Pandora Report 2.1.15

No themed coverage this week, sadly. However, we’ve got stories covering the Federal fight against antibiotic resistance, ISIS airstrikes, and super mosquitoes in Florida. All this in addition to stories you may have missed.

Have a fun Super Bowl Sunday (go team!) and a safe and healthy week!

Obama Asking Congress to Nearly Double Funding to Fight Antibiotic Resistance to $1.2 Billion

One of The White House’s goals for 2015 was to combat growing antibiotic resistance through research into new antibiotics and efforts to prevent the over prescription of these vital drugs. President Obama is requesting that Congress add additional funding to this fight, bringing the total to $1.2 billion. The funding will be a start, but there are many other things that can happen in order to fight this extremely important problem.

U.S. News & World Report—“The Centers for Disease Control and Prevention says more than 23,000 Americans die every year from infections that can withstand some of the best antibiotics. The World Health Organization said last year that bacteria resistant to antibiotics have spread to every part of the world and might lead to a future where minor infections could kill.”

Air Strike Kills IS ‘Chemical Weapons Expert’

News came Saturday morning that U.S. airstrikes in Iraq last week killed a mid-level Islamic State militant who specialized in chemical weapons. Killed on January 24, Abu Malik had worked at Saddam Hussein’s Muthana chemical weapons production facility before joining Al-Qaeda in Iraq in 2005.

Radio Free Europe/Radio Liberty—“Officials say his death could “temporarily degrade” the group’s ability to produce and use chemical weapons. Coalition air strikes have pounded the Mosul area over the past week [and] The U.S.-led coalition has carried out more than 2,000 air raids against IS militants in Syria and Iraq since August 8.”

Millions of Genetically Modified Mosquitoes Could Fight Disease in Florida

On January 11, we had a small note about the possibility of genetically modified mosquitos controlling diseases like chikungunya and dengue, but this week coverage on this issue absolutely exploded! British biotech firm Oxitec plans to release millions of genetically modified mosquitos in Florida to control the existing population and help control the spread of these diseases. The A. Aegypti species of mosquito is extremely prevalent in Florida and recently has become resistant to most chemical pesticides. Residents, of course, are up in arms over the potential release of this “mutant mosquito”.

The Weather Channel—“Technology similar to this is already in use in Florida and other states, Entomology Today points out. Sterile Insect Technique (SIT) employs a similar technique, sterilizing insects so that when they mate, no offspring are produced. “Florida spends roughly $6 million a year using SIT to prevent Mediterranean fruit fly infestations, while California spends about $17 million a year,” Entomology Today wrote.”

Stories You May Have Missed

Image Credit: Wikimedia Commons

Pandora Report 11.16.14

Its getting pretty cold outside, right? So what better way to spend your Sunday than catching up on all the best stories of the week! This week we’ve got Wikipedia as a predictive took for the spread of disease, a catchy new name for Chikungunya, MERS CoV in Saudi Arabia, some stories you may have missed, and, of course, an Ebola update.

How Wikipedia Reading Habits Can Successfully Predict the Spread of Disease

In my absolute favorite story of the week, researchers have identified a link between the spread of disease and the corresponding page hits of those diseases on Wikipedia. No, the Internet isn’t giving people E-bola, but page views seem to have a predictive effect on infectious disease spread. During the three-year study, looking at readers’ habits, the researchers could predict the spread of flu in the U.S., Poland, Thailand, and Japan, and dengue in Brazil and Thailand at least 28 days before those countries’ health ministries.

The Washington Post—“Official government data—usually released with a one- or two-week lag time—lagged four weeks behind Wikipedia reading habits, according to Del Valle; people, she said, are probably reading about the illnesses they have before heading to the doctor.”

The ‘Vacation Virus’

As Chikungunya makes it way through the Americas, awareness of the disease becomes more important—including the creation of a catchy nickname! The vector, transmissibility, and symptoms are similar to Dengue and with Chikungunya being relatively new to the western hemisphere, a story like this one may be helpful in putting a human face on a growing problem.

