Shenzhen Bird Flu Suspect Dies

 

# 6045

 

Numerous media outlets are reporting that the H5N1 suspect from Guangdong Province – adjacent to Hong Kong – has died from his illness.

 

Most of these media reports appear to be based on a trio of statements issued by the Health department in Guangdong province (links to Google translations below)

 

Note: while readable, these machine translations are nonetheless a bit convoluted.

 

Shenzhen confirmed case of human infection of highly pathogenic avian influenza 2011-12-31 16:51:06

Shenzhen diagnoses an example person to infect the high pathogenic bird flu 2011-12-31 16:51: 06

Shenzhen found a case of human infection of highly pathogenic avian influenza suspected cases 2011-12-30 22:35:08

The highlights are that the patient named Chen, a 39 year-old male bus driver in Shenzhen, developed a fever on December 21st, and was taken to a hospital on December 25th and diagnosed with severe pneumonia.

 

The patient subsequently tested positive for the H5N1 virus, and it was announced he died of massive organ failure on December 31st.

 

Based on the title and text of the latest press release local authorities are apparently considering this to be a confirmed case of H5N1.

 

Authorities state that the man had no contact with poultry, or history of travel outside the city, over the past 30 days. The Health Department is actively monitoring 120 recent contacts of the victim, but none reportedly have shown signs of illness.

 

With this latest case of H5N1 in China, along with reports of avian flu in poultry in the region, public health officials and epidemiologists across Asia will no doubt be watching carefully for any signs of disease outbreaks.

 

For January will see the biggest travel holiday on earth; The Lunar New Year.

 

In Vietnam, it is called  Tết Nguyên Đán or Feast of the First Morning.  Tết for short.

 

In Korea it is called Seollal.

 

In China, it is often called Chunyun, Chinese New Year, or simply, The Spring Festival.

 

By whatever name, the lunar new year is no doubt the most  important holiday in all of Asia.  And more than 2.5 billion passenger journeys – mostly by crowded train –will be made in China alone over this six week period.

 

In many Asian cultures it is a long held tradition that people return home to attend a reunion dinner with their families on the eve of the lunar New Year. They stay a few days, then return to the cities from whence they came.

 

Duck and chicken are, as you might imagine, popular dishes during these gatherings.  And the live markets do tremendous business this time of year.

 

All of which provides opportunities for avian, swine, or human flu viruses to hitch rides to remote areas of the world where they may not have arrived yet, and for viruses to be carried from rural areas back to the cities.

 

This year, the lunar New Year will fall on January 23rd.

 

Due to the potential for disease transmission (including mosquito borne illnesses, food poisoning, flu, etc.) during this very busy holiday period, the CDC posts some travel advice each year to those planning a trip to Asia.

 

Good Luck. Good Health. Good Cheer. Happy Lunar New Year!

The year of the Dragon begins January 23, 2012, and many travelers will visit Asia to celebrate the Lunar New Year. If you are traveling to Asia, the Centers for Disease Control and Prevention (CDC) would like to share information and tips that will help you stay healthy and safe during your trip.

 

Every destination, even in different areas of the same country, has unique health issues that travelers need to be aware of. To find specific information about the areas you plan to visit, see the East Asia, South Asia, and Southeast Asia regional pages on the CDC Travelers’ Health website, or click on the country or countries you will be visiting on the destinations page.

(Continue . . .)

Hong Kong: Suspected Human H5N1 Infection In Neighboring Shenzhen

 

 

 

# 6044

 

In the wake of the recent discovery of H5N1 infected wild birds and poultry in Hong Kong, which prompted the raising of the alert level there to `serious’, we are now learning of a suspected human H5N1 infection from the sub-provincial city of Shenzhen which borders Hong Kong to the north.

 

Of particular interest is the announcement that the patient, who is in critical condition, `had no travel history or contact with poultry before the onset of symptoms.’

 

The epidemiological investigation into this case should prove interesting.  If confirmed, this will make the first reported human H5N1 infection in China in 2011.

 

 

A hat tip to Giuseppe Michieli on FluTrackers for posting the following link from the Centre for Health Protection:

 

Notification of a human case of H5N1 in Shenzhen

The Centre for Health Protection (CHP) of the Department of Health received notification from the Ministry of Health (MoH) tonight (December 30) concerning a suspected human case of influenza A (H5N1) in Shenzhen.

 

A CHP spokesman said the patient was a 39-year-old man living in Shenzhen. He developed symptoms on December 21 and was admitted to a hospital on December 25 because of severe pneumonia. He is now in critical condition. The man had no travel history or contact with poultry before the onset of symptoms.

 

Preliminary laboratory tests on the patient's specimen by the Centre for Disease Control and Prevention of Guangdong Province yielded positive result for H5N1.

 

The CHP is maintaining close liaison with the Guangdong Department of Health to obtain more information on the case. We will heighten our vigilance and continue to maintain stringent port health measures in connection with this development, the spokesman said.

 

The spokesman reminded members of the public to remain vigilant against avian influenza infection and to observe the following measures:

 

Avoid direct contact with poultry and birds or their droppings; if contacts have been made, they should wash hands thoroughly with soap and water;

• Poultry and eggs should be thoroughly cooked before eating;
• Wash hands frequently;
• Cover nose and mouth while sneezing or coughing, hold the spit with tissue and put it into covered dustbins;
• Avoid crowded places and contact with sick people with fever;
• Wear a mask when you have respiratory symptoms or need to take care of patients with fever;
• When you have fever and influenza-like illnesses during a trip or when coming back to Hong Kong, you should consult doctors promptly and reveal your travel history.
  

     For further information on avian influenza, please visit the CHP website: www.chp.gov.hk.

Ends/Friday, December 30, 2011
Issued at HKT 23:25

WHO: Statement On Bird Flu Research & PIP Framework

 

 

# 6043

 

 

The PIP (Pandemic Influenza Preparedness) Framework, adopted last May by the 64th World Health Assembly after more than four years of difficult negotiations, provides guidelines for the sharing of biological materials (influenza viruses with human pandemic potential) along with promises of access to research data, vaccines and other benefits to member nations.

 

The PIP_FQA document on the World Health Organization’s website states that the framework’s primary goals are:"

 

1) To increase access to pandemic influenza vaccines and other pandemic influenza-related benefits for countries in need in the event of an influenza pandemic; and

(2) to ensure the continued sharing of viruses necessary for continuous global monitoring and assessment of risks for an influenza pandemic and for the development of safe and effective influenza vaccines.

