant Botulism

3. Notifications
- Molecular Epidemiology and Evolutionary Genetics of Infectious Diseases
- HHS and Institut Pasteur Partner on Pandemic Influenza Preparedness
- Influenza vaccination of health-care personnel: recommendations of HICPAC and ACIP
- National Black HIV/AIDS Awareness Day, Feb 7, 2006
- Surveillance Guidelines for Smallpox Vaccine (vaccinia) Adverse Reactions

4. APEC EINet activities
- Pandemic influenza videoconference ; publications

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Eurasia: Cumulative number of confirmed human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)

2003
Viet Nam / 3 (3)
Total / 3 (3)

2004
Thailand / 17 (12)
Viet Nam / 29 (20)
Total / 46 (32)

2005
Cambodia / 4 (4)
China / 8 (5)
Indonesia / 17 (11)
Thailand / 5 (2)
Viet Nam / 61 (19)
Total / 95 (41)

2006
China / 3 (2)
Indonesia / 6 (5)
Iraq / 1 (1)
Turkey / 12 (4)
Total / 22 (12)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 166 (88)
(WHO 2/9/06 http://www.who.int/csr/disease/avian_influenza/en/ )

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Nigeria: Avian influenza H5N1 infection confirmed in poultry
The confirmation of highly pathogenic H5N1 avian influenza (by the OIE Reference Laboratory) in domestic birds in northern Nigeria marks the further geographical spread of this virus. Experience in other countries has shown how quickly the H5N1 virus can spread and become established in poultry. At present, the only confirmed H5N1 outbreak is thought to be confined to a large commercial farm, located in Kaduna State, where thousands of chickens were kept in battery cages. Investigations are urgently needed to determine whether the outbreak, which began almost a month ago, has spread from the farm to affect household flocks. Poultry deaths in the adjacent province of Kano have been reported, but the cause has not yet been determined.

The most immediate public health need is to reduce opportunities for human infections to occur. Investigations of human cases in Asia and elsewhere have identified close contact with diseased or dead household poultry as the most important source of human exposure to the virus. In Nigeria, as in other parts of Africa, most village households maintain free-ranging flocks of poultry. Close human contact with poultry is extensive. If the virus has spread to household flocks in Nigeria, public information campaigns will be needed to warn populations to avoid high-risk behaviours, including the slaughtering, defeathering, butchering, and preparation for consumption of diseased poultry. WHO is ready to respond to requests from Nigeria for support, including assessment teams and the provision of essential supplies and equipment. Infectious disease staff at WHO’s regional office in Harare, Zimbabwe held an emergency meeting to assess the situation, plan a response, and evaluate the possible risk to other African countries. A team of experts experienced in the investigation of outbreaks has been placed on standby. No clear information about the source of the Nigerian outbreak is presently available, but the country is known to lie along a flight route for birds migrating from central Asia. Full sequence information about the virus in the Nigerian outbreak is expected soon. This information will allow comparison with viruses that have caused human cases elsewhere and thus assist in the assessment of risks to human health. Sequence information may also shed some light on the origins of the outbreak.

Excerpts from the official OIE report
Summary of information received 6 Feb 2006 from Dr Junaidu A. Maina, Acting Director, Department of Livestock and Pest Control Services, Federal Ministry of Agriculture and Rural Development: An outbreak of avian influenza was reported in Jaji, Igabi, Kaduna State, in a poultry layers commercial farm in which ostriches and geese were also kept. Date of first confirmation of event: 6 Feb 2006. Date of start of event: 10 Jan 2006. Total number of susceptible animals in the outbreak: 46,000 (poultry). Number of cases: 42,000. Number of deaths: 40,000. Source of outbreak or origin of infection: unknown or inconclusive. Control measures undertaken: stamping out; quarantine; disinfection of infected premises/establishment. Control measures to be undertaken: movement control inside the country. Affected birds were treated by owner with broadspectrum antibiotics before confirmation of infection. Highly pathogenic avian influenza has never been reported before in Nigeria. Investigations are being carried out in order to define the degree of genetic homology with the currently known H5N1 strains. OIE, together with FAO, will take immediate action and coordinate a common response. (Promed 2/8/06)

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Nigeria: FAO concerned with avian influenza in Africa
The outbreak of the highly pathogenic avian influenza virus (H5N1) in Nigeria confirms the fears expressed by FAO for quite some time that African countries are facing a high risk of becoming infected by the virus, FAO said 8 Feb 2006. Samuel Jutzi, Director of FAO’s Animal Production and Health Division, said, “If the situation in Nigeria gets out of control, it will have a devastating impact on the poultry population in the region; it will seriously damage the livelihoods of millions of people, and it will increase the exposure of humans to the virus. It is important that local and national authorities within other countries in the region remain vigilant for possible outbreaks of suspected avian influenza in poultry and other birds. It is vital that all instances of multiple bird deaths are reported to authorities and investigated promptly.” FAO said people should avoid any contact with diseased or dead birds, maintain personal hygiene after handling poultry or poultry meat and should cook chicken meat and eggs properly. “It remains unclear if the outbreak has been triggered by migratory birds or by the trade and movement of poultry or poultry products,” said Joseph Domenech, FAO Chief Veterinary Officer. FAO and OIE will send experts to Nigeria to assess the situation and examine how the virus has been introduced.

FAO urged veterinary services in Nigeria to eliminate outbreaks through immediate humane culling and to strictly control the movement of people and animals from and to affected spots. Transparency, rapid interventions and close collaboration with the international community are crucial to stop the spread of the virus, FAO said. “The animal health infrastructure in the country is facing a big challenge and will require outside assistance,” Domenech said. Laboratory materials and protective equipment for veterinarians are urgently required. Nigeria is member of the West African network on avian influenza surveillance and diagnostics. The recently launched network is managed by FAO in close collaboration with the Inter-African Bureau for Animal Resources of the African Union. Late Jan 2006, experts from 18 West African countries gathered to draw up a plan to deal with the threat of bird flu, putting USD 120 million into the pot for surveillance of commercial and wild birds. Nigeria is West Africa’s most populous nation, with an estimated population of 110 million people. It is also a regional center for trade and commerce, with some of the region’s largest ports and markets. Nigeria has an important commercial poultry sector, with estimated 140 million poultry.

Nigerian authorities have reported the deaths of 150 000 birds in Kano and Kaduna states (the cause of the Kano outbreak is still under investigation). Kano is near the Hadejia-Nguru inland river delta, which is a major wintering location for Northern pintail and garganey ducks. They summer in breeding grounds across Siberia, where there were numerous outbreaks of H5N1 in poultry and wild birds summer 2005. Birds of those species that winter in Turkey and the Black Sea also summered in the same places in Siberia, and migrants are thought to have carried H5N1 there. See: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/migrationmap.html. (Promed 2/8/06, 2/9/06)

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Iraq: WHO supports avian influenza response; additional suspected cases
A WHO-led team, including veterinary expertise from FAO, is now in the Erbil and Sulaimaniyah area, where a fatal human case of H5N1 infection was confirmed 30 Jan 2006. Confirmed outbreaks of highly pathogenic H5N1 in poultry were reported in the area 2 Feb 2006. The team has met with Iraq’s ministries of health and agriculture officials and is now assessing the situation in hospitals, laboratories, and animals. A list of immediate needs for support has been established. Officials have expressed a need for emergency supplies and equipment (e.g. antivirals), and these have begun to arrive. A 24-hour emergency operations centre has been set up in Cairo to facilitate coordination and provide support. Transportation of samples for diagnostic confirmation has encountered difficulties. Ways to strengthen local testing capacity are being explored together with ways to expedite shipment of samples to WHO reference labs. The team has noted a need to upgrade biosafety standards in labs. Intensive poultry culling is under way. Training to enhance the diagnostic capacity of veterinary laboratories and improve surveillance has begun. Requests for essential supplies, including diagnostic reagents, are being met. A large consignment of masks, gloves and gowns is on its way from the US.

