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Vol. IX, No. 7 ~ EINet News Briefs ~ Apr 07, 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:
- Global: Cumulative number of human cases of avian influenza A/(H5N1)
- Asia and USA: Increase in reported cases of Fusarium keratitis
- Azerbaijan: Suspected human cases of avian influenza H5N1 infection
- Czech Republic: Excerpts from the OIE report on avian influenza H5N1
- Denmark: Excerpts from the OIE reports on avian influenza H5N1
- Georgia: Excerpts from the OIE report on avian influenza H5N1
- Germany (Saxony): Confirmation of first case of H5N1 in domestic fowl
- Germany: Update on avian influenza H5N1 in wild birds
- Greece: Excerpts from the OIE report on avian influenza H5N1
- Israel: Ninth outbreak of avian influenza H5N1 in poultry
- Palestinian Authority (Gaza strip): Poultry culling causing protein shortage
- Russia (Volgograd): Avian influenza H5N1 infection in dozens of dead birds at farm
- Switzerland: Avian influenza H5N1 infection confirmed in fourth bird
- UK (Scotland): Avian influenza H5N1 infection confirmed in dead mute swan
- Cambodia: Sixth human case of avian influenza H5N1 infection
- India (Maharshastra): Avian influenza H5 spreads to more villages
- Indonesia: Update on human cases of avian influenza H5N1 infection
- Hong Kong/Mauritius: Confirmed case of chikungunya
- Malaysia (Perak): Chikungunya outbreak hospitalizes 7 persons
- Malaysia (Negeri Sembilan, Sarawak): Hand, foot and mouth disease outbreak update
- Singapore: Hand, foot and mouth cases surge
- Japan: Update on first Japanese case of vCJD
- USA: Live markets a risk for entry of avian influenza into USA
- USA (Midwest): Number of mumps cases swells
- USA (Washington): Botulism case linked to heroin
- USA: USDA says cooking poultry to 165F will ensure safety
- USA: Discontinuation of Spectinomycin
- Burkina Faso: Excerpts from the OIE report on avian influenza H5N1
- Egypt: Confirmation of 11th human case of avian influenza H5N1 infection
- Nigeria (Lagos): Avian influenza H5N1 infection in poultry

1. Updates
- Influenza
- Dengue

2. Articles
- CDC EID Journal, Volume 12, Number 4—April 2006
- Experts urge including cats in avian flu precautions
- Mumps Epidemic--Iowa, 2006
- Community-Associated Methicillin-Resistant Staphylococcus aureus Infection Among Healthy Newborns--Chicago and Los Angeles County, 2004
- Tuberculosis Control Activities After Hurricane Katrina--New Orleans, Louisiana, 2005
- Update: Guillain-Barré syndrome among recipients of Menactra meningococcal conjugate vaccine--United States, October 2005-February 2006
- Diagnosis and management of tickborne rickettsial diseases
- New vaccine approach relies on weakened Listeria
- Mitigation strategies for pandemic influenza in the United States
- Use of sentinel laboratories by clinicians to evaluate potential bioterrorism and emerging infections
- Genetic susceptibility to vCJD infection
- Vesiviruses: Oceanic Viruses Identified in Human Blood Samples

3. Notifications
- International Scientific Conference on Avian Influenza and Wild Birds
- The Seventh Asia Pacific Congress of Medical Virology
- 2006 National STD Prevention Conference

4. APEC EINet activities
- APEC EID Symposium; HIT Workgroup Meeting

5. To Receive EINet Newsbriefs
- APEC EINet email list


Global
Global: Cumulative number of 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
Azerbaijan / 7 (5)
Cambodia / 2 (2)
China / 8 (6)
Egypt / 4 (2)
Indonesia / 13 (12)
Iraq / 2 (2)
Turkey / 12 (4)
Total / 48 (33)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 192 (109)

A European map on avian influenza in wild birds is available at the EU website and updated daily: http://europa.eu.int/comm/food/animal/diseases/adns/index_en.htm#.
(WHO 4/6/06 http://www.who.int/csr/disease/avian_influenza/en/ ; Promed 4/1/06)

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Asia and USA: Increase in reported cases of Fusarium keratitis
A potentially damaging fungus is infecting the eyes of a small but growing number of people in Florida and elsewhere who wear soft contact lenses, researchers said 29 Mar 2006. The fusarium fungus typically strikes soft-lens wearers only rarely, but a dozen in South Florida have been infected since Jan 2006 in the biggest reported outbreak in the country. Health officials are investigating outbreaks here and in other states. "We have no idea why this is happening to contact lens wearers," said Dr Eduardo C Alfonso, an eye surgeon and chairman of ophthalmology at the University of Miami's Bascom Palmer Eye Institute. In a typical year, Bascom Palmer sees an average of 21 patients with fusarium infections, virtually all among people with eye trauma that lets the fungus penetrate the cornea. Only a few patients infected since 2000 have been lens wearers, Alfonso said. But so far this year, the center already has seen 21 cases, 12 among lens wearers. The fungus poses a small but real worry for the estimated 29 million Americans with soft lenses. Alfonso said soft lenses that are not cleaned well may not let enough oxygen reach the eye, causing small damaged areas, especially when worn for long periods of time. People typically are infected by touching their eyes with fingers that have come in contact with the fungus, or if the fungus gets on the lens. The fungus is common in soil and plants in the tropics but can also survive in colder climates. Alfonso recommends wearers clean their lenses well and not wear them while sleeping.

In Feb 2006, officials in Singapore reported 39 cases of fungal infections among lens wearers (high incidence was also reported in Hong Kong at the time), and 3 cases were reported in New York. Recently, Alfonso said he has heard from eye specialists in Tampa, Atlanta, Texas and California who also had cases. At least 4 research projects have started recently in Florida and other states. Fusarium infections often go undetected and are hard to diagnose, giving the fungus time to spread. In severe cases, about 20 percent of the time, the eye becomes so clouded that the patient requires a cornea transplant. The condition can be treated with an anti-fungal drug, but it is more difficult to defeat than more benign and common eye infections caused by bacteria, Alfonso said. Eye specialists nationally began noticing a slight increase in fusarium infections about 4 years ago, but the number of cases made a big jump since early 2006.

In Feb 2006 sales of Bausch & Lomb's [B&L] ReNu multipurpose solution were halted in Hong Kong and Singapore following the abnormally high number of reports of fungal keratitis in the 2 cities. In an update on the unusual outbreaks of fusarium keratitis, B&L said it was aware of reports of cases in other countries, including Malaysia. More recently, however, B&L commented that initial evidence from Singapore suggests the cause of infections is not related to a specific lens care product. According to Singapore, most of the contact lens-related fungal keratitis infections in that country involved patients with histories of poor contact lens care practices' said B&L, adding that the company is implementing consumer education programmes to raise public awareness of the importance of good hygiene and proper lens care. As the normal incidence of these infections in many markets is not well-understood, the company is working with authorities to improve reporting of cases, and has contacted corneal specialists and treatment centres throughout the world to assess whether there are unusual trends in any other regions. Laboratories in Singapore, Hong Kong, and the US are culturing clinical isolates of Fusarium from patient samples to identify the genetic make-up of the organisms and to determine whether they are different from the strain used in standard biocidal efficacy testing. B&L is collaborating with the Singapore National Eye Centre, which is conducting a case control study to assess whether any common factors, beyond contact lens wear, existed among the patients with infections. The company also is working with the US CDC to investigate and track the incidence of these infections around the world, and has asked Johns Hopkins University to implement a surveillance program in leading corneal treatment centres throughout the US. (Promed 3/30/06)

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Europe/Near East
Azerbaijan: Suspected human cases of avian influenza H5N1 infection
Azerbaijan has sent blood samples from 43 people to the WHO-accredited UK laboratory to test for the H5N1 strain of avian influenza, the Health Ministry stated 5 Apr 2006. 5 young people have died from H5N1 in Azerbaijan. The ministry did not say whether all 43 had been classified as suspected avian influenza cases. It said they had cold-like symptoms and not all had been hospitalized. "The Health Ministry decided to send blood samples (of the 43 patients) to London to test for the H5N1 virus, since we don't have the necessary equipment for this in Azerbaijan," said Health Ministry spokeswoman Samaya Mamedova. Azerbaijan has a laboratory that can test for H5 avian influenza, but it cannot identify whether someone is infected with the H5N1 virus. She did not say whether the 43 people had tested positive for H5 avian influenza. WHO has said it believes the human bird flu outbreak in Azerbaijan has stabilized. Public health officials, citing local test results, said last week a 16-year-old girl had tested positive for bird flu (she is reportedly from a family which has lost 3 members to the H5N1 virus). She is in hospital and is responding to treatment, officials said. Her blood sample was among the 43 sent to Britain. She was the first new case of suspected human bird flu infection in Azerbaijan since the first week of March 2006. (Promed 4/1/06, 4/5/06)

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Czech Republic: Excerpts from the OIE report on avian influenza H5N1
Disease never reported before in the Czech Republic.
Information received 29 Mar 2006 from Dr. Josef Vitasek, Director of the Department for Protection of Health and Animal Welfare, State Veterinary Administration, Ministry of Agriculture: Identification of agent: highly pathogenic avian influenza virus subtype H5. Date of start of event: 20 Mar 2006. Details of outbreak: a mute swan (Cygnus olor) found dead in Ceske Budejovice close to the river Vtala. Within the framework of the surveillance program, a total of 1259 samples of wild birds found dead were tested between 1 Jan and 25 Mar 2006, all with negative results. Diagnostic test results: RT-PCR (gene H5) positive; OIE/FAO Reference Laboratory for avian influenza--pending. (Promed 4/2/06)

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Denmark: Excerpts from the OIE reports on avian influenza H5N1
Information received 24 Mar 2006 from Dr. Preben Willeberg, Chief Veterinary Officer, Danish Veterinary and Food Administration: End of this report period: 24 Mar 2006. Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of start of event: 12 Mar 2006. Details of new outbreaks: Outbreak in Praesto, Storstroem: a tufted duck (Aythya fuligula); Outbreaks in Aeroskobing, Funen: 11 tufted ducks (Aythya fuligula); Outbreak in Frederikssund, North Eastern Zealand: a whooper swan (Cygnus cygnus). Diagnostic test result: RT-PCR positive for H5; virus isolation positive for H5N1; sequencing analysis at cleavage site reveals HPAI profile. The protection and surveillance zones have been established in accordance with European Union legislation. All poultry within the zones must be kept inside, and all poultry holdings -- including hobby holdings -- must be registered. The Danish Veterinary and Food Administration will inspect all poultry holdings in the protection zones in order to look for possible further spread of avian influenza. Restrictions on movement of eggs and poultry have been imposed within the zones. All hunting within the zones is also prohibited.