The Atlantic—“It might be parochial to call Chikungunya a “vacation virus”; however, as Americans prepare to hit the Caribbean beaches in the coming winter months, awareness campaigns are ramping up. Last week, the travel section of the New York Times ran a feature on Chikungunya highlighting how tourism agencies and organizations are both downplaying the scope of the outbreak and advising simple measures to deal with the virus. (Avoid mosquitos.)”

MERS Cases on the Rise in Saudi Arabia

Since September 5, there have been 38 new cases of MERS-CoV in Saudi Arabia, bringing the total number of cases in Saudi Arabia to 798. The WHO said that due to the non-specific symptoms of MERS, it is critical that health care facilities consistently apply standard precautions with all patients regardless of their initial diagnosis. Furthermore, until more is understood about MERS, immunocompromised individuals should practice general hygiene measures, like hand washing, and avoid close contact with sick animals. Nearly one third of the new cases were reported by patients who had recently had close contact with camels.

Outbreak News Today—“The continued increase in cases prompted Anees Sindi, deputy commander of the Command and Control Center (CCC) to say, “MERS-CoV is active and we need to be on full alert.” In addition, the Saudi Arabia Ministry of Health launched a new public information campaign in Taif in response to the recent spike in new cases of MERS-CoV in the region. Medical professionals will be made available at public locations with the aim of educating citizens on the need to avoid unprotected contact with camels because of the risk of infection with MERS-CoV, underlining the crucial role of the community in preventing the spread of the disease in the Kingdom.”

This Week in Ebola

Ebola is on the rise again in Sierra Leone bringing the number of deaths to 5,147 and cases to 14,068. It appears that the virus is finding new pockets to inhabit including villages outside the Liberian capital and in Bamako, the capital of Mali (eclipsing earlier success in that country at containment.) Despite these new infections outside of Monrovia, Liberian President Ellen Johnson Sirleaf has ended the state of emergency in that country. Unsurprisingly, the epidemic has imposed a financial burden on the affected countries including losses in agricultural trade and the service industries. Elsewhere in Africa, Ugandan health officials have declared the country free of an Ebola-like Marburg virus. Stateside, a new report from the CDC outlines steps taken in Dallas to prevent further virus spread and a third Ebola patient headed to the bio containment unit at the Nebraska Medical Center for treatment. Finally, 80 U.S. Military personnel helping to fight Ebola in Liberia returned home this week, and though none are displaying symptoms, they will be monitored for 21 days at Joint Base Langley-Eustis in Virginia.

Stories You May Have Missed

 

Image Credit: Wikipedia

Pandora Report 8.17.14

Another 12 hours at Dulles Airport on Friday and, fortunately, no new travel alerts. This week we look at TB detecting rats, an experimental Chikungunya vaccine, and the latest from West Africa.

Giant Rats Trained to Sniff Out Tuberculosis in Africa

APOPO, the Belgian nonprofit organization known for using rats to sniff out land mines, has been training the African giant pouched rat to detect tuberculosis since 2008 in Tanzania and 2013 in Mozambique. The trained rats are used in medical centers in Dar es Salaam and Maputo to double check potential TB samples. The rats are unable to differentiate between standard and drug-resistant strains of the disease however, the cost of training and maintenance of the rats is significantly cheaper than the new GeneXpert rapid diagnostic tests.

National Geographic—“‘What the rats are trained to do is associate the smell of TB with a reward, so it’s what they call operative conditioning,’ [Emilio] Valverde [manager of the APOPO Mozambique TM Program] said.

It is the same principle applied to detecting land mines, only the rats are trained to recognize the scent of specific molecules that reflect the presence of the tuberculosis germ—not the explosive vapor associated with land mines.”

Experimental Chikungunya Vaccine Shows Promise

Chikungunya, of course, is one of the diseases included in the CDC’s travel alerts, and this week we learned of a promising vaccine for the disease that causes fever and intensely painful and severe arthritis. After the vaccine’s first human trials, the next step is to test in more people and more age groups, including populations where the virus is endemic. The trial leader said that it could be more than five years before a finished vaccine could be offered to the public.