The area has around 1.3 million poultry mainly raised by individual households. Discussions are under way to develop a compensation scheme to lessen the hardship on these families. The team found a good system in place for detecting and managing possible human cases, collecting specimens, and tracing and monitoring contacts. Some improvements in isolation wards are planned. Intensive training courses are being organized for hospital staff to ensure proper personal protection and infection control. 2 patients hospitalized for observation have been discharged, though their condition continues to be monitored. 7 patients are presently being treated, in isolation, at hospitals in the area. Most of these patients have reported a history of direct contact with diseased poultry. In addition to the confirmed fatal case, 2 patients under investigation for possible H5N1 infection have died. Specimens from 1 of these, the 39-year-old uncle of the confirmed case, have tested positive for H5N1 in a local lab; confirmation is pending. A possible H5N1 case in southern Iraq (Omara) has been officially reported. The case, a 13-year-old boy, developed symptoms 1 Feb 2006 and was hospitalized with severe pneumonia 5 Feb 2006, and died the same day. Although no poultry deaths have been reported in the area, pet birds kept by the family (pigeons) are said to have died near the time of symptom onset (and reportedly tested positive for avian influenza H5N1). Samples from the boy have been taken.

In Kirkuk, just south of the Kurdish provinces, rumors are rampant of avian flu cases being covered up by the local government and the price of a chicken has plummeted to a 500 dinars (0.33 dollars). In Diyala province, officials were spreading disinfectant 6 Feb 2006 around poultry-producing areas. “We are checking people coming from Kurdistan and Iran to Diyala and spreading disinfectants on their vehicles,” said Hashim Ibrahim of Diyala’s veterinary department.

Excerpts from an OIE Alert regarding poultry outbreaks:
Information received 3 Feb 2006 from Dr Dawood Sharief, Director General, Iraqi Veterinary Services, Ministry of Agriculture: Report date: 2 Feb 2006. Identification of agent: avian influenza virus type H5. Date of first confirmation of event: 1 Feb 2006. Date of start of event: 18 Jan 2006. Details of outbreaks: First administrative division: Sulaimaniyah. All outbreaks in poultry occurred in backyard flocks which generally included chickens, geese, turkeys and ducks. Source of outbreaks or origin of infection: under investigation. Control measures: stamping out; quarantine; movement control inside the country; screening; zoning; disinfection of infected premises/establishment(s); dipping/spraying. Vaccination prohibited. (Promed 2/4/06, 2/6/06, 2/7/06, 2/8/06)

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Turkey: H5 avian influenza outbreak in chickens
Turkey has reported an outbreak of avian influenza in chickens, less than a month after declaring its territory free of the virus, and said it had culled 359 birds as a precautionary measure. In a statement released 31 Jan 2006, the Agriculture Ministry said it had imposed quarantine in the affected area of Igdir, near Turkey’s far-eastern border with Armenia, after detecting a strain of the bird flu virus in dead chickens. The strain has been identified as the H5 type; samples have been sent to WHO and the European Union for more tests. Igdir is a remote, rural area where farming and animal husbandry are the main means of livelihood. The Agriculture Ministry announced 9 Dec 2005 that it had successfully eliminated bird flu in western Turkey, but experts say Turkey will remain vulnerable to further outbreaks because it lies on the flight path of migratory birds. The ministry said it believed migratory birds may have brought the virus to Igdir from the Caucasus region. A map of HPAI in Turkey, (updated 31 Jan 2006) is available at <http://www.oie.int/cartes/TUR060202A.doc>. (Promed 2/4/06)

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Bulgaria: Swan tests positive for H5 virus; EU prevention plans
Bulgaria shut off wetland areas 6 Feb 2006 and investigated the deaths of scores of birds after announcing its first case of H5 avian flu in a dead swan last week. Veterinarians also prepared to send samples from the infected wild swan (found in Danube River) to Britain to test whether it had the H5N1 strain. Since the first H5 case was announced, vets have tested dozens of waterfowl found dead in wetland areas, including 30 ducks which died at a farm 5 Feb 2006. “The birds, domesticated ducks, died at a farm near the Black Sea port of Varna,” said Dinko Neshovski, head of the veterinary office in Varna. Police began guarding the lakes of Shabla and Durankulak near the border with Romania to prevent people from coming into contact with more than 100 000 wild birds that spend the winter there. Alexander Alexandrov, head of the regional veterinary office in Dobrich, said, “People should forget about taking farm animals to water at the 2 lakes until spring, when the last duck is gone.” Bulgaria has banned [the importation of] poultry from its neighbours, forbidden the hunting of wild birds, told farmers to keep domestic fowl indoors and has stepped up surveillance of migratory birds in wetland areas.

Elsewhere, the German government ordered farmers to keep their poultry indoors beginning 1 Mar 2006 to help counter the threat of avian influenza, Agriculture and Consumer Protection Minister Horst Seehofer said. “We are supplementing the wide-reaching measures which have already been taken over the past couple of months against bird flu”, Seehofer said. In the Netherlands, where regulations prescribing indoor keeping of poultry prevailed since fall 2005, the requirement has been withdrawn since 1 Jan 2006 “in view of the termination of the wild-bird migration period and the results of EU survey in wild birds”. Around 25 000 wild birds have been tested for avian influenza in the EU since Oct 2005. All samples to date have tested negative for the Asian strain of the highly pathogenic avian influenza virus. (Promed 2/3/06, 2/4/06, 2/7/06)

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Romania, Georgia: Suspected avian influenza cases in birds
Romania detected new suspected cases of bird flu in domestic fowl, east of the Danube delta where the disease was first found. “Rapid tests made us suspect the presence of the H5 strain of the virus in 3 hens found dead in the village of Cetatea in Dolj county,” chief veterinarian Ion Agafitei said. He said samples of the dead birds would be further tested in Bucharest to confirm the presence of the virus and they would subsequently be sent to a British laboratory to establish whether it was H5N1. He said 10 birds were culled in the village, which is about 500 km from the delta, but more could be killed if the presence of the virus is confirmed. Avian flu has been discovered in 26 Romanian villages since the first outbreak occurred Oct 2005. Elsewhere, more than 10 dead wild ducks were discovered by fishermen in Batumi port area, southwestern Georgia. Some dead ducks were also discovered [on the beach near the port]. Ajariya borders Turkey. Reportedly, veterinary service staff have already collected dead ducks, which are currently being tested for avian influenza virus. According to the Ministry of Health, no case of avian influenza has yet been identified among birds or humans in Georgia. (Promed 2/4/06, 2/7/06)

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Iran: Samples from dead swans negative for H5, H9 avian influenza virus
Information received 7 Feb 2006 from Dr Hossein Hassani, Head of Iran Veterinary Organization (IVO), Ministry of Jihad-e-Agriculture: On 2 Feb 2006, within the framework of the Avian Influenza Passive Surveillance Plan in place for wild birds in Gilan province, there was a report describing a few mortalities among swans in 2 wetlands. . .Immediately, all specific activities were implemented according to OIE guidelines and recommendations, all of the native birds in 6 villages considered as epidemiological units at risk (within a 2km radius) were destroyed and sampled; owners were compensated. Sera were tested using haemagglutination inhibition (H5, H9 and Newcastle disease) and tissue samples were tested by RT-PCR. All results were negative. Samples from swans will be sent to the OIE Reference Laboratory for Avian Influenza and Newcastle disease in Italy, in order to perform virological tests. ***Swan mortality due to H5N1 has been observed in Mongolia, Romania, Croatia and Russia (Astrakhan region). (Promed 2/7/06)

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Asia
Indonesia: 4 more human cases of avian influenza infection; additional suspected cases
As of 6 Feb 2006, the Ministry of Health has confirmed an additional 4 cases of human infection with the H5N1 avian influenza virus. 2 of these cases were fatal. The first fatal case was a 22-year-old man from West Java who died 26 Jan 2006. He worked as a banana vendor at a market in East Jakarta where poultry meat was sold. Neighbors near his home reported poultry deaths prior to his onset of symptoms. The second fatal case was a 15-year-old boy from the West Java city of Bandung, who died 1 Feb 2006. Deaths in chickens near his home were reported in the week prior to symptom onset. The third case is a 9-year-old girl from West Java who was hospitalized 19 Jan 2006 and has since recovered. She lived in a village neighboring that of the 2 fatal cases in siblings confirmed 23 Jan 2006. Investigation of these cases resulted in the girl’s prompt hospitalization and treatment. She has now fully recovered. Poultry deaths were reported in her village prior to symptom onset. The fourth case is a 5-year-old boy from Lampung Province who developed symptoms Oct 2005 and has since fully recovered. The child is the brother of a previously confirmed case, a 20-year-old man who developed symptoms late Sep 2005 and likewise fully recovered. Both the child and his brother had direct exposure to diseased chickens during slaughtering. As initial tests produced inconclusive results, retrospective confirmation of the child’s infection relied on antibody levels in acute blood samples taken during his illness and convalescent samples taken following recovery. All 3 cases with recent symptom onset resided in West Java, where a resurgence of virus activity in birds has been reported.

