Rumors of H5N1 case in Canada dismissed

Nov 29, 2006 (CIDRAP News) – Internet rumors of a case of H5N1 avian influenza in a little boy in Rimouski, Quebec, were just that, Canadian Press reported today.

Several Web sites on pandemic flu reported rumors that a boy was seriously ill with avian flu at a hospital in the city, but hospital officials dismissed them as entirely false, according to the CP story.

Dr. Patrick Dolce, head of microbiology at the hospital, flatly rejected the reports. “This is totally untrue,” he told CP. “There is no case of respiratory illness in any children right now in the hospital. No cases at all.”

The hospital received calls about the rumors from as far away as Italy, the story said. Rimouski is a city of 42,000 on the St. Lawrence River north of Quebec City.

North America has had no known human case of H5N1 illness to date.

In other developments, the World Health Organization confirmed today that a 35-year-old Indonesian woman who died of H5N1 disease yesterday was the patient who was cited in a WHO update on Nov 13. She was the 57th Indonesian to die of the illness, out of 74 total cases.

In a statement yesterday, Indonesia’s National Committee for Avian Influenza Control and Pandemic Influenza Preparedness said the woman lived in Tangerang, Banten province, and fell ill Nov 7. She was initially hospitalized in Tangerang and was transferred to Sulianti Saroso Infectious Disease Hospital in Jakarta Nov 10.

Although some news reports yesterday said the woman had had contact with sick poultry, the committee said, “A history of contact with poultry has not been established.”

In addition to 74 confirmed H5N1 cases, Indonesia has had 12 probable cases, including 4 fatal ones, and 187 “suspect” cases, of which 50 were fatal, the committee said. The statement said lab tests have ruled out 539 suspected cases.

Nine Indonesian provinces have had human cases, the committee said. West Java leads the list, with 25 cases and 20 deaths, followed by Jakarta, with 18 cases and 16 deaths, and Banten, with 9 cases and 8 deaths.

Source: CIDRAP News

Intro:  I’ve been posting data about Chikungunya Fever (CKF) for a while now.  It’s probably because it sounds exotic and I never heard about it.  Anyway, ProMEDmail is publishing CKF outbreaks in a variety of places recently.  In fact, there were 2 cases diagnosed in Colorado, tourists just back from Africa.  Now, Sri Lanka has been hit.  It’s funny that the traditional U.S. media hasn’t picked up on this yet.

Item: The Sri Lankan government has confirmed that the viral fever
spreading rapidly amongst people in Jaffna is the mosquito-borne
chikungunya fever. It is suspected that more than 5000 people have
been infected with the virus, now at epidemic levels.

Sri Lankan Health authorities have called on the public to clean up
areas where mosquitoes breed in an effort to prevent the spread of
the disease.

The symptoms of the disease — high fever, joint and muscular pain,
severe headaches, body aches and rash — are similar to those caused
by dengue fever, another mosquito-borne illness.

The outbreak has coincided with an outbreak of dengue fever cases, as
monsoon rains create breeding conditions for the mosquitoes that
carry the diseases, and health workers are struggling to cope.

The U.S. Centers for Disease Control and Prevention (CDC) says that
while the disease is painful, no deaths from chikungunya have been
documented in the scientific literature. This contradicts foreign experts who have claimed that a few deaths have been attributed to CKF.

Source: ProMEDmail, 11/28/06

The Health Ministry announced Tuesday,28 Nov 2006, that a
35-year-old woman died of bird flu early Tuesday morning at the Sulianti Saroso Infectious Disease Hospital in Jakarta.

Her death is the 57th
human fatality out of 74 confirmed human H5N1 cases in Indonesia.

Source: ProMEDmail, 11/29/06

Intro:  This news item about Mike Chertoff’s recent speech is really welcome news finally.  His statement concerning his goals to improve communications underscores a fact that most of us know real well:  Communications is the first to fall apart in a disaster.  It’s an historical fact, and it’s been well-documented that communication failures contributed to 9/11 and Katrina response failures (and deaths).

One of his goals is for incident commanders to be able to communicate within 1 hour.  Another of his goals is to have the ability to alert 85% of all Americans within 10 minutes.

News item:  Homeland Security Secretary Michael Chertoff announced
Tuesday that the nation’s 35 highest-risk cities must have systems
enabling first responders to communicate in a disaster by the end of next
year. Every state must have such a system by the end of 2008, he said.