CBS News—“‘This vaccine was safe and well-tolerated, and we believe that this vaccine makes a type of antibody that is effective against chikungunya,’ said trial leader Dr. Julie Ledgerwood, chief of the clinical trials program at the U.S. National Institute of Allergy and Infectious Diseases.”

WHO: Ebola Outbreak Vastly Underestimated

The news from West Africa seems to be getting worse and worse. Earlier in the week there was good news when a new quarantine center opened in Liberia. Then two days later, that same center was destroyed and looted. All of this comes, too, when the World Health Organization has said there is evidence that numbers of cases and deaths are far lower than the actual numbers and MSF has said that the outbreak will take at least six months to get under control.

Al Jazeera—“‘Staff at the outbreak sites see evidence that the numbers of reported cases and deaths vastly underestimate the magnitude of the outbreak,’ the organization said.

‘WHO is coordinating a massive scaling up of the international response, marshaling support from individual countries, disease control agencies, agencies within the United Nations system, and others.’”

Image Credit: James Pursey, APOPO

Pandora Report 08.09.14

I spent about 12 hours at Dulles Airport yesterday. I didn’t fly anywhere, but I was ensuring that 120 international students were able to get from Washington DC to their host families all over the country. You may have noticed that in the security areas of Dulles Airport they have televisions that go over proper security screening procedures. On these same screens, they also show CDC travel alerts.

In June (when I was ensuring that 450 students were able to get back to their home countries), the alerts were for MERS and mosquito borne diseases like dengue and Chikungunya. Yesterday, Ebola was on alert for travelers to West Africa.

Last week we looked at the fever pitch of Ebola, today, lets look at the diseases designated by the CDCs travel alerts at Dulles.

 

Zika Virus: Another Threat from the Asian Tiger Mosquito

Travel alerts from the CDC often include Chickungunya and Dengue fever, but another disease from the same vector—the tiger mosquit0—is receiving alerts as well. Zika Fever, was isolated in humans in the 1970s, but has relatively few documented cases. In 2007, the virus demonstrated epidemic capacity with 5,000 cases in Micronesia. In 2013 there were 55,000 cases in Polynesia. Today the CDC has issued Watch Level 1 alerts for Zika in Easter Island, French Polynesia, and the Cook Islands and urges travelers to practice usual precautions.

Entomology Today—“Originally from Asia, the tiger mosquito was introduced to Africa in 1991 and detected in Gabon in 2007, where its arrival undoubtedly contributed to the emergence of dengue, chikungunya, and as shown by this new study, zika. The rapid geographic expansion of this invasive species in Africa, Europe, and America allows for a risk of propagation of zika fever around the world.”

 

Ramadan pilgrimage season in Saudi Arabia mostly free from MERS

Saudi Arabia reported only ten new cases of MERS from June 28- July 28 during the month of Ramadan. In April and May of 2014, hundreds of people were infected by MERS, which raised concerns about infection rates during Ramadan and during the Hajj, which will take place in October, when millions of pilgrims will travel to Mecca. Since 2012, Saudi Arabia has confirmed over 700 cases of infection resulting in nearly 300 deaths. The CDC designates the Hajj as an Alert Level 2, and urges U.S. residents to practice enhanced precautions.

Al Arabiya—“Saudi Arabia and the World Health Organization have said they are imposing no travel or other restrictions due to MERS during the Hajj, but have encouraged very young or old pilgrims, and those suffering from chronic disease, not to come this year.”

 

WHO: Ebola ‘an international emergency’

This week, the World Health Organization declared that the spread of Ebola in West Africa is an international health emergency. They urged coordinated response in order to keep the spread of the virus under control. Though no travel or trade bans have been enacted, the WHO recommends that Ebola cases or contacts should not travel internationally. This comes at a time when states of emergency have been declared in Liberia, Guinea, and Sierra Leone and the number of total cases has reached nearly 1,800 with over 950 deaths. The CDC designates outbreaks in these countries as a Warning Level 3, and urges U.S. residents to avoid non-essential travel.

BBC—“WHO director-general Dr. Margaret Chan appealed for help for the countries hit by the ‘most complex outbreak in the four decades of this disease.’