Indonesia is also awaiting results from the WHO on 11 more suspected infections. “The latest report we have shows that there has been a total of 23 cases of confirmed infection, 16 of them fatal, while we are still awaiting the result of WHO tests on 11 other probable cases, 4 of them fatal,” said an official at the health ministry’s bird flu information center. The official said local tests on the 11 probable cases had tested positive. Many Indonesians live with chickens around their homes, even in urban areas, creating ideal conditions for infections to pass from birds to humans. WHO warned Jan 2006 that Indonesia needed to focus more on measures aimed at preventing such transmission and also on preparations for a possible human pandemic. (Promed 2/4/06, 2/5/06, 2/6/06)

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China (Fujian): Eleventh confirmed human case of H5N1 infection
The Ministry of Health in China has reported the country’s eleventh laboratory confirmed case of human infection with the H5N1 avian influenza virus. The case is a 26-year-old female farmer from the south-eastern province of Fujian. She developed symptoms 10 Jan 2006 and was subsequently hospitalized with pneumonia. She remains under treatment in stable condition. Like many of the other cases in China, this one occurred in an area where no recent poultry outbreaks have been officially reported. Of China’s 11 laboratory confirmed cases, 7 have been fatal. The cases have occurred in 7 provinces and regions: Anhui, Fujian, Guangxi, Jiangxi, Hunan, Liaoning, and Sichuan. The continuing occurrence of sporadic human cases indicates that the virus is continuing to circulate in birds in at least some parts of the country. Since May 2005, agricultural authorities have reported 32 poultry outbreaks across the country, the majority of which were reported Oct and Nov 2005. 3 poultry outbreaks have been reported so far this year: 1 in Sichuan Province 3 Jan 2006, 1 in Guizhou Province 10 Jan 2006, and 1 in Shanxi Province 8 Feb 2006. China’s first 2 confirmed human cases of H5N1 infection were reported Nov 2005. (WHO 2/9/06)

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China (Shanxi): 200 000 chickens culled in latest poultry outbreak
Nearly 200 000 chickens have been culled, after China reported its first outbreak of bird flu in nearly a month, said officials 8 Feb 2006. The agriculture ministry said that the outbreak took place in a large poultry farm in Shanxi province, with 15 000 chickens dying from the virus in 2 days. The ministry said authorities immediately started culling poultry within a 3-km radius of the affected farm and had so far destroyed 187 745 fowl. China has now reported 34 outbreaks of H5N1 virus among poultry since the beginning of 2005, with most appearing since October 2005. The virus has had a major impact on the nation’s poultry industry, which was the world’s largest with an annual production of 14 billion birds. The government said Nov 2005 that 21.1 million poultry had been culled, while it had attempted to vaccinate every chicken in the country. The previous outbreak was reported 10 Jan 2006 in Guizhou province, although human fatalities have since been recorded in areas where the virus was undetected. The latest outbreak took place during Lunar New Year holiday, which officially ended 4 Feb 2006. Experts had warned that the widespread movement of people and poultry during such festivals could fuel the spread of the virus. People had a habit of giving poultry as gifts and slaughtering chicken at home to ensure freshness, raising the chances of spreading the virus. However, it was unclear what caused the latest outbreak. FAO’s representative in China, Noureddin Mona, said: “Transportation is 1 of the factors; the movement of animals and poultry. . .migratory birds could be 1 reason. . .The most important thing for us is [that] the virus is still circulating and jumping from 1 area to another.” (Promed 2/8/06)

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Hong Kong: Avian influenza situation and prevention
Bird flu has become endemic in Hong Kong after its recent discovery in both local wild birds and chickens. “Since different kinds of wild birds and chickens have this virus, we can be quite sure that this virus is endemic in our birds,” York Chow said. “This virus will exist in neighboring areas, southern China as well as Hong Kong,” he added. Chow’s comments came after the government announced 1 Feb 2006 that both a local chicken brought in from China and a dead crested myna tested positive for the H5N1 bird flu virus. In the past year, Hong Kong officials also found avian flu in the oriental magpie robin and heron species. Previously, bird flu killed 6 people here in 1997, prompting the government to slaughter the entire poultry population of about 1.5 million birds. But since then, there have been no major outbreaks.

Household poultry-keeping is set to be banned to reduce the risk of a bird flu outbreak in Hong Kong, Chow said. Under the legislative amendment, the existing exemption for households keeping up to 20 poultry will be removed. The unauthorised keeping of poultry will be an offence warranting fines of up to 12 890 USD. Dr Chow urged the public to surrender their backyard poultry to the Agriculture, Fisheries & Conservation Department. Those who want to keep birds before the new legislation comes into effect must have them vaccinated against avian flu. The Customs & Excise Department has stepped up patrols at the boundary to prevent the inflow of smuggled chickens. The separation of chickens and humans must be enforced, Dr Chow added. (Promed 2/3/06, 2/4/06)

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Australia (Victoria): Ross River virus becoming a public health threat
Ross River virus, a painful illness, is looming as a health threat due to weather conditions that have been ideal for mosquitoes. Health authorities warn it could be a big year, with 53 cases reported Jan 2006 and more expected. There were only 2 cases Jan 2005 and 2 in 2004. The infection rate is now the highest since Jan 2001 when there were 56 cases. Hot spots are along the Murray River towns of Mildura and Echuca, where locals and visitors are advised to wear protective clothing and apply mosquito repellents, particularly at dusk. Ross River virus is spread by mosquitoes and can cause arthritis of the joints as well as rashes. Victoria’s health chief, Dr Robert Hall, said there was no vaccine against the virus and in many people painful symptoms persisted for years. “Mosquito breeding is occurring, bites are occurring and transmission is occurring,” Dr Hall said. “Preventing mosquito bites is important. Mosquitoes tend to bite at dusk so people out and about should use mosquito repellents, long-sleeved clothing and long pants.” The Department of Human Services funds rural councils in at-risk areas to monitor Ross River virus and other diseases and to spray larvae. The warnings of a rise in Ross River infections come 2 years after Victoria’s mosquito management was criticized by a Department of Sustainability and Environment report, which said partnerships between the state and councils should be reviewed and strengthened. During the 20 years of the department’s program the Ross River and Barmah Forest viruses had become endemic, the report noted. (Promed 2/4/06)

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New Zealand (Dunedin): Suspected Norovirus outbreak
An outbreak of vomiting and diarrhoea following a conference in Dunedin could have a Christchurch connection. Some people who attended the conference, based at the University of Otago, have since become violently ill and suspect the cause is the norovirus, which last week struck dozens of people around Christchurch. Conference organiser Mike Beattie said some people had come to the event via Christchurch. The symptoms matched those usually associated with norovirus, he said. The finger was pointed at restaurants in Christchurch for the outbreak there. Norovirus is the most common cause of acute gastroenteritus, affecting an estimated 53 000 New Zealanders annually. Otago medical officer Dr John Holmes said there had not been any confirmed cases. “We only hear about it if there are large outbreaks because it is something that is probably around in the community all the time. It is not always tested for,” he said. The virus closed wards at Christchurch Hospital in 2004 and is regarded as a particular concern for schools and aged care institutions. It is spread by direct contact with an infected person, but food, water and contaminated surfaces can also be vectors. Illness is self-limiting and rarely has serious consequences. Mr. Beattie said most of those affected at the conference did not begin exhibiting symptoms until after it ended and had since left Dunedin, making it more difficult to determine the scale or cause. Now, if they are heading home, they could be taking it home as well. About 430 people from around the world attended the conference. (Promed 1/31/06)

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Russia (Kemerovo): Trichinellosis associated with bear meat
5 inhabitants of Kemerovo (Kuzbas Region) were infected with Trichinella after eating bear meat. 3 men and 2 women were admitted to the infectious diseases hospital in the City of Kemerovo with the preliminary diagnosis of Trichinellosis. All 5 are from the Krapivinskiy district. Bear meat is a well-known route of Trichinella infection in Russia. Bears have a high prevalence of Trichinella, and the only way of avoiding infection is by not consuming raw or undercooked bear meat. ProMED has reported several previous outbreaks including several cases from the same area after eating meat from an infected badger. Even though wildlife is the main source of infection in previous outbreaks, infected pork is also a risk. Trichinellosis is still a real risk in Russia and in other former Soviet countries, even when consumption of wildlife is disregarded. (Promed 2/4/06, 2/5/06)