 

The devil, as they say, is in the details.

 

And this hard fought agreement contains language designed to deal with a variety of difficult procedural and diplomatic issues, including: intellectual property rights, the sharing of benefits and credit, and protocols for transferring biological material.

 

You can access more details on the PIP Framework at:

 

Pandemic Influenza Preparedness (PIP) Framework

 

 

In light of the recent flap (not yet resolved) over the publication of controversial bird flu research (see The H5N1 Research Debate Goes On), the World Health Organization has concerns how this matter will impact the recently adopted PIP Framework.

 

A statement today from the WHO website:

 

WHO concerned that new H5N1 influenza research could undermine the 2011 Pandemic Influenza Preparedness Framework

Statement
30 December 2011

The World Health Organization (WHO) takes note that studies undertaken by several institutions on whether changes in the H5N1 influenza virus can make it more transmissible between humans have raised concern about the possible risks and misuses associated with this research. WHO is also deeply concerned about the potential negative consequences. However, WHO also notes that studies conducted under appropriate conditions must continue to take place so that critical scientific knowledge needed to reduce the risks posed by the H5N1 virus continues to increase.

 

H5N1 influenza viruses are a significant health risk to people for several reasons. Although this type of influenza does not infect humans often, when it does, approximately 60% of those infected die. In addition, because these viruses can cause such severe illness in people, scientists are especially concerned that this type of influenza could one day mutate so it spreads easily between people and causes a very serious influenza pandemic.

 

Research which can improve the understanding of these viruses and can reduce the public health risk is a scientific and public health imperative. In order to enable those public health gains, countries where these viruses occur should share their influenza viruses for public health purposes while countries and organizations receiving these viruses should share benefits resulting from the virus sharing. Both types of sharing are on equal footing and equally important parts of the collective global actions needed to protect public health.

 

While it is clear that conducting research to gain such knowledge must continue, it is also clear that certain research, and especially that which can generate more dangerous forms of the virus than those which already exist, has risks. Therefore such research should be done only after all important public health risks and benefits have been identified and reviewed, and it is certain that the necessary protections to minimize the potential for negative consequences are in place.

 

In May 2011, the new Pandemic Influenza Preparedness (PIP) Framework came into effect. This Framework was adopted by all WHO Member States as a guide to the sharing of influenza viruses with pandemic potential and the resulting benefits. One specific requirement of this Framework, which pertains to influenza viruses of pandemic potential, and is in keeping with best scientific practice, is for laboratories receiving them through WHO's Global Influenza Surveillance and Response System (GISRS) to collaborate with, and appropriately acknowledge, scientists in countries where the virus originated when initiating research.

 

WHO recognizes that the scientists who led the work of the new studies received their virus samples from the WHO Global Influenza Surveillance Network (GISN), which preceded GISRS, and before negotiations on the new PIP Framework began. However, now that the Framework has been adopted by all WHO Member States, WHO considers it critically important that scientists who undertake research with influenza viruses with pandemic potential samples fully abide by the new requirements.

 

Since the PIP Framework represents a major step forward and was agreed upon only after several years of difficult negotiations, WHO stresses that this H5N1 research must not undermine this major public health achievement. WHO will work with Member States and other key parties to ensure scientists understand the new requirements that have been agreed to with the Framework.

 

 

While today’s strongly worded statement calls specific attention to the need for bird flu researchers to `collaborate with, and appropriately acknowledge, scientists in countries where the virus originated when initiating research’ there are, quite obviously, other issues under deep consideration here as well.

 

Not the least of which is how, and under what conditions, to promote and facilitate the sharing of potentially dangerous `dual use’ research data (and/or biological materials) among laboratories and scientists around the world. 

 

Thorny questions, with admittedly, few clear cut answers.

NEJM: Oseltamivir Resistant H1N1 in Australia

 

 

# 6042

 

A correspondence appears in today’s NEJM that provides some detailed information on a story we began to follow last August (see Australia Reports Cluster Of Antiviral Resistant H1N1); the detection of an unusual number of oseltamivir (Tamiflu ®) resistant H1N1 viruses in and around the Newcastle area of New South Wales.

 

First, a little background.

 

During 2008 and early 2009 -prior to the emergence of the 2009 H1N1 pandemic virus - the old seasonal H1N1 virus developed nearly complete resistance to the antiviral drug oseltamivir.  

 

The H1N1pdm09 virus which replaced the old H1N1 – while resistant to the older amantadines – has remained largely sensitive to oseltamivir. The concern is, that over time, this newer strain might one day develop resistance as well.

 

During the first two years, only 1%-2% of samples tested have shown the most common mutation known to convey oseltamivir resistance; H275Y, where a single amino acid substitution (histidine (H) to tyrosine (Y)) occurs at the neuraminidase position 275.

 

(Note: some scientists use 'N2 numbering' (H274Y) and some use 'N1 numbering' (H275Y))

 

Most of the resistant cases we’ve seen reported have been isolated and sporadic, with no apparent epidemiological links. They have  often occurred in patients under therapeutic or prophylactic treatment with oseltamivir, and are assumed to have been the result of spontaneous resistance. 

 

 

Which brings us to today’s report in the NEJM that looks at the:

 

Community Transmission of Oseltamivir-Resistant A(H1N1)pdm09 Influenza

N Engl J Med 2011; 365:2541-2542 December 29, 2011

 

 

What the authors found was evidence for the sustained community transmission of a resistant strain of the H1N1pdm09 virus. 

 

After analyzing viral samples pulled from 182 patients seen in emergency departments, intensive care units, and doctor’s offices in New South Wales between May and August of 2011, they found 29 (16%) carried the H275Y resistance mutation.

 

Most of the patients lived within 50km of Newcastle, and while 10 of the cases could be epidemiologically linked (2 in 4 households, 2 in a shared car trip), the rest could not.

 

Only one had been treated with oseltamivir prior to testing.

 

The good news is that while 7 of these cases were hospitalized (24%), none ended up in the Intensive care unit, and none died. This resistant strain also appears to be antigenically similar to the vaccine strain.

 

The authors recommend:

 

As winter approaches in the Northern Hemisphere, it remains important to ensure that A(H1N1)pdm09 strains from early in the season are analyzed rapidly for any indication that this transmissible oseltamivir-resistant variant has spread.

