In This Issue:

November 23, New York Times- C.D.C. Proposes New Rules in Effort to Prevent Disease Outbreak

Federal officials yesterday proposed the first significant changes in quarantine rules in 25 years in an effort to broaden the definition of reportable illnesses, to centralize their reporting to the federal government and to require the airline and shipping industries to keep passenger manifests electronically for 60 days. The proposals would also clarify the appeals process for people subjected to quarantines to allow for  administrative due process and give health officials explicit authority to offer vaccination, drugs and other appropriate means of prevention on a voluntary basis to those in quarantine. The proposals could cost the beleaguered airline industry hundreds of millions of dollars, officials of the Centers for Disease Control and Prevention said. The officials are inviting public comment on the proposals, which are to be published in the Federal Register on Nov. 30, they told reporters in a telephone news conference. The proposals are part of a broader Bush administration plan to improve the response to current and potential communicable disease threats that may arise anywhere in the world. If adopted, the new regulations "will allow the C.D.C. to move more swiftly" when it needs to control outbreaks, said Dr. Martin Cetron, who directs the agency's division of global migration and quarantine. The outbreak of severe acute respiratory syndrome (SARS) in 2003 underscored how fast a disease could spread through the world and the need to modernize and strengthen quarantine measures by pointing out gaps in health workers' ability to respond quickly and effectively, Dr. Cetron said. As the C.D.C. joined with cooperative airlines to meet flights and later collect information about passengers who had contact with others who developed SARS, the epidemiologists had to compile and process by hand data collected from flight manifests, customs declarations and other sources. But manifests contained only the name and seat number; customs declarations were illegible, and when readable, the names did not match those on the manifests. "The time required to track passengers was routinely longer than the incubation period," which was two to 10 days for SARS, Dr. Cetron said. "That was really quite shocking," Dr. Cetron said. One proposed change would require airline and ship manifests to be kept electronically for 60 days and made available to the C.D.C. within 12 hours when ill passengers arrive on international and domestic flights. The proposed changes include provisions for maintaining confidentiality and privacy of health information. The outbreak of SARS was stopped in part because of quarantines imposed in some affected countries. Quarantine restricts the movement of a healthy person exposed to someone who has a communicable disease. The quarantine period is determined by the usual length of time that passes from exposure to an infectious agent to the onset of illness. An executive order of the president limits quarantine to nine diseases: cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers like Ebola, SARS and influenza caused by new strains that could cause a pandemic.




November 21, UCSD- UCSD Engineers, Physicians Test Wireless Technologies in Car Bomb Drill


In Joni Mitchell’s Big Yellow Taxi, “they paved paradise and put up a parking lot.” In San Diego last week, the big yellow taxi was in the parking lot – until emergency officials detonated a car bomb that destroyed the taxi and sent plumes of charcoal-gray smoke billowing into the clear blue sky over the Del Mar Fairgrounds. The explosion triggered a six-hour disaster drill simulating the aftermath of a car bomb attack and accidental release of lethal chemicals. The scenario assumed 25 fatalities and 125 injured. The drill brought together roughly 1,100 emergency officials, first responders, volunteer ‘victims’ and nearly two dozen researchers and staff from UCSD and the California Institute for Telecommunications and Information Technology (Calit2). The UCSD team is part of the Wireless Internet Information System for Response in Medical Disasters (WIISARD), a $4 million project funded by the National Institutes of Health’s National Library of Medicine. The Del Mar disaster drill was the latest and largest to be staged by San Diego’s Metropolitan Medical Strike Team (MMST). For fire, police, hazardous materials, SWAT and other first responders, the goal of the joint exercise was to practice working together in a crisis environment in order to be better equipped to respond in case a real disaster strikes. “This is the first time that WIISARD technologies have been integrated in every aspect of the medical response in a disaster drill,” says MMST medical director Theodore Chan, a professor of clinical medicine at UCSD. “The biggest lesson was probably that responders took very well to the new technology,” says professor of medicine Leslie Lenert, principal investigator on the WIISARD project and associate director of Calit2’s UCSD Division for biomedical informatics. “Now we need to work on ways for managers to react to that data and get the knowledge into the decision-making process.”


