Pandora Report 6.7.14

We’re taking the bad news with the good news this week. Highlights include miscalculations in the MERS toll, rising numbers of Ebola deaths, innovations in vaccine delivery using rice, and progress with MRSA. Enjoy your weekend!

Saudi Arabia Reports Big Jump in MERS cases, Including 282 Deaths

On Tuesday, the Saudi Ministry of Health reported that 282 people have died from Middle East Respiratory Syndrome coronavirus (MERS-CoV) which is a major increase from the previously known official death toll of 190. The same day as the announcement, Deputy Health Minister Dr. Ziad Memish was “relieved” from his post according to the Saudi Health Minister. No reason was given.

CNN—“MERS is thought to have originated on the Arabian Peninsula in 2012. No one knows exactly where it came from, but evidence implicating camels is emerging. In a recently published study in mBio, researchers said they isolated live MERS virus from two single-humped camels, known as dromedaries. They found multiple substrains in the camel viruses, including one that perfectly matches a substrain isolated from a human patient.”

Resurgence of Ebola Epidemic in West Africa

Though overall the number of new cases of Ebola appears to be declining, new cases have been recently reported in Guinea and Sierra Leone. Doctors Without Borders/ Medecins San Frontieres have been supporting health authorities in both countries, treating patients, and working to put measures in place to control the epidemic. They have sent over 44 tons of equipment and supplies to assist the outbreak which has infected over 300 people and killed at least 125.

Doctors Without Borders—“The rise in cases may be due to a reluctance on the part of patients to go to hospital. The movement of infected people and cadavers is also a major issue. Families frequently transport dead bodies themselves in order to organize funerals in other towns. The multiplication of affected areas makes it difficult to treat patients and control the epidemic.”

Fighting Deadly Disease, With Grains of Rice

In an effort to fight common diarrheal illnesses including cholera and rotavirus, researchers at the University of Tokyo are working on bioenginerring rice in order to turn it into an easy and low-cost storage and delivery medium to combat these common illnesses.  According to the World Health Organization, cholera alone kills as many as 120,000 annually.  Both the cholera vaccine and rotavirus antibody versions of the rice have been tested on laboratory mice with plans to test on humans within the next few years in a country like Bangladesh where cholera is a major public health threat. The Bill and Melinda Gates Foundation as well as several pharmaceutical companies have shown interest in developing drugs based on the research.

The New York Times—“Vaccines  or antibodies for both exist but require refrigerated storage, Yoshikazu Yuki, an assistant professor of mucosal immunology, said in an interview. Bioengineering vaccines or antibodies into rice would allow them to be stockpiled easily, without the cost of cold storage, for up to three years at room temperature, he said. The rice could be ingested orally, ground into a paste and drunk, delivering the antibodies to the intestine.”

A New Weapon in the Battle Against MRSA

Among serious concern for the growing levels of antibiotic resistant superbugs, it appears there is some promising news. Durata Therapeutics have developed a new drug, Dalvance, which in clinical trials has proven as effective as vancomycin—another powerful antibiotic—against acute skin and soft tissue infections including methicillin-resistant Staphylococcus aureus (MRSA.) According to Durata, more than 4.8 million people were admitted to hospitals with skin and soft tissue infections between 2005 and 2011 and nearly 60% of these staph infections were the methicillin-resistant variety.

The Washington Post—“The drug, Dalvance, is the first approved by the FDA under the government’s Generating Antibiotic Incentives Now program, its effort to encourage pharmaceutical companies to produce new drugs to combat the growing problem of antibiotic resistant bacteria. Even asthe problem has grown around the world, the number of new drugs in the pipeline has dwindled, with drug companies focused on more profitable medications.”

 

Image Credit: Wikimedia Commons

Pandora Report 06.01.14

Highlights include Ebola research at UVA, No person-to-person MERS transmission in the U.S., Syria’s inability to meet deadlines, and the continuing negative impact of Anxi-Vaxxers.  Have a great Sunday!

