The Pandora Report

Highlights include NCov’s mechanism of action, Dengue in Key West (Spring Breakbone?)(sorry, very sorry), the ongoing debate around stocking up on vaccines we may never use, will Assad use biological weapons?, Zithromax and irregular heartbeats, and using bacteria to deliver vaccines for us. Happy Friday!

Novel Virus Entry Portal Found

On the heels of the WHO confirming the 15th case of NCov, it’s now known that the virus utilizes the DPP4 host cell protein for entry.

The Scientist – “Dutch researchers have identified the host cell protein that allows a recently discovered coronavirus to enter its target cells, according to a study published today (March 13) in Nature. The structure of the protein, called DPP4, appears to be conserved between bats and humans, suggesting that the new findings will help shed light on zoonotic transmission of the virus, as well as provide a target for potential vaccines.”

Mosquito-borne dengue virus lands in Key West

Dengue, also known as “breakbone fever”, continues to be one of the most significant “neglected” tropical diseases, with its occurence  seeing a 30-fold increase over the last five decades. It’s re-emergence in the US, therefore, is disturbing but unfortunately not especially surprising.

LA Times – Although the mosquito-borne dengue virus was thought to be fully eradicated in the continental United States, the Centers for Disease Control and Prevention confirmed Wednesday that the tropical disease had indeed returned…after reviewing 93 dengue cases diagnosed in Florida in 2009 and 2010, study authors identified a specific strain of the virus in patients who had not recently traveled outside the country. The strain differed from those cases in which the patient had recently traveled.”

Wary of Attack With Smallpox, U.S. Buys Up a Costly Drug

This debate strikes at the heart of preparedness – do we invest in the smallpox vaccine now, in the off chance a bioterrorist attack with the pathogen occurs, or spend the money elsewhere and risk catastrophic casualties? While those of you born before 1980 (the year we stopped vaccinating) may be shrugging internally, there is some debate about the potency of the vaccine 20 years on. There’s not an easy answer.

New York Times -“The United States government is buying enough of a new smallpox medicine to treat two million people in the event of a bioterrorism attack, and took delivery of the first shipment of it last week. But the purchase has set off a debate about the lucrative contract, with some experts saying the government is buying too much of the drug at too high a price.”

Syria might be prepared to use chemical and biological weapons – US national intelligence director

Meanwhile, in Syria, (unverfiable) reports continue that Assad has already begun using chemical weapons on the rebels. Once again, it’s a poorly-kept secret that Syria had (has?) a clandestine BW program.

Radio Free Russia – “The erosion of the Syrian regime’s authority is accelerating and the ‘increasingly beleaguered’ government, which has been unable to defeat insurgents with conventional weapons, might be prepared to use chemical weapons, according to James R. Clapper, the director of national intelligence.”

FDA says Zithromax can cause fatal irregular heart rhythm

Zithromax, an anti-biotic used to treat everything from respiratory infections to STDs, is now known to cause “potentially fatal” tachycardia.

Reuters – “Last May, a study in the New England Journal of Medicine compared the risk of cardiovascular death in patients who took Zithromax with those who took several other antibiotics, including amoxicillin. It found that patients who took Zithromax, made by Pfizer Inc, had higher rates of fatal heart rhythms.”

Researchers trick bacteria to deliver a safer vaccine

Ha! Stupid bacteria. No, we’re kidding – any step towards development of elderly-, child-, and immunocompromised-friendly vaccines is good news.

R&D Magazine – “Vaccines that employ weakened but live pathogens to trigger immune responses have inherent safety issues, but Yale University researchers have developed a new trick to circumvent the problem—using bacteria’s own cellular mistakes to deliver a safe vaccine. The findings, published online in Nature Communications, suggest new ways to create novel vaccines that effectively combat disease but can be tolerated by children, the elderly, and the immune-compromised who might be harmed by live vaccines.”

Highlights include our CRE soapbox (it’s only 4%!), NCov updates, the surprising news about flu droplets (oh it’s surprising), Hong Kong  and the risks of high population density, the resilience of viruses, and an overview of pandemics. Happy Friday!

CDC- Making Health Care Safer

Drug-resistant CRE (carbapenem-resistant Enterobacteriaceae) has been in the news often this week, following the CDC’s warning about the bacteria. Now, clearly this is a concern, but before we freak out let’s look at some of the figures behind this story. First, the statistic regarding CRE’s case fatality- almost every news source we’ve seen has indicated it’s 50% – aren’t what they seem. What the sources don’t say is that it’s 50% if, and only if, the infection becomes septicemic. Septicemia as a result of almost any bacterial infection is very dangerous. Second, CRE is really only of concern amongst the immunocompromised and those in long-term treatment for prior conditions. If you’re a healthy adult in possession of an active immune system, you’re chances of becoming infected are minuscule. Third, yes the rate of infection from CRE has increased in the last decade, but again let’s keep the actual number in mind – four percent.

