Login   

Vol. IX, No. 9 ~ EINet News Briefs ~ May 05, 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)
- Global: Avian influenza and genetic susceptibility
- Asia Pacific: Action plan released by APEC avian influenza ministerial meeting
- Global: Avian influenza, illegal poultry trade, and wild birds
- Pan-Europe: EU explanatory message on avian influenza
- Germany: Avian influenza H5N1 update
- Germany (Bavaria): Avian influenza H5N1 update in animals
- The Netherlands: Lifting of the requirement to keep poultry indoors
- UK: Case of human conjunctivitis due to low pathogenicity H7N3 avian influenza
- Pakistan (Punjab): 800 birds culled; low pathogenic avian influenza H5 reported
- Indonesia: Additional suspected human case of avian influenza H5N1 infection
- Malaysia: Acute respiratory tract infections in National Service trainees
- Japan (Hokkaido): Recent BSE case linked to meat-and-bone meal
- USA: Contracts totaling more than $1 billion to develop cell-based influenza vaccine
- USA: Avian influenza action group to coordinate U.S. international effort
- USA (New Jersey): Avian influenza found at bird market; low pathogenicity suspected
- USA (Multistate): Update on mumps epidemic
- Canada: Mad cow disease--herd tracing
- USA (Alabama): Conclusion of the epidemiologic investigation into BSE-positive cow
- USA: USDA estimates nation has 4 to 7 BSE cases
- USA: HHS buys another 5 million doses of anthrax vaccine
- Egypt: Fifth human fatality from avian influenza H5N1 infection
- Ivory Coast: Confirmation of avian influenza H5N1 in birds

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

2. Articles
- CDC EID Journal, Volume 12, Number 5—May 2006
- Reusability of facemasks during an influenza pandemic: facing the flu
- Strategies for mitigating an influenza pandemic
- Statistical pattern matching facilitates the design of polyvalent inhibitors of anthrax and cholera toxins
- Antibacterial bacteria may be used in ground beef
- A live, attenuated recombinant West Nile virus vaccine
- Postexposure protection against Marburg haemorrhagic fever with recombinant vesicular stomatitis virus vectors in non-human primates: an efficacy assessment
- Tamiflu protects ferrets in avian influenza study

3. Notifications
- Social Marketing in Public Health Conference and Training Institute
- Society for Vector Ecology Annual Conference (SOVE)
- Introduction to Public Health Surveillance
- New book: “SARS: How A Global Epidemic Was Stopped”

4. APEC EINet activities
- Risky Trade: Infectious Disease in the Era of Global Trade

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 / 8 (5)
Cambodia / 2 (2)
China / 10 (7)
Egypt / 13 (5)
Indonesia / 15 (13)
Iraq / 2 (2)
Turkey / 12 (4)
Total / 62 (38)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 206 (114)
(WHO 5/5/06 http://www.who.int/csr/disease/avian_influenza/en/ )

^top

Global: Avian influenza and genetic susceptibility
People who have been infected with the H5N1 avian influenza virus might be especially susceptible to avian viruses because they are genetically predisposed to them, experts suggested 4 May 2006. Of the 205 [now 206] reported cases of human infections since late 2003, there have been many family clusters involving blood relatives. Of the total infections, 113 people died in 9 countries. "There have been family clusters. So there has to be certainly a genetic aspect to it," Robert Webster of the St Jude Children's Research Hospital told a bird flu conference organized by the journal Lancet. Another leading expert, Hiroshi Kida, has long harbored the same theory. "There has not been a single case of infection involving husband and wife [i.e. family members not related by blood]," Kida said. Kida is with the Department of Diseases Control at Hokkaido University in Japan. Kida explained that people infected with H5N1 have a carbohydrate receptor on cells lining their throats. The receptor--called alpha 2,3--is predominantly found in birds and avian influenza viruses like to bind to this class of receptors to replicate and cause disease. Human influenza viruses, however, prefer to bind to another receptor called alpha 2,6, which is dominant in humans. "I think people who are infected with avian strains are special. They must have alpha 2,3 receptors," Kida said. Although humans have some amount of alpha 2,3, Kida said alpha 2,6 was by far more "dominant" in most people. Kida is now trying to look for H5N1 survivors in Viet Nam and Thailand to verify his theory, and if it proves to be true, it could mean that most people simply cannot catch H5N1 easily--unless the virus mutates. "If it changes receptor specificity, then it must be dangerous," Kida said. A group of researchers recently postulated that the virus lodges itself deep in the lungs, and not in the upper respiratory tract where it could more easily dislodge itself, get out of the body and spread. While Kida does not dismiss this theory, he thinks it is not the only one. (Promed 5/4/06)

^top

Asia Pacific: Action plan released by APEC avian influenza ministerial meeting
Asia Pacific Economic Cooperation (APEC) Ministers have adopted an Action Plan that will strengthen the ability of Member Economies to detect and respond to outbreaks of avian influenza in the Asia-Pacific. At the conclusion of the meeting that was attended by Ministers and Senior Officials from Agricultural and Health Departments from the APEC Region, Ministers endorsed the "APEC Action Plan on the Prevention and Response to Avian and Influenza Pandemics." Covering 5 specific areas, the Action Plan lays down directives and requirements that will now be implemented at a domestic level by APEC Member Economies. Viet Nam's Minister for Agriculture and Rural Development and Co-Chair of the ministerial meeting, Mr. Cao Duc Phat, said Ministers recognize that the only way to defeat the threat posed by an Avian Influenza Pandemic is to work across sectors and across borders. "The Action Plan also recognizes that reducing the massive economic and social costs associated with Avian Influenza also requires a high level of cooperation between government and business. Ministers have agreed to the Action Plan that creates new avenues for each APEC Member to work with colleagues in other economies and at a domestic level to overcome the Avian Influenza threat." The 5 areas covered by the Action Plan are:

- Multi-sectoral cooperation and coordination on avian and pandemic influenza
- Establishing best practices and common approaches to risk communications
- Mitigating negative effects of avian influenza on agriculture and trade
- Working with the private sector to help ensure continuity of business, trade and essential services
- Strengthening regional and international cooperation

The full text of the Action Plan is available for download. Webcasts, podcasts and photographs of the event are now available for download.
(APEC 5/5/06 http://apec.org/ )

^top

Global: Avian influenza, illegal poultry trade, and wild birds
Africa/Europe
The risk from migratory birds carrying the H5N1 virus from Africa to Europe may be easing but countries looking to relax measures protecting their poultry still need to be on guard. The spring migration involving millions of birds from Africa to the northern hemisphere has been underway for weeks, and yet so far there has been no recorded case of avian influenza in Europe linked to wildfowl from the continent. Conservation groups say the international trade in poultry is more to blame for spreading the virus. But [some, not all] animal health experts still believe migration is key, saying one reason H5N1 has not spread from Africa may be that it has largely been confined to poultry farms in the 6 African countries to confirm cases. The African migration season lasts until the end of May, but already some European countries have begun easing bans on keeping their domestic poultry flocks outside. The bird flu cases found so far in Europe have been linked to infected wildfowl displaced by extreme weather around the Black Sea earlier this year. One country that has had no bird flu is Spain. Juan Jose Badiola, head of the Spanish Veterinary Association, said aquatic birds that return to Spain from Africa in the spring tended to winter on the West African coast between Mauritania and Senegal, where there have been no cases.
Conservation groups such as Birdlife International say the pattern of the spread of the virus suggests migration is not to blame in many cases. "Recent outbreaks in Cameroon, Egypt, India, Israel, Jordan, Niger, Nigeria and Pakistan originated within the poultry industry," Birdlife said. "The timing and location of these outbreaks do not match the movements of migratory birds." The groups acknowledge certain wildfowl species can carry the virus but say the birds die after flying relatively short distances. Only by transmitting the disease to other birds can the virus be passed long distances. A top flu expert also warned against blaming migratory birds. "We forget that there is an enormous commercial industry with the movement of animals all the time. That, to me, is the most obvious thing to look for," said Kennedy Shortridge.