On 31 Mar 2006 the Danish Veterinary and Food Research Institute detected high pathogenic avian influenza (H5) in 2 wild birds from 2 locations: a tufted duck (Aythya fuligula) found near Skaelskor in Western Zealand County; a mute swan (Cygnus olor) found dead near Vang on the island Bornholm.

A screening programme for avian influenza in domestic fowl has been operational in Denmark since 2002; Danish poultry has remained free of HPAI since. Also, in Denmark 225 wild birds were analyzed in the period 15 Feb 2006 to 15 Mar 2006 with negative test results. However, following the detection of the first positive bird, 14 Mar 2006, 26 additional H5-positive wild birds have been confirmed between 15 Mar 2006 and 31 Mar 2006. Details, including the precise species of each tested bird, are available at: http://www.uk.foedevarestyrelsen.dk/AnimalHealth/Avian_influenza/Latest_news/Results_in_2006/forside.htm.
(Promed 3/31/06, 4/2/06)

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Georgia: Excerpts from the OIE report on avian influenza H5N1
Information received 9 and 27 Mar 2006 from Dr. Levan Ramishvili, Advisor of the Minister of Agriculture: Identification of agent: highly pathogenic avian influenza (HPAI) virus subtype H5N1. Date of start of event: 23 Feb 2006. Details of outbreak: 10 wild swans (9 dead and 1 still alive) were found at a small lake located far from the village. In 5 villages in a 5-km zone around the outbreak, stamping out has been applied to 1700 domestic poultry. Measures relating to quarantine and the emergency situation were lifted 15 days after the last case [which was 23 Feb 2006]. Diagnostic test results: RT-PCR positive; RT-PCR positive; RT-PCR and virus isolation positive for H5N1. (Promed 4/2/06)

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Germany (Saxony): Confirmation of first case of H5N1 in domestic fowl
Authorities in the state of Saxony said 5 Apr 2006 that tests have confirmed for the first time the presence of the H5N1 bird flu virus in domestic fowl (the exact site of the outbreak is the village Mutzchen). This is the second confirmed case of H5N1 in domestic fowl in the European Union after a case in France in late Feb 2006. "This is the first case of H5N1 in domestic fowl (in Germany), and this makes it somewhat explosive," said Saxony's Minister of Social Affairs, Helma Orosz. "Tonight we will start to kill all the birds." Several EU countries, including Germany, have reported cases of avian flu in wild birds, but most have so far managed to keep it out of domestic flocks. Orosz said the farm had been exempt from a poultry lock-up, which had been in force across Germany since 17 Feb 2006 to prevent avian flu spreading from wild birds to domestic fowl. The first birds had died 2 Apr 2006 on the farm, which houses more than 16 000 turkeys, geese and chickens. A restricted quarantine zone with a radius of 3 km was established, along with a larger observation area inside a 13-km radius from the location of the H5N1-infected birds. The European Commission said the situation will be discussed by the Standing Committee on the Food Chain and Animal Health in the light of the information received from the German authorities. Reportedly, the Ministry for Social Affairs in Dresden said tests had confirmed that some 20 dead turkeys on a poultry farm in the district Muldentalkreis near Leipzig had tested positive for the H5N1 strain. (Promed 4/5/06)

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Germany: Update on avian influenza H5N1 in wild birds
From Franz Conraths franz.conraths@fli.bund.de , Friedrich-Loeffler-Institut:
First detection of avian influenza H5N1 in 4 swans discovered dead on the island of Rugen in the Baltic Sea 8 Feb 2006. Present situation (4 Apr 2006) regarding Avian Influenza H5N1 infection in Germany: 273 wild birds; 3 cats; 1 stone marten. Spatial distribution (by Federal States): Baden-Wurttemberg: 17 wild birds; 5 counties affected, focus at the Bodensee. Bavaria: 47 wild birds; 18 counties affected. Berlin: 1 wild bird. Brandenburg: 15 wild birds; 5 counties affected. Mecklenburg-Western Pomerania: 186 wild birds; 7 counties and towns affected, focus on the Island of Rugen: 3 domestic cats; 1 stone marten. Lower Saxony: 2 wild birds; 2 counties affected. Schleswig-Holstein: 12 wild birds; 4 counties affected.

Excerpts from the OIE report on avian influenza H5N1
Information received 17 Mar 2006 from Prof. Dr. Werner Zwingmann, Chief Veterinary Officer, Ministry of Consumer Protection, Food and Agriculture: End of this report period: 17 Mar 2006. Identification of agent: avian influenza virus subtype H5N1. Date of start of event: 8 Feb 2006. New outbreaks: This report describes 10 cases from 4 places in Mecklenburg-Western Pomerania. 5 cases were from Rugen in Mecklenburg, Western Pomerania. These cases involved Cygnini (swan), Anserini (geese), Falconiforme (falcons and other birds of prey) and Anatinae (ducks). The report also describes 6 cases from 6 sites in Bavaria involving Cygnini (swan), Anserini (geese) and Anatinae (ducks). Diagnostic test results: PCR (M, H5, H7, N1 genes): positive for H5N1. (Promed 4/2/06, 4/5/06)

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Greece: Excerpts from the OIE report on avian influenza H5N1
Information received 27 Mar 2006 from Dr. Spirus Doudounakis, Head, Unit of the Department of Infectious Diseases, Ministry of Rural Development and Food: Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of start of event: 30 Jan 2006. New outbreak: A report of a mute swan (Cygnus olor) found dead at Thessaloniki, Central Macedonia. Diagnostic test results: hemagglutination inhibition test - positive for H5. Hemagglutination test; hemagglutination inhibition test; RT-PCR; - positive for H5N1. Virulence determination by nucleotide sequencing (amino acids at the cleavage site of the hemagglutinin) indicates a highly pathogenic avian influenza profile. (Promed 4/2/06)

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Israel: Ninth outbreak of avian influenza H5N1 in poultry
Israel began culling 20 000 chickens 31 Mar 2006 which are believed to have been exposed to the H5N1 bird flu virus at a collective farm in southern Israel. Moshe Chaimovitz, head of the Israeli Agricultural Ministry's veterinary service, said tests showed the presence of H5N1 at Kibbutz Kerem Shalom, near Israel's border with the Gaza Strip and Egypt. "We are checking into how the outbreak occurred," he said. Israel has culled more than 1.2 million turkeys and chickens in several other farms after detecting the H5N1 virus for the first time in Israel early Mar 2006. There have been no human cases. Agriculture Minister Zeev Boim said the disease had been eradicated, but that another flare-up was possible. The Israeli government approved compensation of 15 million shekels (USD 3.1 million) to affected farmers. The H5N1 strain has also been confirmed in poultry in the densely populated Gaza Strip. In a show of cooperation between Israel and the Palestinian Authority, Israel has carried out testing on birds on behalf of the Palestinians and said it would supply Palestinian teams with protective clothing and professional assistance. (Promed 3/31/06)

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Palestinian Authority (Gaza strip): Poultry culling causing protein shortage
Poultry supplies, the primary source of protein in the Gaza Strip, were being severely affected by measures implemented to contain the spread of the H5N1 avian flu virus. According to Ambrogio Manenti, regional head of office for WHO, the recent closures of the Karni border crossing with Israel have limited the import of alternative protein sources, further increasing concern over a nutrition gap in the Palestinian food supply. UN commended Israeli-Palestinian cooperation on the avian flu threat and called for increased aid in fighting the spread of bird flu in the Palestinian territories. Some 250 000 birds have been culled by UN officials and PA agencies so far. The figure represents 10 percent of the total estimated number of fowl in the Gaza Strip. More than 30 000 farmers lost their chickens to the culling and were left unable to provide for their estimated 200 000 family members. An additional 250 000 birds were slated for culling. The farmers were promised compensation by the UN and the PA. However, according to Luigi Damiani, project manager for the UN's FAO, compensation involves more than just paying for the chickens. It must compensate for the downtime in which the farmers have nothing to sell and for later restocking. The process of culling, vaccinating and restocking, Damiani cautioned, would take many months. The lack of animal protein in the Palestinians' food supplies during this time was particularly problematic for children. Damiani said there were discussions in the World Food Program regarding the addition of fish to food supplies already being sent to the Palestinian territories. Israel has provided several dozen doses of the anti-viral drug Tamiflu on loan to the PA. The PA needed doses for at least 3 percent of its population just to deal with the direct threat of infection, at a cost of some USD 2 million. The UN needed several hundred doses immediately for those officials and farmers who were exposed to the infected birds. No human cases have been reported in either Israel or the Palestinian territories. (Promed 4/5/06)

