The Pandora Report 12.6.13

Highlights this week include the second case of H7N9 in Hong Kong, WHO ramping up calls for increased surveillance for MERS, EEE in Vermont, why that one friend never gets sick, and the Philippines ramping up its biosecurity. Happy Friday!

Hong Kong sees second case of H7N9 bird flu in a week

Hong Kong has seen its second case of H7N9 in the last week. An 80-year old man with diabetes sought medical attention after experiencing minor heart failure, and within a couple days of hospitalization developed symptoms consistent with the flu virus strain. He has subsequently been isolated for further treatment – it remains unclear if he came into contact with poultry prior to his hospitalization. However, don’t freak out yet –  the two cases are consistent with expected resurgent flu numbers following the onset of winter. According to all literature and available case evidence,  the virus still cannot effectively transmit person-to-person.

South China Morning Post – “It was unclear whether the man had come into contact with birds and live poultry and which district in Shenzhen he lived in. The three family members coming with him to the city had been back in Shenzhen and the city had contacted the Shenzhen health authority for subsequent medical monitoring…Border checks have been stepped up after the first confirmed case, and three people, who stayed in the same ward as the helper but had had no symptoms, are being isolated at the Lady MacLehose Holiday Village in Sai Kung.”

WHO calls for action on Mers following death in Abu Dhabi

Earlier this week, a Jordanian woman infected with MERS died from the virus shortly after giving birth to her second child. Her eight-year old son and husband are both also infected, and are still under surveillance in Jordan. It is unclear if the newborn is also infected with the  virus. None of the family had any travel history, any prior contact with animals, or any contact with infected persons, further confounding public health officials trying to determine the virus’ vector. In response to the mother’s death, the WHO has strongly encouraged countries to ramp up their surveillance and monitoring efforts. To date, there have been 163 cases of the virus worldwide, with a case fatality rate of approximately 42% causing 70 deaths.

The National – “More must be done to stop the spread of the deadly Mers coronavirus, the World Health Organisation has warned. Countries must strengthen their surveillance, increase awareness and try to find out how people are infected, the WHO’s emergency committee said on Wednesday…But Mers-CoV is not yet considered an international public health emergency. ‘After discussion and deliberation on the information provided, the committee concluded that it saw no reason to change its previous advice to the director general,’ the WHO said. The 15-member committee, which includes the deputy health minister of Saudi Arabia, Ziad Memish, said the situation continued to be of concern, in view of new cases and of information about the presence of the virus in camels in Qatar last month. It called for more support for countries that are particularly vulnerable, such as Saudi Arabia – where most of the cases have been confirmed – and urged for more studies to investigate exactly how people become infected with Mers-CoV.”

Vt. testing deer samples to test for EEE virus

Biologists in Vermont have begun testing over 700 blood samples collected from local moose and deer in order to track the spread of Eastern Equine Encephalitis (EEE). The virus was first introduced to Vermont in 2011, following the importation of an emu flock. EEE is a zoonotic alphavirus virus which primarily affects horses. The virus’ natural reservoir is wading birds, and it is spread, like so many horrible diseases, by mosquitoes. Although in the US there are usually less than 15 human cases of EEE, the virus’ fatality rate can approach 60%. As an encephalitic virus, symptoms are typically nasty – first fever, splitting headaches, photophobia (aversion to light),  then irritability, coma, and death. Among those lucky enough to survive, the virus often causes permanent sequelae, including severe brain damage.

Seattle PI – “Biologists say that mapping where the virus is found will help broaden the state’s understanding of the spread of the virus — which killed two people in Vermont in 2012 and two horses this year. EEE antibodies detected in deer and moose have been found in every Vermont country. Biologists hope that by looking for antibodies in the deer and moose, they’ll be able to determine if infected animals are more commonly found near certain bodies of water or wetlands.”

A genetic defect protects mice from infection with Influenza viruses

Everyone has that one friend/relative/colleague who not only never gets sick, but also thinks the best time to discuss their fabulous immune system is when you’re knee deep in tissues and throat lozenges. It turns out there may be a genetic reason for their immunological smugness. According to a new study from researchers at the Helmholtz Centre for Infection Research (HZI) in Braunschweig, mice who possess a mutation in the gene which encodes for the Tmprss2 protease (a catalytic enzyme) are resistant to infection from the H1 influenza A viruses. While the virus still infects the mice, it is unable to produce mature, infectious virus particles, and the infection is quickly cleared from their symptoms. This opens up a potential new field for drug development, and by targeting the host system rather than the virus, concerns over drug-resistance fade.