China/Viet Nam
Vietnam, where many human infections and deaths have occurred, launched a nationwide poultry vaccination campaign in 2005 and has intensified surveillance and public awareness. It has not detected any outbreaks in poultry for 4 months and no human cases have been reported since Nov 2005. Its success has boosted demand for poultry as more Vietnamese shed their fears of eating infected meat. That, in turn, has fueled smuggling. Smuggled birds typically come from large Chinese farms where high volume and low feed prices keep overall costs low. Up to 70 percent of chickens smuggled via the northern border into Lang Son province have reportedly escaped proper checks from border guards and police forces. An estimated 4500 chickens from China are smuggled into Viet Nam every day, and the H5N1 virus has shown up in samples taken from some of the confiscated birds. The poultry can be resold in Vietnam for up to 5 times more. Said Dr. Jeff Gilbert, an animal health expert at the U.N. Food and Agriculture Organization in Vietnam, ''I think the biggest risk of re-infection (in Vietnam) is infection from China.'' The World Organization for Animal Health says it is investigating the possible role smuggling has played. In 2005, Taiwan confirmed its first case of bird flu, which was found in birds smuggled from China. A Nigerian official also has blamed illegal poultry imports for introducing the virus there earlier this year. Most countries have strict quarantine laws to protect against importing infected animals and meat products. Bans have also been quickly slapped on countries where bird flu appeared. But a global smuggling network that has long existed hasn't been shut down by new precautions. In the past, infected beef and pork smuggled into Europe from Asia were blamed for outbreaks of foot-and-mouth disease and classical swine fever. Another worry is the trade of manure-based fertilizers and animal feed, which often contains ground-up poultry parts, from infected countries. FAO is examining what role they could play in the spread of H5N1.

Research presented at the 6th International Symposium on Avian Influenza (3-6 Apr 2006) indicates that there are at least 2 reasons why the poultry trade may be significant:

1. Genetics research on H5N1 strains circulating in Viet Nam indicates that there was at least 1 new introduction of an H5N1 strain from China to Viet Nam during 2005. (The reference to the new introduction of H5N1 to Viet Nam during 2005 came from a presentation by Robert Webster, and the finding was published in a PNAS paper Feby 2006 -- PNAS 103(8), see pg 2847, column 2 PP 2.) See also: Chen et al. Establishment of multiple sublineages of H5N1 influenza virus in Asia: Implications for pandemic control. PNAS 103(8), 2845-2850).

2. Experimental studies have shown that vaccinated chickens can harbor and transmit the H5N1 virus without showing any outward signs of infection, and that vaccinated chickens as well as domesticated ducks can serve as infectious asymptomatic carriers of the Asian H5N1 HPAI virus. (The reference for transmission by vaccinated chickens is M. Bublot et al. of Merial (David Swayne of USDA SEPRL co-author), and for transmission in vaccinated ducks is J.A van der Groot et al (CIADC, Leystadt)).

The proceedings of the 6th International Symposium on Avian Influenza will be published in the Dec 2006 issue of Avian Diseases, and the contributed papers should provide many valuable new insights.

USA
Bird flu entering the U.S. through smuggled wildlife is a growing worry. The concern over the trade in wild animals, pets and animal parts has some precedent. Gambian rats imported from Africa brought the monkeypox virus to the US in 2003. They infected prairie dogs purchased as pets. 72 people became ill but none died. In 2004, 2 Crested Hawk-Eagles carrying the H5N1 bird flu virus were seized from the hand luggage of a Thai passenger at Brussels International Airport. The passenger had planned to sell the birds to a Belgian falconer. Not one of the 25 people exposed to the virus became ill. Officials killed 200 parrots and 600 smaller birds that had contact with the eagles.

A surveillance plan for monitoring migratory birds says migrating wild bird is the most likely carrier of the H5N1 virus. The plan, developed by the Interior and Agriculture departments and the state of Alaska for use in all 50 states, also says the virus could arrive through smuggled poultry, an infected traveler, black-market trade in exotic birds or even an act of bioterrorism. The US and China are the biggest markets for an estimated USD 10 billion global trade in illegal wildlife. About 330 000 live birds were imported into the US in 2004. Just 374 were denied entry, suggesting smugglers may focus on different routes. "The borders are where the increased emphasis needs to be," said Simon Habel, director of TRAFFIC North America. (Promed 4/29/06, 5/1/06, 5/4/06)

^top


Europe/Near East
Pan-Europe: EU explanatory message on avian influenza
From the EU Avian influenza home-page, see: http://europa.eu.int/comm/food/animal/diseases/controlmeasures/avian/ten_key_facts_about_avian_influenza.pdf. Key Facts About Avian Influenza (in 20 languages)—the document includes sections on: Core messages; Consumption of poultry products; Groups at risk; Travel and; Human flu pandemic. (Promed 5/4/06)

^top

Germany: Avian influenza H5N1 update
330 cases of avian influenza in wild birds from Germany have been confirmed by the Friedrich Loeffler Institute as of 25 Apr 2006. During the period 21-25 Apr 2006, the following 10 new cases were confirmed:

Municipality/Administrative or City District/State/Species:
Boesdorf / Ploen / Schleswig-Holstein (SH) / Graylag Goose
Molfsee / Rendsburg-Eckernfoerde / SH / Wild Goose
Molfsee / Rendsburg-Eckernfoerde / SH / Wild Goose
Molfsee / Rendsburg-Eckernfoerde / SH / Wild Goose
Stephansposching / Deggendorf / Bavaria / Swan
Olching / Fuerstenfeldbruck / Bavaria / Duck
Olching / Fuerstenfeldbruck / Bavaria / Duck
Lindau on Lake Constance / Lindau / Bavaria / Duck
Straubing-Oeberau / Straubing-Bogen / Bavaria / Falcon
Burghausen / Altoetting / Bavaria / Duck
(Promed 4/30/06)

^top

Germany (Bavaria): Avian influenza H5N1 update in animals
For the year 2006 in Bavaria, 71 cases of avian influenza in wild birds have been confirmed by the Friedrich Loeffler Institute (FLI). During the week of 24 - 28 Apr 2006, the following new cases were confirmed:

Municipality / Administrative or City District / Regional District / Species
Parkstetten/ Straubing-Bogen / Lower Bavaria / Swan
Epfach / Landsberg on the Lech / Upper Bavaria / Merganser
Steinach / Straubing-Bogen / Lower Bavaria / Swan
Kirchroth / Straubing-Bogen / Lower Bavaria / Swan
Olching / Fuerstenfeldbruck / Upper Bavaria/ Duck
Olching / Fuerstenfeldbruck / Upper Bavaria/ Duck
Lindau / Town of Lindau / Schwabia / Crested Grebe
Stephansposching / Deggendorf / Lower Bavaria / Swan

So far in 2006, 6843 wild birds have been handed over to the Bavarian Agency for Health and Food Safety; 6084 of them have already [by 28 Apr 2006] been tested for influenza A, and the 90 samples that were influenza A positive have been sent to the FLI for further testing. FLI has confirmed 71 samples as H5N1 positive, 15 as H5N1 negative, and 4 have yet to be determined. In addition to avians, 295 carnivores (martens, foxes, cats) have been sent to the LGL; 287 have been tested for influenza A virus. 1 influenza A positive sample has been forwarded to the FLI, where it was found H5N1 negative. (Promed 4/29/06)

^top

The Netherlands: Lifting of the requirement to keep poultry indoors
The Netherlands' Agriculture Ministry lifted an order keeping all domestic poultry indoors, as fears over an outbreak of bird flu eased. Among their immediate neighbors, only the Netherlands and Belgium were spared confirmed cases of wild birds infected with the H5N1 strain. Germany, Britain, Denmark and France, all reported cases. More than 13 000 dead wild birds have been tested in the Netherlands since Feb 2006, and none have showed signs of H5N1 (bird migration has now passed its peak). But with the country lying along the same migratory routes as Germany and Denmark, many experts assumed it was only a matter of time before the disease turned up in Holland. "Why no dead swans in Holland? We really do not know," said Juan Lubroth, head of the Infectious Disease Group for the UN's Food and Agriculture Organization. Switzerland also lifted its indoor order 1 May 2006. Germany has said it will keep its birds indoors until at least 12 May 2006. The first infection of commercial stocks was found on a French turkey farm in Feb 2006, and France is lifting quarantines on farms in the stricken Ain region on a case-by-case basis.

In addition to lifting the requirement to keep birds under cover, the current ban on bird fairs and poultry markets or other gatherings of poultry, flightless birds and fancy birds will be relaxed. Starting 1 May 2006 it will be possible in certain circumstances to grant exemptions for gatherings of poultry and flightless birds. Some hygiene measures remain in force. For example, commercial poultry may only eat and drink under cover. This will cause little extra nuisance since poultry are already fed indoors. The ban on keeping poultry outdoors has been in force since 20 Feb 2006. Based upon the Dutch experience in 2003, their policy includes an extensive, well-planned surveillance of wild birds, targeting the most relevant species: ducks, herons, seagulls and swans make up 71.82 percent of the 6288 sampled dead birds tested in recent months. Reportedly, only 15 908 commercially kept chickens have been vaccinated. On "hobby" backyard farms, the figures were higher: 18 448 chicken, 490 turkeys, 3266 ducks, and 2759 geese. (Promed 5/4/06)

^top

UK: Case of human conjunctivitis due to low pathogenicity H7N3 avian influenza
(Excerpted statements from the EU CDC)
Last week, UK authorities reported that there had been some cases of A/H7 avian influenza (AI) in birds in a commercial chicken farm in Eastern England (http://www.defra.gov.uk/news/latest/2006/animal-0426.htm ). Avian influenzas of the A/H7 type can be either highly pathogenic (HPAI) or of low pathogenicity for birds (LPAI). There is now a preliminary report from the European Union Veterinary Influenza Reference Laboratory that the virus in the chickens is of type A/H7N3, and that it is of low pathogenicity. The H7N3 virus last occurred in the UK in 1979. Both low pathogenicity and high pathogenicity H7N3 avian influenza viruses acquired from birds have occasionally infected humans in the past. This sometimes has resulted in mild illness or asymptomatic infection in people handling infected birds.

