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Vol. IX, No. 4 ~ EINet News Briefs ~ Feb 24, 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)
- Global: Changes in H5N1 virus may promote spread in birds
- Russia (Dagestan): Report of confirmed outbreak of H5N1 infection in poultry
- Romania (East): Report of more H5N1 avian influenza infection in birds
- Bulgaria: Excerpts from OIE report on avian influenza H5N1 in swan
- Greece: Additional suspected avian influenza H5 infection in swans
- Slovenia: Confirmation of avian influenza H5N1 infection in dead swan
- Hungary: Confirmation of avian influenza H5N1 infection in swans
- Bosnia and Herzegovina: Avian influenza H5 infection confirmed in swans
- Slovakia: Avian influenza H5 infection in wild birds
- Italy: Excerpts from OIE report on avian influenza H5N1 in swans
- France: Avian influenza H5 infection confirmed in bird; poultry to be vaccinated
- Netherlands: Preventive vaccination of poultry
- Austria: Additional bird cases of avian influenza H5N1 infection
- Germany: Multiple avian deaths infected with avian influenza H5N1 virus
- Switzerland: Preparedness against avian influenza—no vaccination of birds
- Iraq: Second human case of avian influenza H5N1 infection confirmed
- Iran: Excerpts from OIE report on avian influenza H5N1 in swans
- Azerbaijan: Excerpts from OIE report on avian influenza H5N1 in birds
- Egypt: Avian influenza H5N1 infection confirmed in birds
- Nigeria: 4 suspected human cases of avian influenza infection
- Nigeria: Avian influenza in poultry—preparedness and response
- Mauritania: Poultry deaths suspected to be due to avian influenza
- India: Avian influenza H5N1 outbreak confirmed in poultry
- India: No confirmed cases of avian influenza infection in humans
- Indonesia (East Jakarta): Nineteenth fatal case of avian influenza H5N1 infection
- Indonesia (West and Central Java): Spread of avian influenza
- Malaysia: Confirmation of H5N1 avian influenza infection in poultry
- Hong Kong: Additional avian case of H5N1 infection; strains linked to Japan/Korea strains
- Viet Nam (Hanoi): Adenovirus suspected for cases of respiratory disease
- Singapore: Contact lens-related fungal corneal infections
- Australia (West Australia): Recall of sprouts associated with salmonellosis
- USA: ACIP endorses influenza shots for 2-, 3-, and 4-year-olds
- USA: Businesses zero in on details of pandemic flu planning
- Canada (Alberta): Latest Information on BSE, as of 17 Feb 2006
- USA (New York/Pennsylvania): Anthrax case associated with animal hides
- USA: Recall of Balanced Salt Solution—reportedly over 300 patients affected
- USA (Arizona, New Mexico): 3 cases of hantavirus pulmonary syndrome

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

2. Articles
- CDC EID Journal, Volume 12, Number 3—March 2006
- Adamantane Resistance Among Influenza A Viruses Isolated Early During the 2005-2006 Influenza Season in the United States
- Pandemic Influenza: Risk of Multiple Introductions and the Need to Prepare for Them
- Mumps Outbreak at a Summer Camp --- New York, 2005
- Multistate Outbreak of Salmonella Typhimurium Infections Associated with Eating Ground Beef--United States, 2004
- Resurgence of Wild Poliovirus Type 1 Transmission and Consequences of Importation--21 Countries, 2002--2005
- Assessing Capacity for Surveillance, Prevention, and Control of West Nile Virus Infection--United States, 1999 and 2004
- Enterovirus Surveillance--United States, 2002--2004

3. Notifications
- Draft of Applied Epidemiology Competencies
- Release of Computer-Based Case Study: Gastroenteritis at a University in Texas
- Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines
- A New Product (VariZIG™) for Postexposure Prophylaxis of Varicella Available Under an Investigational New Drug Application Expanded Access Protocol

4. APEC EINet activities
- EINet participates in Bird flu Summit

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 / 4 (3)
Indonesia / 9 (8)
Iraq / 1 (1)
Turkey / 12 (4)
Total / 26 (16)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 170 (92)

The following 30 countries/territories are known to be have been infected by highly pathogenic avian influenza H5N1 virus since the start of the panzootic Dec 2003: Austria, Azerbaijan, Bosnia Herzegovina*, Bulgaria, Cambodia, China, Croatia, Egypt, France, Germany, Greece, Hong Kong, Hungary, India, Indonesia, Iraq*, Iran, Italy, Japan, Kazachstan, Korea, Laos, Malaysia, Mongolia, Nigeria, Romania, Russia, Slovakia*, Slovenia, Thailand, Turkey, Ukraine, Vietnam.

* virus identified as H5.
(WHO 2/20/06 http://www.who.int/csr/disease/avian_influenza/en/ ; Promed 2/22/06, 2/23/06)

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Global: Changes in H5N1 virus may promote spread in birds
On 21 Feb 2006, WHO said, "Some recent evolutionary changes in the H5N1 virus appear to have made control efforts more difficult and further international spread of the virus in birds more likely." Among other things, the agency said H5N1 viruses now may be able to infect some wild birds without harming them, making it possible for migratory species to carry the virus for long distances. In addition, H5N1 viruses have grown more lethal to laboratory chickens. Most of the affected European countries have good veterinary surveillance and have found the virus only in a few wild birds, WHO said. At the other end of the spectrum, Iraq's bird outbreak was identified only after a fatal human infection was found. In Azerbaijan and Egypt, die-offs of poultry heralded the spread of the virus. Nigeria and India's cases were found on commercial farms.

WHO said viruses from recent avian outbreaks have shown "remarkable similarity" to those found in migratory birds that died at China's Qinghai Lake in 2005. "Evidence is mounting that this event. . .signaled an important change in the way the virus interacts with its natural reservoir host," the agency said. Before the Qinghai Lake die-off, the virus caused only a few scattered deaths among migratory waterfowl, and the latter were not known to carry the pathogen long distances, WHO said. Viruses from Qinghai Lake had a distinctive mutation that has been linked experimentally with greater mortality in birds and mice, the WHO said. Viruses from the recent outbreaks in Nigeria, Iraq, and Turkey, as well as from earlier outbreaks in Russia, Kazakhstan, and Mongolia, are "virtually identical to Qinghai Lake viruses. It is considered unusual for an avian influenza virus causing outbreaks in birds to remain this genetically stable over so many months. This finding raises the possibility that the virus, in its highly pathogenic form, has now adapted to at least some species of migratory waterfowl and is coexisting with these birds in evolutionary equilibrium. . .and traveling with these birds along their migratory routes.

WHO stopped well short of assigning to migratory birds the major blame for the virus's recent spread. David Halvorson, DVM, a veterinarian in avian health at the University of Minnesota, said 22 Feb 2006 that H5N1 is probably being spread both by the movement of poultry and by wild birds. "I think that the trans-Asian railway system fits the temporal and spatial pattern of virus distribution starting in July of last summer [2005]," Halvorson commented. "For us in the Western Hemisphere, it would be extremely unusual for water birds to be migrating thousands of miles in July and August, a time when they are ordinarily taking care of their young." Even today, it is normal to ship chickens by rail in many places. Birds also can be found on buses and trucks under circumstances that could contribute to spreading the virus, Halvorson said.

Still, "Human infections remain a rare event," WHO said. To date, very few cases have been detected in poultry workers, cullers, or veterinarians. Almost all cases have been linked to close contact to diseased household flocks. No cases have been linked to the consumption of properly cooked poultry meat or eggs, even in households where disease was known to be present in flocks. Investigation of human cases in Turkey has yielded no evidence that viral mutations have changed the epidemiology of the disease in humans. However, WHO expressed concern about the virus becoming established in backyard flocks, a known risk factor for human infections. (Promed 2/22/06)

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Russia (Dagestan): Report of confirmed outbreak of H5N1 infection in poultry
An outbreak of the H5N1 bird flu virus has been registered at a poultry farm in the province of Dagestan, the second such case in the region this week. The outbreak was identified at Eldama farm, where 350 000 birds had died 25 Jan - 1 Feb 2006. An outbreak at another poultry farm in the village of Shamkhal in the North Caucasus region was announced 15 Feb 2006 by veterinary officials, who said it had been spread by wild birds. The outbreaks were the first confirmed cases of H5N1 in the Russian Caucasus, an area close to Turkey. Russian officials have warned of a possible upsurge in bird flu outbreaks towards spring, with the start of bird migrations. Russia has been battling with bird flu in poultry since Jul 2005, culling more than 600 000 domestic fowl. (Promed 2/18/06, 2/20/06)

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Romania (East): Report of more H5N1 avian influenza infection in birds
Reportedly, preliminary tests indicated the H5N1 strain of bird flu has infected birds in 2 more villages in eastern Romania. The samples were taken from several dead birds found in the villages of Vlahi, near the Danube River, and Ostrov, near the border with Bulgaria, said Grigore Mertoiu, who heads the local animal health agency. Access was limited to the villages and authorities said they would cull thousands of domestic birds. Mertoiu said the virus was likely brought to the villages by migrating birds. On 12 Feb 2006, the virus was detected in the village of Topraisar, also in the Black Sea region. Authorities have begun culling the domestic birds in the village. The Topraisar mayor was offering rations to more than 1300 families for compensation. The H5N1 bird flu strain was first detected in the Danube Delta Oct 2005.

