Report: NRC Review of FBI Investigation into Anthrax Case 2001

ROFLAO - Tests Inconclusive - Not Enough Evidence
Article should be titled: "Ft. Detrick Cover-Up" It Wouldnt Be The First Time;
http://www.rense.com/general76/ft.htm


ANTHRAX, HUMAN, 2001 - USA: NATIONAL RESEARCH COUNCIL REPORT
************************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Tue 15 Feb 2011
Source: National Research Council (NRC) of the National Academies,
The National Academies Press [edited]



[Copies may be purchased from that site. There is also the recording
there of the 65-minute 15 Feb 2011 press meeting. - Mod.MHJ]

Review of the scientific approaches used during the FBI's [Federal
Bureau of Investigation] investigation of the 2001 anthrax letters
--------------------------------------------------------
Summary of Committee findings
-----------------------------
Major finding: it is not possible to reach a definitive conclusion
about the origins of the _Bacillus anthracis_ in the mailings based on
the available scientific evidence alone.

S.1: The _B. anthracis_ in the letters was the Ames strain and was
not genetically engineered.

S.2: Multiple distinct colony morphological types, or morphotypes, of
_B. anthracis_ Ames were present in the letters. Molecular assays of
specific genetic sequences associated with these morphotypes provided
an approach to determining relationships among evidentiary samples.

S.3: The FBI created a repository of Ames strain _B. anthracis_
samples and performed experiments to determine relationships among the
letter materials and the repository samples. The scientific link
between the letter material and flask number RMR-1029 is not as
conclusive as stated in the DOJ [Department of Justice] Investigative
Summary.

S.4: Silicon was present in the letter powders but there was no
evidence of intentional addition of silicon-based dispersants.

S.5: It is difficult to draw conclusions about the amount of time
needed to prepare the spore material or the skill set required of the
perpetrator.

S.6: Physicochemical and radiological experiments were properly
conducted to evaluate the samples for potential signatures connecting
them to a source but proved to be of limited forensic value.

S.7: There was inconsistent evidence of _B. anthracis_ Ames DNA in
environmental samples that were collected from an overseas site.
(Finding 3.4)

S.8: There are other tools, methods, and approaches available today
for a scientific investigation like this one.

S.9: Organizational structure and oversight are critical aspects of a
scientific investigation. The FBI generated an organizational
structure to accommodate the complexity of this case and received the
advice of prominent experts.

S.10: A review should be conducted of the classified materials that
are relevant to the FBI's investigation of the 2001 _B. anthracis_
mailings, including all of the data and material pertaining to the
overseas environmental sample collections. (Recommendation 3.1)

S.11: The goals of forensic science and realistic expectations and
limitations regarding its use in the investigation of a biological
attack must be communicated to the public and policymakers with as
much clarity and detail as possible before, during, and after the
investigation. (Recommendation 3.2)

Findings and recommendations
----------------------------
Finding 3.1: Over the course of the investigation, the FBI found and
engaged highly qualified experts in some areas. It benefited from the
unprecedented guidance of a high level group of agency directors and
leading scientists. The members of this group had top secret national
security clearances, met regularly over several years in a secure
facility, and dealt with classified materials. The NRC committee
authoring this report, in keeping with a commitment to make this
report available to the public, did not see these materials.

Finding 3.2: A clear organizational structure and process to oversee
the entire scientific investigation was not in place in 2001. In 2003,
the FBI created a new organizational unit (the Chemical, Biological,
Radiological, and Nuclear [CBRN] Sciences Unit, sometimes referred to
as the Chemical Biological Science Unit, or CBSU) devoted to the
investigation of chemical, biological, radiological, and nuclear
attacks. The formation of this new unit with clearer lines of
authority is commendable.

Finding 3.3: Investigators used reasonable approaches in the early
phase of the investigation to collect clinical and environmental
samples and to apply traditional microbiological methods to their
analyses. Yet during subsequent years, the investigators did not fully
exploit molecular methods to identify and characterize _B. anthracis_
directly in crime scene environmental samples (without cultivation).
Molecular methods offer greater sensitivity and breadth of microbial
detection and more precise identification of microbial species and
strains than do culture-based methods.

Finding 3.4: There was inconsistent evidence of _B. anthracis_ Ames
DNA in environmental samples that were collected from an overseas
site.

Finding 3.5: As was done in the anthrax investigation, at the outset
of any future investigation the responsible agencies will be aided by
a scientific plan and decision tree that takes into account the
breadth of available physical and chemical analytical methods. The
plan will also need to allow for possible modification of existing
methods and for the development and validation of new methods (see
Chapter 4, Section 12).

***Recommendation 3.1: A review should be conducted of the classified
materials that are relevant to the FBI's investigation of the 2001 _B.
anthracis_ mailings, including all of the data and material pertaining
to the overseas environmental sample collections.

***Recommendation 3.2: The goals of forensic science and realistic
expectations and limitations regarding its use in the investigation of
a biological attack must be communicated to the public and
policymakers with as much clarity and detail as possible before,
during, and after the investigation.

Finding 4.1: The committee finds no scientific basis on which to
accurately estimate the amount of time or the specific skill set
needed to prepare the spore material contained in the letters. The
time might vary from as little as 2 to 3 days to as much as several
months. Given uncertainty about the methods used for preparation of
the spore material, the committee could reach no significant
conclusions regarding the skill set of the perpetrator.

Finding 4.2: The physicochemical methods used primarily by outside
contractors early in the investigation were conducted properly.

Finding 4.3: Although significant amounts of silicon were found in
the powders from the New York Post, Daschle, and Leahy letters, no
silicon was detected on the outside surface of spores where a
dispersant would reside. Instead, significant amounts of silicon were
detected within the spore coats of some samples. The bulk silicon
content in the Leahy letter matched the silicon content per spore
measured by different techniques. For the New York Post letter,
however, there was a substantial difference between the amount of
silicon measured in bulk and that measured in individual spores. No
compelling explanation for this difference was provided to the
committee.

Finding 4.4: Surrogate preparations of _B. anthracis_ did reproduce
physical characteristics (purity, spore concentration, dispersibility)
of the letter samples, but did not reproduce the large amount of
silicon found in the coats of letter sample spores. [The committee
appears to have ignored how these significantly high levels of silicon
within the spore coat were achieved ... usually ascribed to the use of
silanes ... and thus where such a technical skill could be found. -
Mod.MHJ]

Finding 4.5: Radiocarbon dating of the Leahy letter material
indicates that it was produced after 1998.

Finding 4.6: The flask designated RMR-1029 was not the immediate,
most proximate source of the letter material. If the letter material
did in fact derive from RMR-1029, then one or more separate growth
steps, using seed material from RMR-1029 followed by purification,
would have been necessary. Furthermore, the evidentiary material in
the New York letters had physical properties that were distinct from
those of the material in the Washington, DC letters.

(Specifically) SEM-EDX measurements showed no silicon in the coats of
spores taken directly from RMR-1029, whereas the majority of spores
analyzed from the New York Post, Daschle, and Leahy letter materials
contained silicon in the coat. Based on recent studies of the
mechanism of silicon incorporation, silicon could have been
incorporated in the coats of the letter spores only if spores from
RMR-1029 were subjected to one or more subsequent growth steps.
Another observation consistent with a separate growth step was the
detection of _B. subtilis_ in the New York Post and Brokaw letter
material but not in RMR-1029 (discussed in Chapter 5). The detection
of meglumine and diatrizoate in RMR-1029 but not in the Leahy and New
York Post samples also is consistent with this finding; however, it is
not conclusive because it might have been possible to rinse these
impurities away without requiring later growth. Some of these
findings, as well as others, indicate that the New York letter
materials were prepared separately from the materials in the
Washington, DC, letters. The presence of _B. subtilis_ in the New York
but not the Washington letter materials and the different physical
properties of the materials indicate that the 2 sets of letter
materials were prepared separately.

Finding 5.1: The dominant organism found in the letters was correctly
and efficiently identified as the Ames strain of _B. anthracis_. The
science performed on behalf of the FBI for the purpose of _Bacillus_
species and _B. anthracis_ strain identification was appropriate,
properly executed, and reflected the contemporary state of the art.

Finding 5.2: The initial assessment of whether the _B. anthracis_
Ames strain in the letters had undergone deliberate genetic
engineering or modification was timely and appropriate, though
necessarily incomplete. The genome sequences of the letter isolates
that became available later in the investigation strongly supported
the FBI's conclusion that the attack materials had not been
genetically engineered.

Finding 5.3: A distinct _Bacillus_ species, _B. subtilis_, was a
minor constituent of the New York Post and Brokaw (New York) letters,
and the strain found in these 2 letters was probably the same. _B.
subtilis_ was not present in the Daschle and Leahy letters. The FBI
investigated this constituent of the New York letters and concluded,
and the committee concurs, that the _B. subtilis_ contaminant did not
provide useful forensic information. While this contaminant did not
provide useful forensic information in this case, the committee
recognizes that such biological contaminants could prove to be of
forensic value in future cases and should be investigated to their
fullest. [The FBI downplayed their failure to identify a possible
source for this contaminant, a species frequently used as a stimulant
and therefore a potential institutional fingerprint as to where one
set of spores were cultured. - Mod.MHJ]

Finding 5.4: Multiple colony morphotypes of _B. anthracis_ Ames were
present in the material in each of the 3 letters that were examined
(New York Post, Leahy, and Daschle), and each of the phenotypic
morphotypes was found to represent one or more distinct genotypes.