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Americas
Chile (Talagante): 2 cases of Hantavirus infection confirmed
Mr. Gonzalo Urrutia, Provincial Governor for Talagante, announced that only 2 cases of hantavirus infection have been reported in the area for 2006 and not 7 as reported by some media sources. Mr. Urrutia pointed out that “the first case, which regrettably was fatal, affected a woman living in the El Oliveto de Lonquen area who contracted the infection through risky conduct, such as working in the field without protection, taking walks in places inhabited by rodents and eating wild fruits from such places.” He added: “The second case is a man who has already recovered from a critical illness contracted as a consequence of hantavirus infection. He lives in Talagante, but he contracted hantavirus infection during the course of agricultural work without adequate precautions in the Chinihue El Cristo area, and he was treated in Melipilla community. The long-tail rice rat (Oligoryzomys longicaudatus) is likely to be the main hantavirus vector in central and southern Chile, and Andes virus is likely to be the species of hantavirus responsible for outbreaks of hantavirus pulmonary syndrome in this region. (Promed 1/29/06)

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USA: Lymphogranuloma venereum believed spreading among MSM’s
A particularly bad strain of chlamydia not usually seen in the USA appears to be slowly spreading among men who have sex with men (MSMs), an infection that can increase their chances of getting or spreading the AIDS virus. Called LGV (lymphogranuloma venereum), this sexually transmitted disease has caused a worrisome outbreak in Europe, where some countries have confirmed dozens of cases. Diagnoses confirmed in the USA still are low, just 27 since they warned in 2005 that the strain was headed here. But specialists say that’s undoubtedly a fraction of the infections, because this illness is difficult to diagnose: few clinics and laboratories can test for it. Painful symptoms can be mistaken for other illnesses, such as irritable bowel syndrome. “My feeling is that what we’re seeing now is still the tip of the iceberg,” says Dr. Philippe Chiliade of the Whitman-Walker Clinic, which diagnosed its first few cases of LGV Jan 2006 and is beginning to push for asymptomatic men to be screened. Increasing the ability to test for LGV is “what’s really critically important,” she adds. “The prevalence of the disease is probably quite a bit higher than the reported cases indicate, either here or in Europe, but we don’t yet know that.”

3 weeks of the antibiotic doxycycline effectively treats LGV. But patients have to know they’re at risk and then find a test. LGV is not a new disease, but one rarely seen outside of Africa or Southeast Asia. So STD specialists were stunned in late 2004, when the Netherlands announced an outbreak that reached over 100 cases; in summer 2005, 1 clinic there reported seeing 1 to 2 new patients a week. Cases also have surfaced in much of Western Europe. As with the cases in the USA, many also have HIV. Symptoms differ from regular chlamydia: swollen lymph nodes in the groin; genital or rectal ulcers; and painful bowel movements and other gastrointestinal symptoms. Such symptoms leave patients particularly susceptible to HIV infection if they also encounter that virus. LGV can infect both sexes, although new cases diagnosed so far are among MSM’s. In a surprise finding in fall 2005, Dutch scientists tested some tissue samples stored in San Francisco since the 1980s and found evidence that today’s LGV strain had gone unrecognized at the time. So has it been simmering here all along, or is it on the rise? (Promed 2/8/06)

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USA (Florida): Legionnaires’ disease found at resort
A Daytona Beach Shores hotel remains closed because of the threat of Legionnaires’ disease. Douglas Kosarek, the Vice President of Ocean Waters Development, said that they voluntarily moved guests out of the Seagarden Inn, after the Volusia County Health Department notified him that 2 former guests were diagnosed with Legionnaires’. The disease is caused by a bacteria found in warm water, and people affected by the disease inhale the bacteria in a vapor or mist. Though there has been no direct link to the hotel yet, managers say they wanted to be proactive. Kosarek said: “Tests that the County Health Department had run, they’re not back yet, and we determined that that was too long to wait. So in order not to put any guests at further risk, or in order to be 100 percent cautious and prudent, we decided to relocate all of our guests.” Symptoms usually show up within 14 days of exposure. Kosarek says the 2 diagnosed cases showed up early Jan 2006. The most reliable link to the facility would be cultured Legionella from an aqueous source at the hotel being shown to be identical to isolates from the 2 affected individuals. (Promed 2/5/06)

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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 18 Jan 2006 report. Please see EINet’s 20 Jan 2006 Alert for further details.

USA. During week 5 (Jan 29 – Feb 4, 2006), influenza activity continued approximately at the same level as recent weeks in the US. 333 specimens (13.9%) 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. 9 states and NYC reported widespread influenza activity; 21 states reported regional activity; 13 states and the District of Columbia reported local activity; and 6 states and Puerto Rico reported sporadic activity.

For the comprehensive update on recent influenza activity in the USA (“Update: Influenza Activity--United States, January 22--28, 2006”): http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5505a4.htm.
(CDC 2/10/06 http://www.cdc.gov/flu/weekly/ )

Avian/Pandemic influenza updates
- WHO’s comprehensive information on avian influenza: http://www.who.int/csr/disease/avian_influenza/en/index.html. WHO pandemic influenza draft protocol for rapid response and containment is available. WPRO website on avian influenza: http://www.wpro.who.int/health_topics/avian_influenza/overview.htm
- FAO updates on avian influenza: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. Includes latest documents on Nigeria situation.
- 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. For avian influenza: http://www.cdc.gov/flu/avian/.
- The US government’s web site for pandemic flu: http://www.pandemicflu.gov/. New State Summit summaries have been uploaded.
- 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/.
- PAHO’s updates on avian influenza: http://www.paho.org/English/AD/DPC/CD/influenza.htm.
- The American Veterinary Medical Association information on animal influenzas: http://www.avma.org/public_health/influenza/default.asp
- US Geological Survey, National Wildlife Health Center: http://www.nwhc.usgs.gov. NWHC Avian Influenza Information (with bulletins, maps, and news reports): http://www.nwhc.usgs.gov/research/avian_influenza/avian_influenza.html.
(WHO; FAO, OIE; CDC; US FDA; CIDRAP; PAHO; APHA; AVMA; USGS)

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Cholera, diarrhea & dysentery
USA (Washington)
An outbreak of shigellosis, an infectious disease that usually causes diarrhea and a fever and is transmitted through contaminated food or water, has forced the postponement of a wrestling tournament 4 Feb 2006. “We want to err on the side of caution,” Blaine athletic director Gary Claussen said. The announcement came 6 days after last week’s Whatcom County League sub- district, which was held 28 Jan 2006. At least 14 wrestlers, 3 assistant coaches, 2 referees and 1 other adult who participated in the tournament have shown symptoms of shigellosis, Claussen said. Buffi LaDue of the Whatcom County Health Department said only 2 cases of shigellosis have been confirmed so far and that the department is investigating others. LaDue said the health department is still investigating the cause of the outbreak. “It could be from food that was served at the tournament. . .” Even with the delay, LaDue warns that secondary infection could occur. “What we recommend is that they tell the coaches and players that if any player still has symptoms that they not be allowed to wrestle,” LaDue said. “I know there have been some other outbreaks in the state, but I don’t know if it is associated with wrestling,” she added. (Promed 2/5/06)

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Dengue
Hong Kong/Indonesia
The Centre for Health Protection has confirmed a Dengue fever case involving a 29-year-old woman living in Siu Sai Wan, bringing 2006’s total number of cases to 3, all imported. The patient traveled to Indonesia 21 Dec 2005 - 1 Jan 2006, and got fever, chills, vomiting, diarrhea and rash 3 Jan 2006. She was admitted to Pamela Youde Nethersole Eastern Hospital 9 Jan 2006 and her condition is stable. Her home contacts have no dengue fever symptoms. For more information on dengue fever http://www.travelhealth.gov.hk/eindex.html. (Promed 1/27/06)

Mexico (Sinaloa)
Dengue fever serotype 1, which had been absent from Sinaloa, reappeared, and caused 3 confirmed cases of the disease. This situation, according to Health Secretary, Dr. Ernesto Echevarria-Aispuro, means a health alert, since 20 other cases suspected to be dengue fever occurred during this month in Sinaloa State. The Epidemiological Surveillance National System sent guidelines in order to strengthen the effort against this Aedes aegypti threat, he confirmed. He also pointed out that the greatest danger with serotype 1 is that it did not occur in Sinaloa for more than 8 years, consequently, there is a whole generation that had not developed antibodies against it. He explained that this means a high likelihood for the occurrence of cases of dengue hemorrhagic fever, since the majority of Sinaloan people have been exposed to dengue serotypes 2 and 3. When a person is infected by a determined dengue fever serotype (there are 4), this person acquires immunity against this specific serotype, but not against the other 3.

