Yuzo Arima

Epidemiological update on the dengue situation in the Western Pacific Region, 2012.

Dengue has caused a substantial public health burden in the Western Pacific Region. To assess this burden and regional trends, data were collated and summarized from indicator-based surveillance systems on dengue cases and deaths from countries and areas in the Western Pacific Region. In 2012, dengue notifications continued to increase with 356,838 dengue cases reported in the Region (relative to 244,855 cases reported in 2011) of which 1248 died. In the Asia subregion, the notification rate was highest in Cambodia, the Philippines and the Lao Peoples Democratic Republic (316.2, 198.9 and 162.4 per 100,000 population, respectively), and in the Pacific island countries and areas, the notification rate was highest in Niue, the Marshall Islands and the Federated States of Micronesia (8556.0, 337.0 and 265.1 per 100,000 population, respectively). All four serotypes were circulating in the Region in 2012 with considerable variabilitiy in distribution. Regional surveillance provides important information to enhance situational awareness, conduct risk assessments and improve preparedness activities.

Avian influenza A(H7N9) and the closure of live bird markets.

WPSAR Vol 4, No 2, 2013 | doi: 10.5365/wpsar.2013.4.2.008 www.wpro.who.int/wpsar 1 a Division of Health Securities and Emergencies, World Health Organization Regional Offi ce for Western Pacifi c, Manila, Philippines. b World Health Organization, Geneva, Switzerland. c Emerging Diseases Surveillance and Response, World Health Organization, China Offi ce, Beijing, China. d Chinese Center for Disease Control and Prevention, Beijing, China. * Members of the World Health Organization Regional Offi ce for the Western Pacifi c Event Management Team: Nyka Alexander, Steve Bice, Joy Rivaca Caminade, Xavier Dufrenot, Emily Jane Fearnley, Alice Ruth Foxwell, Nori Isoda, Michelle McPherson, Zu Rongqiang, Tomoe Shimada. Submitted: 8 May 2013; Published: 21 May 2013 doi: 10.5365/wpsar.2013.4.2.008 On 31 March 2013, the National Health and Family Planning Commission, China notified the World Health Organization of three cases of human infection with avian influenza A(H7N9) from Shanghai and Anhui.1 By 8 May, 131 cases, including 26 deaths, had been notified from 11 provinces/ municipalities.1,2 The majority (81%) of reported cases were from Shanghai municipality and Zhejiang and Jiangsu provinces. Available data indicate that more than three quarters of cases (59/77, 76%) had recent exposure to animals. Among these, 58% (34/59) had direct contact with chickens and 64% (38/59) visited a live bird market (LBM).3 Provincial and national authorities in China have collected more than 80 000 samples from LBMs, poultry slaughter houses, poultry farms, wild bird habitats, pig slaughter houses and their environments. As of 7 May, 50 samples were positive for avian influenza A(H7N9): 39 samples from poultry from LBMs in Anhui, Jiangsu, Jiangxi, Guangdong, Shanghai and Zhejiang provinces (26 chickens, three ducks, four pigeons, six unknown) and 11 environmental samples from LBMs in Shanghai, Henan and Shandong provinces.4 None of the samples from poultry farms or pigs were positive.5

Asynchronous evolution of physiology and morphology in Anolis lizards.

Species‐rich adaptive radiations typically diversify along several distinct ecological axes, each characterized by morphological, physiological, and behavioral adaptations. We test here whether different types of adaptive traits share similar patterns of evolution within a radiation by investigating patterns of evolution of morphological traits associated with microhabitat specialization and of physiological traits associated with thermal biology in Anolis lizards. Previous studies of anoles suggest that close relatives share the same “structural niche” (i.e., use the same types of perches) and are similar in body size and shape, but live in different “climatic niches” (i.e., use habitats with different insolation and temperature profiles). Because morphology is closely tied to structural niche and field active body temperatures are tied to climatic niches in Anolis, we expected phylogenetic analyses to show that morphology is more evolutionarily conservative than thermal physiology. In support of this hypothesis, we find (1) that thermal biology exhibits more divergence among recently diverged Anolis taxa than does morphology; and (2) diversification of thermal biology among all species often follows diversification in morphology. These conclusions are remarkably consistent with predictions made by anole biologists in the 1960s and 1970s.