 

Ebola’s Fist: UVA Unlocks How Deadly Virus Smashes into Human Cells

Further proving the superiority of public universities in Virginia, researchers at the University of Virginia School of Medicine have discovered how the Ebola virus enters the cytoplasm of human cells. This discovery comes at a critical time when Ebola is still raging in West Africa.

Augusta Free Press—“UVA’s new discovery offers important insight into how the virus works its way into cells. After the virus is engulfed by the cell, it is contained within a vesicle where it can do no harm. But Ebola quickly escapes the vesicle, and now scientists understand how. UVA researcher Lukas Tamm, PhD, of the Department of Molecular Physiology and Biological Physics, and his team discovered that the pH level inside the vesicle triggers the surface glycoprotein on the virus to form a “fist” that lets the virus punch its way into the cell’s cytoplasm, where it can effectively turn the cell into a factory for virus production.”

 

Nevermind! It Turns Out the Guy Who Tested Positive for MERS Doesn’t Have it

Everyone can breathe a sigh of relief! It turns out that the Illinois man who tested positive for MERS after shaking hands with an infected man never really had it. The tests used for diagnostics registered a false positive. This means that the only cases of MERS in the United States have been imported and have not passed through person-to-person transmission.

ABC News—“‘There is good news here,” ABC News chief health and medical editor Dr. Richard Besser said. “It was concerning that this man supposedly got infected through minimal contact – a couple of meetings and a handshake. Now that it’s clear that he was not infected, we’re back to a situation where those who have been infected have either been health care workers caring for MERS patients or close contacts, often family members.’”

 

Syria Set to Miss Deadline for Chemical Weapons Destruction

During the past week not only was a chemical weapons inspection team ambushed and held captive in Syria, but reports are coming out that the Syrian government will not meet the June 30, 2014, deadline for removal and destruction of their chemical weapons arsenal.  UN Secretary General, Ban Ki-moon, also voiced concerned about allegations that chlorine gas has been used in recent fighting in Syria.

The Moscow Times—“The Syrian government has missed several deadlines, most recently its own promise to hand over the remaining chemicals by April 27. It has also failed to destroy a dozen facilities that were part of the chemical weapons program. The government has blamed those failures on security problems and rebel activities, but Western officials have voiced skepticism about those explanations.”

 

The New Measles Outbreak: Blame the Anti-Vaxxers

This week, the Centers for Disease Control and Prevention released a report that new measles cases in the United States are at a 20 year high for the first five months of 2014.  The CDC reports that 97% of measles cases have been imported by people who have travelled to other countries and brought the disease back with them and that 90% of the infections have occurred among unvaccinated individuals. In his scathing Time piece, Jeffrey Kluger highlights the worldwide struggle to eradicate polio and the capriciousness of those in the U.S. choosing to not be vaccinated against preventable, and long-dormant, diseases.

Time—“Make no mistake, the measles outbreak in the U.S. is an act of choice, of election, of a decision to get sick—or a decision by parents to put their children at risk. Fully 90% of the new cases are among people who are unvaccinated or whose vaccination status is unknown. And nearly all of those people are unvaccinated for personal, philosophical or religious reasons—as opposed to any medical condition that requires them to avoid vaccines. This is true too of recent outbreaks of mumps and whooping cough, and of the dangerously declining rate of vaccination in the U.S. overall. Nearly all of that folly can be blamed on the rumors and outright lies that continue to be spread about various conditions vaccines are said to cause—autism, ADHD, vaguely defined immune system disorders and on and on depending on which celebrity or health faddist is telling the tale.” 

 

Image Credit: Wikimedia Commons

Image of the Day: MERS CoV!

mers cov orange

MERS CoV is in the mainstream news again (as if it ever went away) as reports of a second case in the U.S. have surfaced, this time, in Florida. An additional case has been diagnosed in the Netherlands as well, continuing the geographic spread of the virus.

The WHO has reiterated that NO cases of MERS have been reported through person-to-person transmission.

 

Pandora Report 5.2.14

Highlights this week include Smallpox Redux, Antibiotic Resistance, and MERS in America. Check us out @PandoraReport for additional stories about the 1918 flu, Obstacle races and their health impact, the deadliest creature on earth, and Stephen Colbert vs. Anti-Vaxxers. Have a great weekend!