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Russia (Volgograd): Avian influenza H5N1 infection in dozens of dead birds at farm
The H5N1 strain of bird flu virus has been found in dozens of dead birds in Russia's southern province of Volgograd. "Today the provincial veterinary laboratory confirmed the presence of the H5N1 virus in the blood of dead birds" found at a farmyard at the village of Vesyoly, a statement from the Volgograd provincial administration said. Preventive work including disinfection is being carried out and 2 million doses of bird flu vaccine have been sent to the province from Moscow, the statement said. Russia's chief veterinarian warned last week that bird flu was posing a growing threat to the country. "In 2005 the virus affected 62 towns in 10 Russian regions, while since the start of 2006, already 56 towns in 9 regions have been affected," Sergei Dankvert said. The outbreak in Volgograd follows outbreaks in several other parts of southern Russia as well as in nearby Turkey, Azerbaijan and Georgia. (Promed 3/31/06)

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Switzerland: Avian influenza H5N1 infection confirmed in fourth bird
The EU Reference laboratory has verified the H5N1 virus in a fourth Swiss avian. The infected bird was a pochard duck (Aythyaferina) found in Steckborn, Thurgau, on Lake Constance. The results from about 12 bird flu samples are pending. It is expected that H5N1 will also be found in these samples. None of the samples sent was negative for H5. The number of H5 bird flu infected birds in Switzerland has increased to 32. The reference laboratory has revealed the infection in another pochard duck found in Steckborn. (Promed 4/1/06)

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UK (Scotland): Avian influenza H5N1 infection confirmed in dead mute swan
A joint statement from the UK and Scottish Chief Veterinary Officers has been published regarding H5N1 avian influenza confirmation in a swan in Scotland. Tests from the Veterinary Laboratories Agency (VLA) have confirmed that the sample from the mute swan found dead in a coastal town in Fife, Scotland did contain the highly pathogenic H5N1 avian flu virus. The partially eaten carcass was found in Fife 29 Mar 2006 and sent to the Weybridge laboratory for analysis 31 Mar 2006. Scotland's chief veterinary officer Charles Milne said it was not known whether the swan was from a local or migratory flock. Milne added there was no indication of infections in domestic poultry, and no reason to believe the carcass had been eaten by a domestic animal. Government officials reviewed bird flu contingency plans and concluded that "all relevant steps are being taken." Milne added: "Bird keepers outside the protection zone should redouble their efforts to prepare for bringing their birds indoors if that becomes necessary. They must also review their biosecurity measures to ensure that all possible precautions have been taken." The discovery in the swan of the highly pathogenic strain makes Britain the 14th country in the European Union to find the disease on its territory. Scottish and UK officials are undertaking an urgent veterinary risk assessment and consulting ornithological experts to consider the specific circumstances of this case and determine the level of any risk it may pose to poultry and other kept birds. Authorities are considering whether there is a need for any regional measures in addition to those that have already been put in place in the Protection and Surveillance Zones. The Scottish Executive has already placed a Protection Zone of 3-km radius where poultry have been housed and a Surveillance Zone of 10 km around the site where the bird was found. Advice from the Food Standards Agency remains that properly cooked poultry and poultry products, including eggs, are safe to eat. Guidance on handling and disposing of dead garden and wild birds has been communicated to the public.

Some details on the UK wild birds surveillance are available at http://www.defra.gov.uk/animalh/diseases/notifiable/disease/ai/pdf/ai-wildbirdsurveillance.pdf and http://www.defra.gov.uk/corporate/vla/science/science-viral-ai-wildbirdsurv.htm.
(Promed 4/5/06, 4/6/06)

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Asia
Cambodia: Sixth human case of avian influenza H5N1 infection
As of 6 Apr 2006, the Ministry of Health in Cambodia has confirmed the country's sixth case of human infection with the H5N1 avian influenza virus (all 6 have been fatal cases). The case occurred in a 12-year-old boy from Prey Veng province, which borders Viet Nam. The boy developed symptoms of fever and headache 29 Mar 2006. He was initially treated at a private clinic, then hospitalized in Phnom Penh 4 Apr 2006. He died 5 Apr 2006. Samples from the boy tested positive for H5N1 infection at the Pasteur Institute in Cambodia. A team from the Ministry of Health, WHO, and the Pasteur Institute investigated the situation. Numerous chicken deaths and some duck deaths were noted in the neighbourhood in recent weeks. The child reportedly gathered dead chickens for distribution to village families for consumption. The investigative team identified 25 close contacts of the child. None of these people show signs of illness at present. House-to-house surveillance for signs of influenza-like illness is continuing. Last week, a government minister said tests confirmed the H5N1 virus in dead ducks near Cambodia's border with Viet Nam. (Promed 4/5/06, 4/6/06)

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India (Maharshastra): Avian influenza H5 spreads to more villages
More poultry samples have tested positive for H5 avian influenza in India's western state of Maharashtra, which has been struggling to contain bird flu since Feb 2006, officials said 5 Apr 2006. The latest outbreak has hit 14 new villages in the Jalgaon district of Maharashtra, near the site of 2 earlier outbreaks, Maharashtra's health director T.P. Doke said. "Laboratory tests have shown it is H5. . .We suspect it will also turn out to be H5N1, because the new outbreak is in the same area," said Uttam Khobragade, Maharashtra's top animal husbandry official. Besides Maharashtra, the virus has struck poultry in Burhanpur district of the central state of Madhya Pradesh. Indian authorities have sought to play down subsequent outbreaks, since the first one in mid-Feb 2006, saying they should not be treated as fresh cases because the new infections were being reported from an area earlier identified as a bird flu zone. "Dozens of samples from poultry had been collected after the first outbreak," said Bijay Kumar, Maharashtra's animal husbandry commissioner. "The results of those are coming out in phases." In Jalgaon, workers were identifying a 10-km radius around the newly affected villages where all poultry would be culled. Officials will simultaneously begin monitoring people for flu-like symptoms. India has culled over 500 000 birds and monitored hundreds of thousands of people to contain the spread of bird flu, but the virus has continued to strike poultry. The country has not reported the infection in humans. (Promed 4/5/06)

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Indonesia: Update on human cases of avian influenza H5N1 infection
Indonesia's 23rd bird flu fatality has been confirmed by tests carried out by WHO, while local tests showed another patient is infected. The health ministry's I Nyoman Kandun said tests of samples from the 23rd victim, a 1 year old girl from the capital Jakarta, were positive. The girl died at Indonesia's main hospital for bird flu patients, Sulianti Saroso, after coming into contact with sick chickens near her house. "We also received information today that an adult patient in West Sumatra has tested positive," Kandun said, adding that the patient was a 23 year old man. "He's still alive and being treated in Padang," he added.

As of 4 Apr 2006, the Ministry of Health in Indonesia has also confirmed an additional case of human infection with the H5N1 avian influenza virus. The fatal case occurred in a 20-month-old girl who resided in Kapuk, West Jakarta. She developed symptoms of fever and cough 17 Mar 2006, was hospitalized 22 Mar, and died 23 Mar 2006. Field investigation found a history of deaths in a chicken flock near her home about 1 week prior to symptom onset. Chicken deaths in the neighbourhood have continued, but the cause has not yet been identified. Family members and neighbours have been placed under observation and samples from these people have been taken for testing. Preliminary results are negative, but investigation is continuing.

In addition, a delayed international test has confirmed that an 8-year-old Indonesian girl who died Jul 2005 had avian influenza. The government had problems getting adequate specimens of the girl's blood which delayed shipment to the WHO-affiliated laboratory, Runizar Ruesin, head of the health ministry's avian influenza information centre, said 4 Apr 2006. The girl's father had been found positive for avian influenza and died Jul 2005, while her sister, who also died that month, had the same symptoms but was not tested. Indonesia has the second highest number of fatalities reported in the world since 2003, after Vietnam. Most cases here have been in the capital and its surroundings, where many people live in close proximity to poultry despite the urban environment, but infected birds have been found in 26 of Indonesia's 33 provinces. (Promed 4/1/06, 4/4/06)

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Hong Kong/Mauritius: Confirmed case of chikungunya
A 66 year old Chinese man was seen in the Prince of Wales Hospital (PWH) Infectious Diseases clinic 24 Mar 2006, after returning from a 1-week stay in Mauritius. He attended the clinic the same day he returned to Hong Kong. He had already been ill with fever, headache, myalgia, arthralgia, and a rash for 2 days. He had been visiting relatives in rural parts of Mauritius and had been bitten by mosquitoes. The differential diagnosis was first dengue fever, but recent postings in ProMED-mail prompted testing for chikungunya. A sample taken from this clinic visit on day 2 of illness tested positive for chikungunya by PCR and confirmatory sequencing. Dengue PCR, IgG and IgM testing were negative. This is the first case of chikungunya diagnosed in Hong Kong. The clinical presentations of dengue (a flavivirus) and chikungunya (an alphavirus) are very similar. In patients presenting with dengue-like illness, with a compatible travel history, where all dengue testing has proved negative, chikungunya may now be considered as a possible alternative diagnosis. Their incubation periods may be similar (dengue 4-7 days, chikungunya 2-4 days), and both can occasionally give rise to a more severe haemorrhagic fever, though this is more common with dengue. With both illnesses, the viraemia is short-lived, with the virus usually only being detectable for only the first 48 hours with neutralising antibodies arising by days 5-7. Chikungunya is endemic in parts of Africa and South East Asia. It is likely that some cases in Hong Kong may have been missed, because until now, the differential diagnosis of chikungunya may have not been considered. (Promed 4/2/06)