On 28 Apr 2006, the UK Health Protection Agency (HPA) reported that a man working with the chickens in the affected farm had developed conjunctivitis, that this had been confirmed to be H7N3. The worker has not required hospital treatment, but was given Tamiflu as a precautionary measure. UK authorities also reported that they had surveillance in place and were offering antivirals to all exposed persons (see http://www.hpa.org.uk/hpa/news/articles/press_releases/2006/060428_avian_flu_h7.htm ). On 29 Apr 2006, UK authorities made public that cases of A/H7N3 had also been found in chickens in another pair of farms in the protection zone around the original farm http://www.defra.gov.uk/news/2006/060429a.htm (near Dereham, Norfolk--the 2 flocks were reportedly slaughtered and a restricted zone put in place extending 1km from each of the infected premises). HPA has widened their surveillance activities to include those farms and other places the chickens will have gone. A few suspect cases of conjunctivitis and other respiratory illnesses are coming through, but to date, all these have proved to be negative for A/H3N7, though some were put on oseltamivir as a precaution.

The human case came to light because, as a precaution, and in addition to the veterinary measures taken to stop further infection of birds, HPA also started monitoring the health of the people working on the farm where the outbreak occurred and engaged in the culling processes. They also made sure the workers and those engaged in culling were taking all the necessary precautions, and they considered whether to start any on medication. UK authorities have pointed out that this is not the first case of conjunctivitis due to an avian influenza in the UK, as in the 1990s, another person caught conjunctivitis attributed to an LPAI (also H7N3) from the waste products of domestic poultry.

The reason for the UK authorities' particularly precautionary action at an early stage was the experience with a different and HPAI virus, A/H7N7, that affected chickens in the Netherlands, Belgium and a small part of Germany in 2003. As well as killing many chickens, that virus infected some people working with the chickens. Some of them even passed the infection onto their immediate close family, though there was no further person to person spread. All these Dutch cases experienced only mild to moderate symptoms but 1 infection in a previously healthy veterinarian had a fatal outcome. Such severe illness has never been reported with a LPAI virus or with A/H7N3 (HPAI or LPAI). Similarly, person to person spread of LPAIs has never been reported. LPAIs are common in poultry and mostly are only of interest to veterinarians, to whom they are of concern because they sometimes change to become highly pathogenic viruses. This case emphasizes the importance of people taking basic hygienic precautions if they are in close contact with any poultry or poultry waste products. The precautions for avoiding low pathogenicity infections are the same as for avoiding HPAIs: http://www.ecdc.eu.int/avian_influenza/Health_Advice.php.

***In the latest news, animal health minister Ben Bradshaw said other farms may be involved in the bird flu outbreak near Dereham, and further tests are needed. A preliminary report could not conclude whether any of the 3 flocks infected with the less serious H7N3 strain of the virus was the "index case".
(Promed 4/28/06, 4/29/06, 4/30/06, 5/1/06, 5/4/06)

^top

Pakistan (Punjab): 800 birds culled; low pathogenic avian influenza H5 reported
A team of experts has culled 800 birds at a poultry farm at village Sarwala near Attock where avian flu virus was found. Director General, Poultry Research, Lahore, Dr Zafar Gill confirming the report 28 Apr 2006 said samples collected from the farm had shown low pathogenic avian influenza H5. Some samples had been sent to National Veterinary Laboratory (NVL) Islamabad, which would be sent to the World Reference Laboratory in the UK for confirmation. He said, after detecting moderate mortality rates in a poultry farm, the experts sent the samples from the poultry farm to the Poultry Research Institute (PRI), Rawalpindi, which tested positive the bird flu virus. A team sealed the farm after culling about 800 birds. But no other farm of the district was found affected so far, he said. The teams have collected samples from all commercial poultry farms, situated within 3-km radius of infected area, which are being sent to labs. The team had been asked to assess the situation in the area, give advice and train local health workers to help contain any outbreak of the bird flu. An emergency meeting was held under the EDO Agriculture Attock, to share information, review the preparedness and discuss plans. Reportedly, the poultry industry had come under unprecedented pressure for the second time during the last 4 months, with poultry prices plummeting.
(Promed 4/30/06)

^top


Asia
Indonesia: Additional suspected human case of avian influenza H5N1 infection
A 30 year old Indonesian man has died of avian influenza, Hariadi Wibisono, director at the Health Ministry, said 28 Apr 2006, citing the results of local tests. His blood samples have been sent to a WHO-affiliated laboratory for confirmation. Local tests are not considered definitive. If confirmed by the Hong Kong laboratory, the man who died 26 Apr 2006 would be Indonesia's 25th death from H5N1 virus infection, which is endemic in poultry in the world's fourth most populous nation. The victim had a history of contact with sick chickens near his house. So far, the WHO has confirmed 24 human deaths from the H5N1 virus in Indonesia. Indonesia ranks now as the country reporting the largest number of confirmed cases during the 2005/2006 period. Also, Indonesian officials announced this week a 3-year pilot project to fight the disease in Tangerang, a municipality outside Jakarta. The idea is to apply the national plan to a local area and measure results. The $5 million project in an area of 3 million people includes bolstering epidemiologic surveillance of animals and humans, increasing poultry vaccinations, and rapidly responding to outbreaks with quarantine and movement controls. The project would also enhance biosecurity by restructuring the traditional "wet markets”.
(CIDRAP 5/5/06 http://www.cidrap.umn.edu/ ; Promed 4/28/06, 5/5/06)

^top

Malaysia: Acute respiratory tract infections in National Service trainees
The number of National Service (NS) trainees who have come down with high fever at a camp in Alor Gajah has risen to 94 and authorities suspect the disease is airborne. "It’s because the speed in which it spreads is explosive a large number of people were infected in a matter of days," said deputy State health director Dr Ghazali Othman. However, he denied that the ailment had anything to do with avian influenza. It was reported that 81 trainees had come down with high fever since 17 Apr 2006, with 25 admitted to the Malacca Hospital. The number under quarantine has now reached 69. They have "acute upper respiratory [tract] infection" and besides fever, they also have sore throat and coughs. Blood samples have been sent to the Institute of Medical Research in Kuala Lumpur and Sungai Buloh Hospital for analysis. Ghazali said the cause of the disease was still unknown. Chief Minister Datuk Seri Mohd Ali Rustam criticised the camp’s canteen for being "very dirty". The city of Malakka is located in mainland Malaysia due south of the capital Kuala Lumpur. The outbreak may be the result of seasonal human influenza virus infection, or one of the many other upper respiratory tract pathogens affecting humans. It could also be due to adenovirus infection, which is well known to have caused explosive respiratory outbreaks in US military recruits.
(Promed 4/23/06, 4/24/06)

^top

Japan (Hokkaido): Recent BSE case linked to meat-and-bone meal
A cow that died Mar 2006 as Japan's 22nd confirmed case of mad cow disease had been fed meat-and-bone meal (MBM). This is the first known use of MBM in Japan since it was banned in 2001 due to suspicions that it causes mad cow disease. The case also marks the first time the feed's use has been linked to a mad cow-infected animal in Japan. The 64 month old cow, which died Jan 2006 in Hokkaido, was fed the meal until Sep 2001, while it was less than 1 year old. In Oct 2001, the central government imposed a ban on MBM. The meal was found to be contained in a mixed ration called the CP Supplement made from meat and bones from chickens, pigs and cows. The Hokkaido government has designated 45 cows, fed the same meal at the same farm where the cow died in Mar 2006, as suspected disease carriers and will destroy them.