The decision by the WHO to declare Ebola a public health emergency is, by its own definition, an ‘extraordinary event’ which marks ‘a public health risk to other states through the international spread of disease’.”

 

Image Credit: The Denver Channel

Pandora Report 7.20.14

I feel like its been a bad week, right? Between the crash—or shoot down—of MH 17 (with nearly 100 WHO HIV/AIDS researchers aboard) and events in Gaza with Israel, it sort of seems like it couldn’t get much worse. Well, turns out, it could. This week we have the first cases of Chikungunya in the U.S. and Ebola still raging. However, no one, in the biodefense world, had a worse week than the CDC.

 

First Chikungunya Case Acquired in the U.S. Reported in Florida

So far, in 2014, there have been 243 travel-associated cases of Chikungunya reported in 31 American states and two territories. This week, the infection numbers grew. The difference in this case, was that the man in Florida who was diagnosed, had not travelled outside the U.S. recently. This makes it the first case of the disease that had been acquired domestically.

WALB—“The Centers for Disease Control and Prevention is working closely with the Florida Department of Health to investigate how the patient contracted the virus; the CDC said they will also monitor for additional locally acquired U.S. cases in the coming weeks and months.

“The arrival of Chikungunya virus, first in the tropical Americas and now in the United States, underscores the risks posed by this and other exotic pathogens,” said Roger Nasci, Ph.D., chief of CDC’s Arboviral Diseases Branch.”

 

WHO Can’t Fully Deal with Ebola Outbreak, Health Official Warns

With the death toll from the ebola outbreak in West Africa at 603 (at least), more bad news emerged this week when we learned that budget cuts to the WHO make it for difficult for the organization to respond to the ongoing medical emergency. Beyond funding issues, efforts to stem the outbreak have been hindered by some countries failure to implement the WHO’s International Health Regulations which outline methods of reporting disease outbreaks.

The LA Times—“‘The situation in West Africa should be a wake-up call to recognize that this weakening of this institution on which we all depend is not in anybody’s interest,” Scott Dowell, director of disease detection and emergency response at the U.S. Centers for Disease Control and Prevention, said during a briefing in Washington. “In my view, there’s no way that WHO can respond in a way that we need it to.’”

 

Update on the Found Vials: There Weren’t 6; There Were 327.

In last week’s Pandora Report we learned about unsecured vials of smallpox that were found in an FDA cold storage room in a Maryland lab. This week we learned that it wasn’t just smallpox and it wasn’t just six vials—it was 327. Some of these vials contained select agents other than smallpox, like dengue, influenza, Q fever and rickettsia. Whoops!

Wired—“Here’ is the gist of the FDA’s external announcement, “…this collection was most likely assembled between 1946 and 1964 when standards for work with and storage of biological specimens were very different from those used today. All of the items labeled as infectious agents found in the collection of samples were stored in glass, heat-sealed vials that were well-packed, intact, and free of any leakage, and there is no evidence that anyone was exposed to these agents.”

 

Image Credit: Eduardo

Pandora Report 7.4.14

I have to offer my apologies and my thanks. Please let me apologize for the lack of Pandora Report and the light coverage on the blog over these past two weeks. The month of June was absolutely insane between work and summer courses. Fortunately, all that craziness is finally over, so let me thank you most sincerely for your patience and understanding. With this special July 4th edition of Pandora Report, please consider things around here back to normal.

Now, onto the news!  Highlights include Syrian chemical weapon disarmament, the arrival of Chikungunya to the U.S., an anthrax incident at the CDC, an Etihad Airlines based polio campaign, and Ebola devastation in West Africa.


Syrian Chemical Weapons Transfer Complete

Earlier this week, the Pentagon reported that the transfer of Syrian chemical weapons, from a Danish cargo ship to the U.S. vessel that will neutralize and destroy the weapons, is complete. The weapons and associated materials were transferred to the Cape Ray, which will travel from Italy into international waters where the weapons will be dismantled and neutralized. The Pentagon press secretary Rear Admiral John Kirby reported that the process should take several weeks to complete.

