The Pandora Report 11.8.13

Highlights include MERS in Spain and Abu Dhabi, a possible H1N1 fatality in Alaska, polio potentially spreading to Europe, and differing containment strategies for H5N1 outbreaks in Cambodia and Vietnam. Be sure to check out this week’s “Delving Deeper”, in which GMU Biodefense’s Yong-Bee Lim explores the threats and challenges of synthetic biology. Happy Friday!

MERS in Spain; Abu Dhabi

Both Spain and Abu Dhabi have identified their first cases of the Middle Eastern Respiratory Virus (MERS). The Spanish case involved a Moroccan citizen who lives in Spain and recently returned from hajj-related travel to Saudi Arabia. Health officials with Spain and the WHO are attempting to determine if the patient was treated in Saudi Arabia, whether she had contact with animals, and whether she flew commercially or by private plane (hopefully the latter). In Abu Dhabi, a 75-year-old Omani man has contracted the virus – it remains unclear where or how he became infected. In both cases, concerns over infection stemming from contact during the Muslim pilgrimage of hajj remain. If the two cases do involve hajj-related transmission, we may start to see similar cases popping up in regions with no prior incidence of the virus (North America, anyone?)

Spain reports its first MERS case; woman travelled to Saudi Arabia for Hajj

Vancouver Sun – “In its press release, the ministry said it is following up with people who were in contact with [the patient] to determine if others have contracted the sickness. That will likely involve tracking people who travelled on the same plane or planes with the ill woman, who journeyed back to Spain shortly before being hospitalized. The woman was already sick before she left the Kingdom of Saudi Arabia, a World Health Organization expert said Wednesday. ‘She became symptomatic while she was in KSA,’ said Dr. Anthony Mounts, the WHO’s point person for the new virus, a cousin of the coronavirus that caused the 2003 SARS outbreak.

Mers coronavirus diagnosed in patient in Abu Dhabi hospital

The National (UAE) – “The victim, who was visiting the UAE, began to suffer from respiratory symptoms last month and is now in intensive care. The diagnosis of Middle East respiratory syndrome was revealed by the Health Authority Abu Dhabi today, reported the state news agency Wam. The health authority is coordinating with the Ministry of Health and other organisations as it treats the patient. The authority said it had taken the necessary precautionary measures in line with international standards and recommendations set out by the World Health Organisation (WHO).”

H1N1 Fatality in Alaska?

A young adult patient in Anchorage has died from what is thought to be the 2009 strain of H1N1. According to Alaskan health officials, it is still too early to tell if H1N1 will be the dominant strain for their flu season – however, the majority of flu cases reported to health officials in the area involved the H1N1 strain. People, even sometimes young, healthy people, die of flu – get vaccinated.

Alaska Dispatch – “The hospital sent out an email Wednesday informing employees of the death of a young adult who had tested positive for what in-depth results could reveal as H1N1. The email also noted that some of the patients admitted to the medical center during the past week who tested positive for flu are ‘seriously ill’…It’s the time of year when flu cases increase, although flu is difficult to predict, said Donna Fearey, a nurse epidemiologist in the infectious disease program with the state of Alaska. There’s no way to know how severe the flu will be or how long it will last, she said.”

Polio emergence in Syria and Israel endangers Europe

In an article published in the Lancet today, two German scientists argue that the outbreak of wildtype poliovirus 1 (WPV1) in Syria, as well as the discovery of the virus in Israeli sewage, may pose a serious threat to nearby Europe. The vast majority of polio infections are asymptomatic – only one in 200 cases results in acute flaccid paralysis. Therefore, the flood of refugees streaming out of Syria and seeking asylum in European countries may serve as a large pool of asymptomatic carriers, resulting in the virus’ silent spread. Following polio’s eradication in Europe in 2002, many states limited their vaccination campaigns, resulting in large, unprotected populations, and a recipe for reintroduction of the crippling disease. This is why we should all care about eliminating polio from Afghanistan, Pakistan, and Nigeria – because the one thing an asymptomatic virus can do well is spread

The Lancet – “It might take more than 30 generations of 10 days (5) —nearly 1 year of silent transmission—before one acute flaccid paralysis case is identified and an outbreak is detected, although hundreds of individuals would carry the infection. Vaccinating only Syrian refugees—as has been recommended by the European Centre for Disease Prevention and Control (6)—must be judged as insufficient; more comprehensive measures should be taken into consideration. Oral polio vaccination provides high protection against acquisition and spreading of the infection, but this vaccine was discontinued in Europe because of rare cases of vaccination-related acute flaccid paralysis. Only some of the European Union member states still allow its use and none has a stockpile of oral polio vaccines.2 Routine screening of sewage for poliovirus has not been done in most European countries, (2) but this intensified surveillance measure should be considered for settlements with large numbers of Syrian refugees.”

H5N1 Epidemics in Cambodia; Vietnam

Both Cambodia and Vietnam are experiencing small outbreaks of H5N1, with the Cambodian outbreak infecting over 23 humans and the Vietnamese outbreak concentrated mainly within farm animals in two regions. To date, twelve of the 23 Cambodian cases have resulted in fatalities, compared with just two cases of human H5N1 in Vietnam. Vietnamese containment of the virus is attributed to the prevalence of larger, commercial farms, in which culling can occur quickly and effectively. This is unfortunately not the case in Cambodia, in which farming is largely sustenance-driven.  The differing methods of spread and containment in two otherwise similar countries help shed light on what practices can be undertaken to limit the virus’ reach.

Cambodia Daily – “But managing [the virus] in backyards, we are dealing with free-range poultry who run around villages and transmit it from one poultry to another,” he said, adding that 80 percent of Cambodian poultry are kept in people’s backyards. In all 23 avian influenza cases reported this year, the victims had contact with dead or sick animals. The Cambodian government also does not provide compensation for farmers whose poultry needs to be killed, which many experts say provides a disincentive to report sick birds.”

Tuoitre News (Vietnam) -“The southern Tien Giang Province People’s Committee on Wednesday declared an epidemic of the H5N1 avian flu in two communes, where the disease spread widely with most of the 557 affected ducks having died. The declaration was issued by deputy chairwoman of the Committee, Tran Thi Kim Mai, who asked the local Veterinary Sub-Department and other concerned agencies to take measures to control and drive back the epidemic in accordance with the Ordinance on Veterinary. All concerned agencies are required to tighten control over poultry-related activities and absolutely ban transporting of poultry into or out of epidemic areas, the authorities said.”

In case you missed it:
Delving Deeper: Synthetic Biology and National Security Policy
Fourth Case of H7N9 in China

(Image: Syrian refugees on the Turkish border, via Henry Ridgwell/VOA/Wikimedia Commons)

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