tag:blogger.com,1999:blog-212477482024-03-18T07:34:59.378-04:00Avian Flu DiaryCovering Pandemic and Seasonal Flu, H5N1 `Bird Flu, Emerging Infectious Diseases, public health, community & Individual preparedness, and anything else that piques my admittedly eclectic interestsMichael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comBlogger17922125tag:blogger.com,1999:blog-21247748.post-17568786506750106272024-03-18T07:15:00.002-04:002024-03-18T07:34:28.013-04:00The Lancet Correspondence: Global Emergence of Neuraminidase Inhibitor-Resistant Influenza A(H1N1)pdm09 Viruses with I223V and S247N Mutations<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container tr_bq" style="background-color: #ebedec; color: #363636; float: left; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; margin-bottom: 0.5em; margin-right: 1em; padding: 4px; position: relative;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8Z_gt31ftuzdr5TWmSWmT01h8C4XNmjTCZWaJunEoyG94TI0XrE8L70gK47b4KVtLaEPE1sjiD2MUjNm1pn_mFDxjrnGQaF5YwHAPMQPcJFB0rg0fuPgDDf86SNd29uzqA3Da/s1600/Niaid+Flu.JPG" style="clear: left; color: #3f3f7f; margin-bottom: 1em; margin-left: auto; margin-right: auto; text-decoration-line: none;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8Z_gt31ftuzdr5TWmSWmT01h8C4XNmjTCZWaJunEoyG94TI0XrE8L70gK47b4KVtLaEPE1sjiD2MUjNm1pn_mFDxjrnGQaF5YwHAPMQPcJFB0rg0fuPgDDf86SNd29uzqA3Da/s1600/Niaid+Flu.JPG" style="background: transparent; border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; padding: 8px; position: relative;" /></a></td></tr><tr><td class="tr-caption" style="font-size: 12.8px; text-align: center;">Credit NIAID</td></tr></tbody></table><p><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /></p><p><br /></p><p>#17,953</p>Twenty years ago Amantadine was the preferred influenza antiviral. It was cheap, plentiful, and worked reasonably well as both a treatment, and a preventative. <div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;">It was so popular it was allegedly used by Chinese farmers to protect their flocks from avian flu, which is believed led to growing resistance (see Nature News <b><a href="https://www.nature.com/articles/4351009a">China's chicken farmers under fire for antiviral abuse).</a></b> </div></blockquote><div><div><blockquote></blockquote>By late 2005 Amantadine was beginning to lose its effectiveness against the H3N2 seasonal flu virus and some strains of the H5N1 bird flu. In January of 2006 the<b> <a href="http://www.antimicrobe.org/h04c.files/history/cdc-flu.pdf">CDC issued a warning</a></b> to doctors not to rely on Amantadine or Rimantadine to treat influenza.<blockquote><span style="font-family: inherit;"><b style="background-color: #ebedec; color: #363636; font-size: 16px;">Tamiflu </b><span style="color: #363636;"><span style="background-color: #ebedec;">(</span></span><i style="background-color: #ebedec; color: #363636; font-size: 16px;">Oseltamivir</i><span style="color: #363636;"><span style="background-color: #ebedec;">) - an NAI </span></span></span>(<i>neuraminidase inhibitor) - </i><span style="background-color: #ebedec; color: #363636; font-family: inherit;">was approved for use in the U.S. in 1999. While far more expensive, it became the new treatment standard. </span></blockquote><p style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="font-family: inherit;">While occasional instances of Oseltamivir resistance were recorded prior to 2007, in nearly every case, it developed<em> <b>after</b></em><b> </b>a person was placed on the drug (i.e. `<em><span style="color: maroon;">spontaneous mutations’</span></em>). </span></p><p style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="font-family: inherit;">Although of obvious concern to the patient receiving treatment, it occurred in only about<b> 1%</b> of treated cases, and studies suggested that these resistant strains were <span style="color: maroon;"><em>`<strong>less biologically fit’</strong></em></span>, and <strong>were therefore thought unlikely to spread from human-to-human.</strong></span></p></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;">Which of course,<span style="color: #990000;"> </span><i><span style="color: #990000;"><b>is exactly what they did do</b></span>.</i> Between 2007 and 2008, the incidence of resistant seasonal H1N1 viruses literally exploded around the globe. </div></blockquote><p>So much so, that by the end of 2008, nearly all of the H1N1 samples tested in the United States were resistant to oseltamivir and the<b> <a href="http://www.cdc.gov/">CDC</a> </b>was forced to issue major new guidance for the use of antivirals (see <a href="http://www.cidrap.umn.edu/index.html"><b>CIDRAP</b></a> article <b><a href="http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/dec1908tamiflu.html">With H1N1 resistance, CDC changes advice on flu drugs</a>)</b>.</p><div><p style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;"><span style="font-family: inherit;"><strong></strong></span></p><blockquote style="background-color: #ebedec; color: #363636; font-size: 16px;"><p><span style="font-family: inherit;">This resistance was primarily due to an <strong>H275Y</strong> mutation <em>-</em> where a single amino acid substitution (<strong>histidine (H) to tyrosine (Y))</strong> occurs at the neuraminidase position <strong>275 </strong>(<em>Note: some scientists use <strong>'N2</strong> numbering' (<strong><span style="color: maroon;">H274Y</span></strong>)</em>). </span></p></blockquote><p><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;">It seemed as if antiviral crisis was inevitable, when in a </span><i style="background-color: #ebedec; color: #363636; font-size: 16px;">Deus Ex Machina</i><span style="background-color: #ebedec; color: #363636; font-size: 16px;"> moment a new swine-origin H1N1 virus - that happened retain its <b><i>sensitivity to Tamiflu</i></b> - swooped in as a pandemic strain in the spring of 2009, supplanting the older resistant H1N1 virus. </span></span></p></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><div><p style="text-align: left;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="font-family: inherit;">Both incidents showed that antivirals - much like antibiotics - can lose effectiveness over time, as pathogens evolve and resistant strains emerge. </span></span></p></div></div></blockquote><div><p><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;">Since 2009 flu surveillance centers around the world have been looking for any signs of growing resistance to NAI inhibitors. For the most part, we've seen the same 1% incidence of spontaneous mutations in people receiving the antiviral, although we've seen a few `<i>clusters'</i> of cases. </span></span></p><ul style="background-color: #ebedec; color: #363636; font-size: 16px; line-height: 1.4; list-style-image: initial; list-style-position: initial; margin: 0.5em 0px; padding: 0px 2.5em;"><li style="border: none; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><span style="font-family: inherit;">Three years ago, in <a href="https://afludiary.blogspot.com/2021/06/eid-journal-cluster-of-oseltamivir.html" style="color: #007f7f;"><b>EID Journal: Cluster of Oseltamivir-Resistant & Antigenically Drifted Influenza A(H1N1)pdm09 Viruses, Texas, USA, January 2020</b></a>, we looked at a cluster of resistant seasonal flu viruses which emerged just before COVID shut down influenza around the globe.</span></li></ul><ul style="background-color: #ebedec; color: #363636; font-size: 16px; line-height: 1.4; list-style-image: initial; list-style-position: initial; margin: 0.5em 0px; padding: 0px 2.5em;"><li style="border: none; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><span style="font-family: inherit;">In 2016, in<a href="http://afludiary.blogspot.com/2016/06/eurosurveilance-ah1n1pdm09-virus-with.html" style="color: #3f3f7f; text-decoration-line: none;"> <b>Eurosurveilance: A(H1N1)pdm09 Virus With Cross-Resistance To Oseltamivir & Peramivir - Japan, March 2016</b></a><b> </b>we looked at an elevated number of NAI resistant viruses with <i>`permissive mutations' </i>circulating in Japan.</span></li></ul><ul style="background-color: #ebedec; color: #363636; font-size: 16px; line-height: 1.4; list-style-image: initial; list-style-position: initial; margin: 0.5em 0px; padding: 0px 2.5em;"><li style="border: none; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><span style="font-family: inherit;">In 2014's <a href="http://afludiary.blogspot.com/2014/01/eurosurveillance-community-cluster-of.html" style="color: #3f3f7f; text-decoration-line: none;" target="_blank"><b><span style="color: blue;">Eurosurveillance: Community Cluster Of Antiviral Resistant pH1N1 in Japan,</span></b></a> we looked at a cluster of six genetically similar resistant viruses in Sapporo, Japan - but without epidemiological links. </span></li></ul>As added insurance, in 2018 the <a href="https://afludiary.blogspot.com/2018/10/fda-approval-of-xofluza-new-class-of.html"><b>FDA Approved Xofluza : A New Class Of Influenza Antiviral</b></a> (aka baloxavir marboxil), but it too has shown signs of resistance (see <b><a href="https://afludiary.blogspot.com/2023/10/eurosurveillance-community-cluster-of.html">Eurosurveillance: A community Cluster of Influenza A(H3N2) Virus infection with Reduced Susceptibility to Baloxavir - Japan 2023</a>), </b>particularly in seasonal H3N2.</div><div><br /></div><div>The CDC's most recent <b><a href="https://www.cdc.gov/flu/weekly/index.htm">FluView report</a> </b>(see below) - based on roughly<b> 2,600 viruses tested</b> since October 1st - finds very low levels of NAI resistance in our armamentarium of influenza antiviral drugs. </div><div><br /></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://www.cdc.gov/flu/weekly/index.htm" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="826" data-original-width="724" height="400" src="https://blogger.googleusercontent.com/img/a/AVvXsEiTDY_7ietWr4P3Et9pkl-gBd9EeAiSs6j5KqQ1QoiEuh82wNoUEamz0SbBym9AOOn3iBPL9569dT-PaE9sEGEEbFfLJlkZEKEVGPT3_IKcrmnRAzrPIlFPFzcog26JGzRSnFhS1KeDXa4_2p0I1e49ZdhG1zTjnblqBhVUi_kc3kQp5wrDW6EK7A=w350-h400" width="350" /></a></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><p style="background-color: white; box-sizing: border-box; margin-bottom: 1rem; margin-top: 0px;"></p><ul style="text-align: left;"><li><span style="color: #2b00fe; font-family: inherit; font-size: x-small;"><b>One </b>A(H1N1)pdm09 virus had NA-H275Y amino acid substitution and showed <b><i>highly reduced inhibition</i></b> by oseltamivir and peramivir.</span></li></ul></div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><ul style="text-align: left;"><li><span style="font-size: x-small;"><b style="color: #2b00fe; font-family: inherit;">One </b><span style="color: #2b00fe; font-family: inherit;">(H1N1)pdm09 virus had NA-I223V and NA-S247N amino acid substitutions and showed </span><b style="color: #2b00fe; font-family: inherit;"><i>reduced inhibition by oseltamivir.</i></b></span></li></ul></div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><ul style="text-align: left;"><li><span style="color: #2b00fe; font-family: inherit; font-size: x-small;"><b>One</b> A(H3N2) virus had PA-I38T amino acid substitution and showed reduced susceptibility to<b><i> baloxavir.</i></b></span></li></ul><p></p></blockquote><div>While this is exactly what we would<i> hope</i> to find, we've a correspondence from researchers at the University of Hong Kong - published last week in <i>The Lancet</i> - of a much higher incidence of oseltamivir resistance among samples tested in Hong Kong in 2023 (<i>along with a concurrent rise in <b>GISAID</b> sequences deposited since last summer). </i></div><div><span style="color: #2b00fe;"><b><br /></b></span></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;">While the numbers are still relatively small, this is not a trend we'd want to see continue. </div></blockquote><p>First the gist of the correspondence <i>(follow the link for supplementary information</i>), after which I'll have a brief postscript. </p><blockquote><div><a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext"><b><span style="color: #2b00fe; font-size: large;">Global emergence of neuraminidase inhibitor-resistant influenza A(H1N1)pdm09 viruses with I223V and S247N mutations: implications for antiviral resistance monitoring</span></b></a></div><span style="color: #2b00fe;"><br /><a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext#">Rhoda Cheuk-Ying Leung</a>, <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext#">Jonathan Daniel Ip</a>, <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext#">Lin-Lei Chen</a> , <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext#">Wan-Mui Chan</a>, <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext#">Kelvin Kai-Wang To</a><br /><a href="mailto:kelvinto@hku.hk"></a>Open Access Published: March 14, 2024 <br />DOI:<a href="https://doi.org/10.1016/S2666-5247(24)00037-5">https://doi.org/10.1016/S2666-5247(24)00037-5</a><br /><a href="https://doi.org/10.1016/S2666-5247(24)00037-5"></a><br />Neuraminidase inhibitors (NAIs), such as oseltamivir and zanamivir, serve as the primary treatment for influenza virus infection. NAI-resistant influenza A(H1N1) strains were widespread during the 2008–09 influenza season, especially in Japan, where 100% of the strains were resistant to oseltamivir.<a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext#bib1">1</a> </span></blockquote><blockquote><span style="color: #2b00fe;">However, after the NAI-susceptible 2009 pandemic subtype (A[H1N1]pdm09) replaced the previous seasonal A(H1N1) subtype in 2009, the incidence of A(H1N1)pdm09 with reduced inhibition (10-fold to 100-fold) or highly reduced inhibition (>100-fold) was only approximately 1% in the 2019–20 influenza season.<a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext#bib2">2</a></span></blockquote><blockquote><span style="color: #2b00fe;">After a period of quiescence during the COVID-19 pandemic, the incidence of influenza has increased following the relaxation of physical distancing measures. In Hong Kong, the resurgence of the influenza virus occurred in 2023 following the relaxation of all COVID-19 restriction measures, with a peak in the spring, predominantly driven by A(H1N1)pdm09 in April, 2023.<a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext#bib3">3</a> </span></blockquote><blockquote><span style="color: #2b00fe;"><b>We have successfully sequenced the influenza neuraminidase gene in 92 individuals with A(H1N1) infection in Hong Kong in 2023. Among them, four individuals (4·35%) carried at least one mutation known to confer reduced susceptibility to the NAIs oseltamivir or zanamivir (<a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext#appsec1">appendix p 3</a>).</b><a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext#bib4">4</a> Notably, t<b>hree of ten (30%)</b> A(H1N1)pdm09 strains collected in October, 2023, <b>harboured both I223V and S247N mutations.</b></span></blockquote><blockquote><span style="color: #2b00fe;">To ascertain the global incidence of A(H1N1)pdm09 strains with I223V or S247N mutations, or a combination of both, we conducted a comprehensive analysis of A(H1N1)pdm09 strains available in the Global Initiative on Sharing All Influenza Data (GISAID) repository collected between January, 2016, and November, 2023 (<a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext#appsec1">appendix p 4</a>).</span></blockquote><blockquote><span style="color: #2b00fe;"><b>The incidence of strains with I223V or S247N mutations, or both, increased in the fall of 2023.</b> The incidence of the<b> I223V mutation increased from fewer than 1200 per 100 000 individuals before August, 2023, to 1250–4972 per 100 000 individuals between August and November, 2023,</b> whereas that of the <b>S247N mutation increased from fewer than 1200 per 100 000 individuals before September, 2023, to 1775–2500 per 100 000 individuals between September and October, 2023.</b></span></blockquote><blockquote><span style="color: #2b00fe;"><b>None of the strains collected before July, 2023, harboured dual I223V/S247N mutations; however</b>, since July, 2023, <b>nine of 1023 strains (880 per 100 000 individuals) harboured dual I223V/S247N mutations</b>, with the highest incidence in October, 2023 (five of 169 strains [2959 per 100 000 individuals]). </span></blockquote><blockquote><span style="color: #2b00fe;"><b>Of the nine strains with dual I223V/S247N mutations, five were collected from Europe (two from the Netherlands and one each from Norway, Sweden, and France), and four were collected from Oman.</b> Additionally, among these nine strains, three were clustered under clade 6B.1A.5a.2a, and the remaining six were clustered within clade 6B.1A.5a.2a.1 (<a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext#appsec1">appendix pp 1–2</a>).<br /></span></blockquote><blockquote><span style="color: #2b00fe;">Previous studies have shown that mutations at neuraminidase amino acid residue 223 are associated with an 11–28-fold increase in the half-maximal inhibitory concentration (IC50) for oseltamivir, whereas mutations at residue 247 are linked to a six-fold increase in the oseltamivir IC50, compared with the reference median IC50 values.<a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext#bib2">2</a>,<a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext#bib5">5</a> </span></blockquote><blockquote><span style="color: #2b00fe;">However, investigations into such associations for dual I223V/S247N mutations have not been reported. Therefore, in this study, <b>we assessed the susceptibility of a strain with dual I223V/S247N mutation</b> (HKU-231217-085) to neuraminidase inhibitors using a chemiluminescent neuraminidase inhibition assay (<a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext#appsec1">appendix p 7</a>). </span></blockquote><blockquote><span style="color: #2b00fe;">The IC50 value for HKU-231217-085 was 10·63-fold higher (from 0·429 nM to 4·563 nM) against oseltamivir and 3·38-fold higher (from 0·924 nM to 3·120 nM) against zanamivir than the average IC50 value for the three A(H1N1) strains (HKU-231217-099/2023, HKU-231217-100/2023, and 415742/2009) without the dual mutation (<a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00037-5/fulltext#appsec1">appendix p 5</a>). <b>Hence, strains harbouring dual I223V/S247N mutations can be considered as having reduced inhibition, as per the WHO definition.</b><br /></span></blockquote><blockquote><span style="color: #2b00fe;"><b>In summary, the findings highlight the global emergence of NAI-resistant A(H1N1)pdm09 strains with dual I223V/S247N mutations. </b>These results emphasise the importance of continual monitoring of antiviral resistance in influenza viruses.</span></blockquote><p>While the recent appearance of dual <b>I223V/S247N</b> mutations in A(H1N1)pdm09 sequences are concerning, it isn't clear whether these are spontaneous mutations occurring people receiving oseltamivir, or if they represent biologically <i>`fit</i>' viruses actually spreading in the wild. </p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;">Of course, in 2008 we saw H1N1 resistance go from one extreme to the other in the space of a little more than a year, so we'll definitely want to keep an eye out for future reports. </p></blockquote>Antivirals, antibiotics, and most anti-fungal medicals all share the same weakness. Over time, and particularly if they are used often enough, the pathogens (<i>viruses, bacteria, or fungi</i>) they were designed to suppress can evolve or mutate enough to render them ineffective<br /><br />Making both improved surveillance, and better stewardship, crucial going forward. <br /><p><br /></p>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-55946511300427787162024-03-17T09:01:00.001-04:002024-03-17T09:01:49.176-04:00Nature Preprint: Serological Analysis in Humans in Malaysian Borneo Suggests Prior Exposure to H5 Avian Influenza<p> <img height="251" src="https://blogger.googleusercontent.com/img/a/AVvXsEjsUEIFIp4desWVlLu-bRzhvZG1cDDmEcWk2A0Eq1JASHTJ-bMwwJT_rLneewF59v_XjqehFLpRrIiDPLyrppUXLNGgXJ9X3ns4S93F9x_yI8CM2groDyePU1II0RlbtjtcCLe2mPhwpc8KeYo282Xc1vUDaxxCcYCNhPd66Popw0GTU7XiC8ie2A=w320-h251" width="320" /><br /><br /></p><p>#17,952</p><p>We've a fascinating, albeit lengthy and fairly technical preprint this week in <i>Nature Portfolio</i>, which describes a seroprevalence survey looking for influenza antibodies (H1N1, H3N2 & 2 HP H5N1) that was conducted in 2015 on 2,000 residents living in Northern (Malaysian) Borneo. </p><p style="text-align: left;">We've seen similar studies in the past - usually conducted either in the wake of a known H5N1 outbreak or among high risk poultry farmers - which have shown varying rates of <i><u>presumed</u> previous H5 exposure</i>, including: </p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"></blockquote><ul style="text-align: left;"><li>In 2012, in <a href="http://afludiary.blogspot.com/2012/04/h5n1-seroprevalence-among-jiangsu.html"><b>H5N1 Seroprevalence Among Jiangsu Province Poultry Workers</b></a>, we saw a study that found across three locations tested (Gaochun, Jianhu and Gaoyou counties) the percentage of <b>workers testing positive ranged from zero (Gaochun) to 5.38%</b> (95%CI, 2.19%–10.78%) in Gaoyou.</li><li>In 2011, a study (see <b><a href="http://afludiary.blogspot.com/2011/12/study-subclinical-h5-h9-infections-in.html">Subclinical H5 & H9 Infections In Humans</a>)</b> tested 605 residents in and around Beijing China for antibodies to H5 and H9 avian flu viruses. Of these, <b>just 5 (less than 1%) had antibodies to H9 avian influenza</b>, and <b>only 1 was positive for antibodies to H5.</b></li><li>In May of 2009 (see <b><a href="http://afludiary.blogspot.com/2009/05/cambodian-study-finds-rare-asymptomatic.html">Cambodian Study Finds Rare Asymptomatic H5N1 Infections</a>)</b> we saw a study published in the <a href="http://www.journals.uchicago.edu/toc/jid/current"><i>Journal of Infectious Diseases</i></a> on more than 600 members of a Cambodian village where 2 human H5N1 cases were detected in 2006. Antibody titers showed that <b>only 1% (7 of 674) of the villagers tested had contracted, and fought off, the H5N1 virus. </b> A figure much lower than many had expected.</li><li>In 2004 (see <a href="http://afludiary.blogspot.com/2008/02/thailand-serological-study.html"><b>The Thailand Serological Study</b></a>) 322 poultry farmers (in provinces where H5N1 had been detected) were tested. Researchers found that "<i><span style="color: #2b00fe;">no poultry workers had microneutralization titers <b>>80</b>, whereas 7 (2%) had lower titers that did not meet the WHO definition for seropositivity".</span></i></li></ul><div>Complicating matters, detectable levels of <b>influenza antibodies can wane</b> over time and tests are <b>designed to detect specific strains of H5N1,</b> and may not reliably pick up others. </div><div><br /></div><div>Conversely, we've seen evidence that exposure to one influenza subtype can sometimes produce<b> cross-neutralizing antibodies</b> to another (see <b><a href="https://afludiary.blogspot.com/2023/12/eid-journal-ah5n1-na-inhibition.html">EID Journal: A(H5N1) NA Inhibition Antibodies in Healthy Adults after Exposure to Influenza A(H1N1)pdm09</a>).</b></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">In other words, there has always been some degree of ambiguity regarding these seroprevalence surveys. </p></blockquote><p>Today's preprint not only offers <b>methods for improving the accuracy of seroprevalence testing</b>, it reports likely HPAI H5 exposure in some individuals living in a region of northern Borneo which - <i>at that time </i>- had never reported H5N1 in poultry or people</p><p>Exposure to poultry - particularly in live bird markets - is often cited as the biggest risk factor for contracting avian flu (see excerpt from <a href="https://www.who.int/news-room/fact-sheets/detail/influenza-%28avian-and-other-zoonotic%29"><b>WHO assessment </b></a>below).</p><blockquote><b><span style="color: #2b00fe;">For avian influenza viruses, the primary risk factor for human infection appears to be exposure to infected live or dead poultry or contaminated environments, such as live bird markets. Slaughtering, defeathering, handling carcasses of infected poultry, and preparing poultry for consumption, especially in household settings, are also likely to be risk factors.</span></b></blockquote><p>Today's study suggests that living in close proximity to large numbers of migratory birds could entail some risks as well, and that those people be<b> included in routine surveillance</b>. </p><p>A finding that is bolstered by last year's H5N1 infection in Chile, <b><a href="https://academic.oup.com/jtm/article/30/5/taad083/7197125">where researchers found:</a></b></p><blockquote><b><span style="color: #2b00fe; font-family: inherit;">An epidemiological investigation being conducted by the Ministry of Health ascertained that the patient’s residence is located one block from the seashore where seabirds infected with H5N1 viruses had previously been detected. For that reason, an infection of environmental origin is suspected. </span></b></blockquote><p>I've only included some excerpts from a much longer report, so follow the link to read it in its entirety. I'll have a brief postscript after the break. </p><b><span style="font-size: large;"><a href="https://www.researchsquare.com/article/rs-4021361/v1"></a></span></b><blockquote><span style="color: #2b00fe;"><b><span style="font-size: large;"><a href="https://www.researchsquare.com/article/rs-4021361/v1">Serological analysis in humans in Malaysian Borneo suggests prior exposure to H5 avian influenza</a></span></b><br /><br />Hannah Klim, Timothy William, Caolann Brady, Tock Chua, Helena Brazal Monzó, and 10 more<br /><br />This is a preprint; it has not been peer reviewed by a journal.<br />https://doi.org/10.21203/rs.3.rs-4021361/v1<br /><br />This work is licensed under a CC BY 4.0 License<br /><br /><b><span style="font-size: medium;">Abstract</span></b><br /><br />Cases of H5 highly pathogenic avian influenzas (HPAI) are on the rise. Although mammalian spillover events are rare, H5N1 viruses have an estimated mortality rate in humans of 60%. <b>No human cases of H5 infection have been reported in Malaysian Borneo,</b> but HPAI has circulated in poultry and migratory avian species transiting through the region. </span><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">Recent deforestation in Malaysian Borneo may increase the proximity between humans and migratory birds. <b>We hypothesise that higher rates of human-animal contact, caused by this habitat destruction, will increase the likelihood of potential zoonotic spillover events. </b></span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;"><b>In 2015</b>, an environmentally stratified cross-sectional survey was conducted collecting geolocated questionnaire data in 10,100 individuals. <b>A serological survey of these individuals reveals evidence of H5 neutralisation that persisted following depletion of seasonal H1/H3 binding antibodies from the plasma.</b></span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;"><b>The presence of these antibodies suggests that some individuals living near migratory sites may have been exposed to H5. There is a spatial and environmental overlap between individuals displaying high H5 binding and the distribution of migratory birds. </b>We have developed a novel surveillance approach including both spatial and serological data to detect potential spillover events, highlighting the urgent need to study cross-species pathogen transmission in migratory zones.</span></div></blockquote><p> <span style="color: #2b00fe;"> (<b>SNIP)</b></span></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">Here, we perform a serological survey of human influenza exposure in Sabah, Malaysian Borneo to examine the immunological footprint of H5N1 in the region.</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><ul style="text-align: left;"><li><span style="color: #2b00fe;">We present<b> a method for minimizing the impact of influenza subtype cross-reactivity</b> on these serological results. </span></li><li><span style="color: #2b00fe;">We define species distributions of domesticated poultry and migratory wild birds and demonstrate that environmental covariates can be used as proxy to model wild bird contact.</span></li><li><span style="color: #2b00fe;">We additionally<b> identify shared spatial distributions and environmental risk factors between the presence of migratory shorebirds and clade-specific H5N1 seroprevalence</b> using a Bayesian framework. </span></li></ul></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">This study highlights the need to increase surveillance for rare zoonotic diseases at migratory sites and presents an approach for modelling the distributions of serological results and reservoir species.</span></blockquote><p><b><span style="color: #2b00fe;"> (SNIP)</span></b></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><b><span style="color: #2b00fe; font-size: medium;">Discussion</span></b></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><span style="color: #2b00fe;"><b>Our results show evidence of heterogenous serological responses to avian influenza in Sabah.</b> These results are <b>spatially correlated and follow the distribution and habitats of migratory wild birds</b> over domesticated poultry in the region. As contact with avian species is currently necessary for a spillover event, it is critical to consider these migratory sights as key interfaces in stopping the viral spread. </span></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;"><span style="color: #2b00fe;"> There are shared environmental risk factors between the wild bird distributions and H5 binding (Fig. 4b). The identification of proximity to the sea, low elevation (i.e. sea level) areas, closeness to the forest, and remote areas indicate that we are not only reporting wild migratory shorebirds in their natural habitats16–18, but that these habitats are also areas where binding to the H5 2.3.4 antigen was highest. Shared environmental risk factors and the overlapping spatial distributions between wild birds and H5 binding, suggest that some kind of contact may be occurring between humans and wild birds in these locations. Future studies could collect contemporaneous data on wild bird movements and pathogen presence.</span></p></blockquote><p style="text-align: left;"></p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p><span style="color: #2b00fe;">One mechanism of H5 spillover is the spread of the virus from wild birds to domesticated poultry and then into humans36. We can surmise that <b>H5 2.3.4 binding is not related to poultry contact in this study</b>, the inclusion of poultry ownership as a fixed effect did not approve model fit. Although poultry farmers can be at risk of encountering avian influenza36, <b>our findings suggest a need to consider individuals living close to these migratory sites as a part of regular surveillance efforts (Supplemental Fig. 5).</b></span></p></blockquote><p></p><p style="text-align: left;"></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p style="text-align: left;"><span style="color: #2b00fe;">Migratory shorebirds transiting between countries may carry influenza and expose individuals in the surrounding areas to avian viruses. <b>Our results suggest that individuals living within 10km of known migratory locations may have had previously unknown exposure to avian influenza of the 2.3.4 or similar clade</b>. As shorebird habits are being destroyed due to rising sea levels and land use changes, there is an urgent need to consider how this may force zoonotic reservoirs including migratory wild birds into closer contact with humans and increasing the risk of HPAI spillover.</span></p></blockquote><p><span style="color: #2b00fe;"> <a href="https://www.researchsquare.com/article/rs-4021361/v1"><b>(Continue . . . )</b></a> </span></p><p><br /></p><p>Despite the common assertion (<i>even mentioned in this report)</i> that <b><i>60%</i> o</b>f those who contract H5N1 have died, that number is based on cases that were sick enough to be hospitalized <i>and</i> lucky enough to be tested. </p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">It is therefore likely that some number of cases (<i>including mild or asymptomatic</i>) go undetected. <i>Perhaps many.</i></p></blockquote><div><p style="text-align: left;">Since we don't have a good handle on the denominator, we can't have a lot of faith in CFR estimates. More reliable seroprevalence techniques could help us better understand that number, as well as track points of entry of the virus into humans. </p></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div><p style="text-align: left;">Ten years ago, HPAI H5 viruses had difficulty persisting in migratory birds (see<a href="http://afludiary.blogspot.com/2016/07/pnas-enigma-of-disappearing-hpai-h5-in.html"> <b>PNAS: The Enigma Of Disappearing HPAI H5 In North American Migratory Waterfowl</b>).</a> After causing a record breaking epizootic in North America over the winter of 2014-2015, the virus failed to return the following fall. </p></div></blockquote><div><p>Over the next few years, the virus <a href="https://afludiary.blogspot.com/2017/01/eid-journal-reassorted-hpai-h5n8-clade.html"><b>underwent several reassortments</b></a>, which have increased its ability to spread via migratory birds. </p><p></p><ul style="text-align: left;"><li>By 2017, HPAI H5 had <b><a href="https://afludiary.blogspot.com/2017/07/daff-statement-on-2-additional.html">crossed the equator</a></b> for the first time and set up shop in South Africa. </li></ul><ul style="text-align: left;"><li>In 2021, HPAI H5N1 began regularly transiting the Atlantic and Pacific flyways (<b><a href="https://afludiary.blogspot.com/2022/08/multiple-introductions-of-h5-hpai.html">Multiple Introductions of H5 HPAI Viruses into Canada Via both</a> </b><a href="https://afludiary.blogspot.com/2022/08/multiple-introductions-of-h5-hpai.html"><b>East Asia-Australasia/Pacific & Atlantic Flywa</b>y<b>s</b></a>).</li></ul><ul style="text-align: left;"><li>In July 2022, in <a href="https://afludiary.blogspot.com/2022/07/defra-unprecedented-order-shift-in-wild.html"><b>DEFRA: The Unprecedented `Order Shift' In Wild Bird H5N1 Positives In Europe & The UK</b></a>, we looked at the unexpected shift in H5N1 infection from mostly <b>Anseriformes </b>(<i>waterfowl, such as ducks, geese, and swans</i>) to <b>Suliformes </b>and <b>Charadriiformes</b> (<i>shore birds</i>) in 2022.</li></ul><p></p>The virus is constantly evolving, as is its threat to humans. As a result, we should expect that many of our long-standing beliefs about the virus - and the ways we study it - will have to change in the years ahead. </div><div><br /></div><div>To paraphrase an old proverb; <i>Time and viral evolution wait for no man.</i></div>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-61197946167265851362024-03-16T06:45:00.002-04:002024-03-16T06:45:53.137-04:00Mpox Update From The CDC, A New Preprint On Transmission & Reports of Spread In Republic of Congo<p></p><div class="separator" style="clear: both;"><img height="300" src="https://blogger.googleusercontent.com/img/a/AVvXsEh_ng6RvHpl074_YsZZ1-fx4lbwLRMM9csrdHQi7dhrV5mJ639KFNIpfxS91wEDvj5S18zz6xtpYeLMgQ2HwfHea_LdpFc2XPqaag7Hev3kHNSUIL5ZF4pzJssNas_ZnyIV1JfNoWfWnw9z4RRXQGjo7lKv7guCkKFd03dp4wfSZwyx6JahcM9PZg=w320-h300" width="320" /></div><p></p><p>#17,951</p><p>Although the <a href="https://afludiary.blogspot.com/2022/07/who-director-declares-monkeypox-public.html"><b>declared global health emergency</b></a> over the international spread of a new clade (<b>IIb</b>) of Mpox <i>(formerly Monkeypox</i>) was ended after only 10 months in the spring of 2023, we continue to see sporadic infections around the globe, while the more dangerous<b> clade I</b> <b>mpox </b>virus continues to rage (<b>>12,000</b> cases in 2023) in the DRC,. </p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p>Four months ago, the <b><a href="https://afludiary.blogspot.com/2023/11/who-reports-1st-confirmed-cluster-of.html">WHO Reported the 1st Confirmed Cluster Of Sexually Transmitted MPXV Clade 1 in the DRC</a>, </b>warning that <i><span style="color: #2b00fe;">`The risk of mpox further <b>spreading to neighbouring countries and worldwide</b> appears to be significant.'</span></i></p></blockquote><p>Last week we looked at a report in <a href="https://afludiary.blogspot.com/2024/03/eurosurveillance-ongoing-mpox-outbreak.html"><b>Eurosurveillance: Ongoing Mpox Outbreak in South Kivu Province, DRC Associated With a Novel Clade I Sub-lineage</b></a>, which contained the first <b>genomic analysis</b> of samples from a previously unaffected region of the DRC. </p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">This study revealed a <b>novel clade I sub-linage </b>had emerged - most likely from a zoonotic introduction - with changes that may <b><i>render current CDC tests unreliable.</i></b></p></blockquote><p>Over the past 48 hours there have been media reports from the DRC's neighbor, the<b> Republic of Congo</b>, of an outbreak of Mpox recorded in several regions not previously affected (see <b><a href="https://www.africanews.com/2024/03/15/republic-of-congo-reports-its-first-mpox-virus-cases-in-several-regions/">Republic of Congo reports its first mpox virus cases in several regions</a>). </b></p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">Since I can find no confirmation on their <b><a href="https://sante.gouv.cg/actualites-du-ministere/">Health Ministry website</a>,</b> we may have to wait for a WHO update. But spread beyond the DRC was one of the risks mentioned last November. </p></blockquote><p>Meanwhile, we've a new preprint on the <b>medRxiv </b>server, which further confirms last year's finding of <i>(primarily heterosexual</i>) sexual transmission of Mpox clade I in the DRC. </p><blockquote><span style="color: #2b00fe; font-size: large;"><a href="https://www.medrxiv.org/content/10.1101/2024.03.05.24303395v1"><b>Epidemiology, clinical characteristics, and transmission patterns of a novel Mpox (Monkeypox) outbreak in eastern Democratic Republic of the Congo (DRC): an observational, cross-sectional cohort study</b></a></span></blockquote><blockquote><span style="color: #2b00fe; font-size: x-small;">Leandre Murhula Masirika, Jean Claude Udahemuka, Pacifique Ndishimye, Gustavo Sganzerla Martinez, Patricia Kelvin, Maliyamungu Bubala Nadine, Bilembo Kitwanda Steeven, Franklin Kumbana Mweshi, Léandre Mutimbwa Mambo, Bas B. Oude Munnink, Justin Bengehya Mbiribindi, Freddy Belesi Siangoli, Trudie Lang, Jean M. Malekani, Frank M. Aarestrup, Marion Koopmans, Leonard Schuele, Jean Pierre Musabvimana, Brigitte Umutoni, Ali Toloue, Benjamin Hewins, Mansi Dutt, Anuj Kumar, Alyson A. Kelvin, Jean-Paul Kabemba Lukusa, Christian Gortazar, David J Kelvin, Luis Flores<br />doi: https://doi.org/10.1101/2024.03.05.24303395</span><div><span style="color: #2b00fe;"><br /><a href="https://www.medrxiv.org/content/10.1101/2024.03.05.24303395v1.full.pdf+html"><b> Preview PDF</b></a><br /><span style="font-size: medium;"><br /><b>Summary (abstract)</b></span><br /><br /><b>Background </b></span><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">In August 2023, an outbreak of mpox was reported in the eastern part, South Kivu Province, of Democratic Republic of the Congo. In this study, we aimed to investigate the origin of this outbreak and to assess how monkeypox virus spread among humans in the city of Kamituga.<br /><br /><b>Methods </b></span><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">We performed an observational cohort study by recruiting hospitalized patients with mpox-like symptoms. Furthermore, we compared structured, de-identified case report forms and interviews were conducted to determine the possible origins and modes of transmission of the mpox outbreak. We describe the clinical characteristics and epidemiology observed in reported infections.<br /><br /><b>Findings </b></span><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">During the study period (<b>24 September 2023 to 29 January 2024</b>), 164 patients were admitted to the Kamituga hospital, 51 individuals were enrolled in the study and interviewed, and 37 (73%) of 51 individuals received a molecularly confirmed mpox diagnosis. </span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">The median age for males was 24 years (IQR 18-30; range 14-36) and 19 years for females (IQR 17-21; range 1-59). The cohort was comprised of 47 <b>(92%) of 51 individuals who identified as heterosexual,</b> and two (4%) of 51 as bisexual, with 31 (61%) of 51 individuals sexually active with more than one partner within the last six months. </span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">The direct transmission routes are unknown; however, it is expected that the majority of infections were transmitted via occupational exposures. Out of the 51 individuals, <b>24 (47%) were professional sex workers (PSWs),</b> while five (10%) were gold miners, 6 (12%) were students, and four (8%) were farmers; the remaining individual occupations were unknown. </span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">The most common symptoms associated with clinical mpox diagnosis were fever, which was described in 38 (75%) of 51 individuals, and rash, which was described in 45 (88%) of 51 individuals. Among those with a rash, 21 (41%) of 51 individuals experienced oral lesions, and 32 (63%) of 51 presented anogenital lesions. Mpox viral DNA was detected by qPCR from vaginal, penile, and oral swabs in 37 (73%) of 51 enrolled individuals. <b>Two deaths were reported.</b><br /><br /><b><span style="font-size: medium;">Interpretation </span></b></span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">In this observational cohort study, mpox virus infection caused symptoms in a wide age range of participants with most cases presenting in sexually active individuals. Symptoms included fever, cough, lymphadenopathy, sore throat, chills, headache, back pain, muscle pain, vomiting, nausea, conjunctivitis, and rash (oral and anogenital). <b>Heterosexual partners dominated human-to-human contact transmission suggesting that heterosexual close contact is the main form of transmission in this outbreak.</b> Furthermore, Professional Sex Workers (PSWs) were the dominant occupation among infected individuals, indicating that PSWs and clients may be at higher risk for developing mpox virus infections.</span></div></div></div></div></blockquote><p>The changing epidemiology and genetic evolution of mpox clade I in central Africa has sparked a number of risks assessments over the past few months, including:</p><div><blockquote><b><a href="https://afludiary.blogspot.com/2023/12/cdc-han-advisory-00501-mpox-caused-by-h.html">CDC HAN Advisory #00501: Mpox Caused by H-2-H Transmission with Geographic Spread in the Democratic Republic of the Congo</a><br /><br /><a href="https://afludiary.blogspot.com/2023/12/ecdc-risk-assessment-on-transmission.html">ECDC Risk Assessment On Transmission & Spread of Clade I Mpox From The DRC</a></b></blockquote><p>For now, the <a href="https://www.cdc.gov/poxvirus/mpox/outbreak/2023-drc.html"><b>CDC assesses the risk</b></a> to the United States from the outbreak in the DRC as low:</p></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><span style="color: #2b00fe;">There have been<b> no cases of the type of mpox spreading in DRC reported in the United States</b> at this time. The risk to the general public in the U.S. from the type of mpox circulating in the DRC is <b>low. </b></span></div></blockquote><div><p>But that assessment could change. Which is why the CDC continues to<a href="https://www.cdc.gov/poxvirus/mpox/index.html"><b> update their Mpox web page</b></a> , adding the following guidance yesterday (March 15th).</p></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><b><span style="font-size: medium;"><a href="https://www.cdc.gov/poxvirus/mpox/prevention/sexual-health.html">Safer Sex, Social Gatherings, and Mpox</a> </span></b>March 15, 2024</div></blockquote><div style="text-align: left;"><br /></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><span style="font-size: medium;"><a href="https://www.cdc.gov/poxvirus/mpox/symptoms/index.html"><b>Signs and Symptoms</b></a> </span>March 15, 2024</div></blockquote><div style="text-align: left;"><br /></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><b><a href="https://www.cdc.gov/poxvirus/mpox/veterinarian/mpox-in-animals.html"><span style="font-size: medium;">Mpox in Animals and Pets</span></a><span style="font-size: large;"> </span></b>March 15, 2024</div></blockquote><div style="text-align: left;"><br /></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><b><span style="font-size: medium;"><a href="https://www.cdc.gov/poxvirus/mpox/about/index.html">About Mpox</a> </span></b>March 15, 2024</div></blockquote><p>During the decade leading up to Mpox clade IIb's world tour (Spring 2022), we saw repeated warnings that the virus was evolving into a more transmissible disease threat (see 2016's<b> <a href="http://afludiary.blogspot.com/2016/05/eid-journalextended-h-2-h-transmission.html">EID Journal:Extended H-2-H Transmission during a Monkeypox Outbreak)</a>.</b></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">A 2020 report, published by the <i>Bulletin of the World Health Organization</i>, warned that our waning immunity to smallpox put society at greater risks of seeing Monkeypox epidemics (see <a href="https://afludiary.blogspot.com/2020/08/who-modelling-human-to-human.html"><b>WHO: Modelling Human-to-Human Transmission of Monkeypox</b></a>).</blockquote><p>And in early 2023, in <a href="https://afludiary.blogspot.com/2023/01/eid-journal-monkeypox-virus-evolution.html"><b>EID Journal: Monkeypox Virus Evolution before 2022 Outbreak</b></a>, researchers suggested that` <i><span style="color: #2b00fe;">. . . the most likely scenario is that there has been <b>silent and undetected circulation of MPXV</b>, possibly including multiple<b> non–MPXV-endemic countries outside Africa, since the 2017–2018</b> outbreak.'</span></i><br /></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">While there are no guarantees that Clade I Mpox will follow suit, similar warning signs are there. Just as they are for novel or avian flu, Lassa Fever, Nipah, MERS-CoV, and an increasing array of other emerging infectious diseases. </blockquote><br />A reminder that nature is nothing, if not persistent. Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-16946523173962078262024-03-15T06:58:00.003-04:002024-03-15T06:58:35.883-04:00ODNI 2024 Annual Threat Assessment: Health Security<p></p><div class="separator" style="clear: both;"><div class="separator" style="clear: both;"><a href="https://www.dni.gov/index.php/newsroom/reports-publications/reports-publications-2024/3787-2024-annual-threat-assessment-of-the-u-s-intelligence-community"><img height="239" src="https://blogger.googleusercontent.com/img/a/AVvXsEg0Xmyw5InA2jdgT9DD_WzxhRDJ5F-WWceqYlFt7eBEZ_b2-UY9D1cslTwG7lIVON45xPhPF8wBjQy-CbbgjeXAJldbuULf4siSh2pdVRnJwnBbuvsbkJ-2BJP5wjyQVhO9vuSi96CND0uWXIGPY619JjZzqh3A5VwxyS40eDG3_JDQT4w-_UNfPQ=w320-h239" width="320" /></a></div><br />#17,950</div><p>While this blog is normally narrowly focused on emerging infectious diseases - with a smattering of individual and community preparedness - from time to time we take a look at <i>(mostly governmental</i>) reports on wider threats. </p><p>In the past we've looked at such diverse topics as:</p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><a href="https://afludiary.blogspot.com/2023/04/fema-preparing-nation-for-space-weather.html"><b><span style="font-size: medium;">FEMA: Preparing the Nation for Space Weather Events</span></b></a><div><b><span style="font-size: medium;"><br /></span></b></div><div><b><span style="font-size: medium;"><a href="https://afludiary.blogspot.com/2018/12/niac-surviving-catastrophic-power-outage.html">NIAC: Surviving A Catastrophic Power Outage</a></span></b></div></blockquote><div><b></b><b><span style="font-size: medium;"><br /></span></b></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><b><span style="font-size: medium;"><a href="https://afludiary.blogspot.com/2017/08/dhs-niac-cyber-threat-report-august-2017.html">DHS: NIAC Cyber Threat Report</a></span></b></div></blockquote><div><b></b><b><span style="font-size: medium;"><br /></span></b></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><b><span style="font-size: medium;"><a href="https://afludiary.blogspot.com/2023/08/uk-2023-edition-of-national-risk.html">UK: 2023 Edition Of the National Risk Register For Civil Emergencies</a></span></b></div></blockquote><div><b></b><b><span style="font-size: medium;"><br /></span></b></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><b><span style="font-size: medium;"><a href="https://afludiary.blogspot.com/2023/11/the-nerc-2023-2024-winter-electrical.html">The NERC 2023-2024 Winter (Electrical Grid) Reliability Assessment</a></span></b></div></blockquote><div><h3 class="post-title entry-title" itemprop="name" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; position: relative; text-align: left;"><a href="https://afludiary.blogspot.com/2023/11/the-nerc-2023-2024-winter-electrical.html" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"><span style="font-size: small;"></span></a></h3><p>Every year the Office of the Director of National Intelligence (<a href="https://www.dni.gov/"><b>ODNI</b></a>) releases an unclassified report on threats to our national security, which covers a wide range of scenarios. One of the threats mentioned every year has been that of a pandemic, although prior to 2020 it was given fairly short shrift.</p><p>The only mention of the word `pandemic' in the <b><a href="https://www.dni.gov/files/ODNI/documents/2019-ATA-SFR---SSCI.pdf">2019 edition</a>,</b> was limited to:</p><p><b><span style="font-size: medium;"></span></b></p><blockquote><p><b><span style="color: #2b00fe; font-size: medium;"><a href="https://www.dni.gov/files/ODNI/documents/2019-ATA-SFR---SSCI.pdf">Global Health</a> </span></b></p><p><i><b><span style="color: #2b00fe;">We assess that the United States and the world will remain vulnerable to the next flu pandemic or large scale outbreak of a contagious disease that could lead to massive rates of death and disability, severely
affect the world economy, strain international resources, and increase calls on the United States for support. </span></b></i></p><p><span style="color: #2b00fe;">Although the<b> international community has made tenuous improvements to global health security</b>,
these gains may be inadequate to address the challenge of what we anticipate will be more frequent
outbreaks of infectious diseases because of rapid unplanned urbanization, prolonged humanitarian
crises, human incursion into previously unsettled land, expansion of international travel and trade,
and regional climate change.</span></p></blockquote><p></p><p>In light of the events of the past 4 years, it is no surprise that <b><a href="https://www.dni.gov/files/ODNI/documents/assessments/ATA-2024-Unclassified-Report.pdf">in the latest edition</a></b> - published last week by the ODNI - the issue of global health threats is given more attention. </p></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div><p style="text-align: left;">Some of the issues discussed include increased risks for future pandemics, <b><a href="https://afludiary.blogspot.com/2023/08/no-news-is-now-commonplace.html">failures of nations to report outbreaks</a></b> in a timely fashion (<i>as required by international law</i>), and the <b><a href="https://afludiary.blogspot.com/2014/05/lipsitch-galvani-gof-research-concerns.html">potential risk from lab leaks</a>.</b> </p></div></blockquote><div><p>In the <a href="https://www.dni.gov/files/ODNI/documents/assessments/ATA-2024-Unclassified-Report.pdf"><b>report's forward</b></a>, the agency warns:</p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;"><span style="color: #2b00fe;">The <b>accelerating
effects of climate change </b>are placing more of the world’s population, particularly in low- and middle income countries, at greater risk from extreme weather, food and water insecurity, and humanitarian
disasters, fueling migration flows and <b>increasing the risks of future pandemics as pathogens exploit
the changing environment</b></span></p></blockquote><p> </p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p><b><span style="color: #2b00fe; font-size: medium;"><a href="https://www.dni.gov/files/ODNI/documents/assessments/ATA-2024-Unclassified-Report.pdf">Health Security </a></span></b></p><p><span style="color: #2b00fe;"><b style="font-style: italic;">National health system shortfalls, public mistrust and medical misinformation, and eroding global health
governance will impede the capacity of countries to respond to health threats. </b>Countries remain
vulnerable to the introduction of a new or reemerging pathogen that could cause another devastating
pandemic. </span></p></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p></p><ul style="text-align: left;"><li><span style="color: #2b00fe;">The predicted shortage of at least 10 million healthcare workers by 2030 will occur primarily in
low- and middle-income countries. </span></li></ul><p></p></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p></p><ul style="text-align: left;"><li><span style="color: #2b00fe;"><b>Global health governance and adherence to UN health protocols may be eroded during the
coming year by continued disregard by governments of international health institutions and
norms and adversary interference in global health initiatives. </b></span></li></ul><p></p></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p></p><ul style="text-align: left;"><li><span style="color: #2b00fe;">Drivers for infectious disease emergence are on the rise, including deforestation, wildlife
harvesting and trade, mass food production, <b>and lack of international consensus on biosafety
norms.</b> These drivers are compounded by factors that facilitate global spread, such as
international travel and trade, inadequate global disease surveillance and control, weakened
health systems, public distrust, and medical misinformation. </span></li></ul><p></p></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p></p><ul style="text-align: left;"><li><span style="color: #2b00fe;"><b>Significant outbreaks of highly pathogenic avian influenza, cholera, dengue, Ebola, monkeypox,
and polio </b>have stretched global and national disease detection and response systems further
straining the international community’s ability to address health emergencies.</span></li></ul><p></p></blockquote><p>The origins of the SARS-CoV-2 virus remains murky, as China continues to resist sharing information: </p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjRTQ2GoZHFHmRpFf7LzBZnpiQeDOAWryuLpO5a2EjHcuTro69ssC_fEPQOeYyvHoYRR2lwsqPMUgV35jYCJpPaFX1cvvV7NHwCP4cGYRPKMO4qhHysSE6XaKCGFORG4bNvY9DAoJ4Tdb63qgn83k3y4viVwSf05ff6U2wuh18kx87NhMe8UNpRXg" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="451" data-original-width="789" height="269" src="https://blogger.googleusercontent.com/img/a/AVvXsEjRTQ2GoZHFHmRpFf7LzBZnpiQeDOAWryuLpO5a2EjHcuTro69ssC_fEPQOeYyvHoYRR2lwsqPMUgV35jYCJpPaFX1cvvV7NHwCP4cGYRPKMO4qhHysSE6XaKCGFORG4bNvY9DAoJ4Tdb63qgn83k3y4viVwSf05ff6U2wuh18kx87NhMe8UNpRXg=w470-h269" width="470" /></a></div> <p></p><p>While much of this 41-page report is focused on state actors (<i>China, Russia, Iran, North Korea, etc.)</i>, it also covers growing technological concerns which include the proliferation of <b>AI,</b> <b>Cyber threats</b>, and <b>synthetic biotechnologies </b>(see <a href="https://afludiary.blogspot.com/2018/06/nat-academy-of-sciences-biodefense-in.html"><b>National Academy Of Sciences: Biodefense in the Age of Synthetic Biology</b></a>).<br />. </p><p><b><span style="font-size: medium;"></span></b></p><blockquote><p><b><span style="color: #2b00fe; font-size: medium;"><a href="https://www.dni.gov/files/ODNI/documents/assessments/ATA-2024-Unclassified-Report.pdf">Disruptive Technology </a></span></b></p><p><b><i><span style="color: #2b00fe;">New technologies—particularly in the fields of AI and biotechnology—are being developed and are
proliferating at a rate that makes it challenging for companies and governments to shape norms regarding
civil liberties, privacy, and ethics. </span></i></b></p><p><b><i><span style="color: #2b00fe;">The convergence of these emerging technologies is likely to create
breakthroughs, which could lead to the rapid development of asymmetric threats—such as advanced
UAVs—to U.S. interests and probably will help shape U.S. economic prosperity. </span></i></b></p></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><blockquote><p style="text-align: left;"><span style="color: #2b00fe;">• For example, <b>stealth technology</b> has significantly impacted conventional defense systems and
has driven the efforts of varying countries to start a new round of research on detection
systems and guided weapons. A key trend is the development of advanced materials with
enhanced stealth properties with reduced reflection and absorption properties. </span></p></blockquote></blockquote><blockquote><p><span style="color: #2b00fe;"><b>Advances in AI and new machine learning models </b>are moving AI into its industrial age, with
potentially huge economic impacts for both winners and followers and unintended consequences—
from rampant deepfakes and misinformation to the development of AI-generated computer viruses
or new chemical weapons. Generative AI is a means for discovering and designing novel
technologies and advanced system-level processes that could strengthen a country’s technological,
economic, and broader strategic competitiveness. </span></p></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><blockquote><p style="text-align: left;"><span style="color: #2b00fe;">• China is pursuing <b>AI for smart cities, mass surveillance, healthcare, drug discovery, and
intelligent weapons platforms</b>. Chinese AI firms are already world leaders in voice and image
recognition, video analytics, and mass surveillance technologies. </span></p></blockquote></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><blockquote><p style="text-align: left;"><span style="color: #2b00fe;">• PRC researchers have described the application of generative AI to drug discovery as
“revolutionary.” On average, it takes more than 10 years and billions of dollars to develop a
new drug. AI can make drug discovery faster and cheaper by using machine-learning models
to predict how potential drugs might behave in the body and cut down on the need for
painstaking lab work on dead-end compounds.</span></p></blockquote></blockquote><blockquote><p></p></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;"><span style="color: #2b00fe;">• Russia is using AI to create deepfakes and is developing the capability to fool experts.
