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Vol. IX, No. 5 ~ EINet News Briefs ~ Mar 10, 2006
*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and
notifications for emerging infections affecting the APEC member economies. It
was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:
- Eurasia: Cumulative number of confirmed human cases of avian influenza A/(H5N1)
- Niger: Excerpts from the OIE report on avian influenza H5N1
- Nigeria: Avian influenza H5N1 situation update
- Nigeria: Suspects avian influenza introduced via illegal poultry importation
- Uganda: Suspected avian influenza—preliminary tests are negative
- Albania: First case of avian influenza H5N1 infection in chicken
- Austria: Tests inconclusive for infection of avian influenza H5N1 in cats
- Azerbaijan: Suspected human cases of avian influenza infection
- France: Avian influenza H5N1 detected in swan and duck
- Germany: Avian influenza H5N1 infected wild birds increases to 8 in Bavaria
- Germany: Avian influenza H5N1 infection found in a stone marten
- Greece: Additional bird cases of avian influenza H5N1 infection; economic impact
- Poland: Confirmation of first case of avian influenza H5N1 infection in swans
- Romania: Avian influenza H5N1 found in wild goose and domestic birds
- Serbia: Avian influenza H5N1 infection confirmed in swan
- Sweden: 4 more bird cases of avian influenza H5 infection
- Switzerland: 4 more bird cases of avian influenza H5N1 infection
- Turkey: 3 more poultry cases of avian influenza H5 infection
- China: WHO concerns regarding avian influenza
- China: Tenth human death from avian influenza H5N1 infection
- Hong Kong: Information available on H5N1-infected birds in Hong Kong
- India (Maharashtra): Excerpts from the OIE report on avian influenza
- Indonesia: 21st fatal human case of avian influenza H5N1 infection
- Malaysia (Wilayah Persekutuan): Excerpts from the OIE report on avian influenza
- Russia (Astrakhan): Avian influenza H5 suspected in poultry
- Brunei: Death of boy due to hand, foot and mouth disease
- Malaysia (Sarawak): Closure of 488 kindergartens to stop hand, foot and mouth disease
- China (Henan): Woman dies of rabies
- USA: HHS using Indonesian strain for second H5N1 influenza vaccine
- USA: Expansion of wild bird testing to prepare for avian influenza
- USA (New York/Pennsylvania): Tests back hides as source in anthrax case
- USA (Texas): Hantavirus infection kills airman
- USA: USDA aims to reduce Salmonella in meat and poultry
- USA: FDA notification about BioMedical tissue services
- Night blindness associated with Chagas disease
- USA: Diarrheal disease on the rise in cruise ships
- Attitudes toward the use of quarantine in a public health emergency in four countries
- Enterobacter sakazakii: An Emerging Pathogen in Powdered Infant Formula.
- Reevaluation of epidemiological criteria for identifying outbreaks of acute gastroenteritis due to norovirus: United States, 1998–2000
- Human Rabies --- Mississippi, 2005
- Public Health Response to Hurricanes Katrina and Rita --- United States, 2005
- Progress in Reducing Global Measles Deaths, 1999--2004
- Harvard global conference on disaster prevention
- CDC March 2006 Infectious Disease conferences
- Southwest Conference on Diseases in Nature Transmissible to Man and International Conference on Diseases in Nature Communicable to Man
- Ground Water Awareness Week, March 12--18, 2006
4. APEC EINet activities
- EINet participates in Bird flu Summit
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Eurasia: Cumulative number of confirmed human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)
Viet Nam / 3 (3)
Total / 3 (3)
Thailand / 17 (12)
Viet Nam / 29 (20)
Total / 46 (32)
Cambodia / 4 (4)
China / 8 (5)
Indonesia / 17 (11)
Thailand / 5 (2)
Viet Nam / 61 (19)
Total / 95 (41)
China / 7 (5)
Indonesia / 10 (9)
Iraq / 2 (2)
Turkey / 12 (4)
Total / 31 (20)
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 175 (96)
Also, a worldwide list of species affected by H5N1, based upon referenced reports of highly pathogenic avian influenza H5N1 in animals has been prepared by the USGS: http://www.nwhc.usgs.gov/disease_information/avian_influenza/affected_species_chart.jsp. The list includes presently 9 mammal and 88 avian species.
(WHO 3/8/06 http://www.who.int/csr/disease/avian_influenza/en/ ; Promed 3/8/06)
Niger: Excerpts from the OIE report on avian influenza H5N1
Information received 28 Feb 2006 from Dr Seini Aboubacar, Director for Animal Health, Ministry of Animal Resources: Report date: 28 Feb 2006. Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of first confirmation of event: 27 Feb 2006. Date of start of event: 13 Feb 2006. Details of outbreak: First administrative division (region): Zinder. Date of start of the outbreak: 13 Feb 2006. Number of animals in outbreak: 20,000 susceptible poultry. Description of affected population: traditionally reared poultry (all breeds).
Diagnostic tests used / Results: RT-PCR27 / positive for H5N1. Source of outbreak or origin of infection: possible introduction of infected poultry from Nigeria. Control measures undertaken: stamping out; quarantine; movement control inside the country; screening; zoning; disinfection of infected premises/establishments. Control measures to be undertaken: vaccination. Treatment of affected animals: no. Since confirmation of the outbreak in Nigeria, Niger has been carrying out an awareness campaign in all regions of the country. All the relevant sanitary measures are currently being implemented, with the help of the country's development partners. An Interministerial Committee on avian influenza control has been in place since Oct 2005. A 12-month contingency plan has been prepared and has been submitted to the development partners.
Nigeria: Avian influenza H5N1 situation update
Nigeria’s outbreak of highly pathogenic H5N1 avian influenza, initially confirmed at a single farm 8 Feb 2006, has now spread to several parts of the country. To date, outbreaks have been detected on more than 130 farms in 11 of the country’s 37 states. By the end of Feb, local lab tests had detected the virus in 7 contiguous states in the northern and central parts of the country (Kaduna, Kano, Plateau, Katsina, Bauchi, Yobe, and Nasarawa) and in the Federal Capital Territory of Abuja. During early March, the virus was detected in 3 additional states, Anambra, Benue, and Rivers, located in the southern part of the country. Reportedly, the U.N. reference laboratory has confirmed the presence of H5N1 in Anambra, Benue, Federal Capital Territory, Plateau and Rivers. Control measures on farms have included culling, disinfection, and safe disposal of carcasses. Altogether, some 450,000 birds have either died or been destroyed since the start of the outbreak early Jan 2006. The federal government has launched its scheme for compensating farmers for lost birds. Payment has been made to farmers, initially in the state of Kano. The government handed over a first batch of cheques worth a total of USD 184 000 to 47 affected farms. Diagnostic capacity for testing samples within the country has been strengthened with support from WHO and US CDC. More than 60 samples taken from patients under investigation have now been tested. All results to date are negative for H5N1. In Niger, where the virus was confirmed in poultry 27 Feb 2006, a WHO team has been deployed to assist authorities in their assessment. Additional suspected outbreaks in poultry have been reported in the initially affected Magaria area. As in Nigeria, no human cases have been reported to date in Niger.
After H5N1 was confirmed in Kaduna, the government ordered that all suspect poultry be culled, all suspect farms quarantined and poultry from affected states should not be transported. But lack of resources to implement these measures meant very little happened on the ground initially, and panic selling of chickens contributed to spreading the disease. Farmers in affected areas had no protective equipment and handled diseased or dead poultry with their bare hands. No human case of bird flu has been found in Nigeria, but a UK laboratory has begun testing samples from 4 possible cases including a woman who died 16 Feb 2006 after being exposed to diseased poultry and suffering respiratory problems. The conditions for detecting any human case are difficult as Nigeria has high mortality rates from a variety of diseases, health services in rural areas are almost non-existent and people are often buried without any medical checks.
WHO staff in Nigeria have emphasized the demands this disease places on resources and capacities in a newly affected country, especially when late detection and delayed introduction of control measures allow the virus to spread widely. While an intense initial emergency response can be mounted, with external support, it is extremely challenging for any country in sub-Saharan Africa to sustain an adequate response beyond a few months. In parts of Asia, where the current poultry outbreaks began mid-2003, experience has demonstrated the difficulty of eliminating the virus once it has become widely present in birds. This experience has also shown that continuing circulation of the virus in birds carries a continuing risk of sporadic human cases. Most human cases have occurred in rural or peri-urban areas where households keep small backyard flocks, allowing close and continuing human exposure to virus from infected birds. Continuing vigilance for human cases in Nigeria is essential. Virus isolated from poultry in Nigeria is genetically almost identical to viruses that recently caused fatal human cases in Turkey and Iraq.
(Promed 3/8/06; WHO 3/9/06 http://www.who.int/csr/don/2006_03_09/en/index.html )
Nigeria: Suspects avian influenza introduced via illegal poultry importation
Nigeria suspects that illegal poultry imports were to blame for introducing bird flu to Africa's most populous country, the information minister said. The H5N1 virus has spread to 7 of the country's 36 states and the capital city since it was first detected in Nigeria 8 Feb 2006, but 90 per cent of infected farms bought day-old chicks from 1 farm in Kano state, minister Frank Nweke said. "There is a very strong basis to believe that avian flu may have been introduced into Nigeria through illegally imported day-old chicks," he said. Customs agents impounded almost 200 smuggled cartons of hatching eggs at the country's main international airport in Jan 2006, he added. Agriculture Minister Adamu Bello had originally blamed illegal imports for the bird flu outbreak, but he later pointed to migrating wild birds as the source.