Human infections with avian influenza A(H7N9) virus in China: preliminary assessments of the age and sex distribution.

WPSAR Vol 4, No 2, 2013 | doi: 10.5365/wpsar.2013.4.2.005 www.wpro.who.int/wpsar 1 a Emerging Disease Surveillance and Response, Division of Health Security and Emergencies, World Health Organization Regional Offi ce for the Western Pacifi c, Manila, Philippines. b Emerging Disease Surveillance and Response, World Health Organization China Offi ce, Beijing, China. * Members of the World Health Organization Regional Offi ce for the Western Pacifi c Event Management Team: Nyka Alexander, Jang Hwan Bae, Joy Rivaca Caminade, Erica Dueger, Xavier Dufrenot, Norikazu Isoda, Frank Konings, Chin-Kei Lee, Ailan Li, Michelle McPherson, Satoko Otsu, Karl Schenkel and Huu Thuan Vo. Submitted: 13 April 2013; Published: 20 April 2013 doi: 10.5365/wpsar.2013.4.2.005 Since 31 March 2013, the Government of China has been notifying the World Health Organization (WHO) of human infections with the avian influenza A(H7N9) virus,1 as mandated by the International Health Regulations (2005).2 While human infections with other subgroups of H7 influenza viruses (e.g. H7N2, H7N3 and H7N7) have previously been reported,3 the current event in China is of historical significance as it is the first time that A(H7N9) viruses have been detected among humans and the first time that a low pathogenic avian influenza virus is being associated with human fatalities.4 In this rapidly evolving situation, detailed epidemiologic and clinical data from reported cases are limited—making assessments challenging— however, some key questions have arisen from the available data. Age and sex data, as one of the first and Human infections with avian infl uenza A(H7N9) virus in China: preliminary assessments of the age and sex distribution

Incidence of dengue virus infection among Japanese travellers, 2006 to 2010

INTRODUCTION Dengue continues to be a global public health concern. In Japan, although dengue cases are currently seen only among travellers returning from endemic areas, the number of reported cases is rising according to the national case-based surveillance system. We evaluated the characteristics of dengue cases imported into Japan and the relationship between the incidence of infection and season of travel to popular destinations. METHODS Dengue cases reported to the national surveillance system were retrospectively examined. The number of reported cases per number of Japanese travellers to a dengue-endemic country was calculated to estimate the country-specific incidence of imported dengue virus infection. The incidence of dengue infection among Japanese travellers was compared between dengue high season and low season in each country using relative risk (RR) and associated 95% confidence intervals (CI). RESULTS Among 540 Japanese residents who were reported as dengue cases from 2006 to 2010, the majority had travelled to Indonesia, India, the Philippines and Thailand. The RR of dengue infection among Japanese travellers during dengue high season versus low season was 4.92 (95% CI: 3.01-8.04) for the Philippines, 2.76 (95% CI: 1.67-4.54) for Thailand and 0.37 (95% CI: 0.15-0.92) for Indonesia. DISCUSSION Overall, higher incidence of imported cases appeared to be related to historic dengue high seasons. Travellers planning to visit dengue-endemic countries should be aware of historic dengue seasonality and the current dengue situation.

Sex, gender and emerging infectious disease surveillance: a leptospirosis case study.