Al Arabiya News—“The disposal process marks the culmination of a program to rid Syria of its chemical weapons stockpile after the outcry that followed chemical attacks by the Bashar al-Assad regime in the suburbs of Damascus on August 23 last year, that may have killed as many as 1,400 people.”

Polio Awareness Videos to be Shown on Flights to Pakistan

Much of my month of June was spent at Dulles airport, so I might be more excited about this story than your average person, but get ready for the coolest news story you have likely ever read about an airline! United Arab Emirates based Etihad Airlines, in response to the polio epidemic in Pakistan, will show a short in-flight movie on all their flights to Pakistan. Etihad said that the goal of the movie, titled “Leap of Faith,” is to raise awareness about “this crippling and potentially fatal disease among thousands of Pakistani workers returning home to visit their families.”

Business Standard—“‘By showing this engaging story on board our flights, Etihad Airways is supporting the efforts of the UAE in helping to eradicate polio in Pakistan,” said James Hogan, President and Chief Executive Officer of Etihad Airways.

Asif Durrani, Pakistan Ambassador to the UAE, said, “With approximately 1.25 million expatriate Pakistanis in the UAE, this is a perfect opportunity to educate our people during their journey home and ultimately help in the overall eradication of this terrible disease in our country.’”

CDC Reassigns Director of Lab Behind Anthrax Blunder 

According to the Centers for Disease Control and Prevention, sometime between June 6 and 13, up to 84 lab employees at the headquarters in Altanta, were possibly exposed to anthrax. The possible exposure, which was caused by technicians not following laboratory protocol, resulted not only in employees taking powerful antibiotics as prophylactics but also in the reassignment of the head of the Bioterror Rapid Response and Advanced Technology Laboratory, Michael Farrell, while the incident is investigated.

Reuters—“CDC spokesman Skinner on Sunday said the bioterror lab sent the anthrax bacteria to other labs in closed tubes. The recipients agitated the tubes and then removed the lids, raising concerns that live anthrax could have been released into the air.”

Mosquitos Carry Painful Chikungunya Virus to Americas

Chikungunya, a viral disease spread by the same mosquitos that spread Dengue fever, has made its way to the Americas. Fortunately, the type of mosquito that spreads the viruse, the Aedes aegypti, is not native to the United States. However, its close breed “cousin” Aedes albo, lives as far north as Chicago and is believed to be able to spread Chikungunya.

National Geographic—“There is no vaccine or medication that can change the course of the disease, though patients are given painkillers and told to drink a lot of fluids….To avoid getting chikungunya while staying in affected areas, take the usual precautions against mosquitoes: Wear long sleeves, use repellents, and keep outside areas free of standing water where mosquitoes can breed.”

West Africa Ebola Epidemic is ‘Out of Control’

With a current death count of 467, the Ebola outbreak affecting Guinea, Sierra Leone, and Liberia has become dire. Doctors without Borders’ (MSF) Director of Operations said “the epidemic is out of control.” He continued, “we have reached our limits. Despite the human resources and equipment deployed by MSF in the three affected countries, we are no longer able to send teams to the new outbreak sites.”

The Huffington Post—“The outbreak of the deadly disease is already the largest and deadliest ever, according to the WHO, which previously put the death toll at 399 as of June 23, out of 635 cases. The 17 percent rise in deaths and 20 percent jump in cases in the space of a week will add urgency to an emergency meeting of 11 West African health ministers in Accra, Ghana on Wednesday and Thursday, which aims to coordinate a regional response.”

 

Image Credit: Wikimedia Commons


From the Pandora Report and all of us at the George Mason Biodefense program, we wish you a happy and safe Independence Day!!

Arthropods, Pathogens, and Bioterrorism

By Chris Healey

Mosquitos are responsible for a chickungunya fever outbreak in the Caribbean several hundred miles off the United States coastline. That outbreak is an addition to the expanding role arthropods play in the spread of illness.

Many arthropods are erroneously classified as insects. While mosquitos, lice, and fleas are indeed insects with six legs, ticks have eight legs and are technically arachnids. The term arthropod is an overarching classification encompassing mosquitos, fleas, and ticks – all common disease vectors. Insects are arthropods, but not all arthropods are insects.