 

 

So far, this appears to be regional phenomenon, and numbers like these have not been reported in other parts of the world.

 

For more on this evolving story, you may wish to revisit:

 

WER: Update On Anti-Viral Resistant Influenza

ECDC: Risk Assessment On Australia’s Antiviral Resistant H1N1 Cluster

CHP: Update On Avian Influenza Situation In Hong Kong

 

 

 

# 6041

 

 

Via Hong Kong’s Centre for Health Protection, we get the latest on the recent detection of H5N1 in poultry (see Hong Kong: CHP Enhances Human Surveillance For H5N1 for earlier reports) that led to an increase in their alert level to `serious’.

 

The following report comes from this week’s Communicable Diseases Watch dated December 29th. 

 

Communicable Diseases Watch Volume 8, Number 26, Week 51-52 (Dec 11, 2011 – Dec 24, 2011)

 

A few excerpts, but follow the link to read it in its entirety.

 

Update on H5N1 avian influenza

Reported by  MISS  AMY  LI,  Scientific Officer, and  DR ALICE WONG, Senior Medical Officer, Surveillance and Epidemiology Branch, CHP.

Hong Kong has raised the response level under the Government’s preparedness Plan for Influenza Pandemic from Alert to Serious on December 20, 2011. This followed the confirmation of highly pathogenic H5N1 avian influenza virus in a chicken carcass sample taken from the Cheung Sha Wan Temporary Wholesale Poultry Market (Wholesale Poultry Market) on December 20, 2011.

 

The Government is tracing the source of the chicken carcass and it is not certain at this stage whether the chicken came from local farm or was imported. All the poultry at the concerned market have been culled on the following day. The Centre for Health Protection (CHP) has worked with public and private hospitals to enhance the detection of suspected human cases. So far, no human cases have been detected in Hong Kong.

 

Avian influenza infection in human is caused by influenza viruses, such as influenza A H5N1, that mainly affect birds and poultry. Severe infection can result in severe respiratory failure, multi-organ failure and even death. Human infection with H5N1 is a rare event. Most cases recorded to date were sporadic infection, with limited human-to-human transmission in some cases. Below we summarize the latest global and local situation of human H5N1 avian influenza infection.

Global Situation

Figure 1 shows the annual trend of human cases.

(Continue . . . )

 

As is evidenced by the chart above, the number of reported human cases in 2011 is running slightly ahead of what we saw in both 2010 and 2008, with the bulk of the detections coming from Egypt.

 

It is probable that some number of human cases have gone undetected, and so the exact global burden and incidence of the disease in humans is not precisely known.

 

Nevertheless, for now H5N1 is primarily a threat to poultry.

 

The virus remains poorly adapted to human physiology, and despite ample opportunities in places like Egypt, Cambodia, and Indonesia - only appears to cause rare, sporadic infections.

 

The concern, of course, is that over time that may change.  And so the world remains at Pre-pandemic Phase III for the H5N1 virus, and we continue to watch for signs that the virus is adapting to humans.

DFID: World Unprepared For Future Shocks

 

 

 

# 6040

 

 

The DFID (Department for International Development) – which is a UK government agency that manages aid to developing countries – issued a warning yesterday that the world is `dangerously unprepared’ to deal with future shocks.

 

International Development Secretary Andrew Mitchell warns that while a system is in place to provide humanitarian relief after disasters (UN’s Central Emergency Response Fund CERF), too few countries and agencies are fully funding it.

 

First their press release, then I’ll return with more.

 

 

 

World 'dangerously unprepared' for future shocks

27 December 2011

Some of the world's richest countries are failing to help prepare for large-scale disasters, such as earthquakes, floods and wars, despite clear evidence that the number of catastrophes is likely to increase in the years ahead, International Development Secretary Andrew Mitchell warned today.

 

Despite a year of unprecedented disasters – including famine in the Horn of Africa, the Japan tsunami, New Zealand earthquake, floods in Pakistan and most recently the Philippines – the United Nations’ international disaster response funding system is expected to be left severely underfunded.

 

The system – set up following the 2004 Boxing Day Tsunami – is designed to bring different countries funding into one single pot that makes the international response faster and more effective.

 

Experts believe that a sufficiently supported, single approach, with a central fund and effective coordination by the UN will save many more lives in the hours and days after a shock hits. It will reduce the chaos, confusion and delays caused by dozens of countries and agencies responding to the same disaster independently.

(Continue . . .)

 

With global economies in turmoil, and recessionary fears continuing to spread, finding money for many relief, humanitarian, or other worthwhile projects becomes more difficult. 

 

As reported earlier this month by IRIN:

 

. . . . money for HIV/AIDS efforts is not as plentiful as in previous years hardly comes as a surprise. UNAIDS notes that the global economic crisis appears to have put an end to a decade of funding increases by donors - after flattening out in 2009 for the first time, international AIDS assistance fell by 10 percent in 2010.

 

And the story is much the same around the globe for many other humanitarian, relief, and public health programs. 

 

Funding cuts - either already implemented or threatened - endanger the ability of government agencies and NGOs to provide the kind of aid and support they have in the past.

 

Last week in TFAH: 2011 Ready or Not Report on public health preparedness in the United States, they wrote that this year’s big concern is that the gains of the past few years may be eroded due to budgetary constraints.

 

The catch-22 to all of this is that the less well we are prepared to deal with disasters - the greater the impact these shocks may have on the global economy - further eroding our ability to prepare.

 

 

That was the theme of a blog I wrote last July (OECD Report: Future Global Shocks), where we looked at a 139 page report  released by the OECD (The Organisation for Economic Co-operation and Development) that warned - as the world becomes more interconnected and interdependent - that `Global Shocks’ to the world economy become more likely.

 

In the report, they define a Global Shock as: a rapid onset event with severely disruptive consequences covering at least two continents.

They write:

 

Extremely disruptive events, such as earthquakes, volcanoes, financial crises and political revolutions destabilize critical systems of supply, producing economic spillovers that reach far beyond
their geographical point of origin.

While such extreme events have been relatively rare in the past, they seem poised to occur with greater frequency in the future. Global interconnections accompanying economic integration enable some risks to propagate rapidly around the world.

 

While discussing a wide range of future shock scenarios, the authors concentrated most of their attention on five highly disruptive future shock events.

