The Pandora Report 1.10.14

Highlights include PEDv thriving in the polar vortex, H5N1 in Canada, archaeological epidemiology,  H7N9 in China, and MERS in Oman. Happy Friday!

Cold, wet weather may help spread deadly pig virus: USDA
Porcine Epidemic Diarrhea virus (PEDv) has officially spread to 22 states, helped in part by the colder weather, and affecting over 2,000 hogs. The virus, which causes diarrhea, vomiting, dehydration, and death in piglets, reaches as far west as California. The cooler weather enables the hardy virus freezes on clothes and on the bottom of shoes, enabling spread.

Baltimore Sun – “‘The virus likes cold, wet and cloudy days,’ said Rodney Baker, a swine veterinarian at Iowa State University at Ames, Iowa, the top pork producing state in the United States.Earlier this week several hog producing states experienced double digit sub zero temperatures, and forecasters now are calling for warmer temperatures as highs climb toward 30 degrees Fahrenheit by the weekend. Baker told Reuters the virus can remain viable after a single, maybe even a couple of freeze-thaw cycles. Cold weather and cloudy conditions protect the virus, but heat and sunlight will deactivate it, Baker said. The spread of the disease has heightened scrutiny of the U.S. trucking industry as livestock transport trailers are seen as a means of transmission.”

H5N1 bird flu death confirmed in Alberta, 1st in North America
The first H5N1 fatality in North America occurred in Canada last week. A Canadian woman returning from China became symptomatic on December 27th, was hospitalized January 1st, and died January 3rd. The woman had not visited any live farms, not had she come in contact with poultry – the method of transmission remains unclear. Remember, while H5N1 has a fatality rate of 60%,  there is currently no indication the virus is readily transmissible person-to-person. It’s just not well adapted to our immune system – for now at least, it prefers the birds.

CBC – “Dr. Gregory Taylor, deputy chief public health officer, said the avian form of influenza has been found in birds, mainly poultry, in Asia, Europe, Africa and the Middle East….The officials added that the woman was otherwise healthy and it’s not yet clear how the person contracted H5N1. Speaking to Evan Solomon, host of CBC News Network’s Power & Politics, Taylor said the patient was relatively young. ‘This was a relatively young — well, a young person compared to me, with no underlying health conditions,’ he said. Taylor is 58 [reports have listed the girl as 20 years old]. Officials emphasized that this is not a disease transmitted between humans.”

Scientists unlock evolution of cholera, identify strain responsible for early pandemics
The next time you’re in Philadelphia, instead of visiting the well-trod landmarks, consider visiting the Mütter museum, home to the 200-year old intestinal samples. Those samples, taken during a cholera epidemic at the turn of the 18th century, has helped scientists characterize the classical biotype of cholera, thought to be responsible for seven outbreaks during the 19th century. Scientists had thus far been unable to study the classical biotype, due to its preference for the intestines – unlike bones which can linger for millennia, the transience of intestines makes collecting DNA samples over time challenging.

Medical Express – “Researchers carefully sampled a preserved intestine from a male victim of the 1849 pandemic and extracted information from tiny DNA fragments to reconstruct the Vibrio cholera genome. The results, currently published in The New England Journal of Medicine, could lead to a better understanding of cholera and its modern-day strain known as El Tor, which replaced the classical strain in the 1960s for unknown reasons and is responsible for recent epidemics, including the devastating post-earthquake outbreak in Haiti. ‘Understanding the evolution of an infectious disease has tremendous potential for understanding its epidemiology, how it changes over time, and what events play a role in its jump into humans,’ explains Poinar, associate professor and director of the McMaster Ancient DNA Centre and an investigator with the Michael G. DeGroote Institute of Infectious Disease Research, also at McMaster University.”

WHO: China Reports Eight New Cases of H7N9
China reported eight new cases of H7N9 in the last five days, including three cases in which exposure to live poultry could not be confirmed. Again, a slight increase in case numbers was expected with the cooler weather, and as of yet, there remains no confirmed, ongoing transmission person-to-person.  For a full breakdown of the seven cases (the eighth case was announced by health authorities in Hong Kong), see the GAR above.