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Malaysia (Perak): Chikungunya outbreak hospitalizes 7 persons
Chikungunya, a rare viral disease, has struck a village in Perak, and more than 200 have been diagnosed, and 7 people have been hospitalized since 2 weeks ago. Communicable disease control director Datuk Dr Ramlee Rahmat said the Health Ministry's laboratory tests on blood samples taken from 30 villagers in Panchut, Pantai Remis confirmed that they had contracted chikungunya, a disease which is not life-threatening. Chikungunya is an urban disease resembling dengue and is a relatively rare form of viral fever caused by an alphavirus that is spread by mosquito bites from the Aedes mosquito. The last known outbreak in Malaysia was in 1999, when 27 people were infected. Dr Ramlee said the Health Ministry was alerted to the possible outbreak 2 weeks ago, after a physician told the Health Department about 30 people who were found to have symptoms like those of chikungunya infection, such as fever, rashes, arthritis affecting multiple joints, as well as headache. He said the ministry believed the outbreak had occurred much earlier, as some of the villagers had been found to have similar symptoms but in smaller numbers. "Following the confirmation of the tests, we have taken action such as fogging, cleaning, as well as providing health education to the people in the affected villages," Dr Ramlee said. Health Ministry Parliamentary Secretary Lee Kah Choon said the virus was believed to have been carried by immigrant workers. (Promed 4/2/06, 4/5/06)

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Malaysia (Negeri Sembilan, Sarawak): Hand, foot and mouth disease outbreak update
13 cases of hand, foot and mouth disease (HFMD) were detected in Negeri Sembilan from Jan 2006 to late Mar 2006, said state health director Datuk Dr Rosnah Ismail. She said 9 were detected in Seremban, 3 in Jempol, and 1 in Tampin. The situation was not alarming, unlike in Sarawak, but all hospitals, medical centers and government clinics statewide had been told to be on alert, she said 29 Mar 2006. "So far, no child care centers and kindergartens have been ordered to close, because the situation is under control," she said. She advised all day care centers to ensure cleanliness of their premises. The disease is caused by a virus that can be found in children's excrement and can be infectious, she said. Dr Rosnah also advised the public to immediately send their children for treatment if they showed symptoms of HFMD (e.g. fever, rashes).

A 16-month-old toddler died from HFMD in Sarawak, bringing the death toll from the illness in 2006 to 9, officials said. The boy was admitted to a hospital in Miri in critical condition, Sarawak Deputy Chief Minister George Chan said. Chan said 7857 infections have been reported in the state this year, but the number of new cases has declined and only 39 patients remain hospitalised. Authorities in Sarawak in early Mar 2006 shut all 1600 kindergartens, day-care centers and preschools to stop the disease from spreading among children -- the main victims of the illness. The premises reopened recently after the number of infections fell. Chan said health officials would beef up enforcement and inspection of all education premises, and those found to have 2 or more cases would be immediately closed until cleared of the disease. HFMD is mildly contagious and rarely fatal. It mainly strikes children below age 10. Officials said the disease seems to emerge cyclically every 3 years in Sarawak. It spread this year to neighbouring Brunei, where a boy died of the disease. Some children in Kedah were also affected but no deaths were reported. (Promed 3/30/06, 4/6/06)

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Singapore: Hand, foot and mouth cases surge
The number of cases of children with hand, foot and mouth disease in Singapore more than doubled to 785 last week, up from 372 the week before, the Straits Times newspaper reported 29 Mar 2006. 2 more daycare centers have been shut down for 10 days, bringing the number of such closures in the city state to 3. Singapore has recorded 2180 cases of the disease since the start 2006. It mainly affects children under the age of 10, causing fever, mouth ulcers, and rashes. Though most cases have been mild, the health ministry has tightened the guidelines for when preschools, kindergartens, and child care centers should close to prevent transmissions. Child care centers must now shut their doors if they have had infections for more than 15 days, affecting more than 13 children, or 18 per cent of the student population. More than 4000 children have been infected with the disease in East Malaysia in 2006, and 8 have died. There has been 1 death in Brunei. According to WHO, there is no specific antiviral treatment for enterovirus infections such as the hand, foot and mouth disease. Treatment focuses on the management of complications. (Promed 3/30/06)

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Japan: Update on first Japanese case of vCJD
A detailed description of the first case of variant Creutzfeldt-Jakob disease (vCJD) in Japan, originally reported Feb 2005, has been published. The patient was a 51-year-old man who had spent around 24 days in the UK in 1990, during the bovine spongiform encephalopathy (BSE) outbreak. He is known to have eaten mechanically recovered meat during his visit, and although exposure in other countries he visited cannot be excluded, it is thought that he may have been exposed to the BSE agent in the UK. If exposure in the UK was the source of his infection, then the incubation period to illness onset was 11.5 years. It is also noted that the patient's illness duration was unusually long, at 42 months, and that periodic synchronous discharges (PSD), which have not been reported in other vCJD cases, appeared on the patient's electroencephalogram, 12 months before death. The working group reporting on the case suggest that the WHO vCJD case definition be revised to state that PSD does not exclude the possibility of vCJD (see below).

The WHO definition of patients with variant Creutzfeldt-Jakob disease (vCJD) should be revised to prevent cases being missed, according to a Case Report in the Lancet journal. Masahito Yamada and colleagues detail the first Japanese case of definitive vCJD. 19 months after the onset of symptoms an electro-encephalogram (EEG) showed no periodic synchronous discharges (PSD). However, the brainwave pattern appeared after 30 months. There have been no previous reports of PSD on EEG in vCJD. The case report cited by Mariko Toya is entitled "The First Japanese case of variant Creutzfeldt-Jakob disease showing periodic electroencephalogram", by Masahito Yamada on behalf of the Variant CJD Working Group, Creutzfeldt-Jakob Disease Surveillance Committee, Japan. (Promed 4/4/06)

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Americas
USA: Live markets a risk for entry of avian influenza into USA
Live poultry markets can be a link between migratory birds, which may be carrying the H5N1 avian influenza virus, and domestic poultry flocks, allowing the virus a portal to enter U.S. commercial poultry flocks, said Charles Beard, an avian influenza expert. Beard said there are about 85 live bird markets, where consumers can purchase from a variety of birds offered for sale, within the New York City metropolitan area. He expressed concerns that the bird flu virus could enter such a market via migratory birds then be transmitted to other birds and carried back to commercial flocks. The highly pathogenic H5N1 Asian strain of avian influenza is deadly to many avian species including domestic birds. There are other ways the virus could find its way into the U.S. as well, such as being carried in by migratory birds to backyard flocks or via smuggled birds such as fighting cocks from countries where bird flu cases have occurred, Beard said.

Beard said the most likely place for the virus to enter the country would be in Alaska, which is on a flyway for migratory birds. The US Department of Agriculture has increased its surveillance there for avian influenza 6-fold, Beard said. Beard said the US poultry industry is already utilizing biosecurity practices. However, if a case of bird flu were to be discovered in Alaska, it would boost biosecurity measures even more across the country. Beard said there must be very strong efforts from government and industry to keep the H5N1 bird flu virus out of the country. The U.S. produces about 8 billion broilers a year. Beard recommends that all commercial flocks be locked down for 3 days before they are sent to slaughter, which would resolve the question about the possibility that a flock could be mistakenly given a clean bill of health a few days before slaughter then somehow become infected before being shipped to a processor. (Promed 4/2/06)

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USA (Midwest): Number of mumps cases swells
The tally of mumps cases has climbed to 300 in an outbreak that started in Iowa and has spread to all bordering states, except for South Dakota. Meghan Harris of the Iowa Department of Public Health said the latest state affected by mumps is Missouri, with 1 reported case. Follow-up reports have been completed on 154 cases. Of those, 68 percent occurred in people who had received the recommended 2 doses of the measles-mumps-rubella vaccine. Iowa is a state with a high vaccination rate and Harris anticipates the majority of mumps infections will occur in people who are considered safe on the basis of their immunization records. "But we know the vaccine doesn't work in everyone," she said. Harris said the vaccine failure rate for mumps is about 5 percent. "So by my estimate, there are about 200 000 people in Iowa who have received the recommended vaccinations but who have no immunity to mumps."