• A Pandemic
• A Cyber Attack
• A Financial Crisis
• A Geomagnetic Storm
• Social Unrest/Revolution

 

They also make special note of the risks of increased antibiotic resistance, and the need for new antibiotics to be developed.

 

While you and I can do little about the level of international preparedness for disasters (other than being generous volunteering time or money to reputable NGOs), there remains an important role and responsibility for all of us; to be prepared to help ourselves, and our community, during any disaster.

 

 

Ultimately, a nation’s resilience in the face of a major crisis –whether it be local or global - comes from the bottom up, not from the top down. 

 

Which is why agencies, like the ones below, urge greater individual, family, and community preparedness.

 

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

 

A few of my preparedness blogs from the past include:

 

When 72 Hours Isn’t Enough

Planning To Survive

An Appropriate Level Of Preparedness

In An Emergency, Who Has Your Back?

The Gift Of Preparedness

Publish or Perish The Thought?

 

 

 

 

# 6039

 

This morning Helen Branswell of the Canadian Press brings us the debate on the possibility that the NSABB may request a temporary moratorium on the publication of sensitive bird flu research projects until a new policy on such matters can be established.

 

You’ll find comments by a virtual who’s who of influenza virology, including Paul Keim of the NSABB,  Malik Peiris of the University of Hong Kong, Richard Webby from the WHO reference laboratory at St Judes Children's Hospital in Memphis, Tenn., Dr. Anthony Fauci director of NIAID, and Michael Osterholm, director of CIDRAP.

 

As with any story from Helen, the only sensible thing for this blogger to do is to step aside and invite you read the entire story at the link below.

 

 

Bird flu study controversy could lead to research chill

12/27/2011  | Helen Branswell, The Canadian Press

The H5N1 Research Debate Goes On

 

BSL-4 Lab Worker - Photo Credit –USAMRIID

# 6038

 

 

As I’ve mentioned in two recent blogs (The Passing Parade Of 2011 and The Passing Parade Of 2011 – Pt. 2), the controversial tinkering with avian flu viruses in the laboratory to create a more transmissible strain is hardly unique.

 

Researchers all over the world, working mostly in BSL-3 labs, are creating new reassortant viruses to study.

 

Their hope is to identify the changes that nature would need to make in order to spark a pandemic, and in doing so, perhaps get a jumpstart on a vaccine.

 

And for the most part, until Ron Fouchier announced the creation of an airborne H5N1 strain last August (see Katherine Harmon’s Sci-Am article and in a follow up to this story in New Scientist: Five Easy Mutations), few in the media took notice.

 

Halfway across the world, Yoshihiro Kawaoka, a highly respected virologist at the University of Wisconsin-Madison School of Veterinary Medicine announced the creation of a comparable H5N1 super flu at roughly the same time.

 

The debate, which encompasses extremely serious and complex issues, has unfortunately devolved in many media outlets to simplistic hyperbolic rants against irresponsible `mad scientists’ creating `Frankenflus’ that will be the death of us all.

 

Luckily, not all of the coverage has taken the low road. A few examples include:

 

Debate Persists on Deadly Flu Made Airborne

By DENISE GRADY and DONALD G. McNEIL Jr.

Published: December 26, 2011 – NY Times

 

 

Studies of deadly H5N1 bird flu mutations test scientific ethics

Dutch scientists have created a version of the deadly H5N1 bird flu that's easily transmitted. In an unprecedented move, a U.S. board asks that some details of the research not be published.

By Eryn Brown, Los Angeles Times

December 26, 2011, 10:21 p.m.

 

 

But one of the best debates is going on at Vincent Racaniello’s Virology Blog in his recent blog post A bad day for science and the 30+ comments (including from Ron Fouchier and Mike Imperiale, a member of the NSABB) that follow.

 

Highly recommended.

The Passing Parade Of 2011 – Pt. 2

 

 

 

# 6036

 

Over the past year I’ve posted more than 900 blogs, dozens of which looked at some of the latest research into influenza and other emerging infectious diseases.

 

Since these studies oft times make an initial splash only to get lost in the passing parade of new reports, today I’ve some brief summaries (with links back to the original blogs) on some of the research of 2011 I believe is deserving of a second look.

 

This is the second such roundup, the first one may be accessed at this link.

 

 

Last April in Lancet Study: NDM-1 In New Delhi Water Supply, we saw a report authored by Timothy Walsh, Janis Weeks , David M Livermore, and Mark A Toleman that looked for – and found – bacteria carrying the NDM-1 enzyme in New Delhi's drinking water supply.

 

We’ve a press release on this study, issued by Cardiff University, that gives the highlights of the research, but the `money quote’ (emphasis mine) buried about halfway down is:

 

Resistant bacteria were found in 4 per cent of the water supplies and 30 per cent of the seepage sites. The researchers identified 11 new species of bacteria carrying the NDM-1 gene, including strains which cause cholera and dysentery.

 

Below is a link to the Lancet study, which you can read in its entirety (a free registration is required).

 

 

The Lancet Infectious Diseases, Early Online Publication, 7 April 2011

doi:10.1016/S1473-3099(11)70059-7

Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study

Prof Timothy R Walsh PhD , Janis Weeks BS, David M Livermore PhD , Mark A Toleman PhD

 

Again in April, we saw research seeking to answer the question over why there was such a wide variance in death rates around the world with the 1918 Spanish influenza. 

 

In 2006, in a Lancet journal (doi:10.1016/S0140- 6736(06) 69895-4) article cited as much as a 30-fold difference in mortality rates around the world:

 

Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918—20 pandemic: a quantitative analysis

Christopher JL Murray , Alan D Lopez , Brian Chin , Dennis Feehan , Kenneth H Hill

Excess mortality ranged from 0·2% in Denmark to 4·4% in India. Since there was some under-registration of mortality in India, total pandemic mortality could have been even higher.

 

 

This wide disparity in mortality rates – much of it based on anecdotal accounts – has long intrigued researchers.  This new study from the Norwegian Institute of Public Health that attempts to answer some of these questions.

 

What they found was that the mortality rate varied nearly 100 fold between remote, rural regions and urban populations, and that in the more remote areas, older persons were just as susceptible to the virus as those who were younger.

 

This study appears in the Journal Epidemics.