***Global FAO assessment on BSE: Cases of bovine spongiform encepalopathy (BSE) worldwide are declining, according to the UN Food and Agriculture Organization (FAO). They have been dropping at the rate of some 50 per cent a year over the past 3 years. In 2005, just 474 animals died of BSE around the world, compared with 878 in 2004 and 1646 in 2003, and against a peak of several tens of thousands in 1992, according to figures collected by the World Animal Health Organization (OIE), with which FAO works closely. Only 5 human deaths resulting from variant Creutzfeldt-Jakob Disease (vCJD), the human form of BSE, were reported worldwide in 2005. All of them were in the UK, where 9 deaths were registered in 2004 and 18 in 2003. Andrew Speedy, an FAO animal production expert, commented: "It is quite clear that BSE is declining and that the measures introduced to stop the disease are effective. But further success depends on our continuing to apply those measures worldwide." FAO insists on the importance of a scientific approach to detect and control the disease, ensuring it is eradicated in affected countries--and kept out of unaffected ones. FAO, together with Swiss experts, has been running courses for specialists on BSE diagnosis, surveillance and prevention in the animal feed and meat industries. Also vital, said Speedy, is a tracking system that allows animals to be identified from birth to shopping basket. This has been adopted across Europe but has yet to be implemented partially or fully in other countries. (Promed 4/27/06)

^top


Americas
USA: Contracts totaling more than $1 billion to develop cell-based influenza vaccine
As part of the plan to prepare for a pandemic, HHS Secretary Mike Leavitt awarded more than $1 billion to accelerate development and production of new technologies for influenza vaccines within the U.S. These 5 contracts support the advanced development of cell-based production technologies for influenza vaccines and will help to modernize and strengthen the nation’s influenza vaccine production by creating an alternative to producing influenza vaccines in eggs. Cell-based vaccine manufacturing -- a technology that is used in many other modern vaccines -- holds the promise of a reliable, flexible and scalable method of producing influenza vaccines. Currently licensed influenza vaccines are produced in specialized chicken eggs in a technique that has changed little in over 50 years. With increasing demand for seasonal influenza vaccine and with the looming threat of a pandemic, a system that allows surge capacity in an emergency is needed. Using a cell culture approach, vaccine manufacturers are able to bypass the steps needed to adapt the virus strains to grow in eggs. Also, cell culture-based influenza vaccines will help meet surge capacity needs in the event of a shortage or pandemic, since cells may be frozen in advance and large volumes grown quickly. Licensure and manufacture in the U.S. of influenza vaccines produced in cell culture also will provide security against risks associated with egg-based production, such as the potential for egg supplies to be unavailable as a result of poultry-based diseases. Finally, cell-based influenza vaccines will provide an option for people who are allergic to eggs and thus unable to receive the currently licensed vaccines.
(5/4/06 http://www.pandemicflu.gov/ )

^top

USA: Avian influenza action group to coordinate U.S. international effort
The Department of State has established a new Action Group to coordinate US preparedness and response to avian influenza and the threat of a global human influenza pandemic. The Avian Influenza Action Group leads U.S. Government efforts to advance the international objectives defined by the “National Strategy for Pandemic Influenza” (which outlines how the US is preparing for, and how it will detect and respond to, a potential pandemic). With the launch of the “Implementation Plan for the National Strategy for Pandemic Influenza”, the Action Group is also responsible for 83 specific actions to implement the U.S. international engagement strategy based on preparedness and communication, surveillance and detection, and response and containment. The Plan describes more than 300 critical actions to address the threat of pandemic influenza. The plan continues to stress the message that states and communities will have to rely mainly on themselves, with the federal government in an advisory role.

The report divides planning and response efforts into 8 areas: federal government planning, federal government response, international efforts, transportation and borders, protecting human health, protecting animal health, law enforcement and public safety, and institutions. The plan also has an appendix with advice for schools, the business sector, families, and individuals. Primary prevention of a pandemic will include vaccination, early detection and treatment with antivirals, and infection control measures. Case tracking and contact tracing in the early stages of a pandemic may be useful in order to isolate the sick and request voluntary quarantine of their contacts, the plan says. The document lists several other methods to reduce the spread of the virus: Social distancing measures, such as advising people to stay at least 3 feet apart; Using more telecommuting or teleconferencing for work; Closing schools; Canceling non-essential public gatherings; Restricting long-distance travel and; "Snow-day restrictions"—suggestions or mandates by community authorities that everyone stay home for 2 incubation periods (about 4 days for typical flu viruses). The plan also emphasizes the importance of expanding healthcare surge capacity. It is also important to slow the virus's spread while minimizing the social and economic consequences. Critical transportation services will need to be sustained to keep communities functioning.

The Avian Influenza Action Group will work in close collaboration with the Departments of Health and Human Services, Agriculture, Homeland Security, Defense, the U.S. Agency for International Development, etc., as well as the State Department’s Bureau of Oceans and International Environmental and Scientific Affairs. The Action Group will serve as the point of coordination for U.S. participation in the International Partnership on Avian and Pandemic Influenza. The goal of this initiative is for countries and international organizations to work together to combat avian and pandemic influenza and to identify priority areas for further collaboration. For more information visit: www.state.gov/g/oes/avianflu and www.pandemicflu.gov.
(5/3/06 http://www.pandemicflu.gov/ ; CIDRAP 5/3/06 http://www.cidrap.umn.edu/)

^top

USA (New Jersey): Avian influenza found at bird market; low pathogenicity suspected
A strain of avian influenza has been found in Camden County. The flu was found among chickens and ducks at a live bird market, said the state Department of Agriculture. The strain "appears to be low pathogenic and cannot harm humans," Charles M. Kuperus, the state's Secretary of Agriculture, said 28 Apr 2006. Kuperus noted none of the birds in the market had died from the virus, which he said suggests the strain is not especially virulent. The owner of the birds voluntarily killed his flock, and the facility was cleaned and disinfected. The market will be inspected by the state agency before it reopens. Kuperus said the sick birds were detected by routine testing, an event described as "not an uncommon occurrence." Preliminary tests were negative for type N1 of the virus, another indicator that the local virus is not particularly dangerous. More testing is being conducted. "It remains safe to eat poultry and poultry products that are properly handled and cooked," Kuperus said, noting all forms of avian influenza are killed by thorough cooking. Low pathogenic avian influenza (LPAI) has periodically cropped up in live bird markets in the northeastern US. Generally, it has been an H7 variety.
(Promed 4/30/06)

^top

USA (Multistate): Update on mumps epidemic
The number of mumps cases has risen to 1100 in 8 Midwestern states and prompted the federal government to distribute vaccines from its stockpile to stop the outbreak's spread. The outbreak is the largest mumps epidemic in the US in more than 20 years. Most are in Iowa, where 815 cases have been recorded. An additional 50 mumps cases have been reported in Minnesota, Kansas, Illinois, Nebraska, Wisconsin, Missouri and Oklahoma. Investigators are reviewing possible cases in 7 other states. Mumps usually is not serious and rarely kills. None of the cases in the recent outbreak have been fatal. Once a common childhood illness, mumps was virtually eradicated with widespread use of the measles, mumps and rubella (MMR) vaccine. But the vaccine is effective in only about 90 percent of people, which could partly explain the recent outbreak, CDC Director Julie Gerberding said. Many college-age students may have received just 1 of the 2 recommended doses when they were young, and therefore may not have the same level of immunity as others, she said. Federal officials urged students, people who work in school or university settings and health-care workers who did not get both doses to get a second dose.

CDC is sending 25 000 doses of MMR vaccine to Iowa for that purpose, Gerberding said. Merck has donated an additional 25 000 doses. Investigators do not yet know how many of the people infected with mumps were vaccinated. So far, "we have absolutely no information to suggest there's a problem with the vaccine," Gerberding said. Mumps is a viral infection that causes fever, headache and swelling of the glands around the jaw. Up to 10 percent of patients may develop encephalitis. Other serious complications that sometimes occur include meningitis, inflammation of the testicles, ovaries or pancreas, or permanent deafness. There is no approved treatment. The mumps virus is transmitted by coughing and sneezing. People can transmit mumps to others for 3 days before they have any symptoms. In the US, an average of 265 mumps cases have been reported each year since 2001. Mumps vaccinations started in 1967.

State-specific information on the mumps epidemic can be found on the 21 Apr 2006 Promed article. See http://www.phppo.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00243 for more information on the outbreak as of 12 Apr 2006 along with more technical information on the disease and control strategies.
(Promed 4/21/06)

^top

Canada: Mad cow disease--herd tracing
The Canadian Food Inspection Agency (CFIA) said that 15 herdmates of Canada's latest mad cow case were exported to the US. The U.S. Department of Agriculture has located 1 of the 15 animals in Washington State and continues to trace the others. "We have just under 150 animals that we are tracing. . .and 23 were located in Canada and quarantined," said Dr. George Luterbach, senior veterinarian with the CFIA. The 23 cattle quarantined in Canada, as well as the 1 located in Washington, will soon be euthanized and tested for bovine spongiform encephalopathy (BSE). The animals may have been exposed to the same feed as the 6-year-old dairy cow from a farm in British Columbia that tested positive for the disease. BSE is believed to be spread by feed containing rendered protein from infected cattle or other ruminants. "I would stress that even during the highest levels of infectivity of BSE in the European situation, there was rarely more than 1 animal in the herd that would become infected and express the disease," USDA's spokesman Ed Loyd said. CFIA’s investigation focuses primarily on the cow's birth farm, which is close to the one it was found on, Luterbach said. CFIA continues to trace the remaining cohorts, cattle born on the same farm 12 months before or after the affected animal. Luterbach said the agency does not expect to find them all, as many would have been killed for a variety of reasons.