Arthropods spread several of the world’s most significant diseases. Notable among them are Lyme disease, typhus, yellow fever, Japanese encephalitis, West Nile virus, and, most significantly, malaria. Of the 45 select agents designated by the U.S. Department of Health and Human Services, 12 are transmitted by arthropods.

Diseases spread by arthropods have influenced some of the greatest conflicts in history. More French soldiers are suspected to have died from louse-borne typhus than actual combat during Napoleon’s ill-fated 1812 invasion of Russia. Staggering mortality among the French army forced Napoleon to renounce Moscow and retreat back to France. During WWII, mosquito-borne malaria was a serious health threat to U.S troops throughout campaigns in the South Pacific.

Several tick-borne bacterial illnesses have been endemic to North America since antiquity, including Lyme disease and Rocky Mountain spotted fever. In recent years, mosquito-borne viruses have made their way across U.S. borders. The introduction of West Nile virus in 1999 and a 2005 dengue hemorrhagic fever outbreak in Texas have solidified emerging and foreign arthropod-borne diseases as threats to U.S. public health.

Arthropods can also serve to carry out bioterrorism. Terrorists could utilize arthropods to execute clandestine bioterror attacks through exploitation of feeding behavior. Inoculation of arthropods with the desired agent and subsequent release into unsuspecting populations could spread illness during, or shortly after, blood meals. Although possible, that scenario is unlikely due to the difficulty associated with production and maintenance of pathogen-inoculated arthropods.

A more likely bioterrorism scenario involves malevolent forces utilizing more passive means of compromising U.S. health. North America has many indigenous mosquito species – several of which can spread pathogens found in other parts of the world, such as Rift Valley Fever in Africa. Introduction of any disease capable of spread and maintenance by indigenous arthropods is a significant public health threat. Some unsubstantiated theories suggest West Nile virus was intentionally introduced to the U.S. in this way. Possibilities of an arthropod-facilitated attack has placed a heavy burden on keeping undesirable pathogens out of the country.

There are steps everyone can take to reduce their risk of arthropod-borne diseases. Mosquito control methods, such as elimination of outdoor untreated stagnant water sources, should be practiced regularly. Also, mosquito repellent, in addition to long-sleeved shirts and pants covering the ankles, should be worn whenever going outdoors.

Similar measures can be taken to prevent tick bites – wear repellent, tuck pants into socks or boots, shower after returning indoors, and perform tick checks daily.

Image of the Week: Chikungunya

This week’s image is of Chikungunya, the mosquito-transmitted virus currently making its way across the Caribbean.  There have been over 1,000 laboratory-confirmed infections since the virus first appeared on St. Martin in December of last year. The virus causes symptoms similar to dengue (ouch), including febrility and severe joint pain. Luckily the disease is rarely fatal, with symptoms usually resolving within ten days.

chikungunya

The Pandora Report 1.17.14

Just a quick note that the Biodefense Policy Seminars are back on! Our February speaker is Charles Duelfer, former Special Advisor to the Director of Central Intelligence for Iraq WMD and former Deputy Executive Chairman of the UN Special Commission on Iraq (UNSCOM). Free and open to the public – click here for more information!

Highlights include Salmonella,  H5N1 in Canada, H7N9 picking up in China, and Chikungunya in St. Martin. Happy Friday!

Why Salmonella bacteria is a near perfect killer
Much like an action film protagonist, Salmonella biofilms are notoriously difficult to kill. According to new research from the Journal of Applied and Environmental Microbiology, once Salmonella bacteria are able to form biofilms on a given surface, three different common disinfectants all are rendered ineffective. Salmonella’s ongoing hardiness explains in part the difficulty in effectively containing outbreaks.

ANI – “Mary Corcoran, a researcher on the study, said that they found that it was not possible to kill the Salmonella cells using any of the three disinfectants if the biofilm was allowed to grow for seven days before the disinfectant was applied, asserting that even soaking the biofilms in disinfectant for an hour and a half failed to kill them.”