Geography May Explain Adult Mortality from the 1918–20 Influenza Pandemic

Original Research Article
Pages 46-60
Svenn-Erik Mamelund

 

The theory that a similar H1 virus circulated prior to 1890 – and that provided some immunity to those over the age of 30 – is bolstered by this study.

 

 

Given the current flap over the H5N1 experiments conducted by Ron Fouchier in the Netherlands and Yoshihiro Kawaoka  at the University of Wisconsin (see The Biosecurity Debate On H5N1 Research) the next two studies deserve a second look as well.

 

 

Simplified Illustration of a Serial Passage Experiment. 

 

In H5N1: A Rite Of Passage we looked at how serial passage studies are conducted, and at one in particular that appeared in the Journal of Animal and Veterinary Advances that looked at increases in pathogenicity (in mice) of two H5N1 viruses after six serial passages in quail.

 

The study is called:

 

The Pathogenicity Variation of Two Quail-Origin H5N1 HPAV to BALB/c Mice after Six Passages in Quail

Hailiang Sun, Peirong Jiao, Yuqiang Cheng, Runyu Yuan, Pengfei Cui, Liming Jin, Chaoan Xin and Ming Liao

 

Another study, profiled in PNAS: Reassortment Potential Of Avian H9N2, looked at the reassortment potential of the avian H9N2 virus and H1N1. Research was done using ferrets whose respiratory physiology is considered relatively close to humans.

 

Compatibility of H9N2 avian influenza surface genes and 2009 pandemic H1N1 internal genes for transmission in the ferret model

J. Brian Kimble, Erin Sorrell,  Hongxia Shao,  Philip L. Martin, and Daniel Roberto Perez

 

(Excerpt from the abstract)

Four reassortant viruses were generated, with three of them showing efficient respiratory droplet transmission. Differences in replication efficiency were observed for these viruses; however, the results clearly indicate that H9N2 avian influenza viruses and pH1N1 viruses, both of which have occasionally infected pigs, have the potential to reassort and generate novel viruses with respiratory transmission potential in mammals.

 

 

The entire study is available online, and open access.

 

 

And in Study: Prior Antibiotic Use & MRSA In Children Canadian researchers, examining 13 years worth of data from the UK’s General Practice Research Database (GPRD), came up with what they called  a `robust association’ between a prior history of antibiotic use and rates of CA-MRSA (Community Acquired Methicillin Resistant Staph Aureus) infection in children.

The study appeared Aug. 1st  in the Archives of Pediatrics & Adolescent Medicine.

 

Antibacterial Drugs and the Risk of Community-Associated Methicillin-Resistant Staphylococcus aureus in Children

Verena Schneider-Lindner, MD, MSc; Caroline Quach, MD, MSc; James A Hanley, PhD; Samy Suissa, PhD

Arch Pediatr Adolesc Med. Published online August 1, 2011. doi:10.1001/archpediatrics.2011.143

 

What these researchers found was that while nearly half of children with MRSA in this study had no recent history of antibiotic use, the adjusted relative risk (RR) of developing MRSA was 3.5 times higher among children who had received antibiotic treatment in the previous 30-180 days before infection.

 

And that relative risk increased substantially among children who received more than one course of antibiotics.

 

To find more blogs specific to research you can use the RESEARCH quick link on my sidebar.

 

As news is often slow during the holiday season, over the next couple of weeks I plan to post one or two more retrospectives on the news and research of the year that was.

Proposed GMO Mosquito Trials In Key West

 

 

 

# 6035

 

When it comes to deadly creatures on this planet, few can compare with the lowly mosquito.

 

Malaria is believed to sicken 200 million people every year, and claim nearly a million lives (cite). Dengue fever has seen an explosive spread over the past 50 years, and infects tens of millions of people every year.

 

Add EEE (Eastern Equine Encephalitis), West Nile Virus, Chikungunya, and a handful of other arboviral encephalopathies into the mix, and you have in mosquitoes a very efficient vector of death and disease.

 

Global Spread of Dengue

The burden of disease carried by mosquitoes is truly staggering, and many places once thought safe from these mosquito borne scourges are now threatened.

 

In 2009, after an absence of nearly 6 decades, Dengue fever was once again reported in Florida.  While the number of cases was small (just over 60 cases in 2010), the concern is that this once-eradicated disease will re-establish itself in the sunshine state.

 

In order to spread, Dengue requires the right mosquito vector.  And the two species best suited to transmit the virus are the Aedes aegypti and Aedes albopictus mosquitoes, which also can spread such diseases as West Nile, Malaria, Yellow Fever, and Chikungunya.

 

Map showing the distribution of dengue fever (red) and the distribution of the Aedes aegypti mosquito (cyan)  in the world, as of 2006. Agricultural Research Service of the US Department of Agriculture.

 

Map showing the native habitat (blue) and recent spread (green) of the Aedes albopictus mosquito.

 

Complicating matters, as these species continue to encroach on new populations, many are developing signs of resistance to insecticides and insect repellants (see Declan Butler On Growing Mosquito Insecticide Resistance & From the `Nature Bats Last’ Dept). 

 

Which has led many scientists to look for novel ways to control mosquitoes without the use of potentially dangerous chemicals.

 

Over a year ago I wrote about the controversial release of genetically modified mosquitoes (see The Cayman Island Mosquito Trials) by the Oxitec company in a bid to learn how to reduce these Dengue vectors.

 

Oxitec’s genetically altered terminator mosquitoes have been bio-engineered to carry a lethal gene that the males can pass on to their progeny that causes them to die in the larval stage.

 

And the early results were very promising.

 

An 80% reduction of mosquitoes in a 25 acre test area after 19,000 males mosquitoes were released over a 4-week period in 2010.

 

Now, according to a report yesterday in The Key West Citizen, there are plans to conduct a similar test in the city sometime in 2012.

 

While still awaiting federal and state approval, already the battle lines are being drawn between those in favor of trying these novel control methods, and those opposed.

 

Group wary of new insects

BY TIMOTHY O'HARA Citizen Staff
tohara@keysnews.com

An environmental group is questioning the Florida Keys Mosquito Control District's plan to introduce sterile mosquitoes into the Keys to battle the spread of dengue fever.

(Continue . . .)

 

 

The plan is to release between 5,000 and 10,000 modified mosquitoes into an undisclosed 36 acre block near the Key West Cemetery. These male mosquitoes would be dusted with a florescent powder to enable tracking.

