Pandora Report 11.2.14

For this edition of the Pandora Report we look at Jonas Salk, avian influenza in China, TB and diabetes as a co-epidemic, and, of course, an Ebola update. As the weather is turning cooler, don’t forget to get your flu shot, and remember to protect yourself by washing your hands!

Have a great week!

On Jonas Salk’s 100th Birthday, A Celebration of his Polio Vaccine

If you visited Google.com on Tuesday you may have seen one of their famous doodles dedicated to Jonas Salk. Salk’s polo vaccine was declared safe and effective in 1955 and was, interestingly enough, never patented. “The notion handed down to us is that Salk decided not to patent the vaccine as a noble act of self-abnegation.”

The Los Angeles Times—“But the more important reason the vaccine went unpatented, as related by David M. Oshinsky in his 2005 book, “Polio: An American Story,” is that legally it was thought to be unpatentable. The National Foundation and the University of Pittsburgh, where much of the work was done, had looked into patenting the vaccine. They were dissuaded by Salk, who informed them that his techniques weren’t novel and his work had been based on years of prior work by others.”

Five Strains of H5 Avian Flu Reported Across China 

The Chinese veterinary authority reported outbreaks of five different subtypes of Highly Pathogenic Avian Influenza (HPAI) to the World Organization of Animal Health (OIE) on October 24. There were a total of 51 positive findings of the following strains; H5N3, H5N8, H5N2, H5N6, and H5N1. A map of all strain outbreaks is available here.

CIDRAP—“Two of the strains—H5N8 and H5N3—have not been reported by China to the OIE before. Two outbreaks of the former were reported in September, each involving one bird (a duck and an unspecified bird) sampled during a national surveillance plan. One was at a slaughterhouse and the other in a wetland area; both were in Liaoning province in the northeast.”

Unlikely Marriage of Diseases: TB and Diabetes Form a ‘Co-Epidemic’

A white paper presented on Wednesday at the 45th Union World Conference on Lung Health in Barcelona, Spain, warns, “diabetes is fueling the spread of TB.” The paper warns that having diabetes increases the risk that a person will become sick with TB will make TB more difficult to manage, adding that a patient with both diseases is more likely to have complications that do not exist when only one disease is present.

NPR—“The TB/diabetes double-whammy has at least two important differences from the TB/HIV co-epidemic. [1.] It involves the interaction of an infectious disease (TB is the world’s second-deadliest, next to HIV/AIDS) and a non-communicable chronic disease, rather than two infections. [2.] It has potentially more global impact. The TB/HIV co-epidemic was concentrated in sub-Saharan Africa, where 18 countries saw TB rates quadruple because of HIV. Many more countries have high rates of TB and, increasingly, of diabetes.”

This Week in Ebola

Not sure if it was because of Halloween or what, but it seemed to me there were fewer Ebola stories this week. Dallas nurse Amber Vinson, was finally released from Emory Hospital, free of the Ebola virus. Many other stories this week focused on quarantine. Kaci Hickox, the nurse who worked treating patients in Sierra Leone, first protested over her isolation in New Jersey, and then broke her quarantine in Maine, was reportedly ‘humbled’ when a judge in her home state of Maine ruled she can come and go as she pleases. She was still in this news this weekend as it was reported that her roommate in Africa tested positive for Ebola and there was a skit about her on SNL. President Obama has said that quarantines may dissuade doctors and nurses from traveling to West Africa, while Secretary of Defense Chuck Hagel has said that U.S. military personnel returning from West Africa will be subject to a 21-day quarantine. The WHO reported that Ebola infections are slowing in Liberia, and the New England Journal of Medicine says they have a suspect zero for this whole outbreak.

Stories You May Have Missed

 

Image Credit: Google

Pandora Report 9.27.14

This week the round up includes concern of growing antibiotic resistance, MERS CoV transmission, and of course, an Ebola update.

Have a great weekend (and don’t forget to get your flu shot)!

White House Orders Plan for Antibiotic Resistance

On Thursday, President Obama signed an executive order to form a government task force and presidential advisory council to address antibiotic-resistant germs. The order calls for new regulations of antibiotic use in hospitals and urges the development of new antibiotics. Scientists at MIT are looking at creating a new class of antibiotic that targets and destroys resistance genes within bacteria.