Individuals in warzones and unstable political environments may serve as some of the highest value targets for such deepfake malign influence.</span></p></blockquote></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;"><span style="color: #2b00fe;">Innovators in synthetic biology probably will control new military and commercial applications and
hold trillions of dollars in production capacity, including supply chains for products that vary from
disease-resistant crop seeds to metals to pharmaceuticals. </span></p></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;"><span style="color: #2b00fe;">• Countries, such as China and the United States, that lead biotechnological breakthroughs in
fields such as precision medicine, synthetic biology, big data, and biomimetic materials, will
not only drive industry growth, but also international competition and will exert substantial
influence over the global economy for generations </span></p></blockquote></blockquote><p>Admittedly this report makes for sobering reading, and while there isn't much any of us can to mitigate most of these threats, we can be better prepared if, and when, the next crisis occurs. </p>Each year FEMA conducts a nationwide poll on preparedness, and they released their <b><a href="https://www.fema.gov/about/openfema/data-sets/national-household-survey">2023 survey</a> </b>last December. Even though these are self-reported assessments, and `<i>being prepared</i>' means different things to different people, they report some small progress over the past 12 months. <p style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;"></p><div class="separator" style="background-color: #ebedec; clear: both; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; text-align: center;"><a href="https://www.fema.gov/sites/default/files/documents/fema_national_household_survey_2023.zip" style="color: #3f3f7f; margin-left: 1em; margin-right: 1em; text-decoration-line: none;"><img alt="" data-original-height="363" data-original-width="863" height="199" src="https://blogger.googleusercontent.com/img/a/AVvXsEj3mVbgJs37TjR0fZGWUh-FBWSRgXXNyt2nZ6fOjw67aLwDuJ-AwnTIESc3DXEBCO4kmBSJT6v9dDQNDQDoiefpApW8fgfP1QbQtNKikEVujzpjhUUO4SP-oMlJCR0ymA3xzQS1SZI3qZ94zlEwyduGVrkdah2xxDAyw66jsouYlSC_8hsRJDnqFg=w471-h199" style="background: transparent; border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; padding: 8px; position: relative;" width="471" /></a></div><p><span style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;">It</span><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;"> is a mixed bag, however. More people have assembled supplies,</span><i style="background-color: #ebedec; font-size: 16px;"><b><span style="color: #363636;"> </span><span style="color: #660000;">b</span></b></i><span style="color: #660000;"><i style="background-color: #ebedec; font-size: 16px;"><b>ut fewer people report practicing emergency drills or habits</b></i><span style="background-color: #ebedec; font-size: 16px;">. </span></span><span style="background-color: #ebedec; font-size: 16px;"><span style="color: #363636;"> More have learned their evacuation routes, but</span><b><span style="color: #660000;"> </span></b></span><i style="background-color: #ebedec; font-size: 16px;"><b><span style="color: #660000;">fewer have made a plan.</span></b><span style="color: #363636;"> </span></i><span style="background-color: #ebedec; color: #363636; font-size: 16px;"> And while more have tested a family communication plan, </span><i style="background-color: #ebedec; font-size: 16px;"><b><span style="color: #660000;">fewer report having signed up for alerts or warnings. </span></b></i></span></p><p style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;"></p><p style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;"></p><div class="separator" style="background-color: #ebedec; clear: both; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; text-align: center;"><a href="https://www.fema.gov/sites/default/files/documents/fema_national_household_survey_2023.zip" style="color: #007f7f; margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="752" data-original-width="556" height="400" src="https://blogger.googleusercontent.com/img/a/AVvXsEiNnGpcQDppnvYEiv_ByQF9S6ZjOY0T1rieDM2I24QoqtYNqB1465UCqsM273_pHrQNIIXjEHG5X5DukKk4npsEiWgpNWEZ_PqKiCQAhBi795G-SdlYVtU3_u0Tl9UBnHzoMEq2lWW8JyJaeZWHoZrZ-P-f8O1tre0erzaH5-mLJ2i9HnWXWH2wug=w295-h400" style="background: transparent; border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; padding: 8px; position: relative;" width="295" /></a></div><p style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="font-family: inherit;">While you can't be prepared for every eventuality, there are some basic goals one should strive for.</span></p><p style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="font-family: inherit;">So . . . if a disaster struck your region today, and the <b>power went out</b>, <b>stores closed their doors</b>, and <b>water stopped</b> flowing from your kitchen tap for the next <b>7 to 14 days</b> . . . are you ready with:</span></p><div style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;"><ul style="line-height: 1.4; list-style-image: initial; list-style-position: initial; margin: 0.5em 0px; padding: 0px 2.5em;"><li style="border: none; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><span style="color: #660000;">A battery operated <a href="http://www.weather.gov/" style="color: #3f3f7f; text-decoration-line: none;"><b>NWS</b></a> Emergency Radio to find out what was going on, and to get vital instructions from emergency officials</span></li><li style="border: none; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><span style="color: #660000;">A decent <b>first-aid kit,</b> so that you can treat injuries</span></li><li style="border: none; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><span style="color: #660000;">Enough <b>non-perishable food and water </b>on hand to feed and hydrate your family (including pets) for the duration</span></li><li style="border: none; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><span style="color: #660000;">A way to <b>provide light</b> when the grid is down.</span></li><li style="border: none; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><span style="color: #660000;">A way to <b>cook safely</b> without electricity</span></li><li style="border: none; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><span style="color: #660000;"><span style="font-family: inherit;">A way to <b>purify or filter water</b></span></span></li><li style="border: none; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><span style="font-family: inherit;"><span face="Arial, Tahoma, Helvetica, FreeSans, sans-serif" style="color: #660000;">A way to handle basic <b>sanitation</b></span><b style="color: #660000;"> </b><span face="Arial, Tahoma, Helvetica, FreeSans, sans-serif" style="color: #660000;">and</span><b style="color: #660000;"> waste disposal. </b></span></li><li style="border: none; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><span style="color: #660000;">A way to <b>stay cool (fans) or warm</b> when the power is out.</span></li><li style="border: none; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><span style="color: #660000;">A small supply of <b>cash</b> to use in case credit/debit machines are not working</span></li><li style="border: none; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><span style="color: #660000;"><span style="font-family: inherit;">An emergency plan, including meeting places, emergency out-of-state contact numbers, a<a href="http://afludiary.blogspot.com/2010/07/in-emergency-who-has-your-back.html" style="color: #3f3f7f; text-decoration-line: none;"> <b>disaster buddy,</b></a> and in case you must evacuate, a <a href="http://afludiary.blogspot.com/2012/07/inside-my-new-bug-out-bag.html" style="color: #3f3f7f; text-decoration-line: none;"><b>bug-out bag</b></a></span></span></li><li style="border: none; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><span style="color: #660000;">Spare supply of essential <b>prescription medicines</b> that you or your family may need</span></li><li style="border: none; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><span style="color: #660000;">A way to entertain yourself, or your kids, during a prolonged blackout</span></li></ul></div><p><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;">If not, you've got some important work to do. A good place to get started is by visiting </span><b style="background-color: #ebedec; color: #363636; font-size: 16px;"><a href="http://www.ready.gov/" style="color: #3f3f7f; text-decoration-line: none;">Ready.gov</a>.</b></span></p></div>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-9235207723136368852024-03-14T12:24:00.003-04:002024-03-14T12:24:20.518-04:00Eurosurveillance: Ongoing Mpox Outbreak in South Kivu Province, DRC Associated With a Novel Clade I Sub-lineage<p> <img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVSbYEFXEPIIHad6nWv8zd6jj8l0nJFZrja_5pNtrKgk99ZQweCPV2cCZR1ocSTMUyK_wr2fz00Asz8g6fNTjE26Ivza4U0-Dyy1qrAliWlMK7oD3LN4ByWgeph1AcM2A4bS2Jlw/" style="background: rgb(235, 237, 236); border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; padding: 8px;" /></p><span face="Arial, Tahoma, Helvetica, FreeSans, sans-serif" style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;"><span style="font-size: x-small;">Countries with endemic Mpox- Credit WHO</span></span><p>#17,949</p><br /><b>Clade I Mpox</b> (<i>formerly Monkeypox)</i> - which is endemic to central Africa (<i>see map at top of post</i>) - is far more severe than the <b>Clade IIb</b> Mpox virus which<b> <a href="https://afludiary.blogspot.com/2022/07/who-director-declares-monkeypox-public.html">began its world tour in 2022</a></b>. It appears more transmissible, can produce more disfiguring lesions, and is associated with a much higher fatality rate. <br /><br /><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;">While we've seen no indication of international spread of the Clade I Mpox virus, last year's discovery of two clusters of sexually transmitted Mpox (<i>in MSM and sex workers</i>) (see <b><a href="https://afludiary.blogspot.com/2023/11/who-reports-1st-confirmed-cluster-of.html">WHO Reports 1st Confirmed Cluster Of Sexually Transmitted MPXV Clade 1 in the DRC</a>) -</b> has raised concerns that - like Clade IIb - this more aggressive strain could eventually turn up outside of Africa.</blockquote><p>Since then we've looked at several reports and risk assessments, including: </p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><a href="https://afludiary.blogspot.com/2023/12/cdc-han-advisory-00501-mpox-caused-by-h.html"><b>CDC HAN Advisory #00501: Mpox Caused by H-2-H Transmission with Geographic Spread in the Democratic Republic of the Congo</b></a></blockquote><b><br /></b><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><a href="https://afludiary.blogspot.com/2023/12/ecdc-risk-assessment-on-transmission.html"><b>ECDC Risk Assessment On Transmission & Spread of Clade I Mpox From The DRC</b></a></blockquote><b><br /></b><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><a href="https://afludiary.blogspot.com/2023/11/cdc-eid-journal-clade-iassociated-mpox.html"><b>CDC EID Journal: Clade I–Associated Mpox Cases Associated with Sexual Contact, the Democratic Republic of the Congo</b></a></blockquote><blockquote class="tr_bq"></blockquote>Like all viruses, Mpox continues to evolve and diversify, as was discussed in the 2014 EID Journal article<b> <a href="#">Genomic </a></b><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901482/"><b>Variability of Monkeypox Virus among Humans, Democratic Republic of the Congo</b></a>, where the authors cautioned:<div><br /><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;"><b>Small genetic changes could favor adaptation to a human host</b>, and this potential is greatest for pathogens with moderate transmission rates (such as MPXV) (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901482/#R40">40</a>). <b>The ability to spread rapidly and efficiently from human to human could enhance spread by travelers</b> to new regions.</span></blockquote><div><br /></div><div>Today we have a the first report on a genomic analysis of samples from a recent outbreak in a previously unaffected region of the DRC, which reveals<b> a novel clade I sub-linage has emerged </b>- most likely from a zoonotic spillover - that may render current CDC tests unreliable. </div><div><br /></div><div>First some excerpts from the<i> Eurosurveillance report</i> (follow the link to read it in its entirety), after which I'll return with a postscript.</div><blockquote><span style="color: #2b00fe;"><b>Rapid communication Open Access</b><br /> <br /><b><a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.11.2400106"><span style="font-size: large;">Ongoing Mpox Outbreak in Kamituga, South Kivu province, associated with Monkeypox virus of a novel Clade I sub-lineage, Democratic Republic of the Congo, 2024</span></a></b></span><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe; font-size: x-small;"><a href="https://www.eurosurveillance.org/search?value1=Leandre+Murhula+Masirika&option1=author&noRedirect=true">Leandre Murhula Masirika</a>1,2 , <a href="https://www.eurosurveillance.org/search?value1=Jean+Claude+Udahemuka&option1=author&noRedirect=true">Jean Claude Udahemuka</a>3,4 , <a href="https://www.eurosurveillance.org/search?value1=Leonard+Schuele&option1=author&noRedirect=true">Leonard Schuele</a>5 , <a href="https://www.eurosurveillance.org/search?value1=Pacifique+Ndishimye&option1=author&noRedirect=true">Pacifique Ndishimye</a>4,6,7 , <a href="https://www.eurosurveillance.org/search?value1=Saria+Otani&option1=author&noRedirect=true">Saria Otani</a>8 , <a href="https://www.eurosurveillance.org/search?value1=Justin+Bengehya+Mbiribindi&option1=author&noRedirect=true">Justin Bengehya Mbiribindi</a>9 , <a href="https://www.eurosurveillance.org/search?value1=Jean+M.+Marekani&option1=author&noRedirect=true">Jean M. Marekani</a>10 , <a href="https://www.eurosurveillance.org/search?value1=L%C3%A9andre+Mutimbwa+Mambo&option1=author&noRedirect=true">Léandre Mutimbwa Mambo</a>11 , <a href="https://www.eurosurveillance.org/search?value1=Nadine+Malyamungu+Bubala&option1=author&noRedirect=true">Nadine Malyamungu Bubala</a>9 , <a href="https://www.eurosurveillance.org/search?value1=Marjan+Boter&option1=author&noRedirect=true">Marjan Boter</a>5 , <a href="https://www.eurosurveillance.org/search?value1=David+F.+Nieuwenhuijse&option1=author&noRedirect=true">David F. Nieuwenhuijse</a>5 , <a href="https://www.eurosurveillance.org/search?value1=Trudie+Lang&option1=author&noRedirect=true">Trudie Lang</a>12 , <a href="https://www.eurosurveillance.org/search?value1=Ernest+Balyahamwabo+Kalalizi&option1=author&noRedirect=true">Ernest Balyahamwabo Kalalizi</a>2 , <a href="https://www.eurosurveillance.org/search?value1=Jean+Pierre+Musabyimana&option1=author&noRedirect=true">Jean Pierre Musabyimana</a>4,13 , <a href="https://www.eurosurveillance.org/search?value1=Frank+M.+Aarestrup&option1=author&noRedirect=true">Frank M. Aarestrup</a>8 , <a href="https://www.eurosurveillance.org/search?value1=Marion+Koopmans&option1=author&noRedirect=true">Marion Koopmans</a>5 , <a href="https://www.eurosurveillance.org/search?value1=Bas+B.++Oude+Munnink&option1=author&noRedirect=true">Bas B. Oude Munnink</a>5,* , <a href="https://www.eurosurveillance.org/search?value1=Freddy+Belesi+Siangoli&option1=author&noRedirect=true">Freddy Belesi Siangoli</a>14,*</span></div><div><span style="color: #2b00fe; font-size: x-small;"><br /></span></div><div><span style="color: #2b00fe; font-size: x-small;">https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.11.2400106</span></div><span style="color: #2b00fe;"><br />In the Democratic Republic of the Congo (DRC), the numbers of people with suspected infection with monkeypox virus (MPXV), the virus that causes mpox, have increased since the start of 2023. A total of<b> 12,569 suspected mpox cases have been reported up to 12 November, </b>the highest number of annual cases ever recorded [<a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.11.2400106#r1">1</a>]. <b>The case fatality rate has been estimated at 4.6%</b> [<a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.11.2400106#r1">1</a>]; moreover, <b>new cases have occurred in geographical areas of the country where the disease was previously not observed</b>, such as Kinshasa and<b> South Kivu province</b> [<a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.11.2400106#r1">1</a>,<a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.11.2400106#r2">2</a>]. </span></blockquote><blockquote><span style="color: #2b00fe;">Despite this concerning situation, there is <b>only limited genomic information available on the circulating viruses</b>, which suggests that they belong to Clade I [<a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.11.2400106#r3">3</a>]. To gain more insight into the characteristics of the strains causing the epidemic, as well as assurance that current and commonly used molecular assays to diagnose MPXV infections can detect these strains, <b>we sequenced monkeypox viral genomes from recently diagnosed cases in South Kivu, DRC.</b><br /> <br /><b><span style="font-size: medium;">Case definitions and patient characteristics</span><br /> </b><br />A case was listed as ‘suspect’ if presenting with an acute illness with fever, intense headache, myalgia, and back pain, followed by 1 to 3 days of a progressively developing rash often starting on the face and spreading on the body. A confirmed mpox case had a monkeypox virus infection which was laboratory-confirmed by PCR. A case was listed as ‘probable’ when satisfying the clinical definition of a suspected case and having an epidemiological link to a confirmed or probable case; a probable case was not laboratory-confirmed [<a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.11.2400106#r4">4</a>].<br /><br />The study involved patients from South Kivu province in the territory of Mwenga, who were hospitalised in the Kamituga hospital, which is in the Kamituga health zone. The first mpox cases in this area were reported from September 2023 onwards.<br /><br /><b>A total of 10 patients were included in the study. All were young adults in their late teenage up to the age of mid-20 years and five were male and five females.</b> Regarding professions comprised, t<b>he majority of the concerned individuals were sex workers</b>. For these patients, admission to the Kamituga Hospital had been based on clinical diagnosis of mpox by hospital staff. According to routines, skin lesion and oropharyngeal swabs collected from the patients had been sent to the national medical research institute of the DRC (Institut National de la Recherche Biomédicale; INRB) in Goma for MPXV infection confirmation by PCR, and all patients had tested positive for the virus.</span></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;"><span style="color: #2b00fe;"><b>(SNIP)</b></span></p><span style="color: #2b00fe;"><b><span style="font-size: medium;">The monkeypox virus outbreak strain in South Kivu lacks the target sequence used for identifying Clade I viruses<br /></span></b> <br />To check if the strains obtained in the current study could be detected by commonly used molecular assays to diagnose MPXV infections, their sequences were aligned to the closely related Clade I sequence EPI_ISL_13056243. This sequence matches primer and probe sequences recommended by the United States (US) Centers for Disease Control and Prevention (CDC) to diagnose MPXV [<a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.11.2400106#r15">15</a>]. The alignment was assessed using an in-house Primer Check Tool (<a href="https://viroscience-emc.shinyapps.io/primer-check/">https://viroscience-emc.shinyapps.io/primer-check/</a> ).</span><br /><br /> </blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><span style="color: #2b00fe;">While the generic primers and probe still seem to be functional with only one mutation in the reverse primer, the specific Clade I virus real-time PCR target, recommended by the US CDC, is absent in the genomes of the novel MPXV strains (<a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.11.2400106#f2"> Figure 2 </a>and <a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.11.2400106#supplementary_data">Supplementary Figure 3</a>). <b>The observed deletion is 1,114 nt in size and results in the complete deletion of the OPG032 gene.</b> The coverage of this region ranged between 76× and 941× sequence reads depending on the sample. <b>Due to the deletion, the rapid US CDC method to identify Clade I in newly diagnosed mpox cases is most likely not reliable for detection of the novel sub-lineage identified in the current study.</b></span></blockquote><p><span style="color: #2b00fe;"> (SNIP)</span></p><b><span style="color: #2b00fe; font-size: medium;"></span></b><blockquote><span style="color: #2b00fe;"><b><span style="font-size: medium;"> Discussion</span></b> <br /> <br />From the mpox outbreak in Kamituga, South Kivu, six near-to-complete MPXV sequences derived from local patients hospitalised with mpox were obtained. <b>Phylogenetic analyses of these sequences together with those available for other Clade I and II viruses, placed them in a new sub-lineage near the root of Clade I, </b>which suggests that the outbreak in this region results <b>from a new introduction, most likely from a zoonotic reservoir. </b>Although sequences from a small 2023 Kinshasa outbreak are not publicly available, the placement of those sequences in a published phylogenetic tree [<a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.11.2400106#r3">3</a>] suggests that the <b>Kamituga outbreak is not related to the outbreak in Kinshasa</b>. Our findings therefore suggest that there are<b> at least two independent outbreaks ongoing in DRC.</b></span></blockquote><blockquote><span style="color: #2b00fe;"><b>Remarkably, a large stretch of sequence in the genomes belonging to the novel MPXV sub-lineage was absent compared to other Clade I genomes, which would lead to failure of the Clade I-specific real-time PCR recommended by the US CDC [<a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.11.2400106#r15">15</a></b>]. A <b>deletion in the same region is also observed in Clade II MPXV,</b> and this was the basis for clade assignment using the CDC PCR. </span></blockquote><blockquote><span style="color: #2b00fe;">Therefore,<b> if the viruses from the new lineage were to spread internationally, this molecular surveillance tool can no longer be used to rapidly identify these Clade I virus infections while the global Clade IIb outbreak is ongoing.</b><br /></span><b style="color: #2b00fe;"><span style="font-size: medium;"></span></b></blockquote><blockquote><b style="color: #2b00fe;"><span style="font-size: medium;">Conclusion</span></b></blockquote><blockquote><span style="color: #2b00fe;">Altogether, the findings of this study strongly suggest that whole genome sequencing of a larger subset of MPXV currently causing mpox cases in DRC, as well as public data sharing, are essential to understand the ongoing epidemic. Further studies, sequencing and analyses are ongoing, but in accordance with the above statement we believe that rapid public sharing of all available information is essential to help to better understand and contain the current mpox emergence.</span></blockquote><br />Although many experts voiced surprise when Mpox clade IIb began spreading internationally in the spring of 2022, we'd seen plenty of warning signs over the years, including in <a href="https://afludiary.blogspot.com/2022/02/plos-ntd-changing-epidemiology-of-human.html"><b>PLoS NTD: The Changing Epidemiology of Human Monkeypox—A potential threat?</b></a>, which had been published just months prior. </div><div><br /></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;">Most were ignored. </div></blockquote><p>While there are no guarantees that Clade I Mpox will follow suit, familiar warning signs are flashing once again. And round two may prove more difficult to contain than round one. </p>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-59527794215977923902024-03-14T07:14:00.002-04:002024-03-14T07:14:49.277-04:00Australian Government: Seabird & Seal Monitoring for HPAI H5 <p></p><p><img src="https://upload.wikimedia.org/wikipedia/commons/thumb/1/11/Central_Asian_Flyway_Map.png/350px-Central_Asian_Flyway_Map.png" /><br /><br /><br />#17,948</p><p><span style="font-family: inherit;">Despite lying beneath both the <b>West Pacific</b> and <b>East Asian–Australasian Flyway -</b> which funnel migratory birds from high latitudes of Alaska and Siberia south, deep into the Southern Hemisphere - Australia, New Zealand and the islands of Oceania have yet to see the arrival of HPAI H5. </span></p><p></p><p style="text-align: left;">Nine years ago, when HPAI H5N8 was winging its way around the world, we looked at <a href="https://afludiary.blogspot.com/2015/10/australia-wild-bird-avian-influenza.html" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"><b>Australia's Wild Bird Avian Influenza Surveillance</b></a>, where their government reported:</p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><span style="color: #2b00fe;">Surveillance continues to show H5N1 avian influenza virus is not present in Australia. <b>Waterfowl, which are the normal hosts of avian influenza</b> and are thought to have had a role in the spread of the H5N1 virus in Europe, Asia and Africa <b>do not migrate to Australia</b>. A number of species of wading birds do migrate to Australia but they are not the normal hosts or spreaders of avian influenza. Australia’s strict quarantine measures prevent the disease coming into Australia through imported birds or poultry products.</span> </blockquote><p style="text-align: left;"><span style="font-family: inherit;">Even though H5N1 emerged in Southeast Asia more than 25 years ago, and has been widely reported across much of the Indonesian archipelago and <b>parts of New Guinea</b>, the virus has never managed to get a foothold in Oceania. </span></p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">This lack of HPAI H5 has often been attributed to the<b> Wallace and Weber lines</b>; imaginary dividing lines used to mark the difference between animal species found in Australia and Papua New Guinea and the rest of Southeast Asia (see 2008 study<b> <a href="https://www.jstor.org/stable/26267978">Will Wallace’s Line Save Australia from Avian Influenza?</a>).</b></p></blockquote><div><div class="separator" style="background-color: #ebedec; clear: both; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; text-align: center;"><a href="https://oceanexplorer.noaa.gov/okeanos/explorations/10index/background/biogeography/media/biogeography_lines.html" style="color: #3f3f7f; margin-left: 1em; margin-right: 1em; text-decoration-line: none;"><img alt="" data-original-height="697" data-original-width="1018" height="274" src="https://blogger.googleusercontent.com/img/a/AVvXsEieIfihkFcuJh11ml2ua4MuNA2vBOMYVZC7d4PAT9EH_tmM8qwTyK-y-K96IrvgWxsaSWBj-ZlPKLWduzoiqFSBrrgn-TZ2PfycEQEJYYBaWsso2PsyHwKPz3GTciadV9_1j19WZKtfUTGDTuID3uIinAZH_itAnybEuPE0t4vViyr5MIc4LFo=w400-h274" style="background: transparent; border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; padding: 8px; position: relative;" width="400" /></a></div>Separated by a relatively narrow strait, on the western side you'll find Elephants, monkeys, leopards, tigers, and water buffalo while on the eastern side, you'll mostly find marsupials (kangaroos, Koalas, wombats, etc.).<br /><br /></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;">These stark faunal differences also extend to birds, reptiles, and even insects.</div></blockquote><div><br />Importantly for avian flu, very few migratory birds appear to cross the Wallace line (see <b><a href="https://www.tandfonline.com/doi/abs/10.1071/MU03026">The Australo-Papuan bird migration system: another consequence of Wallace's Line</a>).</b></div><div><b><br /></b></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">That said, there were <b><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861581/">brief reports</a> </b>in 2007 of <b>H5N1</b> being detected in poultry in both<b> West Papua </b>and the<b> Maluku Islands</b>; both of which lie on the <i><b>Eastern side</b></i> of the Wallace line. Details (and sequences) are limited, since the Indonesian government was notoriously <a href="https://afludiary.blogspot.com/2008/04/leavitt-indonesia-endangering-world-by.html"><b>refusing to share bird flu information</b></a> at the time. </blockquote><p>The arrival of HPAI H5 to Antarctica over the past few months (<i>albeit, thousands of kilometers distant from Oceania - see map below</i>) has the potential to provide the HPAI H5 virus with a different approach - <b>from the south</b> - assuming the virus is able to spread widely in Antarctica's wild birds and mammals. </p><p style="text-align: center;"><a href="https://www.offlu.org/wp-content/uploads/2023/12/OFFLU-wildlife-statement-no.-II.pdf"><img src="https://blogger.googleusercontent.com/img/a/AVvXsEj2kUxTHNpIq89y8_yrGqXwGl0H2CGwmsojbDOnHYesNAsw2-UrXuwXHyRfvacLlAO6WsoWT72yn3SrSrs4gYSOQuJygv1SnL0A1ZdQA3GmcOk9ZctUWZk770zuCzv3SDV_phMfbiRmozLJ3IXOCmSjSefsZBAMCZsIc47eml0Te4lKwPai9w9hwA=w308-h320" style="background: rgb(235, 237, 236); border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; padding: 8px;" /></a><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /></p><p style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; text-align: center;"><a href="https://www.offlu.org/wp-content/uploads/2023/12/OFFLU-wildlife-statement-no.-II.pdf" style="color: #3f3f7f; text-decoration-line: none;"><b>Credit OFFLU</b></a> </p>Last December <a href="https://www.offlu.org/wp-content/uploads/2023/12/OFFLU-wildlife-statement-no.-II.pdf"><b>OFFLU warned:</b></a><div><br /></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><span style="color: #2b00fe;">Given movement data demonstrating connectivity between the polar front to both the Antarctic and Subantarctic islands of Oceania, and Oceania itself, <u>it is plausible </u>that if HPAI H5 were present in the Antarctic region directly south of Oceania, it could be introduced to Oceania.</span></div></blockquote><p>Overnight the <a href="https://www.antarctica.gov.au/">Australian Antarctic Program</a> - a part of the Australian Government's Department of the Environment - published an update on their surveillance program for avian flu, which identified <b>skuas</b> as the biggest threat for bringing the virus into the country.</p>I've only posted some excerpts from a longer report. Follow the link to read it in its entirety. <br /><blockquote><span style="color: #2b00fe;"><b><span style="font-size: large;"><a href="https://www.antarctica.gov.au/news/2024/aad-seabird-expert-in-avian-influenza-monitoring-role/">SEABIRD, SEAL MONITORING CRUCIAL AS AVIAN INFLUENZA REACHES ANTARCTICA</a></span></b><br /><br /><a href="https://www.antarctica.gov.au/">Home</a> > <a href="https://www.antarctica.gov.au/news/">News and media</a> > <a href="https://www.antarctica.gov.au/news/2024/">2024</a> > <br /><br />14 MARCH 2024<br /><br />Monitoring bird and seal colonies in Antarctica has taken on a new urgency with the detection of the highly pathogenic Avian Influenza on the continent for the first time. The Council of National Managers of Antarctic Programs (CONMAP) has confirmed that two dead skuas found near the Argentinian Primavera station on the Antarctic Peninsula tested positive to the virus in late February.<br /><br />There were always fears Avian Influenza would reach Antarctica this season but seabird ecologist Dr Louise Emmerson said it was a shock nonetheless.<br /><br />“It has had a devastating effect in nearby South America,” she said.<br /><br />“Tens of millions of birds have died globally and there is evidence that it also had a dramatic impact on southern elephant seals and fur seals.<br /><br /><b>(SNIP)</b><br /><br /><b><span style="font-size: medium;">Cruise ships adopt new biosecurity measures</span><br /></b><br />Dr Emmerson spent some of the summer monitoring bird colonies for the virus from a cruise ship on the Antarctic Peninsula with a colleague from Oxford University in the UK.<br /><br />Dr Emmerson and her colleague, Dr Tom Hart, would join the expedition team on a zodiac and head out on a scouting trip to a penguin colony.<br /><br />They would visually scout for signs of the disease and go ashore first, to conduct drone surveys of the penguin colonies and check the site was clear for passengers.<br /><br />At the time, there were no signs of the mass deaths or neurological symptoms characteristic of the disease, but biosecurity measures on cruise ships had been ramped up in response to the risk.<br /><br />“Before passengers came down to get on a small boat to visit a penguin colony they’d take their hiking boots and poles and their backpacks and camera bags – anything they were going to take into the field, and they’d disinfect them.<br /><br />“The cruise ship provided rubber boots for everyone to walk in, and an outer layer with a hood and walking poles for people to use so we could make sure everything was clean.<br /><br />“Then when we got back, everyone would scrub their boots and poles and make sure everything that had touched the ground was disinfected.<br /><br />“This year, we didn’t allow people to sit on the ground or put their packs on the ground. But the passengers were great about it, they took the risk to the wildlife and themselves very seriously.”<br /></span></blockquote><blockquote><span style="color: #2b00fe;"><b><i><span style="font-size: medium;">"The species we were always most worried about was skuas"</span></i></b><br /><br />Some colonies along the Peninsula had been closed to visitors while suspect deaths were investigated but none were confirmed as Avian Influenza.<br /><br />However by then, the virus was confirmed on South Georgia and the Falkland Islands.<br /><br />“The species we were always most worried about was skuas <b>because they’re scavengers and they undertake considerable winter migrations</b>. For example, the<b> skuas from East Antarctica fly all the way up to Japan, Korea and China so the chance of them being exposed to the disease was always greater</b>. Penguins that breed in Antarctica don’t go very far north in winter so if they get it, it will be from other wildlife, including the northerly migrating seabirds, or humans.”<br /><br /><b><span style="font-size: medium;">Camera network vital for monitoring</span></b><br /><br />As part of the summer monitoring project, Dr Emmerson and Dr Hart also maintained and downloaded data from Dr Hart’s camera network, set up along the Antarctic Peninsula to monitor nesting sites.<br /><br />The network is based on an idea pioneered in Hobart by Australian Antarctic Division engineers in the early 2000s. <br /><br />The AAD’s network has about 44 cameras set up at key locations along the East Antarctic coastline, taking ten photos a day of about 30 to 40 nests per camera.<br /><br />Species monitored include surface nesters like Adelie penguins, cape petrels, fulmars, southern giant petrels and emperor penguins.<br /><br />“The cameras are on tripods and they’re very robust,” Dr Emmerson said.<br /><br />“We can use the images to monitor when the birds arrive and leave, the timing of chick creche and their breeding success.<br /><br /><b>(SNIP)</b><br /></span></blockquote><blockquote><span style="color: #2b00fe;">The AAD will also revisit its bird flu management protocols.<br /><br />“We need to make sure all our expeditioners know what their responsibilities are and where the disinfectant is and what to do if there are signs of the virus,” Dr Emmerson said.<br /><br />“We can’t stop it spreading through the natural migratory process, but we can stop ourselves moving it around and that’s what we need to focus on.”</span></blockquote><p>While the arrival of HPAI H5 to Oceania is far from assured, should it happen, the virus would gain access to a number of new avian and mammalian species <i>(including marsupials)</i>, along with a fresh array of genetically distinct LPAI viruses which which to potentially reassort.</p><p>Whether that would ultimately help the virus is unknown, but it is an unsupervised field experiment that is best avoided if possible. </p><p><br /></p>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-30264102018451837012024-03-13T06:25:00.000-04:002024-03-13T06:25:01.136-04:00WHO: Influenza At the Human-Animal Interface Summary and Risk Assessment (Feb 26th)<p><img height="133" src="https://blogger.googleusercontent.com/img/a/AVvXsEjUNfcEG_Adq3532QWAxulq3NKkrcSt1AJ-kq9FHZJKL1tv4sAclTs5XVPitQ_Lo0y3Qpc-xTEBEKHJW470XQrP7vS1caAdAJ5gyx9Zb2hj9jBaRH7WlGSVPH7K_W4l0RIH36__6sx1j9I5gDiBTbx2tOgT4A78aqlOQ7dQ00sA3j2PA7WzN4Jvag=w400-h133" width="400" /></p><p>#17,947</p><p>Every couple of months the World Health Organization publishes their latest<i> Influenza at the Human-Animal Interface</i> report, which summarizes recently reported zoonotic flu infections from around the world. </p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">Most of these cases have been previously reported, although additional details may be provided. </p></blockquote><p style="text-align: left;">Yesterday's update covers the period from <b>December 22nd 2023 to February 26th, 2024</b>, and it includes <b>11 novel flu infections</b>, <b>10 </b>of which were officially reported to WHO and a <b>11th</b>, <a href="https://www.chp.gov.hk/en/guideline/107744.html"><b>announced yesterday</b></a> by Hong's CHP (<i>see graphic above</i>), that was <i>conveyed</i> to WHO unofficially by researchers. </p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">With each subtype reported, the WHO provides an updated <b>risk assessment</b>, and the report contains the standard pleas for countries to <b>abide by the IHR rules and report all cases immediately. </b></p></blockquote><p>Due to its length, I've only posted some excerpts. Follow the link to read it in its entirety. I'll have a brief postscript after the break.</p><p></p><blockquote><p><b><span style="color: #2b00fe; font-size: large;"><a href="https://cdn.who.int/media/docs/default-source/influenza/human-animal-interface-risk-assessments/influenza_summary_ira_ha_interface_feb_2024.pdf?sfvrsn=9a552ade_2&download=true">Influenza at the human-animal interfaceSummary and risk assessment, from 22 December 2023 to 26 February 2024</a></span></b></p><p><span style="color: #2b00fe;"><b>New infections </b>: From <b>22 December 2023 to 26 February 2024,</b> <b>five human cases of infection
with influenza A(H5N1)</b> viruses, <b>one human case of infection with an A(H5N6</b>) influenza virus,
<b>one human infection with an A(H9N2) virus</b>, one human case of <b>infection with an A(H10N5)
virus</b>, and <b>two human cases of infection with influenza A(H1N1) variant viruses were reported
officially</b>. Additionally, <b>one human case of infection with an influenza A(H9N2) variant virus was
detected. </b></span></p><p><span style="color: #2b00fe;"><b>• Risk assessment: </b>The overall public health risk from currently known influenza viruses at the
human-animal interface has not changed, and sustained human-to-human transmission of the
viruses from these cases is currently considered unlikely. Although human infections with viruses
of animal origin are unusual, they are not unexpected at the human-animal interface wherever
these viruses circulate in animals. </span></p><p><span style="color: #2b00fe;"><b>• Risk management:</b> New candidate vaccine viruses (CVVs) for zoonotic influenza viruses for
pandemic preparedness purposes were selected through a recent WHO consultation.3 </span></p><p><span style="color: #2b00fe;"><b>• IHR compliance:</b> All human <b>infections caused by a new influenza subtype are required to be
reported under the International Health Regulations </b>(IHR, 2005).2F
4 This includes any influenza A
virus that has demonstrated the capacity to infect a human and its haemagglutinin gene (or
protein) is not a mutated form of those, i.e. A(H1) or A(H3), circulating widely in the human
population. Information from these notifications is critical to inform risk assessments for
influenza at the human-animal interface. </span></p></blockquote><p><br />After an absence of 9 years, in early 2023 Cambodia reported the first of 6 H5N1 cases (clade 2.3.3.1c) in 2023, which was followed in January and February of 2024 with 5 more cases (see chart below).</p><p></p><div class="separator" style="clear: both;"><blockquote><div style="text-align: center;"><a href="https://cdn.who.int/media/docs/default-source/influenza/human-animal-interface-risk-assessments/influenza_summary_ira_ha_interface_feb_2024.pdf?sfvrsn=9a552ade_2&download=true" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="633" data-original-width="775" height="327" src="https://blogger.googleusercontent.com/img/a/AVvXsEjK4ATRl7DVhwqnkY0kCr2hJLCuRY4kRqyKtvlHi18VKyz7BzrXADo52tfeNi_i6YrOnaRcr3h2kHO2oPk67SR8Skj9XOlBY_W532hxaWVoamDM8uKUB9BQH_2MmB_SjDPDHwGJDZiwaAsxsFLL9fGz3TdTCWBo2vWsI-Z3W6ocznEvAlv6BERohw=w400-h327" width="400" /></a></div><span style="color: #2b00fe;"><br />Avian influenza A(H5) viruses A(H5N1), Cambodia Since the last risk assessment of 21 December 2023, five human cases of infection with A(H5N1) influenza viruses were notified to WHO from Cambodia (see Table 1).<br /><br />The A(H5N1) viruses from the first four cases belong to the H5 haemagglutinin (HA) clade 2.3.2.1c. Viruses belonging to this clade have been detected in poultry since 2014 in Cambodia in longitudinal surveillance done in the animal health sector. Clade information on the virus from the last case reported in Kampot province has not yet been determined.</span></blockquote><blockquote><span style="color: #2b00fe;">Based on the phylogenetic patterns, <b>the third and fourth cases were likely exposed to the same source, although the possibility of human-tohuman transmission cannot be excluded.</b> No further cases or evidence of sustained human-to human transmission were reported.</span></blockquote></div><p></p><p>Additionally, China reported 1 case of H5N6 during this reporting period. The onset of this patient's illness was in late <b>November of 2023</b>, but the case was not reported by China until early 2024. </p><blockquote>S<span style="color: #2b00fe;">ince the risk assessment of 21 December 2023, <b>one human case of infection with an A(H5N6) </b>influenza virus was notified to WHO from China on 3 January 2024. <b>A 59-year-old woman, with underlying comorbidities, from Sichuan province</b> developed illness on 25 November 2023 and was hospitalized with severe pneumonia on <b>29 November. </b>As of 9 January 2024, she was improving. She had exposure to a live poultry market. Environment samples from the market tested positive for influenza A(H5). No further cases were detected among her contacts. </span></blockquote><blockquote><span style="color: #2b00fe;">According to reports received by the World Organisation for Animal Health (WOAH), various influenza A(H5) subtypes continue to be detected in wild and domestic birds in Africa, Asia, Europe and the Americas. Infections in non-human mammals are also reported.</span><br /><p></p></blockquote><p> China also reported 2 H9N2 cases (albeit 1 through unofficial channels).</p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><span style="color: #2b00fe;"><b>A(H9N2), </b></span><span style="color: #2b00fe;">China Since the last risk assessment of 21 December 2023,</span><b style="color: #2b00fe;"> two human cases of infection with A(H9N2) influenza viruses were notified to WHO from China</b><span style="color: #2b00fe;">. On 22 February 2024, the International Health Regulations (IHR) Contact Point of Hong Kong SAR, China notified WHO of one human infection with avian influenza A(H9N2). A two-year-old girl had an onset of influenza-like illness (ILI) symptoms on 15 February 2024. She went to hospital on 16 February where a sample was collected, and she was not hospitalized at that time. She was admitted to the isolation ward of a public hospital and was in in stable condition at the time of reporting. According to the initial investigation, the patient visited Guangdong province during the incubation period. The patient has no known poultry exposure or consumption of undercooked poultry. </span><b style="color: #2b00fe;">One of her home contacts developed a sore throat on 17 February, but the symptoms subsided, and the contact was not sampled.</b><span style="color: #2b00fe;"> Other home contacts remain asymptomatic. The epidemiological investigations are ongoing.</span></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><span style="color: #2b00fe;"><br />Additionally, one human case of infection with an influenza A(H9N2) virus was detected in China according to information received during the WHO Consultation and Information Meeting on the Composition of Influenza Virus Vaccines for Use in the 2024-2025 Northern Hemisphere Influenza Season held in February 2024. 3 <b>A six-year-old boy from Anhui province developed illness on 3 January 2024. </b>Avian influenza A(H9N2) viruses are enzootic in poultry in Asia and increasingly reported in poultry in Africa.</span></blockquote><div><br /></div>Next, a case that raised a lot of eyebrows when it was announced in late January (see<b> <a href="https://afludiary.blogspot.com/2024/01/china-nhc-statement-fatal-case-of-h3n2.html">China NHC Statement: A Fatal Case of H3N2 and H10N5 Mixed Infection Discovered in Zhejiang Province</a></b>). While we've seen other H10 infections (see <a href="https://afludiary.blogspot.com/2021/06/china-nhc-reports-1st-human-h10n3-avian.html"><b>here</b></a>, <b><a href="https://afludiary.blogspot.com/2014/02/jiangxi-province-reports-3rd-h10n8-case.html">here</a></b>, and <b><a href="https://afludiary.blogspot.com/2023/11/jiagenetic-and-biological-properties-of.html">here</a></b>), this was the first recorded H10N5 infection in a human. <div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><b><span style="color: #2b00fe;">Avian influenza A(H10N5) viruses </span></b></div><div><b><span style="color: #2b00fe;"> </span></b></div><div><span style="color: #2b00fe;"> Since the last risk assessment on 21 December 2023, one human case of infection with an influenza
A(H10N5) virus was reported from China. A<b> 63-year-old female, with chronic comorbidities, from
Anhui province developed fever, a cough and sore throat on 30 November 2023</b>. She was admitted
to hospital on 2 December, was transferred to a medical institution in Zhejiang province on 7
December and passed away on 16 December. </span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">Zhejiang Province health officials isolated <b>seasonal
influenza A(H3N2) subtype and avian influenza A(H10N5) subtype viruses from the patient’s samples
on 22 January</b> after nucleic acid testing, viral culture and gene sequencing conducted by local health
care facilities.