New York City has already achieved that goal, officials said.
“The bottom line is we have to be able to communicate during a disaster,”
Chertoff told more than 1,000 state and local homeland security officials
assembled at the Washington Hilton Tuesday. “We’re going to get it done.”

The lack of interoperable communications among first responders, and the
poor functioning of fire radios in the World Trade Towers, were
contributing causes in the scores of firefighters’ deaths in the Sept. 11
attacks. Hampered communication also slowed rescue and recovery after
Hurricane Katrina.

Chertoff announced those deadlines five weeks before the start of a new
Congress controlled by Democrats, many of whom have expressed frustration
about the slow pace of progress on first-responder communications and
pledged tougher oversight of his department.

The secretary said public scorecards would be issued in the next few weeks
to the highest-risk cities — including Boston, Houston and Chicago — to
help them prioritize needed improvements. The focus, he said, would be
regional because “threats are region-based.”

So the scorecard for New York City would assess communication not just
among the city’s first responders, but also among police, fire and
emergency management groups in Nassau, Suffolk and Westchester.

The baseline goal is for incident command managers to be able to
communicate with one another within one hour.

Local officials said they expect to do well in the ratings.

“Communications are vastly improved from what they were on Sept. 11,” said
New York Deputy Fire Commissioner Frank Gribbon. “We have radios where we
share frequencies. We have an NYPD videofeed to our operations center.”

Beyond hardware, Gribbon said the city has revamped protocols that set out
who is in charge under what circumstances.

Chertoff also pledged Tuesday that next year’s allocation of anti-terror
grants would be more transparent. While continuing to allocate the lion’s
share of money to high-risk areas, he said, decisions would be based more
on “common sense” than on “bean counting.” This year’s grants, which
included 40-percent funding cuts to New York City and Washington, D.C.,
were widely criticized.

Changes to the program, he said, would include an extended timeline that
will enable municipalities to fine-tune their proposals after getting
feedback.

Chertoff also said that a comprehensive alert system is being developed
with the goal of reaching 85 percent of Americans within 10 minutes.

“Those of you who grew up in the ’50s remember that they used to break
into television programing … ,” he said. “But we’re in the 21st century.
We have text messaging. We have the Internet. We have digital cable. We
have satellite television. We have to upgrade the current patchwork system
and build one that is national in scope for the 21st century.”

Source: Newsday, 11/28/06

Spy: Radiation Found On BA Planes

Last Edited: Wednesday, 29 Nov 2006, 1:30 PM CST
Created: Wednesday, 29 Nov 2006, 1:00 PM CST

11/29/2006 —
Scientists have found traces of radiation on two British Airways planes tested as part of the investigation into the death of former Russian spy Alexander Litvinenko.

British Airways said in a statement: “British Airways has been advised that three of its Boeing 767 short haul aircraft have been identified by the UK government as part of the investigation into the death of Alexander Litvinenko.

“The airline was contacted last night (Tuesday, November 28) by the government. It has taken the three B767s out of service to enable forensic examination to be carried out.

“The initial results of the forensic tests, which was confirmed late this afternoon, has shown very low traces of a radioactive substance onboard two of the three aircraft.

“British Airways has been advised that this investigation is confined solely to these three B767 aircraft, which will remain out of service until further notice.”

“British Airways understands that from advice it has been given that the risk to public health is low.

“The airline is in the process of making contact with customers who have travelled on flights operated by these aircraft, which operate within Europe.

“The airline has published the flights affected on its website, www.ba.com, and customers on these flights who wish to receive further advice are advised to telephone NHS Direct on 0845 4647. Only customers who havetravelled on these specific flights are asked to telephone NHS Direct.

“British Airways has set up a special helpline for customers and staff on 0845 6040171 or 0191 211 3690 for international calls.

“Further information will be released as it becomes available and information will be posted on the airline’s website.”

Source: My fox St. Louis
http://www.myfoxsl.com

Terrorism & Security
posted November 28, 2006 at 12:30 p.m.
Has ’sectarian violence’ in Iraq become a ‘civil war’?
Bush says no, but US media increasingly says yes.
By Tom Regan | csmonitor.com

NBC will now refer to the conflict in Iraq as a “civil war,” joining a growing number of US media enterprises in designating the war as such despite President Bush’s statements against the label.