Also, Croatia reported its second avian flu outbreak. The H5N1 strain was confirmed in Croatia 21 Feb 2006 in a dead swan on an island in the Adriatic. Elsewhere, the European Commission approved 8.35 million Euros for an emergency grant to Turkey, with co-financing by the Turkish government. The Commission grant has been made available for investments in laboratory equipment, rapid tests, and safety equipment. This will help improve animal disease surveillance, diagnostic testing and rapid response capacity. There will also be training and simulation exercises organised by the Turkish Veterinary Services and supported by the Commission. (Promed 2/16/06, 2/21/06, 2/23/06)

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Bulgaria: Excerpts from OIE report on avian influenza H5N1 in swan
Information received 12 Feb 2006 from Dr. Nikola T. Belev, Delegate of Bulgaria to the OIE: Report date: 12 Feb 2006. Identification of agent: avian influenza virus subtype H5N1. Date of first confirmation of event: 3 Feb 2006. Date of start of event: 31 Jan 2006. Details of outbreak: first administrative division: Vidin. Description of affected population: 1 fatal case of mute swan (Cygnus olor). Source of outbreak or origin of infection: unknown or inconclusive. Control measures undertaken: control of wildlife reservoirs; quarantine; movement control inside the country; screening; zoning; disinfection of infected area. Vaccination prohibited. *** On 16 Feb 2006, the EU banned imports of poultry and products from Bulgaria. (Promed 2/20/06)

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Greece: Additional suspected avian influenza H5 infection in swans
Greece said it was sending samples from 3 new cases of suspected H5 bird flu found in wild swans in northeastern Greece for testing at the UK laboratory to determine whether it was the H5N1 strain. "Today, after viral examinations we found suspected H5 bird flu in 2 samples of swans found in wetlands in the Rodopi prefecture and in 1 swan in the Halkidiki prefecture," the Greek Ministry of Agriculture said. Greece on 16 Feb 2006 confirmed another 2 cases of H5N1 bird flu, bringing to 5 the number of wild fowl infected by the disease since the first cases were discovered in Greece 11 Feb 2006. Greece has implemented measures to stop the spread of the disease, including a clamp-down on egg and poultry sales within a 10-km radius of where the infected fowl were found. The bird flu cases detected in Greece so far have only been in migratory birds. Experts say an unusually large number of migratory birds have arrived in Greece this winter, forced south from their usual wintering grounds by severe winter conditions in northern Europe. Poultry sales have reportedly fallen dramatically in Greece.

Excerpts from official OIE report:
Information received 15 Feb 2006 from Dr. Vasilios Stylas, Head, Animal Health Directorate, Ministry of Agriculture: Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of first confirmation of event: 9 Feb 2006. Date of start of event: 30 Jan 2006. Details of outbreak: first administrative division: Sterea. Affected population: a red-breasted goose (Branta ruficollis). On 3 Feb 2006, people informed the veterinary authorities about the presence of a wild goose found dead. The veterinary authorities collected the goose and immediately sent it to the national reference laboratory. Diagnostic tests used: hemagglutination test; hemagglutination inhibition test; PCR(1); other preliminary tests. Results: Positive for H5N1. Source of outbreak or origin of infection: unknown or inconclusive. Control measures undertaken: zoning. Vaccination prohibited. The Veterinary Authorities have been carrying out an epidemiological survey, and all the measures contained in European Commission Decision 2006/86/EU have been fully implemented, since 10 Feb 2006, throughout the territory of Skyros Island. Strict biosecurity measures are being applied to all backyard flocks in Skyros Island. There are no commercial poultry farms in Skyros. The OIE reference laboratory sequenced the Greek isolate and found the nucleotide sequence identified in earlier reports as being similar to isolates from Croatia, Qinghai lake (China), Turkey and Romania. (Promed 2/17/06, 2/20/06)

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Slovenia: Confirmation of avian influenza H5N1 infection in dead swan
A dead swan found in Slovenia had died of the H5N1 avian flu virus strain, according to laboratory tests performed in Italy, Slovenia said 16 Feb 2006. This is the first confirmed case of bird flu in Slovenia. Slovenia sent samples of H5 virus from a swan found dead in an area near the city of Maribor, less than 10 km from the Austrian border last week (see below). Slovenia has ordered the confinement of all poultry.

Excerpts from official OIE report:
Information received 12 Feb 2006 from Dr. Simona Salamon, Deputy Director General, Veterinary Administration of the Republic of Slovenia: Report date: 12 Feb 2006. Identification of agent: avian influenza virus subtype H5. Date of initial detection: 11 Feb 2006. Details of outbreak: First administrative division: Podravska region. Description of affected population: 1 fatal case of mute swan (Cygnus olor). Diagnostic tests used: RT-PCR (M, N, H5); virus isolation. Results: positive for H5. Source of outbreak or origin of infection: unknown or inconclusive. Control measures: quarantine; zoning; movement control within the protection zone and the surveillance zone. (Promed 2/16/06, 2/20/06)

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Hungary: Confirmation of avian influenza H5N1 infection in swans
A UK laboratory detected the H5N1 bird flu strain in 3 dead swans found in Hungary last week, confirming the first cases of the virus in the country, the government said 21 Feb 2006. Spokesman Andras Batiz said Hungarian authorities have sent 4 further samples from swans to Britain for testing from the same area in southern Hungary where the 3 swans had been found. Batiz said there was no need for further precautionary measures after the steps taken last week when the swans found near the villages of Nagybaracska and Csatalja had tested positive for the H5 virus. Hungarian authorities had applied the same precautionary measures as other EU member states in which the H5N1 virus has been confirmed or was suspected in wild birds—i.e. setting up a 3km protection zone around the area where the swans were found, and a surrounding surveillance zone of 10km. Reportedly, poultry were culled in 2 small farms as a precaution. Poultry must be kept indoors in the area, but there are no nationwide restrictions yet. Poultry sales in Hungary have been so far unaffected. (Promed 2/17/06, 2/21/06)

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Bosnia and Herzegovina: Avian influenza H5 infection confirmed in swans
The following details on the detection of avian influenza H5 in the village Plivsko jezero, Canton of Srednjobosanski are derived from the official notification sent to the OIE 20 Feb 2006 by JOZO BAGARIC, CVO, Bosnia and Herzegovina. About 15 swans arrived around 11 Feb 2006 on Plivsko lake. On 16 Feb 2006, 2 swans were showing signs of disease, killed and sent to the laboratory. Pathological findings and fast test immediately showed strong suspicion on avian influenza and further tests by egg inoculation showed H5 strain. ***Also, Bosnia banned hunting of wild fowl, ordered all poultry to be kept indoors and banned imports of live birds and poultry products from Slovenia, Italy, Greece and Bulgaria. (Promed 2/20/06, 2/21/06)

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Slovakia: Avian influenza H5 infection in wild birds
Slovakia became the eighth EU country to report bird flu after finding the H5 strain in a wild hawk and a smew, a type of duck, near its borders with Austria and Hungary. The dead birds have been sent to the UK laboratory for further analysis to see whether it is H5N1. The Slovak authorities have set up a 3km exclusion zone and a 10km surveillance zone around each of the sites, in accordance with EU policy. (Promed 2/22/06)

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Italy: Excerpts from OIE report on avian influenza H5N1 in swans
Information received 11 and 14 Feb 2006 from Dr. Romano Marabelli, Head of the Department for Veterinary Public Health, Nutrition and Food Safety, Ministry of Public Health: Report date: 14 Feb 2006. Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of first confirmation of the event: 11 Feb 2006. Date of start of the event: 1 Feb 2006. Description of affected population: mute swans (Cygnus olor). Source of outbreaks or origin of infection: unknown or inconclusive. Control measures undertaken: control of wildlife reservoirs; movement control inside the country; screening; zoning; disinfection of infected premises/establishment(s). For further details, see http://www.oie.int/eng/info/hebdo/AIS_31.HTM#Sec10. ***Reportedly, 30 000 workers in Italy have been laid off as demand for chicken plunged by 70 percent. (Promed 2/20/06, 2/21/06)

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France: Avian influenza H5 infection confirmed in bird; poultry to be vaccinated
Tests on a duck found in eastern France showed it had the H5 strain of bird flu and probably had the H5N1 strain, the Agriculture Ministry said. Further tests were being conducted on the duck, which was found dead 13 Feb 2006. Also, the owner of an indoor turkey farm in the same region where the H5 virus was found alerted authorities to abnormally high death rates in his flock of more than 11 000 birds. The entire flock was slaughtered and other containment measures to isolate the area were triggered pending confirmation of H5N1 infection. The concern was that the suspected outbreak in commercial poultry has occurred in indoor, and not free-range birds. France has been given clearance to start a limited vaccination programme which the authorities said was necessary because the nation's commercial poultry flocks are so extensive it is not possible to take them all indoors. The plan foresees the vaccination of ducks and geese in areas considered to be at high risk of avian influenza. The intention is to begin vaccination immediately and continue until 1 Apr 2006, during which time around 900 000 birds are expected to be immunized. The EU outlined the measures that would be followed with regard to the vaccinated birds. These include the use of sentinel birds (i.e. unvaccinated control birds) to monitor for an avian influenza outbreak in the vaccinated flock, regular testing of the vaccinated and sentinel birds, and the continued application of bio-security provisions already in place. Vaccinated poultry, their hatching eggs and day-old chicks cannot be exported or moved to any third country, including countries in the EU. There are strict conditions on the movement of vaccinated birds within France. Fresh meat and meat products from vaccinated poultry will be able to be sold in the EU, provided the strict conditions have been complied with by the farm. (Promed 2/17/06, 2/22/06, 2/23/06)