WHO – “The National Health and Family Planning Commission of China has notified WHO of seven additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus. On 4 January 2014, WHO was notified of an 86-year-old man from Shanghai City became ill on 26 December and was admitted to hospital on 30 December. He is currently in critical condition. He has a history of exposure to live poultry. On 5 January 2014, WHO was notified of 34 year old woman from Shaoxing City, Zhejiang Province became ill on 29 December and was admitted to hospital on 2 January. She is currently in critical condition.”

New Case of MERS in Oman
A 59-year-old man has died of MERS in Oman, bringing the total number of cases globally up to 178. The patient became symptomatic on December 24th, was hospitalized on December 28th, and died on December 30th. The patient had extensive exposure to camels, including participation in camel racing events.  It looks more and more like camels, everyone.

WHO – “Globally, from September 2012 to date, WHO has been informed of a total of 178 laboratory-confirmed cases of infection with MERS-CoV, including 75 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.”

(Image depicting jar of intestine, credit: McMaster University)

The Pandora Report 1.3.13

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.)

The Pandora Report 12.27.13

Highlights include H1N1 in Texas, 59 people with TB, a H7N9 fatality, H5N2 in ostriches, and vaccines coming to a mountain train near you. Happy Friday, and as our last Pandora Report from 2013, Happy New Year!

H1N1 Causes Early Spikes in Flu Cases
The flu season is in full swing, a couple weeks earlier than expected, with five deaths in Texas already. Luckily, the vaccine for this year’s flu contains the H1N1 strain currently predominant. Everyone please get vaccinated!

KUT – “‘[H1N1] is actually in the vaccines this year. So we’re finding that people who have been vaccinated, even if they come down with the illness, have a less severe course of it,’ Hydari said. He added that vaccine shortages that complicated flu season in the past is not an issue this year. Hydari also said that flu vaccines take about two weeks to take affect, and because the flu season typically peaks in January it’s not too late to get a shot this year.”

Dozens Test Positive For Tuberculosis After Exposure at Hospital Neonatal Unit
Fifty-nine people have tested positive for TB following exposure at a hospital in Nevada. A mother and her newborn twins are thought to have brought the bacteria to the hospital over the summer. All three died in the hospital, and were not discovered to have TB until after an autopsy was performed on the mother. Following hospital staff falling ill, and 977 people potentially exposed and subsequently tested, just two had active infections – the 59  mentioned above are latent cases. TB is still very real, and very scary – as this case illustrates, as few as three people can potentially infect dozens.

ABC – “‘Unfortunately, this situation is a hospital epidemiologist’s worst nightmare as neonates are highly susceptible to contracting TB and their infections can progress quite rapidly,’ he said. A mother and her newborn twins died of tuberculosis at Summerlin Hospital over the summer, prompting an investigation by the Southern Nevada Health District. Hospital staff didn’t realize the infected woman had tuberculosis until after she and one of the twins died and they performed an autopsy, according to KTNV, ABC’s Las Vegas affiliate. The other twin was in the NICU being treated without being under quarantine. The second twin also tested positive for tuberculosis and died in August, health department spokeswoman Stephanie Bethel told ABCNews.com.”

 Hong Kong confirms first death from H7N9 bird flu
An eighty-year old male has died from H7N9 in Hong Kong. Still, no confirmed, sustained person-to-person transmission yet.

Reuters – “The man, the second person in Hong Kong to be diagnosed with the virus strain, lived in the southern Chinese city of Shenzhen and had eaten poultry there, media reported. The H7N9 strain was first reported in humans in February in mainland China, and has infected at least 139 people in China, Taiwan and Hong Kong, killing more than 40. Experts say there is no evidence of any easy or sustained human-to-human transmission of H7N9, and so far all people who came into contact with the man had tested negative for the strain, authorities said.”

Low Pathogenic Bird Flu in Western Cape Ostriches
Small outbreaks of H5N2 have been reported in South African ostriches. The low pathogenic influenza strain has been reported in seven farms and roughly 2,000 birds. Authorities remain uncertain as to the source of the outbreaks.