H5N1 strain from Alberta nurse resembles Chinese strain
The strain of H5N1 which killed a nurse in Canada closely resembles a Chinese strain of the virus. The nurse, in her early 20s, had recently returned from a three-week visit to Beijing. However, as she had no reported contact with poultry, and Beijing has not reported any recent outbreaks of H5N1, the source of infection and method of transmission remain unclear.

CBC – “Virologist Kevin Fonseca of Alberta Health Services and his colleagues said the patient experienced symptoms of malaise, chest pain, and fever during the return flight on Dec. 27 and went to the local emergency department on Dec. 28…After a chest X-ray and CT scan suggested a diagnosis of pneumonia, the woman was prescribed an antibiotic and discharged home. The patient came back to the same emergency department on Jan. 1 with worsening inflammation of the membrane surrounding the lung, chest pain, shortness of breath, a mild headache that felt worse when she moved her head, nausea, vomiting and other symptoms, Fonseca’s team said in their posting on ProMed, an internet-based disease alert system. On Jan. 2, the patient reported visual changes and a continuing headache. As oxygen needs increased, doctors admitted her to the ICU for intubation and ventilation. In the early morning of Jan. 3, she had sudden tachycardia or fast heart rate and severe hypertension, followed by hypotension. Doctors took steps to keep her heart beating. At this point, the patient’s pupils were dilated and there was no response to pain. Further tests and a neurologic exam indicated brain death.”

New cases put H7N9 pace near last year’s peak
The number of H7N9 cases in China are picking up again, with nearly 35 cases reported in the last week. This is just three under peak numbers during the height of the infection at the virus’ initial emergence. Health officials monitoring the situation remain split on the implications of the increased numbers – however, the prevailing opinion seems to be that as long as the virus remains poorly transmitted between people, we don’t panic.

CIDRAP – “The steady stream of new cases could mean that Chinese health officials are better at detecting cases, but he added that it doesn’t look like they missed many cases last year in the early months of the outbreak. ‘There must be a similar widespread circulation in poultry,’ said Osterholm, who is the director of the Center for Infectious Disease Research and Policy, publisher of CIDRAP News, Recent H7N9 developments raise questions about what’s being done to minimize the risks to humans and should be setting off bells, whistles, and sirens warning about the threat, he said. ‘Each one [case] is another throw at the genetic roulette table’.”

Chikungunya virus spreads in Caribbean just weeks after breaking out in tiny St. Martin
In the two weeks since Chikungunya made it to the Caribbean, it has quickly spread to over 200 people. The virus can cause febrility, joint pain, and intense myalgia. Trouble in paradise (it had to be said)?

FOX – “The virus then spread to neighboring Dutch St. Maarten, and the U.S. Centers for Disease Control says new cases have also been confirmed in the French Caribbean islands of Martinique, Guadeloupe and St. Barthelemy. The British Virgin Islands reported three cases Monday. CDC epidemiologist Erin Staples said Tuesday that ‘further spread to other Caribbean islands and to the surrounding mainland areas is possible in the coming months and years’.”

The Pandora Report 12.20.13

Highlights include more pneumonic plague in Madagascar, H1N1  in Texas, Chikungunya in the Caribbean, H7N9 in Hong Kong, and MERS in Saudi Arabia. Happy Friday, and a very happy holiday season to everyone.

Pneumonic Plague Cases Up in Madagascar
The latest numbers in the plague outbreak in Madagascar suggest as many as  17 of 43 cases may be pneumonic plague – the highly virulent, highly infectious, transmissible person-to-person form of the traditional bacteria. As we’ve mentioned before, the case fatality rate for pneumonic plague is 100% unless antibiotics are prescribed in the first 24 hours following infection. However, as the disease’s incubation period can be up to three days, and as it often presents initially with flu-like symptoms, timely detection can be very challenging. We’ll keep you posted.

Madagascar-Tribune (originally in French) – ” 43 suspected cases of pneumonic plague and bubonic plague were detected Mandritsara since 20 November until 5 December 2013. 17 suspected cases of pneumonic plague were detected Analanjirofo. 15 cases of bubonic plague have been recorded in the district of Ikongo. In the district of Tsiroanomandidy, 3 cases of bubonic plague have been suspected.”