Finding 5.5: Specific molecular assays were developed for some of the
_B. anthracis_ Ames genotypes (those designated A1, A3, D, and E)
found in the letters. These assays provided a useful approach for
assessing possible relationships among the populations of _B.
anthracis_ spores in the letters and in samples that were subsequently
collected for the FBI Repository (see also Chapter 6). However, more
could have been done to determine the performance characteristics of
these assays. In addition, the assays did not measure the relative
abundance of the variant morphotype mutations, which might have been
valuable and could be important in future investigations.

Finding 5.6: The development and validation of the variant morphotype
mutation assays took a long time and slowed the investigation. The
committee recognizes that the genomic science used to analyze the
forensic markers identified in the colony morphotypes was a
large-scale endeavor and required the application of emerging science
and technology. Although the committee lauds and supports the effort
dedicated to the development of well-validated assays and procedures,
looking toward the future, these processes need to be more efficient.

Finding 6.1: The FBI appropriately decided to establish a repository
of samples of the Ames strain of _B. anthracis_ then held in various
laboratories around the world. The repository samples would be
compared with the material found in the letters to determine whether
they might be the source of the letter materials. However, for a
variety of reasons, the repository was not optimal. For example, the
instructions provided in the subpoena issued to laboratories for
preparing samples (that is, the "subpoena protocol") were not precise
enough to ensure that the laboratories would follow a consistent
procedure for producing samples that would be most suitable for later
comparisons. Such problems with the repository required additional
investigation and limit the strength of the conclusions that can be
drawn from comparisons of these samples and the letter material.

Finding 6.2: The results of the genetic analyses of the repository
samples were consistent with the finding that the spores in the attack
letters were derived from RMR-1029, but the analyses did not
definitively demonstrate such a relationship.

Finding 6.3: Some of the mutations identified in the spores of the
attack letters and detected in RMR-1029 might have arisen by parallel
evolution rather than by derivation from RMR-1029. This possible
explanation of genetic similarity between spores in the letters and in
RMR-1029 was not rigorously explored during the course of the
investigation, further complicating the interpretation of the apparent
association between the _B. anthracis_ genotypes discovered in the
attack letters and those found in RMR-1029.

Finding 6.4: The genetic evidence that a disputed sample submitted by
the suspect came from a source other than RMR-1029 was weaker than
stated in the Department of Justice, Amerithrax Investigative
Summary.

Finding 6.5: The scientific data generated by and on behalf of the
FBI provided leads as to a possible source of the anthrax spores found
in the attack letters, but these data alone did not rule out other
sources.

Finding 6.6: Point mutations should have been used in the screening
of evidentiary samples.

Finding 6.7: Biological material from all 4 letters should have been
examined to determine whether they each contained all 4 genetic
markers used in screening the repository samples.

Finding 6.8: New scientific tools, methods, and insight relevant to
this investigation became available during its later years. An
important example is high-throughput "next-generation" DNA sequencing.
The application of these tools, methods, and insight might clarify
(strengthen or weaken) the inference of an association between
RMR-1029 and the spores in the attack letters. Such approaches will be
important for use in future cases.

Finding 6.9: The FBI faced a difficult challenge in assembling and
annotating the repository of _B. anthracis_ Ames samples collected for
genetic analysis.

Finding 6.10: The evidentiary material from this case is, and will
be, immensely valuable, especially in the event of future work on
either this case or other cases involving biological terrorism or
warfare. It is critically important to continue to preserve all
remaining evidentiary material and samples collected during the course
of this (the anthrax letters investigation) and future investigations,
including the overseas environmental samples, for possible additional
studies.

--
Communicated by:
ProMED-mail


[In a word, the scientific evidence at this time does not validate
the FBI conclusions based on their circumstantial evidence and in fact
casts a wider net. For additional comments see
,
,
,
and
.
- Mod.MHJ]

[see also:
2010
----
Anthrax, human, 2001 - USA (06) 20100921.3407
Anthrax, human, 2001 - USA (05) 20100424.1326
Anthrax, human, 2001 - USA (04) 20100324.0933
Anthrax, human, 2001 - USA (03) 20100305.0727
Anthrax, human, 2001 - USA (02): FBI case closed 20100219.0575
Anthrax, human, 2001 - USA 20100125.0281
Anthrax, human, 2001 - USA (03): NAS review 20090507.1707
and 26 additional postings]
.................................................mhj/mj/jw
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Q Fever Epidemic in Netherlands Continues to Grow: More Humans Infected Than Ever

Q FEVER - NETHERLANDS: HUMAN, ANIMAL
************************************
Be sure to page all the way down to see bold text in red

------------------------------------
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

[1]
Date: Sat 12 Feb 2011
Source: Examiner.com [edited]


The outbreak that started in 2007 continues into its 5th year in the
Netherlands. As of 2 Feb 2011, there were 8 more confirmed cases so
far in 2011.

Since 2007, there have been more than 4000 cases and several deaths,
including 11 deaths in 2010.

Though the cases have been seen throughout the country, the US
Centers for Disease Control and Prevention (CDC) notes that most of
these cases have been in Noord (North) Brabant, Gelderland, Limburg,
and Utrecht Provinces in the southern part of the country. The CDC
offers the following prevention recommendations for US travelers to
the Netherlands:
- Avoid farms in the affected areas.
- If you cannot avoid visiting farms, avoid going near areas where
animals are kept, such as barns and pens, and avoid direct contact
with animals.
- Breathing in soil and dust contaminated by animals can make you
sick.
- Eat only milk and dairy products that have been pasteurized. Do not
drink raw milk or eat raw milk products.
- Wash your hands often with soap and water, especially if you have
been near animals. If soap and water are not available, use an
alcohol-based hand gel with at least 60 percent alcohol.
- Pay attention to your health after your trip. People can become
sick with Q fever 2-5 weeks after being exposed to the disease. If you
feel sick, go to the doctor and tell him or her that you have traveled
to The Netherlands.

Q fever is caused by the obligate intracellular pathogen, _Coxiella
burnetii_. The disease is usually transmitted to people through either
infected milk or through aerosols. This disease is found on most
continents with the reported incidence probably much lower than the
actual because so many cases are so mild. Animal reservoirs of _C.
burnetii_ include sheep, cattle, goats, dogs and cats. In areas where
these animals are present, Q fever affects veterinarians, meatpacking
workers and farmers. Q fever is also considered a potential agent of
bioterrorism.

The symptoms of Q fever according to the CDC are an unexplained
febrile illness, sometimes accompanied by pneumonia and/or hepatitis,
the most common clinical presentation. Illness onset typically occurs
within 2-5 weeks after exposure. The mortality rate for acute Q fever
is low (1-2 percent), and the majority of persons with mild illness
recover spontaneously within a few weeks, although antibiotic
treatment will shorten the duration of illness and lessen the risk of
complications. Chronic Q fever is uncommon (less than one percent of
acutely infected patients) but may cause life-threatening heart valve
disease (endocarditis).

[Byline: Robert Herriman]

--
Communicated by:
ProMED-mail

******
[2]
Date: Sun 6 Feb 2011
Source: IMED 2011, Vienna, Austria, 4-7 Feb 2011. Session 17 "Q Fever
in the Netherlands," abstract 17.001 [edited]


Q fever in the Netherlands: The animal health aspects. By Christianne
Bruschke, CVO, Ministry of Economic Affairs, Agriculture and
Innovation, The Hague, Netherlands

Up to 2007, some 20 people became infected yearly with Q fever, a
zoonotic disease. Suddenly in 2007, 170 people fell ill, and in 2008
there were 1000 cases. In 2009, there were more than 2300 known cases
of people becoming infected. Experts believed that there was a
relationship between Q fever abortions on milking goat and milking
sheep farms and the sharp increase in the numbers of human
infections.

In the Netherlands, several measures were taken between June 2008 and
December 2009 to control Q-fever in animals. Measures were directed in
particular at the dairy goat and sheep sector, but measures were also
taken for small ruminants that come into close contact with the
general public. Q fever in sheep and goats was made notifiable in June
2008. Hygiene measures, transport restrictions and restrictions for
visitors were implemented. Vaccination with a non-licensed vaccine was
performed in a restricted area in 2008 (voluntary) and 2009
(compulsory).

In October 2009, monitoring based on bulk milk PCR was started to
detect infected farms. Knowing that the vaccine was not fully
efficacious in infected or pregnant animals, and having the
possibility to detect infected farms at the end of 2009, the
responsible ministers took the following decisions:
1. cull all pregnant animals on infected farms
2. a nationwide breeding ban for dairy sheep and goats
3. a compulsory vaccination program for the whole country in 2010.

With these very drastic measures, further contamination of the
environment during the lambing season would be prevented. Breeding
would be only allowed thereafter with animals coming from non-infected
vaccinated farms.

In 2010, the number of human patients with Q-fever was 382. As of
now, the focus of the measures is to prevent another outbreak, with
yearly vaccination of the dairy goat and sheep population.

