A TIME'S MEMORY

Synergistic TLR2/6 and TLR9 Activation Protects Mice against Lethal Influenza Pneumonia (PLoS ONE, abstract, edited)

2012-01-28T09:14:00.001+01:00

[Source: PLoS ONE, full text: (LINK). Abstract, edited.]

Synergistic TLR2/6 and TLR9 Activation Protects Mice against Lethal Influenza Pneumonia

by Michael J. Tuvim, Brian E. Gilbert, Burton F. Dickey, Scott E. Evans
Lower respiratory tract infections caused by influenza A continue to exact unacceptable worldwide mortality, and recent epidemics have emphasized the importance of preventative and containment strategies. We have previously reported that induction of the lungs' intrinsic defenses by aerosolized treatments can protect mice against otherwise lethal challenges with influenza A virus. More recently, we identified a combination of Toll like receptor (TLR) agonists that can be aerosolized to protect mice against bacterial pneumonia. Here, we tested whether this combination of synthetic TLR agonists could enhance the survival of mice infected with influenza A/HK/8/68 (H3N2) or A/California/04/2009 (H1N1) influenza A viruses. We report that the TLR treatment enhanced survival whether given before or after the infectious challenge, and that protection tended to correlate with reductions in viral titer 4 d after infection. Surprisingly, protection was not associated with induction of interferon gene expression. Together, these studies suggest that synergistic TLR interactions can protect against influenza virus infections by mechanisms that may provide the basis for novel therapeutics.

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Nipah Virus Infects Specific Subsets of Porcine Peripheral Blood Mononuclear Cells (PLoS ONE, abstract, edited)

2012-01-28T09:10:00.001+01:00

[Source: PLoS ONE, full text: (LINK). Abstract, edited.]

Nipah Virus Infects Specific Subsets of Porcine Peripheral Blood Mononuclear Cells

by Beata Stachowiak, Hana M. Weingartl
Nipah virus (NiV), a zoonotic paramyxovirus, is highly contagious in swine, and can cause fatal infections in humans following transmission from the swine host. The main viral targets in both species are the respiratory and central nervous systems, with viremia implicated as a mode of dissemination of NiV throughout the host. The presented work focused on the role of peripheral blood mononuclear cells (PBMC) in the viremic spread of the virus in the swine host. B lymphocytes, CD4−CD8−, as well as CD4+CD8− T lymphocytes were not permissive to NiV, and expansion of the CD4+CD8− cells early post infection was consistent with functional humoral response to NiV infection observed in swine. In contrast, significant drop in the CD4+CD8− T cell frequency was observed in piglets which succumbed to the experimental infection, supporting the hypothesis that antibody development is the critical component of the protective immune response. Productive viral replication was detected in monocytes, CD6+CD8+ T lymphocytes and NK cells by recovery of infectious virus in the cell supernatants. Virus replication was supported by detection of the structural N and the non-structural C proteins or by detection of genomic RNA increase in the infected cells. Infection of T cells carrying CD6 marker, a strong ligand for the activated leukocyte cell adhesion molecule ALCAM (CD166) highly expressed on the microvascular endothelial cell of the blood-air and the blood-brain barrier may explain NiV preferential tropism for small blood vessels of the lung and brain.

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Mexico, Se triplican casos de influenza A(H1N1) en Hidalgo (La Crónica de Hoy, January 27 2012)

2012-01-27T21:54:00.001+01:00

[Source: La Cronica de Hoy, full text: (LINK).]

Se triplican casos de influenza A(H1N1) en Hidalgo

Notimex | Nacional - 2012-01-27 | Hora de creación: 13:57:56| Ultima modificación: 13:58:34

De 35 casos de influenza A(H1N1) registrados la semana pasada, Hidalgo pasó a 103, confirmaron las autoridades de la Secretaría de Salud estatal. De acuerdo con datos oficiales, en los últimos siete días se confirmaron 68 nuevos casos de este padecimiento y dos decesos más, por lo que el número de muertos por este padecimiento llegó a cinco en la entidad.

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2011-2012 Influenza Season Week 3 ending January 21, 2012 (US CDC, January 27 2012, edited)

2012-01-27T21:39:00.001+01:00

[Source: US Centers for Disease Control and Prevention, FluView, full page: (LINK). Extracts, edited.]

2011-2012 Influenza Season Week 3 ending January 21, 2012

All data are preliminary and may change as more reports are received.

Synopsis:
During week 3 (January 15-21, 2012), influenza activity in the United States remained relatively low.

U.S. Virologic Surveillance: Of the 3,572 specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division, 175 (4.9%) were positive for influenza.
Pneumonia and Influenza (P&I) Mortality Surveillance: The proportion of deaths attributed to P&I was slightly above the epidemic threshold.
Influenza-associated Pediatric Mortality: One influenza-associated pediatric death was reported and was associated with an influenza B virus infection.
Outpatient Illness Surveillance:The proportion of outpatient visits for influenza-like illness (ILI) was 1.4%, which is below the national baseline of 2.4%. All 10 regions reported ILI below region-specific baseline levels. New York City and all 50 states experienced minimal ILI activity and the District of Columbia had insufficient data.
Geographic Spread of Influenza: The geographic spread of influenza in four states was reported as regional; eight states reported local activity; Guam and 35 states reported sporadic activity; the U.S. Virgin Islands and three states reported no influenza activity, and the District of Columbia and Puerto Rico did not report.

National and Regional Summary of Select Surveillance Components

[HHS Surveillance Regions* - Data for current week: Out-patient ILI† - % of respiratory specimens positive for flu‡ - Number of jurisdictions reporting regional or widespread activity§ - Data cumulative since October 2, 2011 (Week 40): A (H3) - 2009 H1N1 - A(Subtyping not performed) – B - Pediatric Deaths]

Nation – Normal - 4.9% - 4 of 54 - 726 - 85 - 455 - 220 - 1

Region 1 - Normal - 2.1% - 0 of 6 - 19 - 4 - 0 - 10 - 0

Region 2 - Normal - 1.4% - 0 of 4 - 14 - 2 - 6 - 5 - 0

Region 3 - Normal - 1.1% - 1 of 6 - 25 - 3 - 5 - 3 - 0

Region 4 - Normal - 3.2% - 1 of 8 - 70 - 14 - 196 - 117 - 0

Region 5 - Normal - 14.0% - 0 of 6 - 168 - 12 - 5 - 18 - 0

Region 6 - Normal - 1.9% - 0 of 5 - 21 - 18 - 37 - 21 - 0

Region 7 - Normal - 4.8% - 1 of 4 - 75 - 1 - 26 - 3 - 0

Region 8 - Normal - 6.7% - 1 of 6 - 187 - 3 - 117 - 13 - 0

Region 9 - Normal - 8.4% - 0 of 5 - 98 - 24 - 59 - 19 - 1

Region 10 - Normal - 3.0% - 0 of 4 - 49 - 4 - 4 - 11 - 0

(*) HHS regions (Region 1 CT, ME, MA, NH, RI, VT; Region 2: NJ, NY, Puerto Rico, US Virgin Islands; Region 3: DE, DC, MD, PA, VA, WV; Region 4: AL, FL, GA, KY, MS, NC, SC, TN; Region 5: IL, IN, MI, MN, OH, WI; Region 6: AR, LA, NM, OK, TX; Region 7: IA, KS, MO, NE; Region 8: CO, MT, ND, SD, UT, WY; Region 9: AZ, CA, Guam, HI, NV; and Region 10: AK, ID, OR, WA).