Poultry Site – “The World Organisation for Animal Health (OIE) received follow-up report no. 4 on 23 December. The report states that the affected population comprises commercial ostriches. A total of 10,171 birds were involved, out of which 2,230 tested positive for the virus. None died or been destroyed. According to the OIE’s Animal Health Information Department, H5 and H7 avian influenza in its low pathogenic form in poultry is a notifiable disease as per Chapter 10.4. on avian influenza of the Terrestrial Animal Health Code (2013).”

Keeping Vaccines Fresh
Apparently silicon packets can keep more than your new shoes fresh – scientists at the University of Portland have managed to preserve virus pathogenicity over time by coating the little zombies in a layer of silica. Some viruses subsequently cleansed of the silica coating retained infectivity. While this apparently means viruses may actually be able to survive inside volcanoes (we definitely feel there’s a movie in this somewhere), it also is good news for developing vaccines for use in places lacking widespread refrigeration.

New York Times – “Most vaccines are made of weakened virus or viral bits, and many need refrigeration. Keeping them cold is a major challenge when it comes to protecting children living in villages without electricity.’It’s hard to put a fridge on the back of a donkey,’ said Kenneth M. Stedman, a biologist at Portland State and the lead author of the study. By recreating the chemical-laden hot-spring environment, Dr. Stedman’s team coated four types of virus with silica, stored them, then washed off the silica and tried to infect cells. One heavily studied virus, phage T4, which infects the cells of E. coli bacteria, retained 90 percent of its infectivity for almost a month. The virus used in smallpox vaccines also did well, but it is naturally able to be stored dry.”

(Image: Afrikanischer/Strauss/Wikicommons)

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.”

(image: Clavius66/Wikimedia)

The Pandora Report 12.13.13

Highlights include pneumonic plague in Madagascar, ricin as a biological weapon, H7N9 in live markets in Hong Kong, Myanmar’s ratifying the BWC, and destroying sarin at sea. Happy Friday!

Madagascar hit by ‘pneumonic and bubonic plague’

In addition to the death of approximately 20 villagers who died of bubonic plague last week, a further two cases of pneumonic plague have been discovered. Pneumonic plague can be spread via aerosol. It must be treated within 24 hours; any later and the fatality rate approaches 100%. Understandably, there is concern amongst health officials in Madagascar that the disease will spread to neighboring villages and towns.

BBC – “Pneumonic plague is caused by the same bacteria that occur in bubonic plague – the Black Death that killed an estimated 25 million people in Europe during the Middle Ages. But while bubonic plague is usually transmitted by flea bites and can be treated with antibiotics, pneumonic plague is easier to contract and if untreated, has a very high case-fatality ratio, experts say. Madagascar’s health ministry director-general Dr Herlyne Ramihantaniarivo confirmed to the BBC that two cases of the plague had been reported”

Texas woman pleads guilty to ricin letters sent to Obama, Bloomberg
A Texan woman has been charged in the case involving ricin-laced letters sent to President Obama and Mayor Bloomberg. We’ve discussed the debate surrounding the classification of  ricin as a weapon of mass destruction before, so we do think its interesting they’ve charged her with use of a biological weapon.

CNN – “A Texas woman pleaded guilty Tuesday to a biological weapons charge after she was accused of sending ricin-laced letters to President Barack Obama and New York City Mayor Michael Bloomberg, prosecutors announced. Shannon Guess Richardson, 35, pleaded guilty to possession of a toxin for use as a weapon, prosecutors said in a statement. She could be sentenced to up to life in prison. A sentencing date has not yet been scheduled. Richardson, an actress, was accused of sending the letters earlier this year.”

Shenzhen Finds H7N9 Flu Virus in Markets Near Hong Kong
Three of 70 samples taken from 13 of Guangdong’s  live poultry market have tested positive for H7N9. For some reason, one of the vendors whose stall tested positive for H7N9 was still allowed to sell chickens. China is usually extremely vigilant concerning containment and effective biosurveillance, so the hesitation to shut the live poultry markets is a little baffling.  However, the stalls are  apparently being disinfected daily.