Uganda: Suspected avian influenza—preliminary tests are negative
The Uganda Media Centre director, Robert Kabushenga, said tests carried out in Nairobi, Kenya had established that there was no avian influenza in Uganda. The center, in a statement issued 4 Mar 2006, said, "since its formation, the National Task Force has developed an emergency preparedness and response plan. A surveillance plan has been put in place to monitor migratory birds and domestic poultry." The statement quoted the task force as saying, "in the process of monitoring, samples were collected from dead wild birds and chickens on farms experiencing unusual death rates. These were sent to the CDC at KEMRI, Nairobi, for testing. As of 3 Mar 2006 CDC was unable to confirm the presence of avian influenza in the samples. Further research is being undertaken at more specialized laboratories," it said. The statement advised the public to limit interaction with sick birds. It said Ugandan chicken was free of bird flu and posed no health threat. Thousands of birds died on poultry farms in several districts in central and eastern Uganda in the past week alone. On a positive note, however, bird flu testing kits have arrived in the country. A multi-sector National Task Force has been constituted, comprising Ministry of Health, Ministry of Agriculture, Ministry of Tourism and Trade, Uganda Wildlife Authority, poultry associations and other partners to prepare and set up an emergency response mechanism.
(Promed 3/5/06, 3/6/06)
Albania: First case of avian influenza H5N1 infection in chicken
Albania confirmed its first case of the H5N1 strain of bird flu 8 Mar 2006 in a chicken found in the southern Sarande coastal region, near the border with Greece. "The first case of H5N1 bird flu has been found in a hen at the village of Cuke in the Sarande region," Agriculture Minister Jemin
Gjana said. The findings were confirmed by the UK reference laboratory. A quarantine was in place in an area within a 3-km radius of where the chicken was found and veterinarians would monitor farms within a 10-km radius.
Austria: Tests inconclusive for infection of avian influenza H5N1 in cats
An Austrian cat which has twice tested positive for the H5N1 bird flu virus did not show the virus in a third probe 7 Mar 2006, Austria's health ministry said, adding to uncertainty about the infection in cats. The cat is 1 of 170 that were kept in an animal sanctuary in southern Austria close to a cage of fowl which had been infected with H5N1. 3 cats tested positive for the virus in saliva tests last week, Austria said. A subsequent test of the 3 cats' faeces confirmed H5N1 in only 1 of the samples, in a very low concentration. A third faeces test taken was negative for all of them, a health ministry spokeswoman said. However, the spokeswoman added the ministry was still waiting for the results of tests on the cats' blood.
"Apparently cats are more resistant than chickens," the spokeswoman said. "That you find the virus in the mouth apparently doesn't mean that it reaches the other end too." The 170 cats, 40 of which had been saliva-tested in the Noah's Ark sanctuary in Graz, were brought to a quarantine centre close to Vienna for observation and tests. WHO said that more studies were needed on infections in cats, including how they shed the virus in their environment. WHO asked Austria to provide more detail on the cats, adding that it was potentially significant that an animal could contract the virus and not show any symptoms of illness. Johann Thalhammer, a professor at Vienna's veterinary university who is now monitoring the cats, said he could not confirm that they did not have any symptoms of the virus. German officials have warned pet owners to keep their cats indoors and dogs on a leash in areas where the disease has been detected. Austria confirmed the nation's first case of H5N1 in a wild bird last month and has since detected several dozen cases in birds, including 29 in Styria.
(Promed 3/6/06, 3/8/06)
Azerbaijan: Suspected human cases of avian influenza infection
Since the beginning of Mar 2006, the Ministry of Health has been investigating a cluster of 10 persons placed under observation for possible infection with the H5N1 avian influenza virus. All of these persons are from the Daikyand settlement in Salyan Rayon. The Salyan Rayon is located near wetlands frequented by migratory birds. Recent deaths of poultry have been reported in the Daikyand settlement, but the cause of these deaths has not yet been determined. The investigation was launched when 2 young women, who were neighbours, died within a week of each other. The first patient, a 17-year-old girl, died 23 Feb. Her death is now thought to have been caused by a pre-existing disease. As a precaution, her samples will be sent for H5N1 testing at a WHO collaborating laboratory. The second death occurred 3 Mar 2006 in a 20-year-old woman who died following rapidly progressive acute pneumonia, which is a characteristic feature in many cases of H5N1 infection. The Ministry of Health initiated daily house-to-house investigations, looking for persons in the settlement having respiratory symptoms or fever. As a result, an additional 8 persons were hospitalized for observation. Of these, 6 showed only mild symptoms. They have fully recovered and have now been discharged from hospital. Of the remaining 2 patients, one, a 17-year-old girl, died 8 Mar. A 16-year-old boy remains hospitalized in isolation. His condition is critical. The response of the Ministry of Health has been prompt and efficient, but hampered by the lack of some essential equipment and supplies and inadequate diagnostic capacity. Prior to the event, staff from the Ministry of Health had visited offices of sanitary hygiene and epidemiology in each rayon within the country, creating a high level of awareness of the disease and a correspondingly high level of alert for possible cases of unusual respiratory disease. The house-to-house surveillance for cases is continuing.
A WHO team is presently in Azerbaijan to assess needs and provide technical support. The team will be augmented with additional expertise and supplies, including laboratory equipment and diagnostic reagents. Supplies of the antiviral drug oseltamivir are available in Azerbaijan, but the quantity is limited. To date, all patients under investigation have received treatment with this drug. Highly pathogenic H5N1 avian influenza was initially confirmed in Azerbaijan 9 Feb 2006 in wild birds found near Baku. On 24 Feb, the country announced detection of infection in poultry at farms in Khyzy and Bilasuvar. Some 300,000 birds were culled as a result.
Excerpts from the Official OIE report on avian influenza
Information received 27 Feb and 1 Mar 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 event: 24 Feb 2006. Date of start of event: 22 Feb 2006. Clinical disease: yes. Details of outbreaks: First administrative division: Khyzy. Date of start of outbreak: 22 Feb 2006. Number of animals in outbreaks: destroyed (260 000). First administrative division: Biljasuvar. Date of start of outbreak: 22 Feb 2006. Number of animals in outbreaks: destroyed (36 000 poultry). Diagnostic test used: virological testing. Results: positive. Source of outbreaks or origin of infection: unknown or inconclusive. Control measures undertaken: control of wildlife reservoirs; quarantine; movement control inside the country; screening; disinfection of infected premises/establishments.
(Promed 3/4/06; WHO 3/10/06 http://www.who.int/csr/don/2006_03_10a/en/index.html )
France: Avian influenza H5N1 detected in swan and duck
As announced 5 Mar 2006 by the Minister of Agriculture, H5N1 has been detected in a swan in the region Bouches-du-Rhone (south) and in a duck in Ain (east). So far, 31 wild birds have been found positive in France, 30 in Ain, and now the first report from elsewhere. The swan was found 28 Feb 2006 in Saint-Mitre-les-Ramparts, near Berre. The duck was found in Prevessin-Moens, just across the Swiss border from Geneva. Confirmation as HPAI was received from the national laboratory of AFSSA (French Agency of Sanitary Food Safety).
Excerpts from the official OIE report:
Information received 25 Feb 2006 from Dr Monique Eloit, Deputy Director General, General Directorate for Food (DGAL), Ministry of Agriculture, Food, Fisheries and Rural Affairs: Report date: 25 Feb 2006. Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of first confirmation of event: 25 Feb 2006. Date of start of event: 23 Feb 2006. Details of outbreak: First administrative division (region): Ain. Name of location / Date of start of outbreak / Species: Versailleux/ 23 Feb 2006/ avi. Number of animals in outbreak: susceptible (11,700), cases (10500), deaths (400), destroyed (11,300). Description of affected population: 56-day-old turkeys in a commercial farm. Diagnostic tests used / Results: RT-PCR / positive for H5. Turkey RNA sequencing on tracheal swabs positive for H5N1. All 279 nucleotide positions that have been analysed reveal a 99.3 percent nucleotide sequence homology with the isolate A/BarHeadedGoose/Qinghai/65/05 (virus subtype H5N1) as well as with the virus detected in a pochard (Aythya ferina) 17 Feb 2006 in Joyeux district, 1 km from the turkey farm. Source of outbreak or origin of infection: unknown or inconclusive. Control measures undertaken: control of wildlife reservoirs; stamping out; quarantine; movement control inside the country; screening; zoning; disinfection of infected premises; dipping/spraying. Vaccination prohibited. Clinical signs appeared suddenly, with a very high morbidity rate and a high mortality rate.