The 300 confirmed, probable, or suspected cases of mumps represent the nation's largest mumps outbreak in 17 years. Early on, most of the Iowa cases were reported in college-age students. The mean age at onset was 21. But Harris said that no single college or university was implicated. And, the newer numbers confirmed that the outbreak is moving beyond the college campuses. 21 percent of cases occurred in students attending college, down from 23 percent of cases reported by 30 Mar 2006. Blaise Congeni, M.D., director of infectious diseases at the Akron (Ohio) Children's Hospital, speculated that it may be difficult to identify an index case, because the primary symptom of mumps, parotitis, is often not fully evaluated by clinicians. "If the patient's record indicates that he or she has been received 2 MMR doses, the assumption would be that this is caused by another virus," he said. Harris agreed that Dr. Congeni's theory best explains what has happened in Iowa, especially since the mumps strain is the same one that caused outbreaks in England over the past few years. That suggests that mumps arrived with a recent visitor from Britain, but "because these symptoms are often overlooked -- especially in people who have received the required vaccinations -- we doubt we will ever identify the index case," she said. Dr. Congeni said that a mumps outbreak does not carry the potential for public health disaster that would be associated with a measles or rubella outbreak. "There is a small risk that some kids will develop viral meningitis, and orchitis is a concern, but we know that orchitis doesn't cause sterility," Dr. Congeni said. 5 percent of the current cases included orchitis among symptoms, and there was 1 case of encephalitis being investigated.

Mumps is a viral infection of the salivary glands. Symptoms include fever, headache, muscle aches and swelling of the glands close to the jaw. It can cause serious complications, including meningitis, damage to the testicles and deafness. A mumps vaccine was introduced in 1967. ***See the MMWR article on the mumps epidemic in this Newsbrief’s “Articles” section. (Promed 4/3/06, 4/5/06)

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USA (Washington): Botulism case linked to heroin
A 43 year old woman has been diagnosed with botulism, the second case of the muscle-paralyzing disease in about a month in Yakima County. Both cases have been linked to the use of black-tar heroin, prompting officials to warn drug users that the sometimes fatal disease could threaten others. "With 2 cases in about a month's period of time, it certainly suggests the possibility of a contaminated supply of black tar," said Marianne Patnode, Communicable Disease Services coordinator at the Yakima Health District. CDC rushed antitoxin to treat the woman, who was hospitalized in Yakima. A Yakima County man was also diagnosed with botulism 21 Feb 2006. He stayed in a hospital outside of the county for about a week and was still not speaking or walking normally when he left, Patnode said. Although neither case has been confirmed in a laboratory, Patnode said both patients showed symptoms consistent with wound botulism and have said they believe they contracted the disease from black-tar heroin. Heroin-related cases are classified as wound botulism. Materials that can contain botulism spores are often used to prepare black-tar heroin for injection. If the spores germinate and toxins are released, botulism can occur. The disease cannot be passed from person to person. The only other cluster of botulism cases reported to the health district was in Aug 2003. All 4 of the cases were eventually connected to a bad batch of black-tar heroin. (Promed 3/29/06)

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USA: USDA says cooking poultry to 165F will ensure safety
Cooking poultry to a temperature of 165F will ensure it is safe to eat, though higher heat may be desirable for the sake of taste or appearance, the US Department of Agriculture (USDA) announced. Current federal recommendations list various safe cooking temperatures for poultry, including 180F for whole chickens and 170F for breasts. USDA said it wants to clarify that the key temperature for safety is 165F. The guideline is based on advice from the USDA's National Advisory Committee on Microbiological Criteria for Foods (NACMCF). "The Committee was asked to determine a single minimum temperature for poultry at which consumers can be confident that pathogens and viruses will be destroyed," USDA Under Secretary for Food Safety Dr. Richard Raymond said. Heating to 165F destroys Salmonella, "the most heat resistant pathogen of public health concern in raw poultry," states a March NACMCF report. The temperature is also lethal for Campylobacter bacteria and avian influenza viruses, the USDA said.

The temperature guideline is one of several recommendations the advisory committee made about safe cooking of poultry products: Consumer guidelines should explain that longer cooking is needed if a product is frozen at the beginning of cooking; Consumers should be told that microwave cooking of raw, frozen poultry products is not advisable unless the package gives detailed instructions for determining if the product has reached the recommended temperature; Guidelines should address how to measure product temperature accurately and how to determine if a thermometer is "out of calibration"; Product labels should make clear whether the product is "ready to eat" or not; When a product containing raw poultry appears to be cooked, the label should make clear that it contains raw poultry and requires thorough cooking. (CIDRAP 4/5/06 http://www.cidrap.umn.edu/ )

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USA: Discontinuation of Spectinomycin
In January 2006, CDC learned that Pfizer, Inc. had discontinued U.S. distribution of spectinomycin (Trobicin) in Nov 2005; remaining inventory will expire May 2006. No other pharmaceutical company manufactures or sells spectinomycin in the US. Pfizer is continuing to distribute spectinomycin outside the US for the international market. CDC and the Food and Drug Administration are working with Pfizer to make spectinomycin available again in the US. Historically, spectinomycin has been used to treat persons infected with Neisseria gonorrhoeae who cannot receive 1 of the 2 first-line treatments (i.e., fluoroquinolones or third-generation cephalosporins) currently recommended for treatment of uncomplicated gonococcal infection. Relatively few indications exist for which spectinomycin is the preferred treatment option for N. gonorrhoeae; these include 1) pregnant women with penicillin or cephalosporin allergy (fluoroquinolones are contraindicated during pregnancy), 2) persons with penicillin or cephalosporin allergies who reside in areas with a high prevalence of quinolone-resistant N. gonorrhoeae, and 3) men with penicillin or cephalosporin allergies who have sex with men. No acceptable alternatives to spectinomycin therapy are currently available. Persons with penicillin or cephalosporin allergies who cannot receive fluoroquinolones can be desensitized to cephalosporins before treatment. Although 2 grams of azithromycin orally in a single dose is effective against uncomplicated gonococcal infection, no data are available to assess the safety and efficacy of this regimen in pregnant women. Moreover, concerns exist regarding the emergence of antimicrobial resistance if azithromycin is used widely in the treatment of N. gonorrhoeae. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5513a5.htm
(MMWR April 7, 2006 / 55(13);370)

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Africa
Burkina Faso: Excerpts from the OIE report on avian influenza H5N1
Information received 4 Apr 2006 from Dr. Zacharie Compaore, Director of Veterinary Services, Ministry of Animal Resources: Report date: 3 Apr 2006. Identification of agent: avian influenza virus subtype H5N1. Date of start of event: 1 Mar 2006. An outbreak of avian influenza subtype H5N1 has been reported at a camp site at Gampela, Saaba department, Kadiogo province. Following the death of 123 helmeted guineafowls, samples have been taken and sent to the OIE Reference Laboratory for avian influenza and Newcastle disease, which has confirmed the diagnosis. The following control measures have been undertaken: radio and television national broadcast; provincial decision notifying the outbreak; quarantine; census of traditionally raised poultry and stamping-out in a sequestration zone; screening; zoning; disinfection of the infected zone. The following measures are due to be implemented: stamping-out or vaccination of poultry in modern farms, depending on the level of hygiene measures routinely applied; stepping up of epidemiological surveillance and sampling of poultry and wild birds for submission to the reference laboratory.

The outbreak is located right at the center of the country, both geographically and politically, as Kadiogo province is home to Ouagadougou, the capital of Burkina Faso. Burkina Faso is one the poorest countries in the world and is heavily dependent on livestock agriculture. Approximately 4 out of 5 people in the country make their living from agriculture, so any spread of this disease will have ramifications on the economy and on human health by restricting adequate supplies of meat. This is the fifth country in Africa to report avian influenza (others are Nigeria, Niger, Egypt and Cameroon). Experts from 46 African nations, joined by UN agencies, agreed in Mar 2006 on an emergency plan to fight bird flu, making a joint call for funds from donors and African governments. A UN mission returning from Africa said that governments "do not dispose of the necessary resources to put in place the minimal measures required to start to apply their projects." The African countries promised to apply "coherent programs of communication and public awareness" to reduce the risk of the spread of the disease and its transmission to humans. (Promed 4/4/06, 4/5/06)

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Egypt: Confirmation of 11th human case of avian influenza H5N1 infection
The Ministry of Health in Egypt has announced the country's 11th case of human infection with the H5N1 avian virus and its third death. The case occurred in an 18-year-old girl from the Minufiyah governorate, north of Cairo. She developed symptoms 29 Mar 2006, was hospitalized 5 Apr 2006, and died 6 Apr 2006. Tests conducted by the country's Central Public Health Laboratory were positive for H5N1 infection. In a pattern similar to that seen elsewhere, all case have occurred in children and young adults, and all have a history of close contact with dead or diseased poultry. Egypt reported the outbreak of bird flu in dead poultry 17 Feb 2006, and the first human bird flu case was announced 18 Mar 2006.