WPSAR Vol 3, No 3, 2012 | doi: 10.5365/wpsar.2012.3.3.001 www.wpro.who.int/wpsar 1 a Emerging Disease Surveillance and Response, Division of Health Security and Emergencies, Western Pacifi c Regional Offi ce, World Health Organization, Manila, Philippines. Submitted: 1 June 2012; Published: 2 August 2012 doi: 10.5365/wpsar.2012.3.3.001 Whatever the population, wherever the place, whenever the period, sex has been an essential demographic variable for surveillance. However, the distinction between “sex” and “gender” has not always been well understood or acknowledged by those of us engaged in public health surveillance. Sex refers to the biological and physiological factors that define males and females, while gender refers to socially constructed roles and attributes that a particular society considers appropriate for men and women.1 While both sex and gender factors contribute to reported surveillance data, their full contributions are often not recognized. When such data are then used to ascertain sex/gender differential in disease risk without caution, the complete picture behind the observed distribution may be missed or misinterpreted. Using leptospirosis as a case example, we describe the importance of interpreting surveillance data with a Sex, gender and emerging infectious disease surveillance: a leptospirosis case study

Ongoing increase in measles cases following importations, Japan, March 2014: times of challenge and opportunity.

WPSAR Vol 5, No 2, 2014 | doi: 10.5365/wpsar.2014.5.2.001 www.wpro.who.int/wpsar 1 a Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan. b Department of Virology 3, National Institute of Infectious Diseases, Tokyo, Japan. Submitted: 1 April 2014; Published: 16 May 2014 doi: 10.5365/wpsar.2014.5.2.001 Ongoing increase in measles cases following importations, Japan, March 2014: times of challenge and opportunity

Assessment of gender distribution in dengue surveillance data, the Lao People's Democratic Republic.

OBJECTIVE Adolescent and young adult males account for a large proportion of dengue cases reported through national surveillance systems in the Western Pacific Region. To preliminarily assess the validity of these observed distributions, a field investigation was conducted in the Lao Peoples Democratic Republics Savannakhet Province in November 2011. METHODS Mixed quantitative and qualitative methods were used. Dengue surveillance data from Savannakhet Province, and aggregate hospital admission data from the Savannakhet Provincial Hospital for outpatients and inpatients were analysed by age and sex. Unstructured informal interviews were conducted with local health care workers, primary and secondary school officials and villagers. RESULTS An excess of males was found among reported dengue cases in Savannakhet Province in the 15-49 year age group. Females in the same age group, however, were found to access health care more than their male counterparts. Qualitative assessments attributed this distribution to young females being more health-conscious and having greater health care-seeking behaviour. DISCUSSION The excess of male dengue cases in the surveillance data appeared to be associated with a truly higher risk of dengue rather than greater health care access or health care-seeking behaviour by young men. This investigation indicated the importance of assessing the reported surveillance data within the context of health care utilization behaviour of the population under surveillance.

Disclosure of Genital Human Papillomavirus Infection to Female Sex Partners by Young Men

A survey was administered to male university students who tested positive for high-risk human papillomavirus. Disclosure was more likely in men with fewer partners, in main partnerships, and in longer partnerships. Disclosure was associated with discussing the Pap test/human papillomavirus vaccine with female partners and not associated with a worsening relationship.

Epidemiology of Domestically Acquired Amebiasis in Japan, 2000–2013

Notifications of amebiasis have been increasing in Japan. Using national surveillance data during 2000-2013, reported cases of amebiasis were analyzed. A case of amebiasis was defined as laboratory-confirmed Entamoeba histolytica infection, regardless of presence of symptoms. We described temporal trends and analyzed correlates of asymptomatic versus symptomatic cases based on odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression. Of 9,946 cases reported during 2000-2013, 7,403 were domestic cases. During this period, the proportion of domestic cases increased from 63% to 85%. Among male cases, majority were middle aged, and from 2008, the number of cases attributed to heterosexual contact surpassed that of homosexual contact. During 2010-2013, increase in notifications was associated with asymptomatic cases, colonoscopy diagnosis, and males with unknown or heterosexual route of infection. Among males, colonoscopy (OR = 31.5; 95% CI = 14.0-71.0) and cases with unknown route of infection, relative to homosexual contact (OR = 2.2; 95% CI = 1.3-3.9), were associated with asymptomatic infections in multivariate analysis. Although the recent rise may have been due to enhanced detection by colonoscopy or reporting, the large number of asymptomatic cases, with reportedly unknown or heterosexual route of infection, has led to a better understanding of amebiasis in Japan and highlights the potential public health concern.