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Netherlands: Preventive vaccination of poultry
Dutch vets found no bird flu in 2 dead swans (found in central Netherlands) 17 Feb 2006 but authorities decided to speed up poultry vaccination plans. The country is Europe's second biggest poultry producer after France and a top world exporter. The Netherlands’ poultry exports are worth 1.6 billion euros a year. The Dutch recommended preventive vaccination of poultry in densely populated Netherlands, as the risk is seen as high because of the huge numbers of farmed birds. For the Netherlands, the EU approved vaccination for hobby birds (poultry kept by households for strictly personal use), as well as free-range laying hens throughout the country as an alternative to bringing birds indoors. Biosecurity measures are mandatory whether the owners have vaccinated poultry or not. Vaccinated hobby poultry will only be allowed to be moved to another vaccinated holding, and only with permission. Meat and meat products from hobby poultry are not permitted to be commercially traded anyway, so no extra regulations are required. For vaccinated free-range commercial poultry, there will be strict limits on movements within the Netherlands, and a ban on movement to any other countries. The Dutch plan contains mandatory surveillance and control measures for vaccinated commercial poultry. Full bio-security measures will be required. Eggs, meat and meat products from vaccinated Dutch flocks will be permitted to be traded within the EU, provided the farms and packagers have fully complied with the strict regulations in place.

Elsewhere, the current British position is that vaccination would be countenanced only for birds in zoos or collections, or endangered or exotic species. There is concern that a vaccine will mask the disease and may even spread infection. Each of the 150 million birds in Britain would have to be inoculated manually, and it can take 3 weeks for a bird to develop protective immunity. British authorities have also not ordered its free-range poultry under cover to protect it from infection, a move opposed by the poultry industry [because the poultry will lose its valuable free-range designation]. Officials say they will do so only if the virus is discovered in the UK. (Promed 2/18/06, 2/22/06, 2/23/06)

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Austria: Additional bird cases of avian influenza H5N1 infection
Authorities have found the H5N1 bird flu virus in 2 chickens and 3 ducks in an animal sanctuary in Graz, the regional agriculture ministry said 22 Feb 2006. While Austria's health ministry said the birds were not part of any commercial stock, the birds are the first case of domestic poultry carrying the H5N1 virus in the European Union, rather than in wild birds. The birds had been kept in the same cage as a swan brought to the sanctuary from the area previously hit by the virus, violating regulations imposed after the first occurrence of the virus in Austria. The swan had died in the animal sanctuary last week, prompting the slaughter and testing of all 30 birds that had been kept there. Earlier, Austria found 2 more cases of H5N1 virus infection near Vienna. Health Minister Maria Rauch-Kallat said that a dead swan found in the Vienna suburb of Donaustadt and a dead duck found in nearby Lower Austria province had tested positive for H5N1. In southern Austria, 4 swans and a duck tested positive for H5N1 earlier. Since 19 Feb 2006, the entire country is defined as a "risk area," with all poultry to be kept in stables, enforced biosecurity measures, and prohibition of bird markets according to EU-legislation. Protection and surveillance zones have been established around the detected reservoirs. (Promed 2/18/06, 2/20/06, 2/22/06)

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Germany: Multiple avian deaths infected with avian influenza H5N1 virus
Some 110 wild birds have now tested positive for bird flu since the disease first reached Germany 14 Feb 2006, mostly on Ruegen. Migrating swans accounted for most of the cases, but there have been other wild aquatic birds and a hawk. Genetic analyses of the infected birds revealed closest relationship with recent isolates from Romania, and, more distantly, with sequences from whooper swans of Lake Erkhul, Mongolia. One of the birds to test positive for H5N1 carried a ring that was attached in 2005 in Latvia. The disease has now also been confirmed in birds on the German mainland. The district council in Ruegen had been criticised for slow action. The army is collecting dead birds now in Ruegen. Monitoring activities of wild birds in surrounding areas have been increased. Protection and surveillance zones targeting poultry holdings have been immediately implemented according to EU legislation. A state of emergency was declared in 2 districts of Mecklenburg-Western Pomerania to allow the army to be deployed for disease control measures. Domestic birds in Germany are now required to be indoors to prevent contact with wild fowl. Seehofer urged state officials to be rigorous in enforcing the measures and advised Germans to avoid contact with wild birds. (Promed 2/18/06, 2/19/06, 2/22/06, 2/23/06)

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Switzerland: Preparedness against avian influenza—no vaccination of birds
EU agriculture ministers met 20 Feb 2006 to discuss ways to combat bird flu, including a Europe-wide vaccination programme. "In the current situation Switzerland will not vaccinate poultry," said Marcel Falk, spokesman for the Swiss Federal Veterinary Office. "In our view it would be too risky. If bird flu is introduced to our chicken population, it's vital that it's detected quickly. "Vaccinated animals still get infected and pass the virus to other animals. But they don't get sick and die, so you can't recognise if bird flu has been introduced." He said vaccination made sense if the virus was widespread, as in Asia, and if it was no longer possible to eradicate it. On 20 Feb 2006 the Swiss government reintroduced a ban on keeping chickens outdoors to prevent contact with migratory birds that might be carrying H5N1. Falk described this as "the most important measure to protect poultry". Christian Griot, head of the national laboratory for highly contagious animal diseases, echoed the view that rapid identification and elimination of infected birds represented the best course of action at present. ***All tested swans found dead in Switzerland in recent days have been found negative for the avian influenza virus by the reference laboratory in Zurich. About 600 swans die of normal causes every year in Switzerland, 300 of which are normally noted by the authorities, Falk explained. (Promed 2/16/06, 2/17/06, 2/21/06)

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Iraq: Second human case of avian influenza H5N1 infection confirmed
The Ministry of Health in Iraq has confirmed the country's second case of human infection with the H5N1 avian influenza virus. The fatal case occurred in a 39-year-old man from Sulaimaniyah province. He developed symptoms 18 Jan 2006 and died 27 Jan. He was the uncle of the country's initial case, a 15-year-old girl who died 17 January, and provided care for her during her illness. He also had a documented history of exposure to infected domestic birds. They died 10 days apart. Samples from an initial 15 patients under investigation for possible infection were tested at a US Naval Medical Research Unit in Egypt. Apart from the 39-year-old fatal case, all test results were negative. Duplicate samples are being sent to a WHO collaborating laboratory in the UK for further analysis. A second shipment of samples from additional patients under investigation arrived in Cairo for testing.

Talib Ali Elam, FAO's Cairo-based regional officer for animal health, said after the girl and her uncle’s deaths, the family culled all chicken, geese, turkey, ducks in Serkapkan and 36 villages around. Elam said the U.S. Navy laboratory is working through more than 100 human samples from Iraq and at least 24 samples from birds and cats. Since the confirmation of the first case, the Ministry of Agriculture has culled more than 1.5 million chickens and ducks in Iraq. The government has said it will compensate all farmers whose poultry are killed. Some farmers, especially in Kurdistan, were reportedly resisting culling measures. (Promed 2/17/06, 2/19/06, 2/20/06)

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Iran: Excerpts from OIE report on avian influenza H5N1 in swans
Information received 14 and 15 Feb 2006 from Dr. Hossein Hassani, Head of Iran Veterinary Organization (IVO), Ministry of Jihad-e-Agriculture: Report date: 15 Feb 2006. Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Number of animals in the outbreak: susceptible (3000); cases (153); deaths (153); destroyed (0); slaughtered (0). On 2 Feb 2006, within the framework of the Avian Influenza Passive Surveillance Plan in place for wild birds in Gilan province, a few deaths were reported among swans in 2 marshes (Selkeh and Espand) at Somaesara (Anzali wetland). Species examined: swan samples. Diagnostic tests used: Hemagglutination inhibition and neuraminidase inhibition tests. Results: Positive for subtype H5N1. Amino acid sequence at cleavage site indicates a highly pathogenic avian influenza profile. Source of outbreaks or origin of infection: unknown or inconclusive. Control measures undertaken: preventive culling of domestic birds within a 2-km radius around the marshes of Selkeh and Espand; quarantine; movement control inside the country; screening; zoning; disinfection of infected premises/establishment(s). An investigation was carried out as a qualitative risk assessment in the area where dead and sick swans were found. Protection and surveillance zones were established. Owners of culled birds compensated. All the poultry holdings around the wetland have been identified, appropriate on-farm biosecurity measures have been implemented, movements of poultry products are under control, check point stations are in place for the control of illegal movement, disease awareness among owners has been increased, assembly of live birds at markets and other gatherings is prohibited and under control. Hunting of birds has been prohibited for the past 6 months, and transport, dispatch and movement of risk material is prohibited. Vaccination prohibited. (Promed 2/20/06)