November 23, OC Register- CDC seeks authority

Citing a need to protect Americans from bird flu and other diseases, U.S. health officials Tuesday proposed regulatory changes requiring airlines and shipping firms to hand over passenger and crew lists on demand and expand how they report serious illnesses. The changes would apply to planes and ships arriving from outside the United States as well as some domestic flights, according to the Centers for Disease Control and Prevention, which proposed the regulatory overhaul. The Atlanta-based CDC, the federal agency responsible for monitoring and responding to health threats, also said it wanted authority to vaccinate and treat quarantined people and a clear set of defined legal rights for those quarantined. It noted that the quarantine powers would generally only be used in situations where a person posed a threat to public health and refused to cooperate with a voluntary request to be isolated. In addition, pilots and ship captains would only be required to report passengers or crew who showed symptoms of certain serious infectious diseases, such as cholera, yellow fever and SARS. The proposals come amid growing concern around the world over the spread of bird flu from Asia. The virus cannot yet easily infect people, but it has killed at least 67 people in five Asian nations since late 2003. Bird flu has yet to surface in the United States. The CDC, however, does not want to wait until emerging infections take root before plugging what it sees as gaps in the regulations governing control of communicable diseases. These rules have not been substantially revised for 25 years. The agency learned a lesson during the SARS outbreak of 2003 when problems getting passenger information from airlines stymied its efforts to trace the contacts of those who had been infected. One of its new proposals, which will be open to public comment for two months, calls for airlines and cruise lines to submit passenger and crew lists electronically at its request.


November 23, Los Angeles Times-China Has 2nd Human Death From Bird Flu

BEIJING -- China on Wednesday reported its second confirmed human death from bird flu, while tests showed a teacher who fell ill elsewhere in the country does not have the H5N1 bird flu virus.
China's Health Ministry said Wednesday that the latest fatality -- a 35-year-old farmer identified only by her surname, Xu -- died Tuesday after developing a fever and pneumonia-like symptoms following contact with sick and dead poultry.  The woman tested positive for the H5N1 virus, the official Xinhua News Agency said, citing the Chinese Center for Disease Control and Prevention
.  The woman lived in Xiuning County in the eastern province of Anhui, Xinhua said. It gave no further details.  China's first confirmed bird flu death was also a woman from Anhui.  The country's only other confirmed bird flu case was a 9-year-old boy in the central province of Hunan, who fell ill but recovered. His 12-year-old sister was recorded as a suspected case, and later died. However, her body was cremated before tests could confirm whether she had the virus.  A World Health Organization official on Wednesday said blood tests on a schoolteacher who fell sick in the same area showed that he didn't have bird flu.  "Based on an extensive range of blood tests, he's been excluded as a case of H5N1," said Dr. Julie Hall, an infectious diseases specialist for WHO's Beijing office.  The government said the teacher, 36, became ill after handling raw chicken. He lived in rural Wangtan village in Hunan, which suffered one of China's first bird flu outbreaks in the recent series of cases.  Hall said the children in Hunan were probably infected by handling sick chickens -- which lived on the first floor of the family's rural home -- and not because they ate infected meat, as had been reported by Chinese state media.  The WHO announcement came after China reported three new bird flu outbreaks in poultry. Such outbreaks have been reported almost daily despite a nationwide effort to vaccinate billions of poultry. The latest were in the northwestern cities of Urumqi and Yinchuan, and in the southern province of Yunnan. A total of 2,768 birds died and nearly 175,000 were destroyed to contain the virus.  Health experts had warned that human cases were inevitable if poultry outbreaks could not be stopped. Also Wednesday, Xinhua said China will test 100 people with a vaccine hoped to protect against H5N1. There is currently no human vaccine. The report gave no other details, but said the vaccine had already been tested on minks, chickens and rats.  It is "safe and effective," Yin Weidong, general manager of Sinovac Biotech, one of the developers, was quoted as saying. Sinovac Biotech and China's Center for Disease Control and Prevention jointly developed the vaccine, which uses a modified version of the bird flu virus from WHO, Xinhua said.,1,716696.story?coll=sns-ap-tophealth&ctrack=1&cset=true