(†) Elevated means the % of visits for ILI is at or above the national or region-specific baseline

(‡) National data are for current week; regional data are for the most recent three weeks

(§) Includes all 50 states, the District of Columbia, Guam, Puerto Rico, and U.S. Virgin Islands

U.S. Virologic Surveillance:

WHO and NREVSS collaborating laboratories located in all 50 states report to CDC the number of respiratory specimens tested for influenza and the number positive by influenza type and subtype. The results of tests performed during the current week are summarized in the table below.

Week 3

No. of specimens tested - 3,572

No. of positive specimens (%) - 175 (4.9%)
Positive specimens by type/subtype

Influenza A - 166 (94.9%)

2009 H1N1 - 20 (12.0%)
Subtyping not performed - 45 (27.1%)
(H3) - 101 (60.8%)

Influenza B - 9 (5.1%)

Nationally, low levels of influenza virus positive specimens have been reported this season, with influenza A (H3N2) being most common. However, there are regional differences in activity levels and which virus predominates. Recent increases in the percent of specimens positive for influenza have been noted in Regions 5 and 6. For the past three weeks, 2009 H1N1 viruses have been most commonly reported in Region 6, while in Region 5 influenza A (H3N2) viruses have been most commonly reported.
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View National and Regional Level Graphs and Data

Antigenic Characterization:

CDC has antigenically characterized 217 influenza viruses [29 2009 H1N1, 160 influenza A (H3N2) viruses, and 28 influenza B viruses] collected by U.S. laboratories since October 1, 2011.
2009 H1N1 [29]

Twenty-eight (96.6%) of the 29 viruses were characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2011-2012 influenza vaccine for the Northern Hemisphere.
One virus (3.4%) tested showed reduced titers with antiserum produced against A/California/7/2009.

Influenza A (H3N2) [160]

One hundred fifty-eight (98.8%) of the 160 viruses were characterized as A/Perth/16/2009-like, the influenza A (H3N2) component of the 2011-2012 influenza vaccine for the Northern Hemisphere.
Two viruses (1.2%) tested showed reduced titers with antiserum produced against A/Perth/16/2009.

Influenza B (B/Victoria/02/87 and B/Yamagata/16/88 lineages) [28]:

Victoria Lineage [14]: Fourteen of the 28 influenza B viruses tested belong to the B/Victoria lineage of viruses and were characterized as B/Brisbane/60/2008-like, the influenza B component of the 2011-2012 Northern Hemisphere influenza vaccine.
Yamagata Lineage [14]: Fourteen of the 28 influenza B viruses tested belong to the B/Yamagata lineage of viruses.

It is too early in the influenza season to determine how well the seasonal influenza vaccine strains and circulating strains will match.

Antiviral Resistance:
Testing of 2009 influenza A (H1N1), influenza A (H3N2), and influenza B virus isolates for resistance to neuraminidase inhibitors (oseltamivir and zanamivir) is performed at CDC using a functional assay. Additional 2009 influenza A (H1N1) clinical samples are tested for a single mutation in the neuraminidase of the virus known to confer oseltamivir resistance (H275Y). The data summarized below combine the results of both testing methods. These samples are routinely obtained for surveillance purposes rather than for diagnostic testing of patients suspected to be infected with antiviral resistant virus.
High levels of resistance to the adamantanes (amantadine and rimantadine) persist among 2009 influenza A (H1N1) and A (H3N2) viruses (the adamantanes are not effective against influenza B viruses). As a result of the sustained high levels of resistance, data from adamantane resistance testing are not presented in the table below.

Neuraminidase Inhibitor Resistance Testing Results on Samples Collected Since October 1, 2011

[Oseltamivir: Virus Samples tested (n) - Resistant Viruses, Number (%) – Zanamivir: Virus Samples tested (n) - Resistant Viruses, Number (%)]

Influenza A (H3N2) - 196 - 0 (0.0) - 196 - 0 (0.0)

Influenza B - 30 - 0 (0.0) - 30 - 0 (0.0)

2009 H1N1 - 30 - 0 (0.0) - 28 - 0 (0.0)

All viruses tested for the 2011-2012 season since October 1, 2011 have been susceptible to the neuraminidase inhibitor antiviral medications oseltamivir and zanamivir as were the majority of viruses tested last season; however, rare sporadic cases of oseltamivir resistant 2009 influenza A (H1N1) and A (H3N2) viruses have been detected worldwide. Antiviral treatment with oseltamivir or zanamivir is recommended as early as possible for patients with confirmed or suspected influenza who have severe, complicated, or progressive illness; who require hospitalization; or who are at greater risk for influenza-related complications. Additional information on recommendations for treatment and chemoprophylaxis of influenza virus infection with antiviral agents is available at (http://www.cdc.gov/flu/antivirals/index.htm ).

Pneumonia and Influenza (P&I) Mortality Surveillance:
During week 3, 7.8% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage was slightly above the epidemic threshold of 7.7% for week 3.
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Influenza-Associated Pediatric Mortality:

One influenza-associated pediatric death was reported to CDC during week 3 and was associated with an influenza B virus infection. The death reported during week 3 occurred during the week ending October 29, 2011 (week 43).
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Influenza-Associated Hospitalizations:

Images look good, just need to change the antigenic characterization text from 20 to 29 and in the EIP section there were some text changes to the first couple sentences: The Influenza Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza related hospitalizations in children younger than 18 years of age (since the 2003-04 influenza season) and adults (since the 2005-06 influenza season). The FluSurv-NET covers more than 80 counties in the 10 Emerging Infections Program (EIP) states
The FluSurv-NET covers more than 80 counties in the 10 Emerging Infections Program (EIP) states (CA, CO, CT, GA, MD, MN, NM, NY, OR, TN) and additional Influenza Hospitalization Surveillance Project (IHSP) states. The IHSP began during the 2009-10 season to enhance surveillance during the 2009 H1N1 pandemic. IHSP sites included IA, ID, MI, OK and SD during 2009-2010 season; ID, MI, OH, OK, RI, and UT during the 2010-2011 season; and MI, OH, RI, and UT during the 2011-2012 season. The rates provided are likely to be a vast underestimate of the actual number of influenza-related hospitalizations. First, the FluSurv-NET is not nationally representative, and second, influenza-related hospitalizations can be missed, either because testing is not performed, or because cases may be attributed to other causes of pneumonia or other common influenza-related complications.
Between October 1, 2011 and January 21, 2012, 166 laboratory-confirmed influenza hospitalizations were reported, a rate of 0.6 per 100,000 population. Among cases, 120 (72.3%) were influenza A, 38 (22.9%) were influenza B, and 2 (1.2%) were influenza A and B co-infections; 6 (3.6%) had no virus type information. Among those with influenza A subtype information, 48 were H3N2 and 4 were 2009 H1N1. The most commonly reported underlying medical conditions among adults were chronic lung diseases, asthma and obesity. The most common underlying medical conditions in children were neurologic disorders and obesity. However, more than a third of hospitalized children had no identified underlying medical conditions.
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Outpatient Illness Surveillance:

Nationwide during week 3, 1.4% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is below the national baseline of 2.4%. (ILI is defined as fever (temperature of 100°F [37.8°C] or greater) and cough and/or sore throat.)
The increase in the percentage of patient visits for ILI in previous weeks may be influenced by a reduction in routine healthcare visits during the holiday season, as has occurred in previous seasons.
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View National and Regional Level Graphs and Data

On a regional level, the percentage of outpatient visits for ILI ranged from 1.0% to 2.0% during week 3. All 10 regions reported a proportion of outpatient visits for ILI below their region-specific baseline levels.

