Please send items of interest for the E-News -- and any other feedback -- to E-News editor Dave Cundiff, MD, MPH. Thanks!

CONTENTS:

1) Avian Influenza Update:

Widespread outbreaks of highly pathogenic avian influenza H5N1 (HPAI H5N1), or viruses initially indistinguishable from it, were noted in birds across China this week. A few, apparently sporadic, human cases were noted. Confirmed human cases have not been seen outside Vietnam, Indonesia, Thailand, Cambodia, and China.

A noted Japanese researcher was widely quoted as saying there were many more human cases in China than officially reported. Chinese officials and the WHO denied this. The researcher now says he was misquoted.

China doesn't seem to be achieving much control of HPAI H5N1 from vaccinating birds. Chinese authorities blame vaccination failures primarily on the large quantities of counterfeit vaccines that are allegedly being marketed to Chinese farmers.

China's reliance on avian vaccination to control influenza in birds is scientifically controversial. Veterinary epidemiologists differ in their assessment of whether such a strategy is technically feasible.

Many official sources blame HPAI H5N1 outbreaks on "contact with wild birds". Few data are usually available to support or refute this claim. Both domestic and wild ducks can serve as asymptomatic reservoirs for HPAI H5N1. While direct contact or ingestion appears to be required in order to transmit HPAI H5N1 to humans, fomites can transmit HPAI H5N1 among birds.

Most scientists appear to believe that wild bird culling, or wild bird habitat disruption, would probably not produce any substantial economic or human-health benefits. However, some countries have moved most domestic poultry indoors, decreasing reliance on "free-range" agriculture.

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CDC's Clinician Outreach and Communication Activity (COCA) plans a 90-minute conference call on TUESDAY, DECEMBER 6, 2005, from 1:00 to 2:30 pm Eastern Time. Scott F. Dowell, MD, MPH, director of CDC's Global Disease Detection unit, will speak. PowerPoint slides for the call will be available at http://www.bt.cdc.gov/coca/callsummary.asp .

The teaching objectives for Dr. Dowell's call are as follows: "Following this presentation, the participant will be able to (1) Update on current status of avian influenza, vaccine research, treatment options, and geographic distribution; (2) Describe the possible risk of avian influenza coming to the United States in the next 1-2 years; and (3) Describe the differences between avian and seasonal flu."

The call-in number for Dr. Dowell's "Avian Influenza" call is (888) 282-0428 and the Pass Code is "Influenza". Please call early (anytime after 12:30 pm EST) to assure yourself of a place on the call, and to help assure that everyone completes the operator-mediated login procedures before 1:00 pm.

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2) "Notes" on MCH Statistics and on Lymphoma Risks:

AAPHP member Don MacCorquodale, MD, MSPH sent a new issue of "Notes Washed Up in a Bottle". This issue discusses the latest U.S. statistics on maternal and infant health, and two case-control studies on risk factors for non-Hodgkin's lymphoma.

U.S. maternal health statistics for 2004 showed no significant change in late prenatal care from 2003 to 2004, and only a slight decline (10.4% to 10.2%) in smoking during pregnancy. Cesarean deliveries rose to a record rate of 29.1%, and the rate for vaginal birth after Cesarean section dropped by 13% in a year. The preterm birth rate has climbed 18% since 1990, reaching the highest point since comparable data became available in 1981.

A large case-control study of non-Hodgkin's lymphoma (NHL) in Denmark and Sweden examined the association between medication use and various NHL subtypes. No association was found with most medication/subtype combinations -- but higher lifetime use of antibiotics was associated with increased risk for all subtypes of NHL.

An Australian case-control study of NHL cases and of controls from the Australian "electoral rolls" showed a statistically significant difference in "substantial" pesticide exposure, which was seen in 4% of cases and only 1% of controls.

This issue of "Notes Washed Up in a Bottle" is at http://www.aaphp.org/bottle/2005/nov26.htm . Past "Notes" are indexed at http://www.aaphp.org/bottle/allnotes.htm .

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3) Core Disaster Life Support Course - Register This Week:

SUNDAY, DECEMBER 4, 2005 is the pre-registration deadline for the AMA's Core Disaster Life Support program, to be held at the APHA Annual Meeting in Philadelphia, Pennsylvania, on Sunday 2005-12-11, from 2:30 to 6:30 pm Eastern Time.

Everyone attending the CDLS Course is strongly encouraged to pre-register, in order to assure enough seats and materials for all.

AAPHP members may take the CDLS course without charge, whether or not they are also registered for the APHA Annual Meeting, IF THEY PREREGISTER for CDLS by 2005-12-04.