Bloomberg Businessweek –  “The 12 live poultry stalls at the Hengan Paibang market in Longgan district, one of the markets where authorities found a positive sample, were open today. The stalls get their chickens from the Buji Poultry Wholesale Market in Longgan, according to the market’s manager. ‘There’s been no order yet to shut down,’ said Zhang Jinghui, manager of the Paibang market. ‘We need to wait for instructions from the village committee. We are disinfecting the stalls everyday.’ About 30 chickens, ducks, pigeons and geese were stored in metal cages at his stall, next to a shed for slaughtering the poultry and a metal-spinning vat for defeathering.”

Myanmar Prepares to Ratify Chemical, Biological Weapons Treaties
While Myanmar, formerly known as Burma, has signed both the Chemical Weapons Convention and the Biological Weapons Convention, it has yet to ratify either treaty. There is still some debate over whether the military junta previously in charge had used chemical weapons on the rebels. Myanmar has been cooperating with IAEA inspectors to increase overview of its nuclear program.

Radio Free Asia – “Myanmar’s government asserts the country has no chemical, biological, or nuclear weapons programs. But ethnic armed rebel groups including the Kachin Independence Army (KIA) have accused the Myanmar military of using chemical weapons as recently as last year in their long-running war in the country’s borderlands. In the 1980s and early 1990s, the U.S. government voiced suspicions of a possible chemical weapons program under the military junta in Myanmar, naming China and North Korea as possible suppliers. Since then the U.S. has been less vocal in its concern about the issue. According to global security nonprofit organization the Nuclear Threat Initiative, there is currently ‘no evidence’ to suggest Myanmar has a chemical weapons program.”

Scientists raise alarm over plan to destroy Syria’s chemical weapons at sea
The Department of Defense’s plan to neutralize Syria’s chemical weapons, through hydrolysis, at sea, is coming under sharp criticism. The use of the technology at sea is unprecedented, and requires a tremendous deal of very careful estimating. Of course, when dealing with agents like sarin and VX, very careful estimating is not always enough. News of the criticism comes at the same time as the UN confirmed the repeated use of chemical weapons in the Syrian conflict. 

Washington Times – “‘There’s no precedence. We’re all guessing. We’re all estimating,’ said Raymond Zilinskas, director of the Chemical and Biological Weapons Nonproliferation Program at the James Martin Center for Nonproliferation Studies, who worked as a U.N. biological weapons inspector in Iraq in 1994. ‘For example, you don’t know if the sarin is pure. The Iraqi sarin was rather impure, and had a lot of contaminants, and we don’t know if that’s amenable to hydrolysis,’ said Mr. Zilinskas, a professor at the Monterey Institute of International Studies at Middlebury College. Under the Pentagon plan, the toxic stockpile would be transported to the Syrian port of Latakia, loaded onto a non-U.S. vessel and shipped to a third country. From there, a U.S. cargo ship would take the arsenal to sea for destruction. Richard M. Lloyd, a warhead technology consultant at Tesla Laboratories Inc. who tracks weapons being used in Syria, said he has little confidence in the regime’s ability to transport the weapons safely.”

In case you missed it
Drug Resistant H7N9 Retains Pathogenicity

(image: Wmeinhart/wikimedia)

Drug-Resistant H7N9 Retains Pathogenicity

In a study published Wednesday in Nature Communications, researchers discovered that certain strains of  H7N9 have mutated to become “highly resistant” to antivirals like Tamiflu while maintaining high levels of pathogenicity. This is not normal. Normally when  a virus acquires drug-resistance through mutation, this mutation attenuates it, decreasing viral virulence or replication ability.  The study authors write, “in stark contrast to oseltamivir-resistant seasonal influenza A(H3N2) viruses, H7N9 virus replication and pathogenicity in these models are not substantially altered by the acquisition of high-level oseltamivir resistance”. Moreover, drug resistance in highly pathogenic avian influenza (HPAI) viruses is usually limited to amantadine resistance; infact, many influenza A and B strains are already resistant to amantadine. This means that in many cases, the only  effective antivirals are neuraminidase (NA) inhibitors. Luckily, resistance to NA inhibitors is rare. Unluckily, some strains of H7N9 appear to have it.