(Promed 3/4/06, 3/5/06)
Germany: Avian influenza H5N1 infected wild birds increases to 8 in Bavaria
H5N1 virus was confirmed 8 Mar 2006 in a dead buzzard in Wasserburg on Lake Constance (district Lindau), as well as in a mute swan from the town of Landsberg am Lech, by the Friedrich Loffler Institute (FLI). The buzzard and the swan were found 28 Feb 2006 and 2 Mar 2006, respectively. They tested positive for influenza A virus in tests by the Bavarian Health and Food Safety Agency (Landesamt fur Gesundheit und Lebensmittelsicherheit, or LGL). Both avians were confirmed by FLI as being H5N1-positive. The total number of AI-infected wild birds found in Bavaria increases to 8, of which 5 are already laboratory-confirmed to have the highly
pathogenic H5N1 virus type. Italy also reported to the OIE, 22 Feb 2006, the identification of H5N1 in a buzzard, Buteo buteo.
Germany: Avian influenza H5N1 infection found in a stone marten
Officials in Germany have confirmed H5N1 infection in a second mammalian species, the stone marten (weasel family). This finding marks the first documented infection of this species with an avian influenza virus. Previously, H5N1 infection was confirmed in Germany in 3 domestic cats. The marten was found alive, but showing signs of severe illness, on the Baltic island of Ruegen 2 Mar 2006. The animal was euthanized. Tests conducted at Germany’s Friedrich-Loeffler-Institut for Animal Health confirmed infection with the H5N1 avian influenza virus. The ill animal was found in the same heavily affected area of the island, near Schaprode, as 3 dead domestic cats. Tests conducted subsequently confirmed that all 3 cats were infected with the highly pathogenic H5N1 virus. The stone marten is a predatory nocturnal mammal with feeding habits similar to those of domestic cats. As with the cats found on Ruegen island, the marten is presumed to have acquired its infection after feeding on an infected bird.
Since 16 Feb 2006, German authorities have confirmed H5N1 infection in 125 wild swans, ducks, geese, and birds of prey on Ruegen Island, pointing to considerable opportunities for exposures to occur in small mammals that feed on birds. As is the case with humans, infections in animal species other than birds are rare events. To date, only domestic poultry are known to have played a role in the transmission cycle of the virus from animals to humans. In Jul 2005, tests on 3 rare Owston’s palm civets that died in captivity in Viet Nam detected H5N1 infection, marking the first known infection in this mammalian species. Large cats, including tigers and leopards, kept in capacity and fed on infected poultry carcasses, have also been infected and developed severe disease. Ferrets are another mammalian species known to be susceptible. Further investigation is needed to determine whether evidence of H5N1 infection in new mammalian species has any significance for the risk of human infection or the potential of this virus to adapt to mammals.
(WHO 3/9/06 http://www.who.int/csr/don/2006_03_09a/en/index.html ; Promed 3/9/06)
Greece: Additional bird cases of avian influenza H5N1 infection; economic impact
Greece said 3 more cases of the H5N1 strain of bird flu had been confirmed in wild fowl, bringing to 22 the number of infected birds found in the country. "3 wild swans have been confirmed with H5N1 from a group sent for testing to London on February 24," the Agriculture Ministry said. Greece is awaiting test results on 8 more cases. So far, there have been no cases of
the bird flu in domestic farm poultry. Wildlife experts say Greece has received an unusually large number of migratory birds this winter, many of them forced south from their usual wintering grounds in northern Europe by exceptionally severe weather. Poultry sales have plummeted. Industry sources say chicken sales are down as much as 80 percent since early Feb 2006, when the first case of bird flu was detected on Greek soil. On 2 Mar 2006 Greece said it would offer state-guaranteed loans to poultry farmers hit by the sharp drop in sales.
Poland: Confirmation of first case of avian influenza H5N1 infection in swans
2 dead swans found in northern Poland had the H5N1 strain of bird flu, the Polish veterinary institute said 6 Mar 2006. The institute's Jan Zmudzinski said, "The test specifically for the H5N1 strain was positive." The findings confirm the first case of the virus in Poland after 2 swans were found 5 Mar 2006 infected with the H5 bird flu virus on the banks of the Vistula river in the city of Torun. Preliminary tests for bird flu are routinely conducted in Poland's veterinary research institute in Pulawy. The government said that the samples will now be sent to the UK Reference Laboratory for further tests and confirmation. Polish authorities have informed the European Commission and have established a high risk area of 3 km around the outbreak and a surveillance zone of 10 km. Restrictions have also been placed on the 6 poultry farms and 4 processing plants in the region. Poland imposed a ban Jan 2006on keeping poultry in open spaces after bird flu was confirmed in neighboring Germany.
Affected wild birds--mainly swans--have been recorded, since the beginning of Feb 2006, in 13 European countries without involvement of domestic poultry (Austria, Bosnia, Bulgaria, Croatia, Germany, Greece, Hungary, Italy, Poland, Slovakia, Slovenia, Sweden and Switzerland). A 14th country, France, experienced infected swans in several sites, while a single commercial turkey farm, adjacent to the site where infected swans were located, has been found infected.
(Promed 3/5/06, 3/6/06)
Romania: Avian influenza H5N1 found in wild goose and domestic birds
Romania detected the H5N1 bird flu virus in domestic birds in Catunu, a village 80 km west of the capital and in a wild goose in the city of Buzau. Avian flu has been found in 40 villages and a small Black Sea resort since the virus was first detected in the Danube Delta Oct 2005. "We isolated the H5N1 virus in the village of Catunu in Dambovita county and we will start to take regular measures of culling all the birds and quarantining the village," said Gabriel Predoi of the animal health agency. He said the samples would be sent to the UK reference laboratory to confirm whether the virus found was a highly pathogenic type. Birds have been culled swiftly and Romania has not reported any cases in humans. However, WHO and local experts have warned that Romania could see human cases of bird flu because its rural areas, where around 45 percent of the 22 million population live, lack proper water and sewerage systems.
Excerpts from the official OIE report:
Information received 24 Feb 2006 from Dr Gabriel Predoi, Director General, National Sanitary Veterinary and Food Safety Authority: Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of first confirmation of event: 7 Oct 2005. Date of start of the event: October 2005. New outbreaks: Region/district: Constanta/Tuzla. Date of start of outbreak: 16 Feb 2006. Number of animals in outbreak: susceptible (37), cases (37), deaths (19), destroyed (18). Region/district: Constanta/Navodari. Date of start of outbreak: 16 Feb 2006. Number of animals in outbreak: susceptible (72), cases (72), deaths (37), destroyed (35). Description of affected population: Outbreak in Tuzla: backyard premises with 30 hens and 7 geese. Outbreak in Navodari: backyard premises with 71 hens and 1 pheasant. Diagnosis: Species examined: hens. Diagnostic tests used / Results: rapid detection test; ELISA; RT-PCR / Positive. Source of outbreaks: contact with infected animal(s) at grazing/watering; contact with wild animals. Control measures undertaken: stamping out; quarantine; movement control inside the country; screening; zoning; disinfection of infected premises/establishments. Control measures to be undertaken: control of wildlife reservoirs. Treatment of affected animals: no. Vaccination not prohibited.
Serbia: Avian influenza H5N1 infection confirmed in swan
Serbia confirmed 9 Mar 2006 its first case of the H5N1 strain of bird flu in a swan found last week in the northern Sombor region, close to the Croatian border. The head of Serbia's veterinary directorate, Dejan Krnjaic, said the result was confirmed by the UK reference laboratory. He
said another swan found dead in western Serbia was also assumed to have had H5N1. In both cases, areas within a 10-km radius of where the swans were found have been declared risk zones, and veterinarians were monitoring all wild fowl within it. All domestic poultry in Serbia was being kept indoors. Infections have already been found in the neighbouring countries Hungary, Croatia, Bosnia-Herzegovina and Romania. Krnjajic said that the agency's attention has been placed on making sure that the virus is not found in any livestock or domesticated birds.
(Promed 3/8/06, 3/9/06)
Sweden: 4 more bird cases of avian influenza H5 infection
Swedish authorities said 8 Mar 2006 they had found 4 more cases of the H5 bird flu subtype in wild ducks, however more tests were needed to determine whether it was the H5N1 strain. The Swedish board of Agriculture said they had sent samples to the UK reference laboratory for confirmation. The latest 4 cases were found in the cities of Karlskrona and Oxelosund on Sweden's southeastern coast. "It was not unexpected that the authorities would find new cases at various places and more will probably be found," the Swedish Board of Agriculture said. The previous H5N1 findings in Swedish wild birds were 2 Tufted ducks, Aythya fuligula. A dead mink found in the area where these 2 cases were detected tested negative for bird flu.
(Promed 3/4/06, 3/8/06)
Switzerland: 4 more bird cases of avian influenza H5N1 infection
Switzerland found 4 more cases of H5 bird flu in wild birds, the federal veterinary office said, adding it expected to find further cases. The H5 virus was found in 2 dead ducks in Geneva, and in a duck in a town called Ramsen and a coot in Stein, 2 places in the canton (state) of Schaffhausen near the German border. The country had sent samples for further tests to a laboratory to see if the virus in question was the more aggressive H5N1 strain. Earlier Switzerland said it had found its first case of the H5N1 strain of the virus in a wild duck found earlier in Geneva. It also found the H5 virus in a dead swan, also found close to the German border, putting the total number of bird flu cases in the country at 6. Switzerland has been on
high alert for bird flu since the virus emerged in neighbours France, Germany, Austria and Italy. Starting Feb 2006 it ordered that all poultry be kept indoors for an indefinite period.