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Azerbaijan: Excerpts from OIE report on avian influenza H5N1 in birds
Information received 15 Feb 2006 from Dr. Ismayil Murshud Gasanov, Head, State Veterinary Service, Ministry of Agriculture: Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of first confirmation of the event: 10 Feb 2006. Date of start of the event: 29 Jan 2006. Details of outbreak: First administrative division: coastal area in the vicinity of Baku. Description of affected population: various migratory birds. Laboratories where diagnostic tests were performed: OIE Reference Laboratory for avian influenza in UK. Diagnostic tests used: virological tests. Results: positive. Source of outbreak or origin of infection: unknown or inconclusive. Control measures undertaken: control of wildlife reservoirs; movement control inside the country; disinfection of infected areas. Treatment of affected animals: no. ***It was reported 23 Feb 2006 that detection of the virus has coincided with die-offs of domestic birds. (Promed 2/20/06, 2/23/06)

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Egypt: Avian influenza H5N1 infection confirmed in birds
The South Korean Embassy in Egypt issued a travel warning 21 Feb 2006 for Egypt following the spread of avian flu throughout the country. More than 50 000 South Koreans travel to Egypt each year, according to official data. Quoting the Egyptian government's announcement, officials at the embassy said the H5N1 bird flu virus was increasingly prevalent in Cairo and some other popular tourist areas. The South Korean Embassy in Cairo advised travelers to avoid contact with those poultry and immediately go to hospital if they experience fever, cough and respiratory problems. Also, Egyptian authorities closed 8 state-run zoos for 2 weeks from 19 Feb 2006, after 83 birds died at a zoo. The Health Ministry said that 6 of the 83 dead birds had tested positive for bird flu. The ministry said they included species of ducks, turkeys and geese. The zoo has slaughtered 563 birds and drained all the ponds there. Disinfection around the cages was performed.

In Egypt, outbreaks in domestic poultry have now been confirmed in 10 governorates. Egypt has banned the import of live birds and has tightened quarantine controls at airports. It has also cancelled the annual bird hunting season. 2 million (domestic) birds have, reportedly, been culled. On 19 Feb 2006, merchants who normally slaughter and sell live chickens had closed in compliance with a ban. The movement of poultry between the governorates has been banned and trucks prohibited from entering Sinai and Sharm-el-Sheikh. Though the price of poultry meat has plummeted to USD 0.20 - 0.70 per kg, customers stay away. The Ministry of Defense has been recruited to assist in operations. The government said it was importing 73 000 doses of Tamiflu.

Excerpts from official OIE report
Information received 18 Feb 2006 from Dr. Ahmed Tawfik Mohamed, Chairman of the General Organization for Veterinary Services, Ministry of Agriculture: Report date: 19 Feb 2006. A total of 7 outbreaks of Highly Pathogenic Avian Influenza were reported in 5 governorates in Egypt: Cairo, Giza, Menia, Quena, Qualiubia, Behera, Dakahlia. The cases were diagnosed by Animal Health Research Institute and confirmed by NAMRU-3 as H5N1. Date of first confirmation of the event: 17 Feb 2006. Control measures: Quarantine of infected areas; Disinfection of infected premises; Condemnation and sanitary disposal of birds at infected areas. (Promed 2/17/06, 2/19/06, 2/20/06, 2/21/06, 2/23/06)

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Nigeria: 4 suspected human cases of avian influenza infection
To date, 4 patients with respiratory symptoms and a history of exposure to diseased poultry have been investigated for possible infection. This number includes a woman who died of an acute respiratory illness 16 Feb 2006. The 3 remaining patients are all in good condition. Arrangements are being made to send samples from all 4 patients to the UK laboratory. The initial outbreak in Kaduna state is now known to have begun 10 Jan 2006, raising the possibility that earlier human exposures and cases may have occurred in that area and elsewhere. At hospitals in Kaduna, Kano, and Katsina, near affected farms, staff from the WHO-led teams have now examined hundreds of patient records, searching for possible cases that may have occurred earlier. No such cases have been identified to date. The scale of the outbreak in birds is not yet fully understood. Most investigations have followed poultry deaths on large commercial farms, where outbreaks are highly visible. Little is known about the presence of the virus in small backyard flocks, where the greatest risk of human exposures and infections resides. Rapid spread of the virus within Nigeria has raised concern over possible spread to neighboring countries. Borders are porous, and restrictions on the movement of people and poultry are difficult to enforce. WHO staff are monitoring the situation closely in collaboration with government officials. (Promed 2/22/06)

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Nigeria: Avian influenza in poultry—preparedness and response
The H5N1 avian influenza virus continues to spread in poultry in Nigeria and could cause a regional disaster, FAO said 22 Feb 2006. Joseph Domenech, FAO's Chief Veterinary Officer, said, "The movement and trade of poultry have strongly contributed to the further spread of the virus. The government has taken the right measures. . .but the authorities are facing immense difficulties to enforce controls. Considering the possible widespread entrenchment of the disease in poultry, FAO is advising the government to prepare for a targeted vaccination campaign. Culling and the application of biosecurity measures alone may not stop the spread of the virus," he added. Vaccination campaigns will require the mobilization of several thousand veterinarians and will need a strong commitment from Nigerian authorities and the support of the international community. Surveillance teams should be able to monitor the situation and intervene immediately when an outbreak occurs. The government resolved to ban rearing and stocking of poultry within residential premises in the Federal Capital Territory, Abuja. FAO and the OIE in collaboration with the African Union are assisting the government in assessing the situation and defining strategies to stop the spread of the disease (i.e. building up strategic stocks of vaccines, syringes and protective gear). Equipment such as generators for electricity supply, computers and laboratory equipment are urgently needed. The country has established an avian influenza crisis center for the rapid collection and dissemination of information. "Compensating farmers for the loss of their animals is another important tool to encourage early reporting of outbreaks and for effective application of control measures," Domenech said. Massive communication campaigns are needed to support control efforts and reduce the potential exposure of people to infected poultry. UNICEF has initiated a communication campaign. FAO reiterated that people should avoid contact with diseased or dead birds, maintain personal hygiene after handling poultry or poultry meat and should cook chicken meat and eggs at or above 70 C throughout the product. In outbreak areas, chicken and eggs should not be eaten.

FAO has allocated around USD 1 million to support surveillance and control activities in Nigeria, Niger, Algeria, Mauritania, Egypt, Tunisia, Chad, Benin, Togo, Ghana, Ivory Coast, Guinea, Guinea Bissau, Senegal, Burkina Faso, Liberia, Sierra Leone, Gambia, Mali and Cameroon. This will allow recruiting local consultants and procuring items for surveillance and training. Personal protective equipment has been procured for Nigeria and Niger. Nigeria's poultry population is estimated at 140 million. Backyard farmers account for 60 percent of all poultry producers, commercial farmers for 25 percent and semi-commercial farmers for 15 percent. (Promed 2/16/06, 2/22/06)

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Mauritania: Poultry deaths suspected to be due to avian influenza
Reportedly, several suspicious deaths of poultry have been reported over the past few days in the Mauritanian locality of Toufde-Civet, Kaedi region, within the Senegal River basin. A joint delegation from the ministries of health and of rural development and environment visited the area. The team helped slaughter and incinerate chickens, and samples were taken for analysis in Senegal. The delegation considered the zone to be "a possible bird flu infection area." Authorities banned all poultry imports from Nigeria, which accounts for more than 30 percent of Mauritania's poultry supply. Mauritania is considered a major route for migratory birds from Europe. The Arab Maghreb Union member States recently adopted a joint plan to fight bird flu. (Promed 2/17/06)

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Asia
India: Avian influenza H5N1 outbreak confirmed in poultry
On 18 February, agricultural authorities in India confirmed the country's first outbreak of highly pathogenic H5N1 avian influenza in poultry. The disease was detected at several commercial farms in the Navapur sub-district in the western state of Maharashtra. India's Animal Diseases Laboratory confirmed H5N1 also near Surat, in neighboring Gujarat. Prior to that date, large numbers of poultry deaths, at more than 50 farms in the area, had been noted, but the cause was initially diagnosed as Newcastle disease. The outbreak is now thought to have begun 27 Jan 2006. Reportedly, some backyard farms are also affected. Mass culling of bird at affected farms continued—a Maharashtra state official said about 300 000 birds have been culled so far with tens of thousands more to be killed. Reportedly, poultry workers used little protective gear to bury thousands of culled chickens in farms in Nandurbar, ignoring warnings by health officials. According to the Navapur Poultry Farmers Association President, there are nearly 1.2 - 1.4 million laying birds in 60-odd poultry sheds around Navapur. India's poultry population was 489 million in 2003, according to the latest livestock census, released 2005. Reportedly, thousands of chickens had also been found dead in various areas of Pakistani Kashmir.