ILINet State Activity Indicator Map:

Data collected in ILINet are used to produce a measure of ILI activity* by state. Activity levels are based on the percent of outpatient visits in a state due to ILI and are compared to the average percent of ILI visits that occur during spring and fall weeks with little or no influenza virus circulation. Activity levels range from minimal, which would correspond to ILI activity being below the average, to intense, which would correspond to ILI activity being much higher than average. Because the clinical definition of ILI is very general, not all ILI is caused by influenza; however, when combined with laboratory data, the information on ILI activity provides a clear picture of influenza activity in the United States.
During week 3, the following ILI activity levels were experienced:

New York City and all 50 states experienced minimal ILI activity.
Data were insufficient to calculate an ILI activity level from the District of Columbia.

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Geographic Spread of Influenza as Assessed by State and Territorial Epidemiologists:
The influenza activity reported by state and territorial epidemiologists indicates geographic spread of influenza viruses, but does not measure the intensity of influenza activity.
During week 3, the following influenza activity was reported:

Regional influenza activity was reported by four states (Colorado, Kentucky, Missouri, and Virginia).
Local influenza activity was reported by eight states (California, Kansas, Massachusetts, Michigan, Montana, New Hampshire, New Jersey, and Texas).
Sporadic influenza activity was reported by Guam and 35 states (Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Louisiana, Maine, Maryland, Minnesota, Mississippi, Nebraska, Nevada, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Washington, West Virginia, Wisconsin, and Wyoming).
No influenza activity was reported by the U.S. Virgin Islands, and three states (Delaware, Idaho, and Oklahoma).
The District of Columbia and Puerto Rico did not report.

Flu Activity data in XML Format

Additional National and International Influenza Surveillance Information
U.S. State and local influenza surveillance: Click on a jurisdiction below to access the latest local influenza information.
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Distribute Project: Additional information on the Distribute syndromic surveillance project, developed and piloted by the International Society for Disease Surveillance (ISDS) now working in collaboration with CDC, to enhance and support Emergency Department (ED) surveillance, is available at http://isdsdistribute.org/

Google Flu Trends: Google Flu Trends uses aggregated Google search data in a model created in collaboration with CDC to estimate influenza activity in the United States. For more information and activity estimates from the U.S. and worldwide, see http://www.google.org/flutrends/

Europe: for the most recent influenza surveillance information from Europe, please see WHO/Europe at http://www.euroflu.org/index.php and visit the European Centre for Disease Prevention and Control at http://ecdc.europa.eu/en/publications/surveillance_reports/influenza/Pages/weekly_influenza_surveillance_overview.aspx

Public Health Agency of Canada: The most up-to-date influenza information from Canada is available at http://www.phac-aspc.gc.ca/fluwatch/

World Health Organization FluNet: Additional influenza surveillance information from participating WHO member nations is available at FluNet and the Global Epidemiology Reports

A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/overview.htm

Page last reviewed: January 27, 2012

Page last updated: January 27, 2012

Content source: Centers for Disease Control and Prevention

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Protect Yourself Against H3N2v and Seasonal Influenza (Flu), Facts Sheet (US CDC, January 27 2012, edited)

2012-01-27T21:25:00.001+01:00

[Source: US Centers for Disease Control and Prevention, full page: (LINK). Edited.]

Fact Sheet: Protect Yourself Against H3N2v and Seasonal Influenza (Flu)

Background

Twelve human infections with a variant influenza A H3N2 virus (“H3N2v”) have been detected in 5 states of the country since August 2011 (Indiana, Iowa, Maine, Pennsylvania, and West Virginia). These are viruses that do not usually infect people but that occur in pigs and that are very different from human seasonal H3N2 viruses. In addition, regular flu viruses are spreading in the United States.

About half of the recent infections with H3N2v have occurred after contact with pigs, but in some cases, the virus seems to have spread from person-to-person. So far spread has not continued beyond one or two people. The symptoms and severity of H3N2v illness have been similar to seasonal flu.

This virus is related to human flu viruses from the 1990s, so adults should have some immunity, but young children probably do not. Early steps to make a vaccine against H3N2v have been taken, but no decision to mass produce such a vaccine has been made. Public health authorities are watching closely.

For more information, please visit the CDC Seasonal Influenza (Flu) website, and Information on H3N2 Variant Influenza A Viruses.

Take Action

The risk of infection and spread – for H3N2v and seasonal flu viruses – can be reduced by taking a combination of actions. CDC recommends:

Get a seasonal flu vaccine to protect yourself against seasonal flu viruses. (The seasonal vaccine is not designed to protect against H3N2v. Limited studies show that it may boost immunity against this virus in adults, but will probably not offer protection for children.)
Take everyday preventive actions, including:

Cover your nose and mouth with a tissue when you cough or sneeze. (Throw the tissue in the trash after you use it.)
Wash your hands often with soap and water, especially after you cough or sneeze. If soap and water are not available, an alcohol-based hand rub may be used.
Avoid touching your eyes, nose or mouth. Germs spread that way.
Try to avoid close contact with sick people.
If you are sick, stay home from work or school until your illness is over.

If you live in an area where H3N2v cases have been identified recently and develop flu like illness, contact your health care provider (a doctor, physician’s assistant, nurse practitioner, etc.). Tell them if you have had contact with pigs or with other sick people.
If you live in an area where no H3N2v has been detected, follow CDC’s regular recommendations for seeking treatment for influenza. (If seeking treatment is recommended, and you have had contact with pigs, tell your health care provider about it.)
Also, whenever you have flu symptoms and are seeing a health care provider, always remember to tell them if you have asthma, diabetes, heart disease, are pregnant, or are older than 65 or younger than 5 years. These conditions and age factors (and others) put you at high risk of serious complications if you get the flu.
Flu symptoms usually include fever and respiratory symptoms, such as cough and runny nose, and possibly other symptoms, such as body aches, nausea, or vomiting or diarrhea.
Health care providers will determine whether influenza testing and possible treatment are needed.
There are influenza antiviral drugs that can be used to treat infection with H3N2v viruses as well as seasonal influenza viruses. More information about influenza antiviral drugs is available at Treatment (Antiviral Drugs).

Contact Us:

Centers for Disease Control and Prevention - 1600 Clifton Rd - Atlanta, GA 30333 - 800-CDC-INFO (800-232-4636) - TTY: (888) 232-6348

New Hours of Operation: 8am-8pm ET/Monday-Friday Closed Holidays - cdcinfo@cdc.gov

Page last reviewed: January 27, 2012

Page last updated: January 27, 2012

Content source: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD)

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India, 100 crib deaths in Bengal since Jan 1 (Thaindian News, January 27 2012)

2012-01-27T17:55:00.001+01:00

[Source: Thaindian, full text: (LINK).]

100 crib deaths in Bengal since Jan 1 (Lead)

‎27 January ‎2012 | IANS
Kolkata, Jan 27 (IANS) Five more crib deaths were reported in West Bengal’s Malda district Friday, taking the total number of such deaths to nearly 100 since Jan 1, a senior health official said. The babies were aged between three hours to three months. “Since Jan 1 to Jan 27, 1,600 babies have been admitted [...]

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Strong earthquake felt in northern Italy (CTV News, January 27 2012)

2012-01-27T17:45:00.001+01:00

[Source: CTV, full text: (LINK).]

Strong earthquake felt in northern Italy

‎27 January ‎2012
A strong earthquake has been felt in northern Italy.

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Earthquake shakes northern Italy (BBC News, January 27 2012)

2012-01-27T17:39:00.001+01:00

[Source: BBC, full text: (LINK).]

Earthquake shakes northern Italy

‎27 January ‎2012
A magnitude 5.3 magnitude earthquake is felt in Turin and Milan, the second to hit northern Italy in a week, but there are no reports of damage.