The pure-bred Holstein cow was confirmed to have the disease 16 Apr 2006, making it Canada's fifth native-born mad cow case. CFIA said then that it did not enter the food supply. The animal was born after the 1997 ban that prohibited adding protein from cows and other ruminants to cattle feed. This is not the first time that mad cow cohorts have been exported to the U.S. This also occurred in 2003 and 2005. CFIA has located the cow's 2004 calf, which had been slaughtered, but continues to search for its 2005 calf, as it is believed possible for BSE to be passed to offspring. The cow was pregnant at the time of her death. The Canadian cattle industry suffered in 2003, when the U.S. banned imports of live cattle after the first native-born case was confirmed. The importation of cattle under 30 months old resumed in 2005. (Promed 4/30/06)

^top

USA (Alabama): Conclusion of the epidemiologic investigation into BSE-positive cow
The Alabama Department of Agriculture and Industries, the U.S. Department of Agriculture's Animal and Plant Health Inspection Service (APHIS), and the U.S. Department of Health and Human Services' Food and Drug Administration (FDA) have completed their epidemiologic investigation regarding a cow that tested positive for bovine spongiform encephalopathy (BSE) in Alabama Mar 2006. The results indicate that the positive animal was non-ambulatory on the farm, and examined by a veterinarian. The veterinarian returned to the farm the following day, euthanized the animal and collected a sample, which was submitted for BSE testing. The animal was buried on the farm and did not enter the animal or human food chain. Officials excavated the animal and determined the animal to be more than 10 years old. It was born prior to the implementation of FDA's 1997 feed ban that minimizes the risk that a cow might consume feed contaminated with the agent thought to cause BSE.

Officials investigated 36 farms and 5 auction houses and conducted DNA testing on herds that may have included relatives of the index animal. Investigators were unable to find any related animals except for the 2 most recent calves of the index animal. The most recent calf was located at the same farm as the index animal, and the second calf died the year before. No other animals of interest were located. The living calf of the BSE-positive animal is currently being held at APHIS's National Veterinary Services Laboratory for observation. The investigation did not reveal the BSE-positive animal's herd of origin. However, this was not entirely unexpected due to the age of the animal, along with its lack of identifying brands, tattoos and tags. It is highly unusual to find BSE in more than 1 animal in a herd or in an affected animal's offspring. To ensure that adequate feed controls were in place in the feed facilities in the immediate geographic area of the index farm, FDA conducted a feed investigation into local feed mills that may have supplied feed to the index animal after the 1997 feed ban. This investigation found that all local feed mills that handle prohibited materials have been and continue to be in compliance with the FDA's feed ban.

As part of APHIS's BSE enhanced surveillance program, more than 700 000 samples have been tested since Jun 2004. To date, only 2 of these highest risk animals have tested positive for the disease as part of the surveillance program, for a total of 3 cases of BSE in the US. For more information visit: http://www.aphis.usda.gov/newsroom/hot_issues/bse.shtml.
(Promed 5/3/06)

^top

USA: USDA estimates nation has 4 to 7 BSE cases
After close to 2 years of expanded testing, the US government is estimating that there are between 4 and 7 cases of bovine spongiform encephalopathy (BSE) among the nation's 42 million adult cattle. "The data shows that the prevalence of BSE in the United States is extraordinarily low," US Department of Agriculture (USDA) Secretary Mike Johanns said. The estimate is based on testing of about 730,000 cattle since 1999, including 690,000 since Jun 2004. The testing program was greatly expanded after the country's first BSE case was found in a Canadian-born cow Dec 2003. USDA is looking to cut back the BSE testing program, but it will wait for an independent scientific review of the prevalence estimate, Johanns said. USDA used 2 methods to estimate BSE prevalence. The "BSurvE" method yielded an estimate of 7 cases, while the "Bayesian birth cohort" method indicated 4 cases. The estimates did not factor in the first BSE case, since that was in a Canadian-born cow. With the inclusion of that case, the respective estimates were 11 and 5 cases. The agency ran several additional sets of calculations to assess the effect of changing certain assumptions and to see what the estimates would be if up to 3 more BSE cases had been found. The resulting estimates ranged from 1 to 30 cases. The surveillance is designed to gather enough data to draw statistically valid conclusions about the prevalence of BSE. Food safety, on the other hand, is ensured by the ban on use of nonambulatory cattle and high-risk cattle parts (specified-risk materials) in human food and the ban on feeding cattle protein to cattle, Johanns said. Reportedly, USDA officials said around 40, 000 cattle will be tested per year for BSE in the future, far below the level of the past 2 years.

Dr. Ron DeHaven, administrator of the Food Safety and Inspection Service (FSIS), said the World Organization for Animal Health (OIE) has two sets of guidelines for BSE testing: one for initially determining the prevalence of the disease and another for "maintenance" surveillance. USDA will meet or exceed the recommended level of maintenance testing, he said. USDA is currently testing 5,000 to 7,000 cattle per week at a cost of roughly $1 million weekly. The prevalence estimate comes as the USDA continues to negotiate for reopening of the Japanese market to US beef. Japan banned US beef after the first BSE case was found in 2003. The ban ended in Dec 2005, but it was renewed in Jan of this year when some pieces of bone were found in veal imported from the US.
(CIDRAP 4/28/06 http://www.cidrap.umn.edu/ )

^top

USA: HHS buys another 5 million doses of anthrax vaccine
The US Department of Health and Human Services (HHS) is adding 5 million doses of anthrax vaccine to its stockpile for civilian biodefense, which will double its store of the vaccine. HHS announced it is buying the doses of Anthrax Vaccine Adsorbed (AVA) for $120 million from BioPort Corp. The agency says the added vaccine, together with an "already substantial" supply of antibiotics, helps diversify the nation's medical stockpile. The vaccine is funded by the Project Bioshield Act of 2004, which authorized spending of up to $5.6 billion on medical defenses against biological, chemical, radiological, and nuclear threats. To provide full protection, AVA requires 6 doses over 18 months, followed by annual boosters. The vaccine has generated controversy in the military because of concern over side effects. HHS has a contract to buy 75 million doses of a new anthrax vaccine from VaxGen Inc. for $877 million. Officials hope that vaccine, which is not yet licensed, will provide protection in 3 doses and have fewer side effects than AVA.
(CIDRAP 5/5/06 http://www.cidrap.umn.edu/ )

^top


Africa
Egypt: Fifth human fatality from avian influenza H5N1 infection
The Ministry of Health has announced the country’s fifth death from H5N1 avian influenza. The death occurred in a previously reported case, a 27-year-old woman from Cairo. Reportedly, she had visited a house where many chickens were slaughtered. She died 4 May 2006. Tests conducted by both the national public health laboratory and the US Naval Medical Research Unit 3 produced positive results for H5N1.
(CIDRAP 5/4/06 http://www.cidrap.umn.edu/ ; WHO 5/5/06 http://www.who.int/csr/disease/avian_influenza/en/index.html )

^top

Ivory Coast: Confirmation of avian influenza H5N1 in birds
The Ivory Coast government confirmed the presence of H5N1 avian influenza in birds, making it at least the sixth African country confronting the virus. Laboratory results from the World Organization for Animal Health (OIE) reportedly revealed that 7 chickens, 9 ducks, and a sparrow hawk found in Abidjan—the country's largest city—were infected with the H5N1 strain. The government is looking for the families who were in contact with these infected birds and would put them under surveillance for 10 days. Officials identified 3 separate outbreaks in the city in Apr 2006. The government had been awaiting test results from an OIE reference lab since then. Poultry sales would be banned within a radius of 3 km of the sites where H5N1 had been confirmed. Starting next week, officials plan to slaughter all poultry sold in Abidjan. Chicken sellers would be reimbursed for birds taken from them and slaughtered. The Ivory Coast ministry for animal production said that $11.7 million has been earmarked to reimburse poultry vendors and to develop a system for identifying disease-free chickens. The government also plans to improve how it informs and advises the public about avian flu. Other African countries that have confirmed H5N1 avian flu since Feb 2006 are Nigeria, Egypt, Niger, Cameroon, and Burkina Faso. Sudan has reported an H5 virus in birds, but H5N1 has not yet been confirmed there, according to the OIE.
(CIDRAP 5/5/06 http://www.cidrap.umn.edu/ ; Promed 5/5/06)