The country's first 7 cases and 2 fatalities have been described in previous WHO updates. The eighth case is a 31-year-old Egyptian national who works in Jordan. The man recently visited his hometown in Fayoum governorate, where poultry outbreaks were officially confirmed late Feb 2006. While there, he participated in the slaughter of poultry. He returned to Jordan 29 Mar 2006, following 2 days of travel by ferry boat. He was hospitalized with symptoms of respiratory disease 30 Mar 2006. He remains hospitalized in Jordan in stable condition. Given his exposure history and what is known about the incubation period of this disease, authorities in both Egypt and Jordan have concluded that the man almost certainly acquired his infection while in Egypt. Reportedly, 6 people who shared an apartment with him were put under observation. The ninth case, announced by the government 5 Apr, is a 16-month-old girl from the governorate of Sohaj. She is presently hospitalized in stable condition. The tenth case, announced 6 Apr, is an 8-year-old boy from the Qaliubiya governorate near Cairo. He is presently hospitalized in stable condition. (Promed 4/3/06, 4/4/06, 4/6/06)

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Nigeria (Lagos): Avian influenza H5N1 infection in poultry
The H5N1 bird flu virus has been found in backyard poultry and at a commercial farm in Lagos, Africa's largest city which is home to about 13 million people, officials said 6 Apr 2006. The latest discovery of the virus hundreds of miles from Nigeria's first infection indicates the disease is defeating measures to contain it. "We are taking samples from humans who had contact with infected poultry in Lagos state and sending them to the virology lab," said Jide Coker of the Health Ministry, who is coordinating the response in Lagos and neighbouring Ogun state. H5N1 has been confirmed at Agege Farm, a commercial poultry farm in the Ikeja area of mainland Lagos, and in backyard poultry in Victoria Island, an exclusive business district, he said. The virus has now been confirmed in poultry in 13 of Nigeria's 36 states and in the Federal Capital Territory, but no human case has been detected in Africa's most populous country. Millions of Nigerians keep chickens in their backyards and most poultry is transported and sold live. This has raised fears of widespread contact between infected birds and humans. Analysts say a weak health-care system and Nigeria's high mortality rate could mean that human cases go unreported. Nigeria was the first country in Africa to report an outbreak of H5N1. Nigeria has ordered measures such as culling, quarantine and a transport ban on live poultry in affected areas to contain the disease, but poor coordination and infrastructure has slowed the implementation. The US CDC has helped Nigerian laboratories increase their capacity to detect bird flu in both poultry and humans, and some samples have also been sent to labs in Europe. The World Bank in March 2006 approved a USD 50 million credit for Nigeria to help prevent the spread of bird flu. (Promed 4/6/06)

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1. Updates
Influenza
Seasonal influenza activity in APEC Economies
WHO’s surveillance information has not been updated since the 30 Mar 2006 report. Please see EINet’s 31 Mar 2006 Alert for further details.
USA. During week 13 (Mar 26 – Apr 1, 2006), influenza activity decreased in the US. 464 specimens (16.6%) tested by US 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. 13 states reported widespread influenza activity; 14 states reported regional influenza activity; 12 states, New York City, and the District of Columbia reported local influenza activity; 10 states and Puerto Rico reported sporadic activity; and 1 state reported no activity.

For the comprehensive update on recent influenza activity in the USA (“Update: Influenza Activity--United States, March 19--25, 2006”):
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5513a4.htm.
(CDC 4/7/06 http://www.cdc.gov/flu/weekly/ ; MMWR April 7, 2006 / 55(13);368-370)

Avian/Pandemic influenza updates
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html. Includes: “Pandemic influenza preparedness and mitigation in refugee and displaced populations: WHO guidelines for humanitarian agencies”.
- UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. Includes link to FAO/OIE International Scientific Conference on Avian Influenza and Wild Birds.
- OIE: http://www.oie.int/eng/en_index.htm. Includes information on the Asian European Conference on Avian Influenza 2006.
- US CDC: http://www.cdc.gov/flu/pandemic.htm. Now available: “Instructions to Estimate Impact of Next Pandemic”. For avian influenza: http://www.cdc.gov/flu/avian/.
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. Latest update on U.S. State Summits are available.
- US FDA: http://www.fda.gov/oc/opacom/hottopics/flu.html.
- CIDRAP: http://www.cidrap.umn.edu/.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm.
- American Veterinary Medical Association: 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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Dengue
Mexico
Authorities from Nuevo Leon Health Secretariat reported the first death caused by dengue hemorrhagic fever (a 15 year old girl from Linares community). The first fatal case of hemorrhagic dengue fever in Nuevo Leon was confirmed by Mr Ricardo Huerta-Gallaga, sub-secretary for disease prevention and control. The girl developed a clinical condition with pneumonia and acute tubular necrosis, a kidney complication, which suggests the presence of dengue fever. This is the first fatal case caused by this condition in Nuevo Leon since 1999. Mr Huerta-Gallaga emphasized that 2006 is favorable for having a higher frequency of such cases, since 2005 was not as intense as usual, and mosquitoes were not exterminated as they were in the past. In Nuevo Leon, it is estimated that some 3000 cases may be reported throughout the year. Authorities confirmed 2 additional dengue fever cases, 1 corresponding to hemorrhagic dengue fever, which affected the deceased patient, and another case of classic dengue fever, affecting a 33-year-old person in La Florida area. (Promed 3/28/06)

Philippines
The Zamboanga City Health Office (CHO) wants an anti-dengue city-wide clean up day in all 98 barangays in the city in preparation for the resurgence of dengue disease in 2006. This was proposed after a 3 year old child from Sitio Luyahan, Barangay Pasonanca died of dengue recently, City Health Officer Dr Rodel Agbulos reported. The CHO has also noted that dengue has started to pick up, after several new suspected cases were admitted to the city hospital, in addition to the 8 others previously recorded. The massive clean-up drive, expected Apr 2006, will require residents to destroy all possible breeding grounds of Aedes aegypti, the transmitter of dengue. Officials in the province of North Cotabato are alarmed over the increase of cases of dengue fever in Jan and Feb 2006. Ely Nebrija, chief of the Dengue Control Division of the Integrated Provincial Health Office (IPHO) said a total of 107 patients were admitted in hospitals for dengue. Of this number, 4 died. Nebrija said the deaths were documented in Kidapawan City and the towns of Mlang and Antipas. Nebrija said Kidapawan City remains on top with a total of 35 cases followed by M’lang and Antipas with 26 and 11 cases, respectively. In 2005 a total of 1,194 cases of hemorrhagic dengue fever were recorded in district hospitals and private hospitals in the province. (Promed 3/28/06)

Indonesia
Increasing numbers of both dengue and bird flu patients have forced the Bekasi Municipal Administration to declare an extraordinary occurrence of the diseases in the region. Bekasi Mayor Akhmad Zurfaih said to prevent the diseases from further spreading and to decrease the mortality rate, the administration would allocate Rp 270 million [about USD 30 000] for dengue and Rp 26 million [USD 2888] for bird flu from its budget. Zurfaid said that as many as 924 cases of dengue occurred in Bekasi between Jan and Mar 2006, and 8 people had died. Zurfaih ordered all related institutions to place extra focus on the prevention of the diseases and on death minimization. In all of Indonesia, 7624 dengue fever patients had been recorded in the past 3 months, with 14 deaths (a different report notes 12 deaths in the last 4 months). "During the past 3 months, the number of dengue victims has shown a significant increase," said Evy Zelfino at the city health agency, 2 Apr 2006. She said there were 2470 patients in Jan, 2433 in Feb and 2718 in Mar 2006. "Apart from keeping our neighborhoods clean, fumigation should also be carried out regularly," she said. She urged residents to cover, clean and bury water containers and trash, which are mosquito breeding grounds. (Promed 4/3/06, 4/6/06)

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2. Articles
CDC EID Journal, Volume 12, Number 4—April 2006
The April 2006 issue of the CDC Emerging Infectious Diseases Journal is now available: http://www.cdc.gov/ncidod/EID/index.htm. The following expedited articles are available: Coronavirus HKU1 Infection in the United States, F. Esper et al. and Simple Respiratory Mask, V.M. Date et al.

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Experts urge including cats in avian flu precautions
Growing evidence of H5N1 avian influenza in cats suggests they may play a role in spreading the virus, according to a team of medical and veterinary researchers. "Cats could be more than a dead-end host for H5N1 virus," says a commentary article in Nature. The authors are Thijs Kuiken, Ron Fouchier, Guus Rimmelzwaan, and Albert Osterhaus of Erasmus Medical Centre in Rotterdam and Peter Roeder of the UN Food and Agriculture Organization. They call for efforts to protect cats from the virus and to test those with possible exposure to it—recommendations that are not included in existing official guidelines for controlling avian flu. Infections in cats were first observed in Thailand in 2004. In one case, 14 cats in a household near Bangkok died of the infection. In addition, tigers and leopards in 2 Thai zoos died after eating infected chicken carcasses. Fatal infections in cats have become common in Indonesia, Thailand, and Iraq, where the virus is endemic in poultry, they write. Veterinarians in both Indonesia and Iraq have reported a high incidence of sudden death in cats during poultry outbreaks of avian flu. Dead or sick cats infected with H5N1 virus turned up in Germany soon after the virus was detected in wild birds there, the researchers note.

