The first Pandora Report of the new year, and it’s (unsurprisingly) flu heavy. Highlights include H1N1 attacking the young, new MERS-CoV cases, H7N9 in Taiwan, H5N1 in China, and the gain-of-function debate (so more H5N1). Happy Friday!
Notice to Clinicians: Early Reports of pH1N1-Associated Illnesses for the 2013-14 Influenza Season
The CDC has a health alert out, detailing the tendency of this season’s predominant flu strain (which, as we’ve said before, looks like its going to be H1N1) to disproportionately affect the young. This is possibly because the elder amongst us are more resilient, due to cross-reactive immunity – they’ve been around longer, which means there’s a greater chance they have been exposed to similar viruses. The upshot is if you’re young and healthy, get a flu shot.
CDC – “From November through December 2013, CDC has received a number of reports of severe respiratory illness among young and middle-aged adults, many of whom were infected with influenza A (H1N1) pdm09 (pH1N1) virus. Multiple pH1N1-associated hospitalizations, including many requiring intensive care unit (ICU) admission, and some fatalities have been reported. The pH1N1 virus that emerged in 2009 caused more illness in children and young adults, compared to older adults, although severe illness was seen in all age groups. While it is not possible to predict which influenza viruses will predominate during the entire 2013-14 influenza season, pH1N1 has been the predominant circulating virus so far. For the 2013-14 season, if pH1N1 virus continues to circulate widely, illness that disproportionately affects young and middle-aged adults may occur.”
Six new cases of MERS virus hit Saudi Arabia, UAE
The WHO has reported six new cases of MERS-CoV. Of the six, five are Saudi nationals, with one case in the United Arab Emirates. Three of the cases, including one involving a wife tending to an ill husband, are reportedly asymptomatic. Ages of the new patients range from 59 to 73 years old, with the latter succumbing to the virus. The new cases bring the global total to 176, with 74 deaths. There is still no substantive information on the virus’ source, transmission, or vector. Sadly, “it might be camels” remains our most conclusive evidence to date – which is not to impugn the work of the scientists involved, which has been fastidious, but rather to bemoan the complexity of the virus itself.
Reuters – “MERS emerged in the Middle East in 2012 and is from the same family as the SARS virus. It can cause coughing, fever and pneumonia. Although the worldwide number of MERS infections is fairly small, the more than 40 percent death rate among confirmed cases and the spread of the virus beyond the Middle East is keeping scientists and public health officials on alert. Cases have been reported in Saudi Arabia, Qatar, Kuwait, Jordan, United Arab Emirates, Oman and Tunisia as well as in several countries in Europe, and scientists are increasingly focused on a link between the human infections and camels as a possible ‘animal reservoir’ of the virus.”
Hundreds monitored in Taiwan after H7N9 strain of bird flu after infected tourist discovered
A tourist infected with H7N9 spent over a week travelling through Taiwan from mainland China before being hospitalized. Health authorities in Taiwan are scrambling to reach all people he potentially came in contact with during his tour. Three medical personal who had dealings with the infected patient have subsequently developed symptoms of upper respiratory infections themselves. However, it should be emphasized that there remains no conclusive evidence of sustained person-to-person transmission of the virus.
Channel Asia – ” As many as 500 people may have had contact with him, all of whom are being asked to report to doctors should they develop possible symptoms, the statement added. The 149 people who may have had close contact include two family members accompanying him on the tour, the tour guide, bus driver, medical personnel and patients sharing the same hospital ward, it said.”
China confirms H5N1 bird flu outbreak in Guizhou
Following the death of approximately 8,500 birds on a farm in Southwest China, health authorities have confirmed an outbreak of H5N1 amongst poultry in the area. The area has subsequently been sealed off, with a further 23,000 birds culled for safety. As of yet, no human cases have been reported in the area.
Xinhua – “The southwest China province of Guizhou has reported an outbreak of H5N1 in poultry, the Ministry of Agriculture (MOA) announced Thursday. Some chickens at a farm in a village of Libo County in the prefecture of Qiannan in Guizhou showed symptoms of suspected avian flu and 8,500 chickens died on Dec. 27, 2013. The National Avian Influenza Reference Laboratory confirmed the epidemic was H5N1 bird flu after testing samples collected at the farm, according to the MOA.”
European Researchers Urge H5N1 Caution
The debate over gain-of-function (GOF) research continues to rage in the scientific community – in the most recent move, fifty scientists have drafted an open letter to the head of the European Commission, urging him to hold a press conference to discuss the merits of GOF research. For those of you not interested in macropolitics within the scientific community, gain-of-function research involves experiments in which viruses are carefully but deliberately mutated to increase pathogenicity in some way – in this case, by increasing transmissiblility between mammals. The research which launched the current maelstrom was Ron Fouchier’s mutation of H5N1 to make it more transmissible between ferrets (and therefore, also, humans). We’ll leave the polemic arguments to those who are better informed, but in the meantime, the letter is available here.
Science – “Fouchier’s struggles, which included the Dutch government using export regulations to bar him from publishing his results, compelled the European Society for Virology (ESV) to write its own letter to the EC in October. That letter expressed concern that the Dutch government’s tactics were inappropriate and threatened to set a precedent that could stymie the dissemination of research findings elsewhere. On the scientific side of the debate, some have argued that gain-of-function research, especially those studies that engineer deadly strains of the bird flu virus, can potentially result in inadvertent escapes from the lab and widespread infection. Proponents of the work argue that studying how mutations confer the ability to infect new individuals via novel routes can yield key insights into how the pathogens spread.”
(image of H1N1 via CDC/ Doug Jordan, M.A.)