[Byline: C. Bruschke]

--
Communicated by:
ProMED-mail

******
[3]
Date: Sun 6 Feb 2011
Source: IMED 2011, Vienna, Austria, 4-7 Feb 2011. Session 17 "Q Fever
in the Netherlands," abstract 17.002 [edited]


Q fever in the Netherlands: The public health aspects. By J. Van
Steenbergen, W. V. D. Hoek, D. Notermans, C. Wijkmans & T. Oomen.

Background: From 2007 through 2009, The Netherlands faced a series of
multiple Q fever outbreaks in the southern part of the country. Q
fever was specifically seen in the vicinity of dairy goat farms where
abortion waves due to _Coxiella burnetii_ occurred.

Methods and Materials: Seroprevalence of antibodies against _Coxiella
burnetii_ was tested in 2006 in a random sample of the population
(ELISA phase I and II). Hospital discharge data were used in
retrospect to find previously undetected clusters in time and space.
Incidence of acute Q fever was calculated using notification data.
Smoothing incidence lines were calculated using 6 digit area codes. A
case control study was performed in 2007. A sample of blood donors
originating from the areas with highest incidence was tested twice in
2009 with IFA. A sample of sera from the pregnancy screening (e.g.
HBsAg, lues) was tested for antibodies against _Coxiella burnetii_.

Results: In 2006, the seroprevalence of antibodies against _Coxiella
burnetii_ in The Netherlands was low (less than 2.7 percent). Before
2007, small clusters of lower respiratory tract infections went
undetected. Incidence of Q fever increased from 192 in 2007, to 1000
in 2008 and over 2300 in 2009. Risk for acute Q fever was increased
for males in age group 45-55 yrs and living in proximity of infected
goat farms, not living near infected sheep farms. In areas where blood
donor infection rate could be ascertained, only an estimated 12
percent of infections are leading to microbiologically confirmed
disease. Preliminary data show no serious adverse events of infection
during pregnancy on pregnancy outcome.

Conclusion: The total number of reported acute Q fever cases
approaches 4000. Living near infected dairy goat farms was the major
risk factor. The number of chronic infections with serious
complications remains unknown.

[Byline: J. Van Steenbergen, W. V. D. Hoek, D. Notermans, C. Wijkmans
& T. Oomen]

--
Communicated by:
ProMED-mail

******
[4]
Date: Sun 6 Feb 2011
Source: IMED 2011, Vienna, Austria, 4 - 7 Feb 2011. Session 17 "Q
Fever in the Netherlands," abstract 17.003 [edited]


Q fever in the Netherlands: _Coxiella burnetii_, laboratory aspects.
By: H.-J. Roest, Central Veterinary Institute of Wageningen, Lelystad,
Netherlands

Background: _Coxiella burnetii_ is a Gram-negative intracellular
bacterium, which belongs to the family of the Coxiellaceae and the
order of the Legionellales. Two phases of the bacterium can be
distinguished: phase I, associated with full length lipopolysaccharide
(LPS) and phase II, associated with truncated LPS. In the life cycle
of _C. burnetii_, 2 stages can be distinguished. The Large Cell
Variant (LCV), which is able to multiply, and the Small Cell Variant
(SCV), the spore-like form in which _C. burnetii_ is resistant to
outside influences.

Methods and Materials: Genotyping was performed by MLVA [Multiple
Loci Variable Number of Tandem Repeats Analysis].

Results: The link between dairy goats as the source of human Q fever
cases in the Netherlands has been made on the basis of epidemiological
evidence. Genotyping of _C. burnetii_ is a tool to further investigate
the connection between source and host. Using MLVA, the connection
between sheep and humans in a small Q fever outbreak in the
Netherlands could be made. MLVA was also used to type a considerable
number of goat samples from goats that were considered to be the
source of the Q fever outbreak in the Netherlands. Results show that
one MLVA type is predominantly present on all dairy goat farms in the
epidemic area in the south of the Netherlands.

_C. burnetii_ contaminated goat manure is considered to be a major
factor in the transmission to humans. Little is known about the
temperature build-up in goat manure piles and the influence of the
composting process on _C. burnetii_. In a joint effort of national
research institutes, temperatures and numbers of _C. burnetii_ in goat
manure and the decimal reduction time of _C. burnetii_ under these
conditions were assessed. Results of this study [have been
presented].

Conclusion: Results on genotyping show that one MLVA type is
predominantly present on all dairy goat farms in the epidemic area in
the south of the Netherlands. This MLVA type should also be found in
infected humans. Research on this in ongoing. Conclusions on the
results of the survival of _C. burnetii_ [have been] given during the
presentation.

[Byline: H.J. Roest]

--
Communicated by:
ProMED-mail

[The IMED 2011 International Meeting on Emerging Diseases and
Surveillance, held in Vienna, Austria, 4-7 Feb 2011, was organized by
the International Society for Infectious Diseases. It was co-sponsored
by ProMED-mail, EcoHealth Alliance, European Centre for Disease
Prevention and Control (ECDC), European Commission (EC), European
Society of Clinical Microbiology and Infectious Diseases (ESCMID),
HealthMap, Wildlife Conservation Society (WCS) and the World
Organisation for Animal Health (OIE).

Though the exceptionally high number of human infections in the
affected Dutch districts during 2008-2009, was mainly attributed to
the development of dairy-goat mega-farms during recent years, the
possibility that this epizootic was caused by a strain of the
bacterium with particular characteristics deserves attention. Final
results are anticipated with great interest. - Mod.AS]

[see also:
2010
----
Q fever - Netherlands (31): (NB) investigation report 20100930.3546
Q fever - Netherlands (30): peaked, mitigation measures
20100727.2513
Q fever - Netherlands (29): update 20100716.2382
Q fever - Netherlands (27): risk assessment, Europe 20100525.1742
Q fever - Netherlands (26): update, EFSA 20100512.1544]
.................................................sb/arn/msp/jw
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damages incurred as a result of use or reliance upon posted
or archived material.
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New Species of Mosquito Found / W. Africa

Think GE; http://www.trendhunter.com/trends/genetically-modified-mosquitoes

More info on Anopheles; http://www.tinymosquito.com/anopheles.html

MALARIA, NEW ANOPHELES MOSQUITO - WEST AFRICA
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A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Tue 3 Feb 2011
Source: BBC News [edited]



New mosquito type raises concern
--------------------------------
Scientists have identified a new type of mosquito. It is a subgroup
of _Anopheles gambiae_, the insect species responsible for most of the
malaria transmission in Africa. Researchers tell Science magazine that
this new mosquito appears to be very susceptible to the parasite that
causes the disease -- which raises concern. The type may have evaded
classification until now because it rests away from human dwellings
where most scientific collections tend to be made.

Dr Michelle Riehle, from the Pasteur Institute in Paris, France, and
colleagues made their discovery in Burkina Faso, where they gathered
mosquitoes from ponds and puddles near villages over a period of 4
years. When they examined these insects in the lab, they found many to
be genetically distinct from any _A. gambiae_ insects previously
recorded.

The team grew generations of the unique subtype in the lab to assess
their susceptibility to the malaria parasite and this revealed them to
be especially vulnerable, more so than indoor-resting insect types.

But Pasteur team-member Dr Ken Vernick cautioned that these
mosquitoes' significance for malaria transmission had yet to be
established. "We are in a zone where we need to do some footwork in
the field to identify a means to capture the wild adults of the
outdoor-resting sub-group," he told BBC News. "Then we can test them
and measure their level of infection with malaria, and then we can put
a number on how much -- if any -- of the actual malaria transmission
this outdoor-resting subgroup is responsible for."

The researchers report that the new subgroup could be quite a recent
development in mosquito evolution and urge further investigation to
understand better the consequences for malaria control.

They also emphasise the need for more diverse collection strategies.
The subtype is likely to have been missed, they say, because of the
widespread practice of collecting mosquitoes for study inside houses.
In one sense this has made sense -- after biting, mosquitoes need to
rest up and if they do this inside dwellings, the confined area will
make them an easier target for trapping. However, the method is also
likely to introduce a bias into the populations under study.

Commenting on the study, Dr Gareth Lycett, a malaria researcher from
the Liverpool School of Tropical Medicine in the UK, said it was an
interesting advance that might have important implications for
tackling malaria. Larvae are collected from pools of water for study.


"To control malaria in an area you need to know what mosquitoes are
passing on the disease in that district, and to do that you need
sampling methods that record all significant disease vectors," Lycett
told BBC News. "You need to determine what they feed on, when and
where, and whether they are infectious. And where non-house-resting
mosquitoes are contributing to disease transmission, devise effective
control methods that will complement bed-net usage and house spraying.
A recent 12M euro [16M USD] multinational project (AvecNET), funded by
the European Union, and led by the Liverpool School of Tropical
Medicine has the specific aims of doing just this."

According to the World Health Organization (WHO), there are more than
200 million cases of malaria worldwide each year, resulting in
hundreds of thousands of deaths, most of them in Africa.

Malaria is caused by plasmodium parasites. The parasites are spread
to people through the bites of infected female anopheles mosquitoes.