The occurrence of serotype 1 may be a consequence of the increased presence of Aedes aegypti mosquitoes in the area after devastation caused by hurricanes Stan and Wilma. Dr. Echevarria urged the population to take extreme preventive measures, especially cleaning yards and roofs and using abate in water reservoirs. At temperatures below 15C it stops reproducing with the same intensity compared to being in a warm environment; nevertheless, Aedes aegypti lays its eggs, which may remain dormant for years, waiting for a single drop of water that may trigger their development. The Health Secretariat is designing an attack plan against the mosquito. He said there is a permanent program against dengue fever, and this year fumigation and abate-use campaigns will be intensified, and blood bank supplies will be assured in case of any emergency. (Promed 1/27/06)

Australia (Queensland)
Dengue fever has resurfaced in north Queensland. 4 probable cases of dengue were identified in Townsville, just a month after the city’s last outbreak was declared over. Damien Farrington from the Tropical Public Health Unit says investigations are already under way because the disease can spread quickly. Farrington urged residents in the Cranbrook area to take immediate action to avoid contracting dengue fever. “We will undertake an immediate search of the area surrounding the house,” Mr Farrington said. “The search will be to ensure there are no potential breeding grounds in the area for mosquitoes. A 200-m radius around the suspected infection site will be covered to place traps and to provide residents with advice on the dangers of dengue fever.” He said that while the results of tests on the 4 Cranbrook residents would not be confirmed for a few days, it was never too soon to warn people. He said the best form of control was to clean up mosquito breeding hot spots around the home. A woman died from dengue fever in 2005, with 18 people confirmed with the disease in Townsville in 2005.

Dengue does not occur naturally in North Queensland, but the dengue mosquito is common, and outbreaks can occur when the virus is transmitted to the local mosquito population by infected international travellers or residents. “These people have no recent travel history, so it appears these are all local transmissions,” he said. “The virus was most likely bought into the city from someone who has recently been overseas. We may see other cases of dengue appearing in random areas around the city. . .” To avoid being bitten, residents are urged to use insect repellants, plug-in zappers, to screen sleeping and living areas, and use cockroach surface sprays indoors. Symptoms include a sudden onset of fever lasting 3-7 days, intense headache, muscle and joint pain, loss of appetite, vomiting, diarrhoea, a fine rash as fever subsides, severe itching, minor bleeding in the nose or gums and extreme fatigue. There is no vaccine and no cure. (Promed 1/27/06)

Malaysia (Kelantan)
The Malaysian Health Ministry has sent 2 investigators to the northern state of Kelantan to investigate the death of 2 girls who were feared to have died from dengue (or possibly Japanese Encephalitis (JE)). The work of the 2 experts from the Institute of Medical Research and National Public Health Laboratory would help the health ministry work out strategies to control the disease. A 27-year-old woman confirmed to be infected with dengue is now warded at a local hospital. She initially tested positive for JE and dengue, but the latest tests showed that she had only dengue. On 26 Jan 2006 and 31 Jan 2006, 2 female students 13 years old died after showing JE symptoms. Later tests showed they were actually dengue victims, Health Ministry director general Ismail Merican said. “It is an outbreak of dengue. We have beefed up our control measures. Whether it is dengue or JE, the root cause is mosquitoes, so we have taken measures to ensure cleanliness,” he said. Though tests showed 1 of the girls died of acute neurological syndrome, her father, 34, and her 5-year-old brother showed JE symptoms.

Dengue causes high fever, severe joint pain and sometimes nausea, vomiting and a rash. The JE virus generally causes fever and headaches or no apparent symptoms. But about 1 in 200 infections cause severe complications, resulting in disorientation, comas, seizures, paralysis and death. JE virus is transmitted when Culex mosquitoes bite an animal infected with the virus, usually a pig, before biting humans, causing the virus to enter the bloodstream of the final host. The Veterinary Services Department had taken blood samples from different animals in Tanah Merah to determine whether they carry the virus. If domestic animals are found to be carrying JE virus, they will be culled.. In 2005, 108 people died from dengue fever and 6 from JE. In Tanah Merah alone, where the 2 girls died, there were 11 dengue cases in Jan 2006, Mr Ismail said, adding that measures including fogging are being taken to ensure the outbreak doesn’t spread.***There have been numerous conflicting reports on this situation, with regards to the number of suspected cases and whether they are caused by dengue or JE. (Promed 1/30/06, 2/3/06, 2/6/06, 2/8/06)

China
The World Association of Newspapers (WAN) and World Editors Forum (WEF) have protested to the Chinese government against the jailing of journalist Li Changqing, who exposed an outbreak of dengue fever, a frequent cause of hospitalization and death among children, before the authorities officially announced it. “What makes the jailing of Mr. Li even more heinous is that his disclosure of the outbreak of dengue fever was clearly in the public interest,” said WAN and WEF in a letter to the Minister of Information Industry. Mr. Li, a journalist with the Fuzhou Daily, was convicted 24 Jan 2006 of “spreading false and alarmist information” and sentenced to 3 years in prison. The charges relate to an article Mr. Li published on the banned US-based website Boxun News exposing the dengue outbreak. “We are seriously concerned at the government’s continuing campaign to censor news and silence undesirable views on the internet: up to 86 other journalists and internet-users are reportedly detained in China, more than in any other country in the world,” said WAN and WEF. According to a 14 Oct 2004 report from a Taiwan paper, the dengue outbreak in Fujian (100 cases and some deaths) began early Sep 2004. An official report from the 15 Oct 2004 China Daily reported 30 cases and no deaths. (Promed 2/1/06)

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Viral gastroenteritis
USA (Michigan)
Health officials have identified 195 people who became ill after eating at an Italian restaurant late Jan 2006, and the number of reported cases was expected to increase. “This is a large outbreak, in part because they served a lot of people that weekend,” said Dr. Robert Schirmer, medical director of the Barry-Eaton District Health Department. He said the illnesses resulted from norovirus infection, which can cause severe vomiting and diarrhea that usually lasts about a day. The health department cited the restaurant for allowing an ill employee to work that weekend and for poor hygiene practices, Schirmer said. There are no fines for the violations, but if they are not corrected, the restaurant’s license can be revoked. Reportedly, managers are reviewing and reinforcing food-safety procedures with employees. (Promed 2/9/06)

USA (Illinois)
More than 100 guests, workers and attendees of a fundraising event a hotel in Chicago became ill 4-5 Feb 2006. The outbreak was linked to a norovirus that caused nausea, vomiting and diarrhea, said Tim Hadac, of the Chicago Department of Public Health. Hadac said none of the afflicted had reported any serious complications, and though several people went to local hospital emergency rooms seeking treatment, none had to be admitted. “We have worked with the hotel to essentially order a top-to-bottom scrubbing of not only the kitchens, but the entire hotel,” he said. The hotel is working with the city to find the cause. The hotel is now operating normally, and all of its kitchens and restaurants are open. Noroviruses usually cause symptoms 12-48 hours after exposure. Most people recover in a few days. The virus is transmitted through contaminated food or drink. Its spread can be prevented through careful sanitation and good hygiene. Hotels, cruise ships and other settings with large-scale accommodations are the most common locations for outbreaks. More than 1100 may have been infected Sep 2005 after Hurricane Katrina. (Promed 2/9/06)

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2. Articles
Establishment of multiple sublineages of H5N1 influenza virus in Asia: Implications for pandemic control
The H5N1 flu virus has been circulating continuously in poultry in south-eastern China for a decade, scientists say. A massive genetic analysis shows the virus has mainly been spread by poultry, but also that wild birds carried it from southeast China to Turkey. Yi Guan et al. at Shantou University, plus scientists in Xiamen and Hong Kong, say the only way to stop the virus is to control it in southeast China. The researchers analysed samples taken from 13 000 migratory birds and 50 000 market poultry in southeast China Jan 2004 - Jun 2005, when the Chinese government banned independent sampling. In the markets, they found H5N1 in about 2 percent of apparently healthy ducks and geese, and some chickens, in all but 2 of the months in the sampling period. The genetic make-up of the virus differed slightly between Guangdong, Hunan and Yunnan provinces, forming distinct geographic clusters. But they all descend from a 1996 Guangdong virus, and show the greatest genetic variation in Guangdong and neighbouring Guangxi and Hunan, showing they have been there longest.