^top


1. Updates
Influenza
Seasonal influenza activity for the APEC Economies
During weeks 14-16 overall influenza activity declined. In most parts of the world activity was reported as sporadic for week 16.
Canada. Influenza activity declined during weeks 14–16. The overall influenza-like illness (ILI) consultation rate remained within the expected range, with influenza A and B viruses co-circulating.
Hong Kong. After 14 weeks of ongoing though slight increase, a decline in influenza activity was first observed during week 15. Overall activity was low in week 16, with A(H1N1) and B viruses co-circulating.
Russia. Influenza activity started to decline slightly during week 14 and was reported as regional in weeks 14–16, with A(H1), A(H3N2) and B viruses co-circulating.
USA. Influenza activity in the US peaked in early Mar and continued to decline during week 17 (Apr 23 - 29, 2006). 97 specimens (9.4%) 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 below the national baseline. The proportion of deaths attributed to pneumonia and influenza was below the baseline level. 3 states reported regional influenza activity; 4 states and the District of Columbia reported local influenza activity; 38 states, New York City, and Puerto Rico reported sporadic influenza activity; and 5 states reported no activity.
(WHO 5/5/06 http://www.who.int/csr/disease/influenza/update/en/ ; CDC 5/4/06 http://www.cdc.gov/flu/weekly/ )

Avian/Pandemic influenza updates
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html. Includes Global/country maps.
- UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. A new table provides information on influenza vaccine manufacturers and suppliers.
- 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/avian/index.htm.
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. Latest updates on U.S. State Summits are available. Read the following articles: “HHS Awards Contracts Totaling More Than $1 Billion To Develop Cell-Based Influenza Vaccine”; “National Implementation Plan Released More” and; “Avian Influenza Action Group to Coordinate U.S. International Effort”.
- CIDRAP: http://www.cidrap.umn.edu/. Frequently updated news and scholarly articles.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm. Website recently updated.
- American Veterinary Medical Association: http://www.avma.org/public_health/influenza/default.asp.
- US Geological Survey, National Wildlife Health Center Avian Influenza Information (with bulletins, maps, and news reports): http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp.
(WHO; FAO, OIE; CDC; CIDRAP; PAHO; AVMA; USGS)

^top

Cholera, diarrhea & dysentery
Indonesia (Irian Jaya)
Test results on victims of an acute diarrheal disease in Papua's Jayawijaya regency have confirmed that the disease, which has spread to 2 districts in nearby Yahukimo regency, was cholera. According to Berry Wopari of the Papua Health Office, cholera has killed 178 Jayawijaya residents alone since it was declared an outbreak 16 Mar 2006. In the nearby Yahukimo regency, another 33 residents had died of the disease. In Assologaima district, where the number of people who have died of the diarrheal disease has reached 26, health workers started the mass treatment 24 Apr 2006. Treatment continued until all of the village's 1200 residents were treated. The residents were given a tetracycline injection and provided with other drugs, including penicillin. Berry said the latest figure in Jayawijaya put the number of fatalities at 126 on 26 Apr 2006. He said lab tests on stool specimens conducted by the health agency's laboratory confirmed that the disease was caused by the Vibrio cholerae bacillus. He said the bacteria would further spread due to poor sanitation. The disease has reportedly spread to nearby Yahukimo regency. Reportedly, the disease has killed 33 residents in Kurima and Mugi districts since 7 Apr 2006.

The outbreak reportedly started after residents consumed contaminated pork during a ceremony during Mar 2006 in Abusa village in Kurulu district, where hundreds of pigs had died of hog cholera. Many other residents attending the ceremony were from different districts, thus spreading the outbreak. (It is important to note that hog cholera is not the same infection as that caused by Vibrio cholerae in man. The preferred term for hog cholera is classical swine fever, but it also been referred to as peste du porc, colera porcina, and virusschweinepest. Classical swine fever is a highly contagious viral disease of swine.)
(Promed 4/30/06)

^top

Dengue
Hong Kong/Thailand
The Centre for Health Protection has confirmed Dengue fever in a 25-year-old woman, bringing the year's total cases to 9, all imported. She came down with fever, headache, and muscle and joint pain Apr 7, 2006. She had travelled to Indonesia 28 Jan to 7 Apr 2006. She is in hospital in stable condition. Her family members have no symptoms. People should stay alert to the threat of dengue fever and take measures against mosquito breeding. Travellers should wear long-sleeved tops and trousers, and use insect repellent. (Promed 4/22/06)

Cambodia
An outbreak of dengue fever is reportedly occurring in Kompong Chhnang province, with more than 30 people sickened so far. At least 30 children were hospitalized in the province's Boribor district and some have been taken to hospital for testing, Chhuon Buntha, chief of the district's health office, reportedly said. The outbreak of the fever was first noticed early this month but has worsened following intermittent rains. There have been no reported deaths so far. Insecticide will be sprayed throughout the district to combat the outbreak. The coming rainy season could be cause for concern, he warned. Local residents are advised to be certain that pools of still water do not collect around their homes. (Promed 4/30/06)

Thailand
Dengue fever infections appear to be on the rise in Thailand in 2006. Figures from Jan - mid-April show 4971 Thais have been infected with the disease and that 8 died, 3 in the province of Nakhon Si Thammarat, 2 in Bangkok and 1 each in Phichit, Nakhon Nayok, and Pattani, according to the head of Thailand's Disease Control Department, Dr. Thawat Suntrajarn. Dengue fever, an infection which is spread by the bite of infected mosquitoes, is common in Thailand. Meanwhile, caretaker Public Health Minister Pinij Jarusombat said although the rainy season has yet to arrive in most of Thailand, the current figures show that dengue fever infection rates in the country began to soar since early 2006. The main factor could be that the disease is peaking, that it has come to its full epidemiologic cycle, and that more severe strains of the dengue virus have emerged. He said he had instructed all provincial public health offices to set plans for the control of the outbreaks of dengue fever as well as other major communicable diseases including bird flu. The plans would include the eradication of the Aedes mosquito which transmits dengue. Physical destruction of the mosquito population is considered the most effective preventive measure against infection. (Promed 4/30/06)

^top


2. Articles
CDC EID Journal, Volume 12, Number 5—May 2006
CDC Emerging Infectious Diseases Journal, Volume 12, Number 5—May 2006 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. The following expedited influenza articles are available online: Simple Respiratory Mask, V.M. Dato et al.; H5N1 Influenza A Virus and Infected Human Plasma, S. Chutinimitkul. The journal also includes a Tuberculosis Special Section.

^top

Reusability of facemasks during an influenza pandemic: facing the flu
(Board on Health Sciences Policy; Prepublication copy of new report from IOM)
There is no practical way to clean disposable medical masks and N95 respirators to allow them to safely be reused if supplies run short in an influenza pandemic, a panel of experts at the Institute of Medicine (IOM) has concluded. On the assumption that supplies may run short in a flu pandemic, the IOM assessed the possibility of reuse of disposable masks and N95 respirators. Medical masks fit loosely over the nose and mouth and are mainly meant for use by healthcare workers and patients to prevent them from spreading pathogens. N95 respirators, in contrast, are used in both medical and industrial settings to protect wearers from inhaling harmful microscopic particles. When properly fitted, they should filter out 95% of aerosol particles. Neither type of device has been tested for its ability to protect people from flu viruses. The committee found disposable masks and respirators "do not lend themselves to reuse because they work by trapping harmful particles inside the mesh of fibers of which they are made. This hazardous buildup cannot be cleaned out or disinfected without damaging the components of the device." Further, the panel couldn't identify any simple changes in the devices that would permit reuse, or any changes that would eliminate the need to test the fit of respirators to ensure that they work. But that doesn't necessarily rule out reuse of a respirator or mask by the same person, the report says. A person who wants to reuse an N95 respirator should wear a medical mask or a clear plastic face shield over it to protect it from surface contamination. The user should store the respirator carefully between uses and should wash his or her hands before and after handling it and the device used to shield it.