The patient had exposure to live poultry through the purchase of a duck on 26 November. From the
<b>duck meat stored in the fridge, seven samples tested positive for influenza A(H10N5), and two
samples were positive for N5 (no result for haemagglutinin).</b></span></div><br /></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><span style="color: #2b00fe;">The agricultural authority has
conducted culling and hazard management of the ducks which tested positive for A(H10N5) in a
traceback investigation and has carried out disinfection of affected areas. The patient had no contact
with pigs or other mammals. Environmental samples collected from her home tested negative for
influenza viruses. Monitoring of close contacts did not identify any further cases.
<b>This is the first case of human A(H10N5) infection detected in China and globally</b></span></div></blockquote><p>And lastly, reports on two swine variant H1N1v infections. One in Brazil, and the other in Spain.</p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p><span style="color: #2b00fe; font-family: inherit;">Since the risk assessment of 21 December 2023, one human infection with an influenza A(H1N1)
variant virus [A(H1N1)v] was reported from Brazil and one was reported from Spain. </span></p></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><b><span style="color: #2b00fe; font-family: inherit;">A(H1N1)v, Brazil</span></b></blockquote><span style="color: #2b00fe; font-family: inherit;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe; font-family: inherit;"> On 16 January 2024, Brazil notified WHO of a laboratory-confirmed human infection with swine-origin influenza A(H1N1)v virus, in the State of Paraná. The patient, an adult male who had underlying medical conditions, developed ILI symptoms on 12 December 2023 and was hospitalized on 16 December. He had no history of exposure to pigs. He did not receive antiviral treatment but fully recovered on 18 December, when he was discharged from the hospital. From the epidemiological investigation, no close contacts were identified</span><div style="text-align: left;"><span style="color: #2b00fe; font-family: inherit;"> </span></div></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><span style="color: #2b00fe; font-family: inherit;"><b>A(H1N1)v, Spain</b></span></div><span style="font-family: inherit;"><br /></span></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><span style="color: #2b00fe; font-family: inherit;">On 29 January 2024, the Spanish health authorities notified WHO of a laboratory confirmed human case of infection with swine-origin influenza A(H1N1)v virus, in the province of Lleida (Cataluña autonomous community). An adult male adult male, who worked on a pig farm in the province of Lleida, developed ILI symptoms on 25 November 2023. He sought medical care at an outpatient clinic on 29 November and was seen again twice in December 2023, where he was diagnosed with bronchitis. He did not receive antiviral treatment and has completely recovered. </span></div></blockquote><div style="text-align: left;"><br /><br />As always, surveillance and timely reporting of cases remains a challenge. Whether deliberately, or due to a lack of resources, many countries still fail to meet their obligations to report novel flu infections in a timely manner.</div><div style="text-align: left;"><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">L<span style="font-family: inherit;">ast April, in <b><a href="https://afludiary.blogspot.com/2023/04/lancet-preprint-national-surveillance.html">Lancet Preprint: National Surveillance for Novel Diseases - A Systematic Analysis of 195 Countries</a>,</b> we looked at an independent analysis which suggests that many nations have substantially <i>overstated </i>their compliance with the <a href="https://afludiary.blogspot.com/2015/10/adding-accountability-to-ihr.html"><b>2005 IHR regulations</b></a>, and that surveillance and reporting are far less robust than advertised.</span></blockquote><p>And in far too many countries,<i> `Don't test, don't tell' </i> has - for political, economic, and societal reasons - become unofficial policy. Even when disease reports are provided, they sometimes come weeks or months after the fact, and are often lacking in detail.</p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">But even in countries that are actively looking, it is likely that only a small fraction of cases are ever identified. </p></blockquote><p>A year ago, in <a href="https://afludiary.blogspot.com/2023/03/uk-novel-flu-surveillance-quantifying.html" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"><b>UK Novel Flu Surveillance: Quantifying TTD</b></a>, we looked at concerns that the <b>TTD</b> (<i>Time to Detect</i>) community spread of a novel virus - even in the UK - could be weeks, and then only after hundreds of cases. </p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">A reminder than anything we say about the current threat posed by H5N1, H3N8, MERS-CoV, or any other pandemic threat must carry an implied asterisk. </blockquote><br />A disclaimer that says, ` <span style="color: #660000;"><i>* based on available, and likely incomplete, information. . . '.</i></span>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-91509070966309210532024-03-12T08:45:00.002-04:002024-03-12T08:45:57.526-04:00EID Journal: Divergent Pathogenesis and Transmission of Highly Pathogenic Avian Influenza A(H5N1) in Swine<div class="separator"><p style="clear: left; float: left; margin-bottom: 1em; margin-left: 1em; text-align: center;"><img border="0" data-original-height="262" data-original-width="319" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLHi-rqQ9yhV8BfCVZejXZFMxSer9ZRU7WH1tK044abG2CM92EaWAbH5-GbiiRndqRaBg3g6GBoM42G7NCCXsw0-RSxQO1EEIAOUlL-q7rzNnY5zYsE1pjQIVthef-LD9ZTWR0Qw/s1600/Jump+Species.png" style="background: rgb(235, 237, 236); border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; color: #007f7f; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; padding: 8px; position: relative;" /><span face="Verdana, Arial, Helvetica, sans-serif"><span style="font-size: 14px;"> </span></span></p></div><br /><br /><br /><br /><br /><br /><br /><br /><br /><p><br /><br /><br /><br /><br /><br /><br /><br />#17,946</p><p>While we've been watching HPAI H5 for more than two decades, the biggest -<i> and as yet, unanswered</i> - question is: <i><span style="color: #660000;">what it would take to change H5Nx from primarily an avian disease to a pandemic threat? </span></i></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p style="text-align: left;">Some are comforted by the fact that after > 20 years, millions of rolls of the genetic dice, and roughly 1,000 confirmed human infections (combined H5N1,H5N8,H5N6), the virus has failed to get a foothold in humans. </p></blockquote><p style="text-align: left;">But over the past 3 years we've seen HPAI H5 make huge gains both in terms of susceptible (<i>avian and mammalian</i>) hosts, and geographic expansion. Tens of thousands of marine mammals have died from the virus, along with (<i>largely uncounted)</i> numbers of terrestrial mammals.</p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p style="text-align: left;">As we discussed yesterday, in <a href="https://afludiary.blogspot.com/2024/03/travel-med-inf-dis-pacific-and-atlantic.html"><b>Pacific and Atlantic Sea Lion Mortality Caused by HPAI A(H5N1) in South America</b></a>, while unproven, some scientists believe <i>limited</i> mammal-to-mammal transmission may be happening.</p></blockquote><p style="text-align: left;">While there are limited opportunities for infected marine mammals to spread the virus to humans, we've known for years that pigs are somewhat susceptible to HPAI H5 infection (see 2018's <b><a href="https://afludiary.blogspot.com/2018/04/sci-rpts-evidence-of-h5n1-exposure-in.html">Sci. Rpts.: Evidence Of H5N1 Exposure In Domestic Pigs - Nigeria</a>)</b>, raising concerns they could become <i>`mixing vessels</i>' for the next pandemic virus.</p><div style="text-align: center;"><img src="https://blogger.googleusercontent.com/img/a/AVvXsEiq9B67OTMh9Uavj0oA-u2eosrHnGaTpiUoaG9KRX8C2Pl7HE6qNZl9Zx-kIbuNa7l3urt2wo-cGr691lpW31OIEUW-xpQaStVZh4GP84aAAHdqjtI4E2DHvFDMDzfjgs0zgYTY0RioKtNOOkVXibMQLmih3oTCGW8sh3_kPKOfv0pkdZlc3FU" /></div><div><br /></div> A year ago, the <a href="https://afludiary.blogspot.com/2023/03/ecdcefsa-avian-influenza-overview.html"><b>ECDC/EFSA Avian Influenza Overview December 2022 – March 2023</b></a> warned:<div><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><span style="color: #2b00fe;">The additional reports of <b>transmission events to and potentially between mammals, e.g. mink, sea lion, seals, foxes and other carnivores</b> as well as seroepidemiological evidence of transmission to <b>wild boar and domestic pigs</b>, associated with evolutionary processes including mammalian adaptation are of concern and need to be closely followed up.</span><br /><br /></blockquote>And last May, in <a href="https://afludiary.blogspot.com/2023/05/netherlands-zoonoses-experts-council-db.html"><b>Netherlands: Zoonoses Experts Council (DB-Z) Risk Assessment & Warning of Swine As `Mixing Vessels' For Avian Flu</b></a>, we looked at similar concerns that avian <b>H5Nx</b> could increase its pandemic threat by spreading (<i>and evolving</i>) in farmed swine.</div><div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">While we've seen scattered reports of H5N1 in swine (see <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2004_08_20-en"><b>here</b></a>, <a href="https://afludiary.blogspot.com/2010/08/eid-journal-asymptomatic-h5n1-in-pigs.html"><b>here</b></a>, and <b><a href="https://afludiary.blogspot.com/2016/10/indonesian-media-unusual-report-of-h5n1.html">here</a></b>), between extremely limited testing, and the fact that H5N1 tends to be<b> <a href="https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1000102">asymptomatic (or mildly symptomatic) in pigs</a></b>, it is probably more common than we realize.</blockquote><p>Complicating matters, H5N1 is not a single virus, it encompasses a large (<i>and growing</i>) array of similar viruses, which have evolved into <b>numerous clades </b>and <b>subclades,</b> and literally<b> scores</b> of genotypes. Those (<i>and other small</i>) genetic variations can produce vastly different characteristics (see <a href="https://afludiary.blogspot.com/2012/04/differences-in-virulence-between.html"><b>Differences In Virulence Between Closely Related H5N1 Strains</b></a>).</p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;"><i><span style="color: #990000;">In other words, if you randomly selected a handful of wild H5N1 viruses, you'd find some were <b>more pathogenic</b>, <b>more transmissible</b>, or <b>better adapted to mammals </b>than others. </span></i></p></blockquote><p>In their December<a href="https://www.ecdc.europa.eu/sites/default/files/documents/AI-Report-XXVII.pdf"> <b>2023 EFSA Avian flu report </b></a>for Europe, European authorities reported<b style="font-style: italic;"> eleven different
genotypes, seven of which were new </b>in the previous 3 months. This constant creation and swapping out of genotypes continues - w<i>ith great variety</i> - around the world. </p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">All of which brings us to a new study, published yesterday in the CDC's EID Journal, which looks at the pathogenesis and transmissibility of <b>4 North American H5N1 viruses</b> (<i>2 with known mammalian adaptations</i>) in swine. </p></blockquote><p>Due to its length and technical nature, I've only posted the abstract and some excerpts. The takeaway is that swine were <b>susceptible to all 4 viruses</b>, but only those with a known mammalian adaptation (<b>PB2 E627K</b>), <b>replicated efficiently in the nasal cavity,</b> and was<b> transmissible</b>. <br /><br />Follow the link to read the report in its entirety. I'll have a postscript after the break.</p><p><span style="font-family: inherit;"><b></b></span></p><blockquote><p><span style="color: #2b00fe; font-family: inherit;"><span style="font-size: large;"><b><a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article">Divergent Pathogenesis and Transmission of Highly Pathogenic Avian Influenza A(H5N1) in Swine</a></b><br /></span><br />Bailey Arruda<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#comment"><img border="0" src="https://wwwnc.cdc.gov/eid/content/images/icon/email.gif" /></a> , Amy L. Vincent Baker, Alexandra Buckley, Tavis K. Anderson, Mia Torchetti, Nichole Hines Bergeson, Mary Lea Killian, and Kristina Lantz<br /><br /><b>Abstract</b><br /><br />Highly pathogenic avian influenza (<b>HPAI) viruses </b>have<b> potential to cross species barriers and cause pandemics. </b>Since 2022, HPAI A(H5N1) belonging to the goose/Guangdong 2.3.4.4b hemagglutinin phylogenetic clade have infected poultry, wild birds, and mammals across North America. Continued circulation in birds and infection of multiple mammalian species with strains possessing adaptation mutations increase the risk for infection and subsequent reassortment with influenza A viruses endemic in swine. <b>We assessed the susceptibility of swine to avian and mammalian HPAI H5N1 clade 2.3.4.4b strains using a pathogenesis and transmission model</b>. </span></p><p><span style="color: #2b00fe; font-family: inherit;"><b>All strains replicated in the lung of pigs and caused lesions consistent with influenza A infection</b>. However, <b>viral replication in the nasal cavity and transmission was only observed with mammalian isolates. Mammalian adaptation and reassortment may increase the risk for incursion and transmission of HPAI viruses in feral, backyard, or commercial swine.</b></span></p><p><span style="color: #2b00fe;"><span style="font-family: inherit;"><b>(SNIP)</b></span></span></p><p><span style="color: #2b00fe; font-family: inherit;">If an avian IAV strain, such as H5Nx 2.3.4.4b, successfully infected domestic swine, pig-to-pig transmission, reassortment with endemic swine IAV, or acquisition of adaptive mutations that might enable an avian-to-mammalian switch could potentially occur (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#r1">1</a>). Continued circulation in the wild bird population and peridomestic wild mammal infections elevate the risk for exposure of swine because of the current outbreak’s wide distribution in states with large pig populations. </span></p><p><span style="color: #2b00fe; font-family: inherit;">To address concerns over susceptibility of swine to HPAI H5N1 clade 2.3.4.4b virus detected in the United States and to elucidate potential molecular mutations associated with H5N1 replication and transmission in swine, <b>we conducted a study with 4 strains representing 3 different genotypes in a pig pathogenesis and transmission model. </b>This information is key to building awareness and detection capabilities in the swine sector, as well as to informing risk assessments and early warning systems to safeguard human health.</span></p><p><span style="color: #2b00fe; font-family: inherit;"><b>(SNIP)</b></span></p><p><span style="color: #2b00fe;"><b>DISCUSSION</b></span></p><span style="color: #2b00fe;">We conducted a pathogenesis and transmission study to understand the susceptibility of swine to 3 genotypes of HPAI H5N1 belonging to the goose/Guangdong 2.3.4.4b HA phylogenetic clade detected within the United States. Our data demonstrated that pigs are susceptible to infection.<b> All 4 HPAI isolates that were evaluated replicated in the lungs of pigs.</b> In comparison to an H1N1 swine-adapted virus, the qRT-PCR Ct values in BALF of the 4 HPAI strains were lower (≈3–8 Ct), except for the A/bald eagle/FL/22 (genotype B1.1) 5 dpi group (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141-app1.pdf">Appendix 1</a> Table 3) (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#r24">24</a>). </span><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;"><b>Replication in the nasal cavity and transmission occurred only in the A/raccoon/WA/22 (genotype B2.1) and A/redfox/MI/22 (genotype B3.2) groups containing the mammalian adaptation mutation E627K in the PB2 gene.</b><br /><br /><b>(SNIP)</b><br /><br /><b>Interspecies spillovers commonly result in dead-end infections </b>because the virus <b>likely requires multiple transmission events to acquire the necessary adaptive mutations </b>(<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#r40">40</a>). The probability of a virus acquiring a complete set of adaptive mutations in a single immunocompetent host with onward transmission is <b>extremely low </b>(<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#r34">34</a>). However, continued circulation of HPAI strains that have already adapted within various mammalian species makes that possibility more likely (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#r1">1</a>,<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#r34">34</a>). </span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">On-farm transmission among pigs in Indonesia of an HPAI H5N1 and identification of a purified clone with the ability to recognize α2,6 sialic acid receptors were reported (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#r3">3</a>). <b>More recently, serologic evidence of infection of domestic pigs with clade 2.3.4.4b was reported </b>(<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#r41">41</a>). In addition, because reassortment occurred with the past 4 influenza pandemics, the propensity for reassortment in swine may increase the risk for H5N1 adaptation toward humans, particularly with the maintenance of 2009 pandemic H1N1 human seasonal virus genes in pigs (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#r42">42</a>). Although infrequent, incursion of LPAI into commercial swine herds in North America occurs periodically, yet the sources of incursion often remain unknown (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#r43">43</a>–<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#r45">45</a>). Increased viral fitness characterized by transmission of LPAI strains after reassortment with swine-adapted IAV in pigs was demonstrated both in commercial swine herds and experimentally (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#r43">43</a>,<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#r46">46</a>).<br /><br /><b>The genetic attributes that resulted in the continued circulation of the HPAI H5N1 2.3.4.4b lineage are not well understood.</b> Repeated spillover and spillback events resulted in genotypically and phenotypically diverse reassortant viruses, some of which caused neurologic disease in mammals, a manifestation not observed in pigs (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#r47">47</a>). However, detection of NP antigen in endothelial cells of pigs infected with A/bald eagle/FL/22 suggests this strain might spread systemically.<br /><br /><b>The risk for reassortment of the HPAI H5N1 2.3.4.4b lineage with endemic swine IAV is a consideration </b>on the basis of the susceptibility to this lineage demonstrated in our study, the prevalence of IAV infection and comorbidities in swine herds, and animal husbandry practices (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#r48">48</a>,<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1141_article#r49">49</a>). However,<b> the risk for incursion is likely lower in confinement operations with industry standard biosecurity than for backyard or feral pigs.</b></span></div></blockquote><blockquote><div><span style="color: #2b00fe;"><b>Birdproofing feed and facilities, avoiding the use of untreated water, and restricting peridomestic scavenger mammals from premises</b> are measures to increase biosecurity against HPAI H5N1 clade 2.3.4.4b virus incursion into swine herds.</span></div></blockquote><p><br /></p><p>While swine - due to their susceptibility to influenza, huge numbers, and general lack of surveillance - are a legitimate concern, they aren't the only species where H5N1 might hit the genetic jackpot. <a href="https://afludiary.blogspot.com/2023/07/cdc-new-irat-risk-assessment-on-mink.html"><b>Mink and fur farms have been hit hard by avian flu</b></a>, and have produced worrisome mammalian adaptions as well. </p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEi1tPqupTzh2HuGvYVNoFOxQ9a72c-2NapnoGDOkZ1tRfb6nYPPBHjLQeAhss2e0NdH6FAbRar0L83fAAgVT7yr-u3hxNepEZ8XwP1CSp06uJeAgSuF-E6raaUA1KFhfZplU3bzGRu5vESDxp0yB1L2aEJ7h3VnXXLjDk8sxIsB-eqKLXdH1vhc3w" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="264" data-original-width="400" height="211" src="https://blogger.googleusercontent.com/img/a/AVvXsEi1tPqupTzh2HuGvYVNoFOxQ9a72c-2NapnoGDOkZ1tRfb6nYPPBHjLQeAhss2e0NdH6FAbRar0L83fAAgVT7yr-u3hxNepEZ8XwP1CSp06uJeAgSuF-E6raaUA1KFhfZplU3bzGRu5vESDxp0yB1L2aEJ7h3VnXXLjDk8sxIsB-eqKLXdH1vhc3w" width="320" /></a></div><p></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">Last summer, in <b><a href="https://afludiary.blogspot.com/2023/07/pnas-mink-farming-poses-risks-for.html">PNAS: Mink Farming Poses Risks for Future Viral Pandemics</a>,</b> we looked at an excellent opinion piece penned by two well known virologists from the UK (<b><a href="https://www.imperial.ac.uk/people/w.barclay">Professor Wendy Barclay</a> & <a href="https://twitter.com/PeacockFlu">Tom Peacock</a></b>) on why fur farms - and mink farms in particular - are high risk venues for flu.</blockquote><div><br /></div><div>It is obviously not easy for a novel (<i>avian or swine</i>) influenza virus to adapt well enough to humans to spark a pandemic. And if H5N1 clade 2.3.4.4b were the only virus out there of concern, we might reasonably expect to go years or even decades before anything bad happens. </div><div><br /></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;">But H5N1 is just one of many novel flu viruses with zoonotic potential circulating in the wild. And all of them - to one degree or another - are going through similar evolutionary paths. </div></blockquote><div><br /></div><div>And it only takes of them to get lucky to send the world down the pandemic path again. </div>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-91475146388674813832024-03-12T06:11:00.000-04:002024-03-12T06:11:37.277-04:00HPAI Confirmed In Penguin Populations On South Georgia<img src="https://blogger.googleusercontent.com/img/a/AVvXsEj2kUxTHNpIq89y8_yrGqXwGl0H2CGwmsojbDOnHYesNAsw2-UrXuwXHyRfvacLlAO6WsoWT72yn3SrSrs4gYSOQuJygv1SnL0A1ZdQA3GmcOk9ZctUWZk770zuCzv3SDV_phMfbiRmozLJ3IXOCmSjSefsZBAMCZsIc47eml0Te4lKwPai9w9hwA=w308-h320" style="background: rgb(235, 237, 236); border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; padding: 8px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><p><a href="https://www.offlu.org/wp-content/uploads/2023/12/OFFLU-wildlife-statement-no.-II.pdf" style="background-color: #ebedec; color: #3f3f7f; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; text-decoration-line: none;"><b>Credit OFFLU</b></a> </p><p>#17,945</p><p><span style="font-family: inherit;">Seven months ago, we looked at the <a href="https://afludiary.blogspot.com/2023/08/offlu-statement-on-southbound-expansion.html"><b>FAO/WOAH OFFLU Network's 14-page statemen</b>t</a> on the impacts, and challenges of HPAI facing South America, and the <i><b>strong likelihood that avian flu would soon arrive in the Antarctic region</b></i>. </span></p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;"><span style="font-family: inherit;">Two months later (Oct. 2023) <a href="https://afludiary.blogspot.com/2023/10/sgssi-statement-hpai-confirmed-in-brown.html"><b>we learned</b></a> of the <b>first confirmed HPAI H5 infection in a bird </b>in the sub-Antarctica region from the <b><a href="https://www.facebook.com/GovSGSSI?__cft__[0]=AZULDBtlVnaC29KOfF4wwM3YeBiROrdsyXCoTW2CRZiJet3zy20mhf7muq828l0Iaqh7itUawCk_uXqAcUTVBNlYy732HUcO2LFrSh5ejoykhn928XdcvFjPCxUum2lJf39t0zDpDW9Nr-LXCi7HIepArYdEF0JEo4iHUFQwV4HWQ5Br5pLz4nmjeDsqO9WqAEg&__tn__=-UC%2CP-R">Government of South Georgia & the South Sandwich Islands</a>' (SGSSI)</b> twitter/X account.</span></p></blockquote><p><span style="font-family: inherit;">In mid-January, in <a href="https://afludiary.blogspot.com/2024/01/sgssi-statement-hpai-confirmed-in.html" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"><b>SGSSI Statement: HPAI Confirmed in Mammals in Sub-Antarctica For The First Time</b></a>, we learned the virus had been detected in<b> elephant and fur seals</b> on the sub-Antarctic island of South Georgia.</span></p><p><span style="font-family: inherit;">And just two weeks ago (see <a href="https://www.cidrap.umn.edu/avian-influenza-bird-flu/avian-flu-reaches-antarcticas-mainland"><b>CIDRAP report</b></a>), HPAI was confirmed on Antarctica's mainland; recovered from dead skuas which were found by Argentine scientists near the “Primavera” Antarctic base. </span></p><p><span style="font-family: inherit;">Overnight SGSSI website published the following update, confirming the discovery of HPAI in two colonies of penguins (gentoo & king) on South Georgia. </span></p><blockquote><span style="color: #2b00fe;"><b><span style="font-size: large;"><a href="https://gov.gs/hpai-confirmed-in-penguin-populations-on-south-georgia/">HPAI Confirmed In Penguin Populations On South Georgia</a></span></b><br /><br /> March 11, 2024<br /><br />Highly Pathogenic Avian Influenza (HPAI) was first detected in the brown skua population on Bird Island, South Georgia in October 2023. <br /><br />Since then, <a href="https://www.bas.ac.uk/"><b>British Antarctic Survey</b></a> (BAS) scientists and Government of South Georgia & the South Sandwich Islands (GSGSSI) personnel have undertaken monitoring across the Territory. The teams have been closely supported by the UK <b><a href="https://www.gov.uk/government/organisations/animal-and-plant-health-agency">Animal and Plant Health Agency</a> </b>(APHA) via testing at their laboratories in Weybridge.<br /><br />HPAI has now been confirmed from 23 sites across South Georgia. Species which have historically tested positive for HPAI H5N1 include: brown skua, kelp gul, wandering albatross, elephant seal and Antarctic fur seal. <br /><br />The most recent results from<b> samples taken in early February have confirmed the presence of the disease in one colony of gentoo penguins and one colony of king penguins on South Georgia. <br /></b><br />Whilst the virus has been detected at a range of sites and in several species, the effects appear to be localised. GSGSSI will continue to work with partner agencies to monitor the impact of the disease on wildlife in the Territories.<br /><br />Genomic sequencing surveillance data analysed to-date has confirmed previous assessments that there is no increased risk to human health. <b>The risk of human infection with H5N1 remains very low.</b><br /><br />Guidance for those visiting the Territory is available in the Biosecurity Handbook. As part of the response to HPAI, some sites on South Georgia are closed to visitors. At other sites, visitors are asked to continue following established biosecurity procedures to decontaminate clothing, footwear and field equipment before and after any landing between regions and sites. </span></blockquote>You can find more details and background in the <a href="https://www.bas.ac.uk/"><b>British Antarctic Survey</b></a> news report <b><a href="https://www.bas.ac.uk/media-post/penguins-test-positive-for-avian-flu-on-south-georgia/">Penguins test positive for Avian Flu on South Georgia</a>.</b><br /><br /><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">Remarkably, even though H5N1 emerged in Southeast Asia more than 25 years ago, and has been widely reported across much of the Indonesian archipelago for decades, the virus has never managed to get a foothold in Oceania (Australia/NZ).</blockquote><p>It has long been believed that that this good fortune is due to the <b>Wallace and Weber lines</b> - imaginary dividing lines used to mark the difference between animal species found in Australia and Papua New Guinea and the rest of Southeast Asia.</p><div><div><div><div><div class="separator" style="clear: both;"><a href="https://oceanexplorer.noaa.gov/okeanos/explorations/10index/background/biogeography/media/biogeography_lines.html" style="background-color: #ebedec; color: #3f3f7f; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; margin-left: 1em; margin-right: 1em; text-decoration-line: none;"><img alt="" data-original-height="697" data-original-width="1018" height="274" src="https://blogger.googleusercontent.com/img/a/AVvXsEieIfihkFcuJh11ml2ua4MuNA2vBOMYVZC7d4PAT9EH_tmM8qwTyK-y-K96IrvgWxsaSWBj-ZlPKLWduzoiqFSBrrgn-TZ2PfycEQEJYYBaWsso2PsyHwKPz3GTciadV9_1j19WZKtfUTGDTuID3uIinAZH_itAnybEuPE0t4vViyr5MIc4LFo=w400-h274" style="background: transparent; border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; padding: 8px; position: relative;" width="400" /></a></div><br />While separated by a relatively narrow strait, on the western side you'll find Elephants, monkeys, leopards, tigers, and water buffalo while on the eastern side, you'll mostly find marsupials (kangaroos, Koalas, wombats, etc.).<br /><br /></div></div></div></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div><div><div><div style="text-align: left;">These stark faunal differences also extend to birds, reptiles, and even insects. </div></div></div></div></blockquote><div><div><div><div><p>Importantly for avian flu, very few migratory birds appear to cross the Wallace line (see <a href="https://www.tandfonline.com/doi/abs/10.1071/MU03026"><b>The Australo-Papuan bird migration system: another consequence of Wallace's Line</b></a>).</p></div></div></div><div>The continued expansion of HPAI H5 in the Antarctic region however, potentially provides the virus with a new approach (<i>from the south)</i> to both Australia and New Zealand. While that hasn't happened yet, it may become a possibility down the road. Last December <a href="https://www.offlu.org/wp-content/uploads/2023/12/OFFLU-wildlife-statement-no.-II.pdf"><b>OFFLU warned:</b></a></div><div><div><br /></div></div></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div><div><div style="text-align: left;"><span style="color: #2b00fe;">Given movement data demonstrating connectivity between the polar front to both the Antarctic and Subantarctic islands of Oceania, and Oceania itself, it is plausible that if HPAI H5 were present in the Antarctic region directly south of Oceania, it could be introduced to Oceania.</span></div></div></div></blockquote><div><div><div><br />Whether or not that happens, HPAI H5's global field experiment continues, and there appears to be little we can do to stop it. <br /></div></div></div>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-59511743365801412502024-03-11T06:55:00.000-04:002024-03-11T06:55:29.979-04:00Travel Med. & Inf. Dis.: Pacific and Atlantic Sea Lion Mortality Caused by HPAI A(H5N1) in South America<p></p><div class="separator" style="clear: both;"><a href="https://www.sciencedirect.com/science/article/pii/S1477893924000267"><img height="292" src="https://blogger.googleusercontent.com/img/a/AVvXsEhwRb1uVLkBe--KtHSSSOTDE7yxQqkIsijjtW7fPSyYqQH4lb1zIaEOOnsoVxOfxtVy4h0JU6syEXPJx6RPlgwmbORksxDYCblAZh8wTAWaC_6euMDNZaX-XogJIxgJT7iWqk9StNxhZglEwwLIamW9JsoEdBXMJViuc4ogBMav4mwaMAvZ6PNd1w=w320-h292" width="320" /></a></div><br /><b><span style="font-size: x-small;">P<span style="color: #1f1f1f; font-family: ElsevierGulliver, Georgia, "Times New Roman", Times, STIXGeneral, "Cambria Math", "Lucida Sans Unicode", "Microsoft Sans Serif", "Segoe UI Symbol", "Arial Unicode MS", serif;">rogression of the outbreak in sea lions, by date and country.</span></span></b><div><span style="color: #1f1f1f; font-family: ElsevierGulliver, Georgia, Times New Roman, Times, STIXGeneral, Cambria Math, Lucida Sans Unicode, Microsoft Sans Serif, Segoe UI Symbol, Arial Unicode MS, serif; font-size: x-small;"><b><br /></b></span><p></p><p>#17,944</p>The rapid spread of HPAI H5N1 down the length of South America - which began in the fall of 2022 - brought with it reports of massive die offs of wild birds (see <i>Euronews</i> - <a href="https://es.euronews.com/2022/12/07/peru-decenas-de-miles-de-aves-marinas-han-muerto-por-la-gripe-aviar?utm_term=Autofeed&utm_medium=Social&utm_source=Twitter#Echobox=1670408210"><b>Peru | Tens of thousands of seabirds have died from bird flu</b></a>), along with spillovers into marine mammals (see <a href="https://afludiary.blogspot.com/2023/10/eid-journal-mass-mortality-of-sea-lions.html"><b>EID Journal: Mass Mortality of Sea Lions Caused by HPAI A(H5N1) Virus (Peru)</b></a>).<br /><br /><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">Although we've long known that marine mammals (seals, whales, sea lions, otters, etc.) are susceptible to influenza viruses (see <a href="https://afludiary.blogspot.com/2022/07/uk-hairs-risk-assessment-on-avian-flu.html"><b>UK: HAIRS Risk Assessment On Avian Flu In Seals</b></a>) - we've never seen anything quite like the losses due to HPAI H5 over the past 18 months in South America.</blockquote><p>While the full impact of this marine die off is unknown (<i>many animals may have died at sea, or on remote, unsurveyed beaches), </i>the number is at least several tens of thousands. </p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">Along the way we've seen indications that as HPAI H5 has spilled over into marine mammals, it has acquired a number mammalian host adaptations; small amino acid changes that make it more suitable for carriage in non-avian species.</blockquote><p>In last November's <b><a href="https://afludiary.blogspot.com/2023/11/eid-journal-highly-pathogenic-avian.html">EID Journal: Highly Pathogenic Avian Influenza A(H5N1) from Wild Birds, Poultry, and Mammals, Peru</a>,</b> the authors cited:</p><blockquote style="background-color: #ebedec; color: #363636; font-size: 16px;"><b><span style="color: #2b00fe;"><span style="font-family: inherit;">2 mutations in the polymerase basic 2 protein (Q591K and D701N) associated with mammal adaptation were identified only in sequences from sea lions in Peru and from 1 human case in Chile.</span></span></b></blockquote>The $64 question -<i> still unanswered</i> - is how this virus is managing to spread so devastatingly among marine mammals around the world.<div><br /></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;">Since there are several plausible routes of transmission (e.g. <b>consumption of infected birds</b>, `<i><b>high environmental load</b></i>' of the virus, etc.), <i>mammal-to-mammal transmission</i> - while <a href="https://afludiary.blogspot.com/2023/02/preprint-first-mass-mortality-of-marine.html"><b>considered a possibility</b></a> - can be difficult to prove.</div></blockquote><div><br /><div>A couple of weeks ago, in<b> <a href="https://afludiary.blogspot.com/2024/02/eid-journal-hpai-ah5n1-viruses-from.html" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">EID Journal: HPAI A(H5N1) Viruses from Multispecies Outbreak, Argentina, August 2023</a>, </b>we looked at research from UNIVERSITY OF CALIFORNIA - DAVIS, which <i>suggests</i> that some <b>seal-to-seal transmission</b> may have occurred, writing:</div><div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">Given the rapid and widespread dissemination of the viruses among pinnipeds in South America and the substantial associated mortalities (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#r3">3</a>,<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#r9">9</a>), it seems likely that <b>pinniped-to-pinniped transmission</b> played a role in the spread of the mammal-adapted HPAI H5N1 viruses in the region.</span></blockquote><p>Although still unproven (see <a href="https://afludiary.blogspot.com/2024/03/esfa-role-of-mammals-in-avian-influenza.html"><b>EFSA Report On H5N1 in Mammals</b></a>), we have another study, published last week in <i>Travel Medicine & Infectious Diseases</i>, that looks at the devastating impact of HPAI H5N1 on the sea lion population of South America, and <i>considers the possibility </i>of direct transmission between marine mammals. </p><b><span style="font-size: large;"></span></b></div><blockquote><div><b><span style="color: #2b00fe; font-size: large;"><a href="https://www.sciencedirect.com/science/article/pii/S1477893924000267">Pacific and Atlantic sea lion mortality caused by highly pathogenic Avian Influenza A(H5N1) in South America</a></span></b></div><div><span style="color: #2b00fe;"><span style="font-size: medium;"><b><br /></b></span><span style="font-family: inherit;">Pablo I. Plaza a, Víctor Gamarra-Toledo a b, Juan Rodríguez Euguí c, Natalia Rosciano a, Sergio A. Lambertucci aShow more<br /><br /><a href="https://doi.org/10.1016/j.tmaid.2024.102712">https://doi.org/10.1016/j.tmaid.2024.102712</a><a href="https://s100.copyright.com/AppDispatchServlet?publisherName=ELS&contentID=S1477893924000267&orderBeanReset=true">Get rights and content</a><br /> <br /><b><span style="font-size: medium;">Abstract</span></b><br /><br /><span style="font-family: inherit;">We describe the evolution of the outbreak of Highly Pathogenic Avian Influenza (HPAI) A(H5N1) in sea lions (Otaria flavescens) of South America. At least 24,000 sea lions died in Peru, Chile, Argentina, Uruguay, and Brazil between January–October 2023. <b>The most plausible route of infection is cohabiting with or foraging on infected birds</b>. However, we urge a detailed evaluation of the sea lions actual source of infection given that the concomitant massive wild bird mortalities registered in the Pacific Ocean did not occur in the Atlantic Ocean.</span><br /></span></span><section id="sec1" style="box-sizing: border-box; font-size: 16px; margin: 0px 0px 8px; padding: 0px;"><h2 class="u-h4 u-margin-l-top u-margin-xs-bottom" id="sectitle0020" style="box-sizing: border-box; font-size: 1rem !important; line-height: var(--sd-ui-line-height) !important; margin-bottom: 8px !important; margin-left: 0px; margin-right: 0px; margin-top: 32px !important; padding: 0px;"><span style="color: #2b00fe; font-family: inherit;">1. The arrival of H5N1 in South America</span></h2><p id="p0020" style="box-sizing: border-box; margin: 0px 0px 16px; padding: 0px;"><span style="color: #2b00fe; font-family: inherit;">The (HPAI) A(H5N1) virus was detected in birds for the first time in South America, initially in October 2022 in Colombia and then in November in Peru [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib2" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib2" name="bbib2" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">2</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib6" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib6" name="bbib6" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">6</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib10" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib10" name="bbib10" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">10</span></a>]. Phylogenetic analysis suggests that the virus reached South America through multiple introductions from North America, especially along the Pacific Migratory Pathway [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib9" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib9" name="bbib9" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">9</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib10" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib10" name="bbib10" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">10</span></a>]. The H5N1 virus arrived at the end of 2021 in North America, where high mortalities (hundreds of individuals) were reported in at least 10 wild bird species; more than 20 species of wild mammals were also affected by this pathogen in this region [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib3" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib3" name="bbib3" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">3</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib4" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib4" name="bbib4" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">4</span></a>].</span></p><p id="p0025" style="box-sizing: border-box; margin: 0px 0px 16px; padding: 0px;"><span style="color: #2b00fe; font-family: inherit;">After the introductions of (HPAI) A(H5N1) into Colombia and Peru, the virus spread between birds throughout South America in a short period of time (e.g., Venezuela and Ecuador in November 2022, Chile in December 2022, Bolivia in January 2023, Argentina and Uruguay in February 2023 and Brazil in May 2023) [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib6" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib6" name="bbib6" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">6</span></a>]. In South America, particularly in Peru, the H5N1 virus produced alarming mortality levels in poultry, wild birds, but also in marine mammals [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib5" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib5" name="bbib5" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">5</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib6" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib6" name="bbib6" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">6</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib11" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib11" name="bbib11" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">11</span></a>]. For instance, <b>more than 100,000 wild birds were reported to have been killed by this pathogen in Peruvian protected areas alone</b> [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib11" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib11" name="bbib11" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">11</span></a>].</span></p></section><section id="sec2" style="box-sizing: border-box; margin: 0px 0px 8px; padding: 0px;"><div style="box-sizing: border-box; line-height: var(--sd-ui-line-height) !important; margin-bottom: 8px !important; margin-left: 0px; margin-right: 0px; margin-top: 32px !important; padding: 0px; text-align: left;"><b><span style="color: #2b00fe; font-family: inherit; font-size: medium;">2. Unusual mortality of sea lions</span></b></div><div style="box-sizing: border-box; font-size: 16px; margin: 0px; padding: 0px;"><p id="p0030" style="box-sizing: border-box; margin: 0px 0px 16px; padding: 0px;"><span style="color: #2b00fe; font-family: inherit;">In January 2023, concomitantly with the deaths of wild birds and poultry due to H5N1, several dead or dying sea lions were detected on Peruvian beaches [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib5" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib5" name="bbib5" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">5</span></a>] (<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="fig1" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#fig1" name="bfig1" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">Fig. 1</span></a>A and B). The clinical signs in dying individuals were mainly neurological (e.g., convulsions and tremors) and respiratory (e.g., dyspnea, tachypnea), including pathological lesions compatible with encephalitis and pneumonia [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib5" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib5" name="bbib5" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">5</span></a>]. Given the surrounding epidemiologic context, the first presumptive diagnosis was acute disease due to HPAI [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib5" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib5" name="bbib5" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">5</span></a>]. Laboratory analysis confirmed that HPAI A(H5N1) was the etiologic agent responsible for this mortality [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib9" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib9" name="bbib9" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">9</span></a>]. More than 5000 sea lions died as a result of this outbreak only in Peru during the summer of 2023 [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib5" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib5" name="bbib5" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">5</span></a>]. In addition, a common dolphin (<em style="box-sizing: border-box; margin: 0px; padding: 0px;">Delphinus delphis</em>) and several seabirds were reported as infected and killed by this virus [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib9" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib9" name="bbib9" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">9</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib11" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib11" name="bbib11" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">11</span></a>].</span></p></div></section><section id="sec2" style="box-sizing: border-box; font-size: 16px; margin: 0px 0px 8px; padding: 0px;"><p id="p0035" style="box-sizing: border-box; margin: 0px 0px 16px; padding: 0px;"><span style="color: #2b00fe; font-family: inherit;">During the massive mortality event in Peru, in January–February 2023 Chile began to report sick and dead sea lions with clinical signs compatible with HPAI [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib6" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib6" name="bbib6" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">6</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib8" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib8" name="bbib8" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">8</span></a>] (<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="fig1" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#fig1" name="bfig1" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">Fig. 1</span></a>A and B). The number of <b>dead sea lions associated with the (HPAI) A(H5N1) virus in this country reached more than 14,000,</b> plus thousands of wild birds [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib2" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib2" name="bbib2" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">2</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib6" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib6" name="bbib6" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">6</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib8" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib8" name="bbib8" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">8</span></a>]. Moreover, other mammals, such as the marine otter (<em style="box-sizing: border-box; margin: 0px; padding: 0px;">Lontra felina</em>), southern river otter (<em style="box-sizing: border-box; margin: 0px; padding: 0px;">Lontra provocax</em>), Chilean dolphin (<em style="box-sizing: border-box; margin: 0px; padding: 0px;">Cephalorhynchus eutropia</em>), and a spiny porpoise (<em style="box-sizing: border-box; margin: 0px; padding: 0px;">Phocoena spinipinnis</em>) were reported to have been infected by H5N1 in this country [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib2" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib2" name="bbib2" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">2</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib4" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib4" name="bbib4" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">4</span></a>]. Genome sequences of the virus present in Chilean sea lions suggest that this (HPAI) A(H5N1) cluster monophyletically with the virus affecting the Peruvian populations [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib7" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib7" name="bbib7" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">7</span></a>]. Therefore, the Chilean outbreak could be considered an extension of the Peruvian one.