WTOP—“According to the Centers for Disease Control and Prevention, antibiotic-resistant infections are linked to 23,000 deaths and 2 million illnesses in the United States annually. The impact to the U.S. economy is as high as $20 billion, the White House said, or more, if you count lost productivity from those who are sickened. And the problem is worsening.”

Camels are Primary Source of MERS-CoV Transmission 

A study designed by scientists from Colorado State University and NIH’s National Institute of Allergy and Infectious Disease has transmitted a strain of MERS CoV from human patient to camels. The camels developed a respiratory infection and showed high levels of virus in nasal secretions for up to a week after the infection. Though the camels recovered quickly, the nasal secretions could be the source of transmission to people who handle these animals.

Business Standard—“The researchers theorized that vaccinating camels could reduce the risk of MERS-CoV transmission to people and other camels; NIAID and others are supporting research to develop candidate vaccines for potential use in people and camels.”

This Week in Ebola

This week, the CDC estimated that there could be 500,000 to 1.4 million cases of Ebola by January if the outbreak continues unchecked. Meanwhile, a professor teaching at Delaware State University is telling Liberians that the U.S. Department of Defense, among others, has manufactured Ebola and warns them that doctors are not actually trying to treat them. Claims like this make it even more difficult for those on the ground to relay accurate information about the virus. However, a reverend in Monrovia is working to spread awareness of proper hand washing and social distancing within his congregation and alumni from a State Department funded exchange program help to spread news of the virus throughout neighborhoods. Unsurprisingly, the Ebola outbreak has essentially crippled the fragile Liberian health system which means people are dying from routine medical problems.

Stories You May Have Missed

 

Image Credit: Wikimedia

Tuberculosis and Seals: Sea Mammals as Harbingers of Disease

By Chris Healey

Seals introduced one of the deadliest illnesses in history to the Western Hemisphere centuries before Europeans carried it over. Researchers at the University of Tubingen in Germany published findings in the research journal Nature describing the role seals played in introducing tuberculosis to the Americas.

Before these findings, the presence of tuberculosis in North and South America prior to European exploration was unexplained. Tuberculosis spread across Africa, Europe, and Asia, but there was no evidence demonstrating tuberculosis concurrently existed in the Americas. The bacteria made its first appearance in Peruvian skeletal remains dating back to approximately A.D. 700 – centuries before the arrival of European explorers.

Research findings indicate approximately 2500 years ago, seals contracted a Mycobacterium strain from Africa and carried it across the ocean to the shores of Peru and Northern Chile. Possibly through seal predation, costal humans contracted a version of the seal Mycobacterium which had adapted to humans. Tuberculosis has been found in skeletal remains in North America dating back to approximately A.D. 900, indicating the seal-derived strain spread person-to-person from South America.

One limitation of this study was the inability to rule out humans passing the agent to seals. The researchers deemed that alternative a distant possibility; humans did not treat seals as livestock. A close relationship, such as between farmer and animal, is required to pass a pathogen from human to animal.

The seal-derived strain did not last long in the Western Hemisphere. Following European settlement, European tuberculosis strains outcompeted and eliminated those from seals. Today, viable seal-derived strains do not exist.


Tuberculosis is a condition caused by Mycobacterium tuberculosis, a slow-growing bacterium adept at evading host immune response. The illness is one of the greatest threats to public health worldwide. According to the World Health Organization, tuberculosis kills more people than any other infectious agent except HIV/AIDS.

Despite advancements in therapeutic techniques, there has been a resurgence of tuberculosis fueled by the emergence of HIV/AIDS in the late 20th century. As an opportunistic pathogen, tuberculosis kills more AIDS patients than any other illness.

Tuberculosis is not the first human illness associated with seals. They are susceptible to certain subtypes of influenza, including H7N7, H4N5, and H3N2. Influenza subtypes maintained in seal populations could be re-assorted in other animals, such as fowl or swine, to produce subtypes which are highly virulent in humans.

 

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Pandora Report 8.22.14

Did you see that the destruction of Syria’s most lethal chemicals is now complete? Well, it is! Its good news among so many biodefense stories covering Ebola. I have no interest in making the Pandora Report the “All Ebola, All the Time” newsletter. As such, we will look at one Ebola story as well as stories covering new discoveries in tuberculosis and influenza.