A Smallpox like virus found in the Republic of Georgia

This week, doctors from the Centers for Disease Control and Prevention reported that two herdsmen in the Republic of Georgia have been infected with a new virus that is very similar to smallpox. The news comes in addition to a lot of smallpox talk this week. After unearthing a corpse in Queens, NY, the issue of the virus spreading from dead bodies was raised again. Meanwhile, this month The World Health Assembly (WHA) will meet to discuss destruction of remaining smallpox virus being held in Russia and the U.S. Though the smallpox virus has been eradicated, this new virus in the same family raises concerns about protection from bioterrorists using agents we have no immunity or vaccinations for.

NPR—“Last year the U.S. government spent about $460 million on a relatively new smallpox medicine, in case the virus was deliberately released in a bioterrorism attack. That stockpile could treat about 2 million people.”

MERS Arrives in the U.S. 

An American man returning from Saudi Arabia has been diagnosed with MERS CoV. The man was hospitalized in Indiana and authorities say he poses very little risk to the public.  At least 400 people have been diagnosed with Middle East Respiratory Syndrome and it has killed over 100. Though the disease has not transferred human to human at this point, the high lethality is a concern to health officials.

The Associated Press—“Experts said it was just a matter of time before MERS showed up in the U.S., as it has in Europe and Asia. “Given the   interconnectedness of our world, there’s no such thing as ‘it stays over there and it can’t come here,'” said Dr. W. Ian Lipkin, a Columbia University MERS expert.”

Antibiotic Resistance Threatens Everyone, Warns UN

A United Nations report, released on Wednesday, outlined that antibiotic resistance is now prevalent in all parts of the world and that for up to half of patients antibiotics may not be effective. Many doctors in Canada are encouraging their colleagues to be careful about over-prescribing antibiotics as a “cure all.” If doctors around the world cannot do that, we may be looking at a post-antibiotic future.

CBC-“‘What it means, is that all of us, our family members, all of the persons in this room, our friends, when we are most vulnerable and in need of these medicines, there is a chance that they are simply not going to be available and we are not going to be able to have access to effective medical care in a number of instances,’ Dr. Keiji Fukuda, one of the agency’s assistant directors-general, told reporters.”

 

(image courtesy of Wikimedia Commons/ Arias,F.J)

Pandora Report 4.18.14

I think I was coming down with something yesterday. It manifested as a pretty debilitating headache, so I am pretty sure it wasn’t Ebola, but I also had no desire to drink water, so it might have been rabies. Either way, I’m feeling much better today, and am excited to bring you a Saturday issue of Pandora Report. In fact, I’m pretty sure there is nothing that is more fun on the weekend…so let’s get into it!


Highlights include Bird Flu in North Korea, a TB drug that may be the answer to drug resistance, a new strain of Ebola, MERS CoV’s spread to Asia, and Tamiflu’s real utility. Have a great weekend and see you here next Friday!

Highly Pathogenic Avian Influenza (HPAI) outbreak in North Korea

On April 16, the North Korean veterinary authority sent a notice to the World Organization for Animal Health (OIE) alerting them to two H5N1 outbreaks among poultry in the isolated nation. This is a surprisingly transparent move. The first outbreak occurred at the Hadang chicken factory in Hyongjesan starting on March 21. All 46,217 birds died. A second outbreak occurred on March 27 in the same region at the Sopo chicken factory where an unreported number of birds died in the same cage. The source of the infection remains unknown.

The Poultry Site—“Usual control measures have been put in place to control the spread of infection: quarantine, movement control inside the country, screening and disinfection of infected premises/establishment(s). There is no vaccination and no treatment of affected birds.”

Could a new TB drug be the answer to resistance?

A research study at the University of Illinois shows that a new drug under clinical trials for tuberculosis treatment—SQ109—may be the basis for an entirely new class of drugs that could act against bacterial, fungal, and parasite infection and yet evade resistance. Lead researcher, chemistry professor Eric Oldfield, believes that multiple-target drugs like SQ109 and its analogs hold the key to new antibiotic development in the era of drug resistance and “the rise of so-called ‘superbugs’.” His claim is bolstered by experiments with SQ109 and TB where no instances of resistance have been reported.