</span></p><p id="p0040" style="box-sizing: border-box; margin: 0px 0px 16px; padding: 0px;"><span style="color: #2b00fe; font-family: inherit;">Sea lion mortality due to H5N1 started in Argentina in August 2023 (<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="fig1" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#fig1" name="bfig1" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">Fig. 1</span></a>A); all gene segments of infected individuals showed a close relationship with sequences from Peruvian and Chilean sea lions [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib6" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib6" name="bbib6" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">6</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib12" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib12" name="bbib12" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">12</span></a>]. Several cases were reported along the Atlantic coast in the following provinces: Tierra del Fuego, Santa Cruz, Chubut, Rio Negro and Buenos Aires [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib6" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib6" name="bbib6" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">6</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib12" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib12" name="bbib12" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">12</span></a>] (<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="fig1" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#fig1" name="bfig1" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">Fig. 1</span></a>A and B). Highly Pathogenic Avian Influenza H5N1 has killed at least 1300 sea lions, but this figure is preliminary, considering the outbreak may still be in progress [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib6" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib6" name="bbib6" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">6</span></a>]. Similar to what was observed for this species in Peru and Chile, affected individuals showed neurological signs before dying [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib6" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib6" name="bbib6" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">6</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib12" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib12" name="bbib12" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">12</span></a>]. The first detection in Argentina (in Rio Grande, Tierra del Fuego Province, Argentina; −53.71557, −67.80045) occurred in August 2023, after Chile reported infected sea lion individuals in the vicinity at the end of June 2023 (in Puerto Williams, Tierra del Fuego, Chile; −54.927686, −67.621811) [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib6" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib6" name="bbib6" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">6</span></a>] (<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="fig1" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#fig1" name="bfig1" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">Fig. 1</span></a>A and B). Then, Uruguay began reporting sea lions infected by H5N1 near Montevideo (Cerro beach) in September 2023 and lastly Brazil in Santa Catarina in October 2023 [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib6" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib6" name="bbib6" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">6</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib13" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib13" name="bbib13" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">13</span></a>]. It would therefore be reasonable to assume that the Argentinean outbreak was a continuation of the Chilean event, and the Uruguayan and Brazilian a continuation of the Argentine one (<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="fig1" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#fig1" name="bfig1" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">Fig. 1</span></a>); the Uruguayan and Brazilian viruses detected in sea lions, in fact, clustered with the Peruvian, and Chilean viruses [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib13" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib13" name="bbib13" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">13</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib14" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib14" name="bbib14" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">14</span></a>].</span></p><p id="p0045" style="box-sizing: border-box; margin: 0px 0px 16px; padding: 0px;"><span style="color: #2b00fe; font-family: inherit;">The HPAI A(H5N1) virus traveled approximately 5000 kilometers from Peru to Tierra del Fuego (by way of the Pacific Ocean), and approximately 2800 kilometers from Tierra del Fuego to Uruguay and Brazil (by way of the Atlantic Ocean), infecting sea lions along the way. During this time, <b>H5N1 killed approximately 5% and 12% of the Peruvian and Chilean sea lion populations, respectively</b> [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib5" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib5" name="bbib5" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">5</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib8" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib8" name="bbib8" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">8</span></a>]. The spread of the virus progressed from north to south in the Pacific Ocean between January 2023 and August 2023, and in the Atlantic Ocean, it has progressed very rapidly from south to north during August and October 2023 (<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="fig1" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#fig1" name="bfig1" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">Fig. 1</span></a>). This wave of infection has already produced cases throughout almost the entire distribution range of sea lions, except in the south of the continent [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib6" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib6" name="bbib6" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">6</span></a>] (<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="fig1" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#fig1" name="bfig1" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">Fig. 1</span></a>).</span></p></section></div></blockquote><blockquote><div><section id="sec2" style="box-sizing: border-box; font-size: 16px; margin: 0px 0px 8px; padding: 0px;"><p id="p0045" style="box-sizing: border-box; margin: 0px 0px 16px; padding: 0px;"><span style="color: #2b00fe; font-family: inherit;">This region should be alert and prepared for the early detection of sea lions affected by (HPAI) A(H5N1), especially because in this geographical area there is a large population of this and similar pinniped species that are at risk, many in islands and the Antarctic continent [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib2" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib2" name="bbib2" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">2</span></a>]. In fact, <b>this outbreak expansion recently affected Southern elephant seals (<em style="box-sizing: border-box; margin: 0px; padding: 0px;">Mirounga leonina</em>) in the Atlantic Ocean resulting in huge mortalities, with more than 17,000 pups died during this outbreak</b> [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib6" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib6" name="bbib6" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">6</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib15" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib15" name="bbib15" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">15</span></a>].</span></p></section><section id="sec3" style="box-sizing: border-box; margin: 0px 0px 8px; padding: 0px;"><div style="box-sizing: border-box; line-height: var(--sd-ui-line-height) !important; margin-bottom: 8px !important; margin-left: 0px; margin-right: 0px; margin-top: 32px !important; padding: 0px; text-align: left;"><b><span style="color: #2b00fe; font-family: inherit; font-size: medium;">3. Epidemiologic behavior and transmission</span></b></div><p id="p0050" style="box-sizing: border-box; font-size: 16px; margin: 0px 0px 16px; padding: 0px;"><span style="color: #2b00fe; font-family: inherit;">The <b>most likely source of infection for sea lions in South America is associated with HPAI-infected birds: a spillover from wild birds to mammals seems to be the main cause of infection</b> [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib5" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib5" name="bbib5" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">5</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib9" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib9" name="bbib9" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">9</span></a>]. In fact, sea lions in Peru were in close contact with infected birds and have even been reported ingesting dead and dying birds [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib5" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib5" name="bbib5" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">5</span></a>]. </span></p><p id="p0050" style="box-sizing: border-box; font-size: 16px; margin: 0px 0px 16px; padding: 0px;"><span style="color: #2b00fe; font-family: inherit;">However, it is important to consider and evaluate<b> potential direct transmission among sea lions due to their gregarious behavior, the large number of affected individuals and the clustering of deaths in groups</b> [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib5" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib5" name="bbib5" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">5</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib14" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib14" name="bbib14" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">14</span></a>]. Most importantly<b>, sea lion mortality seems not always associated with wild or domestic bird mortality (e.g., in Argentina there are no official reports of large bird mortalities on the coasts where sea lions are dying) </b>(Table A.1(<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="appsec1" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#appsec1" name="bappsec1" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">Table A.1</span></a>), but this requires further research because it could be due to underreporting of cases by this country.</span></p><p id="p0055" style="box-sizing: border-box; font-size: 16px; margin: 0px 0px 16px; padding: 0px;"><span style="color: #2b00fe; font-family: inherit;">Under the current panzootic scenario, <b>potential mammal-to-mammal transmission of (HPAI) A(H5N1) has already been suggested for both terrestrial and marine mammals </b>[<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib4" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib4" name="bbib4" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">4</span></a>]. Genetic analysis of virus samples obtained from sea lions in Peru, Chile, Argentina, Uruguay and Brazil shows several mutations that suggest a potential adaptation to mammals; the mutations <b>PB2-Q591K and PB2-D701N</b> were present in the viral genomes of infected sea lions of all these countries [<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib7" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib7" name="bbib7" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">7</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib9" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib9" name="bbib9" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">9</span></a>,<a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib12" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib12" name="bbib12" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">[12]</span></a>, <a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib13" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib13" name="bbib13" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">[13]</span></a>, <a class="anchor u-display-inline anchor-paragraph" data-sd-ui-side-panel-opener="true" data-xocs-content-id="bib14" data-xocs-content-type="reference" href="https://www.sciencedirect.com/science/article/pii/S1477893924000267#bib14" name="bbib14" style="box-sizing: border-box; display: inline !important; margin: 0px; padding: 0px; text-decoration-line: none; transition: color 0.3s ease 0s, border-bottom-color 0.3s ease 0s; word-break: break-word;"><span class="anchor-text" style="border-bottom: 2px solid transparent; box-sizing: border-box; margin: 0px; padding: 0px; transition: border-bottom-color 0.3s ease 0s;">[14]</span></a>].<b> The evaluation of (HPAI) A(H5N1) as a virus that has adapted to replicate in mammalian species is key to assessing the likelihood of a future adaptation to humans, which could potentially lead to a pandemic event.</b></span></p><p id="p0055" style="box-sizing: border-box; font-size: 16px; margin: 0px 0px 16px; padding: 0px;"><a href="https://www.sciencedirect.com/science/article/pii/S1477893924000267"><b><span style="color: #2b00fe; font-family: inherit;">(Continue . . .)</span></b></a></p></section></div></blockquote><span style="font-family: inherit;"><br />Nine months ago, in <a href="https://afludiary.blogspot.com/2023/07/avian-flus-new-normal-when.html"><b>Avian Flu's New Normal: When the Extraordinary Becomes Ordinary</b></a>, I wrote about the numbing effect that comes with the constant barrage of HPAI H5 reports from around the world. <br /><br /></span></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div><span style="font-family: inherit;">Events that were nearly unthinkable two or three years ago (<i>e.g</i>. <a href="https://afludiary.blogspot.com/2023/08/viruses-recurring-trans-atlantic.html"><b>Repeated trans-Atlantic introduction of avian flu from Europe</b></a>, the <b><a href="https://afludiary.blogspot.com/2023/09/paho-public-health-risk-assessment.html">spread of HPAI H5 across the length of South America</a>,</b> <b><a href="https://afludiary.blogspot.com/2023/10/denmark-risk-assessment-of-h5n1.html">numerous spillovers of H5 into mammalian species</a>, </b>and the arrival of <a href="https://afludiary.blogspot.com/2024/01/sgssi-statement-hpai-confirmed-in.html"><b>HPAI H5 to Antarctica</b></a><b>) </b>have now become <i>`the new normal'.</i></span></div></blockquote><p>While it remains unknown whether avian H5 viruses have the ability to adapt well enough to humans to spark a pandemic, they continue to spread - a<i>nd evolve </i>- at a furious rate. </p><p>We underestimate them at our own peril. </p>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-81940472100167794582024-03-10T07:50:00.001-04:002024-03-10T07:50:54.873-04:00 Transboundary & Emerg. Dis.: H3 Avian Influenza Virus Isolated from China in 2021–2022 Showed the Emerging H3N8 Posed a Threat to Human Health<p> <a href="https://www.cdc.gov/flu/pdf/avianflu/avian-flu-transmission.pdf"><img height="200" src="https://blogger.googleusercontent.com/img/a/AVvXsEhLv_Mayc5pwbskJR1ck7axDqvbe3KlBlA1tzYdqTjU4LG0u-QJkLwXnJv78pApDpDjYSWP-oJa1QTfJKlLu1VbZwrGceTQ4ji5gMFO3hGnYFwPh860tq_MYqSjzAhDTmD-BALTi61SRvW33Fa7brYwrNQn0NvGJLSAlOBuQv9gtnSHlQ3KMuzJqQ=w149-h200" width="149" /></a><br />17,943</p><p>Although the world is understandably focused on the rapid spread and evolution of <b>HPAI H5N1 clade 2.3.4.4b</b>, it is far from the only novel flu virus with pandemic potential on our list. Even the CDC's <b><a href="https://www.cdc.gov/flu/pandemic-resources/monitoring/irat-virus-summaries.htm">IRAT list</a></b> (<i>with <b>24</b> subtypes</i>) is missing some likely suspects. </p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">While avian H5 or H7 viruses are thought capable of producing severe pandemics, they may be far <i>less likely</i> to emerge than an <b>H1, H2</b>, or <b>H3</b> subtype (see <a href="http://afludiary.blogspot.com/2014/07/are-influenza-pandemic-viruses-members.html"><b>Are Influenza Pandemic Viruses Members Of An Exclusive Club?)</b></a>.</blockquote><p>The CDC's IRAT places the <a href="https://afludiary.blogspot.com/2021/02/cdc-selects-new-swine-variant-ea-h1n1.html"><b>EA H1N1 `G4'</b> <b>swine-origin virus</b></a> well ahead of H5N1 both in terms of likelihood of emerging, and impact. Of course, these assessments are subject to change.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://www.cdc.gov/flu/pandemic-resources/monitoring/irat-virus-summaries.htm" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="230" data-original-width="656" height="112" src="https://blogger.googleusercontent.com/img/a/AVvXsEiulykvu4QXpI0VoiNkhsUqFjf06i3A3l_QMCIDlqK-rAh1rVmrHv5PZh0TaqvF0HAgRTuUo4yJF-Iqy8ajwjTdywg3QD6Z3dnic7dOSOBhEitrHL3r84sxh8YEwUjB8ZS-LZzJelntO4YpjAn-6eTs_S1pBt_v_buH-SNN2XFkaM-lfLCILL03vg" width="320" /></a></div><p></p><p>With so many viruses in play, picking the `<i>next pandemic virus'</i> is pretty much a mug's game. Which is why we spend so much time in this blog looking at an array of lesser known threats; even those that might spark less than a `<i>worst case</i>' pandemic scenario. </p><p>Over the past couple of years we've seen Chinese researchers raise concerns over the evolutionary trajectory of a number of <b>LPAI</b> viruses in China's poultry and wild bird population, some with occasional spillovers into humans. </p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">While <b><a href="https://afludiary.blogspot.com/2024/03/viruses-genetic-and-biological.html">H4N6</a>,</b> <a href="https://afludiary.blogspot.com/2024/02/viruses-wild-bird-origin-h6n2-influenza.html" style="color: #2b00fe; font-weight: bold;">H6Nx</a><b style="color: #2b00fe;">, </b>and<b style="color: #2b00fe;"> </b><span style="color: #2b00fe;"><b><a href="https://afludiary.blogspot.com/2024/02/transboundary-emerg-dis-novel-human.html">H9N2</a></b></span> are frequently mentioned, a recent entry in the zoonotic sweepstakes - <b>LPAI H3N8</b> - which infected two children (<a href="https://afludiary.blogspot.com/2022/06/preprint-human-infection-with-novel.html"><b>1 severely, infecting the family dog and cat as well</b></a>) in China in 2022, and reportedly <a href="https://afludiary.blogspot.com/2023/03/china-guangdong-cdc-reporting-1-h3n8.html"><b>killed a woman in Guangdong province</b></a> in March of 2023, is getting a lot of attention. </p></blockquote> H3N8 is of particular interested because:<div><ul style="text-align: left;"><li>H3N8 remains a <i>plausible cause </i>of a global influenza pandemic that spread out of Russia in <b>1889-1900 </b>(some researchers now suspect a coronavirus instead).</li><li>about 60 years ago <b>H3N8 jumped unexpectedly to horses</b>, supplanting the old equine <b>H7N7</b> virus, and subsequently jumped from horses to dogs in 2004 </li><li>in 2011 avian H3N8 was found in marine mammals (harbor seals), and 2012’s <a href="http://afludiary.blogspot.com/2012/07/mbio-mammalian-adapted-h3n8-in-seals.html"><b>mBio: A Mammalian Adapted H3N8 In Seals</b></a>, provided evidence that this virus had recently adapted to bind to alpha 2,6 receptor cells, the type found in the human upper respiratory tract.</li><li>And lastly, in 2015's <b><a href="https://afludiary.blogspot.com/2015/08/jvirol-experimental-infectivity-of-h3n8.html">J.Virol.: Experimental Infectivity Of H3N8 In Swine</a>,</b> we saw a study that found that avian (<i>but not canine or equine</i>) H3N8 could easily <b>infect pigs.</b></li></ul>Over the past 18 months we've seen a steady stream of cautionary reports (<i>primarily</i>) by Chinese researchers, warning of the zoonotic potential of H3N8. A few recent examples include:</div><div><b><br /></b></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><a href="https://afludiary.blogspot.com/2023/09/cell-airborne-transmission-of-human.html"><b>Cell: Airborne Transmission of Human-isolated Avian H3N8 Influenza Virus Between Ferrets</b></a></div></blockquote><div><b><br /></b></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><a href="https://afludiary.blogspot.com/2023/07/a-novel-triple-reassortment-h3n8-avian.html"><b>A Novel Triple Reassortment H3N8 Avian Influenza Virus: Characteristics, Pathogenicity, and Transmissibility</b></a></div></blockquote><div><b><br /></b></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><a href="https://afludiary.blogspot.com/2023/04/eid-dispatch-replication-of-novel.html"><b>EID Dispatch: Replication of Novel Zoonotic-Like Influenza A(H3N8) Virus in Ex Vivo Human Bronchus and Lung</b></a></div></blockquote><p>To this list we can add the following report, published last week in <i>Transboundary & Emerging Disease</i>s, which finds that multiple genotypes <i>(containing internal genes from <b>LPAI H9N2</b>)</i> have become increasingly adapted to poultry, and are now circulating widely - <i>and asymptomatically</i> - in poultry, posing an increasing threat to human health. </p><div><p>First, a link and some excerpts from this study, after which I'll return with a brief postscript.</p><blockquote><span style="color: #2b00fe;"><b><span style="font-size: large;"><a href="https://www.hindawi.com/journals/tbed/2024/9923259/">Genetic Diversity and Biological Characteristics of H3 Avian Influenza Virus Isolated from China in 2021–2022 Showed the Emerging H3N8 Posed a Threat to Human Health</a></span></b><br />Xin Yin,1Tiantian Wu,1Shuo Liu,1Cheng Peng,1Jinping Li,1Qiuyan Mao,1Yaxin Zhang,1Shuning Zhou,1Wanting Zhou,1Guangyu Hou,1Wenming Jiang<a href="mailto:civcul@163.com"></a><a href="https://orcid.org/0000-0002-1946-7212"></a>,1and Hualei Liu<a href="mailto:liuhualei@cahec.cn"></a><a href="https://orcid.org/0000-0002-7680-1854"></a>1<br /><br />Published 05 Mar 2024<br /><br /><b><span style="font-size: medium;">Abstract</span></b><br /><br />The H3 influenza viruses are widespread in domestic poultry but have been ignored because their pathogenicity in poultry is low. Three human infections with H3N8 influenza viruses have been reported in China since 2022, raising public concern. Here, we comprehensively<b> analyzed 30 H3 subtype avian influenza viruses isolated from live poultry markets in China between 2021 and 2022</b>. </span><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;"><b>Genetic and phylogenetic analyses showed that the H3 viruses have undergone frequent reassortment and have formed complex genotypes. </b>Notably, the viruses that caused human infections in 2022–2023 were highly homologous to the H3N8 viruses circulating in poultry in 2022, <b>with internal genes derived from the H9N2 viruses.</b> </span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">The analysis of chicken infections indicated that the novel H3N8 viruses were more infectious in chickens than those that do not carry H9N2 genes, whereas the H3 viruses detected in China in 2021–2022 showed low pathogenicity in mice.</span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;"> Our findings suggest that the novel <b>H3N8 viruses bearing internal H9N2 genes have adapted to and circulated in chickens and pose a threat to human health</b>. These results highlight the need for continued surveillance of the H3 influenza viruses and their impact on the poultry industry.</span></div><div><span style="color: #2b00fe;"><br /><b>1. Introduction</b><br /><br /></span></div></blockquote><p> <b> <span style="color: #2b00fe;">(SNIP)</span></b></p><blockquote><div><span style="color: #2b00fe;"><b>Low-pathogenic AIVs also pose a threat to human health</b>. In recent years, <b>H6N1, H3N8, H7N4, H9N2, H10N3, and H10N8 AIVs have also been shown to infect humans</b> [11–15]. On April 26, 2022, a novel AIV infecting a 4-year-old boy in Henan Province, China, was identified as the first case of human H3N8 AIV infection. On May 19, 2022, a 5-year-old boy infected with H3N8 AIV was also reported in Hunan Province. On February 22, 2023, H3N8 AIV infection was reported in Guangdong Province in a 56-year-old woman who died on March 16. This was the first human death from H3N8 throughout the world. All three cases had a history of exposure to live poultry [14, 16, 17].<br /><br /><b>The H3 subtype influenza viruses have a wide range of hosts, including birds, poultry, swine, canines, equines, and human</b>s [18–20]. H3 viral infections in poultry and wild birds rarely cause clinical symptoms, or the clinical symptoms are not obvious (often occurring as recessive infections). Several studies have reported the isolation of H3 subtype AIVs in wild birds, but the H3 subtype AIVs detected in poultry are usually from waterfowl and are rarely isolated from chickens [21, 22]. In this study, we analyzed several of the biological characteristics of 30 H3 subtype influenza viruses isolated during our routine surveillance of live poultry markets in 2021–2022. <b>Our findings provide important information about the evolution and circulation of the H3 viruses in poultry in China and provide insights into the prevention and control of these viruses.</b></span></div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><span style="color: #2b00fe;"><b> (SNIP)</b><br /><br /><b><span style="font-size: medium;">4. Discussion</span></b><br /> </span></blockquote><div><blockquote><span style="color: #2b00fe;">The H3 subtype is a low-pathogenic AIV subtype prevalent in domestic poultry. Here, we present a <b>comprehensive analysis of 30 H3 subtype AIVs isolated from live poultry markets in China </b>and have demonstrated that the H3 subtype viruses circulating in poultry <b>have undergone frequent reassortment and formed complex genotypes.</b> Notably, the novel <b>H3N8 viruses circulating in poultry were highly homologous to the human H3N8 isolates</b>, with their internal genes all derived from the<b> H9N2 subtype virus.<br /></b><br />Previous studies showed that the H3 influenza viruses did not form a stable lineage in poultry, with their gene segments originating from different subtypes of influenza viruses detected in wild birds or ducks [21]. <b>H9 viruses are widely detected in live poultry markets and farms in China, resulting in the continuous recombination of H9 with other AIV subtypes [35, 36]. It is the optimal internal gene donor for emerging reassortant viruses that cause human infections, such as the H7N9, H10N3, and H10N8 viruses [4, 15, 37].</b> </span></blockquote><blockquote><span style="color: #2b00fe;">Therefore,<b> we are concerned that the novel H3N8 viruses bearing H9N2 internal genes may become a stable branch and circulate in chickens or even cause sporadic human infections.</b> Close and continuous surveillance of the H3 subtype of AIVs circulating in nature is required, and we must be aware of the impact of the H3 subtype on the poultry industry in the future.<br /><br /><b>Over the past 2 years, many agencies have reported the detection of novel H3N8 viruses in chicken farms and live poultry markets in China [14, 16, 17, 23, 38]. All the studies revealed that the novel H3N8 viruses formed independent lineages in the HA gene trees, with their internal genes being from poultry H9N2 viruses.</b> Notably, Chen et al. [38] showed that the novel H3N8 viruses had been circulating in chickens for over a year at a high prevalence and had disseminated to at least seven provinces before detection in humans. We did not isolate the novel H3N8 viruses in 2021, but the two H3N3 viruses bearing the H9N2 internal genes similar to human strains were isolated in April 2021. The H3 subtype viruses, not just H3N8 subtypes, may have mixed with poultry H9N2 viruses very early on. Therefore, a retrospective analysis of H3 subtype strains isolated before 2021 needs to be conducted.<br /><br /><b>Previous studies have reported that the H3 subtype AIVs detected in poultry were predominantly from waterfowl, were rarely isolated from chickens, and rarely caused clinical symptoms</b> [19, 21, 22]. Our study found that the novel H3N8 viruses bearing the H9N2 internal gene were more infectious in chickens. The virus replicates in more organs, such as the immune organ thymus, than just in the upper respiratory tract. Although challenged SPF chickens rarely show clinical symptoms under laboratory conditions, there have been cases of H3N8-related symptoms during the industrial production of chickens [39]. Recently, Mao et al. [40] reported the novel reassortant H3N3 AIVs bearing the HA gene of novel H3N8 viruses and internal genes of H9N2 showed increased pathogenicity in chicken, with viruses detected in the lungs, trachea, cecal tonsil, spleen, kidneys, pancreas, brain, bursa of fabricius, heart, liver, and thymus [40]. The internal genes derived from H9N2 viruses may play an important role in their infectivity in chickens, and the relevant mechanism requires further research.<br /><br /><b>The H1N1, H2N2, and H3N2 influenza viruses have caused influenza pandemics in humans, and H1N1 and H3N2 viruses are still circulating seasonally in humans</b>. Guan et al. [21] reported that ferret <b>antisera against human H3N2 viruses did not cross-react with any of the avian H3N2 viruses,</b> suggesting that <b>preexisting immunity does not limit the spread of the H3N2 avian viruses in humans</b>. Sun et al. [16] and Zhu et al. [17] verified that the human population was immunologically naïve to the novel H3N8 viruses.</span></blockquote><blockquote><span style="color: #2b00fe;">The <b>E627K mutation of PB2 is known to play a decisive role in the mammalian adaptation of AIVs</b> [41, 42]. The A/Henan/4-10CNIC/2022(H3N8) virus contains the E627K mutation, whereas A/Changsha/1000/2022(H3N8) contains the E627V mutation, which has also been shown to increase the replication or virulence of AIVs in mammals [14, 34, 43]. The E627K mutation of PB2 was not observed in any of the H3 viruses in the present study; two strains that caused large weight loss in mice acquired the 627V mutation of PB2 in our study. Moreover, Cui et al. [23] reported the<b> novel H3N8 isolated from poultry was transmissible between guinea pigs via respiratory droplets</b>. Sun et al. [16] showed that the H3N8 virus isolated from humans had acquired the ability to transmit between respiratory droplets ferrets. Effective control measures must be established to reduce the prevalence of the virus in poultry, which also reduces the likelihood of infection in humans.</span></blockquote> <a href="https://www.hindawi.com/journals/tbed/2024/9923259/"><b>(Continue . . . .)</b></a></div><div><br /></div><div><br /></div><div>In the spring of 2013 a new, <b>LPAI H7N9</b> virus emerged in China, one which produced few clinical signs in poultry, but could produce serious (<i>even deadly</i>) disease in humans. This was a wake-up call that even LPAI viruses could pose a serious public health threat. </div><div><br /></div></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div><div>The virus spread stealthily in poultry, with often the first sign of a problem being when people in direct contact with the birds began to fall ill. Over 5 years more than 1,500 people were infected, with > 600 deaths (both <a href="https://afludiary.blogspot.com/2013/06/lancet-clinical-severity-of-human-h7n9.html"><b>likely under-reported</b></a>). <br /> <br /></div></div></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div><div><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; margin-bottom: 0.5em; margin-left: auto; margin-right: auto; padding: 4px; position: relative; text-align: center;"><tbody><tr><td><a href="https://wwwnc.cdc.gov/eid/article/24/1/17-1393_article" style="clear: left; color: #007f7f; margin-bottom: 1em; margin-left: auto; margin-right: auto; text-decoration-line: none;" target="_blank"><img border="0" data-original-height="273" data-original-width="775" height="112" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0thl4iOsRj6agShtGLSwCyIURFGEcinrZyJHN-91oRiVGEyUhVkXQyhL10WT0aLMI7HCbw8DLCKZ3nD3-LzmhAtH-9lxI8FUXRYmYfsdUdtTvKPl1zhIHjJlzixam0YbHH5ZDZw/w320-h112/EID+Journal+Wave+5.JPG" style="background: transparent; border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; padding: 8px; position: relative;" width="320" /></a></td></tr><tr><td class="tr-caption" style="font-size: 12.8px;"><b><a href="https://wwwnc.cdc.gov/eid/article/24/1/17-1393_article" style="color: #3f3f7f; text-decoration-line: none;" target="_blank">H7N9 Waves - Credit EID Journal</a></b></td></tr></tbody></table></div></div></blockquote><div><br /></div>H7N9 also carried the internal genes from the<b> LPAI H9N2</b> virus, and until an <b><a href="https://afludiary.blogspot.com/2019/04/ofid-avian-h5-h7-h9-contamination.html">emergency H5+H7 poultry vaccine</a></b> was introduced by China in 2017, appeared poised to spark a much larger public health threat.<div><br /></div><div>While H3N8 has yet to demonstrate the sort of threat that we saw with H7N9, it possesses many of the same attributes (<i>stealthy spread in poultry, H9N2 internal genes, zoonotic spillovers, etc.</i>), making it one definitely worth watching for further development. </div>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-78183524888856964072024-03-09T06:14:00.000-05:002024-03-09T06:14:15.111-05:00California Measles Exposure Alert & CDC Update On Measles in 2024<p></p><div class="separator" style="clear: both;"><a href="https://www.facebook.com/photo.php?fbid=757937146431576&set=a.224057816486181&type=3&ref=embed_page"><img height="306" src="https://blogger.googleusercontent.com/img/a/AVvXsEjc1LSf9sX5MA1SutMq4IqmR0UA7eJKrNqSkaNCY9BwDtMj0x3rrVPEYbeQ-0_2LK7OMnNqfaiXWgjpp5jBNUgXzayySsylpvwr4iFLrIONxUqpQ-IO7fiQiZckeU-t91vxmrGX88i9bacIO6dwQOkPxJXAh6Xl3uZmNklryI-MhuLk3d0_gi3LbQ=w320-h306" width="320" /></a></div><br /><p></p><p>#17,942</p><p><span style="background-color: #ebedec; color: #363636; font-family: inherit; font-size: 16px;">In 2019, just prior to the COVID lockdown, the United States reported <b>1274</b> measles cases</span> (see <b><a href="https://afludiary.blogspot.com/2019/05/coca-call-today-most-measles-cases-in.html">COCA Call: Most Measles Cases In 25 Years</a>)</b>, raising <span style="background-color: #ebedec; color: #363636; font-family: inherit; font-size: 16px;">concerns that this scourge - considered eliminated in the U.S. since 2000 - was making a comeback.<br /></span></p><blockquote style="background-color: #ebedec; border: none; color: #363636; font-size: 16px; margin: 0px 0px 0px 40px; padding: 0px;"><p><span style="font-family: inherit;">The following year, when the world went into lockdown for COVID, the rate of measles - along with influenza, RSV, and many other communicable diseases - dropped precipitously. </span></p></blockquote>But in 2022, the number of measles here in the United States began to creep up again (<b>n=121</b> across <b>6</b> jurisdictions). That number dropped in 2023 (<b>n=58</b>), but they were were reported by <b>20</b> jurisdictions: CA, CO, DC, FL, HA, ID, IL, KY, MD, MO, NJ, NYC, OH, OR, PA, TX, UT, VA, and WI.<div><br /></div><div>Just over 2 months into 2024, the number of cases reported (as of yesterday) to the CDC is fast approaching the number reported in all of 2023. This from the CDC's <b><a href="https://www.cdc.gov/measles/cases-outbreaks.html">Measles Cases and Outbreaks</a> </b>web page.</div><blockquote><span style="color: #2b00fe;"><b><span style="font-size: medium;">Measles cases in 2024</span></b><br /><br />As of March 7, 2024, a total of 45 measles cases were reported by 17 jurisdictions: Arizona, California, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Michigan, Minnesota, Missouri, New Jersey, New York City, Ohio, Pennsylvania, Virginia, and Washington.</span></blockquote><div><div class="separator" style="clear: both; text-align: center;"><a href="https://www.cdc.gov/measles/cases-outbreaks.html" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="392" data-original-width="983" height="160" src="https://blogger.googleusercontent.com/img/a/AVvXsEgR7GgRqNKOylGhDYlMBfoMMggJIgyxT-ylk1eZSDD4nrzNlT-eNz2q-plfQLBtopDQw7Lcwki8r4vw0U5OJ1-9zZoEiNVVNu5Jqs_oCt9qtsItsx3Ac2hr5eW3Pnl08pUWPntLZagSicwlSeP1LrS2Xeo4LZFkHvFSrdmx95FVKoQfUvrmJRIPMA=w400-h160" width="400" /></a></div><br /><span style="font-family: inherit;">Three weeks ago, in <a href="https://afludiary.blogspot.com/2024/02/ecdc-threat-assessment-brief-measles-on.html" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"><span style="color: #2b00fe;"><b>ECDC Threat Assessment Brief: Measles on the Rise in the EU/EEA</b></span></a>, we looked at reports of measles' resurgence in Europe, and over the past week we've seen several measles alerts issued, including in <b><a href="https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2024/03/05/measles-update">Michigan (n=3 cases)</a>, </b></span>in <span style="font-family: inherit;"><b><a href="https://www.canada.ca/en/public-health/services/diseases/measles/surveillance-measles/measles-rubella-weekly-monitoring-reports.html">Canada (n=7 active cases)</a></b>,</span> and last night this alert from El Dorado county, California on the potential exposure of up to 300 people. </div><b><span style="font-size: large;"></span></b><blockquote><span style="color: #2b00fe;"><b><span style="font-size: large;"><a href="https://edcgov.us/County%20Press%20Releases/Pages/Possible-Measles-Exposure-in-El-Dorado-County-.aspx">POSSIBLE MEASLES EXPOSURE IN EL DORADO COUNTY</a></span></b><br /><br />(PLACERVILLE, CA) – On March 5th a child with a confirmed case of measles was seen in the Emergency Department at UCDAVIS after being evaluated at San Joaquin Urgent Care. According to estimations approximately 300 people, including a small number of residents from El Dorado County, may have been exposed during that time. Counties of residence for the individuals include El Dorado County.<br /><br />This notification is to provide clear instructions so that appropriate protective measures can be taken for anyone at risk. If you were in the UC Davis ED on March 5th between 12pm and 5 pm, please contact The El Dorado County Public Health line at:<br /><br />Placerville (530) 621-6320<br />South Lake Tahoe (530) 573-3154<br /><br />"We will be receiving a list of those who were confirmed at the UC Davis Emergency Department at that time and will be contacting those individuals for further instructions," said Dr. Matthew Minson, El Dorado County's Public Health Officer. "Please do not go directly to the emergency Department as that could increase spread and put others at risk," he added.<br /><br />Measles is a serious illness especially for the very young, pregnant individuals, and immunocompromised people. It can be prevented with vaccination. If you suspect you or someone you know has measles, early evaluation is critical.</span></blockquote>Measles, which was once almost a youth’s `rite of passage’ in the United States, has been all but eliminated in the years after the introduction of the first measles vaccine in 1963.<br /><br />The chart below (source: <a href="http://www.cdc.gov/"><b>CDC</b></a>) shows the remarkable effectiveness of the vaccination campaign.<br /><br /><div style="text-align: center;"><a href="https://lh5.ggpht.com/_CLJS75_Cnao/TbqtvWd1I5I/AAAAAAAAFKk/1FhS7SFSD_8/s1600-h/image%5B7%5D.png"><img border="0" src="https://lh4.ggpht.com/_CLJS75_Cnao/Tbqtv7MKO4I/AAAAAAAAFKo/-l4Osl-aE8o/image_thumb%5B3%5D.png?imgmax=800" /></a></div> <br />While many parents today think of measles as a relatively benign childhood illness, it actually produced significant morbidity and mortality with respiratory, ocular, and neurological complications - sometimes resulting in death.<div><br /></div><div>Yesterday the CDC released the following update on measles in the United States.</div><blockquote><span style="color: #2b00fe;"><b><span style="font-size: large;"><a href="https://www.cdc.gov/ncird/whats-new/measles-in-us.html">Measles in the United States — March 2024</a></span></b><br /><br />March 8, 2024, 4:15 PM EDT</span><div><span style="color: #2b00fe;"><br /><a href="https://www.cdc.gov/ncird/whats-new/index.html">Updates</a> on respiratory illness and vaccine-preventable diseases.<br /><br />Thanks to a strong childhood vaccination program, measles was declared eliminated from the United States in 2000. Although overall childhood vaccination rates remain high in the U.S., measles still occurs frequently in other parts of the world. That’s especially true right now. The World Health Organization has noted a significant increase in measles cases worldwide, with a 30-fold increase in Europe. This includes popular international tourist destinations for Americans, like England.<br /><br />Measles can easily come to the United States by way of unvaccinated travelers, and <a href="https://www.cdc.gov/measles/cases-outbreaks.html"><b>measles cases have been increasing</b></a> around the country. This most commonly happens when people who live in the United States visit <b><a href="https://www.cdc.gov/globalhealth/measles/data/global-measles-outbreaks.html">countries where there are measles outbreaks</a>.</b> Once someone gets measles and returns to America, measles can spread if people in their community aren’t up-to-date on their vaccinations.<br /></span></div></blockquote><blockquote><div><ul style="text-align: left;"><li><span style="color: #2b00fe;">Measles is so contagious that if one person has it, up to 90% of the people close to them can also become infected if they are not protected by vaccination (or, less commonly, prior infection).</span></li><li><span style="color: #2b00fe;">The measles virus can stay in the air for up to 2 hours after an infected person left an indoor space.</span></li><li><span style="color: #2b00fe;">Someone can get infected by simply being in a room where a person with measles walked through.</span></li><li><span style="color: #2b00fe;">In addition, people with measles can transmit to others when their symptoms are fever, cough, and runny nose, which look like common respiratory viruses.</span></li></ul><span style="color: #2b00fe;">Worse, <a href="https://www.cdc.gov/measles/hcp/index.html#complications"><b>measles can be very serious</b></a>. Children younger than 5 years and adults older than 20 years are more likely to suffer from complications. Common measles complications include ear infections and diarrhea. More severe complications like pneumonia (lung infection) and encephalitis (infection and swelling of the brain) are possible and often require hospitalization and even intensive care. This is a real risk for people who are not vaccinated, especially for young children, adults, pregnant persons, and people who are immunocompromised. On average, nearly 1 in 5 unvaccinated people in the United States who get measles need to be hospitalized. For example, in a <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7231a3.htm"><b>recent outbreak in Ohio</b></a>, over 40% of infants and children infected with measles were hospitalized.<br /><br />When outbreaks do occur, local health departments lead the response. The playbook for ending measles outbreaks is decades old, and it works. People who are infected or who are exposed to measles but haven’t been vaccinated are recommended to stay home and away from settings where unvaccinated people may be exposed, like schools and daycares. By following these simple procedures, countless jurisdictions have successfully curbed local measles outbreaks and limited the illness and suffering that accompany them.<br /><br />Key to maintaining the elimination of measles in the U.S. is vaccination. <b><a href="https://www.cdc.gov/measles/vaccination.html">The measles-mumps-rubella vaccine (MMR)</a> </b>is part of the national immunization schedule for all children and adults. Vaccination with MMR is the best and safest way to prevent measles. When both doses of MMR vaccine are given (typically when the child is about 1 and 4 years old), MMR is 97% effective at preventing measles.<br /><br />CDC recommends the safe and effective MMR vaccination as part of the routine immunization schedule for all<b> <a href="https://www.cdc.gov/measles/vaccination.html">children and adults</a>,</b> with special guidance for those <a href="https://www.cdc.gov/measles/plan-for-travel.html"><b>travelling internationally</b></a>. With spring break travel coming up and people going to and coming from countries that have seen sharp upticks in measles cases, the time to be sure you and your family members are up to date on their MMR is now.</span></div></blockquote><div><br /></div>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-15975985800567021652024-03-08T08:32:00.000-05:002024-03-08T08:32:32.890-05:00Infectious Medicine: Rapid Adaptive Substitution of L226Q in HA protein Increases the Pathogenicity of H9N2 Viruses in Mice<p style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;"><img src="https://blogger.googleusercontent.com/img/a/AVvXsEggoygboJ6OUVnBH9iqVPvbJVe_ir_aNQihdc_KryxhPby-rKi6T3qsBQrhh7xLCIjA1rOxmrBt86RixaoupWaq_NL4kkGrmFHC1qUU5UIh8SxX7Bop0TUQwgqf2tCP5UPxRg22tq-M5wgMfFnu7UwL9Nu6eR9Yv-ehfzEc8G8R1BGam2M9B7mhDA=w400-h276" style="background: transparent; border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; padding: 8px;" /></p><p><span face="Arial, Tahoma, Helvetica, FreeSans, sans-serif" style="background-color: #ebedec; color: #363636; font-size: x-small;">A classic serial passage experiment showing Host adaptation </span> </p><p>#17,942</p><p>Yesterday's EFSA systematic review of <a href="https://afludiary.blogspot.com/2024/03/esfa-role-of-mammals-in-avian-influenza.html"><b>The Role of Mammals in Avian Influenza</b></a> looked at the known (<i>and feared</i>) mammalian adaptations that avian flu viruses may accrue as they continue to spill over into non-avian species. Adaptations that might increase their transmissibility, pathogenicity, or both. </p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;">In addition to<b> HPAI H5</b> and <b>H7</b> viruses, this study also looked at <b>LPAI H10, H3N8</b>, and <b>H9N2</b>, all of which have shown some ability to infect, and sicken, humans. </p></blockquote><p><b>H9N2</b> gets a lot of our attention because <b>1)</b> it is<i> ubiquitous in poultry</i> - <a href="https://afludiary.blogspot.com/2019/07/viruses-global-perspective-on-h9n2.html"><b>particularly in Asia and the Middle East</b>,</a> <b>2) </b>it <b><a href="https://afludiary.blogspot.com/2022/06/eid-journal-natural-reassortment-of-ea.html">readily reassorts with other, often more dangerous viruses</a></b>, <b>3)</b> it has been <a href="https://afludiary.blogspot.com/2021/10/j-virus-erad-ineffective-control-of.html"><b>poorly controlled by poultry vaccination</b></a> <b>4) </b>and while it usually only produces <b>mild illness</b> in humans, <a href="https://afludiary.blogspot.com/2018/12/j-infect-public-health-high.html"><b>seroprevalence studies</b></a> suggest it infects people more often than case counts would suggest. </p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">Globally, a bit over 100 cases have been confirmed (see <a href="https://flutrackers.com/forum/forum/flutrackers-high-pathogenic-h5n1-h1n08-h5n8-h5n6-h5n3-tracking-outbreaks-spread/745429-flutrackers-global-cumulative-h9n2-partial-case-list-1998-current"><b>FluTrackers list)</b></a>, mostly from China. The CDC has designated 2 different lineages (<a href="https://www.cdc.gov/flu/pandemic-resources/monitoring/virus-description.html?Sort=Flu%20Date%3A%3Adesc&Search=H9N2"><b>A(H9N2) G1</b></a> and <a href="https://www.cdc.gov/flu/pandemic-resources/pdf/IR-001Rev0D-CDC-IRAT-Virus-Report_H9N2_2019.pdf"><b>A(H9N2) Y280</b></a>) for their short list of influenza viruses with zoonotic potential (see <a href="https://www.cdc.gov/flu/pandemic-resources/monitoring/irat-virus-summaries.htm#H9N2"><b>CDC IRAT SCORE</b></a>), and <b><a href="https://www.who.int/teams/global-influenza-programme/avian-influenza/vaccine-viruses/docs/default-source/influenza/cvvs/zoonotic-cvv/h9n2/summary_a_h9n2_cvv_nh2021_22_20210305">several candidate vaccines have been developed</a>.