Montgomery County, Texas: Mystery Illness Likely H1N1 Virus
A regional hospital in Texas has reported eight cases of an as yet diagnosed illness – of the eight, four patients have subsequently died. One of the remaining four patients has subsequently been diagnosed with H1N1The CDC is working with local health authorities to determine the pathogen in play.

Houston Chronicle – “Recent mystery deaths in Montgomery County could be attributed to the H1N1 virus. Conroe Regional Hospital this month reported eight cases of a mystery illness to the county’s public health department. Two of the patients tested negative for all flu viruses. Nichols-Contella said the 2013 influenza vaccine protects against the H1N1 virus. None of the patients who died had received a flu shot, the release said.”

Chikungunya Outbreak Grows In Caribbean
Chikungunya has struck the sunny Caribbean, with two cases reported to the WHO last week. Since the initial outbreak, a further 10 cases have emerged. Chikungunya is an Alphavirus, and is spread through arthropods, primarily mosquitoes. The outbreak on St. Martin signifies the first time the virus has appeared in the Western hemisphere. There was no international travel in the case histories of the patients involved. Fortunately, very few people understand better than epidemiologists the tendency of infectious diseases to spread with vigor, so surveillance systems are already in place.

NPR – “Except for a small number of imported cases each year, chikungunya has stayed out of the Americas until now. But U.S. health officials have been on the lookout for its arrival. The chikunguyna virus was discovered in 1955 by two scientists in Tanzania. ‘Microbes know no boundaries, and the appearance of chikungunya virus in the Western Hemisphere represents another threat to health security,’ CDC director Dr. Tom Frieden wrote in statement Wednesday. ‘CDC experts have predicted and prepared for its arrival for several years, and there are surveillance systems in place to help us track it.’ With about 9 million Americans traveling to the Caribbean each year, the CDC anticipates chikungunya will be a more frequent visitor to the U.S. in the next few years. One of the mosquitoes that carries the virus — the Asian tiger mosquito — is already a familiar pest in many parts of the U.S. during the summer.”

Two more H7N9 bird flu cases linked to Shenzhen’s Longgang district
Two individuals who lived or worked near the wet markets which tested positive for H7N9 last week have subsequently contracted the virus themselves. The two have been hospitalized and are in critical condition.  Again, the reemergence of the virus is consistent with expected seasonal patterns.

South China Morning Post – “Three patients who have contracted the H7N9 strain of bird flu had visited the Longgang district of Shenzhen, including the latest case announced yesterday, mainland health authorities said. A 38-year-old Shenzhen man was in critical condition after being diagnosed with the deadly strain of the flu, Shenzhen’s centre for disease control and prevention said. The patient is a migrant worker who lives and works in Nanwan Street, in Longgang district, near one of the infected markets where authorities found the H7N9 virus on December 11. A second patient, a 39-year-old man from Dongguan, commuted to the district. The pair follow Tri Mawarti, a domestic helper who was the first person in Hong Kong diagnosed with the virus. She is believed to have handled a live chicken at a flat in Nanwan Street before falling ill.”

WHO: Middle East respiratory syndrome coronavirus (MERS-CoV) – update
A further two cases of MERS-CoV have been confirmed in Saudi Arabia. The two patients are both female, aged 51 and 26 respectively. The former has no know exposure to the virus, whereas the latter had previously been exposed to an infected patient. Globally, there have been 165 cases to date, with 71 deaths.

WHO – “The first case is a 51 year-old female from Saudi Arabia, living in Jawf province with onset of symptoms on 20 November 2013. She has underlying chronic disease and was transferred to Riyadh for treatment in an intensive care unit. She had no reported contact with animals. The epidemiological investigation is ongoing. The second case is a 26 year-old female who is a non-Saudi healthcare worker in Riyadh. She is asymptomatic. She had reported contact with a 37 year-old male laboratory confirmed case that was reported to WHO on 21 November 2013.”

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