Read the full paper here.

(image of H7N9: CDC/Cynthia S. Goldsmith and Thomas Rowe; false color added by author)

Hong Kong Quarantines 19 people after 2nd H7N9 case

Health authorities in Hong Kong have quarantined 19 people who were thought to have come in contact with an 80-year-old man diagnosed with H7N9 earlier this week. This is the second case of the influenza A virus in the area. The man has subsequently stabilized – however, at least one person with whom he came in contact has symptoms of a “mild” respiratory infection. H7N9 emerged for the first time in humans earlier this year. Case numbers rose to 137 by the end of October, with 45 fatalities, and the newer cases are thought to result from the cooler temperatures. 

(Image caption: “This negatively-stained transmission electron micrograph (TEM) captured some of the ultrastructural details exhibited by the new influenza A (H7N9) virus.” CDC/Cynthia S. Goldsmith and Thomas Rowe)

 

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)

H7N9 in Hong Kong

Hong Kong confirmed its first case of H7N9 yesterday, a 36-year old female who had previously travelled to mainland China and been in contact with poulty. The woman was admitted to Queen Mary’s Hospital last month, after falling ill. She remains in critical condition.

This is the second time the virus has popped up outside of mainland China, with a previous case in Taiwan early this year. Since February of this year, China has reported 137 cases of the avian flu, with 45 fatalities. However, it’s worth noting that while the virus does have pandemic potential, the majority of cases occurred last Spring, with less than ten cases total appearing over the summer and fall. Avian influenza viruses often behave similarly to seasonal flu viruses, with the majority of infections occurring in cooler months.

Prior to February, H7N9 had not infected humans. Labs in the US, UK, and Japan have all developed candidate vaccines.

(Image: James Jin/Flickr)

The Pandora Report 11.15.13

Highlights include H7N9 vaccines, using bacterial toxins as antibiotics, updated numbers for the Mexican cholera outbreak, the dolphin morbillivirus, Albania refusing to host the Syrian CW arsenal, H6N1, and MERS in camels. Happy Friday!

Vaccines for H7N9 Ahead of Pandemic Fears
As the Northern Hemisphere braces for winter, fears of a resurgence of H7N9 cases are rising. Although the cooler weather has brought a few new cases, it’s still to early to tell whether another large-scale outbreak is imminent. Luckily, both Novartis and Novavax have developed vaccines capable of eliciting strong immune responses to H7N9. The Novavax vaccine generated a significant immune response in 81% of study participants, while the Novartis vaccine generated an 85% response. The real story is the time frame – it took both companies just a few months to have a viable vaccine in clinical trials, which is both impressive and encouraging should an outbreak occur.

Fierce Biotech – “Novartis and partners at the Craig Venter Institute in San Diego were able to launch a clinical trial in August after the virus was identified in March. The project was funded by BARDA. The H1N1 scare back in 2009 spurred a global, multibillion-dollar effort to stockpile vaccines. The campaign highlighted just how long it took to develop and manufacture new vaccines and then spurred a backlash after governments around the globe rushed to buy stockpiles only to see the threat evaporate. In Europe some health officials accused pharma companies of capitalizing on the fear of a lethal pandemic, and memories of the controversy will likely influence any new moves to guard against a new outbreak. This winter’s alarm may also fizzle, but these companies have demonstrated that new vaccines can be developed in record time.”

Bacterial Toxins Suggest New Antibiotic Targets
A group of researchers at MIT have found a bacterial toxin which may result in the development of novel antibiotics. The toxin, SocB, is used as a part of the toxin/antitoxin interplay by Caulobacter crescentu to check bacterial growth if necessary. It binds to a highly conserved protein, DnaN, suggesting the possibility of developing new, broad-spectrum antibiotics.