</b></blockquote><p>Due to H9N2's relatively mild presentation in humans, we tend to worry primarily about its role as a possible co-conspirator in a reassortment scenario (<i>with seasonal flu, avian, canine, or swine flu viruses</i>). </p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEif1jQ0eKtnflgyctA5TbwWSYyC1I-rigdWPt4ht0SCzAgVXTfKAV9nC6z7gmCoALFBpfFNQ9yOU1uR_V5db_r8-z9vNcT0MY7EBvgwNy1gD37T9pcbHOegmTHCnSCF1NabD5CM44VHwN-Cf2hMu3Uk-i4EQuNxilILFautJLBR2o4FClvD8kSDLg" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="220" data-original-width="400" height="176" src="https://blogger.googleusercontent.com/img/a/AVvXsEif1jQ0eKtnflgyctA5TbwWSYyC1I-rigdWPt4ht0SCzAgVXTfKAV9nC6z7gmCoALFBpfFNQ9yOU1uR_V5db_r8-z9vNcT0MY7EBvgwNy1gD37T9pcbHOegmTHCnSCF1NabD5CM44VHwN-Cf2hMu3Uk-i4EQuNxilILFautJLBR2o4FClvD8kSDLg" width="320" /></a></div><div><br /></div>But it is also possible that over time - or due to<i><b> its passage</b> </i>through mammalian hosts - it might pick up <b>adaptive mutations</b> that could increase its pathogenicity and transmissibility in humans, increasing its pandemic potential. <br /><p></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;">All of which brings us to a new study, published in the journal <i>Infectious Medicine</i>, that looks at the pathogenicity (<i>in mice)</i> of more than 40 H9N2 viruses collected from humans in China between 2013 and 2021. </p></blockquote><p>While most of these H9N2 viruses showed <b>little or no pathogenicity</b> in mice, <b>three strains</b> (<i>A/Hubei-songzi/1631/2019 (HB-1631), A/Hunan/11173/2020 (HN-11173), A/Guangdong/00470/2021 (GD-00470) </i>produced significant weight loss in inoculated mice.<b> </b><span style="color: #1f1f1f; font-family: ElsevierGulliver, Georgia, "Times New Roman", Times, STIXGeneral, "Cambria Math", "Lucida Sans Unicode", "Microsoft Sans Serif", "Segoe UI Symbol", "Arial Unicode MS", serif; font-size: 16px;"> </span></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;"><span style="color: #1f1f1f; font-family: ElsevierGulliver, Georgia, "Times New Roman", Times, STIXGeneral, "Cambria Math", "Lucida Sans Unicode", "Microsoft Sans Serif", "Segoe UI Symbol", "Arial Unicode MS", serif; font-size: 16px;">An analysis of these 3 outliers led investigators to identify a single amino acid change - </span><span style="color: #1f1f1f; font-family: ElsevierGulliver, Georgia, "Times New Roman", Times, STIXGeneral, "Cambria Math", "Lucida Sans Unicode", "Microsoft Sans Serif", "Segoe UI Symbol", "Arial Unicode MS", serif; font-size: 16px;"><b>L226Q</b> <i>(H3 numbering)</i> in the HA protein sequence - as responsible for increased replication and pathogenicity in mice. </span></p></blockquote><p>The researchers then selected three <span style="color: #1f1f1f; font-family: ElsevierGulliver, Georgia, "Times New Roman", Times, STIXGeneral, "Cambria Math", "Lucida Sans Unicode", "Microsoft Sans Serif", "Segoe UI Symbol", "Arial Unicode MS", serif; font-size: 16px;">viruses (<i>A/Hunan/11173/2020, A/Hunan/34179/2018, and A/Guangdong/12902/2021</i>) - all containing <b>HA 226L</b> - for serial passage through mice (<i>see graphic at top of blog</i>). They reported:</span></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;"><span style="font-family: ElsevierGulliver, Georgia, "Times New Roman", Times, STIXGeneral, "Cambria Math", "Lucida Sans Unicode", "Microsoft Sans Serif", "Segoe UI Symbol", "Arial Unicode MS", serif; font-size: 16px;"><span style="color: #2b00fe;">The sequencing results showed that the proportion of<b> HA 226Q</b> reads exceeded<b> 98%</b> in the lung tissues of all of the infected mice in both the P3 and P4 generations (Table S3). This result indicated that the <b>HA L226Q mutation rapidly occurred during viral replication in the lungs of mice</b>, and was commonly observed in these human H9N2 isolates.</span></span></p></blockquote><p><b>L226Q </b>indicates the switch from <span style="color: #1f1f1f; font-family: ElsevierGulliver, Georgia, "Times New Roman", Times, STIXGeneral, "Cambria Math", "Lucida Sans Unicode", "Microsoft Sans Serif", "Segoe UI Symbol", "Arial Unicode MS", serif; font-size: 16px;"><b>leucine</b> to <b>glutamine</b> substitution at residue 226</span> in the HA. Due to its length, I've only posted the abstract and some excerpts. Follow the link to read the study in its entirety. </p><p>I'll have a brief postscript after the break.</p><b><span style="font-size: large;"><a href="https://www.sciencedirect.com/science/article/pii/S2772431X24000042"></a></span></b><blockquote><span style="color: #2b00fe;"><b><span style="font-size: large;"><a href="https://www.sciencedirect.com/science/article/pii/S2772431X24000042">Rapid adaptive substitution of L226Q in HA protein increases the pathogenicity of H9N2 viruses in mice</a></span></b><br /> Min Tan a, Ye Zhang a, Hong Bo a, Xiyan Li a, Shumei Zou a, Lei Yang a, Jia Liu a, Qi Chen a b, Xiaohao Xu a b, Wenfei Zhu a, Dayan Wang aShow more<br /> <br /><a href="https://doi.org/10.1016/j.imj.2024.100090">https://doi.org/10.1016/j.imj.2024.100090</a><a href="https://s100.copyright.com/AppDispatchServlet?publisherName=ELS&contentID=S2772431X24000042&orderBeanReset=true">Get rights and content</a><br />Under a Creative Commons <a href="http://creativecommons.org/licenses/by-nc-nd/4.0/">license</a><br /> <b><br />Abstract</b><br /><br /><b>Background</b><br /><br />Since the first human infection with H9N2 virus was reported in 1998, the number of cases of H9N2 infection has exceeded one hundred by 2021. However, there is no systematic description of the biological characteristics of H9N2 viruses isolated from humans.<br /><br /><b>Methods</b><br /><br />Therefore, this study analyzed the pathogenicity in mice of all available H9N2 viruses isolated from human cases in China from 2013 to 2021.<br /><br /><b>Results</b><br /><br />Although<b> most of the H9N2 viruses analyzed showed low or no pathogenicity in mice</b>, the leucine to glutamine substitution at residue 226 (<b>L226Q) in the hemagglutinin (HA) protein rapidly emerged during the adaptation of H9N2 viruses</b>, and was r<b>esponsible for severe infections and even fatalities</b>. HA amino acid 226Q conferred a remarkable competitive advantage on H9N2 viruses in mice relative to viruses containing 226L, increasing their virulence, infectivity, and replication.<br /><br /><b>Conclusion</b><br /><br />Thus, our study demonstrates that the adaptive substitution HA L226Q rapidly acquired by H9N2 viruses during the course of infection in mice contributed to their high pathogenicity.</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe; font-size: medium;"><b>4. Discussion</b></span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;"><br />The key findings of the present study are as follows. Forty-three strains of human-infecting H9N2 viruses were screened by inoculation in mice and <b>3 strains possessed higher pathogenicity.</b></span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;"> </span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;"> Sequence analysis showed that the r<b>apid amino acid substitution L226Q in HA mediated the increased pathogenicity of H9N2. </b>HA L226Q also<b> increased the virulence and replication of H9N2 and the inflammatory damage in mice. </b>Although strains such as HN-34179 developed L226Q after multiple mouse lung tissue passages, the original strain with HA 226L had low pathogenicity in mice after initial infection with high viral titers, indicating the significance of this specific mutation in determining pathogenicity.</span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">Avian influenza has undergone adaptive amino acid mutations during its adaptation to mammals, leading to pathological changes in the virus <a href="https://www.sciencedirect.com/science/article/pii/S2772431X24000042#bib0021">[21]</a>. For example, mutations at E627K <a href="https://www.sciencedirect.com/science/article/pii/S2772431X24000042#bib0022">[22]</a> and D701N <a href="https://www.sciencedirect.com/science/article/pii/S2772431X24000042#bib0023">[23]</a> in PB2 of the H9N2 viruses increase their virulence and replication capacities. Combined mutations in HA (L226Q) and PB2 (M147L, V250G, or E627K) or HA (L226Q) and M1 (R210K) significantly increase the virulence of the H9N2 chicken isolate in mice, whereas the single mutation HA L226Q only increases viral replication <a href="https://www.sciencedirect.com/science/article/pii/S2772431X24000042#bib0024">[24]</a>. In the present study, we confirmed the substitution of L226Q in H9N2 viruses from human cases caused phenotypic changes and increased the pathogenicity of the virus in mice. <b>Our animal experiments also showed that viruses with HA 226Q had a competitive advantage in mice over viruses with HA 226L</b>. The proportion of HA 226Q exceeded 84% in the P2 generation and <b>was nearly 100% in the P3 generation of mice inoculated with RG HB-1631 virus.</b></span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">Notably, the <b>L226Q substitution </b>in HA <b>destroyed the binding preference of the virus for the α2,6-SA receptor</b>, allowing it dual-receptor binding ability, <b>binding to both α2,3-SA and α2,6-SA receptors.</b></span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">(<b>SNIP)</b></span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">In summary, we have identified a wt H9N2 virus from human cases with a HA L226Q mutation. We have demonstrated that this mutation arises in a proportion of viruses during replication in a mouse model, alters the viral phenotype, and induces lethal infections in mice. These findings provide valuable insight into the mechanisms underlying the pathogenicity of H9N2 virus in humans, potentially informing the development of effective prevention and control strategies.</span></blockquote><p>While this study is narrowly focused on H9N2's passage through and adaptation in mice, it is illustrative of our general concerns whenever we see a novel flu virus spillover - and sometimes spread - in pigs, mink, seals, or other mammalian species. </p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgKZklQ7-CAiHeB4d_VCreurA_7D-y1aNT9HipIJm0oUdZZ-YiWGDMJa5GWITMaAZYvL6Tx7nHBrZtN4QA-mYIZiGR6dg0Rci373-RvPO6GNIEGpncAVoiFAA-B3Ypc666eoumLS_ehK5GDZBi3HjjtuuRbPUoLJlDQy6esl3iU81XFYydp7VnppA" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="265" data-original-width="400" height="265" src="https://blogger.googleusercontent.com/img/a/AVvXsEgKZklQ7-CAiHeB4d_VCreurA_7D-y1aNT9HipIJm0oUdZZ-YiWGDMJa5GWITMaAZYvL6Tx7nHBrZtN4QA-mYIZiGR6dg0Rci373-RvPO6GNIEGpncAVoiFAA-B3Ypc666eoumLS_ehK5GDZBi3HjjtuuRbPUoLJlDQy6esl3iU81XFYydp7VnppA=w400-h265" width="400" /></a></div><p></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;">Each event is an opportunity for the virus to pick up host adaptations that, over time, could increase its pandemic potential. </p></blockquote><p>If it were easy for an avian virus to fully adapt to humans, we'd be hip-deep in pandemic viruses all of the time. Luckily, it isn't. But it happens often enough that we can't afford to ignore the changes we are seeing in the spread and evolution of novel flu viruses around the globe. </p>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-25535967142421185722024-03-07T10:39:00.003-05:002024-03-08T05:43:38.516-05:00EFSA: The Role of Mammals in Avian Influenza: A Review<p></p><div class="separator" style="clear: both;"><img height="319" src="https://blogger.googleusercontent.com/img/a/AVvXsEg20ovc_ZjGFc2kpVkRGmraOnbzafeb1upnLPOMWYhWj6FrtAsklKatKz3g2w7G9QRuPUY1VOzv8Smv2lgJ-x3ghq6jpf9hq8683QFVtd04LvLfiaEHFhCMdun1Nh_axWJlE_6e8meV268J2TgqbejSaukgepMze2z6FBlr6z9ygSPN1D211n4Ptg=w320-h319" width="320" /></div><br /> #17,941<p></p><p><br /></p><p>Today the ESFA (European Food Safety Authority) has published an extensive systematic review of the literature on mammalian infection with a wide array of avian influenza viruses, with an emphasis on the recent and worrying rise of <b>HPAI H5 clade 2.3.4.4b.</b></p><p>The objective of this review was to answer four questions:</p><p></p><ol style="text-align: left;"><li><span style="color: #2b00fe;">Do wild mammals play a role in the maintenance of the Avian Influenza virus (HPAI and other subtypes different from H5 and H7) favouring current or future spill back to wild birds and spill over to humans or other taxa?</span></li><li><span style="color: #2b00fe;">Can wild mammals acquire immunity and become a reservoir for the AI virus subtypes that are the object of this review?</span></li><li><span style="color: #2b00fe;">According to epidemiological and experimental evidence, how likely is mammal-to-mammal transmission of AI virus?</span></li><li><span style="color: #2b00fe;">Considering the answers to the above questions, what could be the role of mammals in a potential pandemic caused by AI viruses? Could this taxon represent a risk due to the recent increase in cases? And which could be the drivers for a potential pandemic?</span></li></ol><p></p><p></p><p style="text-align: left;">While this this 54-page PDF focuses primarily on HPAI viruses (<b>H5, H7</b>, & <b><span style="color: #990000;"><strike>H10</strike> </span>(<span style="color: #990000;"><i>corr.</i></span> <span style="color: #990000;"><i>should have been LPAI H10 - mpc</i></span></b>), they also single out two <b>LPAI </b>viruses - <b>H3N8 & </b><b>H9N2</b> -<b> </b>as being of heightened interest. </p><p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgMmWlF9zxYttoqBlZ8gytGpYi1LJ8USRGX-FhdIi7fpZ4xZtl_Azxy_4Bxwuv49s5Nf-1xzuHR7VjY9biRAgPLfrZz3VDCtZkQYg3WFs__Sc59bnmcdfrvsID-A_hQVbd8mxV70QZPZibfYUWotIB4c0XVYHp055ifZZUi4EIXXHbTTf45-DJozA" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="244" data-original-width="560" height="174" src="https://blogger.googleusercontent.com/img/a/AVvXsEgMmWlF9zxYttoqBlZ8gytGpYi1LJ8USRGX-FhdIi7fpZ4xZtl_Azxy_4Bxwuv49s5Nf-1xzuHR7VjY9biRAgPLfrZz3VDCtZkQYg3WFs__Sc59bnmcdfrvsID-A_hQVbd8mxV70QZPZibfYUWotIB4c0XVYHp055ifZZUi4EIXXHbTTf45-DJozA=w400-h174" width="400" /></a></div>Due to its length I've only posted the Abstract and some excerpts from the conclusions. You'll want to follow the link to review the full report. <a href="https://efsa.onlinelibrary.wiley.com/journal/23978325" style="background-color: #eeeeee; box-sizing: border-box; cursor: pointer; font-family: "Open Sans", icomoon, sans-serif; font-size: 0px; text-decoration-line: none;" title="EFSA Supporting Publications homepage">Supporting Publications</a><p></p><div class="article-citation" style="box-sizing: border-box; color: #1c1d1e; font-family: "Open Sans", icomoon, sans-serif; font-size: 14px; margin-bottom: 1.125rem;"><div class="citation" style="box-sizing: border-box;"><div class="pb-dropzone" data-pb-dropzone="publicaitonContent-series-title" style="box-sizing: border-box;"><span style="background-color: #eeeeee;"><a class="citation--logo" href="https://efsa.onlinelibrary.wiley.com/journal/23978325" style="box-sizing: border-box; cursor: pointer; display: inline-block; margin: 0.3125rem 0px; max-width: 100%; text-decoration-line: none;" title="EFSA Supporting Publications homepage"></a></span></div></div></div><blockquote><div class="article-citation" style="box-sizing: border-box; font-family: "Open Sans", icomoon, sans-serif; margin-bottom: 1.125rem;"><div class="citation" style="box-sizing: border-box;"><div class="pb-dropzone" data-pb-dropzone="publicaitonContent-series-title" style="box-sizing: border-box; font-size: 14px;"><a class="citation--logo" href="https://efsa.onlinelibrary.wiley.com/doi/abs/10.2903/sp.efsa.2024.EN-8692" style="box-sizing: border-box; cursor: pointer; display: inline-block; margin: 0.3125rem 0px; max-width: 100%; text-decoration-line: none;" title="EFSA Supporting Publications homepage"><span style="background-color: #eeeeee; color: #2b00fe;"><img alt="EFSA Supporting Publications" class="journal-banner-image" id="journal-banner-image" src="https://efsa.onlinelibrary.wiley.com/pb-assets/journal-banners/23978325-1677076782283.jpg" style="border-style: none; box-sizing: border-box; max-width: 100%;" test="test-value" /></span></a></div><div class="doi-access-container clearfix" style="align-items: center; box-sizing: border-box; display: flex; font-size: 14px; margin: 0.625rem 0px;"><span class="primary-heading" style="box-sizing: border-box;"><span class="primary-heading" style="background-color: #eeeeee; box-sizing: border-box;"><span style="color: #2b00fe;">External scientific report</span></span></span><div class="doi-access-wrapper" style="align-items: center; border-left: 1px solid var(--wiley-lightGray-color); box-sizing: border-box; display: flex; font-size: var(--doi-access-font-size); font-weight: var(--doi-access-font-weight); margin-left: 0.5rem; padding-left: 0.5rem;"><div class="open-access access-type" style="align-items: center; box-sizing: border-box; display: flex; line-height: normal; width: 7rem;"><span aria-hidden="true" class="icon-icon-lock_open" face="icomoon !important" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; font-size: 0.9375rem; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: 1; margin-right: 0.3125rem; transition: transform 0.5s ease 0s;"></span><div class="doi-access" style="box-sizing: border-box; line-height: normal; text-transform: capitalize;"><span style="background-color: #eeeeee; color: #2b00fe;">Open Access</span></div></div></div></div><div style="box-sizing: border-box; line-height: 1.875rem; margin: 0.5rem 0px; text-align: left;"><span style="color: #2b00fe; font-size: large;"><a href="https://efsa.onlinelibrary.wiley.com/doi/abs/10.2903/sp.efsa.2024.EN-8692" style="background-color: #eeeeee;"><b>The role of mammals in Avian Influenza: a review</b></a></span></div><div class="pb-dropzone" data-pb-dropzone="publicaitonContent-versions" style="box-sizing: border-box; font-size: 14px;"></div><div class="loa-wrapper loa-authors hidden-xs desktop-authors" style="box-sizing: border-box; font-size: 14px; margin: 0.9375rem 0px;"><div class="accordion" id="sb-1" style="box-sizing: border-box;"><div class="comma__list" style="box-sizing: border-box;"><div class="accordion-tabbed" style="box-sizing: border-box; font-size: 0.875rem;"><span style="background-color: #eeeeee; color: #2b00fe;"><span class="accordion-tabbed__tab-mobile accordion__closed" style="border-top: none; box-sizing: border-box; display: inline-block; position: relative;"><a aria-controls="a1" aria-haspopup="true" class="author-name accordion-tabbed__control" data-db-target-for="a1" data-id="a1" href="https://efsa.onlinelibrary.wiley.com/authored-by/ContribRaw/ENETWILD+Consortium" id="a1_Ctrl" role="button" style="box-sizing: border-box; cursor: pointer; display: inline; font-size: 0.875rem; line-height: 1.25rem; margin-bottom: 0.25rem; padding: 0px; text-decoration-line: none; width: 100%;"><span style="box-sizing: border-box; margin: 0px; padding: 0px;">ENETWILD Consortium<span aria-hidden="true" class="icon-mail_outline" face="icomoon !important" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; display: inline-block; float: none; font-size: 1rem; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: 1; margin: 0px 0px 0px 0.1875rem; transition: transform 0.5s ease 0s; vertical-align: middle;"></span></span></a><span class="comma-separator" style="box-shadow: none; box-sizing: border-box; display: inline-block; position: static;">, </span></span><span class="accordion-tabbed__tab-mobile accordion__closed" style="border-top: none; box-sizing: border-box; display: inline-block; position: relative;"><a aria-controls="a2" aria-haspopup="true" class="author-name accordion-tabbed__control" data-db-target-for="a2" data-id="a2" href="https://efsa.onlinelibrary.wiley.com/authored-by/Flavia/Occhibove" id="a2_Ctrl" role="button" style="box-sizing: border-box; cursor: pointer; display: inline; font-size: 0.875rem; line-height: 1.25rem; margin-bottom: 0.25rem; padding: 0px; text-decoration-line: none; width: 100%;"><span style="box-sizing: border-box; margin: 0px; padding: 0px;">Occhibove Flavia</span></a><span class="comma-separator" style="box-shadow: none; box-sizing: border-box; display: inline-block; position: static;">, </span></span><span class="accordion-tabbed__tab-mobile accordion__closed" style="border-top: none; box-sizing: border-box; display: inline-block; position: relative;"><a aria-controls="a3" aria-haspopup="true" class="author-name accordion-tabbed__control" data-db-target-for="a3" data-id="a3" href="https://efsa.onlinelibrary.wiley.com/authored-by/Sascha/Knauf" id="a3_Ctrl" role="button" style="box-sizing: border-box; cursor: pointer; display: inline; font-size: 0.875rem; line-height: 1.25rem; margin-bottom: 0.25rem; padding: 0px; text-decoration-line: none; width: 100%;"><span style="box-sizing: border-box; margin: 0px; padding: 0px;">Knauf Sascha</span></a><span class="comma-separator" style="box-shadow: none; box-sizing: border-box; display: inline-block; position: static;">, </span></span><span class="accordion-tabbed__tab-mobile accordion__closed" style="border-top: none; box-sizing: border-box; display: inline-block; position: relative;"><a aria-controls="a4" aria-haspopup="true" class="author-name accordion-tabbed__control" data-db-target-for="a4" data-id="a4" href="https://efsa.onlinelibrary.wiley.com/authored-by/Carola/Sauter%E2%80%90Louis" id="a4_Ctrl" role="button" style="box-sizing: border-box; cursor: pointer; display: inline; font-size: 0.875rem; line-height: 1.25rem; margin-bottom: 0.25rem; padding: 0px; text-decoration-line: none; width: 100%;"><span style="box-sizing: border-box; margin: 0px; padding: 0px;">Sauter-Louis Carola</span></a><span class="comma-separator" style="box-shadow: none; box-sizing: border-box; display: inline-block; position: static;">, </span></span><span class="accordion-tabbed__tab-mobile accordion__closed" style="border-top: none; box-sizing: border-box; display: inline-block; position: relative;"><a aria-controls="a5" aria-haspopup="true" class="author-name accordion-tabbed__control" data-db-target-for="a5" data-id="a5" href="https://efsa.onlinelibrary.wiley.com/authored-by/Christoph/Staubach" id="a5_Ctrl" role="button" style="box-sizing: border-box; cursor: pointer; display: inline; font-size: 0.875rem; line-height: 1.25rem; margin-bottom: 0.25rem; padding: 0px; text-decoration-line: none; width: 100%;"><span style="box-sizing: border-box; margin: 0px; padding: 0px;">Staubach Christoph</span></a><span class="comma-separator" style="box-shadow: none; box-sizing: border-box; display: inline-block; position: static;">, </span></span><span class="accordion-tabbed__tab-mobile accordion__closed" style="border-top: none; box-sizing: border-box; display: inline-block; position: relative;"><a aria-controls="a6" aria-haspopup="true" class="author-name accordion-tabbed__control" data-db-target-for="a6" data-id="a6" href="https://efsa.onlinelibrary.wiley.com/authored-by/Valerie/Allendorf" id="a6_Ctrl" role="button" style="box-sizing: border-box; cursor: pointer; display: inline; font-size: 0.875rem; line-height: 1.25rem; margin-bottom: 0.25rem; padding: 0px; text-decoration-line: none; width: 100%;"><span style="box-sizing: border-box; margin: 0px; padding: 0px;">Allendorf Valerie</span></a><span class="comma-separator" style="box-shadow: none; box-sizing: border-box; display: inline-block; position: static;">, </span></span><span class="accordion-tabbed__tab-mobile accordion__closed" style="border-top: none; box-sizing: border-box; display: inline-block; position: relative;"><a aria-controls="a7" aria-haspopup="true" class="author-name accordion-tabbed__control" data-db-target-for="a7" data-id="a7" href="https://efsa.onlinelibrary.wiley.com/authored-by/Alina/Anton" id="a7_Ctrl" role="button" style="box-sizing: border-box; cursor: pointer; display: inline; font-size: 0.875rem; line-height: 1.25rem; margin-bottom: 0.25rem; padding: 0px; text-decoration-line: none; width: 100%;"><span style="box-sizing: border-box; margin: 0px; padding: 0px;">Anton Alina</span></a><span class="comma-separator" style="box-shadow: none; box-sizing: border-box; display: inline-block; position: static;">, </span></span><span class="accordion-tabbed__tab-mobile accordion__closed" style="border-top: none; box-sizing: border-box; display: inline-block; position: relative;"><a aria-controls="a8" aria-haspopup="true" class="author-name accordion-tabbed__control" data-db-target-for="a8" data-id="a8" href="https://efsa.onlinelibrary.wiley.com/authored-by/Sophia/Barron" id="a8_Ctrl" role="button" style="box-sizing: border-box; cursor: pointer; display: inline; font-size: 0.875rem; line-height: 1.25rem; margin-bottom: 0.25rem; padding: 0px; text-decoration-line: none; width: 100%;"><span style="box-sizing: border-box; margin: 0px; padding: 0px;">Barron Sophia</span></a><span class="comma-separator" style="box-shadow: none; box-sizing: border-box; display: inline-block; position: static;">, </span></span><span class="accordion-tabbed__tab-mobile accordion__closed" style="border-top: none; box-sizing: border-box; display: inline-block; position: relative;"><a aria-controls="a9" aria-haspopup="true" class="author-name accordion-tabbed__control" data-db-target-for="a9" data-id="a9" href="https://efsa.onlinelibrary.wiley.com/authored-by/Hannes/Bergmann" id="a9_Ctrl" role="button" style="box-sizing: border-box; cursor: pointer; display: inline; font-size: 0.875rem; line-height: 1.25rem; margin-bottom: 0.25rem; padding: 0px; text-decoration-line: none; width: 100%;"><span style="box-sizing: border-box; margin: 0px; padding: 0px;">Bergmann Hannes</span></a><span class="comma-separator" style="box-shadow: none; box-sizing: border-box; display: inline-block; position: static;">, </span></span><span class="accordion-tabbed__tab-mobile accordion__closed" style="border-top: none; box-sizing: border-box; display: inline-block; position: relative;"><a aria-controls="a10" aria-haspopup="true" class="author-name accordion-tabbed__control" data-db-target-for="a10" data-id="a10" href="https://efsa.onlinelibrary.wiley.com/authored-by/Caroline/Br%C3%B6jer" id="a10_Ctrl" role="button" style="box-sizing: border-box; cursor: pointer; display: inline; font-size: 0.875rem; line-height: 1.25rem; margin-bottom: 0.25rem; padding: 0px; text-decoration-line: none; width: 100%;"><span style="box-sizing: border-box; margin: 0px; padding: 0px;">Bröjer Caroline</span></a></span><a aria-expanded="false" class="read-more" href="https://efsa.onlinelibrary.wiley.com/doi/abs/10.2903/sp.efsa.2024.EN-8692#" style="box-sizing: border-box; cursor: pointer; font-size: 0.875rem; font-weight: 600; text-decoration-line: none; white-space: nowrap;"> <span class="ellipsis" style="box-sizing: border-box;">…</span> See all authors <span class="icon-section_arrow_d" face="icomoon !important" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; font-size: 0.3125rem; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: 1; margin-left: 0.3125rem; padding-bottom: 0.1875rem; padding-top: 0.1875rem; transition: transform 0.5s ease 0s; vertical-align: middle;"></span></a></span></div></div></div></div><div class="epub-sections" style="box-sizing: border-box; font-size: 14px; margin: 0.9375rem 0px;"><span style="background-color: #eeeeee; color: #2b00fe;"><div class="epub-section" style="box-sizing: border-box; display: inline-block; font-size: 0.875rem; line-height: 1.15; margin: 0px; opacity: 1;"><span class="epub-state" style="box-sizing: border-box; display: inline-block; white-space: pre;">First published: </span><span class="epub-date" style="box-sizing: border-box; display: inline-block;">07 March 2024</span></div> <div class="epub-section" style="box-sizing: border-box; display: inline-block; font-size: 0.875rem; line-height: 1.15; margin: 0px; opacity: 1;"><a aria-label="Digital Object Identifier" class="epub-doi" href="https://doi.org/10.2903/sp.efsa.2024.EN-8692" style="box-sizing: border-box; cursor: pointer; font-weight: 600; overflow-wrap: break-word; text-decoration-line: none;">https://doi.org/10.2903/sp.efsa.2024.EN-8692</a></div></span></div><div class="epub-sections" style="box-sizing: border-box; font-size: 14px; margin: 0.9375rem 0px;"><div class="article-header__references-container no-truncate" id="efs38692e-note-0001" style="box-sizing: border-box;" tabindex="0"><div class="header-note-content" style="box-sizing: border-box; display: inline;"><p style="box-sizing: border-box; display: inline; margin-bottom: 0.3125rem; margin-top: 0.3125rem;"><span style="background-color: #eeeeee; color: #2b00fe;"><span style="box-sizing: border-box; font-weight: bolder;">Question number:</span> EFSA-Q-2024-00030</span></p></div></div><div class="article-header__references-container no-truncate" id="efs38692e-note-0006" style="box-sizing: border-box;" tabindex="0"></div></div></div></div><div><span style="color: #2b00fe;"><span style="background-color: #eeeeee;"><a href="https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/sp.efsa.2024.EN-8692"><b><span style="font-size: medium;">PDF</span></b></a><br /><b><span style="font-size: medium;"><br />Abstract</span></b></span><br /><br />Avian influenza (AI) is an infectious viral disease of birds, including domestic poultry, which has been causing outbreaks worldwide, leading to several millions of dead wild birds and culled poultry. AI is mainly found in birds, but recently, there was an increase in reported infections in mammals, ranging from no symptoms to mass mortality events and some human cases. Epidemiologically of great concern, <b>evidence of mammalian adaptations have been found, but the transmission routes and pathogenesis in mammals are still to be defined. </b></span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">Hence, it is paramount to address all facets of AI viruses epidemiology, including investigating taxa not customarily thought to be involved in the transmission and/or trafficking of AI, such as wild mammals. <b>The scope of this report was to assess the role of mammals in AI epidemiology, virology and pathology, i.e. AI maintenance, reservoir role, immunity, role of mammals in a potential pandemic. </b></span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">To do so, we performed an all-encompassing review of the literature on the topic with a two-fold approach: a systematic review of the published AI cases in wild mammals and a narrative approach to provide an expert opinion on the role of mammals in AI spread. The final number of peer-reviewed papers included in the systematic literature review was 76, resulting in 120 unique infection records with AI in wild mammal species. </span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">The most represented taxa were included in the <b>order Carnivora</b>. The risk of infection was identified mainly as <b>predation (or feeding) upon infected birds or contact with avian species</b>.<b> Evidence of mammal-to-mammal transmission in the wild is only circumstantial and yet to be confirmed.</b> Cases of AI from the systematic review of experimental findings were discussed concerning epidemiology, pathology and virology. Knowledge gaps and potential pandemic drivers were identified.</span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">In summary, although a greater number of infections in wild mammals have been reported, there is <b>no hard evidence for sustained mammal-to-mammal transmission in the wild</b>. The factors contributing to the increased number of infections found in wild carnivores are not clear yet, but<b> the unprecedented global spread of highly pathogenic avian influenza (HPAI) viruses creates ample opportunities for intense, mostly alimentary, contact between infected wild birds and carnivores. </b>Close surveillance of circulating strains and continued assessment of new epidemiological situations are crucial to quickly identify strains with enhanced mammalian fitness.</span></div></blockquote><p> <span style="color: #2b00fe;"><b>(SNIP)</b></span></p><p><b><span style="font-size: medium;"></span></b></p><blockquote><p><b><span style="color: #2b00fe; font-size: medium;">Conclusion and recommendations for surveillance</span></b></p><ul style="text-align: left;"><li><span style="color: #2b00fe;">M<b>ammal-to-mammal transmission was not detected in wild mammals</b>, although some experimental evidence suggested that this <b>might be possible</b>, although not very effective, for some combinations of viral genotypes-hosts.</span></li></ul></blockquote><blockquote><ul style="text-align: left;"><li><span style="color: #2b00fe;">In wild mammals, s<b>ustained mortality events due to H5N1 have thus far only been reported in seals</b> (Puryear et al., 2023). No seal-to-seal transmission was identified as a primary route of infection. Yet, the high likelihood of continuous contact of this species with potentially infected birds requires ongoing vigilance, as this increases potential opportunities for further reassortment or adaptation of these viruses to mammalian hosts.</span></li></ul></blockquote><blockquote><ul style="text-align: left;"><li><span style="color: #2b00fe;">In experimental settings, the transmission route was mostly similar to that occurring in birds, i<b>.e. sharing environmental resources, not airborne.</b> Nonetheless, <b>mammal species may play a role in the circulation of the Avian Influenza virus</b> (HPAI and other subtypes).</span></li></ul></blockquote><blockquote><ul style="text-align: left;"><li><span style="color: #2b00fe;">It might be possible that wild mammals, especially synanthropic and periurban species, <b>might serve as bridge hosts,</b> favouring the <b>potential reassortment of various AIVs. </b></span></li></ul></blockquote><blockquote><ul style="text-align: left;"><li><span style="color: #2b00fe;">Beyond HPAIV, subtypes <b>H3N8, and H9N2</b> should be monitored as more easily replicating in mammalian (including humans) respiratory tract cells, favouring potential spillover to humans.</span></li></ul></blockquote><blockquote><ul style="text-align: left;"><li><span style="color: #2b00fe;">Information on species-specific susceptibility, and morbidity and mortality of viral genotype-host combinations are scarce; further studies on the susceptibility of mammalian species to infection with the currently circulating strains of the HPAI H5N1 may be warranted, especially in light of the unprecedented reassortment of the Newfoundland-like virus with North American wild bird origin influenza viruses.</span></li></ul></blockquote><blockquote><ul style="text-align: left;"><li><span style="color: #2b00fe;"><b>Subclinical infections are of great importance</b>, while current investigations mostly focus on mass mortality events of marine mammals and other species of conservation interest. Yet, these have been documented experimentally and in the wild, making it very challenging to implement an active surveillance strategy in wild animals. </span></li></ul></blockquote><blockquote><ul style="text-align: left;"><li><span style="color: #2b00fe;">From this review it can be observed that <b>viral mutations are happening</b>, especially with regards to the polymerase activity and the ability to escape mammalian restriction factors, which might favour infections in humans, but no reassortant with human viruses were isolated. </span></li></ul></blockquote><blockquote><ul style="text-align: left;"><li><span style="color: #2b00fe;">Evaluations of North American<b> HPAI H5N2 and H5N8 isolates in human airway cells demonstrated that these were capable of replication</b>, but at reduced titers compared with H5N1 and H1N1 viruses.Currently, there is not enough evidence to determine whether wild mammal species might represent a reservoir for AIVs.</span></li></ul></blockquote><blockquote><ul style="text-align: left;"><li><span style="color: #2b00fe;"><b>Understanding the complex interplay of intrinsic and extrinsic drivers is imperative for pandemic preparedness</b>. Intrinsic drivers might be summarised in host susceptibility and genetic adaptations within mammalian species. Host features that seemed to favour infection were certainly scavenging feeding habits (e.g. generalist mesopredators such as red foxes and mustelids), and, in general, carnivores were more exposed to infection and displayed more viral mammalian adaptations. Broadly, extrinsic risk factors include human-driven influences such as intensive farming practices that create environments conducive to cross-species transmission. Deforestation, urbanisation, and changes in habitats contribute to increased interactions between domestic and wild species, influencing the transmission dynamics of avian influenza. Global trade and travel facilitate the spread of AIVs, with infected avian and mammalian hosts potentially introducing novel strains to different regions.</span></li></ul></blockquote><blockquote style="text-align: left;"><span style="color: #2b00fe;">Considering the above conclusive points, active monitoring is recommended for early detection of AIVs mutations and/or adaptations favouring the spread in mammals, including humans.Vigilant surveillance, research on transmission mechanisms, and proactive measures to mitigate human-wildlife interactions are critical components in averting potential pandemics.</span></blockquote><blockquote style="text-align: left;"><span style="color: #2b00fe;">Surveillance actions might include testing synanthropic and peridomestic birds as well as syndromic surveillance of “at risk” individuals/workers, e.g. people at poultry farms or dealing with infected deceased animals (Leguia et al., 2023; Burns et al., 2012). Coupling PCR-based diagnostics and/or serology of suspected cases is also highly recommended for early detection of clinical infections and transmission (Leguia et al. 2023). Active surveillance should focus on the wildlife-livestock-domestic animal interface, particularly investigating periurban/peridomestic mammals (multiple samples from different apparatus are recommended if possible). </span></blockquote><blockquote style="text-align: left;"><span style="color: #2b00fe;">Nonetheless, these species are usually difficult to monitor, e.g. synanthropic wildlife such as rodents are very abundant and it is challenging to test an adequate proportion of the population. Additionally, diagnostic tests with high sensitivity and specificity are not necessarily available for every single species (e.g. serologic tests might have different sensitivity/specificity in different species). Mice have been commonly observed in rearing poultry facilities and at farms in general and might represent bridgehosts, so rodent control programs might be an addition to current biosecurity programs in poultry farms, specifically for AIVs control (Shriner et al., 2016). In general, rodents are considered reservoirs for zoonotic diseases and thrive in anthropogenically modified habitats (Mendoza et al., 2020; Plourde et al., 2017). </span></blockquote><blockquote style="text-align: left;"><span style="color: #2b00fe;">Other management actions to reduce the risk of transmission between synanthropic wildlife and poultry, at a farm level might be: removing and/or reducing wildlife attractants such as ponds, standing water, food sources, and waste/carcasses; preventing wildlife access to poultry facilities; increasing wildlife deterrents (Shriner et al., 2016).Finally, capacity building in disease prevention, outbreak investigations, and controlling the spread of disease in wildlife (e.g., through carcass removal) should be priorities.</span></blockquote><blockquote style="text-align: left;"><span style="color: #2b00fe;">Our data support the outcomes of other risk assessments on this topic, e.g.t he CDC Influenza Risk Assessment Tool determination that states that<b> HPAI H5N1 viruses do not pose a substantial (although highly potential) risk to public health at this time</b> (CDC, 2022). However, close surveillance of circulating strains and continued assessment of new viruses are crucial to ensure strains with enhanced mammalian fitness are quickly identified.</span></blockquote><p></p><div></div>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-61866803135485996662024-03-07T07:30:00.001-05:002024-03-07T07:30:44.855-05:00Virology: Novel Influenza A Viruses in Pigs with Zoonotic Potential, Chile<span style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;"> </span><img src="https://blogger.googleusercontent.com/img/a/AVvXsEhoft3PSVh4omMkCE33yTisONsieETm14VyLCKeWioWoKZ1EghewYRAL_qLO-Xhma3EKjZiX_O-N_RgsoguWA8TIKH0zZMoI9IV75gw7CpAQk188NL3OgL20GnS9kwPwECdHQGTVyfoekDhz5KXFP5PBT-qMKz4UbKwXYVew7_K5133dutKvU9e8w" style="background: rgb(235, 237, 236); border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; padding: 8px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><p>#17,940</p><p style="text-align: left;">While we watch high profile pandemic contenders like <b>HPAI H5Nx</b>, <b>H7N9</b>, <b>MERS-CoV</b>, <b>Nipah</b>, and `<i><b>Disease X</b></i>' with considerable interest, there are scores of `<i>lesser</i>' pandemic threats in the wild that are probably more likely to emerge.</p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;">In the spring of 2009, while the world was focused on avian flu, we saw <b>a novel H1N1 virus</b> unexpectedly emerge from swine in Mexico, jump to humans, and begin its world tour.<br /><br /></blockquote>While younger people were disproportionately affected, the pandemic turned out to be relatively mild, and was declared over by the summer of 2010.<br /><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">Similar, mild-to-moderate influenza pandemics occurred in 1968 (<b>H3N2</b>) and 1957 (<b>H2N2</b>), while the <b>1918 H1N1 </b>pandemic represents a far more extreme event. But even relatively mild pandemics are costly, both in terms lives lost and/or disrupted and the global economy.</p></blockquote><p>Since all known influenza pandemics (<i>going back 130 years</i>) have stemmed from <b>H1, H2</b>, or <b>H3</b> viruses (see <a href="http://afludiary.blogspot.com/2014/07/are-influenza-pandemic-viruses-members.html"><b>Are Influenza Pandemic Viruses Members Of An Exclusive Club?</b>)</a> - subtypes to which pigs are also highly susceptible - the potential for seeing another swine-origin pandemic virus seems substantial. </p><p>Every year we see a dozen or so confirmed swine variant virus spillovers into humans, mostly from North America and Europe, but these cases are thought to be just the tip of the iceberg. </p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">During a small outbreak of <b>H3N2v</b> (n=13) a dozen years ago, researchers estimated that fewer than<b> 1 in every 200</b> community cases was identified (see<b> <a href="http://afludiary.blogspot.com/2013/06/cid-journal-estimates-of-human.html">CID Journal: Estimates Of Human Infection From H3N2v (Jul 2011-Apr 2012</a>).</b></p></blockquote><p>Most known spillovers have produced only <b>mild or moderate illness</b>, although a few deaths have been reported. Unfortunately, routine surveillance, testing, and reporting on swine influenza (<i>both in pigs and in humans</i>) ranges from intermittent to non-existent around the globe. </p><p><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;">The </span><b style="color: #363636; font-size: 16px;"><a href="https://www.cdc.gov/flu/pandemic-resources/monitoring/irat-virus-summaries.htm" style="color: #3f3f7f; text-decoration-line: none;">CDC's </a><a href="https://www.cdc.gov/flu/pandemic-resources/monitoring/irat-virus-summaries.htm" style="color: #3f3f7f; text-decoration-line: none;">IRAT</a></b><span style="background-color: #ebedec; color: #363636; font-size: 16px;"> </span><span style="background-color: #ebedec; color: #363636; font-size: 16px;">(</span><i style="color: #363636; font-size: 16px;">Influenza Risk Assessment Tool)</i><b style="color: #363636; font-size: 16px;"> </b><span style="color: #363636; font-size: 16px;">lists 3 North American swine viruses as having at least some pandemic potential (</span><i style="color: #363636; font-size: 16px;">2 added in 2019).</i></span></p><blockquote style="background-color: #ebedec; border: none; color: #363636; font-size: 16px; margin: 0px 0px 0px 40px; padding: 0px;"><span style="font-family: inherit;"><b><a href="https://www.cdc.gov/flu/pandemic-resources/monitoring/irat-virus-summaries.htm#H1N2variant" style="color: #3f3f7f; text-decoration-line: none;">H1N2 variant</a> </b>[A/California/62/2018] Jul 2019 5.8 5.7 Moderate<br /><b><a href="https://www.cdc.gov/flu/pandemic-resources/monitoring/irat-virus-summaries.htm#H3N2" style="color: #3f3f7f; text-decoration-line: none;">H3N2 variant</a> </b>[A/Ohio/13/2017] Jul 2019 6.6 5.8 Moderate<br /><a href="https://www.cdc.gov/flu/pandemic-resources/monitoring/irat-virus-summaries.htm#H3N2variant" style="color: #3f3f7f; text-decoration-line: none;"><b>H3N2 variant</b></a> [A/Indiana/08/2011] Dec 2012 6.0 4.5 Moderate</span></blockquote><div><br /></div>In 2021 the CDC ranked a<b> <a href="https://afludiary.blogspot.com/2021/02/cdc-selects-new-swine-variant-ea-h1n1.html">Chinese Swine-variant EA H1N1 `G4' as having the highest pandemic potential</a></b> <i>of any flu virus</i> on their list (see<b> <a href="https://afludiary.blogspot.com/2022/07/eid-journal-zoonotic-threat-of-g4.html">EID Journal: Zoonotic Threat of G4 Genotype Eurasian Avian-Like Swine Influenza A(H1N1) Viruses, China, 2020</a>)</b>.<div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><br /></div><div>But most of the swine-Influenza A viruses (swIAV) that circulate around the world do so largely under our radar. </div></blockquote></div><div><p>Today we've got what is billed as the largest molecular epidemiological study of swine IAV in South America from researchers in Chile. They report finding a number of novel swine IAVs circulating in Chilean swine to which the local population likely has little or no immunity. </p></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div><p style="text-align: left;">This, as one would expect, is a lengthy and detailed report. I've only posted some excerpts, so follow the link to read it in its entirety. </p></div></blockquote><p>I'll have a bit more after the break.