[byline: Jonathan Amos,science correspondent, BBC News]

--
communicated by:
ProMED-mail


[This news report refers to a paper published on 4 Feb 2011 in
Science (Riehle MM, et al. A cryptic subgroup of _Anopheles gambiae_
is highly susceptible to human malaria parasites. Science.
2011;331:596-8). The study was performed in Burkina Faso, West Africa,
and shows that sampling mosquitoes by collecting of indoor resting
mosquitoes alone fails to estimate the contribution to malaria
transmission by outdoor resting mosquitoes. This is important, as
pointed out in the study, because previous malaria control strategies
using indoor residual spraying with insecticides will not kill outdoor
resting mosquitoes.

By sampling mosquito larvae the study succeeded in identifying a new
subgroup of _Anopheles gambiae_ mosquitoes, which was found to be a
highly effective vector of _Plasmodium falciparum_. The study also
helps to explain why malaria control using impregnated bed nets are
effective where indoor residual spraying has failed in this part of
the world.

A map of the study area is found in the supplementary material to the
paper in Science. - Mod.EP

The interactive HealthMap/ProMED map for Burkina Faso, West Africa,
is available at - CopyEd.EJP]

[see also:
2009
---
Malaria - Nigeria, insecticide resistance 20091210.4210
2006
---
Malaria - South Africa: DDT 20060617.1686
2002
---
Malaria: malaria and mosquito genomes decoded 20021003.5450
2001
---
DDT & malaria control - South Africa 20010103.0019]
.................................................ep/ejp/sh
*##########################################################*
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information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
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FMD / N. Korea Now

FOOT & MOUTH DISEASE - NORTH KOREA (03): SEROTYPE O, BOVINE, PORCINE
********************************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


[1]
Date: Fri 11 Feb 2011
Source: Wireupdate.com, BNO News report [edited]



North Korea confirms large-scale foot-and-mouth disease outbreak
----------------------------------------------------------------
North Korean state media on Friday [11 Feb 2011] acknowledged for the
1st time that foot-and-mouth disease [FMD] has broken out in the Asian
country, affecting 8 provinces.

Rumors had been circling for several weeks that FMD had broken out in
the Communist country. On Thursday [10 Feb 2011], the state-run Korean
Central News Agency (KCNA) confirmed that the disease broke out in
Pyongyang at the end of 2010 and since spread to 8 other provinces.

KCNA said the most seriously affected areas are Pyongyang, North
Hwanghae Province, and Kangwon Province. Other areas which have been
affected are North and South Pyongan Provinces and Jagang Province,
although the other 3 affected provinces were not identified.

"Type O FMD broke out on cooperative farms, dairy farms, and pig
farms in those areas, doing harm to domestic animals," KCNA said.
[This is the 1st report identifying the FMDV serotype in North Korea.
-Mod.AS]. "More than 10 000 heads of draught oxen, [dairy cattle], and
pigs have so far been infected with the disease and thousands of them
died." [see comment]. The state broadcaster said a national emergency
veterinary and anti-epizootic committee has since been established.
"An emergency anti-epidemic campaign was declared throughout the
country," it added.

KCNA further added that infected areas had been quarantined and
disinfected and that measures were taken to treat those infected with
the disease. "All the catering networks and markets have stopped
selling meat of the above-said domestic animals," it concluded.

Late last month [January 2011], the Food and Agriculture Organization
(FAO) of the United Nations called for veterinary and border control
authorities in Asia to be on alert for animals showing signs of
infection by FMD after a large outbreak in South Korea.

Since late November 2010, South Korean authorities have imposed
quarantines, initiated a vaccination campaign that is targeting 9
million pigs and 3 million heads of cattle, and culled 2.2 million
livestock. The overall cost of this effort is estimated at around USD
1.6 billion.

"The current FMD dynamics in eastern Asia, as well as the magnitude
of the outbreak in South Korea, are unlike anything that we've seen
for at least a half century," said Juan Lubroth, FAO's chief
veterinary officer. "This makes preparedness and monitoring extremely
important right now."

In recent years, FMD has made an unparalleled spread through China
and entered eastern regions of Russia and Mongolia for the 1st time.
It recently affected an estimated 1.5 million Mongolian gazelles,
whose migration may have helped carry the virus into China [but see
FAO revised alert in ProMED-mail 20110128.0338]. FAO sent an emergency
response team to Mongolia to help authorities cope with the disease.

The overall situation in Asia is cause for concern, said Lubroth,
especially given the recent Lunar New Year holiday [2-8 Feb 2011],
during which large numbers of people [have been] on the move in the
region, many of them carrying meat products and some transporting
animals.

FMD is a highly contagious disease affecting cattle, buffaloes,
sheep, goats, swine, and other cloven-hoofed animals. It causes
blisters on the nose, mouth, and hooves and can kill young or weak
animals. There are several [sero]types of viruses. The [sero]type
causing the outbreak in South and North Korea is [sero]type O.

The disease does not pose a direct health threat to humans, but
affected animals become too weak to be used to plough the soil or reap
harvests, and farmers cannot sell the milk they produce due to
infection by the virus.

One of the early signs of the disease in infected animals is the
excessive production of saliva and nasal discharges. The virus may
survive for several hours outside the infected animal, especially in
cold and humid environments. This means it can be transported on
almost any object that has been in contact with contaminated saliva or
other discharges [see also comment re airborne spread].

The cost of cleaning farms and culling animals is a burden for
farmers, and trade restrictions based on disease outbreaks can have
major impacts on both local and national economies. Costs resulting
from an outbreak in the UK in 2001 have been estimated at 13 billion
euro (USD 17.6), FAO said.

--
communicated by:
Sabine Zentis
Castleview Pedigree English Longhorns
Gut Laach
52385 Nideggen
Germany



******
[2]
Date: Fri 11 Feb 2011
Source: Malaysian National News Agency (Bernama) [edited]



UN agency to send foot-and-mouth disease experts to North Korea
---------------------------------------------------------------
A United Nations agency handling agricultural matters will send a
group of experts to North Korea next week [week of 14 Feb 2011] to
help the country contain foot-and-mouth disease (FMD), South Korea's
Yonhap news agency quoted the Radio Free Asia (RFA)'s report Friday
[11 Feb 2011].

The Food and Agriculture Organization (FAO) of the UN will dispatch
"3 to 5 experts, including a veterinarian," to North Korea to
determine what sort of assistance North Koreans will need in light of
the FMD outbreak, the RFA reported. Citing an anonymous FAO official,
the report said the agency held an emergency meeting immediately after
North Korea requested aid earlier this week.

"We're very pleased that North Korea informed us of its FMD outbreak
and officially asked for help," the official was quoted as saying.

On Thursday [10 Feb 2011], North Korea confirmed for the 1st time
that it had been hit with the highly contagious livestock disease.
According to the North's state- run Korean Central News Agency (KCNA),
the FMD first broke out in the capital city, Pyongyang, late last year
[2010], and has since spread to 8 provinces. The disease has claimed
the lives of thousands of cows and pigs and has affected more than 10
000 others [see comment].

The KCNA report was released hours after the RFA said the North had
reported the outbreak to the FAO.

South Korea has also been battling FMD that has spread nationwide in
the last 3 months and caused more than 3 million livestock to be
culled. It remains unclear whether the disease spread from the South
to the North. In 2007, North Korea suffered outbreaks of the disease,
prompting South Korea to dispatch a team of animal health experts amid
a mood of reconciliation. Citing recent visitors to the impoverished
neighbor, South Korean officials said last month [January 2011] that
the North is believed to be stepping up its quarantine efforts after
outbreaks were reported.

South and North Korea are divided by one of the world's most heavily
fortified borders. Most cross-border exchanges have come to a halt
over the last 3 years [see comment].

North Korea has banned the inflow of pork and beef from South Korea
since late last year [2010] for fear that the disease may spread
there.

--
communicated by:
FMD News
FMD Surveillance and Modeling Laboratory
University of California at Davis
USA



[According to both newswires, the disease affected more than 10 000
heads of bovines and porcines, thousands of which died. This sounds
like an exceptionally high case fatality rate. Generally, mortality in
adult animals, infected by FMD, rarely exceeds 5 per cent; however, it
may cause high mortality (sometimes exceeding 50 per cent) in
offspring (particularly in sheep, but also in pigs and cattle under
the age of one month). The grave economic losses, characteristic of
FMD, are mainly the result of the extreme infectivity of the virus,
deleteriously affecting production in many farms for extended periods,
and to the severe quarantine and other control measures applied. The
precise numbers of cases and mortalities, per species, and their
respective dates and locations in North Korea, are expected to be
included in the official notification to the OIE which is anticipated
sooner than later.

The 2nd newswire describes the division between the 2 Korea's as "one
of the world's most heavily fortified borders. Most cross-border
exchanges have come to a halt over the last 3 years". It should,
however, be kept in mind that among the various mechanisms by which
FMD can be spread, one should include the transport of virus on the
wind. Though this is an uncommon means of spread over long distances,
requiring the coincidence of particular epidemiological and climatic
factors, spread over hundreds of meters to several kilometers may be
less rare. The topographical and climatic factors which favour
airborne spread are a flat terrain, high humidity, low precipitation,
and low to moderate wind speed; such spread may be particularly
expected when pigs as are the infection source, being extremely
prolific FMD virus emitters, and cattle are the targets. This
mechanism of spread is important because infection can be carried
beyond control areas and across borders and seaways. (Donaldson AI,
Alexandersen S (2002): Predicting the spread of foot and mouth disease
by airborne virus. Rev sci tech Off int Epiz, 21(3): 569-75; available
at ).