Medical Express – “The virus uses haemagglutinin as a key to enter the host cell which is then captured to build new virus particles. To reach its final shape, the coating protein has to be cleaved by a molecular scissor. This is done by an enzyme of the infected host. Otherwise, the protein is not functional and the virus particles are not infectious. A variety of host enzymes, so-called proteases, that process the haemagglutinin have been identified using cell cultures. Scientists from the HZI have now been able to show how important those enzymes are for the progression of the infection. Mice with a mutation in the gene for the protease Tmprss2 do not become infected by flu viruses containing haemagglutinin type H1. They are resistant against H1N1, the pathogen responsible for seasonal influenza epidemics, the ‘swine flu’ and the ‘Spanish flu’, which caused an epidemic in 1918. ‘These mice do not lose weight and their lungs are almost not impacted,’ says Professor Klaus Schughart, head of the Department ‘Infection Genetics’ at the HZI.”

Philippine airports on alert for bird flu

The Philippines is on high alert for the H7N9 strain of avian influenza found in Hong Kong for the first time last week. Manilla has  banned the import of all Chinese poultry products, and  airports across the island nation already screen inbound travelers to prevent the virus’ spread. This is an interesting form of biosecurity, which is something we don’t often talk about on the PR, mostly because it’s not as much of a concern for us as our colleagues in say, Australia.In this instance, the human body itself is seen as the vector for pathogen movement, rather than a kiwi or tomato plant.

Xinhua – “The Philippine government has alerted airport authorities to ensure that the deadly bird flu H7N9 could not enter the country following the recent discovery of first case in Hong Kong, the Philippines’ Department of Health ( DOH) said Wednesday. To date there are 141 cases of bird flu and 47 deaths worldwide. Deaths were due to severe pneumonia with multi-organ failure. So far, two-thirds of bird flu H7N9 cases were males and two-thirds were more than 50 years old.”

(image via Hagerty Ryan, U.S. Fish and Wildlife Service)

The Pandora Report 8.30.13

Highlights include MERS case updates, dengue raging through Central America, Syria’s CW (obviously), eastern equine encephalitis, and the cetacean morbillivirus. Happy Friday, and a very happy Labor Day Weekend to everyone! Stay away from the dolphins!

WHO: MERS global case count 108, 50 deaths 

MERS continues to spread throughout Saudi Arabia, with an additional four cases confirmed today. The total global case count is now 108, with a fatality rate of just below 50%. Two of Saudi Arabia’s four most recent cases involved immunocompromised patients, while the other two are children aged 16 and seven respectively. Interestingly, both children are currently asymptomatic, despite testing positive for the virus. The World Health Organization (WHO) has not recommended travel restrictions to Saudi Arabia, promoting instead strong surveillance and testing measures.

World Health Organization – “Globally, from September 2012 to date, WHO has been informed of a total of 108 laboratory-confirmed cases of infection with MERS-CoV, including 50 deaths.Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns. Health care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations”.

Dengue fever epidemic sparks public health emergency in Central America

Central America is currently experiencing a serious Dengue outbreak, with over 120,000 cases in three states across the region. If not effectively contained, a number of external factors will likely result in the outbreak “exploding”. The rainy season in the area is set to last another three months, with high heat resulting in ideal breeding grounds for dengue’s mosquito vector. Containment of the outbreak in Honduras particularly has proven challenging, prompting the state to turn to the Red Cross for help. The 2010 outbreak of dengue in the area lead to 1.6 million cases, of which 49,000 were severe. Dengue eradication efforts are hampered by its infection through four, distinct serotypes, no one of which offers cross-protection against the other three.

The Guardian – “The poor suburbs of Central American capitals are the main targets for campaigns to raise public awareness. Poor housing, the lack of a mains water supply and the accumulation of household waste make such neighbourhoods an ideal breeding ground for mosquitoes. The authorities have dispatched paramedics, police and the military to remote villages in order to stamp out the epidemic in the areas most at risk. Latin America is particularly exposed to dengue epidemics, which recur on a three- to five-year cycle. In 2010 the fever caused 132 deaths. ‘Aedes aegypti was eradicated in the subcontinent in the mid-20th century, but with increasing global trade it returned in the 1970s, from Asia,’ says Philippe Brémond, an epidemiologist at France’s Institute of Research for Development (IRD).”