Robert Webster, a co-author of the paper, says this shows the virus originated in those provinces, and has been circulating in the region ever since, long enough to evolve divergent strains. These strains then “colonised” neighbouring areas. Viruses from Vietnam and Thailand match Guangdong viruses, while Indonesia has its own related cluster. Genes from Vietnamese viruses reveal repeated introductions from Guangxi. This contrasts with past insistence by Chinese officials that H5N1 exists only in isolated cases in China, and did not necessarily originate there. The existence of distinct clusters also means the main carriers cannot be wide-ranging birds; instead, most transmission is via local poultry movements. Co-author Malik Peiris said: “If there had been repeated waves of virus introduced into, for example, Yunnan, one would expect multiple sub-lineages of the virus. But in each place there is only one.”

But wild birds are involved. The team found H5N1 in 6 apparently healthy migratory ducks in Jiangxi province, in Jan and Mar 2005, before the northward migration. The isolates had all the genes, and certain specific mutations, later found in geese at Qinghai Lake. And this virus is very like H5N1 in Turkey. The team also tested whether the Poyang viruses would make ducks too sick to fly by infecting young mallards. “Most got a bit sick then recovered,” says Webster, and all shed virus for up to a week. “The evidence is now overwhelming that migrating birds can move H5N1 over long distances,” says Peiris. “But they are not the scapegoats for maintaining H5N1 within poultry. There the cause and solution lies within the poultry industry.” Another important finding is that antibodies to each sub-lineage of H5N1 did not bind readily to other sub-lineages. That means vaccinating against 1 strain may not protect against others. The team warns that H5N1 pandemic vaccines should be developed using several strains, and constantly updated. But to head off the threat of a human pandemic, the authors insist “the source of the virus in southern China must be contained.” See http://www.pnas.org/cgi/content/abstract/0511120103v2 to read the abstract: Chen et al. Published online Feb 10, 2006, 10.1073/pnas.0511120103. (Promed 2/7/06)

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Adenovirus vaccines said to offer hope for fighting flu pandemics
A pair of new studies suggests that influenza vaccines based on adenoviruses, 1 of the causes of the common cold, may offer major advantages in the quest for protection from flu pandemics. In both studies, scientists manipulated adenoviruses to duplicate a key protein (hemagglutinin) found in H5N1 avian flu viruses and then injected the engineered viruses into mice. The vaccines generated an immune response that protected the mice when they were exposed to high doses of H5N1 viruses, including strains that did not precisely match the strains from which the hemagglutinin was derived. In one of the studies, the vaccine also protected chickens. The reports raise hopes that pandemic flu vaccines could be produced in cell culture, saving time compared with the months-long process of growing them in eggs. In addition, because the experimental vaccines seemed to offer broader protection than conventional egg-based vaccines, it may be possible to produce and stockpile a pandemic vaccine in advance, the reports say. However, the vaccines have not yet been tested in people.

“This approach is a feasible vaccine strategy against existing and newly emerging viruses of highly pathogenic avian influenza to prepare against a potential pandemic,” states 1 of the reports, published online by The Lancet. The report was prepared by a team from CDC and Purdue University, with Mary A. Hoelscher. The other study was conducted by a team from the University of Pittsburgh, CDC, and the US Department of Agriculture’s Southeast Poultry Research Laboratory, with Wentao Gao. “Our findings as well as those from other adenovirus-based vaccine studies support the development of replication-defective adenovirus-based vaccines as a rapid response in the event of the pandemic spread” of avian flu, write Gao et al. in the Journal of Virology. In the CDC-Purdue study, researchers made a vaccine consisting of a nonreplicating adenovirus containing the hemagglutinin gene from an H5N1 virus identified in Hong Kong in 1997. 1 group of mice was injected with this vaccine, while other groups were injected with saline or 1 of 2 other control vaccines. 4 weeks after their second injection, the mice were given high doses of 1 of 2 H5N1 virus strains, including a Hong Kong 1997 strain (but not the same one as used to make the vaccine) and a 2004 variant from Vietnam. All the mice that received the experimental vaccine survived with minimal illness as measured by weight loss.

The researchers also took blood samples from the vaccinated mice and assessed the serologic response to 3 different H5N1 viruses—the 1997 strain used in the vaccine, plus 2003 and 2004 strains from Hong Kong and Vietnam, respectively. The experimental vaccine produced a “significantly high” antibody response to the 1997 virus but weaker responses to the other 2 viruses. To assess cellular immune responses, the researchers measured the generation of CD8 T-cells in the vaccinated mice. Mice that received the experimental vaccine had a 3 to 8-fold higher frequency of CD8 cells than those that received control vaccines, a significant difference. The results showed that the experimental vaccine effectively protected mice “from H5N1 disease, death, and primary viral replication” after exposure to “antigenically distinct strains of H5N1 influenza viruses,” the authors write. “This strategy has the advantage of inducing strong humoral and cellular immunity and conferring cross-protection against continuously evolving H5N1 viruses without the need of an adjuvant,” they add. Suryaprakash Sambhara of the CDC said the adenovirus-based vaccine can be made much more quickly than conventional flu vaccines.

In the Pittsburgh study, researchers engineered an adenovirus to duplicate hemagglutinin from a 2004 Vietnam strain of H5N1 virus. They injected this into mice and then exposed them to an H5N1 virus 70 days later. The mice were fully protected by the vaccine, which generated both hemagglutinin-specific antibodies and a cellular immune response. The experimental vaccine was also tested in chickens by giving them a single subcutaneous dose and exposing them to H5N1 virus 21 days later. The immunized chickens were fully protected, while a group of unvaccinated chickens all died. The authors write that their results indicate that widespread use of adenovirus-based vaccines in poultry would probably help stop the spread of highly pathogenic avian flu. And in the case of a human flu pandemic, they add, “an adenovirus-based vaccine could be utilized to complement traditional inactivated influenza virus vaccine technology, which is still the primary choice,” despite the limitations of egg-based production. To link to the reports, go to http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/feb0206adeno.html. (CIDRAP 2/2/06 http://www.cidrap.umn.edu )

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Assessment of health-related needs after tsunami and earthquake--three districts, Aceh Province, Indonesia, July--August 2005
“On December 26, 2004, an earthquake measuring 9.2 on the Richter scale off the northwest coast of the island of Sumatra, Indonesia, produced a tsunami that caused the deaths of an estimated 230,000 persons in India, Indonesia, the Maldives, Somalia, Sri Lanka, and Thailand. . .On March 28, 2005, a second major earthquake, measuring 8.7 on the Richter scale, caused large-scale damage to the islands of Simeulue and Nias off the western Sumatra coast; approximately 300 persons died, and thousands were displaced. The international community responded to these events with the largest relief measures ever undertaken for a natural disaster. To determine the health and nutrition status of the affected populations and to evaluate the effectiveness of relief interventions 7 months after the tsunami and 3 months after the second earthquake, Cooperative for Assistance and Relief Everywhere, Inc. (CARE) International Indonesia and CDC conducted surveys in 3 districts of Aceh Province (Aceh Besar, Banda Aceh, and Simeulue). This report summarizes the results of those surveys, which identified routine vaccinations and provision of toilets or latrines as particular areas for improvement and revealed no significant difference in health indicators between internally displaced persons (IDPs) and nondisplaced populations. The relief response in Aceh Province should target areas needing improvement with programs that serve both IDPs and nondisplaced persons, as measures are implemented to rebuild the public health infrastructure. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5504a1.htm (MMWR February 3, 2006 / 55(04);93-97)

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The role of the airline transportation network in the prediction and predictability of global epidemics
Colizza V et al. Proc Natl Acad Sci U S A. 2006 Feb 3.
http://www.pnas.org/cgi/content/abstract/0510525103v1
Abstract: “The systematic study of large-scale networks has unveiled the ubiquitous presence of connectivity patterns characterized by large-scale heterogeneities and unbounded statistical fluctuations. These features affect dramatically the behavior of the diffusion processes occurring on networks, determining the ensuing statistical properties of their evolution pattern and dynamics. In this article, we present a stochastic computational framework for the forecast of global epidemics that considers the complete worldwide air travel infrastructure complemented with census population data. We address two basic issues in global epidemic modeling: (i) we study the role of the large scale properties of the airline transportation network in determining the global diffusion pattern of emerging diseases; and (ii) we evaluate the reliability of forecasts and outbreak scenarios with respect to the intrinsic stochasticity of disease transmission and traffic flows. To address these issues we define a set of quantitative measures able to characterize the level of heterogeneity and predictability of the epidemic pattern. These measures may be used for the analysis of containment policies and epidemic risk assessment.” (CIDRAP http://www.cidrap.umn.edu )