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Indonesia, Tangerang youth dies of H1N1, not H5N1 (ANTARA, January 27 2012)

2012-01-27T17:34:00.001+01:00

[Source: Antara, full text: (LINK).]

Tangerang youth dies of H1N1, not H5N1

‎27 January ‎2012
Health Minister Endang Rahayu Sedyaningsih said that R (18), a Tangerang youth who initially reportedly died of bird flu or H5N1 virus, actually died of the H1N1 virus or also called swine flu.

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Indonesia, West Java: Again, A Citizen Suspected to be Infected by Avian Influenza (VIVA News, January 27 2012, edited)

2012-01-27T17:20:00.001+01:00

[Source: VIVA News, full text: (LINK). Automatic translation from Bahasan to English, edited.]

Indonesia, West Java: Again, A Citizen Suspected to be Infected by Avian Influenza

Friday, January 27, 2012, 16:57 GMT - Aries Setiawan, Ayatollah Humaeni - Bogor, Juna Sanbawa – Yogyakarta

VIVA News - Dozens of chickens died suddenly in the village of Cinnamon, Cibadak Village, District Land Sareal, the city of Bogor, West Java. Apparently, based on the results of the examination conducted by the Department of Animal Husbandry city of Bogor, West Java, saliva samples of dead chickens tested positive for H5N1 or bird flu.

Moreover, one person people also experience pain and suspected bird flu. Ipan Sukarman, 50, said, pet chickens died suddenly. Not just his cock, his neighbor's chickens died suddenly. This incident, he said, had been going on since a week ago.

"Though the afternoon was still fresh and willing to eat," said Ipan, Friday, January 27, 2012. He further said, a sick chicken and then cooked and eaten. Setelahmakan, Ipan claim to feel sick. Apparently, based on examination of the health center, he was suffering from avian flu. Although already know infected with bird flu virus, Ipan remain active. Meanwhile, Arif, a veterinarian from the Animal Husbandry Department, City of Bogor confirmed, that after the rapid tests from one dead chicken found the H5N1 virus or bird flu.

However, to convince, it brings the sample obtained should be more than one. "Therefore, we ask residents to be careful," he said.

While in the district of Bantul, Yogyakarta, breeders pet birds died suddenly reported to the Department of Agriculture and Forestry Bantul regency. Reports to the Office comes from the various districts.

"We're worried about the dead birds would spread to other areas quickly because the new current rainy season," said Edy Suhariyanta, Head of Agriculture and Forestry Bantul regency, Friday, January 27, 2012 Although the results rapid tests have not shown that poultry died suddenly positive of H5N1, but the death of these birds would be very dangerous for the survival of poultry population in Bantul.

"The population of poultry in Bantul, we expect to reach 250 thousand heads. If the bird flu outbreak to attack the poultry population would drop dramatically," he said. This will be exacerbated if there is one area that poultry died suddenly positive avian flu and subsequently carried out culling of poultry in a certain radius. "I can not imagine how many birds to be destroyed because there are birds in the area died of bird flu," he said. Office itself has been as early as possible to anticipate the outbreak of bird flu by distributing disinvektan free of charge to farmers or workers immediately came to localized markets for poultry spraying disinvektan. "Stock disinvektan still quite a lot and the public can request free of charge at the office of agricultural bureau or office puskeswan in every district," he said. (Umi)

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Indonesia, Tangerang: 18 year old boy Death Not Due to Bird Flu (Tempo.co, January 27 2012, edited)

2012-01-27T17:16:00.001+01:00

[Source: Tempo, full text: (LINK). Automatic translation from Bahasan to English, edited.]

Thursday, January 26, 2012 | 23:20 pm
Indonesia, Tangerang: 18 year old boy Death Not Due to Bird Flu
TEMPO.CO , Jakarta - Patients with suspected bird flu from Tangerang, Banten, RO suffering from the H5N1 virus negative.
"He was hit by the H1N1 virus pdm09, it's not swine flu or bird flu," said Director of Disease Control Sourced Animals (PPBB) Rita Kusriastuti, Thursday, January 26, 2012. RO died in the isolation room General Hospital Regional Tangerang Banten, on Wednesday, January 25, 2012. Rita said that RO is not a seasonal virus of bird flu.
However, the hospital entered into the isolation room to meet the fixed procedures (SOPs). "According to the SOPs, he should be placed in isolation rooms in advance," said Rita. RO entered the isolation room since five days ago, or Saturday, January 21, 2012. RO indicated suspect bird flu after being treated at Mercy Hospital Sari Karawaci, Tangerang, since Friday, January 20, 2012. RO admitted to hospital with complaints of high fever, shortness of breath, hoarseness. According to Rita, the virus infecting two patients suspected of bird flu in Tangerang and Jakarta just a seasonal virus.
"Technology is now becoming more sophisticated, so we are biased identification of the virus," he said. But he made sure that the virus is contracted from human to human instead of from animals to humans. Rita said that this year two more bird flu deaths that ASR and PDY. The number of two people making Indonesia on alert status. "The status we are safe, but we must not be complacent," he said. MITRA Tarigan

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EuroFlu - Weekly Electronic Bulletin - Week 3 : 16/01/2012-22/01/2012 - 27 January 2012, Issue N° 429 (edited)

2012-01-27T16:55:00.001+01:00

[Source: EuroFlu, full page: (LINK). Extracts, edited.]

EuroFlu - Weekly Electronic Bulletin - Week 3 : 16/01/2012-22/01/2012 - 27 January 2012, Issue N° 429

Influenza activity continues to rise slowly in the WHO European Region due to A(H3N2)

This issue is based on data for week 3/2012 reported by 46 Member States in the WHO European Region.

Consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) continue to be relatively low in most countries of the Region, but with many countries reporting increasing activity.

29 % of sentinel specimens tested positive for influenza, which is an increase over last week: 95% of these were influenza A.

Of the 352 influenza A viruses from sentinel sources that were subtyped, 99 % were A(H3N2).

Current situation: week 3/2012

Trends in clinical activity were reported by 42 countries: 20 stable, 19 increasing and 3 decreasing.

At the same time, ILI and ARI consultation rates remained at low levels in most countries of the WHO European Region.

Similar to the previous week, consultation rates were highest in young children.

Of the 41 countries reporting on the geographical spread of influenza: 12 reported no activity; 7 local activity; 18 sporadic activity; and 4 countries (Finland, Iceland, Italy and Spain) regional activity.

Intensity was reported to be low in most countries reporting on this indicator, except for Bulgaria, Iceland, Italy and Spain, where influenza activity was at medium levels.

Severe acute respiratory infection (SARI): week 3/2012

11 countries reported data from sentinel hospital-based surveillance for SARI: Albania, Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Romania, the Russian Federation, Serbia and Ukraine.

The number of SARI hospitalizations remained largely unchanged compared to the previous week, except in Kazakhstan, which reported increases in SARI hospitalization – mainly in children aged 0–4 years.

A total of 122 respiratory specimens was collected from SARI patients, of which 10 (8%) tested positive for influenza with 6 being subtyped, all as A(H3N2).

6 countries so far (Albania, Belarus, Kazakhstan, Kyrgyzstan, Romania and Ukraine) have reported influenza detections in SARI patients during the course of this influenza season.

Further information on the sentinel SARI surveillance systems represented in the EuroFlu bulletin can be found in “Overview of sentinel SARI systems in EuroFlu”.

Virological situation: week 3/2012

Sentinel outpatient clinics collected 1469 respiratory specimens, 422 (29 %) of which tested positive for influenza viruses: 401 (95%) were type A and 21 (5%) were type B.