Have a fabulous weekend, and students, enjoy your last one before classes start on Monday!

Tuberculosis is Newer Than Thought, Study Says

A recent study published in Nature reports that tuberculosis originated less than 6,000 years ago and was carried to the new world by seals. Seals! This new research contradicts original timeline and species genesis and some scientists think this study provides more questions than answers.

The New York Times—“In the new paper, the team proposes that humans acquired tuberculosis in Africa around 5,000 years ago. The disease spread to people across the Old World along trade routes. Meanwhile, Africans also spread the disease to animals such as cows and goats. Seals that hauled out onto African beaches to raise their pups became infected. The bacteria then spread through seal populations until reaching South America. Ancient hunters there became infected when they handled contaminated meat.”

Enzyme Holds the Door for Influenza

As the fall season and semester approach, the flu season travels with it. I was delighted to read that Walgreens, in addition to CVS, will now offer seasonal flu shots in their stores. More interesting news about flu came out of Vanderbilt University, too. Researches have investigated enzyme phospholipase D (PLD) and it ability to help the influenza virus escape immune response. Blocking PLD could assist in preventing the flu.

Bioscience Technology Online—“Normally the virus slips into its host cell in the epithelial lining of the lungs through internalized membrane compartments called endosomes. By delaying this process, the researchers propose, PLD2 inhibitors may give the cell’s innate immune response more time to destroy it.”

Patient Checked for Ebola Virus in Sacramento

Internationally, the good news is that quarantines have been set up in Liberia, in attempt to contain the spread of Ebola. The bad news is that they have become fairly violent. Stateside, this week Dr. Kent Brantly and Nancy Writebol were released from Emory University Hospital after recovering from Ebola infections acquired in West Africa.

There was news of a possible case in Northern California. With few details provided as to the patient and transmission route, we learned that there is a patient being tested for Ebola in Sacramento. California Department of Health reported that the cases is low risk but that testing is being done out of “abundance of caution.”

San Francisco Chronicle—“‘In order to protect our patients, staff and physicians, even though infection with the virus is unconfirmed, we are taking the actions recommended by the CDC as a precaution, just as we do for other patients with a suspected infectious disease,” said Dr. Stephen Parodi, an infectious disease specialist at Kaiser Permanente North California. “This includes isolation of the patient in a specially equipped negative pressure room and the use of personal protective equipment by trained staff, coordinated with infectious disease specialists.’”

 

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Pandora Report 8.17.14

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

Giant Rats Trained to Sniff Out Tuberculosis in Africa

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

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

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

Experimental Chikungunya Vaccine Shows Promise

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

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

WHO: Ebola Outbreak Vastly Underestimated

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

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

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

Image Credit: James Pursey, APOPO

Pandora Report 7.26.14

Highlights this week include, Dr. Frieden goes to Washington, top Ebola doc comes down with the virus, a TB patient on the loose in California, and a plague based shut-down in China. Have a great weekend!

CDC Director to Tackle MERS, Measles, Global Health Threats

It was my absolute pleasure to be able to attend a talk given by Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, at the National Press Club on Tuesday.  Though Dr. Frieden briefly covered the stated topics, he spoke primarily about the dangers of growning antibiotic resistance and hospital acquired infections. He urged everyone, including the CDC, to work hard(er) to combat these issues that may usher us into a “post-antibiotic era.” The entire speech is available here. (You may even notice me in the lower left corner chowing down on a CDC cupcake!)

USA Today—“‘Anti-microbial resistance has the potential to harm or kill anyone in the country, undermine modern medicine, to devastate our economy and to make our health care system less stable,” Frieden said.

To combat the spread of resistant bacteria, Frieden said the CDC plans to isolate their existence in hospitals and shrink the numbers through tracking and stricter prevention methods.”

 

Sierra Leone’s Top Ebola Doctor Infected as the Worst Outbreak in History Continues

You may have seen this story pop up earlier this week in our facebook or twitter, but it certainly bears repeating. Dr. Sheik Umar Khan, who has been credited with treating more than 100 Ebola victims, has come down with the virus too. He is now one of hundreds who have been affected by the virus in West Africa, which has killed over 600.