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Epidemiological and genetic correlates of Severe Acute Respiratory Syndrome coronavirus infection in the hospital with the highest nosocomial infection rate in Taiwan in 2003
Yi-Ming Arthur Chen et al. Journal of Clinical Microbiology, February 2006, p. 359-365, Vol. 44, No. 2. http://jcm.asm.org/cgi/content/abstract/44/2/359
Abstract: “Taiwan experienced a series of outbreaks of nosocomial severe acute respiratory syndrome (SARS) infections in 2003. Two months after the final outbreak, we recruited 658 employees from the hospital that suffered the first and most severe SARS infections to help us investigate epidemiological and genetic factors associated with the SARS coronavirus (SARS-CoV). SARS-CoV infections were detected by using enzyme immunoassays and confirmed by a combination of Western blot assays, neutralizing antibody tests, and commercial SARS tests. Risk factors were analyzed via questionnaire responses and sequence-specific oligonucleotide probes of human leukocyte antigen (HLA) alleles. Our results indicate that 3% (20/658) of the study participants were seropositive, with one female nurse identified as a subclinical case. Identified SARS-CoV infection risk factors include working in the same building as the hospital’s emergency room and infection ward, providing direct care to SARS patients, and carrying a Cw*0801 HLA allele. The odds ratio for contracting a SARS-CoV infection among persons with either a homozygous or a heterozygous Cw*0801 genotype was 4.4 (95% confidence interval, 1.5 to 12.9; P = 0.007).” (CIDRAP http://www.cidrap.umn.edu )

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Emergence of a new norovirus genotype II.4 variant associated with global outbreaks of gastroenteritis
Bull RA et al. Journal of Clinical Microbiology, February 2006, p. 327-333, Vol. 44, No.2 http://jcm.asm.org/cgi/content/abstract/44/2/327
Abstract: “Norovirus (NoV) is highly infectious and is the major cause of outbreak gastroenteritis in adults, with pandemic spread of the virus being reported in 1995 and 2002. The NoV genome is genetically diverse, which has hampered development of sensitive molecular biology-based methods. In this study we report on a nested reverse transcriptase PCR (nRT-PCR) that was designed to amplify the highly conserved 3’ end of the polymerase region and the 5’ end of the capsid gene of NoV genogroup II (GII). The nRT-PCR was validated with strains isolated from sporadic and outbreak cases between 1997 and 2004 in New South Wales, Australia. Phylogenetic analysis identified six genotypes circulating in New South Wales, GII.1, GII.3, GII.4, GII.6, GII.7, and GII.10, with GII.4 being the predominant genotype. In 2004, there was a marked increase in NoV GII activity in Australia, with a novel GII.4 variant being identified as the etiological agent in 18 outbreaks investigated. This novel GII.4 variant, termed Hunter virus, differed by more than 5% at the amino acid level across the capsid from any other NoV strain in the GenBank and EMBL databases. The Hunter virus was subsequently identified as the etiological agent in large epidemics of gastroenteritis in The Netherlands, Japan, and Taiwan in 2004 and 2005.” (CIDRAP http://www.cidrap.umn.edu )

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Prions in Skeletal Muscles of Deer with Chronic Wasting Disease
The infectious prions that cause Chronic Wasting Disease (CWD), an infection similar to Bovine Spongiform encephalopathy (BSE) that afflicts North American deer and elk, have been found in the parts of the animals that people eat. CWD was first diagnosed in captive deer and elk in Colorado in the 1970s and in wild deer and elk in the region in the 1980s. But in the 1990s, it spread widely within the elk farming industry, jumped to wild deer, and now affects 2 provinces of Canada and 13 US states. Like scrapie -- though unlike BSE -- CWD spreads from animal to animal, says Glenn Telling of the University of Kentucky. Deer housed with infected animals, or fed infected brain experimentally, contract the disease. Because of this, there are fears that the CWD prion might be distributed widely in the deer’s tissues, as scrapie is in sheep. Efforts to find the prion in the muscle of infected animals by seeing whether antibodies to the prion could find any and bind to them have previously failed. But Telling’s lab has now shown, using transgenic mice, that disease prions can reside in the muscle of deer infected with CWD. The team replaced the gene for the normal mouse version of the prion protein with the normal gene from deer, so the mice made the normal, healthy deer protein. They then injected the mouse brains with tissue from infected deer. 12 to 18 months later, the mice developed encephalopathy.

Tissues from both the infected deer’s brains and thigh muscles caused disease. Muscle took slightly longer to cause disease than brain tissue, showing it had slightly less prion. “We don’t know that it is transmitted in the wild by animals eating muscle from infected animals,” cautions Telling. “We now have to see where else the prion might be,” including saliva and even excrement. “Because we tested deer that were already ill,” he said, “we don’t know what the distribution of prion is in animals that are still incubating the disease.” Hunters have been warned not to kill and eat obviously ill animals, but an animal not yet showing signs of the disease might still carry the abnormal prion, albeit less of it. It is also unknown whether people can catch encephalopathy by eating CWD-infected meat, as they can from eating BSE-tainted meat. Officials have warned hunters not to eat brain or spinal cord. Telling notes that the prevalence of CWD infection is unclear. See http://www.sciencemag.org/cgi/content/abstract/1122864v1. Angers RC, et al. Science, 26 Jan 2006. (Promed 2/6/06)

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Racial/Ethnic Disparities in Diagnoses of HIV/AIDS--33 States, 2001--2004
“In 2003, an estimated 1.2 million persons in the United States were living with. . .HIV infection, 47% of whom were non-Hispanic blacks. This report describes racial/ethnic disparities in diagnoses of HIV/acquired immunodeficiency syndrome (AIDS) during 2001--2004 and reported to CDC through June 2005 by 33 states that used confidential, name-based reporting of HIV and AIDS cases for at least 4 years. Of the estimated 157,252 diagnoses of HIV infection, the number of cases and diagnosis rates among blacks were higher than those for all other racial/ethnic populations combined. Among males, blacks had the largest or second-largest percentage of cases in every transmission category; among females, blacks had the largest percentage of cases in all transmission categories. Moreover, among both males and females, blacks represented the largest percentage of HIV/AIDS diagnoses in every age group. New and improved prevention strategies, including expanded HIV testing, targeted communications, and tailored prevention services, are needed to help address disparities in HIV transmission among blacks. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5505a1.htm (MMWR February 10, 2006 / 55(05);121-125)

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Leptospirosis After Flooding of a University Campus--Hawaii, 2004
“On November 19, 2004, the Hawaii Department of Health (HDOH) received a report that a University of Hawaii professor aged 56 years had been hospitalized with suspected leptospirosis after cleaning his flooded laboratory. On October 31, heavy rains had caused an adjacent stream to overflow its banks and flood the campus. Persons exposed to fresh water or mud contaminated by the urine of animals infected with the spirochete Leptospira interrogans can have systemic illness if the leptospires enter the body through broken skin or mucous membranes. This report describes the subsequent investigation by HDOH, assisted by CDC, which highlights the importance of maintaining clinical suspicion for leptospirosis after flooding in areas where the illness is endemic, even in well-developed urban settings. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5505a2.htm (MMWR February 10, 2006 / 55(05);125-127)

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Imported Vaccine-Associated Paralytic Poliomyelitis--United States, 2005
“Paralytic poliomyelitis is rare in the United States because of the success of universal childhood immunization and the Global Polio Eradication Initiative. Poliovirus vaccine was introduced in the 1950s. Since then, the United States has eliminated indigenous wild poliovirus transmission, controlled imported wild poliovirus cases, and, through a vaccine policy change (i.e., from live, attenuated oral polio vaccine [OPV] to inactivated polio vaccine [IPV]), eliminated vaccine-associated paralytic polio (VAPP) cases. The most recent VAPP case occurred in 1999. The primary risk for paralytic polio for U.S. residents is through travel to countries where polio remains endemic or where polio outbreaks are occurring. This report describes the first known occurrence of imported VAPP in an unvaccinated U.S. adult who traveled abroad, where she likely was exposed through contact with an infant recently vaccinated with OPV. This case highlights the previously unrecognized risk for paralytic polio among unvaccinated persons exposed to OPV during travel abroad. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5504a2.htm (MMWR February 3, 2006 / 55(04);97-99)