The Boston Globe reports that the host of NBC’s Today Show, Matt Lauer, said the network would buck the White House and from now on refer to the violence in Iraq as a “civil war.” Media specialists are comparing it to the moment when former CBS anchor Walter Cronkite declared in 1968 that America was losing the war in Vietnam, and Ted Koppel’s updates of the Iranian hostage crisis that “infuriated Jimmy Carter’s White House.”

“How you frame a problem frames what the public thinks is the right thing to do,” said James Steinberg , dean of the Lyndon B. Johnson School of Public Affairs at the University of Texas. “If Iraq is a democracy struggling against insurgents and you describe it that way, people might still support you. If it is a civil war, it is indisputably the case that Americans will say, ‘What are we doing in the middle of a civil war?’”

Steinberg, who was deputy national security adviser under President Clinton, added: “The more they hear ‘civil war,’ the harder it is going to be to support a strategy that keeps a lot of American troops there in large numbers.”

The Globe also notes that other media sources have referred to the conflict as a civil war, including the Los Angeles Times, McClatchy, and The Christian Science Monitor. [Editor's note: Marshall Ingwerson, managing editor of The Christian Science Monitor, commented on the use of the term "civil war," saying, "We've often quoted people describing the fighting in Iraq as a civil war. But we have so far put qualifiers in front of the term when we use it ourselves, as a way of acknowledging that it's still a fuzzy judgment call, not a clearcut, yes-or-no definition."]

The Washington Post reports that UN Secretary General Kofi Annan says Iraq is not in a civil war situation, but it is very close to one, while Saudi Arabia is so worried about what is happening in Iraq that it “basically summoned” Vice President Dick Cheney for talks over the weekend.

Editor & Publisher reports that in an appearance on the CNN show Reliable Sources, CNN’s Iraq correspondent John Roberts said the situation there is far worse than the media has shown it to be.

The place is a mess. It’s an absolute mess. There is nowhere you can go in the Baghdad area as a Western journalist without an escort, where you could feel safe from being kidnapped, shot at, whatever. The amount of death that’s on the streets of Baghdad for US forces and for the Iraqi people is at an astronomical level …

Because television can’t – and even print – can’t fully capture the scope of what’s going on in Iraq. And to some degree, too, over the last three-and-a-half years, it’s become the daily traffic report, the daily drumbeat.

The Associated Press reports that Mr. Bush still says that the violence in Iraq is not a civil war. Rather, he says, it is actually part of an Al Qaeda plot to “use violence to goad Iraqi factions into repeatedly attacking each other.” He made the comments at a news conference with Estonian President Toomas Hendrik Ilves.

Bush, who travels to Jordan later in the week for a summit with Iraqi Prime Minister Nouri al-Maliki, said the latest cycle of violence does not represent a new era in Iraq. The country is reeling from the deadliest week of sectarian fighting since the war began in March 2003.

“We’ve been in this phase for a while,” Bush said.

But the president’s remarks were at odds with those of national security advisor Stephen Hadley who, AP reports, said that Iraq is in a “new phase characterized by an increase in sectarian violence” that does require change.

“Obviously everyone would agree things are not proceeding well enough or fast enough,” Mr. Hadley had told reporters on the flight to Estonia. Hadley also said he did not believe that Iraq had fallen into civil war, even if it had entered this new phase.

Agence France-Presse reports, however, that in Baghdad itself, residents don’t really care much about the argument of what to call the violence in their city.

For Iraqis the semantic question over whether the fighting meets the criteria of full scale warfare – a dispute revived this week by the decision of some media outlets to adopt the term – misses the point.

“If we wake up every morning to hear that 40 to 60 bodies have turned up here and there in Baghdad, civil war cannot be any different,” said Damis Abdullah, a Sunni Arab woman working in the culture ministry.

Nevertheless, most Iraqis who spoke to AFP on Tuesday said that while they feared new horrors lying in wait for their shattered country, civil war has not yet begun in earnest. They accused Iraq’s political leadership pushing a sectarian agenda that can only lead to more intense conflict between the armed Sunni and Shiite factions launching mortar barrages and bomb attacks in the divided capital.

Source: The Christian Science Monitor
http:www.csmonitor.com

Certified managers may reduce restaurant food hazards
Robert Roos News Editor

Nov 28, 2006 (CIDRAP News) – Restaurants that have a certified kitchen manager (CKM) seem to have a lower risk of serving food that triggers infectious illnesses, according to a study comparing restaurants that were involved in disease outbreaks with those that were not.