</p><div><b><span style="font-size: large;"></span></b><blockquote><span style="color: #2b00fe;"><b><span style="font-size: large;"><a href="https://journals.asm.org/doi/10.1128/spectrum.02181-23">Novel influenza A viruses in pigs with zoonotic potential, Chile</a></span></b><br /><br />Authors: <a href="https://journals.asm.org/doi/10.1128/spectrum.02181-23#con1">Rodrigo Tapia</a>, <a href="https://journals.asm.org/doi/10.1128/spectrum.02181-23#con2">Bárbara Brito</a>, <a href="https://journals.asm.org/doi/10.1128/spectrum.02181-23#con3">Marco Saavedra</a>, <a href="https://journals.asm.org/doi/10.1128/spectrum.02181-23#con4">Juan Mena</a>, <a href="https://journals.asm.org/doi/10.1128/spectrum.02181-23#con5">Tamara García-Salum</a>, <a href="https://journals.asm.org/doi/10.1128/spectrum.02181-23#con6">Raveen Rathnasinghe</a>, <a href="https://journals.asm.org/doi/10.1128/spectrum.02181-23#con7">Gonzalo Barriga</a> DOI: <a href="https://doi.org/10.1128/spectrum.02181-23">https://doi.org/10.1128/spectrum.02181-23</a><br /><br /><a href="https://journals.asm.org/doi/reader/10.1128/spectrum.02181-23"><b><span style="font-size: medium;">PDF/EPUB</span></b></a><br /><br /><b>ABSTRACT</b></span><div><span style="color: #2b00fe;"><br />Novel H1N2 and H3N2 swine influenza A viruses (IAVs) have recently been identified in Chile. The objective of this study was to evaluate their zoonotic potential. We perform phylogenetic analyses to determine the genetic origin and evolution of these viruses, and a serological analysis to determine the level of cross-protective antibodies in the human population. </span></div></blockquote><blockquote><div><span style="color: #2b00fe;"><b>Eight genotypes were identified, all with pandemic H1N1 2009-like internal genes</b>. H1N1 and H1N2 were the subtypes more commonly detected. S<b>wine H1N2 and H3N2 IAVs had hemagglutinin and neuraminidase lineages genetically divergent from IAVs reported worldwide</b>, including human vaccine strains. </span></div></blockquote><blockquote><div><span style="color: #2b00fe;">These genes originated from human seasonal viruses were introduced into the swine population since the mid-1980s. Serological data indicate that the general population is susceptible to the H3N2 virus and that elderly and young children also lack protective antibodies against the H1N2 strains, suggesting that these viruses could be potential zoonotic threats. Continuous IAV surveillance and monitoring of the swine and human populations is strongly recommended.</span></div><div><span style="color: #2b00fe;"><br /><b>(SNIP)</b></span></div></blockquote></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><span style="color: #2b00fe;">Novel <b>H1N2 and H3N2 swine IAVs</b> have recently been identified in Chile. The HA genes of these viruses were likely introduced from humans in the past and now are genetically distant from other IAVs identified in swine and humans globally, including commercial vaccine strains used in pigs.</span></div><br /></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><span style="color: #2b00fe;">These<b> viruses replicated and were shed, without prior adaptation, in the upper respiratory tract of guinea pigs,</b> which were used to evaluate their infection dynamics (</span><a href="https://journals.asm.org/doi/10.1128/spectrum.02181-23#core-B7">7</a><a href="https://journals.asm.org/doi/10.1128/spectrum.02181-23#core-B8">–</a><a href="https://journals.asm.org/doi/10.1128/spectrum.02181-23#core-B9">9</a><span style="color: #2b00fe;">). These findings suggest that these viruses could have public health importance, emphasizing the need to carry out further studies to evaluate the zoonotic potential of these viruses.</span></div></blockquote><div><span style="color: #2b00fe;"><br /></span></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><span style="color: #2b00fe;">Here, we performed a <b>systematic swine and human molecular epidemiological study</b>, analyzing all gene segments to determine the genetic diversity, predominant lineages, and the origins and evolution of swine IAVs circulating in commercial farms in Chile. We also performed a <b>serological analysis to evaluate the presence of cross-reactive antibodies against these swine viruses in the Chilean human population</b>.</span></div></blockquote><p> <span style="color: #2b00fe;"> (<b>SNIP) </b></span> </p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://journals.asm.org/doi/10.1128/spectrum.02181-23" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="696" data-original-width="664" height="400" src="https://blogger.googleusercontent.com/img/a/AVvXsEieu4QVX6lhAZXTse25wGVMO8P5-c7BVakEXYHh3PN2yRrmWEyuUIpXpjyVhY0vydi-nRIYYyu1DsQkqM7gT9wcyhgc146kxrTHdDoQmOsiiLnuB-TyV5Ub11Lq_yubHLmaH7D_vYTf-hMMAjq7itq_-DH-DhPkQpy5ZcTBRr8Dx5PZFrEFe7ZhHg=w382-h400" width="382" /></a></div><p></p><div role="paragraph" style="box-sizing: border-box; margin: 0px 0px 1em;"></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;"> Based on these phylogenetic analyses and their results, we proposed a model of the introduction of human influenza viruses into the swine population in Chile leading to the generation of novel swine IAVs, considering potential introduction times and evolution through multiple reassortment events (<b><a href="https://journals.asm.org/doi/10.1128/spectrum.02181-23#F7">Fig. 7</a>).</b></span></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;"><b><span style="color: #2b00fe;">(SNIP)</span></b></p></blockquote><blockquote><div role="paragraph" style="box-sizing: border-box; margin: 0px 0px 1em;"><span style="color: #2b00fe; font-family: inherit;"><b>In summary,</b> we showed that Chilean swine H1N2 and H3N2 viruses likely originated from human seasonal viruses introduced to the swine population multiple times since the mid-1980s. Our results also show that the introduction of human A(H1N1)pdm09 viruses into swine populations generated a series of additional reassortment events that further diversified the swine IAV genotypes and completely displaced the internal genes of the pre-pandemic swine IAV endemic stains. </span></div><div role="paragraph" style="box-sizing: border-box; margin: 0px 0px 1em;"><span style="color: #2b00fe; font-family: inherit;">Overall, three to four putative reassortment patterns generated eight distinct swine IAV genotypes that circulate in the Chilean swine population today (<a href="https://journals.asm.org/doi/10.1128/spectrum.02181-23#F7">Fig. 7</a>), which differ from other swine and human IAVs previously reported worldwide. <b>Importantly, our results indicate that the general population is susceptible to the swine H3N2 viruses and that the elderly and young children (<10 years of age) also lack protective antibodies against the swine H1N2 strains, suggesting that these viruses could be potential zoonotic threats.</b></span></div><div role="paragraph" style="box-sizing: border-box; margin: 0px 0px 1em;"><span style="color: #2b00fe; font-family: inherit;">To date, this is the largest molecular epidemiological study of swine IAV in South America, contributing to global IAV studies in both humans and animals. Continuous surveillance of IAVs circulating in Chilean swine populations and monitoring of workers in the swine industry are necessary and strongly recommended.</span></div></blockquote><div role="paragraph" style="box-sizing: border-box; margin: 0px 0px 1em;"><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;">Last November the UK reported their first laboratory-confirmed swine variant </span><b style="background-color: #ebedec; color: #363636; font-size: 16px;">H1N2v</b><span style="background-color: #ebedec; color: #363636; font-size: 16px;"> infection (see </span><b style="background-color: #ebedec; color: #363636; font-size: 16px;"><a href="https://afludiary.blogspot.com/2023/11/ukhsa-identifies-1st-h1n2v-swine.html" style="color: #3f3f7f; text-decoration-line: none;">UKHSA Identifies 1st H1N2v (Swine Variant) Infection In the UK</a>), </b><span style="background-color: #ebedec; color: #363636; font-size: 16px;">which raised alarm bells and set off an immediate public health investigation. </span></span></div><div role="paragraph" style="box-sizing: border-box; margin: 0px 0px 1em;"><blockquote style="background-color: #ebedec; border: none; color: #363636; font-size: 16px; margin: 0px 0px 0px 40px; padding: 0px;"><p><span style="font-family: inherit;">In January the <b>ECDC'</b>s journal <i>Eurosurveillance </i>published a <i><a href="https://afludiary.blogspot.com/2024/01/eurosurveillance-case-of-swine.html" style="color: #3f3f7f; text-decoration-line: none;"><b>Rapid Communications</b></a></i> on this event, which describes <b>1 laboratory confirmed</b> - and<i> <b>two probable</b></i> - infections that were detected by the UK's epidemiological investigation. </span></p></blockquote><p style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="font-family: inherit;">Although swine variant viruses are generally not efficiently transmitted between humans (<i>until, as we saw in the H1N1 pandemic of 2009, they suddenly are</i>) some limited human-to-human transmission does appear to occur. </span></p></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div role="paragraph" style="box-sizing: border-box; margin: 0px 0px 1em; text-align: left;">While we've been understandably focused on avian H5Nx viruses the past few months, swine-origin influenza viruses constitute a plausible pandemic threat, are very much worthy of our attention.</div></blockquote>A few recent blogs on these viruses include.<br /><a href="https://afludiary.blogspot.com/2024/02/virologica-sinica-evolution.html"></a><blockquote><b><a href="https://afludiary.blogspot.com/2024/02/virologica-sinica-evolution.html">Virologica Sinica: The Evolution, Pathogenicity & Transmissibility of Quadruple Reassortant H1N2 Swine Influenza Virus in China</a><br /><br /><a href="https://afludiary.blogspot.com/2024/02/who-update-risk-assessment-h1n1v-case.html">WHO Update & Risk Assessment: H1N1v Case In Brazil</a><br /><br /><a href="https://afludiary.blogspot.com/2024/01/preprint-potential-pandemic-risk-of.html">Preprint: Potential Pandemic Risk of Circulating Swine H1N2 Influenza Viruses</a><br /> <br /><a href="https://afludiary.blogspot.com/2023/08/jid-pathogenesis-transmission.html">JID: Pathogenesis & Transmission Assessment of 3 Swine-origin Influenza A(H3N2) viruses in the U.S. from 2017-2020</a></b><div><b><br /><a href="https://afludiary.blogspot.com/2023/08/cdc-eid-journal-interspecies.html">CDC EID Journal: Interspecies Transmission of Swine Influenza A Viruses and Human Seasonal Vaccine-Mediated Protection Investigated in Ferret Model</a><br /><br /><a href="https://afludiary.blogspot.com/2023/06/eid-journal-long-term-epidemiology-and.html">EID Journal: Long-term Epidemiology and Evolution of Swine Influenza Viruses, Vietnam</a><br /><br /><a href="https://afludiary.blogspot.com/2023/02/viruses-swine-to-ferret-transmission-of.html">Viruses: Swine-to-Ferret Transmission of Antigenically Drifted Contemporary Swine H3N2 Influenza A Viruses</a></b></div></blockquote><div><a href="https://afludiary.blogspot.com/2023/02/viruses-swine-to-ferret-transmission-of.html"></a></div>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-44639196971755185252024-03-06T06:48:00.000-05:002024-03-06T06:48:05.703-05:00FDA Statement On Moving To A Trivalent Seasonal Flu Vaccine For 2024-2025<img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdAkNRZX6uaFbpYekKofTVq5NPZQqcajuVofRujQHQehl3DLdRLywZbZE91FkiJBgEhHbcijswwqIFZZLueVSwEdqO5Y0JdVqVWbrf7JymC5-4AG7F5P1u67AZjWIZT4EJcBG6MQ/w200-h162/ACIP+Syringe.png" /><br /><br />Credit ACIP/CDC<br /><br /><p>#17,939</p><br />Twelve years ago this week (see <b><a href="https://afludiary.blogspot.com/2012/03/two-b-or-not-two-b-that-is-question.html">Two B's Or Not Two B's? That Is the Question</a>)</b> the FDA approved the use of a <b>quadrivalent seasonal flu vaccine </b>that would incorporate both influenza B virus lineages (B/Victoria and B/Yamagata). <br /><br /><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">Up until that time, a trivalent formulation, containing <b>two A strains</b> and <b>1 B strain</b>, had been the standard for seasonal influenza vaccines. </blockquote><div><br /></div><div>One of the surprises coming out of our COVID pandemic was the suppression of influenza for the first few years, and the apparent extinction of the B/Yamagata lineage. It has now been 48 months since the last reported human infection. </div><div><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">As a result, the decision was made last fall to remove the B/Yamagata strain from the flu vaccine, and to return to a trivalent shot, as soon as possible. </blockquote><div><br /></div>Yesterday the FDA issued their recommendations for trivalent vaccines to be used in the United States this fall. <br /><br /><b><span style="font-size: large;"></span></b><blockquote><span style="color: #2b00fe;"><b><span style="font-size: large;"><a href="https://www.fda.gov/vaccines-blood-biologics/lot-release/use-trivalent-influenza-vaccines-2024-2025-us-influenza-season">Use of Trivalent Influenza Vaccines for the 2024-2025 U.S. Influenza Season</a></span></b><br /><br /><br />FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC) met on March 5, 2024, to discuss and make recommendations on the selection of influenza viruses for the composition of influenza vaccines for the 2024-2025 U.S. influenza season. This follows the October 5, 2023, VRBPAC meeting during which FDA and the committee engaged in scientific discussion pertaining to the continued need for a quadrivalent formulation of seasonal influenza vaccine for the U.S. as <b>there have been no confirmed detections of circulating B/Yamagata lineage viruses worldwide after March 2020.</b><br /><br />Influenza B viruses are classified into two lineages: B/Yamagata and B/Victoria. However, the evidence indicates that the B/Yamagata lineage virus no longer poses a public health threat. During the October 2023 meeting, the committee unanimously voted to recommend excluding the B/Yamagata lineage component from quadrivalent seasonal influenza vaccines as soon as possible.<br /><br />In the interest of public health,<b> FDA strongly recommended to influenza vaccine manufacturers the removal of the B/Yamagata lineage virus from seasonal influenza vaccines in the U.S. for the 2024-2025 influenza season. </b>FDA and the manufacturers have been working together so that the <b>move from quadrivalent to trivalent seasonal influenza vaccines occurs for the upcoming influenza season</b>.<br /><br /><b>2024-2025 Trivalent Seasonal Influenza Vaccines for the United States</b><br /><br />Influenza virus strains for a trivalent vaccine composition for use in the U.S. were recommended on March 5, 2024, by the Committee based on the influenza vaccine production method: egg-based and cell- or recombinant-based. Trivalent seasonal influenza vaccines include two influenza A viruses (H1N1 and H3N2) and one influenza B virus.<br /><br />During this meeting, the advisory committee reviewed and evaluated the surveillance data related to epidemiology and antigenic characteristics of recent influenza isolates, serological responses to 2023-2024 vaccines, and the availability of candidate strains and reagents.<br /><br />The committee recommended that the trivalent formulation of egg-based influenza vaccines for the U.S. 2024-2025 influenza season contain the following:</span></blockquote><blockquote><ul style="text-align: left;"><li><span style="color: #2b00fe;">an A/Victoria/4897/2022 (H1N1)pdm09-like virus;</span></li><li><span style="color: #2b00fe;">an A/Thailand/8/2022 (H3N2)-like virus; and</span></li><li><span style="color: #2b00fe;">a B/Austria/1359417/2021 (B/Victoria lineage)-like virus.</span></li></ul><span style="color: #2b00fe;">The committee recommended that the trivalent formulation of cell- or recombinant-based influenza vaccines for the U.S. 2024-2025 influenza season contain the following:</span></blockquote><blockquote><ul style="text-align: left;"><li><span style="color: #2b00fe;">an A/Wisconsin/67/2022 (H1N1)pdm09-like virus;</span></li><li><span style="color: #2b00fe;">an A/Massachusetts/18/2022 (H3N2)-like virus; and</span></li><li><span style="color: #2b00fe;">a B/Austria/1359417/2021 (B/Victoria lineage)-like virus.</span></li></ul><span style="color: #2b00fe;"><b>Use of FDA-Approved Quadrivalent Seasonal Influenza Vaccine Outside of the United States for 2024-2025</b><br /><br />Of note, not all countries will be able to revert to trivalent seasonal influenza vaccines as quickly as FDA has facilitated the process for the United States. For those manufacturers who have an existing FDA-approved quadrivalent seasonal influenza vaccine and want to export that quadrivalent vaccine for use outside the United States, the committee also recommended the inclusion of a second B strain, a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus for quadrivalent egg-, cell- or recombinant-based vaccines.<br /><br /><b>Next Steps<br /></b><br />Based on the scientific evidence, and since the October 2023 VRBPAC meeting, FDA has been planning for the use of trivalent seasonal influenza vaccines for the U.S. for the 2024-2025 influenza season. As such, FDA has been engaging and interacting with manufacturers of FDA-approved seasonal influenza vaccines and providing scientific and regulatory advice to them to facilitate the timely availability of approved safe and effective trivalent seasonal influenza vaccines for the 2024-2025 U.S. influenza season. FDA anticipates that there will be an adequate and diverse supply of approved trivalent seasonal influenza vaccines for the United States in the coming season.</span></blockquote><br />Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-56987935049730435732024-03-06T06:21:00.002-05:002024-03-06T06:21:46.926-05:00WHO DON Update & Risk Assessment On Psittacosis In Europe<p></p><div class="separator" style="clear: both;"><img height="213" src="https://blogger.googleusercontent.com/img/a/AVvXsEiisUkrf1a-dpNyezDENHX5e8U1zr442OBhuugSF5dx6rCUevm5wrgNVJlWjO-_zpZgLqiKbDAJsF0gNTvvlIWxEdTXWLTQ_omhwNfXfrYWDsqtoeG89YobDuZlPKoxkqcYCxG-q6ZviyWZyzXXUKwMY40WAH99eqA_IBLUgmVS26UEMnBI6E4Hug=w218-h213" width="218" /></div><span style="font-size: x-small;"><b>5 Nations reporting Psittacosis Uptick</b></span><p></p><p><br /></p><p>#17,938</p><p><br /></p><p>Last week, in <a href="https://afludiary.blogspot.com/2024/03/denmark-ssi-marked-increase-in-parrot.html"><b>Denmark SSI: Marked Increase In Parrot Fever Cases Over the Past 60 Days</b></a>, we looked at reports of an unusual number of Psittacosis cases being reported by Denmark's SSI, along with similar media reports from Sweden. </p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">Psittacosis - often called parrot fever - is a rarely reported, atypical bacterial pneumonia caused by <i>Chlamydia psittaci</i>, which is often carried by wild or captive birds. </p></blockquote><p>Most infections are mild, and usually respond to antibiotic treatment, although untreated it can progress to cause substantial morbidity and mortality. While likely under-reported, the <a href="https://www.cdc.gov/pneumonia/atypical/psittacosis/surveillance-reporting/"><b>U.S. reports roughly 10 cases per year</b></a>. </p><p>Psittacosis (aka `<i>Parrot Fever</i>') has occasionally sparked small outbreaks around the wolrd, such as the following CDC report on an outbreak at two U.S. poultry plants in 2018. </p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://archive.cdc.gov/#/details?url=https://www.cdc.gov/pneumonia/atypical/psittacosis/surveillance-reporting/outbreaks/2018-poultry-multistate-investigation.html" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="478" data-original-width="858" height="178" src="https://blogger.googleusercontent.com/img/a/AVvXsEi6iNtzz5163DMVKk06l-MI-mn8tA6qNwb3s-0ZiLl00u1uRYVIRb8ZW1n9hLkLWDFtT9L8yQsY-cK3ybE_4NuZ06PSO73w9mHm_Bc9jsEb9N8nuIbhyvsUVFXIIf_lJZbOKxeXgtMzeb3KcymGymF64UAMXMg5wXcf94Csq470Unv_NYe1I6l3PA" width="320" /></a></div><p style="text-align: left;">In 1929, before the advent of modern antibiotics, the United States experienced <b><a href="https://afludiary.blogspot.com/2012/03/how-parrot-fever-changed-public-health.html">a short-lived `Parrot Fever Epidemic'</a>,</b> spread by infected birds sold by a pet store in Maryland. By the time it was over, at least 169 cases were reported across several states, along with<b> 33 deaths</b>.</p><p></p><p>While normally spread by (<i>direct or indirect</i>) bird-to-human transmission, in recent years we've seen a few documented instances strongly suggesting human-to-human transmission. </p><p></p><ul style="text-align: left;"><li><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;">In 2012, the journal </span><a href="http://www.eurosurveillance.org/" style="background-color: #ebedec; color: #3f3f7f; font-size: 16px; text-decoration-line: none;" target="_blank"><b>Eurosurveillance</b></a><span style="background-color: #ebedec; color: #363636; font-size: 16px;"> carried a report called </span><a href="http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20186" style="background-color: #ebedec; color: #3f3f7f; font-size: 16px; text-decoration-line: none;" target="_blank"><b>Psittacosis outbreak in Tayside, Scotland, December 2011 to February 2012</b>,</a><b style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="color: blue;"><span style="font-size: small;"> </span></span></b><span style="background-color: #ebedec; color: #363636; font-size: 16px;">involving four family members and a health-care worker, which</span><i style="background-color: #ebedec; color: #363636; font-size: 16px;"> suggested human-to-human transmission</i><span style="background-color: #ebedec; color: #363636; font-size: 16px;">.</span></span></li></ul><ul style="text-align: left;"><li><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;">The following year, in<a href="http://afludiary.blogspot.com/2013/07/sweden-reports-rare-outbreak-of-parrot.html" style="color: #3f3f7f; text-decoration-line: none;"> <b>Sweden Reports Rare Outbreak Of Parrot Fever,</b></a><b> </b>we saw a credible report of human transmission of parrot fever, where a 75 year old man who died in Kronoberg appeared to have s<b>pread the infection </b>to at least <b>8 close contacts</b>, including healthcare personnel.</span></span></li><ul><li>In 2014, the ECDC's Eurosurveillance Journal carried<a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES2014.19.42.20937"><b> a follow up report</b></a> expanding the Swedish outbreak to <b>10</b> secondary cases. </li></ul><li><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;">And in 2018 we saw another example, in</span><b style="background-color: #ebedec; color: #363636; font-size: 16px;"><a href="https://afludiary.blogspot.com/2018/04/plos-currents-psittacosis-outbreak.html" style="color: #3f3f7f; text-decoration-line: none;"> PLoS Currents: A Psittacosis Outbreak Among Office Workers With Little Or No Bird Contact - UK.</a></b></span></li></ul><p></p> Late yesterday afternoon the World Health Organization published a DON (Disease Outbreak News) <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON509"><b>update and risk assessment</b></a> on the recent rise in Psittacosis reported by at least five European nations <i>(Austria, Denmark, Germany, Sweden, and the Netherlands). </i><p><span style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="font-family: inherit;">Due to its length, I've only posted some excerpts. Follow the link to read the full report. </span></span></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><div><span style="color: #2b00fe; font-size: large;"><b><a href="https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON509">Psittacosis – European region</a></b></span></div></div><div><div><span style="color: #2b00fe;">5 March 2024</span></div></div></blockquote><div><div><span style="color: #2b00fe;"><br /></span></div></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div><div style="text-align: left;"><b><span style="color: #2b00fe;">Situation at a Glance</span></b></div></div></blockquote><div><div><span style="color: #2b00fe;"><br /></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><div><span style="color: #2b00fe;">In February 2024, Austria, Denmark, Germany, Sweden and The Netherlands reported through the Early Warning and Response System (EWRS) of the European Union, an increase in psittacosis cases observed in 2023 and at the beginning of 2024, particularly marked since November-December 2023. <b>Five deaths were also reported</b>.<br /><br /><b>Exposure to wild and/or domestic birds was reported in most of the cases</b>. Psittacosis is a respiratory infection caused by Chlamydophila psittaci (C. psittaci), a bacteria that often infects birds. Human infections occur mainly through contact with secretions from infected birds and are mostly associated with those who work with pet birds, poultry workers, veterinarians, pet bird owners, and gardeners in areas where C. psittaci is epizootic in the native bird population.<br /><br />The concerned countries have implemented epidemiological investigations to identify potential exposures and clusters of cases. Additionally, implemented measures include the analysis of samples from wild birds submitted for avian influenza testing to verify the prevalence of C. psittaci among wild birds. The World Health Organization continues to monitor the situation and, based on the available information, assesses <b>the risk posed by this event as low.</b></span></div></div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><div><span style="color: #2b00fe;"><br /><b>(SNIP)</b></span></div></div></blockquote><blockquote><span style="color: #2b00fe;"><b>Epidemiology</b><br /><br />Chlamydophila psittaci is a bacterium that causes the zoonotic disease of psittacosis in humans. Human infections are generally associated with those who work with pet birds, poultry workers, veterinarians, pet bird owners, and gardeners in areas where C. psittaci is epizootic in the native bird population.<br /><br />C. psittaci is associated with more than 450 avian species and has also been found in various mammalian species, including dogs, cats, horses, large and small ruminants, swine, and reptiles. However, birds, especially pet birds (psittacine birds, finches, canaries, and pigeons), are most frequently involved in causing human psittacosis. Disease transmission to humans occurs mainly through inhalation of airborne particles from respiratory secretions, dried faeces, or feather dust. Direct contact with birds is not required for infection to occur.<br /><br />In general, psittacosis is a mild illness, with symptoms including fever and chills, headache, muscle aches and dry cough. Most people begin developing signs and symptoms within 5 to 14 days after exposure to the bacteria. Prompt antibiotic treatment is effective and allows avoiding complications such as pneumonia. <b>With appropriate antibiotic treatment, psittacosis rarely (less than 1 in 100 cases) results in death</b>.<br /><br /><b><span style="font-size: medium;">WHO Risk Assessment</span></b></span></blockquote><div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><span style="color: #2b00fe;">Overall, <b>five countries in the WHO European region reported an unusual and unexpected increase in reports of cases of C. psittaci.</b> <b>Some of the reported cases developed pneumonia and resulted in hospitalization, and fatal cases were also reported.</b></span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">Sweden has reported a general increase in psittacosis cases since 2017, which could be associated with the increased use of more sensitive polymerase chain reaction (PCR) panels. The increase in reported psittacosis cases across all countries requires additional investigation to determine whether it is a true increase in cases or an increase due to more sensitive surveillance or diagnostic techniques.</span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">While birds that carry this disease could be crossing international borders, there is currently no indication of this disease being spread by humans nationally or internationally. Generally, people do not spread the bacteria that causes psittacosis to other people, so <b>there is a low likelihood of further human-to-human transmission of the disease</b>. If correctly diagnosed, this pathogen is treatable by antibiotics.</span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">WHO continues to monitor the situation, and based on the available information<b>, assesses the risk posed by this event as low.</b></span></blockquote></div><br /><b></b><blockquote><span style="color: #2b00fe;"><b><span style="font-size: medium;">WHO Advice</span></b><br /><br />WHO recommends the following measures for the prevention and control of psittacosis:</span><div><ul style="text-align: left;"><li><span style="color: #2b00fe;">increasing the awareness of clinicians to test suspected cases of C. psittaci for diagnosis using RT-PCR.</span></li><li><span style="color: #2b00fe;">increasing awareness among caged or domestic bird owners, especially psittacines, that the pathogen can be carried without apparent illness.</span></li><li><span style="color: #2b00fe;">quarantining newly acquired birds. If any bird is sick, contact the veterinarian for an examination and treatment.</span></li><li><span style="color: #2b00fe;">conducting surveillance of C. psittaci in wild birds, potentially including existing specimens collected for other reasons.</span></li><li><span style="color: #2b00fe;">encouraging people with pet birds to keep cages clean, position cages so that droppings cannot spread among them and avoid over-crowded cages.</span></li><li><span style="color: #2b00fe;">promoting good hygiene, including frequent hand washing, when handling birds, their faeces, and their environments.</span></li><li><span style="color: #2b00fe;">standard infection-control practices and droplet transmission precautions should be implemented for hospitalized patients.</span></li></ul></div></blockquote><div></div>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-32892932195567605872024-03-05T07:37:00.004-05:002024-03-05T07:44:03.626-05:00Emerg. Microbes & Inf.: H7N6 Highly Pathogenic Avian Influenza in Mozambique, 2023 <img src="https://blogger.googleusercontent.com/img/a/AVvXsEhQJZJroXJtAvyvdXTqitqGgsKLJN7jbJ3jHft1oHUI9v1NYLyDSTBc-Qi5VY8mCsqZhzmN06qoyiMC1QD4JbhC1uL0fXUy_xnacNfiNGl_MllcvOiTAmwPUDOOWQnLA0W8W6T1Z8fjmEAZ6ps04UjRKYya5YJT1cimZLqBHnzFQmhLhCevdYNJqw=w320-h296" /><br /><p style="text-align: left;">#17,937</p><p style="text-align: left;">Nine months ago, South Africa - which has been dealing with sporadic outbreaks of HPAI<b> H5Nx</b> since <a href="https://afludiary.blogspot.com/2017/06/oie-south-africa-reports-outbreak-of.html"><b>H5N8 arrived in 2017</b></a> - announced the emergence of a new, <b>HPAI H7N6</b> virus (see <b><a href="https://wahis.woah.org/#/in-review/5095">WOAH report</a></b>) which has spread rapidly through that nation's poultry industry. </p><p style="text-align: left;">The virus appears to have started out as a low path <b>(LPAI) H7N6</b>, carried relatively harmlessly by wild birds, that made its way into domesticated poultry, and then mutated into a HPAI virus. This is a process we've discussed often, most recently in this<a href="https://afludiary.blogspot.com/search?q=LPAI+to+HPAI+spontaneous&max-results=20&by-date=true"> <b>PLoS Pathogens study</b></a><b>.</b></p><p style="text-align: left;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgDEZbQ2EMl1hOutsfTrK6b-IcdYEcEToXvL_X_SELShFcqn-lln1PnhQkQyaNFA-Hx-N2iVLCjo3yaxdZeXijGpUqoLj-T5aMg3M4p6Ufp-nkz9b_D9r4ue0Q1JwdyWy9pCfcv_qGX81jcX9qqJyvLMY8gmVz5hT3AKT-vkRvng9kZrN0Ln-XYuw" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="143" data-original-width="361" height="159" src="https://blogger.googleusercontent.com/img/a/AVvXsEgDEZbQ2EMl1hOutsfTrK6b-IcdYEcEToXvL_X_SELShFcqn-lln1PnhQkQyaNFA-Hx-N2iVLCjo3yaxdZeXijGpUqoLj-T5aMg3M4p6Ufp-nkz9b_D9r4ue0Q1JwdyWy9pCfcv_qGX81jcX9qqJyvLMY8gmVz5hT3AKT-vkRvng9kZrN0Ln-XYuw=w400-h159" width="400" /></a></div><p style="text-align: left;">According to <a href="https://theconversation.com/bird-flu-in-south-africa-expert-explains-whats-behind-the-chicken-crisis-and-what-must-be-done-about-it-215667"><b>a report published last October in The Conversation</b></a>:</p><p style="text-align: left;"></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p style="text-align: left;"><span style="color: #2b00fe; font-family: inherit;"><b><i style="background-color: #eeeeee;">The strain is well-adapted to chickens – it infects them easily and replicates effectively in them, in preference to other avian species – and spreads very easily between birds and farms. An <a href="https://sapa.jshiny.com/jdata/sapa/outbreaklanding/" style="--tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-ring-color: rgba(51,168,204,0.5); --tw-ring-offset-color: #fff; --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-offset-width: 0px; --tw-ring-shadow: 0 0 #0000; --tw-rotate: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-scroll-snap-strictness: proximity; --tw-shadow-colored: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-skew-x: 0; --tw-skew-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; outline: none; overflow-wrap: break-word; white-space: pre-wrap;">estimated</a> 10 million have become infected while 6 million died from the H7N6. A further 1.7 million died from H5N1 earlier in the year. </i></b></span></p></blockquote><p style="text-align: left;">While HPAI H5Nx has spread globally over the past couple of years, this emerging HPAI H7N6 strain has so far remained largely confined to South Africa, although neighboring <b><a href="https://wahis.woah.org/#/in-event/5285/dashboard">Mozambique reported an outbreak of H7Nx</a></b> in October of last year. </p><p style="text-align: left;">We've looked at several outbreaks of H7N6 over the years, including:</p><a href="https://afludiary.blogspot.com/2020/08/australia-victoria-reports-outbreak.html"></a><blockquote style="text-align: left;"><b><a href="https://afludiary.blogspot.com/2020/08/australia-victoria-reports-outbreak.html">Australia: Victoria Reports Outbreak From 3rd Avian Flu Subtype (H7N6) In A Month</a><br /><br /><a href="https://afludiary.blogspot.com/2019/02/frontiers-in-microbiology-novel.html">Frontiers in Microbiology: A Novel Reasortant H7N6 Is Transmissible in Guinea Pigs via Respiratory Droplets</a><br /></b></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; position: relative; text-align: left;"><b><a href="https://afludiary.blogspot.com/2017/01/chile-moa-reports-2nd-lpai-h7-outbreak.html" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">Chile: MOA Reports 2nd LPAI H7 Outbreak Near Valparaiso</a> </b></div></blockquote><blockquote style="text-align: left;"><b><a href="https://afludiary.blogspot.com/2009/03/japan-aichi-prefecture-strain.html">Japan: Aichi Prefecture Strain Identified As H7N6</a></b></blockquote><a href="https://afludiary.blogspot.com/2009/03/japan-aichi-prefecture-strain.html"></a><p style="text-align: left;">Today's article further identifies Mozambique's H7 virus as HPAI H7N6, links it to the South African outbreak, and discusses its <b>zoonotic potential</b> and its impact on local poultry production. Due to its length, I've only posted some excerpts.</p><p style="text-align: left;">Follow the link to read the report in its entirety. I'll have a postscript after the break. </p><blockquote style="text-align: left;"><span style="color: #2b00fe;"><b><span style="font-size: large;"><a href="https://www.tandfonline.com/doi/full/10.1080/22221751.2024.2321993">H7N6 highly pathogenic avian influenza in Mozambique, 2023</a></span></b><br /><br /><a href="https://www.tandfonline.com/author/Monjane%2C+Iolanda+Vieira+Anahory">I<span style="font-family: inherit;">olanda Vieira Anahory Monjane</span></a><span style="font-family: inherit;">, <a href="https://www.tandfonline.com/author/Djedje%2C+Hern%C3%A2ni">Hernâni Djedje</a>, <a href="https://www.tandfonline.com/author/Tamele%2C+Esmeralda">Esmeralda Tamele</a>, <a href="https://www.tandfonline.com/author/Nhabomba%2C+Virg%C3%ADnia">Virgínia Nhabomba</a>,<br /><a href="https://www.tandfonline.com/author/Tivane%2C+Almiro+Rog%C3%A9rio">Almiro Rogério Tivane</a>, <a href="https://www.tandfonline.com/author/Massicame%2C+Zacarias+Elias">Zacarias Elias Massicame</a>,<a href="https://www.tandfonline.com/doi/full/10.1080/22221751.2024.2321993#"> show all</a><br />Article: 2321993 | Received 12 Dec 2023, Accepted 16 Feb 2024, Published online: 29 Feb 2024<br /> <a href="https://doi.org/10.1080/22221751.2024.2321993"><b>https://doi.org/10.1080/22221751.2024.2321993</b></a> <br /><br /><b>ABSTRACT</b><br /><br />On 13 October 2023, the National Directorate for Livestock Development in Mozambique was notified of a suspected outbreak of avian influenza in commercial layers. Samples were screened by real-time and conventional RT–PCR and <b>were positive for both H7 and N6.</b> Full genome sequences were obtained for three representative samples. Sequence analysis of the H7 cleavage site confirmed that the viruses were <b>highly pathogenic</b> (i.e. 333- PEPPKGPRFRR/GLF-346). </span></span></blockquote><blockquote style="text-align: left;"><span style="color: #2b00fe;"><span style="font-family: inherit;">In addition, the<b> H7 and N6 sequences were highly similar (from 99.4-99.5% and 99.6-99.7% for the HA gene and the NA gene, respectively) to the sequences of a H7N6 virus identified in the Republic of South Africa</b> in May 2023 indicating a similar origin of the viruses. The identification of H7N6 HPAIV in Mozambique has important implications for disease management and food security in the region.<br /></span><br /><br /><br />Highly pathogenic avian influenza (HPAI) is caused by H5 and H7 subtypes of type A influenza virus. In the last number of years, global attention has been focused on the spread and impact of H5Nx viruses that have caused devastating outbreaks in both domestic and wild bird populations worldwide [<a href="https://www.tandfonline.com/doi/full/10.1080/22221751.2024.2321993#">Citation1</a>]. However, H7 subtype viruses have also caused numerous outbreaks in domestic poultry. Examples include H7N1 outbreaks in Italy; H7N2 outbreaks in Australia, USA, UK; H7N3 in Canada, Chile, Italy, Mexico, Pakistan; H7N4 in Australia; H7N7 in Australia, Germany, Italy, Spain, the Netherlands, United Kingdom; H7N8 and H7N9 in the USA [<a href="https://www.tandfonline.com/doi/full/10.1080/22221751.2024.2321993#">Citation2</a>, <a href="https://www.tandfonline.com/doi/full/10.1080/22221751.2024.2321993#">Citation3</a>].<br /><br />The most recent outbreaks caused by an H7 subtype virus were reported in the Republic of South Africa (RSA) in May 2023 [<a href="https://www.tandfonline.com/doi/full/10.1080/22221751.2024.2321993#">Citation4</a>]. This H7N6 virus has resulted in the death or culling of tens of thousands of poultry (layers). Following the occurrence of the H7N6 (and previous H5N8, H5N1, H5N2 outbreaks) in the RSA, the Ministry of Agriculture and Rural Development (MADER) in Mozambique suspended the importation of live domestic and wild birds and poultry products from the RSA on 6 October 2023. Additionally, prevention and surveillance measures were reinforced throughout the national territory.<br /><br />As a result of the intensification of these measures, on 13 October 2023, MADER was notified of the suspected occurrence of avian influenza in a commercial poultry farm in the district of Morrumbene, Inhambane province, 500 km northeast of the capital Maputo. The birds showed enteric and respiratory symptoms with increased morbidity and mortality (the mortality was an average of 400 birds per day). The farm consisted of three sheds housing 45,000 birds (approximately 15,000 thousands birds perished). Abnormal mortality was recorded by the farm on September 25th with a total of 64 dead birds. On September 29th, the company reported the death of 102 birds in shed #1. On October 5th, the two remaining sheds recorded unusual mortality with cases increasing in shed #2 from 14 to 28 and in shed #3 from 12 to 57. Two days later the number of dead birds increased dramatically to 128 in shed #2 and 214 in shed #3. Virus spread was believed to have been due to poor biosecurity and the movement of individuals between the sheds. It was also determined that 45,000 live birds (17 weeks of age) were introduced into the farm between 30 August and 7 September 2023 in three different batches of 15,000 birds per batch, from an establishment certified as free of avian influenza in the North West province of the RSA.<br /><br /><b>(SNIP)</b><br /><br /><b>The zoonotic potential of this new virus should be considered</b>. H7N2, H7N3, H7N7 viruses have all been previously associated with conjunctivitis and/or respiratory symptoms in humans while in 2003 in the Netherlands a fatal case occurred following an infection with H7N7 [<a href="https://www.tandfonline.com/doi/full/10.1080/22221751.2024.2321993#">Citation8</a>, <a href="https://www.tandfonline.com/doi/full/10.1080/22221751.2024.2321993#">Citation9</a>]. In March 2013, cases of human avian influenza A(H7N9) were reported in China and to date there have been 616 recorded deaths due to this virus [<a href="https://www.tandfonline.com/doi/full/10.1080/22221751.2024.2321993#">Citation10</a>]. More recently, in 2018, a human infection by an H7N4 virus was reported in China [<a href="https://www.tandfonline.com/doi/full/10.1080/22221751.2024.2321993#">Citation11</a>].<br /><br />To date, there have been several identifications of H7N6 subtype viruses in wild birds but they have all been of low pathogenicity. There have been some recent reports of low pathogenic H7N6 viruses in poultry in Chile and Cambodia but none of these viruses have caused significant disease [<a href="https://www.tandfonline.com/doi/full/10.1080/22221751.2024.2321993#">Citation12</a>, <a href="https://www.tandfonline.com/doi/full/10.1080/22221751.2024.2321993#">Citation13</a>].<br /><br />Currently, there is <b>not enough data publicly available on the circulation of H7N6 in the southern African region to make meaningful comparisons and to identify a definitive source of the outbreak in Mozambique</b> but there is no doubt that there is a molecular epidemiological link between the H7N6 viruses identified in Mozambique and those in the RSA. Analysis of viruses from similar outbreaks in the region will add greatly to understanding the movement and potential impact of this new subtype. In the meantime, a risk based active surveillance should be initiated with national veterinary authorities remaining vigilant and prepared to control and manage possible future outbreaks of H7N6.</span></blockquote><p style="text-align: left;"><span style="color: #2b00fe;"> <b><a href="https://www.tandfonline.com/doi/full/10.1080/22221751.2024.2321993">(Continue . . .)</a></b></span></p><p style="text-align: left;"><br />While the following <a href="https://www.fao.org/animal-health/situation-updates/sub-saharan-africa-hpai/"><b>FAO map</b></a> makes it appear as if avian flu is quite limited in Sub-Saharan Africa, the reality is that surveillance, testing, and reporting across most of this region is nearly non-existent<b> (</b>see 2017's<b> <a href="https://afludiary.blogspot.com/2017/01/the-challenge-of-avian-flu-surveillance.html">The Challenge Of Avian Flu Surveillance In Sub-Saharan Africa</a>).</b> </p><p style="text-align: left;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://www.fao.org/animal-health/situation-updates/sub-saharan-africa-hpai/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="602" data-original-width="625" height="193" src="https://blogger.googleusercontent.com/img/a/AVvXsEjurGxw1wXsOcq4RLSDj98sQLXfdCUwQju1jAzLxAZYB1Powl72kydXqSMrdtkmBQbTi6FnQ9vCn6lvzbwv2E-HzCrNrhED_Cnx9URtzc1lvYS7Y4_tFyhR77OyejxIS6sXS3UV39oGcwNxP4tIHOV4aQq8hIbWRT5ZZckVOYAS_mTXhUHZXvCh-A=w200-h193" width="200" /></a></div><br /><p style="text-align: left;"></p>Until LPAI H7N9 appeared in China during the winter/spring of 2013, Low Path H7 viruses were generally regarded as less of a threat than H5 avian viruses, and primarily a risk to poultry.<br /><br /><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">Human infection with any H7 virus (LPAI or HPAI) until then had been rare, and generally mild (see </blockquote><br />All of that changed when <b>LPAI H7N9</b> - which is carried asymptomatically in birds - began infecting humans and driving a yearly epidemic with an estimated 30% Case Fatality rate in humans. Over 1,500 cases and > 600 deaths were officially reported by China over 5 years. <br /><br /><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; margin-bottom: 0.5em; margin-left: auto; margin-right: auto; padding: 4px; position: relative; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://wwwnc.cdc.gov/eid/article/24/1/17-1393_article" style="clear: left; color: #007f7f; margin-bottom: 1em; margin-left: auto; margin-right: auto;" target="_blank"><img border="0" data-original-height="273" data-original-width="775" height="112" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0thl4iOsRj6agShtGLSwCyIURFGEcinrZyJHN-91oRiVGEyUhVkXQyhL10WT0aLMI7HCbw8DLCKZ3nD3-LzmhAtH-9lxI8FUXRYmYfsdUdtTvKPl1zhIHjJlzixam0YbHH5ZDZw/w320-h112/EID+Journal+Wave+5.JPG" style="background: transparent; border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; padding: 8px; position: relative;" width="320" /></a></td></tr><tr><td class="tr-caption" style="font-size: 12.8px; text-align: center;"><b><a href="https://wwwnc.cdc.gov/eid/article/24/1/17-1393_article" style="color: #3f3f7f; text-decoration-line: none;" target="_blank">H7N9 Waves - Credit EID Journal</a></b></td></tr></tbody></table><br /><div>Ever since then, LPAI and HPAI H7 viruses have garnered new respect as zoonotic threats. In 2016's<span style="color: #2b00fe;"><b> <a href="https://afludiary.blogspot.com/2016/11/j-virol-potential-for-lpai-h7-to-cause.html" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">J. Virol: Potential For LPAI H7 To Cause Disease In A Mammalian Model</a>, </b></span>we looked at an attempt to quantify those risks.<br /><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;">Researchers tested 30 <b>LPAI H7 </b>viruses collected from North America on DBA/2J mice, and found 90% of them produced varying degrees of mortality. Remarkably<b> 75%</b> (24 of 30) were as pathogenic as the 2013 Anhui strain of H7N9. Duck borne viruses tended to be more pathogenic than shorebird viruses.</div></blockquote><div> <br />These viruses replicated beyond the respiratory system of these mice (i<i>ncluding in their hearts and brains</i>), and while they bound <b>preferentially to avian α2,3</b> receptor cells, they demonstrated some ability to bind to mammalian <b>α2,6 receptors</b>.