Pre-registrants will be assured admission if they arrive by 2:30 pm. "Walk-in" registrants from the APHA Annual Meeting will be admitted if space and materials are available.

Registration forms are available in either PDF or Microsoft Word format at http://www.aaphp.org/Meetings/fall05apha.htm . If you have trouble downloading or sending the form, please contact the AAPHP Secretary, cundiff@reachone.com .

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Pre-registration is not required for the AAPHP General Membership Business Meeting in Philadelphia on Sunday morning 2005-12-11. The AAPHP Business Meeting will be held from 10:30 to 11:30 am, at the Philadelphia Marriott Downtown Hotel, Room 301. The business agenda will be published in E-News and on the Web before the meeting.

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4) Job Postings and Featured Jobs:

The AAPHP/ACPM Job Market Initiative (JMI) Web page at http://www.aaphp.org/JobMarket/PHP_positions.asp currently shows 181 jobs and training opportunities where job performance would benefit from BOTH a physician's biomedical knowledge AND the additional skills and experience of a Preventive Medicine physician. Among the current listings, at least two jobs deserve special mention.

Texas is recruiting a PHYSICIAN II - STATE EPIDEMIOLOGIST and has placed a free "Full Page Ad" at http://www.aaphp.org/Jobs/2005/Nov/112205txstateepi.htm . Texas requires Board Certification in a relevant specialty; Public Health and Preventive Medicine are the first in that list of specialties.

Pennsylvania's ad for a DIRECTOR, BUREAU OF EPIDEMIOLOGY is at http://www.aaphp.org/Jobs/2005/Nov/112105padirepi.htm , with an application deadline of 2005-12-23.

When hiring for suitable positions, please consider specifying your preference for a physician with training and experience in Public Health and/or Preventive Medicine.

JMI's "Full Page Ads" are free to employers and are posted as a service to our specialty. Job announcements in Word format, approximately one page in length, may be sent to JMI Chair Joel L. Nitzkin, MD, MPH, DPA, at jln@jln-md.com .

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5) After-Action Notes from Hurricane Wilma:

AAPHP Vice President Kevin M. Sherin, MD, MPH recently returned to Orlando from service in South Florida, where he helped manage state and federal medical relief efforts for the Florida Department of Health after Hurricane Wilma. He and his team surveyed communities, set up tetanus clinics, performed medical surveillance, and provided primary care. They saw and heard of numerous cases of orthopedic injuries, abrasions, lacerations, mold exposures, asthma exacerbations, and post-traumatic stress disorder.

Dr. Sherin shared the following comments, which he emphasizes are his personal opinions and NOT those of the Florida Department of Health:

First, when selecting shelters for Persons with Special Needs, including those with medical and developmental problems, remember the disadvantages of a modern hotel. Frail, overheated, chronically ill elderly patients needed an air-conditioned place. A hotel appeared to be the only suitable facility. Patients were transferred to this hotel. Once there, some patients locked themselves into the rooms with the auxiliary door latch. Many of the locked-in patients were hard of hearing, so they couldn't hear phone calls or knocks on the door. This created significant confusion and could have been dangerous. Because hotels may have other significant advantages and they may be the only facilities available, public health officials should be prepared to manage the patient-access challenges of hotel security systems when evacuations are ordered.

Second, detailed Federal review of assistance requests can be perceived as inefficient by state and local personnel, and can hamper the response "in the field" to the unexpected complications of a disaster event. Pre-event relationship building may allow higher trust levels, which should result in a more efficient response.

Third, federally funded entities, including Federally Qualified Health Centers, did not respond consistently to Hurricane Wilma. Public Health officials should build relationships with healthcare entities before a disaster strikes, so that private clinics and health departments may confidently call on each other for assistance in a crisis.

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6) Animal Health, Applied Ecology, and Human Health:

The 2005-11-26 issues of both the British Medical Journal ( BMJ ) and the British Veterinary Association's The Veterinary Record focus on the inter-relationship of animal health and human health. On-line access to both journals is free: BMJ at http://bmj.bmjjournals.com/content/vol331/issue7527/ and The Veterinary Record at http://veterinaryrecord.bvapublications.com/content/vol157/issue22/ .

The BMJ editorial explaining the shared theme is at http://bmj.com/cgi/content/full/331/7527/0-f . Excerpts:

"The threat of an influenza pandemic in humans and the deaths of millions of birds around the world brings the link between human and animal health sharply into focus. Now is a good time to consider the wider connections between animal and human health and to think about how the medical and veterinary professions might work more closely together for the benefit of patients of all species."