Some of the outbreaks in the north west of South Korea were rather
close to the border with DPR Korea (see interactive map at
;
zoom in).

The proximity of FMDV serotype O outbreaks in South Korea to the
North Korean border was particularly notable during the previous
epizootic (8 outbreaks), which started in Incheon on 8 Apr 2010 and
was declared as resolved on 7 Jun 2010. See the interactive map at
.
Both epizootics were caused by the same virus strain (FMDV O SEA
topotype, Mya-98 lineage); it will be interesting to obtain
information on the strain currently circulating in North Korea, now
locally identified (item 1 above) as serotype O, as well as
information on the North Korean situation since early 2010. - Mod.AS]

[see also:
Foot & mouth disease - North Korea (02): bovine, susp, RFI
20110210.0457
Foot & mouth disease - North Korea: bovine, susp, RFI 20110117.0203
Foot & mouth disease - Asia (02): FAO, alert (revised), RFI
20110128.0338
Foot & mouth disease - Asia: FAO, alert 20110127.0328]
.................................................arn/mj/sh
*##########################################################*
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ProMED-mail makes every effort to verify the reports that
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information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
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H1N1: To Type or Not to Type, and If Not, Why Not?

Viral Evolution


Viruses can evolve in a short time frame. Consequently new booster shots are required annually for viruses like influenza. To rapidly evolve, viruses use recombination, which involves swapping of genetic information within specific genes. This is accomplished by a "copy choice" method in cells infected by two distinct viruses.

The recombination mechanism recycles polymorphisms in various combinations. These polymorphisms have already been selected over millions of years, and the virus simply creates new combinations to evade immune surveillance or drug treatments. Recombination follows specific rules that can be used to predict the sequence of emerging viruses.

So why are not all suspected cases of H1N1 NOT being "typed?"


Unsubtypables on the rise; http://www.recombinomics.com/News/02081101/trH3N2_PA_Unsubtypables.html

CDC Silence on unsubtypables deafning;
http://fluboard.rhizalabs.com/forum/viewtopic.php?f=5&t=6817&p=52646#p52646

COWPOX, HUMAN - USA: (GEORGIA), LABORATORY INFECTION

And what use would we have of cow pox?
http://www.bioprepwatch.com/news/211064-cowpoxs-genetic-code-could-lead-to-bioweapon-vaccines

***********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Sat 6 Feb 2011
Source: IMED 2011: International Meeting on Emerging Diseases and
Surveillance, via Medscape [subscription required, edited]



The 1st human cowpox virus infection in the United States has been
documented in an unvaccinated laboratory researcher, according to a
report by investigators from the US Centers for Disease Control and
Prevention (CDC) in Atlanta, Georgia.

The findings were reported by Andrea McCollum, MPH, an epidemiologist
from the Mycotic Diseases Branch of the CDC at the IMED 2011:
International Meeting on Emerging Diseases and Surveillance.

"Current recommendations by the CDC's Advisory Committee on
Immunization Practices include vaccination of laboratory workers who
handle cultures or animals infected with non-highly attenuated
orthopoxviruses that infect humans, including cowpox virus," Dr.
McCollum told Medscape Medical News at the conference. "This patient
was offered a vaccination but declined ... because the patient was
not intentionally conducting work with an orthopoxvirus."

According to Dr. McCollum and colleagues, cowpox infections occur
rarely, even in Eurasia where the virus is endemic. "Laboratory
exposures to vaccinia virus have been documented, but, to date, there
have been no reports of accidental laboratory-acquired cowpox
infections," the authors note.

The unvaccinated lab worker became infected in July 2010 while
working with a nonhuman pathogenic poxvirus and developed a
suspicious, painful, ulcerated lesion on a finger that lasted
approximately 3 months. In October 2010, biopsy specimens of the
suspected orthopoxvirus were submitted to the CDC for testing.
Real-time polymerase chain reaction assays on the biopsy tissue
showed positivity for a non-variola orthopoxvirus and cowpox DNA and
negativity for vaccinia virus. "Further sequencing identified the
strain as cowpox Brighton," Dr. McCollum and colleagues note. "The
investigation revealed cowpox virus stocks in the laboratory's
freezer but no known or intentional use of cowpox in the patient's
laboratory in the previous 5 years," they add.

Sequencing of an isolate from the laboratory worker revealed a
recombinant region consistent with recombinant cowpox strains stored
in the freezer. In addition, cowpox was detected in multiple viral
stocks and 2 viral lines, including the viral stocks used by the
patient prior to the onset of illness. Orthopoxvirus DNA was also
found in environmental swabs of several surfaces in the laboratory
and a freezer room, although no live virus was recovered from the swabs.

According to Dr. McCollum, the patient described noticing a small cut
at the site of the lesion a few days before lesion onset. "The
patient had no recollection of an accidental needle stick," she said.
"Evidence suggests that the patient was likely infected by handling
laboratory reagents or environmental surfaces that were contaminated
with cowpox virus."

Dr. McCollum said that orthopoxvirus infections can be severe,
particularly in individuals with a risk factor for severe
complications, including those with an immuno-compromising condition,
eczema, or other similar skin conditions, and pregnant women. "Cowpox
infections are transmissible by contact with lesions or matter from
lesion exudates, and lesions are considered capable of producing
infectious virus until a scab falls off and a fresh layer of skin
forms," she said. "Prompt recognition, diagnosis, and reporting of
orthopoxvirus infections to appropriate public health agencies can
help reinforce appropriate infection control practices."

Independent commentator Prof. Hermann Meyer, from the Institut fur
Mikrobiologie der Bundeswehr in Munich, Germany noted that infection
with cowpox virus from an injury is relatively common. There have
been several cases in Europe of human cowpox cases in people who have
had close contact with pet cats or rats, luckily without dire
consequences. However, Dr. Meyer points out that upon infection with
a genetically modified virus, it is unclear whether a foreign gene
will be expressed and whether it might lead to unexpected clinical
signs; fortunately, that was obviously not the case with this
patient. It is important to "stick to good laboratory practice rules:
wear protective gloves; frequently disinfect hands and surfaces; and
avoid working directly with these agents if you are pregnant,
immuno-compromised, diabetic, etc."

[Byline: Emma Hitt]

--
Communicated by:
ProMED-mail

[Cowpox virus is a misnomer. Cowpox virus is not normally present in
cows. The natural hosts are probably rodents, but it has been
isolated from a variety of animals, including domestic and wild
felines and canines, elephants and humans. Human infections have
usually been traced to handling of cowpox-infected animals, or, as in
this case, gross environmental contamination. Infections in humans
are usually benign, isolated lesions which slowly resolve without
deleterious consequences. Cowpox virus isolates exhibit unusual
genetic diversity. - Mod.CP]

[see also:
2009
----
Cowpox, rodents, human (06): Europe, background 20090306.0938
Cowpox, rodents, human (05): Europe, monkeypox? 20090305.0912
Cowpox, rodents, human (04): Europe 20090304.0890
Cowpox, rodents, human (03): Czech Republic, NOT 20090303.0870
Cowpox, rodents, human (02): France 20090226.0809
Cowpox, rodents, human - Germany, France ex Czech Rep. 20090225.0786
2007
----
Cowpox, human - Germany (02): comment 20070420.1299
Cowpox, human - Germany 20070419.1286
2003
----
Monkeypox, human, prairie dogs - USA (06) 20030612.1450]
..................................................cp/msp/dk

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information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
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Influenza, Pneumonia, Killing Manitoba's Aboriginals

STREPTOCOCCUS PNEUMONIAE, INVASIVE DISEASE - CANADA: (MANITOBA)
REQUEST FOR INFORMATION
***************************************************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Tue 1 Feb 2011
Source: chrisd.ca/blog [edited]



An outbreak of invasive pneumococcal disease is making its way
through the city's downtown and Point Douglas areas, the Winnipeg
Regional Health Authority [WRHA] warned on Tuesday [1 Feb 2011]. The
threat of the disease is severe enough for the WRHA to begin
organizing mass immunization clinics to protect those who are most vulnerable.

Winnipeg saw 98 cases of the disease in 2010, compared to an average
of 55 annually in the previous 3 years. The WRHA says the elderly,
homeless and those with chronic illness are most at risk.

"This is a very serious, potentially fatal illness," Dr. Carol
Kurbis, a Medical Officer of Health with the WRHA, said. "It's
important we vaccinate as many members of the at-risk population as possible."

Clinics in the area will be available throughout February and into
March [2011]. Public Health Nurses will visit shelters, soup kitchens
and select housing complexes in the area for those at high risk and
provide the vaccine at no cost to anyone who wants it and fits the
following criteria: Anyone who is homeless; Anyone with a chronic
illness, such as a weakened immune system; kidney, heart or lung
disease; diabetes; Anyone who suffers from an addiction (to illicit
drugs or alcohol); Anyone 65 years or older; and Anyone living in a
long term care facility. A full list of conditions can be found on
the province's website.

Those who meet the criteria can also visit their family doctor of
community health clinic to receive the vaccination.