Turkey: 3 more poultry cases of avian influenza H5 infection
Turkey confirmed 3 new cases of the H5 strain of bird flu among poultry in an area to the west of Istanbul and said culling of birds was under way. The Agriculture Ministry said samples from the infected ducks and chickens had been sent to Britain for further tests to ascertain whether they
had the H5N1 form of the virus. 4 children died of the H5N1 strain in eastern Turkey in Jan 2006, the first human fatalities outside East Asia. 8 other Turkish people who tested positive for H5N1 have since recovered, according to WHO. The latest cases were detected in ducks and chickens in Catalca and Silivri, both near the Sea of Marmara. Ministry officials said some 2800 poultry had already been culled in Silivri. Earlier, authorities said they had culled a total 2.27 million poultry so far across the country of 72 million people. They said more than 60 of a total 106 districts where bird flu has been confirmed remained under quarantine. Quarantine in Turkey means 21-day restrictions on the movement of poultry in the designated area and increased hygiene precautions for the local human population. Doctors say there has been no new incidence of bird flu among humans since 13 Jan 2006. ***There is a full OIE report from Turkey which summarizes 39 outbreaks: http://www.oie.int/eng/info/hebdo/AIS_29.HTM#Sec3.
China: WHO concerns regarding avian influenza
"It's very conceivable that there are more cases," said Dr. Henk Bekedam, WHO's representative for China, when asked whether he felt there was more human cases of avian influenza in China. "But we do not have the impression, at least from the central ministry, that they are hiding information from the outside world." Rather, Dr. Bekedam said he believes China has a "capacity problem" in terms of its ability to conduct surveillance for infection in birds and detect all human cases, particularly those in which the virus triggers milder disease. When suspected human cases have cropped up in other countries, WHO has required testing by a external laboratory before it officially confirms a case. But to date, China has not agreed to send out its specimens for independent testing. And WHO has accepted positive tests from China as confirmation of H5N1 infection. "There are some challenges in a big country like China," Dr. Bekedam said. "But our sense is when the central Ministry of Health knows about it and when they have done their confirmation test, that we are being informed."
Unlike other jurisdictions, where suspected human cases are quickly reported Chinese authorities do not report until confirmatory testing is completed. Dr. Bekedam said WHO doesn't object to that system, so long as there are no hints of human-to-human transmission among the people
being investigated. Clusters of cases could signify that the H5N1 virus is mutating in ways that allow it to more easily jump to and between people. Dr. Bekedam said a worrisome feature of China's problem is that the massive die-offs of domestic poultry that typically alert authorities
to the presence of H5N1 have dwindled off in China. Widespread use of poultry vaccines may be masking the virus's presence. Vaccinated poultry can acquire and shed the H5N1 virus, perpetuating a sort of low level or invisible spread of virus. "So somehow the animal surveillance system is not picking up the sick poultry. . ." he said. Recent statements from Chinese officials lay the blame for the virus's spread on migratory birds. Dr. Bekedam suggested his Chinese counterparts may be focusing too much attention on the wrong facet of the problem. "We do believe that China ... has also still a major threat on the ground over here, meaning that I think the virus is endemic in many parts of China."
China: Tenth human death from avian influenza H5N1 infection
As of 8 Mar 2006 the Ministry of Health in China has reported the country's tenth death from H5N1 avian influenza. The patient, a 9-year-old girl from the eastern province of Zhejiang, developed symptoms 10 Feb 2006 and died 6 Mar 2006. This case was previously announced by Chinese authorities 27 Feb 2006, when the patient was listed as in critical condition. To date, China has reported 15 laboratory-confirmed cases of human infection with the H5N1 avian influenza virus. Of these, 10 have been fatal. It was reported previously that this girl from Zhejiang developed symptoms 10 Feb 2006 following a visit to relatives in the adjacent province of Anhui. No animal outbreaks had been reported in Zhejiang Province at that time since 2004.
The ninth case, a 32-year-old man, died from the H5N1 avian influenza virus infection in the southern province of Guangdong. He was a local resident of Guangzhou, the capital of Guangdong. He was believed to have contracted the virus at a poultry market. He developed symptoms of fever 22 February followed by pneumonia. His condition deteriorated rapidly and he died 2 March. He was unemployed. People in close contact with the man have been isolated for medical observation. The places near where the patient had been staying have been disinfected. No outbreaks in poultry have been reported in Guangdong since 2004. He was the first reported human case from Guangdong. Hong Kong is less than 2 hours from Guangzhou by train, and the flow of travellers between the 2 cities is heavy.
(Promed 3/4/06, 3/6/06, 3/8/06)
Hong Kong: Information available on H5N1-infected birds in Hong Kong
Information on H5N1-infected birds found in Hong Kong so far in 2006 has been uploaded onto the website of Hong Kong Agriculture, Fisheries and Conservation Department (http://www.afcd.gov.hk/news/news_e.htm). Details available include the infected species, submission date for laboratory tests, and location found, together with a distribution map. A number of H5N1-infected bird cases have been reported recently and all the bird parks in Hong Kong nature reserves and big parks have been closed as a move to prevent the possible prevention of [spread of] the virus. Hong Kong had also decided to suspend the import of live poultry from Guangdong Province starting 5 Mar 2006 after receiving a notification by the Ministry of Health of a confirmed case of human infection of H5N1 avian influenza virus in Guangzhou City, Guangdong's capital. A set of safety guidelines for handling and disposing of dead wild birds is also available on the website. The 16 birds found so far during 2006 are: Chicken (2); Common Magpie (4); Crested Myna (1); House Crow (2); Japanese White Eye (1); Large-billed Crow (1); Little Egret (1); Munia (1); Oriental Magpie Robins (2); White-backed Munia (1).
India (Maharashtra): Excerpts from the OIE report on avian influenza
Information received 23 Feb 2006 from Mr P.M.A. Hakeem, Secretary to the Government of India, Ministry of Agriculture, Department of Animal Husbandry and Dairying: Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of first confirmation of event: 18 Feb 2006. Date of start of event: 27 Jan 2006. Details of outbreak (reminder): First administrative division: Maharashtra. Name of the location/Date of start of the outbreak/Species: Navapur/ 27 Jan 2006/ avi. Description of affected population: poultry. Source of outbreaks or origin of infection: unknown or inconclusive. Control measures undertaken: movement control inside the country; stamping out; disinfection of infected premises/establishment(s). Due to the very small number of poultry in the infected and surveillance zones, we have resorted to stamping out in the entire 10-km radius infected zone. To date, no further cases of avian influenza have been reported from this area or from any other parts of the country.
Indonesia: 21st fatal human 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 fatal case occurred in a 4-year-old boy from Semerang, Central Java. He developed symptoms (fever) 10 Feb 2006 and died 28 Feb 2006. Provincial health and agricultural authorities found that chickens had died in the boy’s neighbourhood in the days preceding symptom onset. The boy had reportedly been in contact with fowl. No other human cases were identified in the family or neighbourhood. The newly confirmed case brings the total in Indonesia to 28. Of these, 21 were fatal. Agricultural authorities have reported a recent increase in the number of poultry deaths in Central and East Java. These reports have led to heightened awareness of the risk of human cases and a higher level of clinical suspicion when patients present with respiratory symptoms. The Ministry of Health and WHO are monitoring the situation. Many patients under investigation have subsequently been ruled out by further tests.
The highly pathogenic strain of bird flu has affected birds in about 2/3 of the country's provinces. Stamping out the virus is a huge task in Indonesia, a sprawling archipelago of about 17 000 islands and 220 million people. The government has resisted the mass culling of fowl, citing the expense and the impracticality in a country where the keeping of a few chickens or ducks in backyards of homes is common in cities and on farms. Agencies have concentrated instead on selective culling, and on public education and hygiene measures aimed at prevention. A sweeping door-to-door campaign to try to control the disease in Jakarta, only got underway late Feb 2006. Agriculture officials estimate that Jakarta alone has some 500 000 fowl.
(Promed 3/4/06; WHO 3/10/06 http://www.who.int/csr/don/2006_03_10/en/index.html )
Malaysia (Wilayah Persekutuan): Excerpts from the OIE report on avian influenza
Information received 23 Feb 2006 from Dr Hawari Bin Hussein, Director General, Department of Veterinary Service, Ministry of Agriculture, Kuala Lumpur: Report date: 23 Feb 2006. Identification of agent: highly pathogenic avian influenza H5N1. Date of first confirmation of event: 19 Feb 2006. Date of start of event: 6 Feb 2006. Details of outbreak: First administrative division (state): Wilayah Persekutuan. Name of the location (village): Pasir Wardieburn. Number of animals in the outbreak: susceptible (150) cases (50) deaths (50) destroyed (100) slaughtered (0). Description of affected population: free-range village chickens. Diagnostic tests result: RT-PCR (M gene); RT-PCR (H5 gene); RT-PCR (N1 gene), positive for H5N1. Source of outbreak or origin of infection: unknown or inconclusive. Control measures undertaken: stamping out; quarantine; movement control inside the country; screening; zoning; disinfection of infected premises/establishment(s); dipping/spraying. Vaccination prohibited. A 1km-radius Infected Zone was established around the index case. Culling in the infected Zone started 20 Feb 2006 and was completed 22 Feb 2006 (1970 chickens, 62 ducks and 72 other birds). 505 eggs were also destroyed. A 10-km-radius Surveillance Zone was established. Clinical and laboratory surveillance is underway in the Surveillance Zone. Surveillance is also underway in other States.