</div><div><br /></div><div>While China's H7N9 epidemic (<i>at least for now,</i> <i>suppressed by their <a href="https://afludiary.blogspot.com/2019/04/ofid-avian-h5-h7-h9-contamination.html"><b>H5+H7 vaccination campaign</b></a></i>) has been our closest call with an H7 virus, along the way we've seen lesser events including:</div><a href="https://afludiary.blogspot.com/2018/02/who-update-risk-assessment-on-avian-h7n4.html"></a><blockquote><b><a href="https://afludiary.blogspot.com/2018/02/who-update-risk-assessment-on-avian-h7n4.html">WHO Update & Risk Assessment On Avian H7N4</a><br /><br /><a href="https://afludiary.blogspot.com/2018/11/j-infect-dis-serological-evidence-of.html">J Infect Dis: Serological Evidence Of H7N2 Infection Among Animal Shelter Workers, NYC 2016</a></b><div><b><br /><a href="https://afludiary.blogspot.com/2013/09/ecdc-update-assessment-human-infection.html">ECDC Update & Assessment: Human Infection By Avian H7N7 In Italy</a><br /><br /><a href="https://afludiary.blogspot.com/2012/09/mmwr-mild-h7n3-infections-in-two.html">MMWR: Mild H7N3 Infections In Two Poultry Workers - Jalisco, Mexico</a></b></div></blockquote><div><a href="https://afludiary.blogspot.com/2012/09/mmwr-mild-h7n3-infections-in-two.html"></a>A pattern that suggests that we will continue to see new H7 threats emerge over time. </div>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-56447661086423484432024-03-04T06:49:00.000-05:002024-03-04T06:49:01.497-05:00EID Journal: Chlamydia pneumoniae Upsurge at a Tertiary Hospital, Lausanne, Switzerland<img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRJaWBhElSTYFZFwbHT00MF3h7P6p5zDClG6gmqvcgDb7FSws6NS3Yg0TvVqphxq61qpNKUKz6tz6q2ZKiljzIaY-6J4X8UURyib6-RIKCir-iCheAmSoxKiBtInEU7DrXXEVnfA/w200-h176/Petri+Dish+EID.png" style="background: rgb(235, 237, 236); border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; padding: 8px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><p><span style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;">Credit EID Journal</span><span style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;"> </span> </p><p>#17,936</p>Over the past year we've seen numerous outbreaks of CAP (<i>Community Acquired Pneumonia</i>) around the world, with large epidemics of<i> Mycoplasma Pneumonia</i> reported last fall in China (see <b><a href="https://afludiary.blogspot.com/2023/11/who-statement-don-on-respiratory.html">WHO Statement (DON) On Respiratory Illness Surge Reported In Northern China</a>)</b>, along with outbreaks in Europe (see <b><a href="https://afludiary.blogspot.com/2023/12/ecdc-on-increased-mycoplasma-pneumonia.html">ECDC On Increased Mycoplasma Pneumonia Reported In EU/EEA Countries</a>)</b>.<blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">Late last week we looked at a report from Denmark's SSI on a <a href="https://afludiary.blogspot.com/2024/03/denmark-ssi-marked-increase-in-parrot.html" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"><b>Marked Increase In Parrot Fever Cases Over the Past 60 Days</b></a>, and we've seen a recent risk assessment on increased incidence of <b><a href="https://afludiary.blogspot.com/2024/02/ecdc-risk-assessment-increase-of.html">H</a><a href="https://afludiary.blogspot.com/2024/02/ecdc-risk-assessment-increase-of.html">ypervirulent Carbapenem-Resistant Klebsiella pneumoniae in the EU/EEA</a> </b>as well.</p></blockquote> Often the cause of CAP goes undetermined. A 2015 study published in the NEJM (see <b><a href="http://afludiary.blogspot.com/2015/07/the-cdcs-epic-ca-pneumonia-study.html">The CDC’s EPIC CA-Pneumonia Study)</a> </b>followed 2500 cases over 5 years and found that in the majority (62%) of cases <i>no definitive pathogenic agent </i>was identified.<div><br /></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div><div><div style="text-align: left;">Today we've a research letter, published last week in the CDC's EID Journal, on another recent surge in CAP - this time <i><b>Chlamydia pneumoniae </b>(not to be confused with Chlamydia psittaci aka `Parrot Fever</i>') - in Switzerland.</div></div></div></blockquote><br />While <i>C. pneumoniae</i> infection often produces only mild disease, serious complications can occur, including encephalitis and myocarditis. <a href="https://www.cdc.gov/pneumonia/atypical/cpneumoniae/hcp/treatment.html"><b>According to the CDC </b></a>this bacterial infection is increasingly resistant to penicillin, Ampicillin, and Sulfa drugs it is still generally susceptible to Macrolides, Tetracyclines and Fluoroquionolones.<div><br /><div><div><div>First some excerpts, then I'll return with a bit more. </div><br /><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">Research Letter<br /><b><span style="font-size: large;"><a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610_article">Chlamydia pneumoniae Upsurge at a Tertiary Hospital, Lausanne, Switzerland</a></span></b></span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">Florian Tagini, Onya Opota, and Gilbert Greub<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610_article#comment"><img border="0" src="https://wwwnc.cdc.gov/eid/content/images/icon/email.gif" /><br /></a>Author affiliation: Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland</span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><b><span style="color: #2b00fe;">Abstract</span></b></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><b><span style="color: #2b00fe;">Chlamydia pneumoniae infection cases have usually accounted for <1.5% of community-acquired respiratory tract infections. Currently, Lausanne, Switzerland is experiencing a notable upsurge in cases, with 28 reported within a span of a few months. This upsurge in cases highlights the need for heightened awareness among clinicians.</span></b></blockquote><span style="color: #2b00fe;"><br /><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">The intracellular bacterium Chlamydia pneumoniae is a recognized cause of community-acquired pneumonia (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610_article#r1">1</a>). High-frequency estimates were initially derived from serologic studies, but the advent of molecular techniques has revealed rates that are generally <1.5% among patients with respiratory tract infections, although epidemiological change between initial and current rate estimates cannot be ruled out (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610_article#r2">2</a>,<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610_article#r3">3</a>). Sporadic outbreaks have been documented, such as a 2014 prison outbreak in Texas (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610_article#r4">4</a>) and a 2016 community-acquired pneumonia outbreak in South Korea (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610_article#r5">5</a>). In recent years, studies have also linked C. pneumoniae bacteria to bronchitis and asthma (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610_article#r6">6</a>). C. pneumoniae bacteria has also been documented in patients with cystic fibrosis (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610_article#r7">7</a>). Of note, infections occur at higher rates in children than in adults (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610_article#r2">2</a>).</span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;"><b>At the height of the SARS-CoV-2 pandemic, C. pneumoniae bacteria detection rates were low, paralleling the near-extinction state observed for Mycoplasma pneumoniae bacteria in Europe</b> (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610_article#r8">8</a>). However, a current rebound of M. pneumoniae infections is occurring (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610_article#r9">9</a>). We report a similar increase in PCR-positive C. pneumoniae bacteria detection rates at a tertiary hospital in Switzerland. As the case series and the analysis thereof derive from the pathogen surveillance to which our institute is legally bound by the health authorities, Swiss legislation on human research is not applicable and the consent of the patients concerned is not required. This publication complies with the applicable data protection legislation and institutional guidelines.</span></blockquote><div><span style="color: #2b00fe;"><br /></span><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjrO0wXAH9SI6Dwx2y0mJONV7fw6ZPKcctP17Q7H3Ykr4hjL5hDNczY6ww33sRlECMZf23kgZCrkMCFCIpa67qtp0pRHOfXuPH9r5O_nAttVXJ_xSCnHJFEibjRTmYnmzQlXMMBk6qzuhEVVHJIROs40l4jPBdFCuzNUQFan1-vEhq40rl6tTlreg" style="margin-left: 1em; margin-right: 1em;"></a></span><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjrO0wXAH9SI6Dwx2y0mJONV7fw6ZPKcctP17Q7H3Ykr4hjL5hDNczY6ww33sRlECMZf23kgZCrkMCFCIpa67qtp0pRHOfXuPH9r5O_nAttVXJ_xSCnHJFEibjRTmYnmzQlXMMBk6qzuhEVVHJIROs40l4jPBdFCuzNUQFan1-vEhq40rl6tTlreg" style="margin-left: 1em; margin-right: 1em;"></a><a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610_article" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="816" data-original-width="1121" height="233" src="https://blogger.googleusercontent.com/img/a/AVvXsEgPGzPLmE4kq82oWmaQSdG_P33u-CRZZxke0TIIbWn7869MBrPNQRqNV45CAZogby-wi13xV8Ks49DGFovpir7ogXIpL3qa6twRyrBm9TNDaiVzycMcZO9DufJ4xjE0Cd6KoFkwiQ2FkWAmeBAvv6zlRMZahNp6Mbghhy9hxJr4USq883mikPpKeA" width="320" /></a></span></div><span style="color: #2b00fe;"><br /></span></div></div><blockquote><div><span style="color: #2b00fe;">During routine epidemiologic surveillance at Lausanne University Hospital in Lausanne, Switzerland, positive <b>C. pneumoniae bacteria PCR rates surged to 3.61% during October–December 2023, peaking at 6.66% in October</b>, contrasting with the usual 0%–0.75% range reported over the past decade (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610-f1">Figure 1</a>, panel A, B). The PCR method we used for testing has been previously described in Opota et al. (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610_article#r10">10</a>). </span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">In this most recent outbreak, <b>we documented C. pneumoniae bacteria in 28 patients in 2023; of those, 20 were children (mean age 8 years) and 8 were adults (mean age 43 years).</b> Patients with C. pneumoniae bacteria sometimes reported wheezing as a major clinical complaint. We tested bacterial loads in patients positive for C. pneumoniae bacteria and found that the mean bacterial load was 1,534,821 DNA copies/mL (range 200–11,998,897 DNA copies/mL). We collected nasopharyngeal swabs most frequently (n = 24), whereas we collected sputum samples (n = 5) and nasal swab samples (nostril only, n = 1) less frequently. Of note, bacterial loads were not higher in the analyzed sputa than in the nasopharyngeal swabs (p = 1 by Wilcoxon rank-sum test) (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610-f2">Figure 2</a>).<br /><br />The results of this analysis should be interpreted with caution in the absence of a larger number of paired samples. This analysis includes only 2 paired samples exhibiting <1 logarithm (decimal) of difference in DNA copies per milliliter.<br /><br />To explain this sudden surge of C. pneumoniae bacterial infection, we suspect 2 primary factors. First, decreased immunity may have developed because of fewer circulating strains in the population over the past 3 years, related to SARS-CoV-2 transmission prevention measures. Second, recently relaxed hygiene standards after the SARS-CoV-2 pandemic may have increased the risk for infection.<br /><br /><b>(SNIP)</b></span></div><div><span style="color: #2b00fe;"><br />In conclusion, we outline an upsurge of C. pneumoniae bacterial infections in the Lausanne region of Switzerland, especially in the pediatric population, raising concerns for other settings and regions. We found<b> no clear epidemiologic link between patients</b>, which suggests that<b> we are detecting a minority of cases and that infections may occur at higher rates in the community than we have documented</b>. This local finding highlights the importance of considering this intracellular bacterium as a causative agent, along with other fastidious organisms such as M. pneumoniae bacteria, which are also on the rise (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1610_article#r9">9</a>).<br /><br /><span style="font-size: x-small;">Dr. Tagini is a trainee in clinical microbiology and infectious diseases at the Lausanne University Hospital. His research interests are focused mainly on intracellular bacteria and bacterial genomics.</span></span></div></blockquote><div><br /></div><div>As we discussed last December in <b><a href="https://afludiary.blogspot.com/2023/12/chinas-growing-antibiotic-resistance.html">China's Growing Antibiotic Resistance Problem</a>, </b>overuse of antibiotics has led to greatly increased<b> AMR</b> (antimicrobial resistance) among common CAP bacteria in Asia.<br /><span style="font-family: inherit;"><br /></span></div></div></div></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div><div><div><div style="text-align: left;"><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;">Resistance runs as high as</span><b style="color: #363636; font-size: 16px;"> 90% in parts of China </b><span style="background-color: #ebedec; color: #363636; font-size: 16px;">- with rates in the United States estimated at roughly</span><b style="color: #363636; font-size: 16px;"> 10%</b><span style="background-color: #ebedec; color: #363636; font-size: 16px;">, and even lower in much of Europe (</span><i style="color: #363636; font-size: 16px;">see chart below)</i><span style="background-color: #ebedec; color: #363636; font-size: 16px;">. </span></span></div></div></div></div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><div><div class="separator" style="background-color: #ebedec; clear: both; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; text-align: center;"><a href="https://www.frontiersin.org/articles/10.3389/fped.2023.1115009/full" style="color: #3f3f7f; margin-left: 1em; margin-right: 1em; text-decoration-line: none;"><img alt="" data-original-height="640" data-original-width="682" height="300" src="https://blogger.googleusercontent.com/img/a/AVvXsEiDGFmMFXG-hR3oGBCN_d_XLZPf5rj45RARKSxFIq0VyKOxZ7wdmvW2bw7FSXq13CA1GCamncH8J-4OWfi9s-zlGvPUdqEK7JMUIXtWuVeeCoZMOmNCI_o3KX2N_u33sgivrL5BJT1eFzWE9eskOaXI4s2a7yR_GGP1kfzdkG5Fs9sTMZ9deOkcBw=w320-h300" style="background: transparent; border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; padding: 8px; position: relative;" width="320" /></a></div><p style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;"></p></div></div></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div><div style="text-align: left;"><span style="font-size: x-small;">Credit: <a href="https://www.frontiersin.org/articles/10.3389/fped.2023.1115009/full"><b>The molecular characteristics, diagnosis, and treatment of macrolide-resistant Mycoplasma pneumoniae in children</b></a> Frontiers in Peds. March 2023</span></div></div></blockquote><div><div style="text-align: left;"><br /></div></div><div style="text-align: left;">We live in a hugely interconnect world, and the odds that these resistant pathogens will remain sequestered in Asia are remote. </div><div style="text-align: left;"><span style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;"><br /></span></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;">As we've discussed often (see</span><b style="background-color: #ebedec; color: #363636; font-size: 16px;"> <a href="https://afludiary.blogspot.com/2023/01/massachusetts-dph-first-detection-of.html" style="color: #3f3f7f; text-decoration-line: none;">here</a>, <a href="https://afludiary.blogspot.com/2021/03/ecdc-risk-assessment-emergence-of.html" style="color: #3f3f7f; text-decoration-line: none;">here</a></b><span style="background-color: #ebedec; color: #363636; font-size: 16px;">, and</span><span style="background-color: #ebedec; color: #363636; font-size: 16px;"> </span><a href="https://afludiary.blogspot.com/2019/01/uk-launches-5-year-action-plan-against.html" style="background-color: #ebedec; color: #3f3f7f; font-size: 16px; text-decoration-line: none;"><b>here</b></a><span style="background-color: #ebedec; color: #363636; font-size: 16px;">), every year we draw a little closer to an oft-predicted `</span><i style="background-color: #ebedec; color: #363636; font-size: 16px;">post-antibiotic era</i><span style="background-color: #ebedec; color: #363636; font-size: 16px;">', where something as simple as a scraped knee, community acquired pneumonia (CAP), or elective surgery, could prove deadly.</span></span></div></blockquote><div style="text-align: left;"><span style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;"><br /></span></div><div style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="font-family: inherit;">Antibiotics still work today for<i> most</i> infections, but for tens of thousands of people every year, the <i>`post-antibiotic era' </i>is already here. According to<b> <a href="https://www.cdc.gov/media/releases/2022/s0712-Antimicrobial-Resistance.html" style="color: #3f3f7f; text-decoration-line: none;">a recent report from the CDC</a>:</b></span></div><div style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="font-family: inherit;"><br /></span></div><blockquote style="background-color: #ebedec; border: none; color: #363636; font-size: 16px; margin: 0px 0px 0px 40px; padding: 0px;"><span style="color: #2b00fe;"><span style="font-family: inherit;"><b><a href="https://www.cdc.gov/drugresistance/biggest-threats.html" style="color: #3f3f7f; text-decoration-line: none;">In the 2019 report</a>,</b> the last year comprehensive healthcare and community data were available to calculate, CDC estimated that more than 2<b>.8 million antimicrobial-resistant infections occur in the U.S. each year</b>, with more than<b> 35,000 people dying </b>as a result.</span></span></blockquote><p><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;">Complicating matters, the prolonged COVID pandemic proved to be </span><b style="color: #363636; font-size: 16px;"><a href="https://afludiary.blogspot.com/2022/07/cdc-covid-19-reverses-progress-in-fight.html" style="color: #007f7f;">a setback for the fight against antimicrobial resistance </a></b><span style="background-color: #ebedec; color: #363636; font-size: 16px;">in the United States</span><span style="background-color: #ebedec; color: #363636; font-size: 16px;"> </span><i style="color: #363636; font-size: 16px;">(see below)</i><span style="background-color: #ebedec; color: #363636; font-size: 16px;">, and presumably many other places in the world.</span></span><span style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;"> </span></p><p style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;"></p><div class="separator" style="background-color: #ebedec; clear: both; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjqHWhdOf5KypjutG6DaCLCBPyjtAf8rzwIPsSaLVgL8u6rgw0DxmfB5Y86h-Kx9XxvOr7QjAWrt8VZ1u0Ayzs3WOrlLs5zwHqlazSUX8pvY24Xh7MmOY_cp90Kx4H-WUxprw7EUlzDWSh3vF0TJe0-2tI7uC8xgNpzSL-WVtt_l286Gs4aZQy6qA" style="color: #3f3f7f; margin-left: 1em; margin-right: 1em; text-decoration-line: none;"><img alt="" data-original-height="226" data-original-width="400" height="226" src="https://blogger.googleusercontent.com/img/a/AVvXsEjqHWhdOf5KypjutG6DaCLCBPyjtAf8rzwIPsSaLVgL8u6rgw0DxmfB5Y86h-Kx9XxvOr7QjAWrt8VZ1u0Ayzs3WOrlLs5zwHqlazSUX8pvY24Xh7MmOY_cp90Kx4H-WUxprw7EUlzDWSh3vF0TJe0-2tI7uC8xgNpzSL-WVtt_l286Gs4aZQy6qA=w400-h226" style="background: transparent; border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; padding: 8px; position: relative;" width="400" /></a></div><br /><span style="font-family: inherit;">Short of seeing another COVID or 1918-like pandemic, the biggest threat to global health over the next decade or two is undoubtedly antimicrobial resistance. </span><br /><br />While I cover AMR topics occasionally in this blog, I can heartily recommend <a href="http://www.cidrap.umn.edu/asp"><b>CIDRAP's Antimicrobial Stewardship Project</b></a> as the best place to learn about the growing global threat of AMR.Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-2047436592462182742024-03-03T08:44:00.004-05:002024-03-03T08:55:03.880-05:00Viruses: Genetic and Biological Characteristics of Duck-Origin H4N6 Avian Influenza Virus Isolated in China in 2022<p></p><div class="separator" style="clear: both;"><a href="https://www.mdpi.com/1999-4915/16/2/207"><img height="148" src="https://blogger.googleusercontent.com/img/a/AVvXsEiQNpwgJ-raUmAUDdpHPxiv0rmD1vA0XdOnvCWXrVF666lML-BB5Ln5qTOeUQk62WZx6Lo9pBB4JuShRIADFwSJld94Lmwaq3xZ2s9Reorv-x3oEcz_8oT2zXGQ9ZvCiyf4xxKCi_MT9xQH0iJt9myMRWRBRmRriqRNt1Qgr_QSs61za2U8bTEhWQ=w320-h148" width="320" /></a></div><p></p><p>#17,935</p><p>Divining exactly what is going on with avian flu, COVID, or any other emerging disease threat in China has always been challenging, since the CCP often treats `<i>negative news'</i> as a national security issue, and state run media only publishes what is approved for public consumption. </p><p></p><ul style="text-align: left;"><li>We are routinely only belatedly notified of human avian flu infections (see <a href="https://afludiary.blogspot.com/2024/01/hong-kong-chp-monitoring-h5n6-case-in.html"><b>here</b></a>,<a href="https://afludiary.blogspot.com/2023/03/chp-monitoring-h5n6-case-in-guangdong.html"><b> here</b></a>, and <a href="https://afludiary.blogspot.com/2015/03/h7n9-no-news-is-curious.html"><b>here</b></a>), and then often with few details.</li><li>During the <b>first 3 years of the COVID pandemic</b>, China - with a population of 1.4 billion - only admitted to <b>5242 deaths</b> from the virus.</li><li>After their Zero-COVID policy collapsed in December 2022, China reported<b> roughly 80K deaths</b> from COVID during Jan-Feb of 2023, but outside estimates (<b><a href="https://afludiary.blogspot.com/2023/08/eid-journal-estimate-of-covid-19-deaths.html">here</a> </b>and <b><a href="https://afludiary.blogspot.com/2023/08/jama-open-excess-all-cause-mortality-in.html">here</a></b>) put that number between <b>1.4 and 1.9 million. </b></li></ul><div>China isn't alone in holding their cards close to their vest (see <b><a href="https://afludiary.blogspot.com/2020/11/saudi-moh-5-months-without-mers-cov.html">here</a>, <a href="https://afludiary.blogspot.com/2023/01/media-reports-pyongyang-under-lockdown.html">here</a>,</b> and <b><a href="https://afludiary.blogspot.com/2015/02/regarding-silence-of-egyptian-moh.html">here</a>), </b>but they do represent nearly 1/6th of the world's population, and China has frequently been ground zero for emerging infectious diseases (see <b><a href="https://afludiary.blogspot.com/2013/03/eid-journal-predicting-hotspots-for.html">EID Journal: Predicting Hotspots for Influenza Virus Reassortment</a>).</b></div><div><br /></div><div>Fortunately, China permits the publication of scientific papers on many of these EID concerns. Although the CCP may still be exerting some editorial control, the focus of these papers may give us some clue as to what is currently on Chinese scientist's radar. </div><div style="text-align: left;"><br /></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><b>HPAI H5 &</b><b> H7</b>, and Swine viruses have typically garnered the most attention, but over the past couple of years we've been seeing a growing number of studies on the spread, evolution, and potential public health threat from <b>LPAI H3, H4, H6</b> and <b>H9</b> viruses in China. </div></blockquote><div><br /></div><div>A few recent examples include:<br /><a href="https://afludiary.blogspot.com/2024/02/viruses-wild-bird-origin-h6n2-influenza.html"></a><blockquote><span style="color: #2b00fe;"><b><a href="https://afludiary.blogspot.com/2024/02/viruses-wild-bird-origin-h6n2-influenza.html">Viruses: Wild Bird-Origin H6N2 Influenza Virus Acquires Enhanced Pathogenicity after Single Passage in Mice</a><br /><br /><a href="https://afludiary.blogspot.com/2024/02/genetics-and-pathogenicity-of-influenza.html">Genetics and Pathogenicity of Influenza A (H4N6) Virus Isolated from Wild Birds in Jiangsu Province, China, 2023</a><br /><br /><a href="https://afludiary.blogspot.com/2024/02/transboundary-emerg-dis-novel-human.html">Transboundary & Emerg. Dis.: Novel Human-Avian Reassortment H9N2 Virus in Guangdong Province, China</a><br /><br /><a href="https://afludiary.blogspot.com/2023/12/frontiers-microbiology-chinas-growing.html">Frontiers Microbiology: China's Growing Concerns Over The H3 AIV</a><br /><br /><a href="https://afludiary.blogspot.com/2023/11/emerg-microb-inf-emergence-of-novel.html">Emerg. Microb & Inf.: Emergence of Novel Reassortant H3N3 Avian Influenza viruses, China 2023</a></b></span></blockquote><p>While it may be coincidence, for the 2nd time in the space of a couple of weeks, Chinese scientists published a major review article on <b>LPAI H4N6, </b>which is ubiquitous in wild birds both in Asia and around the world, and which <b><a href="https://afludiary.blogspot.com/2024/02/genetics-and-pathogenicity-of-influenza.html">has previously shown signs</a></b> of better adapting to mammalian hosts.</p><p>Due to its length, I've just posted some excerpts. Follow the link to read the full report. I'll have a brief postscript after the break. </p><b><span style="font-size: large;"></span></b></div><blockquote><div><span style="color: #2b00fe;"><b><span style="font-size: large;"><a href="https://www.mdpi.com/1999-4915/16/2/207">Genetic and Biological Characteristics of Duck-Origin H4N6 Avian Influenza Virus Isolated in China in 2022</a></span></b><br /> <br /><span style="font-size: x-small;"><a href="https://sciprofiles.com/profile/author/Sm9YdE5QMXdnN0JaRlFNeTBPR3NXOFVoQnY2ZFlKK2VsT21yWnJ6Y0hQYz0=?utm_source=mdpi.com&utm_medium=website&utm_campaign=avatar_name">Tian Li</a> 1<a href="mailto:litiansweet7@163.com"></a>, <a href="https://sciprofiles.com/profile/620323?utm_source=mdpi.com&utm_medium=website&utm_campaign=avatar_name">Chuankuo Zhao</a> 1, <a href="https://sciprofiles.com/profile/3388366?utm_source=mdpi.com&utm_medium=website&utm_campaign=avatar_name">Yuxin Guo</a> 1<a href="mailto:yuuuxin_guo@163.com"></a>, <a href="https://sciprofiles.com/profile/3306901?utm_source=mdpi.com&utm_medium=website&utm_campaign=avatar_name">Jinze Dong</a> 1, <a href="https://sciprofiles.com/profile/author/OTNPaXdNVU1YMFE4dkNVakZlRFRRQT09?utm_source=mdpi.com&utm_medium=website&utm_campaign=avatar_name">Fanshu Du</a> 1<a href="mailto:dudfs97@163.com"></a>, <a href="https://sciprofiles.com/profile/3298262?utm_source=mdpi.com&utm_medium=website&utm_campaign=avatar_name">Sicheng Shu</a> 1, <a href="https://sciprofiles.com/profile/3298600?utm_source=mdpi.com&utm_medium=website&utm_campaign=avatar_name">Yang Liu</a> 2<a href="mailto:liuy353@mail.sysu.edu.cn"></a>, <a href="https://sciprofiles.com/profile/author/MGh2TzNXRXlYVHc4cldkTlpxckJuOUFJN2hldnZQUkVpVHRsVDNHWTJVMD0=?utm_source=mdpi.com&utm_medium=website&utm_campaign=avatar_name">Yachang Cheng</a> 2, <a href="https://sciprofiles.com/profile/author/WXJzTGltQkdlaHN4anVnNmpnNkNoRHBXUFNCdSt5NWxydGl4eVZXaDk0WT0=?utm_source=mdpi.com&utm_medium=website&utm_campaign=avatar_name">Zhiyong Cao</a> 3<a href="mailto:18770269096@139.com"></a>, <a href="https://sciprofiles.com/profile/author/OXd1aGdpVHN0c3h1S2JzRUxrWjQ2YXZsYm9GYlA4QzN1cWtkT0xEemhKMD0=?utm_source=mdpi.com&utm_medium=website&utm_campaign=avatar_name">Qi Cao</a> 4<a href="mailto:18711702705@163.com"></a>, <a href="https://sciprofiles.com/profile/author/Rk1JOERWZi9jV05PVnZ0cEt2WVYzNVBPOE13Ukw1VFZQRHV6M282eEUzRT0=?utm_source=mdpi.com&utm_medium=website&utm_campaign=avatar_name">Shuiping Shi</a> 5<a href="mailto:5237661dchn@163.com"></a>, <a href="https://sciprofiles.com/profile/3398017?utm_source=mdpi.com&utm_medium=website&utm_campaign=avatar_name">Yinhua Huang</a> 6<a href="mailto:cauhyh@cau.edu.cn"></a>, <a href="https://sciprofiles.com/profile/2297273?utm_source=mdpi.com&utm_medium=website&utm_campaign=avatar_name">Juan Pu</a> 1<a href="mailto:pujuan@cau.edu.cn"></a> and <a href="https://sciprofiles.com/profile/2305347?utm_source=mdpi.com&utm_medium=website&utm_campaign=avatar_name">Litao Liu</a> 1,*<a href="mailto:liulitao@cau.edu.cn"></a><br /></span></span><span style="color: #2b00fe; font-size: x-small;">Viruses 2024, 16(2), 207; <a href="https://doi.org/10.3390/v16020207">https://doi.org/10.3390/v16020207</a><br />Submission received: 5 December 2023 / Revised: 23 January 2024 / Accepted: 25 January 2024 / Published: 30 January 2024</span></div><div><span style="color: #2b00fe;"><br /><b>Abstract</b></span></div><div><span style="color: #2b00fe;"><br />The interaction between migratory birds and domestic waterfowl facilitates viral co-infections, leading to viral reassortment and the emergence of novel viruses. In 2022, samples were collected from duck farms around Poyang Lake in Jiangxi Province, China, which is located <b>within the East Asia–Australasia flyway. </b></span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">Three strains of H4N6 avian influenza virus (AIV) were isolated. Genetic and phylogenetic analyses showed that the isolated H4N6 avian influenza viruses (AIVs) belonged to <b>new genotypes, G23 and G24.</b> </span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;">All isolated strains demonstrated<b> dual receptor binding properties</b>. Additionally, the isolated strains were <b>able to replicate efficiently not only in avian cells but also in mammalian cells</b>. Furthermore, the H4N6 AIV isolates could infect chickens, with viral replication detected in the lungs and extrapulmonary organs, and could transmit within chicken flocks through contact, with viral shedding detected only in oropharyngeal swabs from chickens in the contact group. </span></div><div><b><span style="color: #2b00fe;"><br /></span></b></div><div><span style="color: #2b00fe;"><b>Notably, the H4N6 AIV could infect mice without prior adaptation and replicate in the lungs with high viral titers, suggesting that it is a potential threat to humans. </b>In conclusion, this study provides valuable insight into the characteristics of H4N6 strains currently circulating in China.</span></div></blockquote><div><div class="html-dynamic" style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><section style="box-sizing: border-box; margin: 0.5em 0px; max-height: 1e+06px;"><div class="art-abstract art-abstract-new in-tab hypothesis_container" style="box-sizing: border-box; display: inline-block; margin: 0px; max-height: 1e+06px; padding: 0px; text-align: justify;"><div style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><div><div class="html-p" style="box-sizing: border-box; display: inline; margin-block: 1em; margin-inline: 0px; margin: 0px; max-height: 1e+06px; padding: 0px;"> <b>(SNIP)</b></div></div></div><blockquote><div style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><span style="color: #2b00fe; font-size: medium;"><b>Discussion</b></span></div><div style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><span style="color: #2b00fe;"><br />(<i>Excerpt)</i></span></div><div style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><span style="color: #2b00fe;"><br />In this study, we conducted genetic and phylogenetic analyses of three newly isolated duck-origin H4N6 AIVs and investigated their biological characteristics. Previous studies have found that multiple genotypes of H4 viruses are cocirculating in the live poultry markets of China [<a href="https://www.mdpi.com/1999-4915/16/2/207#B8-viruses-16-00207">8</a>], and the results of phylogenetic analysis and the genotypes in this study revealed that the three isolated viral strains belonged to novel genotypes, G23 and G24. The genetic sequences of various segments of the isolated strains shared high similarity with virus strains isolated from neighboring countries and regions around China, such as Bangladesh, Mongolia, Vietnam, South Korea, and Japan. </span></div><div style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><span style="color: #2b00fe;"><br /></span></div><div style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><span style="color: #2b00fe;">Notably, these countries are located along the East Asia–Australasia flyway, a major migratory route for birds. Thus, we hypothesized that the genetic origin of the isolated strains was likely due to the introduction of different AIV subtypes through the migratory activities of birds, which then underwent reassortment with the AIVs carried by domestic waterfowl in China.</span></div><div style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><span style="color: #2b00fe;"><br />Molecular characterization analysis revealed that <b>all three isolated strains had a T160A mutation in the HA gene associated with receptor binding properties.</b> In addition to<b> T160A, G228S, and Q226L play an important role in altering the receptor binding properties of H4 AIV</b> [<a href="https://www.mdpi.com/1999-4915/16/2/207#B16-viruses-16-00207">16</a>]. Subsequently, we conducted an analysis of receptor binding characteristics. </span></div><div style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><span style="color: #2b00fe;"><br /></span></div><div style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><span style="color: #2b00fe;">The results showed that the isolated strains could bind <b>not only to α-2,3 sialic acid-linked receptors but also to α-2,6 sialic acid-linked receptors, indicating that H4N6 AIVs have the potential to break species barriers and initiate cross-species infections</b>. </span></div><div style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><span style="color: #2b00fe;"><br /></span></div><div style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><span style="color: #2b00fe;">Pathogenicity experiments on chickens revealed that an H4N6 virus isolate was able to replicate in infected chickens, although no significant clinical symptoms were observed. However, some studies have reported that H4N6 can cause weight loss in broiler chickens and soft-shelled eggs in laying hens [<a href="https://www.mdpi.com/1999-4915/16/2/207#B9-viruses-16-00207">9</a>]. <b>Transmissibility experiments on chickens showed that the isolate had limited transmissibility and was not capable of becoming widespread in chicken flocks</b>, and this characteristic was similar to the previously prevalent H4 subtype AIV, which was mainly found in waterfowl and migratory birds, and failed to adapt well to terrestrial poultry. </span></div><div style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><span style="color: #2b00fe;"><br /></span></div><div style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><span style="color: #2b00fe;">Surprisingly,<b> the isolate could infect mice directly without prior adaptation and exhibited robust replication in both the respiratory and digestive systems of mice. </b>Other studies have found that some H4 strains have been found to be transmitted between guinea pigs by direct contact, and some can also transmit via respiratory droplet, albeit with limited efficiency [<a href="https://www.mdpi.com/1999-4915/16/2/207#B8-viruses-16-00207">8</a>].</span></div><div style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><br /><span style="color: #2b00fe;">In conclusion, we characterized the genetic evolution and biological properties of the H4N6 virus isolated from waterfowl in Poyang Lake, Jiangxi Province, China. Our study not only offers valuable insights into the prevalence of H4N6 AIVs in China but also highlights the importance of proactive monitoring of wild birds and domestic ducks. This monitoring aids in tracking the evolution of AIVs in waterfowl.<b> It is crucial to monitor AIVs that may pose a threat to poultry or humans and to take appropriate control measures in time.</b></span></div></blockquote><p> <b><span style="color: #2b00fe;"><a href="https://www.mdpi.com/1999-4915/16/2/207"> (Continue . . . )</a></span></b></p><br /><br />While the <b><a href="https://afludiary.blogspot.com/2022/07/eid-journal-zoonotic-threat-of-g4.html">EA H1N1 `G4' Swine virus</a></b>, and HPAI H5 (<i>and to a lesser extent, HPAI H7) </i>remain at the top of our pandemic watch list, our track record in predicting the `<i>next pandemic'</i> has been notoriously bad.<br /></div></section></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><div class="html-dynamic" style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><section style="box-sizing: border-box; margin: 0.5em 0px; max-height: 1e+06px;"><div class="art-abstract art-abstract-new in-tab hypothesis_container" style="box-sizing: border-box; display: inline-block; margin: 0px; max-height: 1e+06px; padding: 0px; text-align: justify;">In 2009, when all eyes were on H5N1, we were blindsided by a <b><a href="https://afludiary.blogspot.com/2009/06/who-meeting-today-on-swine-flu.html">swine H1N1 pandemic</a></b>, in 2019, when H7, H5, and MERS-CoV were on top of our pandemic hit parade, we were ambushed by SARS-CoV-2.</div></section></div></div></blockquote><p>The next global health crises could just as easily come - as did the 1957 and 1968 pandemics - from the reassortment of an <b><a href="https://afludiary.blogspot.com/2023/04/the-other-mixing-vessel-for-pandemic.html">LPAI H2 or H3 virus with seasonal flu</a></b>, or from an <b><a href="https://afludiary.blogspot.com/2024/01/viruses-review-sars-cov-2-outbreaks-on.html">unexpected spillback of COVID from a non-human host,</a></b> some obscure<b> </b><a href="https://afludiary.blogspot.com/2019/06/plosntds-prioritizing-surveillance-of.html"><b>bat-borne henipavirus</b>,</a> or from some as-yet, unknown zoonotic threat (<i>Disease X). </i></p><p>We live in an interconnected and ever-changing pathogen-rich environment. Which means we need to be preparing for a wide range of pandemic threats, not just the obvious ones. </p><div><div class="html-dynamic" style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><section style="box-sizing: border-box; margin: 0.5em 0px; max-height: 1e+06px;"><div class="art-abstract art-abstract-new in-tab hypothesis_container" style="box-sizing: border-box; display: inline-block; margin: 0px; max-height: 1e+06px; padding: 0px; text-align: justify;"><div style="box-sizing: border-box; margin: 0px; max-height: 1e+06px; padding: 0px;"><div id="html-keywords" style="background-color: white; box-sizing: border-box; color: #222222; font-family: Arial, Arial, Helvetica, sans-serif; font-size: 13.2px; margin: 5px 0px 0px; max-height: 1e+06px; padding: 0px;"></div></div></div></section></div><a href="https://afludiary.blogspot.com/2023/11/emerg-microb-inf-emergence-of-novel.html"></a></div>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-52711212781457811742024-03-02T08:18:00.003-05:002024-03-02T08:18:48.497-05:00The CDC's New Respiratory Virus Guidance For The Public<p></p><div class="separator" style="clear: both;"><div class="separator" style="clear: both;"><a href="https://www.cdc.gov/respiratory-viruses/background/index.html"><img height="220" src="https://blogger.googleusercontent.com/img/a/AVvXsEhY5gf23axATxbMEQPK8KY_-zgdNIda7UdGi9zoYcsFVK9snONPNwdnICuMuatsVvwDzNKjbKvrEMQEpmv0w1qIOpclKYrOqnM4SV68x4cmxpzfWP-vRvFLMtoTXmUD7YrdjwQItSy9qf6NnI2txk8q6NdvvzqfSq8ONbqE1kl4vmm4Cq2Vy_qDGw=w320-h220" width="320" /></a></div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">#17,934</div></div><p></p><p>Although it's gist had been <b><a href="https://www.npr.org/sections/health-shots/2024/02/14/1231249566/cdc-may-be-reconsidering-covid-isolation-guidance">telegraphed in the media</a></b> for several weeks, yesterday the <a href="https://www.cdc.gov/media/releases/2024/p0301-respiratory-virus.html?ACSTrackingID=USCDC_1_3-DM123769"><b>CDC unveiled</b></a> their revised (<i>and unified for Flu, RSV, COVID, etc.</i>) <a href="https://www.cdc.gov/respiratory-viruses/guidance/respiratory-virus-guidance.html"><b>respiratory virus guidelines</b></a> for the public, which removes the arbitrary <b>5-day</b> isolation rule for COVID. </p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">While evidence suggests that COVID infection can be more dangerous than influenza or RSV (see blogs <b><a href="https://afludiary.blogspot.com/2024/02/denmark-ssi-population-study-covid-19.html">here</a></b>, <b><a href="https://afludiary.blogspot.com/2024/02/eid-journal-estimates-of-incidence-and.html">here</a></b>, <b><a href="https://afludiary.blogspot.com/2023/12/the-lancet-long-term-outcomes-following.html">here</a></b>, and <b><a href="https://afludiary.blogspot.com/2023/09/nih-study-shows-sars-cov-2-infects.html">here</a></b>), it is pretty apparent that very few were adhering to the old guidelines. </p></blockquote><p>COVID infections remain quite common, but between vaccines and past exposures, we tend to have less severe disease than we did 2 or 3 years ago. As a result hospitals are no longer overrun, deaths have sharply declined, and fewer people are bothering with home test kits. </p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">COVID deaths or hospitalizations are now only rarely reported (see <b><a href="https://afludiary.blogspot.com/2023/08/no-news-is-now-commonplace.html">No News Is . . . Now Commonplace</a></b>), even to the WHO. </p></blockquote><p>In other words, while the threat hasn't disappeared entirely, <i>the world has moved on</i>. At least until the next high-impact virus emerges (see <b><a href="https://afludiary.blogspot.com/2023/11/bmj-global-historical-trends.html">BMJ Global: Historical Trends Demonstrate a Pattern of Increasingly Frequent & Severe Zoonotic Spillover Events</a>). </b></p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;"><span><span style="font-family: inherit;"><b>It is important to note that the CDC's new guidance still calls for staying home (<i>and other </i></b></span><b><i>appropriate</i></b><span style="font-family: inherit;"><b><i> measures</i>) both when and <u>after</u> experiencing any symptomatic respiratory virus. </b></span></span></p></blockquote><p>Below you'll find links to the new CDC guidance, followed by an excerpt from their home isolation recommendations. I'll have postscript after the break. </p><b><span style="font-size: large;"><a href="https://www.cdc.gov/respiratory-viruses/guidance/respiratory-virus-guidance.html"></a></span></b><blockquote><span style="color: #2b00fe;"><b><span style="font-size: large;"><a href="https://www.cdc.gov/respiratory-viruses/guidance/respiratory-virus-guidance.html">Respiratory Virus Guidance</a></span></b><br /><br />This guidance is not applicable to <a href="https://www.cdc.gov/infectioncontrol/index.html"><b>healthcare settings</b></a>. Nothing in this guidance supersedes accommodations required under <b><a href="https://www.hhs.gov/ocr/index.html">federal civil rights laws</a>.</b><br /><br />Each year, respiratory viruses are responsible for millions of illnesses and thousands of hospitalizations and deaths in the United States. In addition to the virus that causes COVID-19, there are many other types of respiratory viruses, including flu and respiratory syncytial virus (RSV). The good news is there are actions you can take to help protect yourself and others from health risks caused by respiratory viruses.</span><div><span style="color: #2b00fe;"><br /><b><span style="font-size: medium;">CDC’s Respiratory Virus Guidance</span></b><br /><br />This guidance provides practical recommendations and information to help people lower risk from a range of common respiratory viral illnesses, including COVID-19, flu, and RSV.<br /><br /><a href="https://www.cdc.gov/respiratory-viruses/prevention/index.html"><b>Preventing Respiratory Viruses</b></a></span></div><div><span style="color: #2b00fe;"><b><a href="https://www.cdc.gov/respiratory-viruses/prevention/immunizations.html">Immunizations for Respiratory Viruses</a><br /><a href="https://www.cdc.gov/respiratory-viruses/prevention/hygiene.html">Hygiene and Respiratory Virus Prevention</a><br /><a href="https://www.cdc.gov/respiratory-viruses/prevention/air-quality.html">Taking Steps for Cleaner Air for Respiratory Virus Prevention</a><br /><a href="https://www.cdc.gov/respiratory-viruses/prevention/precautions-when-sick.html">Preventing Spread of Respiratory Viruses When You’re Sick</a><br /><a href="https://www.cdc.gov/respiratory-viruses/prevention/masks.html">Masks and Respiratory Virus Prevention</a><br /><a href="https://www.cdc.gov/respiratory-viruses/prevention/physical-distancing.html">Physical Distancing and Respiratory Viruses</a><br /><a href="https://www.cdc.gov/respiratory-viruses/prevention/testing.html">Testing and Respiratory Viruses</a></b></span></div><div><span style="color: #2b00fe;"><br /><b><span style="font-size: medium;">Special Considerations</span></b><br /><br />In addition to CDC’s Respiratory Virus Guidance, there are several special considerations for people with certain risk factors for severe illness.<br /><br /><a href="https://www.cdc.gov/respiratory-viruses/risk-factors/index.html"><b>Risk Factors for Severe Illness from Respiratory Viruses</b></a></span></div></blockquote><blockquote><div><span style="color: #2b00fe;"><b><a href="https://www.cdc.gov/respiratory-viruses/risk-factors/older-adults.html">Older Adults</a><br /><a href="https://www.cdc.gov/respiratory-viruses/risk-factors/young-children.html">Young Children</a><br /><a href="https://www.cdc.gov/respiratory-viruses/risk-factors/weakened-immune-systems.html">People with Weakened Immune Systems</a><br /><a href="https://www.cdc.gov/respiratory-viruses/risk-factors/people-with-disabilities.html">People with Disabilities</a><br /><a href="https://www.cdc.gov/respiratory-viruses/risk-factors/pregnant-people.html">Pregnant People</a></b></span></div><div><span style="color: #2b00fe;"><br /><b><span style="font-size: medium;">Treatment as Prevention</span></b><br /><br />Treatment is a core prevention strategy to lower risk from respiratory viruses.<br /><br /><a href="https://www.cdc.gov/respiratory-viruses/treatment/index.html"><b>Treatment of Respiratory Viruses</b></a></span></div><div><span style="color: #2b00fe;"><br /><b>About the Guidance</b></span></div><div><span style="color: #2b00fe;"><br /></span></div><div><span style="color: #2b00fe;"><b><a href="https://www.cdc.gov/respiratory-viruses/background/index.html">Background for the Guidance</a><br /><a href="https://www.cdc.gov/respiratory-viruses/guidance/faq.html">Frequently Asked Questions</a></b></span></div></blockquote><br /><br /><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">(EXCERPT)</blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><span style="background-color: #eeeeee;"><br /><span style="color: #2b00fe;"><a href="https://www.cdc.gov/ncird/whats-new/updated-respiratory-virus-guidance.html"><b><span style="font-size: large;">What is the updated guidance?</span></b></a><br /><br /><b>Protect Yourself from Getting Sick:</b></span></span><span style="color: #2b00fe;"><br /><br /><span style="font-family: inherit;">The most important thing you can do to protect yourself from COVID-19, flu, and RSV is to </span><b style="font-family: inherit;">stay up to date on your recommended vaccines</b><span style="font-family: inherit;">. Even when vaccines don’t prevent infection, they often tame these viruses, reducing severity, and preventing their worst outcomes, like hospitalization and death. Along with staying up-to-date on your vaccines, practicing good hygiene by covering your coughs and sneezes, washing or sanitizing your hands often, and cleaning frequently touched surfaces can help. Also, taking steps for cleaner air can help reduce the spread of respiratory viruses. This can mean bringing in fresh outside air by opening a window, purifying indoor air, or having outdoor social activities.</span><br /><br /><b><span style="background-color: #eeeeee; font-family: inherit;">If You Get Sick:</span></b></span></blockquote><span style="background-color: #eeeeee; color: #2b00fe; font-family: inherit;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><span style="background-color: #eeeeee;"><span style="color: #2b00fe;"><span style="font-family: inherit;">Even if you practice these core prevention strategies, you may still catch a virus and develop respiratory symptoms. If that happens, the updated Guidance recommends two actions:</span><br /><br /><span style="font-family: inherit;"><b>Step 1: Stay at home. </b>As much as possible, you should stay home and away from others until at least 24 hours after both:</span></span></span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><ol style="text-align: left;"><li><span style="background-color: #eeeeee; font-family: inherit;"><span style="color: #2b00fe;">Your symptoms are getting better overall, <b>and </b></span></span></li><li><span style="background-color: #eeeeee; color: #2b00fe; font-family: inherit;">You have not had a fever (<i>and are not using fever-reducing medication)</i>.