The pneumococcal vaccine prevents pneumococcal infections, which can
cause serious and sometimes deadly illness, including infections in
the lung (pneumonia), blood (bacteremia), and brain (meningitis).
There are more than 90 different types of pneumococcal bacteria. The
pneumococcal polysaccharide vaccine protects against the 23 types
that cause most of the severe pneumococcal infections. The
vaccination is generally only given once in a lifetime, except to
individuals at highest risk.

--
Communicated by:
ProMED-mail


[The news release above reports on an outbreak of invasive
pneumococcal disease (IPD) in the downtown and Point Douglas areas of
Winnipeg, capital of the Canadian province of Manitoba. IPD is a term
for used for pneumococcal disease when pneumococci are isolated from
cultures of normally sterile body fluids: for example, blood,
cerebrospinal fluid, and pleural fluid. IPD thus includes primary
pneumococcal bacteremia (i.e., blood cultures positive for
pneumococci when no source is identified), pneumonia complicated by
pneumococcal bacteremia, empyema (positive pleural fluid cultures),
and meningitis (positive cerebrospinal fluid cultures).

However, in the absence of cultures of normally sterile fluids that
are positive for pneumococci, pneumococcal pneumonia is not included
in the definition of IPD because of diagnostic uncertainty. Most
patients with pneumococcal pneumonia will not have normally sterile
fluids (e.g., blood, cerebrospinal fluid, or pleural fluid) that grow
pneumococci. Thus, this definition of IPD underestimates the
frequency of severe pneumococcal disease in the community.

Although the news release does not mention of ethnic make-up of the
cases of IPD, we are told that IPD is occurring among the homeless in
Winnipeg's downtown and Point Douglas areas. It has been estimated
that 72% of the homeless men are Aboriginals in some Winnipeg
neighborhoods
()
and that one 3rd of the population in Winnipeg's Point Douglas
neighborhood is Aboriginal
(), compared with just 8
per cent in the whole of Winnipeg
().

Also, although the above news release does not mention if these cases
of IPD were a complication of influenza, influenza A activity has
recently been reported by ProMED-mail in the aboriginal population of
Manitoba. Influenza can predispose to secondary bacterial pneumonia,
a cause of substantial illness and death in pandemic and seasonal
influenza. _Streptococcus pneumonia_ is a common cause of bacterial
pneumonia that follows influenza A infection.

Also, we are not told if the isolates of pneumococci were serotyped.
ProMED-mail reported that Canada was having a problem with
multidrug-resistant _Streptococcus pneumonia_ serotype 19A (see
ProMED-mail Strep. pneumoniae, serotypes 5, 19A - Canada: (BC, ON)
20071111.3666). This serotype is included in the pneumococcal
polysaccharide vaccine that covers 23 serotypes (PPV23) and the new
pneumococcal conjugate vaccine that covers 13 serotypes (PCV13), but
not PCV that covers 7 serotypes (PCV7).

Winnipeg is located in southern Manitoba and is its largest city,
with more than 60% of Manitoba's population
(). The HealthMap/ProMED-mail
interactive map of Canada, showing the location of the province of
Manitoba, can be accessed at:
. - Mod.ML]

[see also:
2010
----
Influenza (17): Canada (MB), 1st nation 20101203.4341
2007
----
Strep. pneumoniae, serotypes 5, 19A - Canada: (BC, ON), cor 20071114.3695
Strep. pneumoniae, serotypes 5, 19A - Canada: (BC, ON) 20071111.3666
Strep. pneumoniae, non-vaccine strain emergence - USA (02): (MA) 20071022.3437
Strep. pneumoniae, non-vaccine strain emergence - USA (AK) 20070425.1348
2006
----
Streptococcus pneumoniae, serotypes 5,8 - Canada (AB) 20061214.3520
Streptococcus pneumoniae, serotype 5 - Canada (BC) (02) 20061212.3502
Streptococcus pneumoniae, serotype 5 - Canada (BC) 20061209.3477
1999
----
Drug resistance, Pneumococcus - Canada (02) 19990904.1550
Pneumococcal meningitis, Japan: RFI 19990329.0499
1998
----
Antibiotic resistance, pneumococcal - South Africa & USA 19980428.0823
1997
----
Strep. pneumoniae, drug resistant - Canada (Ontario) 19970503.0904]
...................ml/ejp/dk

*##########################################################*
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ProMED-mail makes every effort to verify the reports that
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information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
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INFLUENZA (11): EUROPE, UK, WHO

Influenza as a WMD; http://www.sunshine-project.org/publications/others/gmoflu.html

********************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


In this posting:
[1] Europe: WHO
[2] UK

******
[1] Europe: WHO
Date: Fri 4 Feb 2011
Source: WHO Regional Office for Europe, EuroFlu: Weekly Electronic
Bulletin [summ., edited]



High influenza activity across the European Region
--------------------------------------------------

Current situation -- week 4/2011 [24-30 Jan 2011]
-------------------------------------------------
During week 4/2011, 2 countries (Georgia and Luxembourg) reported
very high intensity of influenza activity; 8 reported high intensity,
and 26 reported medium intensity. The geographical spread of influenza
activity was reported to be widespread in 23 countries. Of the 25
countries reporting on the impact of influenza on health care systems,
1 (Georgia) reported severe impact, 10 countries reported moderate
impact and 14, low impact.

Clinical data also indicated increasing influenza activity in much of
the WHO European Region, as 31 countries reported increasing trends in
consultation rates for influenza-like illness (ILI) and/or acute
respiratory infection (ARI). In general, the highest consultation
rates were reported for children aged 0 to 4 and 5 to 14 years. In
contrast, declining clinical trends in ILI were observed in Ireland
and the United Kingdom, and some southern countries (Israel, Malta,
Portugal, and Spain).

Seven countries (Georgia, Kyrgyzstan, Romania, the Republic of
Moldova, the Russian Federation, Serbia and Ukraine) reported clinical
data on SARI (severe ARI) from sentinel hospitals. Hospitalizations
due to SARI have increased during recent weeks in Georgia, Kyrgyzstan,
Romania, the Russian Federation, and Serbia, which also reported
increases in clinical consultation rates for ILI or ARI.

Virological situation -- week 4/2011 [24-30 Jan 2011]
-----------------------------------------------------
Pandemic influenza A(H1N1) 2009 continued to predominate in the
Region. It was reported to be dominant in 19 countries and co-dominant
with influenza B in 13 countries. Influenza B was dominant in 4
countries. Sentinel physicians collected 3656 respiratory specimens,
of which 1691 (46 percent) were positive for influenza virus: of these
1100 (65 percent) were influenza A and 591 (35 percent) were influenza
B. Of the influenza A viruses, 981 were subtyped: 926 (94 percent) as
pandemic A(H1) and 55 (6 percent) as A(H3). In the 31 countries
testing 20 or more sentinel specimens, influenza positivity ranged
from 9 percent to 75 percent, with a median of 50 percent (mean: 45
percent). In addition, 5940 non-sentinel specimens were reported
positive for influenza: 4428 (75 percent) influenza A and 1512 (25
percent) influenza B. Of the influenza A viruses, 3555 were subtyped:
3480 (98 percent) as pandemic A(H1) and 75 (2 percent) as A(H3). Out
of 195 sentinel SARI specimens collected during week 4/2011, 86 (44
percent) tested positive for influenza: 61 (71 percent) were influenza
A, 25 (29 percent) were influenza B. All the influenza A viruses were
subtyped: 59 (97 percent) as pandemic A(H1), and 2 (3 percent) as
A(H3). The percentage of SARI specimens testing positive for influenza
ranged from 10 percent (Ukraine) to 70 percent (Serbia) with a median
of 45 percent (mean: 43 percent).

Respiratory syncytial viruses (RSV) continue to circulate, and were
detected in 18 countries. In 15 of these countries, however, fewer RSV
detections were reported during week 4/2011 than in week 3/2011 [17-23
Jan 2011].

Cumulative virological update -- weeks 40/2010- 4/2011 [4 Oct 2010-30
Jan 2011]
----------------------------------------------------------------------
A total of 38 300 influenza virus detections was reported during this
period, of which 27 460 (72 percent) were influenza A and 10 840 (28
percent) influenza B. Of the influenza A viruses, 18 944 were
subtyped: 18 073 (95 percent) as pandemic influenza A(H1), 869 (5
percent) as influenza A(H3) and 2 as influenza A(H1).

From week 40/2010 to week 4/2011, 377 out of 1959 sentinel SARI
specimens (19 percent) have tested positive for influenza. Of these
influenza viruses: 140 (37 percent) were influenza A and 237 (63
percent) influenza B. Of the influenza A viruses, 127 were subtyped:
117 (92 percent) as pandemic influenza A(H1) and 10 (8 percent) as
influenza A(H3).