Bio-IT World – “To regulate their own growth and proliferation, bacteria maintain an intricate network of toxin-antitoxin (TA) systems, in which they produce a mix of toxins and targeted antitoxins that can skew toward a disruptive level of toxins in poor environmental conditions to limit growth. Some bacteria have been found to contain as many as 50 of these TA systems, all prepared to check bacterial growth should anything trigger a reduction in antitoxins…[SocB] inhibits replication in Caulobacter crescentus by binding to a protein that participates in numerous crucial reactions in the replisome, playing roles in mismatch repair, translesion synthesis, and especially DNA replication itself.”

WHO: Update on Cholera Outbreak in Mexico
The cholera outbreak which began in September is continuing apace in Mexico, with four cases in the last week bringing the total laboratory-confirmed case count to 180. The majority of the cases are concentrated within the state of Hidalgo, just north of Mexico City. This is the first outbreak of cholera in Mexico in over a decade. The strain is 95% identical to that of the Haitain outbreak, which was caused by an influx of infected UN aid workers following the 2010 Haitian earthquake. The Haitian outbreak, described as the “worst in recent history” by the CDC, is ongoing, with 684,085 cases to date.

WHO – “The health authorities of Mexico continue to strengthen outbreak investigation and surveillance at the national level and continue to ensure the availability and quality of care in medical units. Health professionals at different levels of the health care system are being trained in prevention and treatment of the disease. Measures are being implemented to ensure access to drinking water and basic sanitation at the community level. Awareness campaigns, particularly around safe water and food consumption are being carried out in Spanish and indigenous languages. An antimicrobial susceptibility test for Vibrio cholerae O1 Ogawa was conducted by the Institute of Epidemiological Diagnostics and Reference (InDRE) which demonstrated that the bacterium was susceptible to doxycycline and chloramphenicol, with reduced susceptibility to ciprofloxacin and resistance to trimethoprim/sulfamethoxazole.”

Dolphin-Killing Virus Spreads South, May Be Infecting Whales Too
There’s been a lot of coverage recently of the morbillivirus infecting dolphins, killing 753 of the animals since July.  The virus has subsequently spread to two species of whales, humpback and pygmy respectively. In humans, measles belongs to the genus Morbillivirus, but to date there have been no documented cases of strains of morbillivirus jumping from a dolphin or other marine mammal to a human, and the likelihood of it doing so remains very low. However, the virus may be able to infect dogs, so if you see a stranded dolphin, keep Fido away as you’re calling animal control.

Wired – “The outbreak began along the coast between New York and Virginia this summer. Now, carcasses are washing ashore in the Carolinas and Florida. Researchers have identified the cause as dolphin morbillivirus, a pathogen that’s related to human measles and canine distemper…The die-off has already been classified as an Unusual Mortality Event by the federal government – a designation that frees up resources and sends investigators and responders to the hardest-hit areas. It’s already exceeded the pace set by the last major morbillivirus outbreak on the East Coast, an event that lasted for 11 months, between June 1987 and May 1988, and ultimately claimed 742 dolphins.”

Albania shuns Syria chemical weapons destruction
How does one destroy a chemical weapon? It’s a question we’ve asked before here on the Pandora Report, and one which our October Biodefense Policy Seminar Speaker, Dr. Paul Walker, answered pretty clearly – very carefully (for a slightly more detailed answer, his full talk is available on our YouTube channel). According to the BBC, there has been a slight hiccup in the destruction of the Syrian arsenal. Following mass protests, the Albanians, who were supposed to host and destroy the materials, have flat out refused to do so. This has left the poor OPCW investigators scrambling to find a different destination for the weapons before the Friday deadline for submission of final plans lapses. Someone get these people (another) medal!

BBC – “The Balkan nation recently destroyed its own chemical stockpile, and the US had requested that it host the dismantling of Syria’s arsenal. Under the deal brokered by Russia to remove Syria’s chemical weapons, it was agreed that they should be destroyed outside the country if possible. Mr Rama attacked the Albanian opposition for having criticised the government’s willingness to consider the idea. A key meeting of the Organisation for the Prohibition of Chemical Weapons (OPCW) – the international watchdog supervising the destruction – had adjourned for several hours, awaiting Albania’s decision.”

In case you missed it:

First Human Infection with H6N1
MERS Confirmed Live in Camel

(image: Docklands Tony/Flickr)