Of the 352 influenza A viruses subtyped, 349 (99%) were influenza A(H3N2) and 3 (1%) were A(H1N1)pdm09.

In the 18 countries testing 20 or more sentinel specimens, influenza positivity ranged from 0% to 85%, with a median of 22% (mean: 25%).

In addition, 525 non-sentinel specimens were reported positive for influenza: 504 (96%) type A and 21 (4%) type B.

Of the influenza A viruses, 189 were subtyped: 173 (92%) as A(H3N2) and 16 (8%) as A(H1N1)pdm09.

Cumulative virological data: weeks 40/2011 – 3/2012

During this period, 3436 influenza virus detections were reported: 3226 (94%) were influenza A and 210 (6%) were influenza B.

Of the influenza A viruses, 2099 were subtyped: 1985 (95%) as A(H3N2) and 114 (5%) as A(H1N1)pdm09.

In addition, 56 influenza viruses were characterized antigenically:

46 were A(H3) A/Perth/16/2009 (H3N2)-like;

2 were A(H1N1)pdm09 A/California/7/2009 (H1N1)-like;

2 were B/Florida/4/2006-like (B/Yamagata/16/88 lineage);

2 were B/Bangladesh/3333/2007-like (B/Yamagata/16/88 lineage); and

4 were B/Brisbane/60/2008-like (B/Victoria/2/87 lineage).

Of 95 influenza viruses characterized genetically,

1 belonged to the A(H1N1)pdm09 group represented by A/Astrakhan/1/2011;

1 belonged to the A(H1N1)pdm09 group represented by A/St Petersburg/100/2011;

5 belonged to the B/Bangladesh/3333/2007 clade (Yamagata lineage);

2 belonged to the B/Brisbane/60/2008 clade (Victoria lineage); and

86 belonged to the A/Victoria/208/2009 A(H3) clade – 63 in the group represented by A/Stockholm/18/2011 (group 3), 19 in the group represented by A/Iowa/19/2010 (group 6) and 1 in the group represented by A/Johannesburg/114/2011(group 7).

Comment

Influenza activity has increased consistently over the past several weeks, but influenza detections remain low compared to the same period of the 2010/2011 season.

Influenza A and B viruses are co-circulating in the Region, with the vast majority of detections in both outpatient clinics and hospitals being A(H3N2).

Further information

The EuroFlu bulletin describes and comments on influenza activity in the 53 countries in the WHO European Region. Further information can be obtained from the WHO/Europe, WHO headquarters and European Centre for Disease Prevention and Control web sites.

(…)

Country comments (where available)

Denmark: one H3N2 were detected in surveillance samples, recieved from other labs in Denmark

Kazakhstan: In week 03/2012, 185 respiratory specimens were collected of which: 0 tested positive for influenza virus, 5 were adenoviruses, 5 parainfluenza-1, 13 parainfluenza-3, 4 respiratory syncytial viruses (RSV)

(…)

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Highly pathogenic avian influenza, Hong Kong (SAR - PRC) (WAHID Interface - OIE World Animal Health Information Database, January 27 2012, edited)

2012-01-27T16:46:00.001+01:00

[Source: OIE, full page: (LINK). Edited.]

Highly pathogenic avian influenza, Hong Kong (SAR - PRC)

Information received on 27/01/2012 from Dr Thomas Sit, Chief Veterinary Officer / Assistant Director (Inspection & Quarantine), Agriculture, Fisheries and Conservation Department, Hong Kong Special Administrative Region Government, Hong Kong , Hong Kong (SAR - PRC)

Summary

Report type Follow-up report No. 5
Start date 17/12/2011
Date of first confirmation of the event 20/12/2011
Report date 27/01/2012
Date submitted to OIE 27/01/2012
Reason for notification Reoccurrence of a listed disease
Date of previous occurrence 13/12/2011
Manifestation of disease Clinical disease
Causal agent Highly pathogenic avian influenza virus
Serotype H5N1
Nature of diagnosis Laboratory (advanced)
This event pertains to the whole country
Related reports

Immediate notification (23/12/2011)
Follow-up report No. 1 (30/12/2011)
Follow-up report No. 2 (06/01/2012)
Follow-up report No. 3 (12/01/2012)
Follow-up report No. 4 (20/01/2012)
Follow-up report No. 5 (27/01/2012)

New outbreaks

Outbreak 1 - 13 milestone, Castle Peak Road, Sham Tsengon, HONG KONG

Date of start of the outbreak 20/01/2012
Outbreak status Resolved (20/01/2012)
Epidemiological unit Not applicable
Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered

Birds - … – 1 – 1 – 0 – 0
Affected Population:

A goose carcass from unknown source was collected on 20 January 2012 at Anglers’ Beach of Sham Tsengon.
The carcass was badly decomposed at the time of collection.

Summary of outbreaks

Total outbreaks: 1
Outbreak statistics: Species - Apparent morbidity rate - Apparent mortality rate - Apparent case fatality rate - Proportion susceptible animals lost*

Birds – ** – ** - 100.00% – **
* Removed from the susceptible population through death, destruction and/or slaughter
** Not calculated because of missing information

Epidemiology

Source of the outbreak(s) or origin of infection

Unknown or inconclusive

Epidemiological comments

An intensive surveillance system is in place for all poultry farms, poultry markets and pet bird shops in Hong Kong.
The H5N1 infected wild birds and goose carcass from unknown source were detected in ongoing surveillance programme on wild birds.
The dates of the outbreaks are the same as the dates the birds were collected (i.e. 17 December 2011, 30 December 2011, 1 January 2012, 12 January 2012 and 20 January 2012 respectively).
A total of 19,451 poultry, including 15,569 chickens, 810 pigeons, 1,950 pheasants and 1,122 silky fowls were culled in the Cheung Sha Wan Temporary Wholesale Poultry Market on 21 December 2011.
The Wholesale Poultry Market was closed. Importation of live poultry and movement of poultry in local farms is banned for 21 days.
Surveillance and monitoring of local chicken farms has been stepped up.
No H5 virus was detected in samples taken from the 30 chicken farms in Hong Kong.
The Wholesale Poultry Market was reopened on 12 January 2012.

Control measures

Measures applied

Stamping out
Quarantine
Movement control inside the country
Screening
Zoning
Disinfection of infected premises/establishment(s)
Dipping / Spraying
No vaccination
No treatment of affected animals

Measures to be applied

No other measures

Diagnostic test results

Laboratory name and type Tai Lung Veterinary Laboratory, Agriculture, Fisheries & Conservation Department (National laboratory)

Tests and results: Species – Test - Test date – Result

Birds - virus isolation - 26/01/2012 – Positive

Laboratory name and type Department of Microbiology, University of Hong Kong (Regional Reference Laboratory)

Tests and results: Species – Test - Test date – Result

Birds - gene sequencing - Pending

Future Reporting

The event is continuing. Weekly follow-up reports will be submitted.

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Low pathogenic avian influenza (poultry), Australia (WAHID Interface - OIE World Animal Health Information Database, January 27 2012, edited)

2012-01-27T16:38:00.001+01:00

[Source: OIE, full page: (LINK). Edited.]