Since week 40/2010, 1083 influenza viruses have been characterized
antigenically: 618 were A(H1) pandemic A/California/7/2009
(H1N1)-like; 363 were B/Brisbane/60/2008-like (B/Victoria/2/87
lineage); 79 were A(H3) A/Perth/16/2009 (H3N2)-like; 22 were
B/Florida/4/2006-like (B/Yamagata/16/88 lineage); and 1 was
B/Bangladesh/3333/2007-like (B/Yamagata/16/88 lineage). Based on the
genetic characterization of 165 influenza viruses, 90 belonged to the
pandemic A/California/7/2009 A(H1N1) clade; 4 belonged to the pandemic
A/Christchurch/16/2010 A(H1) clade; 23 belonged to the pandemic A/Hong
Kong/2213/2010 A(H1) clade; 16 were reported as A(H1) pandemic not
attributed to group category but belonging to the recently emerged
A/England/142/2010 subgroup characterized by S185T substitution in the
HA; 5 belonged to the A(H3) clade represented by A/Perth/16/2009; 2
belonged to the A(H3) clade represented by A/Victoria/208/2009; 17
belonged to the subgroup represented by A/Hong Kong/2121/2010 in the
A/Victoria/208/2009 A(H3) clade; 7 belonged to the
B/Bangladesh/3333/2007 clade (Yamagata lineage); and 1 to the
B/Brisbane/60/2008 clade (Victoria lineage).

Since week 40/2010, 3 countries (Italy, Norway, and the United
Kingdom) have screened viruses for resistance to the neuraminidase
inhibitors oseltamivir and zanamivir. The United Kingdom analysed most
of the viruses screened (678). Out of the total of 714 isolates of
pandemic influenza A(H1N1) 2009 viruses that were tested, 688 were
sensitive to both inhibitors and 26 viruses (3.6 percent) carried the
H275Y mutation. These 26 viruses were resistant to oseltamivir but
remained sensitive to zanamivir. One influenza A(H3N2) virus was
tested and found to be sensitive to both inhibitors. All of the 61
influenza B viruses tested for oseltamivir resistance and the 62
tested for zanamivir resistance were found to be sensitive. All 35
pandemic (H1N1) 2009 viruses and 2 A(H3N2) viruses that were screened
for susceptibility to adamantanes were found to be resistant.

Comment
-------
ILI and ARI consultation rates are increasing in much of the WHO
European Region. In week 4/2011 [24-30 Jan 2011], 46 percent of
sentinel ILI/ARI specimens and 44 percent of sentinel SARI specimens
were positive for influenza. Influenza A(H3N2) has substantially
decreased in circulation relative to pandemic influenza A(H1N1) 2009
during the course of the 2010/2011 influenza season. Influenza B
viruses continue to co-circulate. During this week the relative
distribution of influenza types and subtypes in hospitalized SARI
patients appeared similar to that observed from other sentinel and
non-sentinel data sources. There is a notable difference in the
proportion of influenza A to influenza B among viruses from SARI
patients in week 4/2011, when compared to all viruses from SARI
patients for the cumulative 2010/2011 influenza season. This reflects
the recent shift in the relative circulation of influenza A to
influenza B viruses in the Caucasus, central Asia, and Russian
Federation, as most of the countries that are conducting sentinel SARI
surveillance are located in this part of the WHO European Region.

Since the genetic characterization algorithms were put in place for
pandemic influenza A(H1N1) viruses at the start of the 2010/2011
influenza season, a new genetic subgroup has been observed to emerge
that is geographically dispersed and increasing in prevalence. This
genetic subgroup is characterized by an S185T substitution in HA and
is represented by A/England/142/2010. To date, viruses carrying the
S185T substitution remain antigenically similar to the current vaccine
virus A/California/7/2009. At present, 98 percent of antigenically
characterized viruses from the 2010/2011 influenza season are similar
to the viruses included in the 2010/2011 northern hemisphere influenza
vaccines.

******
[2] UK: HPA
Date: Fri 4 Feb 2011
Source: Health Protection Agency (HPA) Report, 5(5) [edited]



Influenza activity declining in the UK
--------------------------------------
Influenza activity has been declining in the UK in recent weeks. In
England, community, primary care and secondary care indictors have all
declined from the peak in activity over the Christmas period.

The cumulative number of confirmed influenza deaths has increased but
most of the increase is due to deaths which occurred during the
Christmas and New Year period rather than more recently.

Influenza A(H1N1)2009 has been the predominant virus and continues to
circulate but influenza B, which is mainly affecting children, is now
being reported more frequently than A(H1N1)2009.

The heightened activity in influenza this season is also thought to
have contributed to increases in invasive _Streptococcus pyrogenes_
and _S. pneumoniae_ above the seasonally expected levels [1].
Fatalities have been documented from invasive group A streptococcal
infections implicating influenza co-infection [2].

Another area of concern is that in contrast to the 2009/2010 season,
low-level community transmission of oseltamivir-resistant strains of
influenza A(H1N1)2009 virus has been reported which, if it increases,
may have implications for antiviral prescribing recommendations [3].

The headline influenza indicators reported in the 3 Feb 2011 edition
of the HPA National Weekly Influenza Bulletin were [4] included the
following:

- in week 4 (ending 30 Jan 2011) the weekly ILI consultation rate
decreased in England (24.1 per 100 000), Scotland (45.7 per 100 000),
Wales (24.7 per 100 000), and Northern Ireland (76.2 per 100 000). GP
consultation rates are below baseline levels in England, Wales, and
Scotland.

- 28 of 128 (21.96 percent) specimens from patients with ILI
presenting to sentinel GPs in England in week 4 were reported as
positive for influenza;

- since week 36, 395 UK deaths associated with influenza infection
have been reported. Excess all-cause mortality continues to be
observed in week 3;

- 45 H1N1 (2009) viruses have been found to carry the H275Y mutation,
which confers resistance to the antiviral drug oseltamivir.

References
----------
1. Zakikhany K, Degail MA, Lamanghi T, et al: Increase in invasive
_Streptococcus pyogenes_ and _Streptococcus pneumoniae_ infections in
England, December 2010 to January 2011. Euro Surveill. 16(5), 2011.
Rapid communication [available at
].

2. Scaber J, Saeed S, Ihekweazu C, et al: Group A streptococcal
infections during the seasonal influenza outbreak 2010/11 in South
East England. Euro Surveill. 16(5), 2011. Rapid communication
[available at
].

3. Lackenby A, Gilad JM, Pebody R, et al: Continued emergence and
changing epidemiology of oseltamivir-resistant influenza A(H1N1)2009
virus, United Kingdom, Winter 2010/11. Euro Surveill. 16(5), 2011.
Rapid communication [available at
].

4. HPA Weekly National Influenza Report, 3 Feb 2011. Available from
the HPA website at
.

--
Communicated by:
ProMED-mail


[[In brief; influenza activity is increasing in most countries in the
region, and 23 of them report widespread influenza activity. The
outbreak continues to progress west to east, with decline in the UK. A
slightly higher percentage of specimens from patients with ILI
(influenza-like illness) and/or acute respiratory infections (ARI),
were positive for influenza in week 4/2011 (24-30 Jan 2011) than
previously. Most antigenically characterized viruses are similar to
the viruses included in the 2010/2011 northern hemisphere influenza
vaccines. Influenza A(H3N2) has substantially decreased in circulation
relative to pandemic influenza A(H1N1) 2009 during the course of the
2010/2011 influenza season. The previous seasonal (H1N1) virus has
virtually disappeared. In the UK the heightened activity in influenza
this season is thought to have contributed to increases in invasive
_Streptococcus pyrogenes_ and _S. pneumoniae_

A new genetic subgroup has emerged that is geographically dispersed
and increasing in prevalence. This genetic subgroup is characterized
by an S185T substitution in HA. To date, viruses carrying the S185T
substitution remain antigenically similar to the current vaccine virus
A/California/7/2009.

Low-level community transmission of oseltamivir-resistant strains of
influenza A(H1N1)2009 virus has been reported in the UK which, if it
increases, may have implications for antiviral prescribing
recommendations. - Mod.CP]]

[see also:
Influenza (10): Europe 20110129.0351
Influenza (09): WHO update 126 20110128.0337
Influenza (08): Europe 20110121.0247
Influenza (07): Israel 20110119.0232
Influenza (06): Europe, comment 20110115.0175
Influenza (05): WHO update 125 20110115.0171
Influenza (04): Europe 20110114.0163
Influenza (03): Egypt, France 20110111.0128
Influenza (02): UK 20110107.0086
Influenza: Egypt 20110103.0029]
................................................. cp/mj/jw
*##########################################################*
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thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
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UNDIAGNOSED FATAL DISEASE, BOVINE - LAOS

(HOUAPHAN) REQUEST FOR
INFORMATION
********************************************************
* Suspected: FMD

A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Fri 4 Feb 2011
Source: Vientiane Times [edited]



About 200 cow and buffalo calves in Aed district, Houaphan province,
have died after contracting a mouth infection, according to local
officials yesterday [3 Feb 2011]. "The animals that died were aged
between 1 and 6 months," an official from the provincial Livestock and
Fisheries Sector, Mr Phuangsavath Phommasy, told Vientiane Times
during a telephone interview.

According to a laboratory investigation into the cause of death, the
animals did not die from foot-and-mouth disease [FMD] or as a result
of the recent cold weather but from a mouth infection [see comment
below]. Animals from 9 villages in Aed district have been infected
with the disease. The district is located in the north of Laos and
shares a border with Viet Nam.