Russia (Astrakhan): Avian influenza H5 suspected in poultry
A suspected outbreak of bird flu has hit another region in Russia, a regional Emergency Situation Ministry official said 6 Mar 2006. The official said that provisional laboratory tests of fowl that died 2 Mar 2006 in the Astrakhan Region, home to more than a million people, had found "antibodies [to] both the H5 bird flu strain and Newcastle disease," which means that "birds were infected either with one virus or both of them." Newcastle disease is an acute, highly contagious viral disease found in birds. Local officials said that measures were being taken to prevent the disease from spreading from a village about 1000 miles southeast of Moscow, where the dead birds had been found. According to the ministry, almost 800 000 birds in southern Russia have died of bird flu or been culled Feb 2006. The Agriculture Ministry said earlier that cases of bird flu had been registered in 7 regions in the Southern Federal District. Areas hit included the republics of Kabardino-Balkaria, Daghestan, Chechnya, Kalmykia and Adygea, and the Krasnodar and Stavropol territories. Over 1.3 million birds have died or been slaughtered in 3 outbreaks of bird flu since Jul 2005. No human cases of bird flu have yet been reported in Russia.
Brunei: Death of boy due to hand, foot and mouth disease
Brunei recorded its first hand-foot-and-mouth disease (HFM) casualty with the death of a 2-year-old boy. The Ministry of Health said 16 mild cases have also been detected (case fatality rate of 5.9 percent). Parent have been advised to consult a doctor if their child has any of the following conditions: persistent high fever, repeated vomiting and poor appetite, extreme tiredness and sleepiness, irritability, abdominal distension, urine retention, shortness of breath, fast heart beat or pulse (of more than 160 per minute), unsteady gait or limb weakness, muscle jerks, abnormal eye movement and cold sweating. The public are advised to take precautionary steps. Personal hygiene is most important in avoiding to contract and transmit enterovirus infection: washing hands thoroughly before eating, after going to the toilet or handling nappy/excreta, covering mouth and nose when coughing or sneezing, cleaning thoroughly surfaces of toys and other appliances and maintaining cleanliness among children. Infected children should stay away from public places like schools and childcare centres.
HFM is caused by enteroviruses, among which coxsackievirus A16 (CA16) is the most common etiologic agent. It is a mild disease and nearly all patients recover without medical treatment in 7-10 days. Complications are uncommon. It is moderately contagious. A second common cause of HFM is enterovirus 71(EV71). In addition to HFM, EV71 may also cause aseptic or viral meningitis, encephalitis, or a polio-like paralysis. Infection spreads from person to person by direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. A person is most contagious during the first week of the illness. The usual period from infection to onset of symptoms is 3-7 days. Infants, children and adolescents are more likely to be susceptible to infection as they are less likely than adults to have antibodies and be immune from previous exposures to them. No effective treatments are available. General treatment is palliative. Preventive measures are focused on enforcement of personal hygiene and public awareness.
Since the advent of the 1998 outbreak in Taiwan (78 deaths), Department of Health (DOH) of
Taiwan has determined the pattern of the annual seasonal HFMD epidemic, the peak of which tends to fall in the beginning of July. The DOH schedules the reminder campaign according to this pattern. The disease has been brought under control. The Taiwan example can be
used as a role model for any countries which may encounter the same problem.
Malaysia (Sarawak): Closure of 488 kindergartens to stop hand, foot and mouth disease
The Malaysian Health Ministry ordered the immediate closure of 488 kindergartens in the Borneo state of Sarawak for 2 weeks, after rising cases of hand, foot and mouth disease (HFM) among children, a news report said 3 Mar 2006. "This action is taken to stem the transmission of the disease, which has increased rapidly in Sarawak," Health Minister Chua Soi Lek reportedly said. The 2-week kindergarten closure follows 3 deaths in 2006 (other reports indicate 4 deaths) in the state from the viral disease, which produces symptoms that include fever, a rash in the mouth and sores with blisters on the palms of the hands and soles of the feet. The latest death occurred 1 Mar 2006. Chua said 942 cases had been reported 1 Jan - 18 Feb 2006, compared with 270 in the same period 2005. Tests on 1 of victims revealed the presence of enterovirus 71, the virus that caused deaths during a 1997 HFM outbreak (29 children died), he said. The disease is spread through the saliva and feces from those infected, and Chua advised parents to promote cleanliness among their children and said those with symptoms of the disease should seek treatment immediately. The disease normally takes 3-5 days to manifest, and death is caused by complications.
(Promed 3/3/06, 3/5/06)
China (Henan): Woman dies of rabies
A 37 year old woman died of rabies in Beijing, reports the Municipal Bureau of Health. The victim, from Henan Province, was bitten by her puppy, which had not been immunized, 10 Jan 2006. She died 14 Feb 2006. From 13 to 19 Feb 2006, hospitals in Beijing saw a rapid increase in numbers of patients who had been injured by their pets. 204 citizens called the city's health hotline for information about rabies during the past week, accounting for 42 percent of all calls to the service. Rabies is an acute, infectious, fatal viral disease that can affect most warm-blooded animals. It attacks the central nervous system and is transmitted by the bite of infected animals. The latent period of rabies can be as short as 10 days or as long as 10 years, according to Su Bogu of the Emergency Treatment Department of the China-Japan Friendship Hospital in Beijing. Beijing has seen a gradual increase in rabies cases in recent years due to the increase of pet cats and dogs raised by citizens, he said. He urged authorities to improve public awareness.
USA: HHS using Indonesian strain for second H5N1 influenza vaccine
A second vaccine against human H5N1 influenza is being developed, US Health and Human Services (HHS) Secretary Mike Leavitt said. The decision is routine, HHS spokesman Bill Hall said. "We’ve been following the virus and trying to monitor it. We have determined there is a strain that is distinct enough from the Asian strain that first arose," Hall said. It was isolated in Indonesia, so it’s named after that country: A/Indonesia/5/2005. "If a third strain were to evolve, which is very likely, we would do the same thing," he said. The US has been testing and stockpiling vaccines based on an earlier strain of H5N1, isolated from Vietnam, 2004. Sanofi Pasteur and Chiron Corp. have been producing the vaccines under HHS contracts. But no one knows how effective those vaccines will be if the virus evolves into a pandemic strain. Work with the Indonesian strain of H5N1 began Oct 2005, said Ruben Donis, team leader of the molecular genetics group in CDC’s flu branch. He said the vaccine is ready for further development by companies now. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, reportedly said this second vaccine could give companies a head start if a viral variant similar to the Indonesian strain were to develop efficient human-to-human transmission. Using a CDC-developed prototype virus will allow companies to decide how best to grow viruses that can be used in the vaccine, Fauci said. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy, praised HHS for closely tracking the H5N1 virus. However, he expressed hope that eventually vaccine development will be sophisticated enough that instead of constantly updating, suppliers could produce a vaccine for any H5 virus.
Sanofi Pasteur and Chiron recently reported progress in fulfilling their contracts for producing vaccines based on older H5N1 strains. The contracts are for the national emergency stockpile of vaccines and drugs. In Feb 2006, Sanofi Pasteur reported it had finished making a supply of H5N1 in bulk concentrate form under a $150 million contract with HHS. Sanofi recently delivered 15,000 experimental doses of the vaccine to the NIH for use in the clinical trials. The doses include the adjuvant aluminum hydroxide, intended to stimulate the immune system so it will take less vaccine to generate an effective response. The doses contain varying amounts of antigen for testing purposes. Chiron reported Feb 24, 2006 that HHS had agreed to give the company more time to complete production of its H5N1 vaccine. HHS awarded Chiron a $62.5 million contract in Oct 2005 to produce the vaccine in bulk form.
(CIDRAP 3/7/06 http://www.cidrap.umn.edu/ )
USA: Expansion of wild bird testing to prepare for avian influenza
Reportedly, US federal officials concerned that the H5N1 virus will reach North America described plans to test nearly 8 times as many wild birds this year as have been tested in the past 10 years. Starting Apr 2006, samples from 75,000 to 100,000 birds in Alaska and along the West Coast will be tested by the departments of Agriculture and Interior and by state wildlife agencies. The federal government plans to spend USD 7.4 million in 2006 to test wild birds. Agriculture Secretary Mike Johanns and other officials said they expect the virus to arrive on the continent. That assessment was reportedly echoed by OIE Director General Bernard Vallat. He said, "The probability of this strain appearing in Australia is very high. The possibility is also very high for the United States and Canada." H5N1 could reach the US via infected birds that spend the winter in Asia and migrate to Alaska in spring, Frank Quimby of the Dept of the Interior said. During the summer, the birds from Asia could pass the virus to birds that migrate south in the fall, said Nicholas Throckmorton of the US Fish and Wildlife Service. Scientists will test birds by capturing them in nets and taking swabs from the throat or cloaca. Birds killed by hunters will also be tested in Alaska this spring and in West Coast states in the fall.