Low pathogenic avian influenza (poultry), Australia

Information received on 27/01/2012 from Dr Mark Andrew Schipp, Chief Veterinary Officer, Ministry of Agriculture, Fisheries and Forestry, Ministry of Agriculture, Fisheries and Forestry, Canberra, Australia

Summary
- Report type Immediate notification
- Start date 25/01/2012
- Date of first confirmation of the event 25/01/2012
- Report date 27/01/2012
- Date submitted to OIE 27/01/2012
- Reason for notification First occurrence of a listed disease
- Manifestation of disease Sub-clinical infection
- Causal agent Low pathogenic avian influenza virus
- Serotype H5
- Nature of diagnosis Laboratory (advanced)
- This event pertains to the whole country
New outbreaks
- Outbreak 1 - Melbourne area, VICTORIA
  - Date of start of the outbreak 25/01/2012
  - Outbreak status Continuing (or date resolved not provided)
  - Epidemiological unit Farm
  - Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
    - Birds – 24500 - … – … – 24500 – 0
    - Affected Population:
      - The epidemiological unit is a duck grower farm and associated breeding facility in the Melbourne area.
      - Low pathogenic notifiable avian influenza subtype H5 was detected during routine surveillance from a healthy flock.
Summary of outbreaks
- Total outbreaks: 1
- Outbreak statistics: Species - Apparent morbidity rate - Apparent mortality rate - Apparent case fatality rate - Proportion susceptible animals lost*
  - Birds – ** – ** – ** – **
  - * Removed from the susceptible population through death, destruction and/or slaughter
  - ** Not calculated because of missing information
Epidemiology
- Source of the outbreak(s) or origin of infection
  - Unknown or inconclusive
Epidemiological comments
- H5 LPAI confirmed by Victorian Department of Primary Industries (DPI) and sequencing at the Australian Animal Health Laboratory.
- N1 has been ruled out on N1-specific PCR.
- Virus isolation and characterisation is being conducted.
- The outbreak was confirmed on the index duck meat grower farm.
- Due to close commercial links with a second duck breeding farm, the second farm has also been designated as infected premises being part of the same epidemiological unit.
- Notes by the OIE Animal Health Information Department:
  - Since this is the first time that LPAI is identified in poultry in the history of the country, the reason for notification as first occurrence applies to the country but the event is in fact circumscribed to a small area as shown on the map.
  - H5 and H7 avian influenza in its low pathogenic form in poultry is a notifiable disease as per Chapter 10.4. on avian influenza of the Terrestrial Animal Health Code (2011).
Control measures
- Measures applied
  - Stamping out
  - Quarantine
  - Movement control inside the country
  - Screening
  - Zoning
  - Disinfection of infected premises/establishment(s)
  - Vaccination prohibited
  - No treatment of affected animals
- Measures to be applied
  - No other measures
Diagnostic test results
- Laboratory name and type DPI Diagnostic Veterinary Laboratory, Attwood (Local laboratory)
  - Tests and results: Species – Test - Test date – Result
    - Birds - polymerase chain reaction (PCR) - 25/01/2012 – Positive
- Laboratory name and type Australian Animal Health Laboratory (OIE’s Reference Laboratory)
  - Tests and results: Species – Test - Test date – Result
    - Birds - polymerase chain reaction (PCR) - 27/01/2012 – Positive
Future Reporting
- The event is continuing. Weekly follow-up reports will be submitted.

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Earthquake M 5.3, northern Italy (USGS, January 27 2012)

2012-01-27T16:11:00.001+01:00

[Source: USGS, full text: (LINK).]

Earthquake M 5.3, northern Italy

‎27 January ‎2012

Friday, January 27, 2012 14:53:13 UTC
Friday, January 27, 2012 03:53:13 PM at epicenter
Depth: 59.80 km (37.16 mi)

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Pseudomonas baby deaths: Health minister Edwin Poots to make statement (Belfasttelegraph.co.uk, January 27 2012)

2012-01-27T09:22:00.001+01:00

[Source: Belfast Telegraph, full text: (LINK).]

Pseudomonas baby deaths: Health minister Edwin Poots to make statement

‎24 January ‎2012
Northern Ireland health minister Edwin Poots is due to make a new statement today on attempts by medical staff to discover the source of a killer infection which has claimed the lives of three babies at the Royal Jubilee Maternity Hospital in Belfast.

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Low Pathogenic Avian Influenza detected in ducks near Melbourne (ABC News, January 27 2012)

2012-01-27T09:03:00.001+01:00

[Source: ABC, full text: (LINK).]

Bird flu detected in ducks near Melbourne

Updated January 27, 2012 18:28:42
More than 10,000 ducks will be destroyed at two farms north of Melbourne after an outbreak of bird flu. Health authorities would not say where the farms are located but maintain the low-strength influenza strain is not a threat to humans.
(…)

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Earthquake M 5.2, Crete, Greece (USGS, January 27 2012)

2012-01-27T09:00:00.001+01:00

[Source: USGS, full text: (LINK).]

Earthquake M 5.2, Crete, Greece

‎27 January ‎2012

Friday, January 27, 2012 01:33:22 UTC
Friday, January 27, 2012 03:33:22 AM at epicenter
Depth: 8.90 km (5.53 mi)

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Low Pathogenic Avian Influenza detected in Victoria Poultry (Sydney Morning Herald, January 27 2012, edited)

2012-01-27T08:34:00.001+01:00

[Source: Sydney Morning Herald, full text: (LINK).]

Low Pathogenic Avian Influenza detected in Victoria Poultry

Steve Lillebuen

January 27, 2012 - 5:24PM

AAP - At least 10,000 ducks will have to be destroyed to contain an outbreak of bird flu at two Victorian farms. The virus found in birds on the two properties is a low pathogenic avian influenza (LPAI) and not the deadlier form of the virus that spread through Asia, threatening humans and leading to a mass cull of poultry.

(…)

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Indonesia, Tangerang man positive for swine flu: Health Ministry (The Jakarta Post, January 27 2012, edited)

2012-01-27T08:31:00.001+01:00

[Source: Jakarta Post, full text: (LINK).]

Tangerang man positive for swine flu: Health Ministry

The Jakarta Post, Jakarta | Fri, 01/27/2012 11:00 AM

The 18-year-old man in Tangerang, who was suspected of being infected with bird flu and who died on Wednesday, tested positive for swine flu, the Health Ministry said. The ministry’s head of research and development, Trihono, told The Jakarta Post on Thursday that the man, known as R, had contracted H1N1, which caused a pandemic in 2009.

(…)

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Novel Orthobunyavirus in Cattle, Europe, 2011 (Emerg Infect Dis., abstract, edited)

2012-01-26T21:36:00.001+01:00

[Source: US Centers for Disease Control and Prevention, Emerging Infectious Diseases Journal, full text: (LINK). Abstract, edited.]

Volume 18, Number 3—March 2012

Dispatch

Novel Orthobunyavirus in Cattle, Europe, 2011

Bernd Hoffmann¹, Matthias Scheuch¹, Dirk Höper, Ralf Jungblut, Mark Holsteg, Horst Schirrmeier, Michael Eschbaumer, Katja V. Goller, Kerstin Wernike, Melina Fischer, Angele Breithaupt, Thomas C. Mettenleiter, and Martin Beer

Author affiliations: Friedrich-Loeffler-Institut, Greifswald–Insel Riems, Germany (B. Hoffmann, M. Scheuch, D. Höper, H. Schirrmeier, M. Eschbaumer, K.V. Goller, K. Wernike, M. Fischer, A. Breithaupt, T.C. Mettenleiter, M. Beer); State Veterinary Diagnostic Laboratory, Arnsberg, Germany (R. Jungblut); Chamber of Agriculture for North Rhine-Westphalia, Bovine Health Service, Bonn, Germany (M. Holsteg)

Abstract

In 2011, an unidentified disease in cattle was reported in Germany and the Netherlands. Clinical signs included fever, decreased milk production, and diarrhea. Metagenomic analysis identified a novel orthobunyavirus, which subsequently was isolated from blood of affected animals. Surveillance was initiated to test malformed newborn animals in the affected region.