Syria’s Red Line

We know everyone’s talking about chemical weapons in Syria (ourselves included), and with President Obama now apparently set on unilateral (ugh) military action in the area, we wager everyone will continue to talk about Syria for a good while longer. We’re including Jeanne Guillemin’s review article because it’s a thorough overview of the storied history and political maneuverings of chemical weapons use. Read it and be an expert.

The Boston Review – “When the present crisis in Syria is resolved, as inevitably it will be, the CWC [Chemical Weapons Convention] must be made universal. It almost is: 188 states adhere to it; 7 are holdouts (Israel, Syria, Egypt, Myanmar, Angola, North Korea, and South Sudan). Syria must allow its chemical weapons to be identified, contained, and destroyed. It should have been done years ago. Israel and Egypt must also be persuaded to join the treaty and comply with it, before more chaos erupts. ‘Almost universal’ is simply not good enough.”

Eastern equine encephalitis threat level raised to ‘high’ in four communities

Ongoing detection of eastern equine encephalitis (EEE) in four communities in Massachusetts has prompted local health authorities to raise threat levels to “high”, encouraging residents to avoid outdoor evening activities until the end of the mosquito season. Although most cases of EEE are aysmptomatic, in severe cases the virus can cause permanent brain damage and death. We can’t remember if we already posted this, but here is an excellent Nature article explaining why it would actually be totally fine if we exterminated all mosquitoes.

Boston – “The EEE threat is high in Easton, Raynham, Taunton, and West Bridgewater. Residents in high-risk areas are urged to avoid evening outdoor events for the remainder of the mosquito season, said the statement from the Massachusetts Department of Public Health…There has been one human case of EEE this year, in a Norfolk County woman in her 80s, who died earlier this month. There were seven cases of EEE in 2012, including three deaths.Symptoms of EEE show up about 3 to 10 days after a person is bit by an infected mosquito and they include high fever, a stiff neck, headache, and lack of energy.”

Because People Will Ask: Measles-like virus may be cause of dolphin deaths on U.S. coast

Included so you can assure concerned friends and families that the virus, which is killing bottlenose dolphins up and down the East Coast, cannot be transmitted to humans. Since July, 333 dolphins – 10 times the normal number for the same period – have died from cetacean morbillivirus, a measles-like virus which is thought to cause immunosuppression.  Virginia’s beaches have seen the highest number of strandings, at 174 n the last couple months. While the virus cannot be transmitted to humans, beach goers are advised not to approach any stranded dolphins, as they may carry other bacterial or fungal infections.

National Geographic – “‘Along the Atlantic seaboard, this [outbreak] is extraordinary,’ Rowles said. The last morbillivirus outbreak in the region occurred from June 1987 to May 1988, and resulted in the deaths of at least 900 bottlenose dolphins. Officials are unsure of how long the current outbreak will last. ‘Typically, outbreaks will last as long as there are susceptible animals,’ Rowles said. But if it plays out like the 1987-1988 outbreak, ‘we’re looking at mortality being higher and morbillivirus traveling southwards and continuing until May 2014,’ she added. Right now, experts think this current outbreak is probably due to a dip in herd immunity.”

(image credit: Jeff Kraus/Flickr)

Eastern Equine Encephalitis confirmed in Maryland horse

A horse in Worcester County, Maryland has tested positive for Eastern equine encephalitis (EEE),  a mosquito-bourne virus which can be fatal to horses and cause serious disease in humans. Although the County is spraying for mosquitoes, horse owners in the area are  strongly encouraged to discuss vaccinations with their veterinarians.

The US averages 15 cases of EEE a year, usually within southern and eastern states. Symptoms of EEE in humans include fever, vomiting, photophobia (fear of light), and headache, with siezures, coma and eventual death possible as secondary symptoms. The case fatality in humans can be as high as 60%, with survivors often experiencing severe brain damage.

For more information of the Worcester case, see here.

(image courtesy of CDC)