As for masks, manufacturers told the committee that several models can be used repeatedly by the same person until they become damaged, moist, dirty, or hard to breathe through. It says this is acceptable for infected patients in particular, since reuse is unlikely to increase their risk of contamination. The report also notes that there are respirators with replaceable filter cartridges, and these can be reused by one or more wearers. "Even the best respirator or surgical mask will do little to protect a person who uses it incorrectly, and we know relatively little about how effective these devices will be against flu even when they are used correctly," said Donald S. Burke, professor of international health and epidemiology at Johns Hopkins University and co-chair of the IOM committee. The committee calls for HHS to sponsor research on how well masks, respirators, and other filtering materials protect against flu viruses. Also, methods should be developed to decontaminate masks and respirators without damaging them, the IOM says. To read the IOM report, go to: http://darwin.nap.edu/books/0309101824/html/
(CIDRAP 4/28/06 http://www.cidrap.umn.edu/ )

^top

Strategies for mitigating an influenza pandemic
Neil M. Ferguson1 et al. Nature. 2006 Apr 26; [Epub ahead of print]
http://www.nature.com/nature/journal/vaop/ncurrent/full/nature04795.html
Abstract: “Development of strategies for mitigating the severity of a new influenza pandemic is now a top global public health priority. Influenza prevention and containment strategies can be considered under the broad categories of antiviral, vaccine and non-pharmaceutical (case isolation, household quarantine, school or workplace closure, restrictions on travel) measures1. Mathematical models are powerful tools for exploring this complex landscape of intervention strategies and quantifying the potential costs and benefits of different options. Here we use a large-scale epidemic simulation to examine intervention options should initial containment of a novel influenza outbreak fail, using Great Britain and the United States as examples. We find that border restrictions and/or internal travel restrictions are unlikely to delay spread by more than 2–3 weeks unless more than 99% effective. School closure during the peak of a pandemic can reduce peak attack rates by up to 40%, but has little impact on overall attack rates, whereas case isolation or household quarantine could have a significant impact, if feasible. Treatment of clinical cases can reduce transmission, but only if antivirals are given within a day of symptoms starting. Given enough drugs for 50% of the population, household-based prophylaxis coupled with reactive school closure could reduce clinical attack rates by 40–50%. More widespread prophylaxis would be even more logistically challenging but might reduce attack rates by over 75%. Vaccine stockpiled in advance of a pandemic could significantly reduce attack rates even if of low efficacy. Estimates of policy effectiveness will change if the characteristics of a future pandemic strain differ substantially from those seen in past pandemics.”
(CIDRAP http://www.cidrap.umn.edu/ )

^top

Statistical pattern matching facilitates the design of polyvalent inhibitors of anthrax and cholera toxins
Rai P, Padala C, Poon V, et al. Nature Biotech 2006 Apr 23 (early online publication)
Abstract: “Numerous biological processes involve the recognition of a specific pattern of binding sites on a target protein or surface. Although ligands displayed by disordered scaffolds form stochastic rather than specific patterns, theoretical models predict that recognition will occur between patterns that are characterized by similar or "matched" statistics. Endowing synthetic biomimetic structures with statistical pattern matching capabilities may improve the specificity of sensors and resolution of separation processes. We demonstrate that statistical pattern matching enhances the potency of polyvalent therapeutics. We functionalized liposomes with an inhibitory peptide at different densities and observed a transition in potency at an interpeptide separation that matches the distance between ligand-binding sites on the heptameric component of anthrax toxin. Pattern-matched polyvalent liposomes inhibited anthrax toxin in vitro at concentrations four orders of magnitude lower than the corresponding monovalent peptide, and neutralized this toxin in vivo. Statistical pattern matching also enhanced the potency of polyvalent inhibitors of cholera toxin. This facile strategy should be broadly applicable to the detection and neutralization of toxins and pathogens.”

"This novel approach to the design of anthrax antitoxin is an important advance, not only for the value it may have in anthrax treatment, but also because this technique could be used to design better therapies for cholera and other diseases," said NIH Director Elias A. Zerhouni. The article says the experiment was the first to show that a liposome-based polyvalent inhibitor works in animals. The team plans to infect animals with B anthracis and allow the disease process to begin before treating them with the anthrax antitoxin.
(CIDRAP 4/25/06 http://www.cidrap.umn.edu/ )

^top

Antibacterial bacteria may be used in ground beef
Smith L et al. Reduction of Escherichia coli O157:H7 and Salmonella in ground beef using lactic acid bacteria and the impact on sensory properties. J Food Protect 2005;68(8):1587-92
Abstract: “Studies were conducted to determine whether four strains of lactic acid bacteria (LAB) inhibited Escherichia coli O157:H7 and Salmonella in ground beef at 5°C and whether these bacteria had an impact on the sensory properties of the beef. The LAB consisted of frozen concentrated cultures of four Lactobacillus strains, and a cocktail mixture of streptomycin-resistant E. coli O157:H7 and Salmonella were used as pathogens. Individual LAB isolates at 107 CFU/ml were added to tryptic soy broth containing a pathogen concentration of 105 CFU/ml. Samples were stored at 5°C, and pathogen populations were determined on days 0, 4, 8, and 12. After 4 days of storage, there were significant differences in numbers of both pathogens exposed to LAB isolates NP 35 and NP 3. After 8 and 12 days of storage, all LAB reduced populations of both pathogens by an average of 3 to 5 log cycles. A second study was conducted in vacuum-packaged fresh ground beef. The individual LAB isolates resulted in an average difference of 1.5 log cycles of E. coli O157:H7 after 12 days of storage, and Salmonella populations were reduced by an average of 3 log cycles. Following this study, a mixed concentrated culture was prepared from all four LAB and added to ground beef inoculated with pathogen at 108 CFU/g. After 3 days of storage, the mixed culture resulted in a 2.0-log reduction in E. coli O157:H7 compared with the control, whereas after 5 days of storage, a 3-log reduction was noted. Salmonella was reduced to nondetectable levels after day 5. Sensory studies on noninoculated samples that contained LAB indicated that there were no adverse effects of LAB on the sensory properties of the ground beef. This study indicates that adding LAB to raw ground beef stored at refrigeration temperatures may be an important intervention for controlling foodborne pathogens.”

Food stores may soon be able to offer meat products treated with a mixture of harmless bacteria that reportedly can reduce common pathogens by 99% or more. The mixture contains 4 strains of lactic acid bacteria (LAB), a class of organisms that has long been used in cultured dairy products. In this study, the mixture, called Bovamine Meat Cultures, progressively reduced the levels of Escherichia coli O157:H7 and Salmonella in ground beef during several days of refrigerated storage. Also, tasters could not detect a difference between treated and untreated ground beef samples that had been stored for 3 days before cooking. The Food and Drug Administration (FDA) has classified the product as "generally regarded as safe" (GRAS), clearing the way for commercial use.
(CIDRAP 4/26/06 http://www.cidrap.umn.edu/ )

^top

A live, attenuated recombinant West Nile virus vaccine
Monath TP, Liu J, Kanesa-Thasan N, et al. Proc Nat Acad Sci 2006 Apr 25;103(17):6694-9 http://www.pnas.org/cgi/content/full/103/17/6694
Abstract: “West Nile (WN) virus is an important cause of febrile exanthem and encephalitis. Since it invaded the U.S. in 1999, >19,000 human cases have been reported. The threat of continued epidemics has spurred efforts to develop vaccines. ChimeriVax-WN02 is a live, attenuated recombinant vaccine constructed from an infectious clone of yellow fever (YF) 17D virus in which the premembrane and envelope genes of 17D have been replaced by the corresponding genes of WN virus. Preclinical tests in monkeys defined sites of vaccine virus replication in vivo. ChimeriVax-WN02 and YF 17D had similar biodistribution but different multiplication kinetics. Prominent sites of replication were skin and lymphoid tissues, generally sparing vital organs. Viruses were cleared from blood by day 7 and from tissues around day 14. In a clinical study, healthy adults were inoculated with 5.0 log10 plaque-forming units (PFU) (n = 30) or 3.0 log10 PFU (n = 15) of ChimeriVax-WN02, commercial YF vaccine (YF-VAX, n = 5), or placebo (n = 30). The incidence of adverse events in subjects receiving the vaccine was similar to that in the placebo group. Transient viremia was detected in 42 of 45 (93%) of ChimeriVax-WN02 subjects, and four of five (80%) of YF-VAX subjects. All subjects developed neutralizing antibodies to WN or YF, respectively, and the majority developed specific T cell responses. ChimeriVax-WN02 rapidly elicits strong immune responses after a single dose, and is a promising candidate warranting further evaluation for prevention of WN disease.”