 

But some environmental groups, like Friends of the Earth, are vehemently opposed, claiming that this planned release of GMO mosquitoes could have unintended consequences on the local ecosystem.

 

The FOE Blog on December 21st warned:

 

Floridians face genetically engineered mosquito threat

 

 

The Florida Keys Mosquito Control District counters these concerns with a FAQ of their own on the dangers of Dengue, and the planned sterile male release project.

 

I’ve a few excerpts posted below.

 

Dengue Fever FAQs

Frequently Asked Questions

 

What are the likely impacts on the environment and on humans?

The main impact on human health will be to reduce the number of Aedes aegypti mosquitoes that can spread dengue.

 

There is no permanent change to the wild mosquito population and therefore unlikely to have any impact on the environment compared to the currently used alternatives.

 

Aedes aegypti is not originally native to Key West, though it has been present on and off in the last few decades.  It is not a keystone species, there are no birds, fish or other insects that feed exclusively on it and therefore reducing the number of Aedes aegypti is most unlikely to have any impact on the environment. Additionally, the released mosquitoes will die in the environment and their progeny will die so this is a 'self limiting' approach. i.e. there is no permanent change to the wild mosquito population.

 

Oxitec has a short  FAQ page on their technology, which you can access here. Oxitec’s GM process isn’t the only bid to modify mosquitoes to reduce disease transmission. 

 

Earlier this year in A Mosquito STD To Fight Dengue I wrote about a project to infect mosquitoes with Wolbachia, a bacteria commonly found in fruit flies that – for reasons that aren’t entirely clear - inhibits a mosquito’s ability to transmit Dengue Fever.

 

Nearly a year ago in Queensland, Australia researchers began releasing thousands of Wolbachia infected mosquitoes each week into the remote communities of Gordonvale and Yorkeys Knob.

 

Within a matter of a few months the Wolbachia infected mosquitoes overran the uninfected mosquito population in these two test environments.

 

Although extremely encouraging, more tests are needed, including confirmation that this process works against all dengue serotypes. The Gates Foundation is providing further funding to support the release of Wolbachia mosquitoes in Australia, Vietnam and Thailand.

 

While it has required impressive skill and technology to bring these `Brave New Mosquitoes’ to the point of being ready for field tests, the bigger challenge may well lie in getting an increasingly wary and skeptical public to accept their release.

Three Would Make For A Crowded Viral Field

 

 

Will we have to add another Influenza A strain to this chart?

# 6034

 

 

Although our knowledge of what influenza viruses were in circulation prior to 1918 is very limited, we do know that from 1918 to 1977 only one influenza A virus seemed to circulate in humans at a time.

 

In 1918, the H1N1 virus appeared (although it wasn’t isolated until the 1930s), replacing whatever had been in circulation before it. And H1N1 reigned supreme for nearly 40 years, until a new upstart virus – called H2N2 – appeared with the pandemic of 1957, driving H1N1 into obscurity.

 

Eleven years later, another pandemic virus – called H3N2 – arrived with the Hong Kong Flu of 1968, and H2N2 followed H1N1 into the viral dustbin.

 

So naturally scientists assumed that the natural order of things was to have only one influenza A virus dominant at a time. True, there might be small isolated outbreaks of differing strains, but it appeared that only one could be king of the viral mountain.

 

Then in 1977, the H1N1 virus mysteriously reappeared after an absence of 20 years (possibly escaping from a Russian or Chinese research lab) . . .  and this time, it did not drive out the currently circulating H3N2 virus.

 

Since those over the age of 20 had some immunity to the H1N1 virus, it mainly affected children. Some scientists believed that this left a substantial reservoir of adults susceptible to the H3N2 virus, allowing its survival. 

 

Suddenly we had two influenza A viruses (H1N1 & H3N2) co-circulating - along with a couple of B strains -  and that status quo continued until the spring of 2009 when a new H1N1 swine flu virus arrived on the scene.

 

While the new H1N1 virus supplanted the old seasonal H1N1 virus, it did not displace the H3N2 virus, which again left us with two co-circulating influenza A viruses.

 

Fast forward a couple of years, and today we are seeing some new variants of both H3N2 and H1N1 swine viruses popping up, apparently the result of the 2009 pandemic virus re-entering the swine population and reassorting with other swine flu viruses to produce hybrids.

 

 

While the number of human infections with these novel flu viruses remains small, the concern is that one (or perhaps more) of these variant viruses could end up adapting well enough to humans to begin to spread efficiently.

 

Most researchers are downplaying the pandemic potential for these variant viruses – at least in their present form – since there is probably a fair amount of community immunity to them, particularly among adults.

 

While the future of these variant viruses is impossible to see, the possibility exists that we could end up seeing three influenza A viruses co-circulating. 

 

Helen Branswell of the Canadian Press brings us more on this possibility in her report from last night. As always with a Branswell story, you should follow the link and read it in its entirety.

 

U.S. finds new human infection with swine H3N2 flu

Updated: Fri Dec. 23 2011 17:16:22
The Canadian Press

U.S. public health officials have found another case of human infection with a swine-origin H3N2 virus, this time in a child from West Virginia. And they also reported finding a human infection with a new swine influenza virus never before seen in humans, in a person in Wisconsin who had contact with pigs.

(Continue . . . )

 

 

Yesterday the CDC prepared and released a small avalanche of guidance documents on these emerging variant viruses.

 

Yesterday I linked to Guidance For People Involved In Raising Swine and the early release MMWR on H3N2v Transmission and Guidelines.

 

Today, you’ll find links to interim guidance documents designed for Healthcare professionals.

 

• Prevention Strategies for Seasonal and Influenza A(H3N2)v in Health Care Settings

• Interim Guidance for Influenza Surveillance: Additional specimen collection for detection of Influenza A(H3N2)v Virus infections

• Interim Guidance on Specimen Collection, Processing, and Testing for Patients with Suspect Influenza A(H3N2)v Virus Infection

• Interim Guidance on Case Definitions to be Used For Investigations of Influenza A(H3N2)v Virus Cases

 

 

The public health risk from these variant viruses appears low at this time, but the CDC reminds us:

 

While there is no evidence that sustained human to human transmission is occurring, all influenza viruses have the capacity to change and it's possible that this virus may become widespread.