Excerpts from official OIE report
Information received 20 Feb 2006 from Mr. P.M.A. Hakeem, Secretary to the Government of India, Ministry of Agriculture, Department of Animal Husbandry and Dairying: Report date: 18 Feb 2006. Precise identification of agent: Avian influenza virus type H5N1. Location of the outbreaks: Navapur, Nandurbar district, Maharashtra state. Date of first confirmation of the event: 18 Feb 2006. Date of start of the event: 27 Jan 2006. Description of affected population: outbreaks in poultry (chickens) occurred both in commercial and backyard farms. Origin of infection: under investigation. Control measures undertaken: Culling and stamping out all domestic poultry within a radius of approximately 3-4 km, followed by thorough disinfection of premises; Vaccination of all poultry within a zone of approximately 6-7 km around the zone of culling/stamping out; Movement control within the infected zone; Quarantine; Surveillance has been intensified around the infected area as well as in the entire country; Rapid response teams, both from veterinary and public health authorities, are in place. (Promed 2/20/06)

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India: No confirmed cases of avian influenza infection in humans
The Ministry of Health and Family Welfare in India has informed WHO that no human cases of H5N1 infection have been detected to date. Tests conducted on samples taken from persons under investigation and their close contacts (approximately 90 persons) have yielded no positive results. On 23 Feb 2006 Indian authorities cleared of suspected H5N1 infection 11 out of 12 people in Navapur (Maharashtra state) quarantined following an H5N1 outbreak in chickens. The pending suspected case is reportedly a 27-year-old man from Gujarat State, said to have died of respiratory disease 17 Feb 2006. Authorities were continuing their house-to-house surveillance in the infected zone to identify suspected cases among those exposed to the infected poultry. The health of workers and officials involved in the culling of chickens in the infected zone was also being monitored, the Health Ministry said. The government has equipped a Navapur hospital for the management, in isolation, of possible human cases. An additional 3 patients have been hospitalized, also for observation, in the Vaira sub-district of the adjacent Gujarat state.

WHO strongly recommends that patient samples be sent to a WHO collaborating laboratory for confirmation. Analyses conducted by WHO-approved labs can also yield information about the possible evolution of the virus and clues about how the virus may have arrived in the country. Genetic and antigenic studies of circulating viruses also help ensure that work on the development of a pandemic vaccine stays on track. In India, where hundreds of millions of people live in rural areas side-by-side with livestock and domestic fowl, the risk of human infection is deemed higher than in other countries. WHO has supplied about 200 bottles of Tamiflu in syrup form. The government is also inviting bids from Cipla, Hetero and Ranbaxy for supply of anti-viral drugs. The federal Health Ministry said it had 50 000 courses of Tamiflu in stock. Another 20 000 courses had been ordered and were expected by 23 Feb 2006. Analysts have warned that if the outbreak is not contained, the economic costs to Asia's third largest economy, which is forecast to grow around 8 percent in the current financial year to Mar 2006, would be "very, very high." Reportedly, demand for chicken meat has gone down in parts of India. (Promed 2/19/06, 2/21/06, 2/22/06, 2/23/06)

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Indonesia (East Jakarta): Nineteenth fatal case of avian influenza H5N1 infection
The Ministry of Health in Indonesia has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 23-year-old man from East Jakarta who was employed as an egg seller at a wet market. He developed symptoms 5 Feb 2006, was hospitalized 7 Feb, and died 10 Feb. None of the contacts traced showed influenza-like illness. According to WHO, the newly confirmed case brings the total in Indonesia to 26 (reported as 27 by the Indonesian Health Ministry). Of these, 19 were fatal. Indonesia is the country with the most bird flu deaths so far in 2006. (Promed 2/18/06, 2/20/06)

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Indonesia (West and Central Java): Spread of avian influenza
Officials are planning emergency measures to deal with a spike in the incidence of avian flu in densely populated West and Central Java. Data show that chickens tested positive for the H5N1 virus in 17 of the 25 regencies in West Java, while human infection has been found in 12 regencies. Fatimah Resmiati of the West Java health office blamed the fast spread of the virus on the limited control of the traffic of live chickens in West Java. West Java Governor Danny Setiawan was scheduled to hold an emergency meeting on curbing the spread of bird flu 19 Feb 2006. In Central Java, representatives from the province's 35 regencies will be invited to a ceremony for the avian flu eradication campaign in Ungaran, Semarang regency, 21 Feb 2006. Central Java Deputy Governor Ali Mufiz said 16 Feb 2006 that the government would go ahead with its plan to undergo mass culling of infected chickens. Central Java Governor Mardiyanto also confirmed in Surakarta that mass culling would be conducted in 5 regencies, Boyolali, Klaten, Karanganyar, Sukoharjo and Sragen, where 151 000 of 161 640 chickens tested positive for the virus. The provincial administration earmarked Rp 32 billion (USD 3.45 million) for the culling, with farmers compensated at Rp 10 000 (USD 1.85) for each chicken killed. The Central Java health office will also distribute 12 million bird flu vaccine samples this year, more than double the amount distributed last year. (Promed 2/19/06)

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Malaysia: Confirmation of H5N1 avian influenza infection in poultry
The Agriculture and Agro-Based Industry Ministry has confirmed that the deaths of chickens at 4 villages along Jalan Genting-Klang were caused by avian influenza H5N1. Minister Tan Sri Muhyiddin Yassin said all chickens in Kampung Pasir Wardieburn, Taman Danau Kota, Pekan Danau Kota and Kampung Belakang JPJ had been culled [kampung means "village"]. Reportedly, 495 chickens, ducks and birds were culled by 22 Feb 2006. The affected areas lie within a 1.5-km radius of the source of the outbreak in Kampung Pasir Wardieburn. Besides culling the chicken, the integrated action also included setting up checkpoints and patrolling the roads in the affected areas, he added. He said all chicken coops in the area would be disinfected, and urged the public to contact the department if there were any large-scale deaths of any type of bird. Selangor and Federal Territory Poultry Traders Association adviser Datuk Dr Lee Chong Meng said it was possible that the villagers smuggled in fighting cocks from Thailand and these birds may have infected the kampung chickens. He stressed that chickens were still safe for consumption as no commercial chickens were involved. Singapore is suspending poultry and egg imports from Selangor. Stock prices of poultry companies listed on Bursa Malaysia plummeted after the suspected case became known. This is the second time there had been H5N1 case reported in the country in the past 3 years. The last case in 2004 was in Kota Baru where several fighting cocks smuggled in from Thailand died of the disease. (Promed 2/21/06, 2/22/06)

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Hong Kong: Additional avian case of H5N1 infection; strains linked to Japan/Korea strains
A common magpie found dead has tested positive for the H5N1 avian influenza virus, the government said 18 Feb 2006. It was the ninth bird to be found infected with the disease since late Jan 2006 in Hong Kong, and the government warned people to avoid touching wild birds or poultry. The bird was found dead in Sham Shui Po, a district crammed with open-air markets, run-down residential buildings and often unsanitary alleyways. The government also said it was testing another common magpie for H5N1 after the bird was found dead 17 Feb 2006 in Mongkok, another heavily populated district that is home to a pet bird market. Magpies are common in this city and often kept as pets. The Hong Kong government began enforcing a ban on backyard poultry. Household chickens are not protected by biosecurity measures and experts see them as a weak link that could allow the virus to fester and mutate into a pandemic strain.

Virus samples taken from wild birds found dead in Hong Kong recently were closely linked to a strain of the H5N1 virus that surfaced in Japan and South Korea in 2004, but not the one spreading in Europe and Africa. This finding suggests that apart from the strain circulating in Europe, there could be a reservoir of another strain of the H5N1 virus that is entrenched, probably in wild birds, said microbiologist Malik Peiris of the University of Hong Kong. Experts believe that the more distinct and lethal strains there are, the greater would be the risk to humans. 8 wild birds and 2 stray chickens were found dead with the H5N1 avian influenza virus in Hong Kong recently, although poultry farms here have not been affected so far. Hong Kong scientists analyzing virus isolates from the dead birds found that their genotype belongs to a strain called the V-genotype, which was found in dead birds in Japan and South Korea in 2004, Peiris said. "The Japan outbreak is thought to have been introduced by wild birds as well. So one of the things under investigation is whether this is a genotype that is established in wild birds. . ." Peiris said the strain spreading in Europe was not linked to the V-genotype, but rather to the strain found in dead migratory birds in China's Qinghai Lake in mid 2005. The V-genotype is not known to have surfaced in countries in Southeast Asia, Peiris added. Peiris said: "There is very little risk of infection directly from wild birds to humans. The risk is that wild birds can introduce the virus into poultry, then the virus amplifies in the poultry, and of course, the human exposure then becomes much greater." (Promed 2/18/06, 2/22/06)

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Viet Nam (Hanoi): Adenovirus suspected for cases of respiratory disease
Concerns about the spread of a respiratory disease among children are growing more serious for parents in Hanoi, as an increasing number of young patients are hospitalised. A report from the Hanoi-based Central Hospital for Paediatrics stated that for 2 weeks now, thousands of children have been hospitalised daily to be checked, many showing signs of respiratory disease. On 21 Feb 2006, 3/4 of the 900 children at the hospital showed some of the disease's symptoms, including coughing, high fever and diarrhoea. According to the hospital's deputy director, Dr Nguyen Van Loc, the reason for the increasing number of affected children was the recent change in seasons, which gave rise to favourable conditions for viruses and bacteria to flourish. According to the hospital's doctors, the disease usually affects small children but this year had spread to children aged from 3 to 15. Children with weak resistance to viruses were especially prone to infection in schools with overcrowded classrooms. Also, Saint Paul Hospital in Hanoi has received over 1500 children affected by respiratory diseases. Many of them were diagnosed with adenovirus infection. Most sick children were quickly taken to hospital, so many of them have recovered and been discharged. Adenovirus is a common virus that flourishes between winter and spring. It claimed the life of 1 student in Tay Ho District, early Feb 2006. Dr Loc warned parents to take careful precautions to keep their children warm and minimise their exposure to sudden changes in temperature. The disease spreads via the respiratory system, said Dr Loc, so children should maintain good dental hygiene as well as practise food safety and general hygiene. Children should also be isolated from other children who had contracted the disease, he said. (Promed 2/23/06)