Locals said the disease had broken out in Viet Nam prior to its
appearance in Houaphan at the end of November [2010], Mr Phuangsavath
said. The disease quickly spread after people threw infected carcasses
into rivers, he observed. When it started appearing in Aed district,
provincial authorities took immediate action to contain the disease
and prevent any further outbreaks.

"We are required to closely monitor the transport and trading of pigs
or pork and pork products at the Lao-Vietnamese border and seize and
destroy pigs of unclear origin," he said.

In 9 communities along the border, pig farms, vehicle tyres, markets,
and slaughterhouses have been disinfected and pig herds vaccinated.
Officials are also campaigning to raise awareness about the disease
and are warning people not to eat animals that have fallen ill or died
from it. Villagers have also been advised to bury carcasses to prevent
the disease spreading and becoming an epidemic.

If anyone comes across a case of the mouth infection they should
report it immediately to the provincial livestock and fisheries sector
via their local village office.

No new cases of infection have been reported recently but some deaths
are still occurring among animals already infected, Mr Phuangsavath
said.

For the next few months, provincial authorities are required to
monitor the situation closely in Aed district to ensure the outbreak
is permanently eradicated.

[Byline: Khonesavanh Latsaphao]

--
Communicated by:
Sabine Zentis
Castleview Pedigree English Longhorns
Gut Laach
52385 Nideggen
Germany



[[This is rather blurred information:
1. What laboratory test excluded FMD?
2. What is the meaning of "mouth infection" which, apparently,
replaced the initially suspected FMD, in 1-6 month old calves? (In
young calves, FMD is generally expected to primarily cause
pancarditis, clinically manifested by sudden deaths).
3. Is this a bacterial infection? Otherwise?
4. How does the "mouth infection" cause mortality: by interfering
with the feeding of the animals, causing starvation/dehydration?
Otherwise?
5. Allegedly, "the disease quickly spread after people threw infected
carcasses into rivers." Were these calves' carcasses, or -- in view of
the alleged involvement of a pig health problem (see further) -
carcasses of pigs?
6. The newswire includes information on a pig health problem,
apparently related to the "mouth infection" in calves. For example
(excerpts):
- "We are required to closely monitor the transport and trading of
pigs or pork and pork products at the Lao-Vietnamese border and seize
and destroy pigs of unclear origin."
- "In 9 communities along the border, pig farms, vehicle tyres,
markets, and slaughterhouses have been disinfected and pig herds
vaccinated."

The reported disinfection of pig farms, vehicle tyres, markets and
slaughterhouses, and the vaccination of pigs, brings to mind FMD,
which is indeed common to pigs and cattle.

Since FMD is known to have recently spread throughout Viet Nam, most
probably due to serotype O, clearer information from Laos, including
clarification of the points above, is anticipated (see Viet Nam's data
at ).

Previous undiagnosed mortalities in Laotian cattle were attributed to
several causes, including hemorrhagic septicaemia. - Mod.AS

2 more quaestions: What vaccine is being given to the pigs? And if
they know what vaccine is necessary to protect the pigs, why aren't
they vaccinating the cattle? - Mod.JW

A map showing the location of Houaphan province in northeastern Laos
can be seen at
.
The HealthMap/ProMED-mail interactive map of Laos is available at
. - Sr.Tech.Ed.MJ]

[see also:
2010
----
Porcine reprod. & resp. syndrome - Laos: (VT) OIE 20100708.2278
Undiagnosed deaths, bovine - Laos: (VI) RFI 20100114.0168
2009
----
Undiagnosed die-off, bovine - Laos: RFI 20090526.1961
Foot & mouth disease, bovine - Laos: (BL) RFI 20090304.0877
2008
----
Foot & mouth disease - Laos: (Luangnamtha), OIE 20081115.3603]
.................................................arn/ejp/mj/jw
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
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************************************************************
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Send all items for posting to: promed@promedmail.org (NOT to
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Still Dying in Bangladesh: Encephalitis Now

http://dangerousnewsnetwork.blogspot.com/2011/02/undiagnosed-encephalitis-bangladesh.html

What it is; http://kidshealth.org/parent/infections/bacterial_viral/encephalitis.html

Use as a WMD; http://www.globalsecurity.org/wmd/intro/bio_vee.htm

Virtual Bangladesh: The Grand Tour; http://www.virtualbangladesh.com/bd_tour.html

Dengue Updates, Paraguay, Peru, Brazil, Australia, American Samoa

DENGUE/DHF UPDATE 2011 (05)
********************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


In this update:
Cases in various countries: Paraguay (Central), Paraguay (Alto
Parana), Peru (Amazonas), Brazil (Mato Grosso do Sul), Australia
(North Queensland), American Samoa

- Paraguay (Central). 26 Jan 2011. Heriberto Marmol, the mayor of
Mariano Roque Alonso said he was confident of controlling the outbreak
of dengue in the city within 2 weeks. A total of 17 cases were
confirmed in that locality.

in Spanish, trans. Corr. SB.

[A map of Mariano Roque Alonso, just north of the capital of
Asuncion, can be accessed at
.
A HealthMap/ProMED-mail interactive map of Paraguay can be accessed at
. - Mod.TY]

- Paraguay (Alto Parana). 27 Jan 2011. Paraguayan health officials
today expressed concern over a possible epidemic of dengue, after
confirming 2 deaths and dozens of patients. According to the medical
announcement the majority of those infected are in the Alto Parana
department, 340 kilometers east of the capital, but there are
suspicions of outbreaks in 14 other locations. The Ministry of Public
Health reported 2 deaths, 30 confirmed cases and results are awaited
from 405 other possible infections. Official figures say that in 2010,
14 people died here from the disease, while 13 000 others suffered
from the disease.

in Spanish, trans. Corr.SB

[A map showing the location of Alto Parana department in eastern
Paraguay can be accessed at
. A
HealthMap/ProMED-mail interactive map of Paraguay can be accessed at
. - Mod.TY]

Paraguay (Alto Parana). 30 Jan 2011. The number of dengue deaths (in
Alto Parana, Paraguay) has now climbed to 3. All are residents to
Alto Parana department.

in Spanish trans. - Mod.TY

- Peru (Amazonas). 27 Jan 2011. The health minister Oscar Ugarte said
today that the dengue outbreak that is showing up in the Peruvian
forest and has caused 10 deaths, had originated in Brazil and is a new
variety of the virus that was not known previously in Peru. He noted
that this new strain, which has a rapid worsening (clinical) evolution
which produces the "shock type" without causing bleeding. [Although
this report does not indicate where this outbreak occurred,
ProMED-mail reported a significant dengue outbreak this month (January
2011) in Iquitos, in the Peruvian Amazon, caused by dengue virus-2
Asian/American (genotype III), so one presumes that this is the dengue
virus serotype to which the Minister refers (see ProMED-mail archive
number 20110124.0292. - Mod.TY)
in
Spanish, trans. Corr.SB

[A map showing the location of the Peruvian Amazon region can be
accessed at .
A HealthMap/ProMED-mail interactive map of Peru can be accessed at
. - Mod.TY]

- Brazil (Mato Grosso do Sul). 29 Jan 2011. This week, Mato Grosso
do Sul had the 1st suspected case of dengue (virus) type 4 (infection)
in a resident of Campo Grande, who may have contracted the infection
in Para (state). This is of concern because just (!) 3 (of the 4)
dengue virus types 1, 2, and 3 are circulating in Mato Grosso do Sul.


in Portuguese, trans. - Mod.TY

[A map showing the states of Brazil can be accessed at
. A
HealthMap/ProMED-mail interactive map of Brazil can be accessed at
. - Mod.TY]

- Australia (North Queensland). 28 Jan 2011. A new outbreak of dengue
fever has been declared in the far north Queensland town of Innisfail.
Queensland Health on Friday (28 Jan 2011) declared an outbreak after
receiving confirmation at least one locally acquired case of the
mosquitoborne virus. Meanwhile, an outbreak of the virus in the
Cairns suburbs of Parramatta Park and Westcourt has been declared
over.


[A HealthMap/ProMED-mail interactive map showing Queensland state in
north eastern Australia can be accessed at
. - Mod.TY]

- American Samoa. 29 Jan 2011. The number of reported cases of dengue
fever in American Samoa are on the rise. Officials at LBJ Medical
Center in Pago Pago said this week that 467 cases were discovered last
year (2010), compared with 436 in 2009 and 667 in 2008. Hospital chief
medical officer Dr Aloiamoa Anesi says there have been no deaths
attributed to the disease in recent years. [This report does not
indicate how many cases have occurred so far in 2011. Interestingly, a
resurgence of dengue in American Samoa was reported in February last
year (see ProMED-mail archive number 20100222.0597), with just 17
cases in January 2010, climbing to 467 cases subsequently that year. -
Mod.TY]

[A map showing the American Samoa Islands can be accessed at
. A
HealthMap interactive map of the American Samoa Islands in the South
Pacific can be accessed at
. - Mod.TY]

[see also:
Dengue/DHF update 2011 (04) 20110124.0292
Dengue/DHF update 2011 (01) 20110102.0020
2010
---
Dengue/DHF update 2010 (08) 20100222.0597
.................................................jw/sb/ty/mj/sh
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Donate to ProMED-mail. Details available at:

************************************************************
Visit ProMED-mail's web site at .
Send all items for posting to: promed@promedmail.org (NOT to
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