Science Codex—“’Drug resistance is a major public health threat,” Oldfield said. “We have to make new antibiotics, and we have to find ways to get around the resistance problem. And one way to do that is with multi-target drugs. Resistance in many cases arises because there’s a specific mutation in the target protein so the drug will no longer bind. Thus, one possible route to attacking the drug resistance problem will be to devise drugs that don’t have just one target, but two or three targets.’”

Outbreak in West Africa is caused by a new strain of Ebola virus

As the death toll from the Ebola outbreak in West Africa climbs above 120, scientists are reporting that the virus is not the same strain that has killed in other African nations.  While the source of the virus is still unknown, blood samples from Guinea victims has confirmed that it is not imported strains of Ebola Zaire—the original strain of the virus discovered in Democratic Republic of Congo (formerly known as Zaire.)

The Huffington Post—“‘It is not coming from the Democratic Republic of Congo. It has not been imported to Guinea” from that country or from Gabon, where Ebola also has occurred, [Dr. Stephan] Gunther [of the Bernhard Nocht Institute for Tropical Medicine in Hamburg, Germany] said.

Researchers think the Guinea and other strains evolved in parallel from a recent ancestor virus. The Guinea outbreak likely began last December or earlier and might have been smoldering for some time unrecognized. The investigation continues to try to identify “the presumed animal source.’”

MERS CoV leaves the Middle East and travels to Asia

Though the method of transmission of Middle East Respiratory Syndrome (MERS) remains unknown—a report last week from the CDC finds the virus can stay alive in Camel milk—and thankfully, transmission from human to human has been rare, the disease has now spread beyond the Middle East to Asia via an infection emerging in Malaysia. A Malaysian man returning from Mecca, in Saudi Arabia, tested positive for, and died from, MERS on April 13. So far, a reported 33 people who have travelled to the Middle East for the Haj have tested negative for presence of the virus in neighboring Singapore.

Today Online—“There is currently no advisory against travel to countries of the Arabian Peninsula, or to countries reporting imported cases of MERS-CoV (including Malaysia).

Frequent travellers to the Middle East and Umrah/Haj pilgrims have been advised to take precautions, such as being vaccinated against influenza and meningitis. Those aged 65 years and above or with chronic medical conditions should also get vaccinated against pneumococcal infections before travelling. Pilgrims with pre-existing chronic medical conditions like diabetes, chronic heart and lung conditions should consult a doctor before traveling, to assess whether they should make the pilgrimage.”

A closer look at Tamiflu

With seasonal flu season behind us in the U.S., maybe it is time to look at better treatment options. A study published last week in the British Medical Journal, calls into question the effectiveness of Oseltamivir—brand name, Tamiflu. The international team of researchers found that while Tamiflu can shorten flu symptoms it does not reduce hospital admissions or medical complications. The study also demonstrated that Tamiflu can also cause nausea and vomiting and increases the risk of headaches and renal and psychiatric symptoms.

Global Biodefense—“‘The trade-off between benefits and harms should be borne in mind when making decisions to use oseltamivir for treatment, prophylaxis, or stockpiling,” concludes the study authors from The Cochrane Collaboration, an independent global healthcare research network. “There is no credible way these drugs could prevent a pandemic,” Carl Heneghan, one of the lead investigators of the review and a professor at Oxford University, told reporters. “Remember, the idea of a drug is that the benefits should exceed the harms. So if you can’t find any benefits, that accentuates the harms.’”

(Image credit: Robert Sharp/Flickr)

The Pandora Report 2.21.14

Editor’s note: Hello all Pandora Report subscribers! This is unfortunately my last week as author of the Pandora Report. It’s been such a pleasure having the opportunity to write the Pandora Report, and I would like to thank all of you for taking the time to subscribe and read it. I leave you all in the trusty hands of the new Pandora Report team – goodbye, thank you, and remember to stay away from the bats.