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Bangladesh, Another Nipah suspect dies in Joypurhat (bdnews24.com, January 26 2012)

2012-01-26T21:34:00.001+01:00

[Source: BDNews24, full text: (LINK).]

Another Nipah suspect dies in Joypurhat

‎26 January ‎2012
A young man has died in Joypurhat with symptoms of Nipah virus, taking the toll of such deaths in the district to six.

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Nodding Syndrome — South Sudan, 2011 (MMWR Morb Mortal Wkly Rep., January 26 2012, edited)

2012-01-26T18:36:00.001+01:00

[Source: US Centers for Disease Control and Prevention, MMWR Morbidity and Mortality Weekly Report, full PDF document: (LINK). Extract, edited.]

Nodding Syndrome — South Sudan, 2011

In November 2010, the Ministry of Health of the proposed nation of South Sudan requested CDC assistance in investigating a recent increase and geographic clustering of an illness resulting in head nodding and seizures. The outbreak was suspected to be nodding syndrome, an unexplained neurologic condition characterized by episodes of repetitive dropping forward of the head, often accompanied by other seizure-like activity, such as convulsions or staring spells. The condition predominantly affects children aged 5–15 years and has been reported in South Sudan from the states of Western and Central Equatoria (1) and in Northern Uganda and southern Tanzania (2,3). Because of visa and security concerns, CDC investigators did not travel to South Sudan until May 2011. On arrival, a case-control study was conducted that included collecting exposure information and biologic specimens to assess the association of nodding syndrome with suspected risk factors. A total of 38 matched case-control pairs were enrolled from two different communities: Maridi and Witto. Overall, current infection with Onchocerca volvulus diagnosed by skin snip was more prevalent among the 38 case-patients (76.3%) than the controls (47.4%) (matched odds ratio [mOR] = 3.2). This difference was driven by the 25 pairs in Maridi (88.0% among case-patients, 44.0% among controls, mOR=9.3); among the 13 pairs in Witto, no significant association with onchocerciasis (known as river blindness) was observed. Although onchocerciasis was more prevalent among case-patients, whether infection preceded or followed nodding syndrome onset was unknown. Priorities for nodding syndrome investigations include improving surveillance to monitor the number of cases and their geographic distribution and continued work to determine the etiology of the syndrome.

Investigation and Results

As part of the outbreak investigation, a descriptive case series and a case-control study to assess for risk factors were conducted in two locations (Witto village and Maridi town) in the state of Western Equatoria, in South Sudan, where cases of nodding syndrome had been reported. Witto village is a rural setting inhabited by internally displaced persons, and Maridi town has a large, semiurban population. To ascertain whether the clinical syndrome was the same as that observed in other East African countries, a clinical case series study, with complete physical and neurologic examinations, clinical and epidemiologic history, assessments of family history, and relevant laboratory investigations, was conducted. A case of nodding syndrome was defined as onset of repetitive dropping of the head within the preceding 3 years, as reported by a caregiver, in any previously developmentally normal child aged <18 years who had at least one other neurologic or cognitive abnormality or seizure type, based upon investigator observation or caregiver history.

Ten case-patients from the case-control study were included in the case series study by selecting every third case. Additionally, 14 case-patients were enrolled in the case series with the same criteria as the case-control study enrollment except for the age at head nodding onset. To gain an understanding of the natural history and progression of the illness, these 14 children were selected to represent affected children who displayed earlier onset of head nodding and therefore longer duration of illness.

The mean age of patients in the case series was 13.1 years, with 91.7% reporting onset of disease at ages 5–15 years. Clinical findings included reports by caregivers of typical nodding episodes, other seizure-like activity, and apparent cognitive defects, but a relative lack of focal neurologic deficits. In-depth analysis of these clinical features and comparison with other nodding syndrome reports is under way.

To identify possible risk factors, a case-control study compared those who met the case definition to controls matched by age and location. Based on power calculations from previous investigations in Uganda, 38 matched pairs were enrolled in the case-control study from the two separate locations. Case finding was done through community mobilization. Persons with suspected cases of nodding syndrome were then brought to the study site by caregivers, along with potential neighbor controls, and after screening by investigators, the first 38 pairs that fulfilled the case definition were enrolled in the study. Eighteen (47.4%) of the 38 case-patients and 20 (52.6%) of the controls were female. The mean age of the case-patients was 11.1 years (range: 7–16 years), and the mean age of the controls was 10.6 years (range: 6–17 years).

Overall, prevalence of current onchocerciasis as diagnosed by skin snip was found to be significantly greater among case-patients (76.3%) than among controls (47.4%). Onchocerciasis was more prevalent among case-patients for the 25 pairs in Maridi (88.0% among case-patients and 44.0% among controls); among the 13 pairs in Witto, no significant association with onchocerciasis was observed (Table). In preliminary analyses, no association with nodding syndrome was found with other risk factors, including exposure to munitions, parents’ occupations and demographic characteristics. Additional analyses of case-series data and additional exposures related to nutrition are under way.
Results of laboratory testing (e.g., for vitamins A, B6, and B12; Onchocerca antibodies; heavy metals [urine analysis]; and genetic markers) are pending.

Public Health Response

Although the cause of nodding syndrome remains unknown, based on these preliminary findings, reinforcing mass ivermectin treatment for onchocerciasis and conducting seizure management using antiepileptic medications were recommended by CDC to the South Sudan Ministry of Health. Enhancing surveillance to identify new cases as they occur, their location, and the age of patients at onset will enable identification of epidemiologic patterns. Exploring the association of nodding syndrome with onchocerciasis and evaluating the role of malnutrition are important future priorities.

Reported by

Lul Reik, MD, Ministry of Health, Government of South Sudan. Abdinasir Abubakar, MD, South Sudan, World Health Organization, Martin Opoka, MD, Eastern Mediterranean Region, World Health Organization. Godwin Mindra, MD, South Sudan, United Nations Children’s Fund (UNICEF). James Sejvar, MD, Div of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases; Scott F. Dowell, MD, Carlos Navarro-Colorado, MD, Curtis Blanton, MS, Jeffrey Ratto, MPH, Div of Global Disease Detection and Emergency Response, Center for Global Health; Sudhir Bunga, MD, Jennifer Foltz, MD, EIS officers, CDC. Corresponding contributor: Sudhir Bunga, sbunga@cdc.gov, 678-314-1380.

Editorial Note

The clinical presentation, neurologic findings, and patient age distribution of cases, along with other features of the South Sudan nodding syndrome outbreak described in this report are consistent with previous descriptions of the disease from neighboring Uganda. Nodding syndrome might be a new seizure disorder (2). Often accompanied by other seizure-like activity such as convulsions or staring spells, the nodding is reported by some caregivers to be precipitated by food or cold weather. During the episodes, the child stops feeding and appears nonresponsive, with or without loss of consciousness (2). Reports of nodding syndrome from Uganda and Tanzania, in addition to South Sudan, describe progressively worsening head nodding, along with cognitive decline and malnutrition (2,3); however, documented natural history studies are lacking.

A published report on 12 nodding syndrome patients studied with magnetic resonance imaging of the brain found normal results or non-specific changes, and electroencephalography performed on 10 patients between nodding episodes showed abnormal background in six patients and electrographic seizures in two patients (2). No child is known to have recovered from nodding syndrome, and the long-term outcomes of illness are not known. Reports from caregivers indicate that affected children sometimes suffer serious injuries or death resulting from falls during seizure episodes.