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Singapore: Contact lens-related fungal corneal infections
Investigations are still ongoing on the cause of the recent reported incidence of contact lens-related fungal corneal infections. As a precautionary measure, Bausch & Lomb (S) Pte Ltd has voluntarily suspended sales of its ReNu multipurpose solution and is cooperating with the Ministry of Health and Health Science Authority in the investigations. In response to the spike of cases Jan 2006, MOH had initiated active case finding of fungal corneal infections that have occurred since 2005. As of 20 Feb 2006, MOH has found 39 cases of fungal corneal infection (which tested positive for Fusarium) with a history of contact lens use. Out of the 39 cases, 34 said that they had used ReNu, 4 were unsure of the brand of contact lens solution they used and 1 other had used a different brand. 92 percent of the 39 cases started developing infection in the second half of 2005 onwards. There are 20 males and 19 females. Half of all cases were in the 15-24 years age group while an additional quarter were aged 25-34 years. MOH strongly advises all contact lens users as a precautionary measure to discontinue the use of B & L ReNu multipurpose contact lens solution for the time being. The high incidence of fungal corneal infections is unprecedented, as most corneal infections related to contact lens use had previously been bacterial in nature. Fungal infections of the cornea are also more difficult to treat and can have adverse visual consequences if diagnosed and treated late. Some of the patients have suffered significant loss of vision in the affected eye as a result of the fungal corneal infection. Fusarium is a filamentous fungus widely distributed on plants and in the soil. As well as being common contaminants and well-known plant pathogens, Fusarium spp are causative agents of superficial and systemic infections in humans. Trauma is the major predisposing factor for development of cutaneous or corneal infections due to Fusarium strains. (Promed 2/23/06)

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Australia (West Australia): Recall of sprouts associated with salmonellosis
Small children are among more than 100 West Australians who have fallen ill with salmonella poisoning after eating sprouts. Contaminated alfalfa sprouts, mung beans, bean shoots and other sprout products have been sold in supermarkets since Nov 2005, resulting in 110 reported cases of food poisoning. An investigation led to the sprout products being pulled from supermarket shelves 17 Feb 2006. The department believes animal waste is a likely reason for salmonella in the sprouts, which were germinated in South Australia. West Australian Health Department communicable disease control director Paul Van Buynder urged people to discard any Parilla Fresh sprouts products. He said it was rare for the particular strain of salmonella to result in death and said no one had been admitted to hospital after eating the sprouts. (Promed 2/21/06)

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Americas
USA: ACIP endorses influenza shots for 2-, 3-, and 4-year-olds
A federal advisory committee recommended that children aged 2 through 4 and their household contacts and caregivers get annual influenza shots, a move that increases the number of people included in official flu-immunization recommendations by more than 16 million. Since 2004 CDC has recommended flu shots for children aged 6 to 23 months. CDC's Advisory Committee on Immunization Practices (ACIP) has now voted to recommend expanding this recommendation to include ages 24 through 59 months (2-, 3-, and 4-year-olds). The expanded recommendation will cover about 5.3 million children and 11.4 million household contacts and caregivers, CDC said. Dr. Anne Schuchat, director of CDC's National Immunization Program, said, "Vaccination of children 24 to 59 months old will likely reduce the risk of influenza-related complications for all children in this age group, not just those identified as those with the highest risk of complications from influenza." The ACIP continues to "strongly" recommend vaccination of children who have chronic medical conditions such as asthma, diabetes, kidney disease, or weakened immunity, CDC said. The panel will continue to consider new flu vaccination strategies, "including the possibility of expanding routine influenza vaccination recommendations to the entire US population," the agency said. CDC said manufacturers have indicated that they plan to produce between 100 million and 120 million doses of flu vaccine for the 2006-07 season. Besides 6- to 23-month-old children, people for whom CDC already recommends flu immunization because of an increase risk of flu complication include those aged 50 and older, those with certain chronic medical conditions, nursing home residents, children and adolescents on long-term aspirin therapy, and pregnant women. Immunization is also advised for healthcare workers and household contacts and caregivers of people at increased risk for flu complications. (CIDRAP 2/23/06 http://www.cidrap.umn.edu/ )

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USA: Businesses zero in on details of pandemic flu planning
Critical for businesses in preparing for a flu pandemic will be taking care of their primary asset—their employees. This was an overarching theme expressed by participants in the Business Planning for Pandemic Influenza: A National Summit. The conference was hosted by the University of Minnesota's Center for Infectious Disease Research and Policy in collaboration with the Minnesota and US Chambers of Commerce. Results of breakout sessions showed that good communication with employees was seen as essential, with a focus on providing clear, accurate, and honest information both prior to and during a pandemic. Of primary importance to a business is having an adequate workforce that can be drawn upon, given the prediction that a large percentage of workers may be unable to fulfill their responsibilities over the span of a pandemic. Given that forewarning, employers can do a number of things to ensure worker availability and productivity. Among these is making the investment to support working from home or other remote sites and developing worker training programs that emphasize cross-training, replacement training, and recalling and training retirees. Along with a critical focus on workers, participants identified other areas of primary importance for pandemic planning:
• The need for involvement by business leaders and government leaders at the highest levels in planning strategies
• The need for regulatory relief
• The need to reconsider the consequences of the current "just-in-time" model for obtaining materials, supplies, and goods
• The need to address global considerations that include staffing issues, cultural differences, and government regulations and restrictions

Specific strategies or "best-practice" approaches to planning included development of systematic and proactive procedures to shut down and restart operations. In addition, managing client expectations in advance was seen as important to maintaining operations. For healthcare, one of the key strategies noted was to keep workers working and to continue to provide routine care along with the special care needed in a pandemic. Businesses in the field of energy said they needed to look at the minimal acceptable level of service needed to remain operational and to develop proactive plans for responding for civil disturbances. In manufacturing, the question "Will there be demand for the same products after a pandemic as there is now?" needs to be examined, that group noted. For transportation, key strategies will be to maximize efficiency and to relax existing work rules so that more products can be moved by fewer workers. (CIDRAP 2/17/06 http://www.cidrap.umn.edu/ )

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Canada (Alberta): Latest Information on BSE, as of 17 Feb 2006
The CFIA's (Canadian Food Inspection Agency) animal investigation is complete. A total of 156 cattle from the affected animal's birth cohort were identified and traced. The BSE-confirmed animal was a crossbred cow in north-central Alberta. All animals were accounted for, and no additional cases of BSE were detected. The feed investigation is nearing conclusion. A final analysis of records collected at the farm, retail and mill levels is underway. (Promed 2/20/06)

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USA (New York/Pennsylvania): Anthrax case associated with animal hides
On 16 Feb 2006, a 44 year old male presented to a hospital in Pennsylvania with respiratory symptoms including dry cough, shortness of breath and general malaise. Laboratory Response Network and Polymerase Chain Reaction on 21 Feb 2006 and gamma phage lysis on 22 Feb 2006 from blood culture isolate were positive for Bacillus anthracis (bacterium that causes anthrax). Patient resides in New York City and makes drums from unprocessed animal hides (cow and goat). Patient reports frequent travel to Africa (most recent travel 21 Dec 2005, Ivory Coast). Patient reports last work with animal hides 15 Feb 2006. Process includes cleaning and removal of hair from hides without chemical fixatives. While traveling to Pennsylvania 16 Feb 2006, the patient collapsed with rigors and was transported and admitted to a small local hospital.

Patient transferred to a tertiary care center 18 Feb 2006. Patient is reported to be stable on antibiotic therapy in the ICU without mechanical ventilation. No signs of cutaneous or pharyngeal anthrax lesions. Preliminary clinical impression suggests anthrax sepsis secondary to inhalation route of exposure due to spores from contaminated animal hides. Ongoing investigation includes environmental assessment of patients storage/work facility and home, and identification of individuals who may have had contact with unprocessed hides. At least 3 other people are given antibiotics. Tests so far both at the patient’s apartment building in Manhattan and his Brooklyn warehouse showed no evidence that anthrax had been produced there.