Avian influenza could enter in other ways, Johanns says, including smuggling of infected pet birds or fighting cocks, but the chance that it could be carried in with the spring migration "is definitely a possibility." If tests find the virus in birds in North America, it would not signal the start of a human pandemic, because it still primarily is a disease of birds, he says. If the virus is detected in wild birds in North America, there will be no massive killing of them to contain it, because experts, including those from the WHO, the OIE and the USDA, agree that destroying birds is not an effective control method. What would happen is that officials would warn people to make sure poultry are separated from wild birds.
(CIDRAP 3/8/06 http://www.cidrap.umn.edu/ ; Promed 3/5/06, 3/9/06)
USA (New York/Pennsylvania): Tests back hides as source in anthrax case
Laboratory testing in the case of the drum maker who recently contracted anthrax has supported the belief that he inhaled anthrax spores while working with contaminated animal hides. CDC said Feb 24, 2006 that tests revealed Bacillus anthracis in the workplace, home, and van of Vado Diomande, age 44. He fell ill with inhalational anthrax after performing in a concert in Pennsylvania, Feb 16, 2006. Diomande, who has the first known US anthrax case since 2001, reportedly remains in serious condition in a Pennsylvania hospital. He was reported to have made drums from goat hides imported from Africa. The Environmental Protection Agency planned to begin cleaning his Greenwich Village apartment and his studio near the Brooklyn waterfront this week. The agency intended to clean the apartment hallways and other common areas, plus other residents' apartments on request. Reportedly, testing had revealed no anthrax in an apartment in Brooklyn, where a man worked on unprocessed hides obtained from Diomande. CDC said about two thirds of anthrax cases in the US in recent decades were linked with handling animal hides or hair, but that hides "pose a low risk of cutaneous [skin] anthrax, and an extremely low risk of inhalation anthrax," the agency said. Among 236 anthrax cases reported to CDC from 1955 through 1999, 153 (65%) were tied to industrial handling of hides or hair. But only 9 of the 153 cases (6%) were inhalation anthrax, the most dangerous form.
"No cases of inhalation anthrax in the US have ever been associated with animal hide drums," the agency said. Diomande's exposure "occurred when he was making and finishing drums made from untanned animal hides, and was not associated with playing finished drums. His exposure was similar to that experienced during industrial handling of hides." While CDC does not recommend preventive treatment for people who have had contact with animal-hide drums, drum owners or players should report any unexplained fever or skin lesions. Diomande's illness worried parents of children attending a New York school where he performed about a week before he got sick. Doctors assured parents there was virtually no chance that their children would contract anthrax. The drums used had been treated with chemicals that would kill anthrax spores.
(CIDRAP 2/28/06 http://www.cidrap.umn.edu/ )
USA (Texas): Hantavirus infection kills airman
Reportedly, Air Force service members at an Army base (Fort Bliss near El Paso, Texas) were dangling or tossing dead mice for laughs, which is thought to have led to the death of an airman 11 Feb 2006. An autopsy found he died from hantavirus infection, which is transmitted through the urine, droppings, or saliva of infected rodents. The military reported the cause of death 24 Feb 2006. He was a 24 year old senior airman from Arizona. Clarence Davis III, a spokesman for the William Beaumont Army Medical Center where the airman died, said 7 service members had been admitted there recently with "symptoms of viral illness." So far 4 have tested negative for hantavirus, with results pending for the 3 others. Fort Bliss officials said they are taking several precautions to ensure safety, including cleaning buildings that house troops.
The hantavirus strain most commonly found in the this country is often called "Sin Nombre", and is carried by the deer mouse. More than a third of those who contract it die. Common disinfectants can kill the hantavirus, but if particles disperse--by sweeping up droppings, for example--they can be inhaled. While the incubation period can last from a few days to several weeks, death is often swift. The Sin Nombre virus causes hantavirus pulmonary syndrome, in which the blood vessels leak fluid into the lungs so the victim can't breathe. Infection is not transmitted from person-to-person. For more information on hantaviruses and HPS: http://www.cdc.gov/ncidod/diseases/hanta/hps/noframes/hpsslideset/hps slides1- 12.htm.
USA: USDA aims to reduce Salmonella in meat and poultry
The US Department of Agriculture (USDA) announced a new initiative to reduce Salmonella contamination in raw meat and poultry, mainly by focusing more effort on processing facilities that need improvement and reporting test results faster. A steady increase in Salmonella in broiler chickens tested by USDA since 2002 is among the reasons for the initiative, USDA's Food Safety and Inspection Service (FSIS) said Feb 23, 2006. FSIS said it will concentrate its resources on facilities with higher levels of Salmonella and will provide sample-by-sample test results to facilities as soon as they become available. Currently, firms receive results after a full set of samples is completed, which for broilers means after 51 consecutive days of sampling. Giving the results for each sample when they become available "will help establishments in their assessment of whether their slaughter dressing procedures are adequate for pathogen reduction," the agency said. FSIS also will begin posting the overall nationwide results of its Salmonella testing on its Web site each quarter. Currently results are posted annually. The agency also said it plans to identify Salmonella serotypes more quickly so it can notify meat firms and investigate outbreaks in coordination with health agencies. "Where FSIS has performed Food Safety Assessments (FSAs) in establishments that have persistently poor performance records for controlling Salmonella, there has been a dramatic reduction in the levels of Salmonella," the agency added.
In 2005, 16.3% of the 9,592 broiler samples from processing plants of all sizes tested positive for Salmonella. That compares with 13.5% in 2004, 12.8% in 2003, and 11.5% in 2002. Also in 2005, the agency found Salmonella in 32.4% of 145 tested samples of ground chicken and 23.2% of 925 samples of ground turkey. In 2004 the respective figures were 25.5% for ground chicken and 19.9% for ground turkey. Salmonella was found far less often in the other product categories in 2005: 3.7% for market hogs, 1.3% for cows and bulls, 0.6% for steers and heifers, and 1.1% for ground beef. For all product categories combined in 2005, FSIS found Salmonella in 5.7% (2,322) of the 40,714 samples tested. FSIS is accepting comments on its new policy until May30.
(CIDRAP 3/6/06 http://www.cidrap.umn.edu/ )
USA: FDA notification about BioMedical tissue services
In Oct 2005, the Food and Drug Administration (FDA) issued information regarding an investigation of Biomedical Tissue Services (BTS), a tissue supplier suspected of inadequately screening donors for bloodborne pathogens (syphilis, hepatitis B, C and HIV 1 and 2). On Jan 31, 2006, FDA issued an Order to Cease Manufacturing and to Retain Human Cells, Tissues and Cellular and Tissue Based Products to BTS after FDA investigation uncovered serious violations of donor screening and record keeping regulations. FDA and CDC have been working together with state and local health departments nationally to identify clinicians whose patients received BTS products, so that the patients can be informed and screened for bloodborne pathogens.
(FDA 3/2/06 http://www.fda.gov/cber/safety/bts030206.htm )
Seasonal influenza activity in the APEC Economies
A slight increase in influenza activity was observed since week 4 2006 in many countries of the northern hemisphere. However, overall activity remained medium to low during weeks 4–7.
Canada. Influenza activity increased slightly during weeks 4-7. The consultation rate of influenza-like illness (ILI) was within the expected range in week 7, when widespread influenza activity was reported in parts of British Columbia and Saskatchewan. Activity was medium or low in the rest of Canada.
Hong Kong. A slight increase in influenza A(H1) and B activity continued to be observed during weeks 4–7. Overall activity remained low to medium.
Japan. After widespread influenza A(H3N2) activity sustaining for 7 weeks, activity started to decline quickly in week 5 and was reported as sporadic during week 7.
Russia. An increase in influenza A(H3N2) activity has been observed since week 4. Localized activity remained during weeks 4–7.
Other reports. In weeks 4-7, low activity was detected in Mexico (H3 and B) and Thailand (B).
(WHO 3/8/06 http://www.who.int/csr/disease/influenza/update/en/ )
USA. During week 9 (Feb 26 – Mar 4, 2006), influenza activity increased in the US. 701 specimens (21.6%) tested by U.S. WHO and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories were positive for influenza. The proportion of patient visits to sentinel providers for influenza-like illness (ILI) was above the national baseline. The proportion of deaths attributed to pneumonia and influenza was below the baseline level. 25 states and New York City reported widespread influenza activity; 13 states reported regional influenza activity; 8 states and the District of Columbia reported local influenza activity; and 4 states reported sporadic influenza activity.
For the comprehensive update on recent influenza activity in the USA (“Update: Influenza Activity--United States, February 19--25, 2006”): http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5509a9.htm
(CDC 3/10/06 http://www.cdc.gov/flu/weekly/ )
Avian/Pandemic influenza updates
- WHO’s comprehensive information on avian influenza: http://www.who.int/csr/disease/avian_influenza/en/index.html. 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.