"When doctors think about the relation between animals and human health, they tend to focus mainly on the hazards animals pose to humans. But humans pose threats to animals too—emerging diseases can do terrible damage to wildlife and domesticated animals. Animals can also benefit human health and wellbeing in many ways—for example, as pets, in therapy for depression, and even through human involvement in wildlife conservation projects."

"There is some fruitful cross fertilisation of ideas between the two professions on the subject of eradication programmes, ethics in clinical practice, and the UK government's response to animal and human health issues."

"The Veterinary Record this week looks at the threat from emerging diseases, and the lessons being learnt internationally. It considers steps being taken to improve surveillance and to identify and assess the risks of new diseases as they emerge. Other articles compare approaches to professional training and clinical audit."

"We would welcome feedback and hope that readers of both journals will join our one hour web chat at 4 pm local UK time on Thursday 1 December. Go to http://quest.bmj.com/chat to register, read the rules of engagement, and suggest themes the webchat might explore."

[Editor's Note: The BMJ Webchat site gives North American times for the 2005-12-01 Webchat as 11 am to noon EST (8 to 9 am PST).]

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The 2005-11-14 issue of Newsweek included an interview on "Tracking Disease" from a wildlife biologist's perspective. Mary Pearl, president of the New York-based organization Wildlife Trust ( http://www.wildlifetrust.org ) discusses findings of the Trust's Consortium for Conservation Medicine ( http://www.conservationmedicine.org ).

Mary Pearl relates that, "Damaged ecosystems … create conditions for pathogens to move in ways they wouldn't normally move." She notes the dramatic increases in mosquitoes when Peruvian rain forests are cleared. She also discusses the proliferation of Lyme disease when suburban development displaces forest species other than mice. Since mice are more efficient Lyme disease hosts and transmitters than the displaced animals, the Lyme bacterium is more commonly found in the New York City suburbs than in the rural Adirondacks.

Ms. Pearl also discusses disease transmission from humans (and their pets) to wildlife. Her interview concludes, "I foresee the time when departments of public health will have conservation-medicine specialists. It's rare for diseases to jump between species. But we can look for hot spots in landscapes, where problems are likely to arise."

The full text of Ms. Pearl's interview is at http://www.msnbc.msn.com/id/9936993/ .

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Finally, an upcoming event, which we heard about from the Association of Schools of Public Health ( http://www.asph.org ):

“Human Health and Animal Disease: An Epidemiologic Collision?,” an all-day symposium from the Office of Public Health Practice at the University of Michigan School of Public Health will take place in Ann Arbor, Mich. on January 24, 2006. The symposium will be Web cast live. A list of speakers is available at http://www.sph.umich.edu/micphp/pdf/Save.the.Date.1.24.06.pdf .

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7) CDC Names Public Health Physicians as Center Directors:

Recently received from the U.S. Centers for Disease Control:

"Centers for Disease Control and Prevention (CDC) Director Dr. Julie Gerberding announced today the appointment of new directors for three key organizational components of the federal agency responsible for protecting the nation's health.

“'These individuals are outstanding scientists and will strengthen the agency's scientific foundation on all fronts. They all bring tremendous skills that will build on the strong foundation of outstanding leadership to help CDC meet the daily challenges to make our nation safer and healthier,' Dr. Gerberding said.

" The announcement of these key positions marks another important step forward in the transformation of CDC that began two years ago.  These new appointments will play a key role in helping to further shape the agency's Coordinating Center for Infectious Diseases, and will move us closer to achieving our vision of a stronger more resilient CDC.

" The appointments include Anne Schuchat, M.D., as director of the National Immunization Program.  Dr. Schuchat began her career at CDC as an Epidemic Intelligence Service (EIS) Officer in 1988 and most recently served as the Acting Director of the National Center for Infectious Diseases. She has made critically important contributions to prevention of infectious diseases in children, including her role in group B streptococcal disease prevention, where she spearheaded the development of CDC's guidelines which have led to an 80% reduction in newborn infections and a 75% narrowing of racial disparity in this infectious disease. She also has been instrumental in pre- and post-licensure evaluations of conjugate vaccines for bacterial meningitis and pneumonia and in accelerating availability of these new vaccines in resource poor countries through WHO and the Global Alliance for Vaccine and Immunization.

" In a second appointment, Rima Khabbaz, M.D., was named as the director of the National Center for Infectious Diseases (NCID).  Dr. Khabbaz began her career at CDC as an EIS Officer in 1980 and most recently served as Acting Deputy Director of NCID.  She has worked in research and epidemiology of hospital acquired infections, viral diseases and played a leading role in coordinating CDC's programs around blood safety, food safety as well as emerging infectious diseases. She has played critical roles in CDC's responses to bioterrorism, outbreaks of new diseases, and infectious disease responses to natural disasters.