Anthrax is caused by exposure to B. anthracis, an encapsulated, aerobic, gram-positive, spore-forming, rod-shaped bacterium. Depending on the route of infection, human anthrax can occur in 3 clinical forms: cutaneous, inhalational, and gastrointestinal. Inhalation of aerosolized spores, such as through industrial processing of contaminated wool, hair, or hides, can result in inhalational anthrax. The incubation period for anthrax is generally less than 2 weeks. However, due to spore dormancy and slow clearance from the lungs, the incubation period for inhalational anthrax may be prolonged. Case-fatality rates for inhalational anthrax are high, even with appropriate antibiotics, and supportive care. Person-to person spread of inhalational anthrax has not been documented. For more information, see Anthrax Information for Health Care Providers http://www.bt.cdc.gov/agent/anthrax/anthrax-hcp-factsheet.asp (Promed 2/22/06, 2/23/06)

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USA: Recall of Balanced Salt Solution—reportedly over 300 patients affected
The FDA delivered a letter to Cytosol Laboratories, Inc. to request a recall of all brands and sizes of Balanced Salt Solution (BSS) that the firm manufactures. BSS is a solution used by health professionals to irrigate a patient's eyes, ears, nose and/or throat during a variety of surgical procedures. FDA requested the recall because product lots were found to have elevated levels of endotoxin. Endotoxins, also known as pyrogens, are substances found in certain bacteria that cause a wide variety of serious reactions such as fever, shock, changes in blood pressure and in other circulatory functions. FDA has received reports of a serious and potentially irreversible eye injury called Toxic Anterior Segment Syndrome (TASS) which occurs when a contaminant, such as endotoxin, enters the anterior segment of the eye during surgery and causes an inflammatory reaction. FDA has also received complaints relating to injuries in over 300 patients who were given BSS manufactured by Cytosol Laboratories, Inc. The FDA requests that the company take immediate action to retrieve all inventories of the product. FDA is instructing hospitals, physicians, and consumers to immediately stop using any of these products, quarantine any remaining product, and if no return instructions from Cytosol are received, destroy the product. An estimated 1 million units of BSS products were distributed Dec 2003 - Dec 2005. (Promed 2/18/06)

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USA (Arizona, New Mexico): 3 cases of hantavirus pulmonary syndrome
2 fatal hantavirus cases have been confirmed in Arizona in the past 6 weeks. One of them, a man in his 60s, lived in northwest Maricopa County, Arizona. He may have been exposed while sweeping mice droppings out of his garage. The second victim from Arizona was a Navajo County woman. New Mexico's first case of hantavirus for 2006 has been confirmed in a McKinley County woman. The woman was hospitalized 7 Feb 2006 in critical condition at University of New Mexico Hospital in Albuquerque. "Hantavirus is alive and well, and people still need to take precautions. In fact, we have seen an increase in cases in Arizona," Arizona state epidemiologist David Engelthaler, said. One reason for the increased number of cases is the increased number of wild mice born after last year's early rains. Now, with a drought, some of those same rodents are moving into people's homes looking for food and water.

Hantavirus pulmonary syndrome first created a scare in the Southwest in 1993 when a series of previously healthy young adults suddenly developed acute respiratory symptoms, about half of them died. The number of cases have ebbed and flowed since then, but the disease is still considered rare with a total of 416 cases nationally since the 1993 outbreak. About 36 percent of all reported cases have been fatal. There is no specific treatment, cure or prevention for the virus. However, those who are infected with hantavirus are closely monitored in a hospital and given oxygen therapy because of difficulty breathing. The virus is contracted after direct contact with the urine, droppings and/or saliva of wild rodents. (Promed 2/11/06)

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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 13 Feb 2006 report. Please see EINet’s 17 Feb 2006 Alert for further details.

USA. During week 7 (Feb 12 – Feb 18, 2006), influenza activity increased in the US. 437 specimens (15.3%) tested by U.S. WHO and National Respiratory and Enteric Virus Surveillance System 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. Seventeen states and New York City reported widespread influenza activity; 18 states reported regional influenza activity; 10 states reported local influenza activity; 4 states and Puerto Rico reported sporadic influenza activity; and the District of Columbia reported no activity.

For the comprehensive update on recent influenza activity in the USA (“Update: Influenza Activity--United States, February 5--11, 2006”): http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5506a4.htm (CDC 2/24/06 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. 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. Includes latest updates on Nigeria situation.
- 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/. USAID is increasing funding for poor countries’ preparations for a potential avian influenza pandemic.
- 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/disease_information/avian_influenza/index.jsp.
(WHO; FAO, OIE; CDC; US FDA; CIDRAP; PAHO; APHA; AVMA; USGS)

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Cholera, diarrhea & dysentery
Russia (Volgograd and Altai)
A dysentery outbreak has been registered in the Volgograd region, the regional Emergency Situations Ministry said 8 Feb 2006. The disease has been confirmed in 15 people. 20 patients suspected of having acute intestinal infection are staying in hospital. Causes of the infection outbreak are being investigated. A group of specialists is heading to the town of Alkseyevskaya of the Volgograd region to help with the sanitary and epidemiological situation.

The Prosecutor's Office of the Krasnoshchekovsky district of Russia's Altai Territory has instituted an investigation related to an intestinal infection outbreak in the Maralikha settlement correctional school. An official of the regional department of the Russian Emergency Situations Ministry said, "At present 54 children remain hospitalized, and dysentery was diagnosed in 25 children. . .A set of control measures is in place." An inspection conducted in the boarding school found that the main infection source was 1 of the canteen workers who had dysentery. Sanitary rules were not observed in the canteen, and the boarding school is overcrowded. The school has been closed. (Promed 2/10/06)

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Dengue
Australia (Queensland)
Queensland Health confirmed that there are now 7 cases of dengue, with the latest onsets of the illness reported 2 Feb and late Jan 2006. The cases were found in Cranbrook, with the health authority issuing a warning in the area where the cases were found. This follows an outbreak of the disease in the area between late Dec 2005 and mid-Jan 2006. 4 people from the same house, aged 19 to 79, were affected by the disease while another case was reported 28 Jan 2006. Townsville City Council Community Safety Committee chairwoman Councillor Jenny Hill said council staff inspected 140 properties out of 205 in the area, and 8 per cent were found to have mosquitoes breeding on the premises. "The dengue mosquito is a mosquito that primarily exists in household areas, so we need householders to look at potential breeding places. . ." she said. There were 18 confirmed cases of dengue fever in Townsville last year and 1 death in Queensland. (Promed 2/16/06)

Singapore
Singapore's worst dengue fever outbreak is under control following a sharp drop in the number of people infected. From an average of 99 weekly cases in Dec 2005, the number fell to 61 in Jan 2006, Minister for the Environment and Water Resources Yaacob Ibrahim said. The dengue fever outbreak left 19 people dead in 2005 and more than 13 000 infected with the disease, which is caused by the Aedes mosquito. At the peak of the outbreak the number of new cases reached more than 100 people a day. The wealthy Southeast Asian city-state, which has built a reputation as one of the cleanest in the region, set aside 18.4 million USD to contain the outbreaks. (Promed 2/16/06)

Viet Nam
Reportedly, some 2000 people in Vietnam's Mekong Delta were infected with dengue fever Jan - early Feb 2006, of whom 1 died. Most of the sufferers are from the provinces of Hau Giang, An Giang and Dong Thap, where weather conditions and the local people's habit of storing water in containers favored the development of mosquitoes. Residents are encouraged to kill mosquitoes and larvae more actively. Vietnam reported 49 400 cases of dengue fever infections, including 51 fatalities in 2005, down 32.7 percent and 49.5 percent, respectively, from 2004. (Promed 2/16/06)

Indonesia
A 2-year-old girl has been diagnosed with dengue fever, but due to the rising number of dengue fever patients at local hospitals, she is confined to a cot in a corridor of the hospital. The number of dengue fever patients at the hospital, according to director Mulyo Hartono, has risen markedly throughout Feb 2006. Over the last 4 weeks, his hospital has treated 87 dengue patients. Most of the patients, he said, were children, while the children's ward could only accommodate 20 patients. The head of Yogyakarta's health agency, Choirul Anwar, blamed the rise in dengue cases on local residents, who he claimed had been negligent in keeping their surroundings clean. (Promed 2/16/06)

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2. Articles
CDC EID Journal, Volume 12, Number 3—March 2006
CDC Emerging Infectious Diseases Journal, Volume 12, Number 3—March 2006 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. The following expedited article is available online: Discrimination between Highly Pathogenic and Low Pathogenic H5 Avian Influenza A Viruses, S. Payungporn.

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Adamantane Resistance Among Influenza A Viruses Isolated Early During the 2005-2006 Influenza Season in the United States
Rick A. Bright, et al. JAMA. 2006;295:891-894.
http://jama.ama-assn.org/cgi/content/abstract/295/8/891
Abstract: “Context: The adamantanes, amantadine and rimantadine, have been used as first-choice antiviral drugs against community outbreaks of influenza A viruses for many years. Rates of viruses resistant to these drugs have been increasing globally. Rapid surveillance for the emergence and spread of resistant viruses has become critical for appropriate treatment of patients. Objective: To investigate the frequency of adamantane-resistant influenza A viruses circulating in the United States during the initial months of the 2005-2006 influenza season. Design and Setting Influenza isolates collected from 26 states from October 1 through December 31, 2005, and submitted to the US Centers for Disease Control and Prevention were tested for drug resistance as part of ongoing surveillance. Isolates were submitted from World Health Organization collaborating laboratories and National Respiratory and Enteric Virus Surveillance System laboratories. Main Outcome: Measures Using pyrosequencing and confirmatory assays, we identified viruses containing mutations within the M2 gene that are known to confer resistance to both amantadine and rimantadine. Results A total of 209 influenza A(H3N2) viruses isolated from patients in 26 states were screened, of which 193 (92.3%) contained a change at amino acid 31 (serine to asparagine [S31N]) in the M2 gene known to be correlated with adamantane resistance. Two of 8 influenza A(H1N1) viruses contained the same mutation. Drug-resistant viruses were distributed across the United States. Conclusions: The high proportion of influenza A viruses currently circulating in the United States demonstrating adamantane resistance highlights the clinical importance of rapid surveillance for antiviral resistance. Our results indicate that these drugs should not be used for the treatment or prophylaxis of influenza in the United States until susceptibility to adamantanes has been reestablished among circulating influenza A isolates.” (CIDRAP http://www.cidrap.umn.edu/ )