“We were much less likely to find a certified kitchen manager in a restaurant that experienced an outbreak,” said Craig W. Hedberg, PhD, lead author of the research report in the November issue of the Journal of Food Protection. He is an associate professor of environmental and occupational health in the University of Minnesota School of Public Health in Minneapolis.

Certified kitchen managers—those who have completed a food safety training course—are required in some states but not all, the researchers say.

Hedberg, along with researchers from the Centers for Disease Control and Prevention (CDC) and the University of Tennessee, examined 22 restaurants involved in disease outbreaks between June 2002 and June 2003 and 347 restaurants with no recent outbreaks. The study was a project of the CDC’s Environmental Health Specialists Network (EHS-Net), which covers all or parts of nine states.

“This was the first systematic attempt to look at the environmental evaluations in restaurants with outbreaks and compare that to a large body of similar data from restaurants with no indication of any outbreak going on,” Hedberg told CIDRAP News.

The researchers used a combination of interviews and direct observation to assess restaurant operations and policies related to food safety. Observers followed the preparation of certain food items, Hedberg said.

The EHS-Net specialists identified 107 restaurant-linked outbreaks in their areas (out of 179 outbreaks overall), but staff size limited the number investigated to 22. Nonoutbreak restaurants were defined as those with no history of outbreaks for the preceding 3 years and no complaints of food-related illness within the past year.

Outbreak and nonoutbreak restaurants were similar in many respects, but 71% of the nonoutbreak restaurants (243 of 347) had a CKM, versus 32% (7 of 22) of outbreak restaurants, the researchers found.

The findings “suggest that the presence of a CKM reduces the risk for an outbreak and was the major distinguishing factor between the outbreak and nonoutbreak restaurants,” the report says. In particular, CKMs seemed to be associated with a lower risk of outbreaks linked to norovirus and Clostridium perfringens, two of the three most common outbreak pathogens. Also, bare-hand contact with food was less likely to be a factor in outbreaks in restaurants that had CKMs.

Most restaurants, regardless of outbreak history, relied on on-the-job food safety training for workers, the authors found. They surmised that CKMs probably improved the quality of this training, leading to less bare-hand contact with ready-to-eat foods and better control of food temperatures.

However, in restaurants with outbreaks, the presence of a CKM didn’t seem to reduce the role of infected food handlers as contamination sources leading to the outbreaks, according to the report.

In addition, the researchers found that most restaurants had policies requiring food workers to report illnesses and barring staff members from working while sick, but those policies appeared to make little or no difference in the rate of outbreaks or in the role of infected food handlers as contamination sources. Most restaurants, both outbreak and nonoutbreak, did not offer sick leave for food workers.

The findings suggest that food safety training programs need to put more emphasis on managing food worker illnesses, the authors say. On the basis of previous studies on gastrointestinal illness, they estimate that 50,000 US food workers are likely to work while infected with norovirus.

Carol Selman of the CDC, senior author of the study, said the Food and Drug Administration (FDA) and the Conference for Food Protection, which advises the FDA, have recommended that all states require restaurants to have CKMs. She said the findings may help sway those who have been “on the fence” as to whether to adopt that requirement.

“It basically lent credence to what had been recommended by the FDA and the Conference for Food Protection,” Selman told CIDRAP News. She is a senior public health advisor in the division of emergency and environmental health services of the CDC’s National Center for Environmental Health in Atlanta.

However, while the findings suggest that CKMs may help prevent norovirus outbreaks, “the key determinant appears to be the presence of an infected food worker,” the researchers write. “This conclusion must be confirmed by further studies involving a larger series of outbreaks.”

Selman said EHS-Net is an offshoot of the CDC’s Foodborne Diseases Active Surveillance Network, or FoodNet, which collects data on all laboratory-diagnosed cases of common foodborne diseases in all or parts of 10 states. EHS-Net includes at least one environmental health specialist and one epidemiologist in each participating state or area, she said.

Hedberg said EHS-Net was set up to help explain some of FoodNet’s findings about exposure to foodborne pathogens, especially “a number of suggestions coming out of FoodNet that restaurants were playing an important role in the epidemiology of foodborne diseases.”

Previous studies have failed to find consistent links between restaurant inspection results and disease outbreaks, the authors say. Their study was designed to identify both system failures that led to outbreaks and underlying reasons for the failures.