According to CDC, West Nile virus, a flavivirus, infected at least 2,949 people in 2005, causing 116 deaths. Although 80% of those infected will have no symptoms, about 20% of infected patients will develop a fever, headache, tiredness, body aches, and, occasionally, a rash on the trunk. And 1 in 150 patients develops severe neuroinvasive disease, such as encephalitis, meningitis, or poliomyelitis.
(CIDRAP 5/2/06 http://www.cidrap.umn.edu/ )

^top

Postexposure protection against Marburg haemorrhagic fever with recombinant vesicular stomatitis virus vectors in non-human primates: an efficacy assessment
Daddario-DiCaprio KM et al. Lancet 2006 Apr 29;367:1399-404
Abstract: “Background: Effective countermeasures are urgently needed to prevent and treat infections caused by highly pathogenic and biological threat agents such as Marburg virus (MARV). We aimed to test the efficacy of a replication-competent vaccine based on attenuated recombinant vesicular stomatitis virus (rVSV), as a postexposure treatment for MARV haemorrhagic fever. Methods: We used a rhesus macaque model of MARV haemorrhagic fever that produced 100% lethality. We administered rVSV vectors expressing the MARV Musoke strain glycoprotein to five macaques 20-30 min after a high-dose lethal injection of homologous MARV. Three animals were MARV-positive controls and received non-specific rVSV vectors. We tested for viraemia, undertook analyses for haematology and serum biochemistry, and measured humoral and cellular immune responses. Findings: All five rhesus monkeys that were treated with the rVSV MARV vectors as a postexposure treatment survived a high-dose lethal challenge of MARV for at least 80 days. None of these five animals developed clinical symptoms consistent with MARV haemorrhagic fever. All the control animals developed fulminant disease and succumbed to the MARV challenge by day 12. MARV disease in the controls was indicated by: high titres of MARV (10(3)-10(5) plaque-forming units per mL); development of leucocytosis with concurrent neutrophilia at end-stage disease; and possible damage to the liver, kidney, and pancreas. Interpretation: Postexposure protection against MARV in non-human primates provides a paradigm for the treatment of MARV haemorrhagic fever. Indeed, these data suggest that rVSV-based filoviral vaccines might not only have potential as preventive vaccines, but also could be equally useful for postexposure treatment of filoviral infections.”

There is no licensed vaccine and no specific treatment for Marburg fever, which resembles Ebola hemorrhagic fever and is fatal in most cases. A Marburg epidemic in Angola in 2004 and 2005 killed 227 of 252 people infected, according to Angolan government figures. Future animal studies, the report says, should focus on how long after exposure the vaccine can be used successfully and whether the vaccine used in this study, based on the Musoke strain of Marburg, will work against other strains. (CIDRAP 5/2/06 http://www.cidrap.umn.edu/ )

^top

Tamiflu protects ferrets in avian influenza study
A new study suggests that the antiviral drug oseltamivir (Tamiflu) can prevent deaths in ferrets infected with H5N1 avian influenza. The oseltamivir study was reported at a meeting sponsored by the journal The Lancet. In the experiment, a group of ferrets was infected with H5N1 and, 4 hours later, was given half the oseltamivir dose recommended for humans. Treatment continued for 5 days. A second group of ferrets received a higher dose of oseltamivir starting 24 hours postinfection. All of the treated ferrets survived, while none of the untreated animals did. Elena Govorkova, MD, PhD, of St Jude Children's Research Hospital in Memphis, presented the findings. Oseltamivir has been widely touted as 1 of 2 neuraminidase inhibitors that show the most promise in fighting H5N1, and countries worldwide are stockpiling the drug in the face of a potential flu pandemic. However, its effectiveness against avian flu in humans is unknown, and Govorkova's research is designed to help predict optimal dosing for humans in the event of a pandemic, according to Roche, the manufacturer of Tamiflu. Ferrets provide good models for testing, because they are very susceptible to influenza and experience symptoms similar to humans when infected.
(CIDRAP 5/4/06 http://www.cidrap.umn.edu/ )

^top


3. Notifications
Social Marketing in Public Health Conference and Training Institute
Clearwater Beach, Florida, USA; 22-25 Jun 2006
The Academy for Educational Development and the University of South Florida, College of Public Health Social Marketing in Public Health, will be hosting a conference this summer on the Avian Influenza epidemic. In both small sessions and a plenary session, the conference will examine Social Marketing approaches to addressing Avian Influenza in the health sector and wider arenas. Key Topics: The Social Marketing in Public Health Conference is designed for public health professionals and health educators in a variety of settings including CDC, state and local health departments, other public agencies, colleges and universities, volunteer agencies, and nonprofit organizations. Participants usually include CDC designees, program planners and administrators, health educators, health communication and health information specialists, researchers, academicians, and graduate students. Conference goals: Provide public health professionals who are new to social marketing a working knowledge of this approach; Advance social marketing practice and knowledge; Encourage networking between novice/intermediate practicing social marketers and leaders in the field; and Advance practice by sharing program successes and challenges.

Contact: Tel (813) 974-6695; Fax (813) 974-7860;
http://www.outreach.usf.edu/conted/conferences/smph/
Kristina M. Dunlevy, Managing Editor - Social Marketing Quarterly
Social Change Group, Academy for Educational Development
1825 Connecticut Avenue NW, Washington, DC 20009
kdunlevy@smtp.aed.org
(Promed 5/2/06)

^top

Society for Vector Ecology Annual Conference (SOVE)
Anchorage, Alaska, USA; 30 Sep - 3 Oct 2006
The Society for Vector Ecology will hold its annual conference 30 Sep - 3 Oct 2006 in Anchorage. For more details, contact Dr. Major Dhillon at mdhillon@northwestmvcd.org or go to http://www.sove.org.
(Promed 5/3/06)

^top

Introduction to Public Health Surveillance
CDC and Rollins School of Public Health at Emory University will cosponsor the course, "Introduction to Public Health Surveillance," May 8-12, 2006, at Emory University. The course is designed for practicing state and local public health professionals. The course will provide the theoretical and practical tools necessary to design, implement, and evaluate effective surveillance programs. Topics include an overview and history of surveillance systems; planning considerations; sources and collection of data; analysis, interpretation, and communication of data; surveillance systems technology; ethics and legalities; state and local concerns; and future considerations. Tuition is charged. For more information: Emory University, Hubert Department of Global Health, 1518 Clifton Road N.E., Room 746, Atlanta, GA 30322; tel 404-727-3485; fax 404-727-4590; at http://www.sph.emory.edu/epicourses; or by e-mail pvaleri@sph.emory.edu. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5516a6.htm
(MMWR April 28, 2006 / 55(16);462)

^top

New book: “SARS: How A Global Epidemic Was Stopped”
SARS caused more fear and social disruption than any other disease of our time. While it killed a relatively small number of people, it nevertheless buckled economies, crippled international trade and travel, and emptied the streets of some of the world's most prosperous cities. Where did this frightening disease come from? How did it spread? And will the world be any better prepared if it returns? For the first time, these and other questions are answered in this inside account of what really took place in those fateful months of 2003 when SARS threatened to engulf the world. Written largely by the public-health experts and scientists who were at the centre of the battle, the book tracks the ways in which the virus spread, how close it came to bringing public-health systems to their knees and how, in the end, an unprecedented global coalition stopped it in the tracks. For health specialists, this book will serve as an indispensable guide to the science of SARS, providing a detailed account of the clinical symptoms associated with the disease, the unravelling of the genetic secrets of the SARS coronavirus and the development of vaccines and diagnostics.
(WHO http://www.wpro.who.int/publications/PUB_9290612134.htm )

^top


4. APEC EINet activities
Risky Trade: Infectious Disease in the Era of Global Trade
Ann Marie Kimball, University of Washington (Ashgate publishing)
The current value of global trade has reached a staggering annual figure of $6 trillion in merchandise crossing borders. Such prolific global trading has, at the same time, begun to raise fears of pandemics and concerns for global health. Yet, investment in public health infrastructure and disease control was never designed to cope with international trade of this volume and diversity. Most health systems lag far behind, especially in poor countries. This has created new vulnerabilities for global populations to the introduction and amplification of infection through trade. Public fears have been further heightened by reports of diseases such as Mad Cow disease and E.Coli. Risky Trade provides a thorough examination of the risks posed by disease in the age of globalization. Drawing on the economics of international trade and epidemiology, the author explores the critical health issues arising from the enormous increase in global trade and travel.

Issues covered include: The scale of the problem with particular reference to the Sakai outbreak of E.Coli; Risks from particular microbes—Enteric and viral infections; Highly infectious agents; Antimicrobial resistance and Stealth agents; Global outbreaks as a result of human travel and trade; Prevention, surveillance and control and; The future health of global trading. In addition to highlighting the problems, the book also addresses some of the potential benefits globalization can bring to epidemic control through surveillance, diagnostics, treatment and investigation. The approach ties together existing descriptions and case studies of epidemics building a comprehensive framework for examining new events and considering historical experience with infectious outbreaks. The volume will be a valuable guide to students, academics, practitioners and policy makers in the areas of international trade, health economics, epidemiology, international/public health and disease control. Visit www.ashgate.com for more information.

^top


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/.

^top

 apecein@u.washington.edu