 

Which makes maintaining good flu hygiene this winter (washing/sanitizing your hands, covering coughs & sneezes, staying home when sick), and getting your seasonal flu shot, your best strategies to avoid getting sick during holiday season.

MMWR: H3N2v Transmission and Guidelines

 

 

# 6033

 

 

Late this afternoon the CDC published an early release to the MMWR titled Update: Influenza A (H3N2)v Transmission and Guidelines — Five States, 2011 focused on the novel H3N2v flu that has captured our attention since August.

 

Earlier today (see CDC: Variant Influenza Strains) we saw a chart giving the geographic spread of these detections.

 

States reporting the new A(H3N2)v virus since July. – Source CDC

 

We are also reminded that:

 

It's possible that sporadic infections and even localized outbreaks among people with this virus will continue to occur.

While there is no evidence that sustained human to human transmission is occurring, all influenza viruses have the capacity to change and it's possible that this virus may become widespread.

 

 

Today’s MMWR provides details on three recent cases in Indiana and West Virginia, along with background information on the virus and its spread.  You can read the entire release at the link below:

 

Update: Influenza A (H3N2)v Transmission and Guidelines — Five States, 2011

Early Release

December 23, 2011 / 60(Early Release);1-4

 

 

The authors provide the following summary:

 

 

What is already known on this topic?

During August–December 2011, a total of 12 human infections with influenza A (H3N2)v viruses were identified in the United States (two from Indiana, three from Iowa, two from Maine, three from Pennsylvania, and two from West Virginia).

What is added by this report?

This report provides the new nomenclature for the virus and describes three cases, one in an adult with occupational exposure and two in children involving limited human-to-human transmission in a day care setting. It also provides an overview of the U.S. Department of Agriculture's swine influenza virus (SIV) surveillance program along with data on influenza A (H3N2) viruses in swine. Out of approximately 150 SIV isolates that have undergone sequencing of three genes (hemagglutinin, matrix, and neuraminidase gene segments), 30 have been identified as A(H3N2) viruses; eight of those 30 have the M gene from the influenza A (H1N1)pdm09 virus.

What are the implications for public health practice?

Nonhuman influenza virus infections rarely result in human-to-human transmission, but the implications of sustained ongoing transmission between humans is potentially severe; therefore, prompt and thorough identification and investigation of sporadic human infections with novel influenza viruses are needed to reduce the risk for sustained transmission.

 

 

 

The CDC has also posted a new report on their Have you heard? website, with useful details and background on these H3N2v viruses.

 

CDC Confirms Detection of A Different Influenza A Variant Virus

December 23, 2011 -- An influenza A (H1N1) virus that is known to circulate in U.S. swine but not humans has been detected in an adult in the state of Wisconsin. The patient reported occupational contact with swine prior to illness onset. No human-to-human transmission with this virus has been identified. CDC laboratory testing has confirmed that this is a new reassortant influenza A H1N1 virus as it has acquired the matrix [M] gene from the 2009 H1N1 pandemic virus. Laboratory testing shows that the virus is susceptible to the influenza antiviral medications, oseltamivir and zanamivir. Surveillance for additional human cases in the area has been enhanced. Providers are being asked to collect specimens for influenza virus testing from any patient presenting with influenza-like illness.

(Continue . . . )

 

 

 

Of course, it isn’t just the H3N2v virus that concerns health authorities. The H5N1 bird flu virus, avian H9N2, along with some H7 and H11 strains of avian influenza have all demonstrated some ability to infect humans. 

 

While none have as yet managed to adapt well enough to human physiology to spread efficiently, the CDC and public health officials are obviously taking these novel virus detections very seriously, and are encouraging enhanced global surveillance to track their evolution and spread.

 

It is too soon to know whether any of these flu strains will take hold in the human population. 

 

As I wrote in Pseudo Pandemics And Viral Interlopers it is possible for new strains of influenza to appear and circulate among humans, without sparking a pandemic.

 

 

For now, we are in a watchful waiting mode; looking for signs that one of these novel viruses is getting better adapted to human physiology.

 

In the meantime, maintaining good flu hygiene this winter (washing/sanitizing your hands, covering coughs & sneezes, staying home when sick), and getting your seasonal flu shot, remain the best strategies to avoid getting sick during this flu season.

CIDRAP: H5N1 Transmissibility in Ferrets vs Humans

 

 

# 6032

 

 

Robert Roos, News Editor at CIDRAP has a terrific in-depth piece on an important aspect of the recent H5N1 research controversy (see The Biosecurity Debate On H5N1 Research).  He focuses on whether a virulent and easily transmissible H5N1 virus strain in ferrets is necessarily going to behave the same in humans.

 

Rather than try to summarize this article, I’ll simply step aside and direct you to:

 

 

Fears about mutant H5N1 hinge on ferrets as flu model

Robert Roos News Editor

Dec 23, 2011 (CIDRAP News) – In the influenza literature, it's a given that ferrets are the best animal model for influenza in humans. They show similar clinical signs of disease, such as fever, coughing, and sneezing, and flu viruses that spread among humans usually spread in ferrets as well.

(Continue . . . )

CDC: Guidance For People Involved In Raising Swine

 

 

# 6031

 

 

We are getting a number of updates today from the CDC that have to do with the H3N2v swine virus that has infected about a dozen people since last July.

 

Today, some interim guidance on the prevention of transmission of influenza viruses for people who either work at commercial swine farms, or who raise pigs. 

 

CDC Interim Guidance for Workers who are Employed at Commercial Swine Farms: Preventing the Spread of Influenza A Viruses  Friday, December 23, 2011 10:49:00 AM

 

What People Who Raise Pigs Need To Know About Influenza (Flu )

Friday, December 23, 2011 10:47:00 AM

CDC: Variant Influenza Strains

 

 

# 6030

 

The CDC today has posted a brief summary covering the recent emergence of variant swine-origin influenza strains, and indicates that they will be using the new nomenclature released by the WHO/FAO/OIE earlier today.

 

I’ve reproduced the statement below (slightly reformatted for readability).  Follow the link to go to the original webpage.

 

States reporting the new A(H3N2)v virus since July. – Source CDC

 

 

Information on Variant Influenza A Viruses

Novel influenza A viruses that normally circulate in animals may infect humans. Following discussion among international human and animal health agencies, these viruses will now be referred to as “variant influenza viruses” and, as an abbreviation going forward, will be designated with a “v”; recent examples include A(H3N2)v, A(H1N1)v, and A(H1N2)v.