The Washington Post-“In late June, Khan seemed keenly aware of the risk he faced. “I am afraid for my life, I must say, because I cherish my life,” he told Reuters. “Health workers are prone to the disease because we are the first port of call for somebody who is sickened by disease. Even with the full protective clothing you put on, you are at risk.’”

 

California Police Seek Man Who Refused Tuberculosis Treatment

Prosecutors in Northern California have obtained an arrest warrant for Eduardo Rosas Cruz, a 25 year old transient, who was diagnosed with TB and disappeared before he started treatment. Rosas Cruz needed to complete a nine-month course of treatment. Tuberculosis spreads through the air when an infected person coughs or sneezes. It is not known if Rosas Cruz is currently contagious. By law, health officials cannot force a patient to be treated but courts can be used to isolate an infectious individual from the public at large.

FOX News—“County health officials asked prosecutors to seek the warrant, in part, because Rosas Cruz comes from a part of Mexico known for its drug-resistant strain of tuberculosis. County health officials are searching for Rosas Cruz, and his name is in a statewide law enforcement system, San Joaquin County Deputy District Attorney Stephen Taylor said.”

 

In China, A Single Plague Death Means an Entire City Quarantined

Parts of Yumen City, in Gansu Province, were quarantined after a farmer died from bubonic plague. The man developed the disease after coming in contact with a dead marmot on a plain where his animals were grazing. According to experts, Chinese authorities categorize plague as a Class 1 disease, which enables them to label certain zones as “infection areas” and seal them off. 151 people were affected by the quarantine, which was lifted after none developed symptoms.

The Guardian—“The World Health Organization’s China office praised the Chinese government’s handling of the case. “The Chinese authorities notified WHO of the case of plague in Gansu province, as per their requirements under the International Health Regulations,” it said in a statement to the Guardian. “The national health authorities have advised us that they have determined this to be an isolated case, though they are continuing to monitor the patient’s close contacts.’”

 

Image Credit: RT

Pandora Report 3.28.14

It’s been a busy week between Ebola and Ricin! Friday highlights include a Polio-free India, tuberculosis transmission from cat to human, and mandatory vaccines in Croatia. Have a great weekend!

India is Polio-Free after 3 years of no new cases

On March 27, 2014, India was declared Polio-Free by the World Health Organization after three years of no new cases. The last case of polio in India was Rukhsar Khatoon, a 4 year old girl who became ill as a baby when her parents forgot to vaccinate her.

The Huffington Post—“Being declared polio-free once was considered all but impossible in a nation hobbled by corruption, poor sanitation and profound poverty. Although the disease could return, eradicating it is a landmark public health achievement.

This is “a day that we have dreamt about,” said Poonam Khetrpal Singh, a WHO official at a ceremony in New Delhi to declare the entire Southeast Asian region free of the disease. Singh described it as ‘a day that all countries fought hard for, and a day when all stakeholders come together to celebrate the victory of mankind over a dreaded disease.’”

Pet cats infect two people with TB

Two people in England have contracted tuberculosis from a house cat infected with Mycobacterium bovis—a form of tuberculosis normally found in cattle. Nine cats in the Berkshire and Hampshire areas have tested positive for M.bovis which is extremely uncommon in cats and usually affects livestock.

BBC—“‘These are the first documented cases of cat-to-human transmission, and so although PHE has assessed the risk of people catching this infection from infected cats as being very low, we are recommending that household and close contacts of cats with confirmed M. bovis infection should be assessed and receive public health advice’ said Dr. Dilys Morgan, head of gastrointestinal, emerging and zoonotic diseases department at Public Health England.”

Thank You, Croatia: All Hail Mandatory Vaccinations

This week, the Constitutional Court of Croatia passed a law that mandates all children must receive childhood vaccinations for diphtheria, pertussis, measles, polio and others. This decision comes at a time when lively debate rages, in the U.S. and abroad, about vaccination and its importance or harm. This step by Croatia, in the words of the court, is a victory for children’s health over parents (wrong) choices.

The Daily Beast—“… public health imperatives and individual rights are often at odds: a country like the U.S. that values the rights of the individual always has trouble with laws that remind us that not everything is a choice. Kids must go to school. People must pay taxes. Children must be vaccinated. It is called living in modern society.”

 

Image Credit: Dwight Sipler/ Wikimedia Commons

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)