Highlights include PEDv, 1918 Spanish Flu, MERS-CoV, and Ebola. Happy Friday!

As deadly pig virus spreads, USDA warns of impact on hog supply

Porcine epidemic diarrhea virus (PEDv)has spread to a further two states, with Montana and Idaho reporting cases for the first time. The virus, which has a fatality rate approaching 100% in piglets, has swept across the country, with 3,528 cases in 25 states. Contaminated feed was recently put forth as a potential source of the virus’ spread. Before you start autoclaving your pork products, remember that the virus poses no threat to humans.

Chicago Tribune – “PEDv causes diarrhea, vomiting and severe dehydration in pigs. Research by the U.S. hog industry determined it is spread orally through infected pig manure, and can be carried by trucks, boots, clothes and water. But feed containing porcine by-products, including but not limited to plasma, recently came into focus as a means of transmission. The Canadian Food Inspection Agency (CFIA) found the virus in samples of U.S.-origin plasma from a third-party manufacturer for Grand Valley Fortifiers, a livestock feed company based in the province of Ontario. The company recalled the feed.”

Study revives bird origin for 1918 flu pandemic

According to a new study published in Nature, the 1918 (H1N1) Spanish flu virus originated not from reassortment in pigs, but from domestic water and shore birds. This most recent study contradicts finding in a persuasive 2009 study which found the virus to have circulated in humans and pigs for up to 15 years prior to the pandemic. Historical epidemiology is critical to better understanding, and therefore predicting, emerging  pandemic threats.

Nature – “The virus that caused the 1918 influenza pandemic probably sprang from North American domestic and wild birds, not from the mixing of human and swine viruses. A study published today in Nature1 reconstructs the origins of influenza A virus and traces its evolution and flow through different animal hosts over two centuries. ‘The methods we’ve been using for years and years, and which are crucial to figuring out the origins of gene sequences and the timing of those events, are all flawed’, says lead author Michael Worobey, an ecologist and evolutionary biologist at the University of Arizona in Tucson. Worobey and his colleagues analysed more than 80,000 gene sequences from flu viruses isolated from humans, birds, horses, pigs and bats using a model they developed to map evolutionary relationships between viruses from different host species. The branched tree that resulted showed that the genes of the deadly 1918 pandemic virus are of avian origin.”

Saudi Arabia’s MERS Death Toll Reaches 60

The sixtieth MERS-CoV fatality in Saudi Arabia was a 22-year old male with previously existing conditions. The young man was also battling cancer. There have been 182 cases of the virus globally, of which 165 have been in Saudi Arabia. All but nineteen of the fatalities have been in Saudi Arabia. No word yet on whether he had previous contact with camels.

Gulf Business – “The virus, which first appeared in 2012, has affected around 182 people globally and has resulted in 79 deaths till date, according to World Health Organisation (WHO). MERS, a deadly but less transmissible virus than SARS, has symptoms such as coughing, fever and pneumonia. Although the worldwide number of MERS infections is fairly small, the high 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, UAE, Oman and Tunisia as well as in several countries in Europe.”

Man steals phone from Ebola patient, gets infected

As this is my last Pandora Report, it is only appropriate Ebola is mentioned at least once. This story is making the rounds again following it’s use in a promotional AARP blog post (bold move, AARP, bold move). Its moral? Don’t steal things from hospitals. Especially things located in a hospital’s active quarantine zone. Especially things located in a hospital’s active quarantine zone during an Ebola outbreak.

The Daily Monitor (Uganda) – “Security and medical officials in Kibaale District have registered a case in which a man allegedly went in an isolation ward at Kagadi Hospital and stole a cellular phone from one of the Ebola patients…Police detectives began tracking him after he apparently began communicating to his friends using the phone. But as police zeroed in on him, he developed symptoms similar to those of Ebola and sought medication at the hospital…In his confession made to the police, the suspect, now patient, claimed he had visited the isolation ward to give them comfort although he confessed to knowing none in person.”