An illness descriptively similar to nodding syndrome has been reported from Tanzania for decades; however, nodding syndrome has only recently been reported from South Sudan and Uganda in geographically localized areas (1,2,4). This temporal and geographic clustering of an unusual and unexplained syndrome, consistent with epilepsy but with a stereotypic presentation, has drawn attention of international public health agencies (5,6). CDC is assisting the South Sudan Ministry of Health with its ongoing investigations.

Several etiologic factors have been proposed, including infectious, nutritional, environmental, and psychogenic causes. Specific exposures evaluated in previous studies include munitions, measles, monkey meat, relief seeds, or relief food (e.g., lentils and sorghum). However, despite previous investigations, the cause of the syndrome and the pathophysiology remain unknown (1,2,4). Previous studies also have found an association with onchocerciasis, but the causal pathophysiologic mechanism by which infection with the nematode O. volvulus might lead to neurologic illness is not clear, and some have concluded that the association is spurious (1,2,4). Additionally, onchocerciasis has been endemic in large parts of West and Central Africa, as well as parts of Central and South America; however, nodding syndrome has only been reported in three small localized regions.

A series of investigations by the World Health Organization and South Sudan Ministry of Health in 2001, 2002, and 2010 in Western Equatoria could not identify the cause for nodding syndrome (1,4,7,8). Nodding syndrome in South Sudan appears to be the same clinical entity as described previously in other parts of East Africa, but the etiology remains unknown. Further collaborative investigations into nodding syndrome are needed to identify the cause, preventive measures, and treatments.

What is already known on this topic?

Nodding syndrome is an unexplained disorder characterized by stereotypic head nodding that affects primarily children aged 5–15 years. The condition has been reported from Tanzania and Uganda, but its cause and natural history are unclear.

What is added by this report?

Two clusters of nodding syndrome cases reported in South Sudan in 2010 were investigated. Multiple features of the disease (e.g., clinical presentation, neurologic findings, and patient age distribution) are consistent with those investigated previously in Uganda. As noted in previous cases, a positive association was observed between onchocerciasis and nodding syndrome, but whether the relationship is causative remains unknown.

What are the implications for public health practice?

Collaboration among investigators in South Sudan and other countries where nodding syndrome has been reported will be important for future investigations in identifying the cause of this debilitating condition.

Acknowledgments

Robert Breiman, Eric Gogstad, John Neatherlin, CDC Kenya; Christi Murray, CDC South Sudan; Michael Leju, US Agency for International Development (USAID) South Sudan; Kenya Medical Research Institute; Romanos Mkerenga, United Nations Children’s Fund (UNICEF) South Sudan.

References

1. Nyungura JL, Akim T, Lako A, Gordon A, Lejeng L, William G. Investigation into nodding syndrome in Witto Payam, Western Equatoria State, 2010. Southern Sudan Medical Journal 2010;4:3–6.
2. Winkler AS, Friedrich K, Konig R, et al. The head nodding syndrome—clinical classification and possible causes. Epilepsia 2008;49:2008–15.
3. Winkler AS, Friedrich K, Meindl M, et al. Clinical characteristics of people with head nodding in southern Tanzania. Trop Doct 2010;40:173–5.
4. Lacey M. Nodding disease: mystery of southern Sudan. Lancet Neurol 2003;2:714.
5. CDC. CDC responds to nodding disease in Uganda [Video]. Available at http://www.cdc.gov/globalhealth/video/nodding/nodding.htm. Accessed January 20, 2012.
6. Wadman M. African outbreak stumps experts. Nature 2011;475:148–9.
7. Kaiser C. Head nodding syndrome and river blindness: a parasitologic perspective [Letter]. Epilepsia 2009;50:2325.
8. Ministry of Health, Government of Southern Sudan. Nodding disease/syndrome. In: Neglected tropical disease in Southern Sudan. Ministry of Health, Government of Southern Sudan; 2008:45.

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Outbreak of haemolytic uraemic syndrome due to Shiga toxin-producing Escherichia coli O104:H4 among French tourists returning from Turkey, September 2011 (Euro Surveill., abstract, edited)

2012-01-26T18:16:00.001+01:00

[Source: Eurosurveillance, full text: (LINK). Abstract, edited.]

Eurosurveillance, Volume 17, Issue 4, 26 January 2012
Rapid communications
Outbreak of haemolytic uraemic syndrome due to Shiga toxin-producing Escherichia coli O104:H4 among French tourists returning from Turkey, September 2011
N Jourdan-da Silva¹, M Watrin², F X Weill³, L A King ()¹, M Gouali³, A Mailles¹, D van Cauteren¹, M Bataille⁴, S Guettier⁴, C Castrale⁵, P Henry⁵, P Mariani⁶, V Vaillant¹, H de Valk¹

French Institute for Public Health Surveillance (Institut de veille sanitaire), St Maurice, France
Regional Office of the French Institute for Public Health Surveillance, Caen, France
Institut Pasteur, National Reference Centre for Escherichia coli and Shigella, Paris, France
University Hospital of Caen, Neurology department, Caen, France
University Hospital of Caen, Nephrology department, Caen, France
Laboratory associated to the National Reference Centre for Escherichia coli and Shigella, Robert Debré Hospital, Paris, France

Citation style for this article: Jourdan-da Silva N, Watrin M, Weill FX, King LA, Gouali M, Mailles A, van Cauteren D, Bataille M, Guettier S, Castrale C, Henry P, Mariani P, Vaillant V, de Valk H. Outbreak of haemolytic uraemic syndrome due to Shiga toxin-producing Escherichia coli O104:H4 among French tourists returning from Turkey, September 2011. Euro Surveill. 2012;17(4):pii=20065. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20065
Date of submission: 06 January 2012

Eight cases of diarrhoea, including two cases of haemolytic uraemic syndrome (HUS), were identified among 22 French tourists who travelled to Turkey in September 2011. A strain of Escherichia coli O104:H4 stx2-positive, eae-negative, hlyA-negative, aggR-positive, ESBL-negative was isolated from one HUS case. Molecular analyses show this strain to be genetically similar but not indistinguishable from the E. coli O104:H4 2011 outbreak strain of France and Germany. Although the source of infection was not identified, we conclude that the HUS cases had probably been infected in Turkey.

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Two invasive mosquito species, Aedes albopictus and Aedes japonicus japonicus, trapped in south-west Germany, July to August 2011 (Euro Surveill., abstract, edited)

2012-01-26T18:13:00.001+01:00

[Source: Eurosurveillance, full text: (LINK). Abstract, edited.]

Eurosurveillance, Volume 17, Issue 4, 26 January 2012
Rapid communications
Two invasive mosquito species, Aedes albopictus and Aedes japonicus japonicus, trapped in south-west Germany, July to August 2011
D Werner ()¹, M Kronefeld², F Schaffner³, H Kampen²

Leibniz-Centre for Agricultural Landscape Research, Müncheberg, Germany
Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald – Insel Riems, Germany
Institute of Parasitology, University of Zurich, Zurich, Switzerland

Citation style for this article: Werner D, Kronefeld M, Schaffner F, Kampen H. Two invasive mosquito species, Aedes albopictus and Aedes japonicus japonicus, trapped in south-west Germany, July to August 2011 . Euro Surveill. 2012;17(4):pii=20067. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20067
Date of submission: 23 January 2012

Adult females of two invasive species, Aedes albopictus and Aedes japonicus japonicus, were collected for the first time in July and August 2011 in Germany. Previously, only immature stages of these species had been found in the country. Repeated detection of these species reveals the Upper Rhine Valley in south-west Germany to be a particularly sensitive region for the introduction and establishment of exotic mosquito species that needs careful observation.

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