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Pandemic Influenza: Risk of Multiple Introductions and the Need to Prepare for Them
Mills CE, Robins JM, Bergstrom CT, Lipsitch M. PLoS Biol. 2006 Feb 21;3(6):e135.
“The World Health Organization recently stated the following: “Since 2003, the world has moved closer to a[n] [influenza] pandemic than at any time since 1968”[1]. Influenza A (H5N1) viruses have reached high prevalence in both domesticated and wild birds in several parts of Asia [2]; the virus has spread over an area ranging from Romania to Indonesia, possibly carried over this distance by migratory waterfowl [3]. Over 160 human cases, about half of them fatal, have occurred [4], from Indonesia to Turkey. These trends suggest an increasing risk that the virus may acquire the ability to transmit efficiently from human to human, equipping it to cause a new pandemic. . . Even if these conditions are met and the next introduction of a pandemic-capable strain is contained, a containment policy alone is unlikely to prevent a pandemic entirely. We argue here that if a single introduction of a pandemic-capable strain is expected, multiple introductions should also be expected. Each containment effort would likely be more difficult than the last as manpower, antiviral stockpiles, and other scarce resources become depleted. Even if each successive containment effort is no more difficult than its predecessor, the chance of at least one failure increases with the number of introductions. At best, a containment policy will only postpone the emergence of a pandemic, “buying time” to prepare for its effects. In this article, we consider the risk of multiple introductions and its implications for pandemic planning. . .” (CIDRAP http://www.cidrap.umn.edu/ )

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Mumps Outbreak at a Summer Camp --- New York, 2005
“On July 26, 2005, the Sullivan County Health Department (SCHD) and the New York State Department of Health (NYSDOH) were notified of a cluster of cases of parotitis among campers and staff members at a summer camp. An investigation conducted by NYSDOH identified 31 cases of mumps, likely introduced by a camp counselor who had traveled from the United Kingdom (UK) and had not been vaccinated for mumps. This report summarizes the results of the subsequent investigation by NYSDOH, which determined that, even in a population with 96% vaccination coverage, as was the case with participants in the summer camp, a mumps outbreak can result from exposure to virus imported from a country with an ongoing mumps epidemic. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5507a2.htm
(MMWR February 24, 2006 / 55(07);175-177)

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Multistate Outbreak of Salmonella Typhimurium Infections Associated with Eating Ground Beef--United States, 2004
“. . .In September 2004, the New Mexico Department of Health received reports from the New Mexico Scientific Laboratory Division of eight Salmonella enterica serotype Typhimurium isolates that had indistinguishable pulsed-field gel electrophoresis (PFGE) patterns using XbaI and BlnI restriction enzymes. The patients were from three New Mexico counties and had onsets of illness during August 18--29. A review of PFGE patterns submitted to the National Molecular Subtyping Network for Foodborne Disease Surveillance (PulseNet) database for Salmonella revealed 31 indistinguishable patient isolates of S. Typhimurium from nine states (Colorado, Kansas, Minnesota, New Jersey, New Mexico, New York, Ohio, Tennessee, and Wisconsin) and the District of Columbia, with illness onset occurring during August 11--October 2, 2004. The S. Typhimurium isolates were susceptible to all antimicrobial agents tested. An investigation conducted. . .identified ground beef purchased at a national chain of supermarkets as the source of S. Typhimurium infections. Traceback results indicated product originating from a common supplier; however, evaluators determined that plant practices conformed to FSIS production guidelines, and no product recalls were made. This report describes the investigation and underscores the risk for salmonellosis from contact with contaminated ground beef, despite regulatory directives to reduce Salmonella contamination in beef production. Reduced contamination and consumption of raw or undercooked meat and further education of the food service industry and consumers are critical to reducing foodborne salmonellosis. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5507a4.htm
(MMWR February 24, 2006 / 55(07);180-182)

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Resurgence of Wild Poliovirus Type 1 Transmission and Consequences of Importation--21 Countries, 2002--2005
“After the 1988 World Health Assembly resolution to eradicate poliomyelitis globally, the number of polio-endemic countries decreased from 125 in 1988 to six (Afghanistan, Egypt, India, Niger, Nigeria, and Pakistan) in 2003. However, during 2002--2005, a total of 21 previously polio-free countries were affected by importations of wild poliovirus (WPV) type 1 from the six remaining countries (primarily Nigeria) where WPV was endemic; four countries (Indonesia, Somalia, Sudan, and Yemen) had outbreaks of >100 polio cases. By the end of 2005, WPV transmission in all 21 countries except Somalia had been interrupted or substantially curtailed. This report summarizes WPV importations into polio-free countries during 2002--2005 and the status of WPV transmission in these countries as of January 24, 2006, and describes actions that polio-free countries can take to improve importation preparedness. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5506a1.htm
(MMWR February 17, 2006 / 55(06);145-150)

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Assessing Capacity for Surveillance, Prevention, and Control of West Nile Virus Infection--United States, 1999 and 2004
“Indigenous human disease caused by West Nile virus (WNV) was first identified in the United States in August 1999 in the greater New York City area. . .During 1999--2005, a total of 19,525 cases of WNV disease in humans and 771 deaths were reported in the United States. In 2000, CDC first published guidelines for WNV surveillance, prevention, and control and created ArboNET, an electronic surveillance and reporting system. Beginning in 1999, WNV surveillance and prevention activities had been initiated in selected states and large cities through the CDC Epidemiology and Laboratory Capacity (ELC) cooperative agreements for emerging infectious diseases and subsequently expanded to all 50 states, six large cities/counties, and Puerto Rico. In 2005, to assess the capacity of state and large-city/county health departments to conduct WNV surveillance, prevention, and control activities, the Council of State and Territorial Epidemiologists (CSTE), with assistance from the Association of Public Health Laboratories (APHL) and CDC, surveyed WNV programs in the 50 states and six large-city/county health departments. This report describes the results of that assessment, which indicated that all participating states and cities had well-developed surveillance and control programs for human, avian, equine, or mosquito WNV. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5506a2.htm
(MMWR February 17, 2006 / 55(06);150-153)

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Enterovirus Surveillance--United States, 2002--2004
“Enteroviruses are common viruses associated with diverse clinical syndromes, ranging from minor febrile illness to severe, potentially fatal conditions. . .A total of 68 enterovirus serotypes are recognized, including 65 nonpolio enteroviruses. Individual serotypes have different temporal patterns of circulation and can be associated with different clinical manifestations. This report describes trends in reported enterovirus infections in the United States during 2002--2004, including widespread circulation of two serotypes, echovirus 9 and echovirus 30, commonly associated with aseptic meningitis outbreaks. Monitoring circulating enteroviruses helped identify these two serotypes as primary causes of aseptic meningitis outbreaks in 2003. Increased state laboratory participation and timely reporting by all laboratories to CDC would further increase the public health utility of enterovirus surveillance. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5506a3.htm
(MMWR February 17, 2006 / 55(06);153-156)

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3. Notifications
Draft of Applied Epidemiology Competencies
In October 2004, CDC and the Council of State and Territorial Epidemiologists (CSTE) convened a panel to define competencies for applied epidemiology for local, state, and federal government public health epidemiologists. This panel includes representatives from state and local health agencies, academia, private industry, and CDC. The complete draft of defined competencies for all levels of practicing epidemiologists is now available for review and comment at http://www.cste.org/assessment/competencies/indexnew.asp. Practicing epidemiologists and those employing applied epidemiologists can also submit questions and comments to CSTE by e-mail (competencies@cste.org) through Mar 17, 2006. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5506a5.htm
(MMWR February 17, 2006 / 55(06);158)

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Release of Computer-Based Case Study: Gastroenteritis at a University in Texas
A new computer-based case study, "Gastroenteritis at a University in Texas," is now available from CDC. Based on an actual outbreak investigation, this self-instructional, interactive exercise teaches public health practitioners epidemiologic skills in outbreak investigation and allows them to apply and practice those skills. Other case studies include "Botulism in Argentina" (released in 2002) and "E. coli O157:H7 Infection in Michigan" (released in 2004). The three case studies cover a range of outbreak investigation topics. Students can select which learning activities to undertake and focus on areas in which they are deficient or that are most relevant to their job activities. The Foodborne Disease Outbreak Investigation series was created for students with knowledge of basic epidemiologic and public health concepts. Each case study was developed in collaboration with the original investigators and experts from CDC and the Council of State and Territorial Epidemiologists. All three case studies can be downloaded for free or purchased on CD-ROM through the Epidemiologic Case Studies website: http://www.cdc.gov/epicasestudies. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5507a6.htm
(MMWR February 24, 2006 / 55(07);185)

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Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines
The updated Recommendations of the Advisory Committee on Immunization Practices (ACIP) are available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr55e223a1.htm.
(MMWR February 23, 2006 / 55(Early Release);1-34)

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A New Product (VariZIG™) for Postexposure Prophylaxis of Varicella Available Under an Investigational New Drug Application Expanded Access Protocol
To read about the investigational VariZIG, see: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm55e224a1.htm.
(MMWR February 24, 2006 / 55(Early Release);1-2)

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4. APEC EINet activities
EINet participates in Bird flu Summit
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). She is also speaking at the Bird flu Summit 27 Feb 2006, on Prevention Education Efforts and Risk Communication: http://www.new-fields.com/birdflu/agenda.htm.

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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