" In addition, Kevin Fenton, M.D., Ph.D., was named director of the National Center for HIV, STD, and TB Prevention (NCHSTP).  Dr. Fenton has served as Chief of CDC's National Syphilis Elimination Effort since January 2005.  He has worked in research, epidemiology, and the prevention of HIV and other STDs since 1995 and was previously the Director of the HIV and STI Department at the United Kingdom's Health Protection Agency. Dr. Fenton has spearheaded the development of a number of national HIV, STD and behavioral surveillance and research programs in the U.K and Western Europe including the National Chlamydia Screening Programme in England, the 2nd British National Survey of Sexual Attitudes and Lifestyles and the European Surveillance of STI (ESSTI) Network.

" The experienced leadership, scientific expertise, and innovative ideas these directors bring to their new roles will help ensure that CDC achieves the goal of positioning the centers for greater efficiency and even greater public health impact."

(Announcement from Mitchell L. Cohen, M.D., Director, Coordinating Center for Infectious Diseases, U.S. Centers for Disease Control and Prevention)

AAPHP congratulates Drs. Schuchat, Khabbaz, and Fenton on their new positions!

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8) Membership/Contribution Update:

Thanks to Ellen S. Alkon, MD, MPH; Virginia M. Dato, MD, MPH; William Greaves, MD, MSPH; Mark J. Magenheim, MD, MPH; Joseph Murphy, MD, BSH; Marie-Claude Rigaud, MD; Marion Warwick, MD, MPH; Neil E. Winston, MD; and Quentin Young, MD, MS, for joining or renewing AAPHP membership since the last update.

Thanks to AAPHP Lifetime Member Donald S. Kwalick, MD, MPH for a generous contribution, in addition to Lifetime dues previously paid.

AAPHP's 2006 membership form is available at http://www.aaphp.org/Membership/2006MembershipForm.pdf . Medical students and residents (in any specialty) may join AAPHP without charge for 2006 and 2007. Other physicians may join or renew at the 2005 dues level until 2005-12-15.

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9) Acknowledgements and Technical Notes:

In addition to sources cited above, AAPHP thanks the ProMED-Mail service of the International Society for Infectious Diseases ( http://www.promedmail.org ) for much of this week's material on avian influenza. Thanks also to AAPHP Webmaster Kim Buttery, MD, MPH; David R. Johnson, MD, MS; and AAPHP Vice President Kevin M. Sherin, MD, MPH, for sending additional material summarized in this issue.

Because of the new process of moderation and message approval, the E-mailed version of the 2005-11-20 AAPHP E-News had a blank subject line, and it lacked the usual line spacing between paragraphs. This may have made the E-News harder to read. New procedures should restore the subject line and improve the appearance of future E-News issues. (Thanks again to AAPHP member Virginia M. Dato, MD, MPH for technical assistance.)

The 2005-11-20 AAPHP E-News can be viewed with its intended formatting on the Web at http://www.aaphp.org/Bulletins/news2005/nov20.htm . Please E-mail the editor at cundiff@reachone.com if you would like us to E-mail you a replacement copy of the 2005-11-20 issue.

Dave Cundiff, MD, MPH ( cundiff@reachone.com )

AAPHP Secretary and E-News Editor

9) Acknowledgements and Technical Notes:

In addition to sources cited above, AAPHP thanks the ProMED-Mail service of the International Society for Infectious Diseases ( http://www.promedmail.org ) for much of this week's material on avian influenza. Thanks also to AAPHP Webmaster Kim Buttery, MD, MPH; David R. Johnson, MD, MS; and AAPHP Vice President Kevin M. Sherin, MD, MPH, for sending additional material summarized in this issue.

Because of the new process of moderation and message approval, the E-mailed version of the 2005-11-20 AAPHP E-News had a blank subject line, and it lacked the usual line spacing between paragraphs. This may have made the E-News harder to read. New procedures should restore the subject line and improve the appearance of future E-News issues. (Thanks again to AAPHP member Virginia M. Dato, MD, MPH for technical assistance.)

The 2005-11-20 AAPHP E-News can be viewed with its intended formatting on the Web at http://www.aaphp.org/Bulletins/news2005/nov20.htm . Please E-mail the editor at cundiff@reachone.com if you would like us to E-mail you a replacement copy of the 2005-11-20 issue.

Dave Cundiff, MD, MPH ( cundiff@reachone.com )

AAPHP Secretary and E-News Editor

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This message is an electronic update from the American Association of Public Health Physicians (AAPHP) to public health physicians.
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