- OIE updates and documents on avian influenza: http://www.oie.int/eng/en_index.htm.
- CDC website on pandemic influenza: http://www.cdc.gov/flu/pandemic.htm. For avian influenza: http://www.cdc.gov/flu/avian/.
- The US government’s web site for pandemic flu: http://www.pandemicflu.gov/. Latest update on U.S. government’s preparedness activities.
- 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)
The Centre for Health Protection has confirmed a Dengue fever case involving a 48-year-old woman living in Sheung Shui, bringing the year's total cases to 4, all imported. The patient travelled to Thailand 27-30 Jan 2006, and got a fever, headache, a rash, and joint and muscle pain 4 Feb 2006. She was admitted to North District Hospital 9 Feb and was discharged 15 Feb 2006. Her home contacts have no symptoms. Dengue is not transmitted person-to-person.
Dengue fever has killed 3 people in Bandarlampung, where hospitals are currently treating some 30 patients, mostly children, for the disease.
Cases of dengue in Bacolod City may have increased in 2005 compared with those in 2004 but fewer deaths were related to the disease in 2005 than in 2004. Records from the City Health Office [CHO] show that the total reported cases of dengue in 2005 was 909, compared with the 467 in 2004, but there were only 3 reported deaths in 2005 and 5 in 2004. City Health Officer Dr Idilleon Isidto attributed the lower death rate in 2005 to the education campaign. He said the CHO resumed its operation against dengue Feb 2005 because of the rainy weather. It continues to conduct fogging operations where there are reported cases on dengue. Isidto is reminding the public to keep surroundings clean and rid them of possible breeding places of mosquitoes.
20 southern provinces and cities have reported dengue epidemics with around 400 patients hospitalized by 26 Feb 2006, reported the Ministry of Health. The provinces with the highest numbers of dengue patients are HCM [Ho Chi Minh] City 57, Soc Trang 27, Dong Thap 32, Da Nang 17 and Can Tho 11. Doctors have warned of dengue pandemics in the south. The HCM City Pasteur Institute in late 2005 warned of dengue epidemics in many southern provinces in early 2006. Last year more than 44 000 cases of dengue were recorded in the southern region, and 47 died. Vietnam has recorded over 4800 dengue cases so far in 2006; 2 died [CFR of 42 per 100 000], an increase of nearly 20 percent year on year, according to the Ministry.
Night blindness associated with Chagas disease
Researchers have determined that night blindness is a new clinical symptom of Chagas disease. A team led by Howard Hughes Medical Institute international research scholar Mariano Jorge Levin and Cristina Paveto of the Institute for Genetic Engineering and Molecular Biology, National Research Council, National Council of Scientific Research and Technology in Argentina, found that the immune system of individuals with the disease can shut down a key reaction in the retina, causing night blindness. Their findings are in the Mar 2006 issue of the FASEB Journal. Chagas disease affects people living in regions of Latin America where "kissing bugs" carrying the parasite Trypanosoma cruzi thrive in crowded and substandard housing. At night, the insects bite, transferring the Chagas parasite into a new host. After an acute infection, those infected usually feel better. But the parasite remains in a chronic phase of infection, invading cells and stimulating the immune system. People can develop heart and gastrointestinal problems months or years after being infected. Some 30 000 people die each year from Chagas disease, but the number of people who are carrying latent infections is unknown. "We now know that Chagas patients may have trouble seeing at night," said Levin, head of the Laboratory of the Molecular Biology of Chagas Disease at the University of Buenos Aires. "And this gives us additional motivation to improve conditions for people living in areas where Chagas disease is common."
Silvia Matsumoto of the Dr. Teodoro Alvarez Hospital conducted eye examinations of 45 Chagas disease patients with heart problems. She found that under bright conditions, the patients performed comparably to 50 healthy controls. But in the dark, 37 of 45 (82 percent) patients had trouble seeing with at least 1 eye, and 19 of 45 (42 percent) had trouble with both eyes. Levin et al. found that antibodies geared to attack T. cruzi also block rhodopsin, a molecule that converts light into electrical impulses sent to the brain. Levin said that Chagas patients' vision problems are caused exclusively by the antibodies that block rhodopsin, and not by inflammation. ". . .No one knew about the night blindness, so we don't know, for instance, whether Chagas patients have more accidents at night. . ." More studies are now needed to confirm the results.
USA: Diarrheal disease on the rise in cruise ships
Cruise ship passengers are currently more likely to experience diarrheal disease than they were in the 1990's, new study findings suggest [published in Mar 2006, American Journal of Preventive Medicine]. The expected incidence of gastroenteritis per 7-day cruise has increased from 2 cases in 1990 - 2000 to 3 cases in 2001 - 2004, the report indicates. "Despite good environmental health practices on cruise ships, and high performance scores on environmental health inspections, gastroenteritis likely associated with person-to-person spread of illness caused by norovirus infection is difficult to predict and prevent," said author Elaine H. Cramer of the US CDC.
In 2000, the incidence of diarrheal disease among cruise ship passengers was 16 cases per 100 000 passengers, down from 29 cases per 100 000 passengers in 1990. Just a short while later, however, diarrheal disease outbreaks on cruise ships increased. According to CDC, 29 outbreaks occurred in 2002, compared with just 3 in the previous year. Cramer et al. evaluated the incidence of gastroenteritis on cruise ships that docked in US ports and carried at least 13 passengers from 2001 - 2004. The number of gastroenteritis outbreaks per 1000 cruises increased from 0.65 to 5.46. What's more, the total number of gastroenteritis outbreaks increased to a median of 15 per year from 2002 to 2004, up from 2 in 2001. Yet, the ships continued to perform well on regular, unannounced inspections throughout the study period. Inspection scores were not associated with either increased or decreased rates of gastroenteritis, and they also did not appear to predict more or less frequent outbreaks. "The increase we have seen at sea is paralleled by an increase in the prevalence of norovirus-associated gastroenteritis on land," Cramer said. Still, passengers have less than a 1 percent chance of contracting gastroenteritis while spending an average of 7 days at sea, the researchers note. "The most important preventive strategy against gastroenteritis associated with person-to-person transmission of disease is hand washing," Cramer said.
Attitudes toward the use of quarantine in a public health emergency in four countries
Blendon RJ et al. Health Aff (Millwood). 2006 Jan 24; [Epub ahead of print]
Abstract: “Countries worldwide face the threat of emerging infectious diseases. To understand the public’s reaction to the use of widespread quarantine should such an outbreak occur, the Harvard School of Public Health, with the U.S. Centers for Disease Control and Prevention, undertook a survey of residents of Hong Kong, Taiwan, Singapore, and the United States. A sizable proportion of the public in each country opposed compulsory quarantine. Respondents were concerned about overcrowding, infection, and inability to communicate with family members while in quarantine. Officials will need specific plans to deal with the public’s concerns about compulsory quarantine policies.”
(CIDRAP http://www.cidrap.umn.edu/ )
Enterobacter sakazakii: An Emerging Pathogen in Powdered Infant Formula.
Drudy D et al. Clin Infect Dis. 2006 Apr 1;42(7):996-1002. Epub 2006 Feb 22.
Abstract: “Enterobacter sakazakii represents a significant risk to the health of neonates. This bacterium is an emerging opportunistic pathogen that is associated with rare but life-threatening cases of meningitis, necrotizing enterocolitis, and sepsis in premature and full-term infants. Infants aged <28 days are considered to be most at risk. Feeding with powdered infant formula (PIF) has been epidemiologically implicated in several clinical cases. Infants should be exclusively breast-fed for the first 6 months of life, and those who are not should be provided with a suitable breast-milk substitute. PIF is not a sterile product; to reduce the risk of infection, the reconstitution of powdered formula should be undertaken by caregivers using good hygienic measures and in accordance with the product manufacturer's food safety guidelines.”
(CIDRAP http://www.cidrap.umn.edu/ )
Reevaluation of epidemiological criteria for identifying outbreaks of acute gastroenteritis due to norovirus: United States, 1998–2000
Turcios RM et al. Clin Infect Dis. 2006 Apr 1;42(7):964-9. Epub 2006 Feb 27.
Abstract: “Background. Noroviruses are believed to be the most common etiologic agent of foodborne outbreaks of gastroenteritis, yet diagnostic tests for these agents are not readily available in the United States. In the absence of assays to detect norovirus, several clinical and epidemiologic profiles—the criteria of Kaplan et al. (vomiting in >50% of patients, mean incubation period of 24–48 h, mean duration of illness of 12–60 h, and no bacterial pathogen) and the ratios of fever to vomiting and diarrhea to vomiting—have been used to distinguish foodborne outbreaks of gastroenteritis caused by noroviruses from those caused by bacteria. Methods. To examine how well clinical and epidemiological profiles discriminate between foodborne outbreaks of gastroenteritis due to noroviruses and those due to bacteria and to estimate the proportion of reported outbreaks that might be attributable to noroviruses, we reviewed subsets of the 4050 outbreaks reported from 1998 to 2000. Results. The set of criteria of Kaplan et al. is highly specific (99%) and moderately sensitive (68%) in discriminating confirmed outbreaks due to bacteria from those due to norovirus and was the most useful diagnostic aid evaluated. Each individual component of the criteria, the fever-to-vomiting ratio, and the diarrhea-to-vomiting ratio were more sensitive, yet less specific, and therefore less useful, than the criteria of Kaplan et al. We estimated that, at a minimum, 28% of all the foodborne outbreaks reported to the Centers for Disease Control and Prevention may be attributed to norovirus on the basis of these criteria. Conclusion. Until norovirus diagnostic tests become widely available, the criteria of Kaplan et al. remain the most useful and discriminating diagnostic aid to identify foodborne outbreaks of gastroenteritis due to noroviruses.”