 

In the second half of 2011, a number of U.S. residents were found to be infected with influenza A variant viruses, especially A(H3N2)v. Investigations have revealed human infections with these viruses following contact with swine as well as limited human-to-human transmission.

 

While this virus has been detected in U.S. swine, it's unknown how widespread it is. It's possible that sporadic infections and even localized outbreaks among people with this virus will continue to occur. While there is no evidence that sustained human to human transmission is occurring, all influenza viruses have the capacity to change and it's possible that this virus may become widespread.

 

So far, the severity of illnesses associated with this virus has been similar to the severity of illnesses associated with seasonal flu virus infections. Limited serologic studies indicate that adults may have some pre-existing immunity to this virus while children do not.

 

CDC is closely monitoring human infections with all novel influenza viruses, including H3N2v viruses, and will provide more information as it becomes available.

WHO/FAO/OIE: Call It A(H3N2)v

 

 

H3N2 influenza virions –CDC PHIL

# 6029

 

 

When a new flu strain appears there is often some confusion of what to call it, particularly when the HA and NA components are the same as other circulating flu viruses.

 

This is the problem we ran into when a novel H1N1 virus (now officially dubbed  A(H1N1)pdm09) emerged.  The media latched on to `Swine flu’, while scientific publications used a variety of nom de flus, including A/H1N1/09 and pdmH1N1.

 

It took more than two years before a consensus was reached (see WHO: Call It A(H1N1)pdm09).  And while that does not exactly roll off the tongue, it does have the the advantage of being precise.

 

Today we’ve a joint announcement from the World Health Organization, FAO, and OIE on a standardized nomenclature for the recently emergent trH3N2 virus that has been detected in a handful of people across several states since last summer.

 

They’ve decided to go with A(H3N2)v.

 

We’ll have to wait to see if this designation is adopted elsewhere. What will be done if another variant of the A(H3N2) virus should appear is not mentioned.

 

A hat tip to Giuseppe Michieli on FluTrackers for posting the following link.

 

 

Standardization of terminology for the variant A(H3N2) virus recently infecting humans

Joint announcement of FAO, OIE and WHO

23 December 2011

FAO, OIE and WHO continue working closely together to address influenza issues related to public health and animal health.

 

Since July 2011, twelve human cases of infection with a variant influenza A(H3N2) virus have been detected in the United States. To date, no report has been received from elsewhere in the world. This virus has different virological characteristics from current circulating seasonal influenza viruses in humans, and has a new gene constellation: 7 genes from the triple reassortant A(H3N2) viruses known to have been circulating in pigs in the North America and the M gene from an A(H1N1)pdm09 virus, a seasonal virus currently circulating in humans.

 

In order to improve communications and avoid confusion, FAO, OIE and WHO have established a working group of experts to standardize the terminology for variant influenza viruses. The joint recommendation for the above mentioned A(H3N2) virus is: A(H3N2)v , where “v” stands for “variant”.

An example of use of the terminology:

• Sporadic human cases of infection with a variant influenza A(H3N2) virus A(H3N2)v have been reported in the USA. The A(H3N2)v virus is different from seasonal viruses currently circulating in humans.

Iowa: No New trH3N2 Cases

 

H3N2 influenza virions –CDC PHIL

 

# 6028

 

 

Over the past few months we’ve been carefully watching the evolution and spread of a novel swine flu variant called trH3N2, that is a reassortment of the swine H3N2 virus that has acquired the Matrix (M) gene segment from the 2009 H1N1 virus.

 

So far, fewer than a dozen cases have been reported across 4 states - although the suspicion is that additional cases may have gone undetected.

 

While the majority of these cases reportedly had recent contact with swine, three recent cases out of Iowa were notable as they appear to be the result of Human-to-Human (H-2-H) transmission.

 

Nearly a month ago, the CDC released a special MMWR  dispatch that provided details on these three new cases, some background on earlier SOIV (swine origin influenza viruses) cases, and some analysis. 

 

A few excerpts follow (underscores & bolding mine), but follow the link to read the entire dispatch.

 

Limited Human-to-Human Transmission of Novel Influenza A (H3N2) Virus — Iowa, November 2011

Dispatch

November 23, 2011 / 60(Dispatch);1-3

On November 20, 2011, CDC confirmed three cases of swine-origin triple reassortant influenza A (H3N2) (S-OtrH3N2) virus infection in children in two counties in Iowa. None of the children were hospitalized, and each has recovered from a mild episode of febrile respiratory illness. All three were in contact with one another, and none had a known recent exposure to swine. No additional human infections with this virus have been detected in Iowa, and no evidence of sustained human-to-human transmission of this S-OtrH3N2 virus exists; surveillance is ongoing.

(Continue . . .)

 

 

Understandably, local health officials have been on increased alert, looking for more cases.  Overnight it’s been widely reported that, according to Iowa state health officials, no new cases  of this novel influenza virus have been seen since early November.

 

State Medical Director Dr. Patricia Quinlisk is quoted yesterday by The Des Moines Register (see New flu virus blips out of Iowa as quickly as it appeared) as saying the virus `apparently failed to continue spreading’.

 

Nonetheless, state health officials continue to be on watch for new cases

 

Surveillance isn’t perfect, of course, and relatively few people get tested when they get a flu-like illness. So it is possible (perhaps even likely) that there are some cases out there going undetected.

 

All of which makes it premature to sound the all-clear on this fledgling flu.

 

But this lack of new case detections in the face of enhanced surveillance would seem a pretty good indicator that this flu isn’t ready for prime time, and supports the CDC’s contention that there is no evidence of sustained human-to-human transmission of this S-OtrH3N2 virus.

 

As this trH3N2 virus has been detected in multiple swine herds, and in humans across four states, It would not be unreasonable to expect that we’ll see more cases of this novel flu crop up in the future.

 

The evolution of flu viruses is an ongoing process, and each new host infection presents the virus with another opportunity to evolve and change.

 

At some point, this virus may adapt well enough to human physiology to become a major player on the field of flu. Or it may simply fizzle out, and end up in evolution’s dustbin of failed mutations.

 

Influenza is notoriously unpredictable, and I certainly wouldn’t care to hazard a guess as to what happens next with this virus.

But for now, no flus is good news.