(image courtesy of NIAID)

The Pandora Report 2.14.14

Highlights include H7N9 in Hong Kong, H5N1, a new case of MERS, and a new global initiative to counter infectious diseases. Happy Friday, stay warm, and Happy Valentine’s day!

Hong Kong Reports Fifth H7N9 Bird Flu Case

We wrote earlier this week about the H7N9 case in Malaysia, in which a Chinese tourist brought the virus to Malaysia. Hong Kong has since reported its fifth case of the virus. The patient is a 65 year old male with underlying medical conditions.  Tensions are understandably running high in the area, with Chinese authorities recently arresting a man for spreading false rumors about the virus.

Naharnet – “Preliminary investigations showed the man had traveled to the neighboring Chinese province of Guangdong from January 24 to February 9, and had purchased a slaughtered chicken in the village near his residence on January 29. Seven family members had remained asymptomatic, with five classified as close contacts to be admitted to hospital for observation and testing. Hong Kong late last month slaughtered 20,000 chickens after the deadly H7N9 bird flu virus was found in poultry imported from Guangdong. Fears over avian flu have grown following the deaths of three men from the H7N9 strain in the city. All had recently returned from mainland China.”

Canadian who died from H5N1 flu might have caught it in illegal bird market
It is thought the Canadian who contracted H5N1 became infected after passing through an illegal live poultry market in Beijing. Such markets have been banned in the city since 2005 – local demand for fresh poultry, however, has caused a thriving illicit industry to spring up.

CBC – “The source of the woman’s infection has been a mystery; she spent her entire trip in Beijing, where H5N1 reportedly hasn’t been discovered for some time, and her travelling companion said she did not have contact with live birds while there. But scientists from Beijing’s Centre for Disease Prevention and Control are hypothesizing that illegal live bird markets may have been the source of the woman’s infection.”

Camel-owner in Abu Dhabi in intensive care after contracting MERS virus
A camel-owner in the UAE has presented with MERS, giving further credence to the theory of camels as potential hosts. The 67-year old man had previously existing medical conditions, becoming symptomatic on January 20th.  There have been 182 laboratory-confirmed cases of the virus to date, with 79 deaths.

The National – “A camel owner in the emirate has become the latest person to be infected with the Mers coronavirus. The Emirati, 66, is in intensive care after complaining of respiratory problems and was found to have contracted the virus, it was confirmed on Thursday…He owns camels in the UAE and had recently travelled to Oman where he was in contact with other beasts, the World Health Organisation says.”

U.S. launches new global initiative to prevent infectious disease threats
Working with WHO, the Food and Agriculture Organization, and the World Organization for Animal Health, the US launched a new global initiative to help countering emerging infectious diseases. Speaking about the threat of emergent infectious diseases, Health and Human Services Secretary Kathleen , “A threat anywhere is indeed a threat everywhere”.

Washington Post – “Faced with what they describe as a perfect storm of converging threats from infectious-disease epidemics, U.S. officials launched a global effort Thursday with more than two dozen countries and international organizations to prevent deadly outbreaks from spreading. The goal is to prevent, detect and respond to infectious-disease threats where they start. That’s more effective and less costly than treating sick people after diseases spread. The new initiative is intended to bolster security at infectious-disease laboratories, streng-then immunization programs and set up emergency-response centers that can react to outbreaks within two hours.”

The Pandora Report 2.6.14

Highlights include H10N8, H7N9’s second wave, MERS-CoV update, and a Burholderia antrimicrobial. Happy Friday!

New China bird flu a reminder of mutant virus risk

We covered this story when it first came out, but the emergence of a novel strain of highly pathogenic avian influenza (HPAI) is noteworthy enough to mention twice.  It’s H10N8 everyone and it’s in humans. There have been just two cases since the virus jumped from birds to humans in December of 2013, including one fatality. There are a couple things about H10N8 which is troubling scientists. The first is that it’s jumped host, and in the process, opened up a completely naive population (us) to infection. The second is that it’s thought to be reassorted – a mix of a couple other strains of avian flu. Reassortment scares everyone – if it can mutate once to be able to infect humans, it can mutate twice to become readily transmissible person-t0-person. Still, we’re novel hosts, which means the virus isn’t yet well-adapted to us. It’s also worth mentioning here that H7N9 also made the jump from poultry to person, and it remains poorly suited to human hosts.