Antibiotic-resistant pathogenic bacteria are a real concern, and steps should absolutely be taken to mitigate their growth and prevent their spread. However, disproportionately scaring the public is not the way to do that, and can be detrimental in the long run – the “boy who cried wolf” anyone? But our soapbox aside, check out the CDC’s review if you haven’t already.

CDC – “Untreatable and hard-to-treat infections from CRE germs are on the rise among patients in medical facilities. CRE germs have become resistant to all or nearly all the antibiotics we have today. Types of CRE include KPC and NDM. By following CDC guidelines, we can halt CRE infections before they become widespread in hospitals and other medical facilities and potentially spread to otherwise healthy people outside of medical facilities.”

Novel coronavirus infection – update

Yesterday the WHO reported another fatality from the novel coronavirus, bringing the total number of cases up to 14 and the fatalities to eight. This case is of special concern because it remains unclear how the man became infected.

WHO – “The Ministry of Health in Saudi Arabia has informed WHO of a new confirmed case of infection with the novel coronavirus (NCoV). The patient, a 69-year-old male, was hospitalized on 10 February 2013 and died on 19 February 2013. Preliminary investigation indicated that the patient had no contact with previously reported cases of NCoV infection and did not have recent history of travel.”

Study provides new clues to how flu virus spreads

According to this study, the tiny aerosol droplets of flu we exhale when sick contain nine-times the amount of virus than the larger cough/sneeze generated droplets. So the next time an infected colleague/friend/loved one walks toward you, make them stop four feet away and calmly explain that their breath is infectious. (GMU Biodefense is not responsible for the implications of you calling the breath of a colleague/friend/loved one infectious).

Medical Express – “People may more likely be exposed to the flu through airborne virus than previously thought, according to new research from the University of Maryland School of Public Health. The study also found that when flu patients wear a surgical mask, the release of virus in even the smallest airborne droplets can be significantly reduced. ‘People are generally surprised to learn that scientists don’t know for sure how flu spreads,’ says Donald Milton, M.D., Dr.P.H., who directs the Maryland Institute for Applied Environmental Health and led the study of influenza virus aerosols published in the journal PLoS Pathogens…”

Hong Kong Prison Homes Spur Virus Risk Decade After SARS

Population density remains an important factor in understanding pandemic potential, and Hong Kong is close to the top of the list in terms of people-per-square-mile. As housing prices continue to increase, many of the city’s 7.2 million residents are settling for smaller and more cramped living quarters.

Bloomberg – “Hong Kong electrician Chan, who shares a mold-stained toilet with his neighbors, says he’d move out if it weren’t for the rising cost of accommodation. Last year, residents were forced to bathe using a shared kitchen sink for six months when a plastic shower hose in the communal bathroom broke, Chan said…Chan Sung-ming says the coughs and sneezes echoing through the plywood walls of his windowless, 60- square foot Hong Kong apartment get him thinking: is there a bug going around and could it be deadly?”

Virus overcomes ‘enormous hurdle’ to survive

Wonderful. As if viruses aren’t good enough at surviving against all possible odds in the first place. For things that technically aren’t alive (I know, I know, I read the piece about viral immune systems as well – they’re still undead in my book), they are disturbingly resilient.

Futurity – “Researchers have uncovered a virus inside a host with a non-standard nuclear genetic code—one that differs from the standard genetic code that almost all living things use to produce proteins.’The finding is significant because it shows that these viruses can overcome what appears to be an insurmountable change in the host genome,’ says researcher Derek J. Taylor, professor of biological sciences at the University at Buffalo.’So the fact that we haven’t previously seen any viruses in these species with a modified genetic code may not be because the viruses can’t adapt to that shift. It may be that we haven’t looked hard enough.'”

Bioterrorism and the Pandemic Potential

A good overview of the basics of pandemics (I tend to disagree with their bioterror assessment, but to each their own!)

STRATFOR – “”The potential for a disease to spread is measured by its effective reproduction number, or R-value, a numerical score that indicates whether a disease will propagate or die out. When the disease first occurs and no preventive measures are in place, the reproductive potential of the disease is referred to as R0, the basic reproduction rate. The numerical value is the number of cases a single case can cause on average during its infectious period. An R0 above 1 means the disease will likely spread (many influenza viruses have an R0 between 2 and 3, while measles had an R0 value of between 12 and 18), while an R-value of less than 1 indicates a disease will likely die out. Factors contributing to the spread of the disease include the length of time people are contagious, how mobile they are when they are contagious, how the disease spreads (through the air or bodily fluids) and how susceptible the population is. The initial R0, which assumes no inherent immunity, can be decreased through control measures that bring the value either near or below 1, stopping the further spread of the disease.”