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Human Botulism Immune Globulin for the Treatment of Infant Botulism
Arnon SS et al. N Engl J Med. 2006 Feb 2;354(5):462-71.
http://content.nejm.org/cgi/content/short/354/5/462
Abstract: Background: We created the orphan drug Human Botulism Immune Globulin Intravenous (Human) (BIG-IV), which neutralizes botulinum toxin, and evaluated its safety and efficacy in treating infant botulism, the intestinal-toxemia form of human botulism. Methods: We performed a five-year, randomized, double-blind, placebo-controlled trial statewide, in California, of BIG-IV in 122 infants with suspected (and subsequently laboratory-confirmed) infant botulism (75 caused by type A Clostridium botulinum toxin, and 47 by type B toxin); treatment was given within three days after hospital admission. We subsequently performed a 6-year nationwide, open-label study of 382 laboratory-confirmed cases of infant botulism treated within 18 days after hospital admission. Results: As compared with the control group in the randomized trial, infants treated with BIG-IV had a reduction in the mean length of the hospital stay, the primary efficacy outcome measure, from 5.7 weeks to 2.6 weeks (P<0.001). BIG-IV treatment also reduced the mean duration of intensive care by 3.2 weeks (P<0.001), the mean duration of mechanical ventilation by 2.6 weeks (P=0.01), the mean duration of tube or intravenous feeding by 6.4 weeks (P<0.001), and the mean hospital charges per patient by $88,600 (in 2004 U.S. dollars; P<0.001). There were no serious adverse events attributable to BIG-IV. In the open-label study, infants treated with BIG-IV within seven days of admission had a mean length of hospital stay of 2.2 weeks, and early treatment with BIG-IV shortened the mean length of stay significantly more than did later treatment. Conclusions: Prompt treatment of infant botulism type A or type B with BIG-IV was safe and effective in shortening the length and cost of the hospital stay and the severity of illness. (CIDRAP 2/8/06 http://www.cidrap.umn.edu )

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3. Notifications
Molecular Epidemiology and Evolutionary Genetics of Infectious Diseases
The 8th International Meeting “Molecular Epidemiology and Evolutionary Genetics of Infectious Diseases” (MEEGID VIII) will be held in Bangkok, 30 Nov-4 Dec 2006. It will be co-organized by the US CDC, the Centre National de la Recherche Scientifique and the Institut de Recheche pour le Developpement in France. Mahidol University will be an offficial co-organizer, which will be supported also by the French Embassy. MEEGID meetings are organized in synergy with the journal Infection, Genetics and Evolution. Communications on genetics, genomics, proteomics, population biology, mathematical modelling, bioinformatics are welcome. They can deal with the host, the pathogen or the vector. All pathogens are within the scope: viruses, parasitic protozoa, helminths, fungal organisms, prions. All infectious models can be considered, including those of veterinary or agronomical relevance. Papers accepted for MEEGID VIII will be published in a special issue of Infection, Genetics and Evolution. MEEGID VIII will include plenary lectures, specialized symposia, “express-debates” and poster sessions. Emphasis will be given to health problems of special interest to Thailand and South-East Asia: avian flu, SARS, malaria, dengue. A satellite meeting will be organized in the framework of MEEGID VIII by the think tank “Biology, Medicine and Society”. Societal problems linked to genetics, evolution and transmissible diseases will be discussed in roundtables.

Michel Tibayrenc, MD, PhD; Editor-in-chief Infection, Genetics and Evolution; IRD representative in Thailand: Michel.Tibayrenc@ird.fr ; http://www.th.ird.fr. (Promed 1/31/06)

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HHS and Institut Pasteur Partner on Pandemic Influenza Preparedness
The U.S. Department of Health and Human Services (HHS) and Institut Pasteur (IP) agreed to carry out joint activities, beginning in Southeast Asia, to strengthen global capacity to detect influenza viruses that could have the potential to trigger a pandemic. The Memorandum of Understanding, signed by HHS and IP, establishes a Joint HHS-IP Working Group to oversee the development of collaborative projects, to include the following: Building capacity in terms of surveillance, epidemiological investigation, testing, diagnosis, and control of infectious disease in countries affected by and at-risk for the spread of the H5N1 influenza strain; Exchanging technical expertise to foster rapid response to disease threats; and Disseminating effective and accurate public information on infectious disease, including in local languages in developing countries. The working group will initially focus on activities and cooperation in Southeast Asia, where the bulk of reported cases of H5N1 avian influenza has been found. In addition, potential activities include organizing scientific conferences, conducting training exercises, and fostering exchanges among experts that will improve preparedness for and response to infectious diseases, with particular emphasis on respiratory diseases and influenza. (HHS 2/6/06 http://www.hhs.gov/news/press/2006pres/20060206.html )

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Influenza vaccination of health-care personnel: recommendations of HICPAC and ACIP
This report summarizes recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP) concerning influenza vaccination of health-care personnel (HCP) in the US. These recommendations apply to HCP in acute care hospitals, nursing homes, skilled nursing facilities, physician’s offices, urgent care centers, and outpatient clinics, and to persons who provide home health care and emergency medical services. The recommendations are targeted at health-care facility administrators, infection-control professionals, and occupational health professionals responsible for influenza vaccination programs and influenza infection-control programs in their institutions. HICPAC and ACIP recommend that all HCP be vaccinated annually against influenza. Facilities that employ HCP are strongly encouraged to provide vaccine to their staff by using evidence-based approaches that maximize vaccination rates. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr55e209a1.htm (MMWR February 9, 2006 / 55(Early Release);1-16)

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National Black HIV/AIDS Awareness Day, Feb 7, 2006
The sixth annual National Black HIV/AIDS Awareness Day is Feb 7, 2006. This observance is sponsored by a coalition of nongovernment organizations, with support from CDC, to call attention to the disproportionate impact of HIV and AIDS on the black population in the US. In 2004, blacks accounted for 20,965 (49%) of the estimated number of AIDS cases diagnosed in the US, although they represented only 12.3% of the U.S. population. HIV/AIDS was also among the top 3 causes of death for black men aged 25--54 years and among the top 4 causes of death for black women aged 25--54 years in 2002, the most recent year for which those data are available. HIV/AIDS was the leading cause of death for black women aged 25--34 years. Race and ethnicity alone are not risk factors for HIV infection. However, blacks are more likely to face certain risk factors for HIV infection and barriers to testing and treatment, including poverty and limited access to health care and HIV prevention education. Testing, health-care, education, and prevention services remain critical to stopping the spread of HIV in this community. Information about HIV/AIDS and the black community is available from CDC at telephone 1-800-CDC-INFO and at http://www.cdcnpin.org and http://www.cdc.gov/hiv/pubs/facts/afam.htm#5. Information about National Black HIV/AIDS Awareness Day is available at http://www.blackaidsday.org.

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Surveillance Guidelines for Smallpox Vaccine (vaccinia) Adverse Reactions
In Jan 2003, the US Department of Health and Human Services implemented a preparedness program in which potential first responders to a biologic terrorism event received smallpox vaccine. As part of the program, CDC established surveillance case definitions for adverse events resulting from smallpox vaccination. This report provides uniform criteria used for the surveillance case definition and classification for adverse reactions to small vaccine. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5501a1.htm (MMWR February 3, 2006 / 55(RR01);1-16)

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4. APEC EINet activities
Pandemic influenza videoconference ; publications
EINet celebrated its 10th anniversary of service to the Asia Pacific by hosting the Virtual Symposium on Pandemic Influenza Preparedness, 20 Jan 2006, 02:00 – 07:00 UTC. Participants in the videoconference included the economies of: Australia, Canada, People’s Republic of China, Republic of Korea, Philippines, Singapore, Chinese Taipei, Thailand, USA, and Viet Nam. The collaborative event was very successful, and the economies were able to share a rich level of information and engage in productive discussions. The formal report is currently in progress. http://depts.washington.edu/einet/symposium.html.

Dr. Ann Marie Kimball, the director of APEC EINet, has recently published a comment in Lancet: "The health of nations: happy birthday WTO" (Lancet. 2006 Jan 21;367(9506):188-90.) and a book titled, "Risky Trade: Infectious Disease in the Era of Global Trade" (Publisher: Ashgate, available May 2006).

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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