Reuters – “The death of a woman in China from a strain of bird flu previously unknown in humans is a reminder of the ever-present potential pandemic threat from mutating animal viruses, scientists said on Wednesday. The new strain, called H10N8, has so far infected only two people – a fatal case in a 73-year-old and another in a woman who is critically ill in hospital. But the fact it has jumped from birds to humans is an important warning, they said. ‘We should always be worried when viruses cross the species barrier from birds or animals to humans, as it is very unlikely that we will have prior immunity to protect us’, said Jeremy Farrar, director of Wellcome Trust and an expert on flu.”

China reports 11 new H7N9 human cases

Chinese health authorities have reported a further 11 laboratory-confirmed cases of H7N9, bringing the number of second wave infections up to 181, and the total number of cases up to 317. The majority of the cases are coming from just two Chinese provinces, Guandong and Zhejiang. While the influx of cases in Hong Kong are all thought to originate from poultry imports, there has been no evidence to indicate the virus has been transmitted internationally. Also, aside from one cluster, there has been no evidence of sustained person-to-person transmission.

Xinhua – “Eleven Chinese people were confirmed to be infected with the H7N9 bird flu on Wednesday in four regions, with 8 in critical condition, according to local health authorities. The southern province of Guangdong reported 4 new cases, including a 5-year-old girl and a 42-year-old man in Zhaoqing City, a 49-year-old man in Foshan City and a 56-year-old man in Shenzhen City, said the provincial health and family planning commission. The girl and the man from Foshan are in stable condition while the other two remain in critical condition, according to the commission. The eastern province of Zhejiang, the region hit hardest by the H7N9 virus, confirmed four new human cases on Wednesday, bringing the total number of affected cases to 69 in the province so far this year, said the provincial health and family planning commission.”

Middle East respiratory syndrome coronavirus (MERS-CoV) – update

With H7N9 picking up and H10N8 emerging, MERS-CoV has been flying under the comparative radar. Speaking anecdotally, the number of cases seems to be declining, with just one new case in the last two weeks. Globally, there have been 181 cases to date. While camels remain the likely culprit, no vector or reservoir has been confirmed.

WHO – “The case is a 60-year-old man from Riyadh who became ill on 19 January and who had underlying medical conditions. He was hospitalized on 24 January and died on 28 January. Respiratory specimens were collected and sent to the central laboratory in Riyadh and confirmed positive for MERS-CoV on 28 January. Details of his possible contact with animals are unknown, and he has no history of contact with a laboratory-confirmed case. WHO has also been informed by the United Arab Emirates of the death on 16 January of a previously reported case of a 33 year-old male healthcare worker from Dubai (see Disease Outbreak News update from 3 January 2014).”

U.S. Eyes $90 Million Contract for Bioterror Treatments

The Department of Health and Human Services (HHS) awarded a $19.8 million dollar contract to a company working on  antimicrobials against the agents Burkholderia mallei, the causative agent of glanders,  and B. pseudomallei, the causative agent of melioidosis, respectively.  B. mallei, it should be noted, may have been used during WWI by the Germans, in an ill-fated attempt to use infected horses to spread the disease across the Russian front lines. While B. mallei does cause serious disease in horses and donkeys, cases of human infection are rare.

NTI – “The contract award marked a new investment in ‘broad-spectrum antimicrobials’ by the federal agency’s Biomedical Advanced Research and Development Authority. Such treatments are designed to be of use in responding to a potential biological strike, as well as for handling other health threats. ‘Antibiotic resistance adversely impacts our nation’s ability to respond effectively to a bioterrorism attack and to everyday public health threats,’ BARDA Director Robin Robinson said in a statement. ‘By partnering with industry to develop novel antimicrobial drugs against biothreats that also treat drug-resistant bacteria, we can address health security and public health needs efficiently.’

(image: James Jin/Flickr)

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.)