Hedberg CW, Smith SJ, Kirkland E, et al. Systematic environmental evaluations to identify food safety differences between outbreak and nonoutbreak restaurants. J Food Protection 2006 Nov;69(11):2697-702 [Abstract]

Center for Infectious Disease Research & Policy
Academic Health Center — University of Minnesota
Copyright © 2006 Regents of the University of Minnesota

Source: CIDRAP News
http://www.cidrap.unm.edu

City faults Children’s on disease reporting
Orders training after lag over whooping cough
By Stephen Smith, Globe Staff | November 28, 2006

City health officials have ordered staff training at Children’s Hospital Boston to improve reporting of disease outbreaks — the first time the Boston Public Health Commission has ever issued such a mandate.

The action, detailed in a memo obtained by the Globe, is in response to the hospital’s failure last month to expeditiously notify the agency about an outbreak of whooping cough that eventually sickened 33 hospital employees. State law requires that such infectious disease clusters be reported within 24 hours, but Boston health authorities did not learn of the outbreak until several weeks later — and even then, only indirectly.

The move by the health commission is the most striking example of a yearlong push to make sure doctors, clinics, and hospitals abide by their responsibility to report cases of certain infectious diseases as soon as a diagnosis is made. The sooner public health agencies know about a hospital-based outbreak, specialists said, the sooner they can stem its spread into the community.

“If the physician waits too long to report, you miss the opportunity to prevent disease,” said Dr. Jeffrey S. Duchin , chief of communicable disease control in Seattle and a leading member of the Infectious Diseases Society of America . “The clinicians who see the patients are really the eyes and ears of the public health system.”

At the same time the order was sent to Children’s, the Boston health department issued memos to all of the city’s hospitals stressing the importance of prompt reporting, noting that “delayed notification of a recent infectious disease outbreak made it more difficult for us to take measures to contain its spread.”

Health commission officials said the delay in reporting by Children’s was especially troubling because some of the infected workers had second jobs at other medical facilities and could have exposed patients and staff there, although there is no evidence that the outbreak extended beyond the Longwood-area hospital.

A spokeswoman for Children’s, Michelle Davis , said the hospital has already taken steps since the outbreak of whooping cough to prevent a repeat of the reporting delay, including establishing redundancies in its notification system. The city’s order gives Children’s until Dec. 15 to submit a plan to educate staff on their legal responsibilities.

“My sense is that the public health department is going to be pleased with the way that we’re moving forward and attempting to comply with our reporting requirements,” Davis said. “We’re taking that responsibility seriously.”

Nationally and globally, a series of events during the past five years demonstrated the importance of intervening swiftly to arrest disease outbreaks.

First, in 2001, there were the anthrax attacks. Then, in 2003, SARS — severe acute respiratory syndrome — hopscotched from East Asia to Canada, taking root in a Toronto hospital.

Most recently, avian influenza has fueled fears of a global flu epidemic that could result in millions of human deaths.

Public health authorities in Massachusetts have increasingly recognized that physicians and medical institutions are not always complying with reporting laws, including in 2004, when Boston University waited nearly two weeks to report that three lab researchers had been exposed to the bacterium tularemia while conducting experiments.

In September, the public health commissioner in Worcester said authorities at St. Vincent Hospital did not alert him to a whooping cough outbreak until nearly three weeks after the first diagnosis. Whooping cough is also known as pertussis.

In Boston, the public health department in 2004 strengthened its rules governing disease reporting, providing $1,000 fines for lapses in reporting any case of more than 75 diseases, such as hepatitis, measles, and rabies. No fines have been levied so far.

“We did put a little bit of teeth into the regulation,” said Dr. Anita Barry , Boston’s director of communicable disease control. “If people continually fail to report and don’t have some kind of corrective action, then I think we’re really pushed into having to assign penalties just to get people’s attention.”

When health agencies get reports on disease outbreaks, they typically try to contain the disease by identifying other potential victims, giving them preventive treatment when possible and, when necessary, isolating them.

Barry said the public health commission did not learn of the outbreak at Children’s until Oct. 25, even though the hospital internally had identified and moved to contain a cluster of whooping cough cases by late September.

The health agency, Barry said, found out about the cases only when the state lab forwarded results of a positive pertussis test to a city nurse.

She followed up by dialing a telephone number on the report. “It was Children’s Hospital occupational health, and the response to our nurse was, ‘It’s just another case related to the outbreak,’ and our nurse said, ‘What outbreak?’ ” Barry recalled.

Stephen Smith can be reached at stsmith@globe.com.

Source: Boston.com Local News
http:/www.boston.com/news/articles/2006/11/28/city_faults_childrens_on_disease/reporting.