(CIDRAP http://www.cidrap.umn.edu/ )
Human Rabies --- Mississippi, 2005
“On September 27, 2005, a previously healthy boy aged 10 years in Mississippi died from encephalitis later attributed to rabies. This report summarizes the patient's clinical course and the subsequent epidemiologic investigation, which implicated exposure to bats at the boy's home as the likely source of rabies. The findings underscore the importance of recognizing the risk for rabies from direct contact with bats and seeking prompt medical attention when exposure occurs. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5508a4.htm
(MMWR March 3, 2006 / 55(08);207-208)
Public Health Response to Hurricanes Katrina and Rita --- United States, 2005
“On August 29, 2005, Hurricane Katrina struck the U.S. Gulf Coast, the eye making landfall at Plaquemines Parish, Louisiana. . .The events that followed made Katrina the deadliest hurricane since 1928 and likely the costliest natural disaster on record in the United States. Devastating storm surge, strong winds, and heavy rains caused widespread destruction in Louisiana, Mississippi, Alabama, and Florida. Storm-induced breeches in the levee system surrounding New Orleans flooded 80% of the city. The disaster was compounded when Hurricane Rita made landfall 26 days later near the Texas-Louisiana border, forcing cessation of hurricane-response activities in New Orleans and evacuation of coastal regions of Louisiana and Texas. The economic and health consequences of Hurricanes Katrina and Rita extended beyond the Gulf region to affect states and communities throughout the United States. MMWR is highlighting the public health response to Hurricanes Katrina and Rita with two special issues. The first issue, published January 20, 2006, focused on public health activities in Louisiana. This second issue focuses on activities in other states directly or indirectly affected by the two hurricanes. . .”
(MMWR March 10, 2006 / 55(09);229-231)
***MMWR March 10, 2006 (http://www.cdc.gov/mmwr/ ) focuses on Katrina and Rita:
- Surveillance for Illness and Injury After Hurricane Katrina--Three Counties, Mississippi, September 5--October 11, 2005
- Rapid Community Needs Assessment After Hurricane Katrina--Hancock County, Mississippi, September 14--15, 2005
- Carbon Monoxide Poisonings After Two Major Hurricanes--Alabama and Texas, August--October 2005
- Mortality Associated with Hurricane Katrina--Florida and Alabama, August--October 2005
- Rapid Assessment of Health Needs and Resettlement Plans Among Hurricane Katrina Evacuees--San Antonio, Texas, September 2005
- Illness Surveillance and Rapid Needs Assessment Among Hurricane Katrina Evacuees--Colorado, September 1--23, 2005
Progress in Reducing Global Measles Deaths, 1999--2004
“Measles remains a substantial cause of global childhood mortality, particularly in developing countries. In their joint strategic plan for Measles Mortality Reduction, 2001--2005, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) targeted 45 priority countries. . .with the highest measles mortality for implementation of a comprehensive strategy for accelerated and sustained measles mortality reduction. Components of this strategy include achieving high routine vaccination coverage (>90%) in every district and ensuring that all children receive a second opportunity for measles vaccination. In May 2003, the World Health Assembly endorsed a resolution urging member countries to achieve a goal (adopted in 2002 by the United Nations General Assembly Special Session on Children) to reduce 1999 deaths resulting from measles by half by the end of 2005. This report updates progress toward this goal and introduces a new goal for measles mortality reduction by 2010. . .”
(MMWR March 10, 2006 / 55(09);247-249)
Harvard global conference on disaster prevention
The Harvard School of Public Health will host a meeting 26-28 Apr 2006 entitled "Preventing Disasters and Minimizing Their Consequences.” Discussions will be relevant to those involved in long range planning to reduce the human and financial loss of disasters. Speakers include Salvano Briceno, director of the UN/ISDR; Jennifer Leaning, HSPH professor of the practice of public health; Tova Solo, senior urban specialist/disaster management, the World Bank; Mir Ali Asgar, regional humanitarian coordinator for South Asia, Oxfam America; Dr Mary E Wilson, Harvard School of Public Health; and Harvey V Fineberg, president, Institute of Medicine/The National Academies. Leadership, financial incentives, infrastructure, and policy will be examined in the context of 4 threats: disease epidemics; natural catastrophes; emerging technologies; and consequences of maritime activity. Novel approaches to prevention and mitigation, and opportunities for future collaborations, will be generated during the meeting. For more information: http://www.hsph.harvard.edu/disasters ; email@example.com ; 617-432-6417.
CDC March 2006 Infectious Disease conferences
Atlanta, Georgia, USA; 16-24 Mar 2006
New, re-emerging, and drug-resistant infectious diseases present global challenges to the clinical, scientific, and public health and animal health communities. Particularly critical to CDC’s mission of protecting public health are collaborations that facilitate rapid dissemination of the latest information on infectious diseases -- critical components in controlling their spread. To generate global exchange of information and cooperation in addressing emerging infectious diseases, CDC and its partners are sponsoring 3 conferences in Atlanta in Mar 2006:
- the International Conference on Women and Infectious Diseases, 16-18 Mar 2006, seeks to enhance prevention and control of infectious diseases among women worldwide http://www.womenshealthconf.org.
- the International Conference on Emerging Infectious Diseases, 19-22 Mar 2006, presents programs and activities that address emerging infectious disease threats, identify infectious disease program gaps, increase awareness of emerging infectious disease issues, and enhance partnerships in addressing emerging infectious diseases http://www.iceid.org.
- the International Symposium on Emerging Zoonoses, 22-24 Mar 2006, brings together public health and animal health professionals to strengthen the development of effective and co-operative partnerships to face off emerging zoonotic microbial threats http://www.isezconference.org.
Southwest Conference on Diseases in Nature Transmissible to Man and International Conference on Diseases in Nature Communicable to Man
San Antonio, Texas, 1-4 Aug 2006
This year the 56th Annual Meeting of the Southwest Conference on Diseases in Nature Transmissible to Man & 61st Annual Meeting of the International Conference on Diseases in Nature Communicable to Man will be a joint conference. Abstract Deadline: 1 Apr 2006 for both oral and poster presentations. Keynote Speakers are: Dr. Gregory C. Gray, MD, MPH, Director, Center for Emerging Infectious Diseases and Professor, Department of Epidemiology, College of Public Health, University of Iowa and Dr. Kenneth Gage, PhD, Chief of the Vector Ecology and Control Laboratory at the Division of Vector-Borne Infectious Disease, CDC, Fort Collins, Colorado. Session Topics include: Bacterial and Parasitic Zoonoses, Influenza and Other Viral Zoonoses, West Nile Virus and other Vector-borne Zoonoses, Emerging Zoonoses in the Western Hemisphere, Risk Communication, and Bioterrorism and Post-Disaster Recovery.
Conference Coordinator: Jim Schuermann, BS, Southwest Conference Coordinator, Staff Epidemiologist for Vectorborne and Zoonotic Diseases, Zoonosis Control Branch, Texas Department of State Health Services. Phone : 512-458-7111 ext. 2890; Fax: 512-458-7454; firstname.lastname@example.org
Kevin Fonseca, INCDNCM, Provincial Laboratory of Public Health (Microbiology), 3030 Hospital Drive NW, Calgary, Alberta, Canada. Phone: 403 944 1263; Fax: 403 270 2216; email@example.com.
Ground Water Awareness Week, March 12--18, 2006
Each year, the National Ground Water Association (NGWA) sponsors Ground Water Awareness Week to focus public attention on protecting ground water and the importance of private well maintenance and water testing with other partners. During 2001-2002, a total of 31 waterborne-illness outbreaks were reported to CDC; 16 (52%) of these outbreaks were attributed to improperly treated or untreated groundwater. Because private wells are not covered by the Safe Drinking Water Act, NGWA and its partners recommend annual well-maintenance checkups and water tests for contaminants. Certain contaminants, such as arsenic, can occur naturally in groundwater, whereas others are linked to well placement, construction, or maintenance. . .Improper disposal of household waste. . .can also contaminate groundwater used for drinking. In addition, wells are susceptible to bacterial contamination if surface runoff pools around the wellhead or if the wellhead is too close to an animal enclosure, feedlot, or septic system drain field. For more information: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5509a12.htm
(MMWR March 10, 2006 / 55(09);251-252)
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 also recently spoke at the Bird flu Summit 27 Feb 2006, on Prevention Education Efforts and Risk Communication: http://www.new-fields.com/birdflu/agenda.htm.
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 firstname.lastname@example.org. Further information about APEC EINet is available at http://depts.washington.edu/einet/.