They also note that experiments at Erasmus Medical Centre have shown that cats can be infected with the virus by respiratory and gastrointestinal routes and by contact with other infected cats. The infected cats all excreted the virus from the nose, throat, and rectum. It is unknown how long cats can shed the virus or whether they can spread it to humans, poultry, or other species, the article says. Nonetheless, the researchers write that cats "may provide the virus with an opportunity to adapt to efficient transmission within and among mammalian species, including humans, thereby increasing the risk of a human influenza pandemic." Dr. Osterhaus said, “. . . Although the risk is not large because the level of virus excretion is lower than birds, there is a concern because people tend to take good care of sick pets. It is unlikely that people will get too close to a chicken, but many people do with cats. You would not want an infected cat in a household situation. . .” Therefore, despite the uncertainties, official guidelines for controlling the spread of avian flu should consider the potential role of cats, the authors say. "In areas where H5N1 virus has been detected in either poultry or wild birds, we recommend taking steps to prevent contact between cats and infected birds or their droppings, and to quarantine and test cats suspected of such contacts, or cats showing clinical signs suggestive of H5N1 influenza," the article states. That means keeping cats indoors where possible. Affected regions of Germany and France have already ordered that cats be kept indoors. (CIDRAP 4/5/06 http://www.cidrap.umn.edu/ ; Promed 4/6/06)

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Mumps Epidemic--Iowa, 2006
“In the United States, since 2001, an average of 265 mumps cases (range: 231--293 cases) have been reported each year, and in Iowa, an average of five cases have been reported annually since 1996. However, in 2006, by March 28, a total of 219 mumps cases had been reported in Iowa, and an additional 14 persons with clinically compatible symptoms were being investigated in three neighboring states (11 in Illinois, two in Nebraska, and one in Minnesota) in what has become the largest epidemic of mumps in the United States since 1988. This report summarizes and characterizes the ongoing mumps epidemic in Iowa, the public health response, and recommendations for preventing further transmission. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm55d330a1.htm
(MMWR March 30, 2006 / 55(Dispatch);1-3)

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Community-Associated Methicillin-Resistant Staphylococcus aureus Infection Among Healthy Newborns--Chicago and Los Angeles County, 2004
“Methicillin-resistant Staphylococcus aureus (MRSA) infection has long been associated with exposure in health-care settings but emerged in the late 1990s among previously healthy adults and children in the community. Community-associated MRSA (CA-MRSA) infections most commonly are skin and soft-tissue infections; however, certain cases can progress to invasive tissue infections, bacteremia, and death. This report describes two independent investigations by local health departments, assisted by CDC, into outbreaks of MRSA skin infection among otherwise healthy, full-term newborns delivered at hospitals in Chicago, Illinois, and Los Angeles County, California. In both locations, MRSA transmission likely occurred in the newborn nursery; however, laboratory testing identified the MRSA strain as one that was described initially in association with CA-MRSA infections and outbreaks and that differs from predominant health-care--associated MRSA (HA-MRSA) strains. The findings from these investigations underscore 1) the need for health-care providers to be aware that MRSA can cause skin infections among otherwise healthy newborns and 2) the importance of adhering to standard infection-control practices, including consistent hand hygiene, in newborn nurseries. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5512a1.htm
(MMWR March 31, 2006 / 55(12);329-332)

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Tuberculosis Control Activities After Hurricane Katrina--New Orleans, Louisiana, 2005
“On August 29, 2005, when Hurricane Katrina struck the U.S. Gulf Coast, 130 Louisiana residents in the greater New Orleans area were known to be undergoing treatment for tuberculosis (TB) disease. Standard treatment and cure of TB requires a multidrug regimen administered under directly observed therapy (DOT) for at least 6 months. This report updates previous information and summarizes TB cases reported as of December 31, 2005, among persons undergoing TB treatment in the New Orleans area when Hurricane Katrina made landfall and among persons who were evacuated and subsequently received a diagnosis of TB in other parts of the country. By October 13, 2005, through intensive local, state, and national efforts involving both government and private sector partners, all 130 TB patients from the New Orleans area had been located and, if still indicated, had resumed TB treatment. As a result of heightened public health surveillance among Hurricane Katrina evacuees, six other New Orleans evacuees began treatment. . .after arriving in other states. The success of these post-disaster TB control measures affirms the utility of alternative data sources during health-related emergencies and the importance of maintaining a strong TB control component in the public health sector. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5512a2.htm
(MMWR March 31, 2006 / 55(12);332-335)

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Update: Guillain-Barré syndrome among recipients of Menactra meningococcal conjugate vaccine--United States, October 2005-February 2006
“In October 2005, a possible association between Guillain-Barré Syndrome (GBS) and receipt of meningococcal conjugate vaccine (i.e., meningococcal polysaccharide diphtheria toxoid conjugate vaccine [Menactra]) (MCV4) was reported. GBS is a serious neurologic disorder involving inflammatory demyelination of the peripheral nerves. At the time of the first report, five confirmed cases of GBS after receipt of MCV4 had been reported to the Vaccine Adverse Events Reporting System (VAERS). During the 4 months since, three additional confirmed cases of GBS have been reported. This report describes two of these recent cases and provides additional data collected through February 2006. Because available evidence neither proves nor disproves a causal relation between MCV4 and GBS, further monitoring and studies are ongoing within VAERS and the Vaccine Safety Datalink (VSD). CDC continues to recommend use of MCV4 for persons for whom vaccination is indicated; the additional reported cases have not resulted in any change to that recommendation. . .” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5513a2.htm
(MMWR April 7, 2006 / 55(13);364-366)

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Diagnosis and management of tickborne rickettsial diseases
Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis--United States: a practical guide for physicians and other health-care and public health professionals
Tickborne rickettsial diseases (TBRD) continue to cause severe illness and death in otherwise healthy adults and children, despite the availability of low cost, effective antimicrobial therapy. The CDC recommendations in this report will assist clinicians and other health-care and public health professionals to 1) recognize epidemiologic features and clinical manifestations of TBRD, 2) develop a differential diagnosis that includes and ranks TBRD, 3) understand that the recommendations for doxycycline are the treatment of choice for both adults and children, 4) understand that early empiric antibiotic therapy can prevent severe morbidity and death, and 5) report suspect or confirmed cases of TBRD to local public health authorities to assist them with control measures and public health education efforts. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5504a1.htm
(MMWR March 31, 2006 / 55(RR04);1-27)

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New vaccine approach relies on weakened Listeria
Researchers have announced a new approach to making a vaccine for listeriosis that may also bode well for fighting certain other infections, including salmonellosis and tuberculosis. All 3 infections involve bacterial pathogens that grow inside cells. Essentially, antibodies in the blood don't recognize them because they are hidden within cells. Listeria monocytogenes, which can grow on refrigerated meat, can cause serious illness in pregnant women, elderly people, and others with weak immune systems. In pregnant women the pathogen can lead to influenza-like illness, premature delivery, and stillbirth. A team led by Darren Higgins, associate professor of microbiology at Harvard Medical School, and H.G. Archie Bouwer, immunology research scientist at the Earle A. Child Research Institute and Portland (Oregon) VA Medical Center, published their findings in the Proceedings of the National Academy of Sciences.

The scientists made an attenuated strain of L monocytogenes that cannot replicate inside a host cell. The strain was readily killed in normal and immunocomproised mice, but it spurred the production of T-cells that generated an effective immune response when the mice were subsequently challenged with a virulent strain of L monocytogenes. Immunized animals were able to resist 40 times the normally lethal dose of Listeria. "It [the vaccine strain] does not cause disease in the animal models that we tested. But it stimulates these T-cell responses, so, now, if we come back and challenge that mouse with a disease strain of Listeria, that mouse does not get sick," Higgins said. "For the first time an attenuated strain of Listeria that does not replicate in an animal and does not require any manipulation of the bacterium or host prior to immunization still provides protective immunity,” he said. "This approach of directed antigen delivery suggests a general strategy for developing safe, intracellular replication-deficient vaccine strains for stimulating protective cellular immunity to intracellular bacterial pathogens," the authors wrote. They added that this strategy "stimulates protective cell-mediated immunity to native target antigens, alleviating the need to identify specific antigenic determinants relevant for each host, and does not require additional modification to the vaccine or host." The recent work builds on a 2002 study in which Higgins et al. developed killed Escherichia coli strains that served to deliver antigens to antigen-presenting cells in the body. The E coli-based vaccines protected mice from tumors after they were challenged with melanoma-producing cells.

Bouwer HGA, Albert-Segui C, Berkowitz N, et al. Directed antigen delivery as a vaccine strategy for an intracellular bacterial pathogen. Proc Nat Acad Sci 2006;103(13):5102-7. To read the abstract: http://www.pnas.org/cgi/content/abstract/103/13/5102.
(CIDRAP 3/28/06 http://www.cidrap.umn.edu/ )

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Mitigation strategies for pandemic influenza in the United States
Timothy C. Germann et al. Published online before print April 3, 2006
Proc. Natl. Acad. Sci. USA, 10.1073/pnas.0601266103
Abstract: Recent human deaths due to infection by highly pathogenic (H5N1) avian influenza A virus have raised the specter of a devastating pandemic like that of 1917-1918, should this avian virus evolve to become readily transmissible among humans. We introduce and use a large-scale stochastic simulation model to investigate the spread of a pandemic strain of influenza virus through the U.S. population of 281 million individuals for R0 (the basic reproductive number) from 1.6 to 2.4. We model the impact that a variety of levels and combinations of influenza antiviral agents, vaccines, and modified social mobility (including school closure and travel restrictions) have on the timing and magnitude of this spread. Our simulations demonstrate that, in a highly mobile population, restricting travel after an outbreak is detected is likely to delay slightly the time course of the outbreak without impacting the eventual number ill. For R0 < 1.9, our model suggests that the rapid production and distribution of vaccines, even if poorly matched to circulating strains, could significantly slow disease spread and limit the number ill to <10% of the population, particularly if children are preferentially vaccinated. Alternatively, the aggressive deployment of several million courses of influenza antiviral agents in a targeted prophylaxis strategy may contain a nascent outbreak with low R0, provided adequate contact tracing and distribution capacities exist. For higher R0, we predict that multiple strategies in combination (involving both social and medical interventions) will be required to achieve similar limits on illness rates. (CIDRAP http://www.cidrap.umn.edu/ )

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Use of sentinel laboratories by clinicians to evaluate potential bioterrorism and emerging infections
Pien BC, Royden Saah J, Miller SE, Woods CW.
Clin Infect Dis. 2006 May 1;42(9):1311-24. Epub 2006 Mar 31.
http://www.journals.uchicago.edu/CID/journal/issues/v42n9/38344/38344.html
Abstract: “With the persistent threat of emerging infectious diseases and bioterrorism, it has become increasingly important that clinicians be able to identify the diseases that might signal the occurrence of these unusual events. Essential to a thoughtful diagnostic approach is understanding when to initiate a public health investigation and how to appropriately use commonly performed microbiology procedures in the sentinel laboratory to evaluate potential pathogens. Although diagnostic test development is evolving rapidly, recognizing many of these pathogens continues to challenge the capabilities of most sentinel laboratories. Therefore, effective, ongoing communication and education among clinicians, infection control personnel, sentinel laboratorians, public health authorities, and Laboratory Response Network reference laboratorians is the key to preparedness.” (CIDRAP http://www.cidrap.umn.edu/ )

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Genetic susceptibility to vCJD infection
Everyone could be susceptible to vCJD infection via blood transfusions but their genes could determine how it will affect them, a study suggests. So far, all cases of vCJD in humans have been in people with 1 particular genetic profile. But mouse tests by the National CJD Surveillance Unit and Institute for Animal Health scientists suggest those with other gene types are at risk. The new study in Lancet Neurology said incubation periods could be longer for some. To date, 161 cases of vCJD have been reported in the UK, 18 in France and 12 from elsewhere--most of those of UK origin. At present, it is not clear how susceptible people might be to transmission of vCJD through routes such as blood transfusions. As there is currently no test for the disease, this could mean that someone receives blood or blood products from someone who is carrying vCJD but does not know it. The researchers focused on differences in a gene which makes the normal version of the rogue "prion" protein involved in vCJD. The gene encodes for 2 different types of amino acid--methionine (M) or valine (V). Everyone has 2 copies of the gene, so they can be MM, MV or VV. Virtually all those who have developed vCJD so far have had the MM genotype, carried by around 40 percent of the population. There has only been 1 exception--an MV patient developed the disease following a blood transfusion. Around 50 percent of the population are MV, while the rest carry the VV genotype.

The researchers altered mice to have 1 of the 3 human genotypes, or a bovine form, before injecting them with brain material from cases with vCJD or the related cattle disease BSE (bovine spongiform encephalopathy). Post-mortem brain tissue tests were performed. BSE was transmitted to mice with bovine genes, but not to those with human ones, which the researchers say shows there is a significant "species barrier" which could explain why relatively few people have developed vCJD. However, vCJD was successfully transmitted to mice with all 3 human genotypes, but behaved differently in each. Transmission occurred least easily in the 16 VV mice compared to the 16 with the MV pattern and the 17 with MM. However, most of the MV animals did not develop clinical signs of vCJD during their short lifetime compared to those with MM, most of whom did. Only 1 mouse with VV showed signs it had contracted the disease, though it had no clinical symptoms. The researchers led by Jean Manson said: "Our findings raise concerns relevant to the possibility of secondary transmission of vCJD through blood transfusion, blood products or contaminated surgical instruments." They added: "For human-to-human vCJD infection it should be assumed that all genotype individuals--not just MM--can be infected, that long incubation times can occur, and that a significant level of subclinical [symptom-free] disease might be present in the population." (Promed 4/4/06)

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Vesiviruses: Oceanic Viruses Identified in Human Blood Samples
A virus that can cause a range of diseases in several animal species has been found in human blood samples. The virus, or antibodies to it, was found most often in the blood of individuals with liver damage or hepatitis of unknown cause related to blood exposure. A study on these findings was published online 22 Mar 2006 in the Journal of Medical Virology by scientists from Oregon State University (OSU), the Center for Pediatric Research at Eastern Virginia Medical School, and AVI BioPharma. The association between viral infection and the presence of a disease of unknown cause does not prove causality, the researchers say, but the data raise important new questions. The viruses being studied belong to the genus Vesivirus, 1 of 4 genera in the family Caliciviridae. Some caliciviruses cause disease in humans, such as those classified in the genera Norovirus and Sapovirus. Part of what has been found to be unusual about caliciviruses is that they can cause multiple diseases and affect a broad range of marine and terrestrial species; a single vesivirus serotype has infected species of fish, seals, shellfish, swine, cattle, primates and humans, the researchers said.

In this study, scientists looked at samples from more than 700 blood donors at a lab that serves 8 western states as well as some samples from patients with clinical hepatitis. In 4 study groups, they found the following: In blood samples from normal blood donors that had been determined to be safe and were used in blood transfusions, 12 percent exhibited vesivirus antibodies, suggesting a previous infection; In donors who had evidence of liver damage based upon a liver enzyme test, and whose blood had been discarded as a result, 21 percent had vesivirus antibodies; In blood samples from persons who had been diagnosed with clinical hepatitis, 29 percent had vesivirus antibodies; in persons who previously had transfusions or dialysis and who then developed hepatitis of unknown cause, 47 percent had vesivirus antibodies; In tests that looked for actual virus in the blood rather than antibodies, 5 percent of blood samples from normal donors revealed vesiviruses. Among persons with evidence of liver damage, 11 percent had vesivirus-contaminated blood.

"This study clearly demonstrates that both vesiviruses and the antibodies against them are fairly common in humans," said Alvin Smith, a professor at OSU and a leading expert on caliciviruses. "Vesiviruses are widely distributed in many animal species, but this is a previously unrecognized relationship between vesiviruses and humans. This research also shows an increasing prevalence of vesivirus antibody in persons who have hepatitis of unknown cause," Smith said. Previous individual case reports have documented human disease associated with vesivirus infection, said Dr. David O. Matson, a co-author on the study. "This study adds to our knowledge of the potential for [vesivirus-associated] illness in humans, a potential as-yet unstudied by others," Matson said. Possible sources of vesivirus infection in humans could include meat, seafood, contaminated water, contact exposure and blood transfusions, researchers say. (Promed 3/26/06)

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3. Notifications
International Scientific Conference on Avian Influenza and Wild Birds
Rome, Italy; FAO Headquarters; 30-31 May 2006
The Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (OIE) are organizing the FAO/OIE International Scientific Conference on Avian Influenza (AI) and Wild Birds. Objectives are to exchange scientific information on AI and the role of wild birds, to assess the risk of the introduction of highly pathogenic avian influenza (H5N1) to as yet uninfected areas, and measures of control and prevention. The Conference will present scientific state of the art knowledge in: Ecology and Virology; Surveillance, Sampling and Analysis; Risk Analysis (Migratory Routes, Disease Dynamics, Human Aspects and Human Risk and Risk for Domestic Poultry); Disease Management. Scientists from all over the world will participate in the conference. For practical reasons, FAO/OIE are unable to make open invitations. If you would like to be considered as a participant, please contact Willem Schoustra , providing your name, position and the institution you work for. (Promed 4/5/06)

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The Seventh Asia Pacific Congress of Medical Virology
New Delhi, 13-15 Nov 2006. http://www.apcmv2006.com.
The last date for abstract submission and early bird registration is 15 May 2006. For further information contact either of the following:

Conference Secretariat
Planit by Creative Travel
Creative Travel Pvt. Ltd., Creative Plaza, Nanakpura, Motibagh, New Delhi - 110021 Telephone: +91- 11 - 26872257 / 58 / 59, 24679192; Fax: +91- 11 - 26885886 / 26889764
Email: conference@apcmv2006.com ; Website: http://www.apcmv2006.com

Dr. Shobha Broor, Organising Chairperson - 7th APCMV
Department of Microbiology, All India Institute of Medical Sciences, New Delhi -110029
Tel: +91- 11 – 26594926; Fax: +91- 11 - 26588663
Email: sbroor@aiims.ac.in ; shobha.broor@gmail.com
(Promed 4/6/06)

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2006 National STD Prevention Conference
“Beyond the Hidden Epidemic: Evolution or Revolution?”
May 8-11, Jacksonville, Florida, USA (Pre-Registration ends April 17, 2006). For more information on the conference, visit: http://www.cdc.gov/stdconference/ (CDC)

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4. APEC EINet activities
APEC EID Symposium; HIT Workgroup Meeting
Dr. Ann Marie Kimball, Director of APEC EINet, will be speaking at the APEC Symposium on Emerging Infectious Diseases in Beijing, China, April 4-5, 2006 http://apec.org/apec/apec_groups/som_special_task_groups/health_task_force.html ; and at the Health Information Technology and Policy workgroup meeting in Tokyo, Japan April 11-12, 2006. She will discuss pandemic influenza preparedness and recent EINet activities. Recent updates by the APEC Health Task Force (HTF) can be found at: http://apec.org/apec/news___media/media_releases/280206_vn_htf.html.

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5. To Receive EINet Newsbriefs
APEC EINet email list
The APEC EINet email list was established to enhance collaboration among health, commerce, and policy professionals concerned with emerging infections in APEC member economies. Subscribers are encouraged to share their material with colleagues in the Asia-Pacific Rim. To subscribe, go to: http://depts.washington.edu/einet/?a=subscribe or contact apecein@u.washington.edu. Further information about APEC EINet is available at http://depts.washington.edu/einet/.

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 apecein@u.washington.edu