</span></li></ol></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><span style="background-color: #eeeeee;"><span style="color: #2b00fe;"><span style="font-family: inherit;">This advice is similar to what has been recommended for flu for decades and will help reduce the spread of COVID-19 and other respiratory viruses during the most contagious period after infection. Not all respiratory virus infections result in a fever, so paying attention to other symptoms (cough, muscle aches, etc.) is important as you determine when you are well enough to leave home. If your symptoms are getting better, and stay better for 24 hours, you are less likely to pass your infection to others and you can start getting back to your daily routine and move on to <b>step 2.</b></span><br /><br /><span style="font-family: inherit;"><b><span style="box-sizing: border-box;"><u style="box-sizing: border-box;">Step 2:</u></span><span style="box-sizing: border-box;"> </span></b><span style="box-sizing: border-box; font-weight: bolder;">Resume normal activities, and use added prevention strategies </span>over the next five days, such as taking more steps for cleaner air, enhancing your hygiene practices, <b>wearing a well-fitting mask, keeping a distance from others, and/or getting tested for respiratory viruses</b>. People can choose to use these prevention strategies at any time. Since some people remain contagious beyond the “stay-at-home” period, taking added precautions can lower the chance of spreading respiratory viruses to others</span></span></span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><span style="background-color: #eeeeee;"><span style="color: #2b00fe;"><br /> People who are at higher risk for severe illness who start to feel sick should seek health care right away so that they can access testing and/or treatment. Early treatment for COVID-19 or flu may prevent severe disease in people at higher risk, even if they are up to date with their vaccines.<br /><br /><b><span style="font-size: medium;">Examples</span></b></span></span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><span style="background-color: #eeeeee;"><span style="color: #2b00fe;"> </span></span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="background-color: #eeeeee; color: #2b00fe; font-family: inherit;">Depending on your circumstances, here are a few examples of what updated guidance could look like if you come down with a respiratory infection:</span></blockquote><span style="background-color: #eeeeee; color: #2b00fe; font-family: inherit;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><b><span style="background-color: #eeeeee; color: #2b00fe; font-family: inherit;">Example 1: Person with fever and symptoms.</span></b></blockquote><span style="background-color: #eeeeee; color: #2b00fe; font-family: inherit;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="background-color: #eeeeee; color: #2b00fe; font-family: inherit;"><a href="https://www.cdc.gov/ncird/whats-new/updated-respiratory-virus-guidance.html"><img height="104" src="https://www.cdc.gov/respiratory-viruses/images/preventing-spread-respiratory-viruses-a.jpg" width="400" /></a></span></blockquote><span style="background-color: #eeeeee; color: #2b00fe; font-family: inherit;"><a href="https://www.cdc.gov/respiratory-viruses/guidance/faq.html"></a><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="background-color: #eeeeee; color: #2b00fe; font-family: inherit;"><b>Example 2: Person with fever but no other symptoms.</b><a href="https://www.cdc.gov/ncird/whats-new/updated-respiratory-virus-guidance.html"><img height="104" src="https://www.cdc.gov/respiratory-viruses/images/preventing-spread-respiratory-viruses-b.jpg" width="400" /></a></span></blockquote><span style="background-color: #eeeeee; color: #2b00fe; font-family: inherit;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><b><span style="background-color: #eeeeee; color: #2b00fe; font-family: inherit;">Example 3: Person with fever and other symptoms, fever ends but other symptoms take longer to improve</span></b></blockquote><p></p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;"><span style="background-color: #eeeeee; color: #2b00fe; font-family: inherit;"><a href="https://www.cdc.gov/ncird/whats-new/updated-respiratory-virus-guidance.html"><img height="104" src="https://www.cdc.gov/respiratory-viruses/images/preventing-spread-respiratory-viruses-c.jpg" width="400" /></a></span></p></blockquote><p></p><div><span style="background-color: #eeeeee; color: #2b00fe; font-family: inherit;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="background-color: #eeeeee; color: #2b00fe; font-family: inherit;"><b>Example 4: Person gets better and then gets a fever.</b><a href="https://www.cdc.gov/ncird/whats-new/updated-respiratory-virus-guidance.html"><img height="104" src="https://www.cdc.gov/respiratory-viruses/images/preventing-spread-respiratory-viruses-d.jpg" width="400" /></a></span></blockquote><span style="font-family: inherit;"><br /></span><br /> </div><div>Admittedly, creating a perfect or practical, <i>one-size-fits-all</i> plan for dealing with seasonal respiratory viruses is a tall order. People have different risks, and different needs. And there will always be a sizable gap between what people <i>should do</i>, and <i>what you can realistically get them to do</i>. </div><div><br /></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;">Compliance, even with these newly revised recommendations, is likely to be low or inconsistent. But even if everyone followed them diligently, respiratory viruses would still circulate. </div></blockquote><div style="text-align: left;"><br /></div><div style="text-align: left;">In the end, the only thing you can really control is your own <b>vaccination</b> <b>status</b>, whether you choose to <b>avoid crowds </b>or wear a <b>face mask</b> in public, your use of <b>hand sanitizer </b>and<b> respiratory etiquette</b>, and how long you<b> stay home</b> if you are sick. </div><div style="text-align: left;"><br /></div><div style="text-align: left;">But given those tools, you can still do a lot to lower your risks of infection. </div>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-43567055779264611762024-03-01T08:06:00.001-05:002024-03-01T08:06:17.610-05:00Denmark SSI: Marked Increase In Parrot Fever Cases Over the Past 60 Days<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAm6y18T6ZY8ZWRt3nowLFc7F6muL_YRSHW0iJwm0yug1TjOsYmkAKUYMpt7qnYIsieaCZUNutAcTMKW26G-VwqUrQkoBK9gyABFS6zHqR6S2_2nev_wQV43ERzWN2139qO5D7xg/s1600/X-Ray.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAm6y18T6ZY8ZWRt3nowLFc7F6muL_YRSHW0iJwm0yug1TjOsYmkAKUYMpt7qnYIsieaCZUNutAcTMKW26G-VwqUrQkoBK9gyABFS6zHqR6S2_2nev_wQV43ERzWN2139qO5D7xg/s1600/X-Ray.png" /></a></div><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><p> #17,933</p><p><span style="background-color: #ebedec; color: #363636; font-family: inherit; font-size: 16px;"><i>Psittacosis</i> - often called parrot fever - is a rarely reported, <b>atypical bacterial pneumonia</b> caused by </span><i style="background-color: #ebedec; color: #363636; font-family: inherit; font-size: 16px;">Chlamydia</i><span style="background-color: #ebedec; color: #363636; font-family: inherit; font-size: 16px;"> </span><i style="background-color: #ebedec; color: #363636; font-family: inherit; font-size: 16px;">psittaci</i><span style="background-color: #ebedec; color: #363636; font-family: inherit; font-size: 16px;">. The</span><a href="https://www.cdc.gov/pneumonia/atypical/psittacosis/surveillance-reporting/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fpneumonia%2Fatypical%2Fpsittacosis%2Fsurveillance-reporting.html" style="background-color: #ebedec; color: #3f3f7f; font-family: inherit; font-size: 16px; text-decoration-line: none;" target="_blank"><b> CDC cites</b></a><span style="background-color: #ebedec; color: #363636; font-family: inherit; font-size: 16px;"> an average of </span><b style="background-color: #ebedec; color: #363636; font-family: inherit; font-size: 16px;">10 cases of Psittacosis </b><span style="background-color: #ebedec; color: #363636; font-family: inherit; font-size: 16px;">reported each year in the US, although many others may go undiagnosed.</span></p><p style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="font-family: inherit;">The CDC also reports:<br /></span></p><blockquote class="tr_bq" style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="color: blue;"><span style="font-family: inherit;">Since 1988, there has been a<b> decline</b> in reported psittacosis cases. This decline may be the result of improved diagnostic tests that distinguish <i>Chlamydia psittaci </i>from more common<i> Chlamydia pneumoniae </i>infections.</span></span></blockquote><div><span style="font-family: inherit;">From time to time we see small outbreaks reported, usually in Asia</span> (<a href="https://afludiary.blogspot.com/2017/04/japan-reports-2-fatal-cases-of-parrot.html"><b>Japan Report 2 Fatal Cases of Parrot Fever (Psittacosis) In Pregnant Women</b></a>) or in Europe (see 2007's <a href="http://afludiary.blogspot.com/2007/11/to-you-my-heart-cries-out-chlamydia.html">T<b>o You, My Heart Cries Out Chlamydia</b></a><b> </b>about a small outbreak that occurred at a Bird lovers Society show in Weurt, Norway).</div><div><br /></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;">Until fairly recently, human infection has been solely attributed to <b><i>direct or indirect contact with infected birds. </i></b></div></blockquote><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" />But in 2012, the journal <a href="http://www.eurosurveillance.org/"><b>Eurosurveillance</b></a> carried a report called <b><a href="http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20186">Psittacosis outbreak in Tayside, Scotland, December 2011 to February 2012,</a> </b>involving f<b>our family members and a health-care worker</b>, which suggested human-to-human transmission.<br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;">The following year, in</span><a href="http://afludiary.blogspot.com/2013/07/sweden-reports-rare-outbreak-of-parrot.html" style="background-color: #ebedec; color: #3f3f7f; font-size: 16px; text-decoration-line: none;"> <b>Sweden Reports Rare Outbreak Of Parrot Fever,</b></a><b style="background-color: #ebedec; color: #363636; font-size: 16px;"> </b><span style="background-color: #ebedec; color: #363636; font-size: 16px;">we saw a credible report of human transmission of parrot fever, where a 75 year old man who died in Kronoberg appeared to have s<b>pread the infection </b>to at least </span><b style="background-color: #ebedec; color: #363636; font-size: 16px;">8 close contacts</b><span style="background-color: #ebedec; color: #363636; font-size: 16px;">, including healthcare personnel.</span><br style="background-color: #ebedec; color: #363636; font-size: 16px;" /></span><span style="background-color: #ebedec; color: blue; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;"><br /></span><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;">In 2014, the ECDC's </span><i style="background-color: #ebedec; color: #363636; font-size: 16px;">Eurosurveillance Journal </i><span style="background-color: #ebedec; color: #363636; font-size: 16px;">carried a follow up report called</span></span><span style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;">:</span><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><blockquote class="tr_bq" style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;"><div id="ES_Article_issue"><span style="color: blue;">Eurosurveillance, Volume 19, Issue 42, 23 October 2014</span></div><span style="color: blue;">Surveillance and outbreak reports</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><b><span style="font-family: inherit; font-size: large;"><a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES2014.19.42.20937">Multiple human-to-human transmission from a severe case of psittacosis, Sweden, January–February 2013</a></span></b></blockquote><blockquote class="tr_bq" style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="color: blue;"><span style="font-family: inherit;">Proven transmission of Chlamydia psittaci between humans has been described on only one occasion previously. We describe an outbreak which occurred in Sweden in early 2013, where the epidemiological and serological investigation suggests that one patient, severely ill with psittacosis after exposure to wild bird droppings, <b><i>transmitted the disease to ten others</i></b>: Two family members, one hospital roommate and seven hospital caregivers. Three cases also provided respiratory samples that could be analysed by PCR. All the obtained C. psittaci sequences were indistinguishable and clustered within genotype A.</span></span></blockquote><blockquote class="tr_bq" style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="color: blue;"><span style="font-family: inherit;">The finding has implications for the management of severely ill patients with atypical pneumonia, because these patients may be more contagious than was previously thought. In order to prevent nosocomial person-to-person transmission of <i>C. psittaci,</i> stricter hygiene measures may need to be applied.</span></span></blockquote><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;">And in 2018 we saw another example, in</span><b style="background-color: #ebedec; color: #363636; font-size: 16px;"><a href="https://afludiary.blogspot.com/2018/04/plos-currents-psittacosis-outbreak.html" style="color: #3f3f7f; text-decoration-line: none;"> PLoS Currents: A Psittacosis Outbreak Among Office Workers With Little Or No Bird Contact - UK.</a></b></span> In 2022 the Lancet published a correspondence (see <b><a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(22)00191-4/fulltext">Gestational psittacosis: an emerging infection</a></b>) that called: <div><span style="background-color: #eeeeee;"><br /></span></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><span style="background-color: #eeeeee; color: #2b00fe; font-family: inherit;">`Human-to-human transmission of psittacosis is an emerging public health risk to medical workers and other close contacts, including pregnant women.'</span></div></blockquote><div><span style="font-family: inherit;"><br style="background-color: #ebedec; color: #363636; font-size: 16px;" /><span style="background-color: #ebedec; color: #363636; font-size: 16px;">While <b>H-2-H</b> transmission of </span><i style="background-color: #ebedec; color: #363636; font-size: 16px;">C. psittaci </i><span style="background-color: #ebedec; color: #363636; font-size: 16px;">now appears possible, <b>contact with infected birds</b> remains <b><i>the primary suspected route of transmission</i></b>. </span></span></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;"><br /></span></span></div><div><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;">Today Denmark's SSI is reporting an uptick in Psittacosis cases (n=<b>23 </b>since December 20th), which is roughly as many as they see in an average year. Notably, most of these cases report no known contact with birds. </span></span></div></blockquote><div><div><br /></div><div>This report mentions other European countries reporting cases (see <b><a href="https://news.yahoo.com/health-alert-parrot-fever-infects-162830649.html">Health alert after parrot fever infects humans in Sweden)</a>.</b> I'll have a bit more after the <i>(translated</i>) statement. </div><br /><b><span style="font-size: large;"></span></b><blockquote><span style="color: #2b00fe;"><b><span style="font-size: large;"><a href="https://www.ssi.dk/aktuelt/nyheder/2024/flere-tilfaelde-af-papegoejesyge-ornitose-i-danmark">Several cases of parrot disease/ornithosis in Denmark</a></span></b><br /><br /><b>During the past two months, there have been more cases of parrot disease in Denmark than usual. The disease spreads from birds to humans. SSI therefore encourages doctors to be aware of the disease.</b></span></blockquote><blockquote><span style="color: #2b00fe;">Last edited on March 1, 2024</span><div><span style="color: #2b00fe;"><br />Since 20 December 2023,<b> 23 cases of parrot disease</b> in humans have been detected in Denmark. Normally we register around <b>15-30 cases in a whole year. </b><br /><br />"We are currently experiencing more cases than usual, a<b>nd we hear the same message from other colleagues around Europe</b>. That is why we ask doctors in practice and in hospitals to pay particular attention to the disease," says senior researcher Søren Uldum from the Statens Serum Institut.<br /><br />Parrot disease is also called ornithosis (bird disease), as it is not only parrots that can infect humans. It is a bacterial respiratory infection caused by the bacterium Chlamydia psittaci. The bacterium can be transmitted from infected birds to humans through close contact, but can also be transmitted by inhaling atomized particles from feathers or excrement. People are most often infected from domestic birds or various hobby birds such as ring pigeons.<b> Most of the patients infected this winter report no or unknown contact with birds</b>, while some report having fed birds at bird trays or automatic feeders.<br /><br />"We suspect that the main cause of the infection must be found among wild birds, and we have several measures underway to examine samples from wild birds in an attempt to clarify this."Søren Uldum, senior researcher, Statens Serum Institut.<br /><br />Parrot disease is in most cases a mild disease, and most often presents with flu-like symptoms such as fever, muscle aches and headaches. In some people, it can develop into a severe pneumonia affecting several organs. The disease can be treated with antibiotics.<br /><br />In general, you should not be afraid to feed the birds in the garden, but you can follow these tips:</span></div><div><ul style="text-align: left;"><li><span style="color: #2b00fe;">Do not touch dead birds. If you find several dead or sick wild birds within a small area, it can be reported to the Danish Veterinary and Food Administration, primarily because of the risk of bird flu.</span></li><li><span style="color: #2b00fe;">If you have to clean (sweep/rake) where there have been birds at feeding places, in outbuildings and the like, you should wet the surface beforehand so that it does not create dust.</span></li><li><span style="color: #2b00fe;">If you find dead or sick birds in the garden, you must stop feeding them.</span></li><li><span style="color: #2b00fe;">You must then scald the places where there has been feed and water.</span></li><li><span style="color: #2b00fe;">Wash hands after contact with wild birds, feeding area or droppings.</span></li></ul></div></blockquote><div> <b> <a href="https://www.ssi.dk/aktuelt/nyheder/2024/flere-tilfaelde-af-papegoejesyge-ornitose-i-danmark">(Continue . . . )</a></b></div></div><div><br /></div><div style="text-align: left;"><br /><div>Fourteen years ago, in <b><a href="https://afludiary.blogspot.com/2012/03/how-parrot-fever-changed-public-health.html" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">How Parrot Fever Changed Public Health In America</a>, </b>I wrote about the 1929 Parrot Fever epidemic which briefly revived fears of a new pandemic 10 years after the Spanish Flu. </div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><br /></div><div>While overblown by the newspapers eager for something other than the stock market crash to focus on, at least 169 people were diagnosed with the illness across several states, and 33 died. </div></blockquote><br />Among the dead were 3 members of the public health team investigating the outbreak (<b>Dr. Daniel S. Hatfield</b> and <b>Dr. William Stokes</b> of the Baltimore Health Department, and<b> Henry (Shorty) Anderson</b> of the Hygienic Lab). <br /><div><p>The outbreak was finally quashed, but out of it (<em>and concerns over the recent rise in flu</em>) came funding from Congress for a new, better staffed and equipped laboratory to replace the old Hygienic Lab. </p><blockquote><p style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="font-family: inherit;">They also gave it a new name: The <em><a href="http://www.nih.gov/" style="color: #3f3f7f; text-decoration-line: none;" target="_blank"><strong>National Institute of Health</strong></a><strong>.</strong></em></span></p></blockquote><p>Today, treatment of Psittacosis is much easier than it was in 1930, as it generally responds well to Tetracyclines. </p></div>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-28559212708552281432024-03-01T06:35:00.001-05:002024-03-01T06:35:30.292-05:00CDC MMWR: Interim 2023-2024 Flu Vaccine Effectiveness Estimates<p></p><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgDjL7ihPzCYbj21OLbR4wx6grOsOVfVSdyOZSV0r3IsZY_LRxYQe0ypU-UrMMptpFDo_s3uFIJMd41uT2wXxZQzZodJeikegY5lwl4o3y3M-D-ZOq-LHi96mV0Hg83DXMJZe3pU4US6-Gi-wUrgwlQKR8xgbXLUgcE2cRdbFX3ZO8QK0Z_KGdw9Q" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" data-original-height="491" data-original-width="800" height="245" src="https://blogger.googleusercontent.com/img/a/AVvXsEgDjL7ihPzCYbj21OLbR4wx6grOsOVfVSdyOZSV0r3IsZY_LRxYQe0ypU-UrMMptpFDo_s3uFIJMd41uT2wXxZQzZodJeikegY5lwl4o3y3M-D-ZOq-LHi96mV0Hg83DXMJZe3pU4US6-Gi-wUrgwlQKR8xgbXLUgcE2cRdbFX3ZO8QK0Z_KGdw9Q=w400-h245" width="400" /></a></div><br /><br /></div><br /> <p></p><br style="background-color: #ebedec; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px;" /><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div>#17,932</div><div><br /></div><div>Uptake of the flu seasonal flu vaccine, which had been rising over the past decade, appears to have peaked in 2020-2021 (<i>see chart above</i>) and has since experienced a slow decline. Some of this likely due to pandemic fatigue, rampant anti-vaccine rhetoric on social media, and a significant amount of <i>`breakthrough' </i>infection among the vaccinated. </div><div><br /></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636;">While I firmly believe that the seasonal flu vaccine reduces morbidity and mortality, and get the shot every year, I</span></span>'ve written often about the dangers of `overselling' its benefits to the general public (see <b><a href="https://afludiary.blogspot.com/2012/10/cidrap-need-for-game-changing-flu.html">here</a>, <a href="https://afludiary.blogspot.com/2012/10/peter-sandman-on-ccivi-vaccine-report.html">here</a>,</b> and<a href="https://afludiary.blogspot.com/2018/01/canada-fluwatch-week-52-diminished.html"> <b>here</b>)</a><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636;">.</span></span></div></blockquote><div><p style="text-align: left;"><span style="font-family: inherit;">Up until about a dozen years ago, the <a href="https://afludiary.blogspot.com/2012/10/peter-sandman-on-ccivi-vaccine-report.html" style="color: #3f3f7f; text-decoration-line: none;"><b>oft repeated mantra</b></a> from the CDC was:<i> <span style="color: #2b00fe;">". . . for healthy adults under the age of 65, in years when the vaccine is a <b>good match to circulating strains,</b> effectiveness ranges from </span><b style="color: #2b00fe;"><u>70%-90%</u>.</b><span style="color: #2b00fe;">"</span></i></span></p><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636; font-size: 16px;">In 2011 the CDC lowered expectations somewhat, stating in a </span><b style="background-color: #ebedec; color: #363636; font-size: 16px;">FAQ</b><span style="background-color: #ebedec; color: #363636; font-size: 16px;">: `</span><i style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="color: #2b00fe;">. . . recent RCTs of inactivated influenza vaccine among adults <u><b>under 65</b></u> years of age have estimated </span><b style="color: #2b00fe;"><u>50-70%</u></b><span style="color: #2b00fe;"> vaccine efficacy <u><b>during seasons in which the vaccines' influenza A components were well matched</b> </u>to circulating influenza A viruses.'</span></i></span></div><div><span style="font-family: inherit;"><i style="background-color: #ebedec; color: #363636; font-size: 16px;"><span style="color: #2b00fe;"><br /></span></i></span></div><div><span style="font-family: inherit;"><span style="background-color: #ebedec; color: #363636;">Based on more recent studies, the </span><b style="color: #363636;"><a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm" style="color: #007f7f;">CDC's revised assessment of flu vaccine VE</a></b><span style="background-color: #ebedec; color: #363636;"> now reads:</span></span></div><div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><br /><a href="https://www.cdc.gov/flu/vaccines-work/effectiveness-studies.htm"><b>While vaccine effectiveness (VE) can vary</b></a><b style="background-color: #ebedec; color: #2b00fe; font-family: inherit; font-size: 16px;">, </b><span style="background-color: #ebedec; color: #2b00fe; font-family: inherit; font-size: 16px;">recent studies show that flu vaccination reduces the risk of flu illness by between </span><b style="background-color: #ebedec; color: #2b00fe; font-family: inherit; font-size: 16px;"><u>40% and 60%</u></b><span style="background-color: #ebedec; color: #2b00fe; font-family: inherit; font-size: 16px;"> among the overall population</span><b style="background-color: #ebedec; color: #2b00fe; font-family: inherit; font-size: 16px;"><u> during seasons when most circulating flu viruses are well-matched</u></b><span style="background-color: #ebedec; color: #2b00fe; font-family: inherit; font-size: 16px;"> to those used to make flu vaccines. In general, current flu</span><b style="background-color: #ebedec; color: #2b00fe; font-family: inherit; font-size: 16px;"> vaccines tend to work better against influenza B and influenza A(H1N1) viruses</b><span style="background-color: #ebedec; color: #2b00fe; font-family: inherit; font-size: 16px;"> and </span><b style="background-color: #ebedec; color: #2b00fe; font-family: inherit; font-size: 16px;">offer less protection against influenza A(H3N2) viruses.</b></blockquote><p>As the following CDC chart shows, flu vaccine effectiveness can vary greatly from one year to the next. </p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://www.cdc.gov/flu/vaccines-work/effectiveness-studies.htm" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="760" data-original-width="969" height="314" src="https://blogger.googleusercontent.com/img/a/AVvXsEi7ZslK3jBB-n_hJfgayYd3zfzef9spAvEQqXe2AVJi473FQfNitVrh17RARbeJYwUkNQh4PWXTSccHi4oF20UmnGleH9hEJ4L0UEFc8ulecXd1KWStIjdNimHPlaVJF8KaUph1bCI5p-elDjDd5dTtg5_B0Ph2F-N5wBVyMscaPrcEZJwa1KEIkQ=w400-h314" width="400" /></a></div><p>The measure of a vaccine's `<i>effectiveness'</i> can vary between studies, with some looking at outpatient visits or other <i>medically attended illnesses</i>, and others looking at more serious outcomes like <i>hospitalizations or deaths</i>. </p></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div><p style="text-align: left;">In other words, a vaccine doesn't necessarily have to prevent symptomatic infection in order to be considered effective. </p></div></blockquote><div><p>Last September, in a bid to change the public's perception of the benefits of the flu vaccine (see <a href="https://afludiary.blogspot.com/2023/09/cdc-hopes-to-reset-flu-vaccine.html"><b>CDC Hopes to `Reset' Flu Vaccine Expectations With New Campaign</b></a>), the CDC began emphasizing the vaccines ability to <b>reduce the severity of flu infection,</b> over it preventing infection entirely. </p><p></p></div><div><br /></div><div><div style="text-align: center;"><img height="121" src="https://blogger.googleusercontent.com/img/a/AVvXsEinDwwjpxSApxbUyjPc-kx0fOwD17PFpKCBWppbnRJOXpXQkGXJMDpehzwlcbeIhCb1132UsqYzpSh9ZzDGAOv7-21dX1PRpe-1QP-PmzWqA6htQx8Lx2F0HwSHf-FRCTp6B1PXw434PVxOR2_1S4WrcRZX96JpwsO_H7tNdMKQTb3ymX6fMS48jA=w400-h121" style="background: rgb(235, 237, 236); border-radius: 0px; border: 1px solid transparent; box-shadow: rgba(0, 0, 0, 0.2) 0px 0px 0px; color: #363636; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 16px; padding: 8px;" width="400" /></div></div><div><br /></div><div><br /></div><div>Yesterday the CDC's MMWR published their interim flu vaccine effectiveness report for the 2023-2024 flu season. While the final numbers won't be available until next summer, this year's vaccine appears to provide moderate protection against <b>seriou</b>s (<i>i.e. medically attended)</i> influenza virus infection.</div><br /><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><a href="https://www.cdc.gov/mmwr/volumes/73/wr/mm7308a3.htm?s_cid=mm7308a3_w"><b><span style="color: #2b00fe; font-size: large;">Interim Estimates of 2023–24 Seasonal Influenza Vaccine Effectiveness — United States</span></b></a></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">Weekly / February 29, 2024 / 73(8);168–174</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;"><br /><span style="font-size: x-small;">Aaron M. Frutos, PhD1,2; Ashley M. Price, MPH1; Elizabeth Harker, MPH1; Emily L. Reeves, MPH1; Haris M. Ahmad, MPH1; Vel Murugan, PhD3; Emily T. Martin, PhD4; Stacey House, MD, PhD5; Elie A. Saade, MD6; Richard K. Zimmerman, MD7; Manjusha Gaglani, MBBS8,9,10; Karen J. Wernli, PhD11,12; Emmanuel B. Walter, MD13; Marian G. Michaels, MD7,14; Mary A. Staat, MD15,16; Geoffrey A. Weinberg, MD17; Rangaraj Selvarangan, PhD18,19; Julie A. Boom, MD20,21; Eileen J. Klein, MD22; Natasha B. Halasa, MD23; Adit A. Ginde, MD24; Kevin W. Gibbs, MD25; Yuwei Zhu, MD23; Wesley H. Self, MD23; Sara Y. Tartof, PhD12,26; Nicola P. Klein, MD, PhD27; Kristin Dascomb, MD, PhD28; Malini B. DeSilva, MD29; Zachary A. Weber, PhD30; Duck-Hye Yang, PhD30; Sarah W. Ball, ScD30; Diya Surie, MD31; Jennifer DeCuir, MD, PhD31; Fatimah S. Dawood, MD31; Heidi L. Moline, MD31; Ariana P. Toepfer, MPH31; Benjamin R. Clopper, MPH31; Ruth Link-Gelles, PhD31; Amanda B. Payne, PhD31; Jessie R. Chung, MPH1; Brendan Flannery, PhD1; Nathaniel M. Lewis, PhD1; Samantha M. Olson, MPH1; Katherine Adams, MPH1; Mark W. Tenforde, MD, PhD1; Shikha Garg, MD1; Lisa A. Grohskopf, MD1; Carrie Reed, DSc1; Sascha Ellington, PhD1; CDC Influenza Vaccine Effectiveness Collaborators (<a href="https://www.cdc.gov/mmwr/volumes/73/wr/mm7308a3.htm?s_cid=mm7308a3_w#contribAff">VIEW AUTHOR AFFILIATIONS</a>)<a href="https://www.cdc.gov/mmwr/volumes/73/wr/mm7308a3.htm?s_cid=mm7308a3_w#suggestedcitation">View suggested citation</a></span></span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><b><span style="color: #2b00fe; font-size: medium;">Summary</span></b></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">What is already known about this topic?</span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">Influenza vaccines are reviewed biannually and updated as needed. In the United States, annual influenza vaccination is currently recommended for all persons aged ≥6 months.</span></blockquote><b><span style="color: #2b00fe; font-size: medium;"><br /></span></b><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><b><span style="color: #2b00fe; font-size: medium;">What is added by this report?</span></b></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">Analysis of data from four vaccine effectiveness (VE) networks estimated <b>interim pediatric influenza VE was 59%–67%</b> in outpatient settings and 52%–61% against influenza-associated hospitalization. Interim<b> adult influenza VE was 33%–49%</b> in outpatient settings and 41%–44% against influenza-associated hospitalization.</span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><b><span style="color: #2b00fe; font-size: medium;">What are the implications for public health practice?</span></b></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">These findings indicate that the 2023–24 seasonal influenza vaccine is effective at reducing the risk of influenza-associated outpatient visits and hospitalization. All eligible persons aged ≥6 months should receive annual influenza vaccination.</span></blockquote><div><span style="color: #2b00fe;"><br /></span></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><b><span style="color: #2b00fe; font-size: large;">Abstract</span></b></div></blockquote><div style="text-align: left;"><span style="color: #2b00fe;"><br /></span></div><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><span style="color: #2b00fe;">In the United States, annual influenza vaccination is recommended for all persons aged ≥6 months. Using data from four vaccine effectiveness (VE) networks during the 2023-24 influenza season, interim influenza VE was estimated among patients aged ≥6 months with acute respiratory illness-associated medical encounters using a test-negative case-control study design.</span></div><span style="color: #2b00fe;"><br /></span></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><span style="color: #2b00fe;">Among <b>children and adolescents</b> aged 6 months–17 years,<b> VE against influenza-associated outpatient visits ranged from 59% to 67%</b> and <b>against influenza-associated hospitalization ranged from 52% to 61%.</b></span></div><span style="color: #2b00fe;"><br /></span></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><span style="color: #2b00fe;">Among <b>adults aged ≥18 years</b>, VE against influenza-associated <b>outpatient visits ranged from 33% to 49%</b> and against<b> hospitalization from 41% to 44%</b>.</span></div><span style="color: #2b00fe;"><br /></span></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><span style="color: #2b00fe;">VE against influenza A ranged from 46% to 59% for children and adolescents and from 27% to 46% for adults across settings. VE against influenza B ranged from 64% to 89% for pediatric patients in outpatient settings and from 60% to 78% for all adults across settings.</span></div><span style="color: #2b00fe;"><br /></span></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><div style="text-align: left;"><span style="color: #2b00fe;">These findings demonstrate that the 2023–24 seasonal influenza vaccine i<b>s effective at reducing the risk for medically attended influenza virus infection</b>. CDC recommends that all persons aged ≥6 months who have not yet been vaccinated this season get vaccinated while influenza circulates locally.</span></div></blockquote><p><span style="color: #2b00fe;"> <b> <a href="https://www.cdc.gov/mmwr/volumes/73/wr/mm7308a3.htm?s_cid=mm7308a3_w">(Continue . . . )</a></b></span></p><p> </p><div style="text-align: left;">The CDC also released the following statement yesterday:</div><div style="text-align: left;"><br /></div><br /><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;"><b><span style="font-size: large;"><a href="https://www.cdc.gov/flu/spotlights/2023-2024/vaccines-reduce-medical-visits.htm">This Season’s Flu Vaccines Reduced Flu Medical Visits and Hospitalizations Across All Ages</a><br /></span></b> </span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">February 29, 2024 — Interim flu vaccine effectiveness estimates show that so far during the 2023-2024 flu season, flu vaccines have worked, substantially reducing the risk of flu-related medical visits and hospitalizations across all age groups, with some estimates higher than have been previously observed, even during well-matched seasons. Additionally, the data show that flu vaccination is working against both the influenza A and B viruses that have spread most commonly so far this season. CDC continues to recommend getting a yearly flu vaccine as long as flu viruses are spreading in the community.</span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">Specifically, flu vaccination has reduced the risk of flu medical visits by about two-thirds and flu-related hospitalization by about half for vaccinated children and flu medical visits by half and hospitalization by about 40% for vaccinated adults. This is the first time that interim flu vaccine effectiveness estimates for children and adults from <a href="https://www.cdc.gov/flu/vaccines-work/vaccine-effectiveness-networks.htm"><b>four major networks</b></a> are available at the same time, providing extensive data on <b><a href="https://www.cdc.gov/mmwr/volumes/73/wr/mm7308a3.htm">how well flu vaccines are working this season</a> </b>across influenza virus types, by age, and across a spectrum of illness severity.</span></blockquote><p> <a href="https://www.cdc.gov/flu/spotlights/2023-2024/vaccines-reduce-medical-visits.htm"> <b>(Continue . . . )</b></a></p><p><span style="font-family: inherit;">A side benefit we've looked at repeatedly over the year</span>s (see <b><a href="https://afludiary.blogspot.com/2019/01/chest-flu-vaccine-reduces-severe.html">here</a>, </b><a href="https://afludiary.blogspot.com/2019/08/study-suggests-flu-vaccine-may-lower.html"><b>here</b>,</a> and <a href="https://afludiary.blogspot.com/2022/11/the-lancet-influenza-vaccine-to-reduce.html"><b>here</b></a>) h<span style="font-family: inherit;">as been the flu vaccine's apparent impact on reducing <b>heart attacks, strokes</b>, and possibly even <b>dementia</b> later in life.</span></p><div><span style="font-family: inherit;">Last November, in</span><b> <a href="https://afludiary.blogspot.com/2023/11/nature-influenza-vaccination-major.html">Nature: Influenza Vaccination & Major Cardiovascular Risk: a Systematic Review & Meta-Analysis</a></b><span style="font-family: inherit;"><a href="https://afludiary.blogspot.com/2023/11/nature-influenza-vaccination-major.html" style="color: #3f3f7f; text-decoration-line: none;"><b>.</b></a> the authors wrote that they found:</span></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><ul style="line-height: 1.4; list-style-image: initial; list-style-position: initial; margin: 0.5em 0px; padding: 0px 2.5em;"><li style="border: none; color: #363636; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><i><span style="color: #2b00fe;"><b><span style="font-family: inherit;">`. . . compelling evidence that influenza vaccination is associated with a decreased risk of major cardiovascular events'.</span></b></span></i></li><li style="border: none; color: #363636; margin: 0px 0px 0.25em; padding: 0.25em 0px;"><span style="font-family: inherit;">Specifically, the authors found that <i><span style="color: #2b00fe;"><b>". . . patients who received the influenza vaccine experienced a remarkable risk reduction of over 20% in cardiovascular death".</b></span></i> This particular analysis focused on patients with an existing diagnosis of CVDs (Cardiovascular diseases).</span></li></ul></blockquote><p><span style="font-family: inherit;">While a VE of less than 50% may be disappointing, a fifty percent reduction in<i> severe flu</i> is still significant - and when you add in the reduced risk of cardiovascular events - the flu shot undoubtedly saves a lot of lives every year. </span></p><p><span style="font-family: inherit;">Which is why I get the flu shot every year, and urge others to do the same. </span></p>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-78933195930910151602024-02-29T09:08:00.002-05:002024-02-29T09:08:34.623-05:00CDC Statement On Spring COVID Vaccine For Seniors<a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2024-02-28-29/06-COVID-Wallace-508.pdf"><span style="color: #2b00fe;"><img height="228" src="https://blogger.googleusercontent.com/img/a/AVvXsEhsCoQ0VqZZF5K9TYokfdzd5rWTnkdCpP2W458XXAirmdtFNPhRQAxKwi6BFboDDe9mpMwzmdSRqeZBjLhxWEHPkzBSf2d46eqveR3AearZb7msU48qccEEn7dfYGY_eauP_xNQYAhKvuxYZsWb-62X_QVUWyPu95SWiSaFhRSBL4gV0gI3XlhMPA=w400-h228" width="400" /></span></a><br /><br /><blockquote><p></p><div class="separator" style="clear: both;"><span style="color: #2b00fe;"><br /></span></div><p></p></blockquote>#17,931<br /><p style="text-align: left;">Yesterday the CDC's <a href="https://www.cdc.gov/vaccines/acip/index.html"><b>ACIP</b></a> (<i>Advisory Committee on Immunization Practices)</i> - after <b><a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2024-02-28-29/06-COVID-Wallace-508.pdf">reviewing the evidence</a></b> - recommended people 65 and older receive an additional dose of the current monovalent COVID-19 vaccine this spring.</p><p style="text-align: left;">Late yesterday the CDC published the following statement in support of that recommendation. </p><blockquote><span style="color: #2b00fe;"><br /><b><span style="font-size: large;"><a href="https://www.cdc.gov/media/releases/2024/s-0228-covid.html">Older Adults Now Able to Receive Additional Dose of Updated COVID-19 Vaccine</a></span></b><br /><br />Media Statement<br /><br />For Immediate Release: Wednesday, February 28, 2024<br />Contact: <a href="https://www.cdc.gov/media">Media Relations</a><br />(404) 639-3286<br /><br /><br />Today, CDC Director Mandy Cohen endorsed the CDC Advisory Committee on Immunization Practices’ (ACIP) recommendation for adults ages 65 years and older to receive an additional updated 2023-2024 COVID-19 vaccine dose. The recommendation acknowledges the increased risk of severe disease from COVID-19 in older adults, along with the currently available data on vaccine effectiveness.<br /><br />Previous <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html">CDC recommendations</a> ensured that people who are immunocompromised are already eligible for additional doses of the COVID-19 vaccine.<br /><br />Data continues to show the importance of vaccination to protect those most at risk for severe outcomes of COVID-19. An additional dose of the updated COVID-19 vaccine may restore protection that has waned since a fall vaccine dose, providing increased protection to adults ages 65 years and older.<br /><br />Adults 65 years and older are disproportionately impacted by COVID-19, with more than half of COVID-19 hospitalizations during October 2023 to December 2023 occurring in this age group.<br /><br />CDC and ACIP will continue to monitor COVID-19 vaccine safety and effectiveness. CDC continues to recommend that everyone <b><a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html">stay up to date on their COVID-19 vaccines</a>,</b> especially <a href="https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html"><b>people with weakened immune systems</b></a>.<br /><br /><b>The following is attributable to Dr. Mandy Cohen:</b><br /><br />“Today’s recommendation allows older adults to receive an additional dose of this season’s COVID-19 vaccine to provide added protection,” said Mandy Cohen, M.D., M.P.H. “Most COVID-19 deaths and hospitalizations last year were among people 65 years and older. An additional vaccine dose can provide added protection that may have decreased over time for those at highest risk.”</span></blockquote><p>ACIP will meet in June to review the evidence for next fall's vaccine as illustrated by the following two slides from yesterday's <b><a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2024-02-28-29/07-COVID-Panagiotakopoulos-508.pdf">Next Steps for the COVID-19 Vaccine Program</a></b> presentation. </p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2024-02-28-29/07-COVID-Panagiotakopoulos-508.pdf" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="621" data-original-width="1098" height="253" src="https://blogger.googleusercontent.com/img/a/AVvXsEimYzyFWO5mtZjG_hi6UezhDfo16gR_qwMtK1Wa7FrMYryJaGqw2X4q_W-0c8sTThW_yxl9txk-63wK0HBk5HLoKI7WRSeSagPtddU4MD_jF8lI_NzXm11RfMM7VJkHGNCO9ltiCyLrbqxGSEuYLZth4B_XBMiXAHBJYlpfbsXCI10SotWkNBHwtA=w448-h253" width="448" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2024-02-28-29/07-COVID-Panagiotakopoulos-508.pdf" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="607" data-original-width="1072" height="250" src="https://blogger.googleusercontent.com/img/a/AVvXsEhu_yATWO60sQqXYuboewRFMf_-eOQVDBGK-i9kf8F-O9aeLyzB57nOIWlEQvyd3tB2VSaTfxVdHTtShefkQXtbOOVGGUyyyDzt9G1xvwRHtfN21-aWVcW_y8zIJzSr-DPyS8Lc9V9spboiLxHUZMMo4qqdrgdy-SjRTyapxMmsY1T7o8mLesV85A=w441-h250" width="441" /></a></div><br /><p></p> Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.comtag:blogger.com,1999:blog-21247748.post-84215436816025446772024-02-29T07:04:00.003-05:002024-02-29T07:04:36.150-05:00EID Journal: HPAI A(H5N1) Viruses from Multispecies Outbreak, Argentina, August 2023<img src="https://blogger.googleusercontent.com/img/a/AVvXsEjJzXNefHjrpINBYZ8gAmAwegdIssD8iV3K9oCRzve2Tr7tvN5g7BjEjb9cbbHRh4qnwelUNI6a5yXIhDvSejBZ__uytYdfSs0UuctX9bGDPk0f2n3mqOfAMVAmYmauny_vvOzfQF6evJuRjPY76--7R_kTQIVGmn-kJV2Jo8a-tclarhWo-kXqog=w101-h200" /><br /><br /><p>#17,930</p><p>The rapid spread of HPAI H5N1 down the length of South America - which began in the fall of 2022 - brought with it numerous reports of marine mammal die offs (see<b> <a href="https://afludiary.blogspot.com/2023/10/eid-journal-mass-mortality-of-sea-lions.html">EID Journal: Mass Mortality of Sea Lions Caused by HPAI A(H5N1) Virus (Peru)</a>)</b>, along with the loss of hundreds of thousands of wild birds.</p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;">Although we've long known that marine mammals (<i>seals, whales, sea lions, otters, etc.)</i> are susceptible to influenza viruses (see<b> <a href="https://afludiary.blogspot.com/2022/07/uk-hairs-risk-assessment-on-avian-flu.html">UK: HAIRS Risk Assessment On Avian Flu In Seals</a>)</b> - we've never seen anything quite like the losses due to HPAI H5 over the past 16 months in South America.</blockquote><p>Along the way we've seen indications that as HPAI H5 has spilled over into marine mammals, it has acquired a number <b>mammalian host adaptations</b>. Small amino acid changes that make it more suitable for carriage in non-avian species. </p><p>In last November's <a href="https://afludiary.blogspot.com/2023/11/eid-journal-highly-pathogenic-avian.html" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"><b>EID Journal: Highly Pathogenic Avian Influenza A(H5N1) from Wild Birds, Poultry, and Mammals, Peru</b></a>, the authors cited:</p><blockquote><b><span style="color: #2b00fe;">2 mutations in the polymerase basic 2 protein (Q591K and D701N) associated with mammal adaptation were identified only in sequences from sea lions in Peru and from 1 human case in Chile.</span></b></blockquote><p>Today we've a research letter, published in the EID Journal, from <i>University of California, Davis, </i>and<i> </i>the <i>National Institute of Agricultural Technology (INTA)</i> in Argentina, that characterizes the full genome of the HPAI H5N1 virus collected from samples taken from four sea lions, one fur seal and a tern last August.</p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;">They found the same two mutations (<b>Q591K</b> and <b>D701N</b>) described above in the Peruvian study, along with others, which suggest that the virus has adapted to mammalian hosts, while still retaining the ability to infect birds. </p></blockquote><p>They authors also state<i> that,</i> based on the available evidence, `<span style="color: #2b00fe;">.<i> . . </i></span><b style="color: #2b00fe;"><i>it seems likely that pinniped-to-pinniped transmission played a role in the spread of the mammal-adapted HPAI H5N1 viruses in the region.'</i></b></p><p>You'll find a less technical summary in the following press release from the UNIVERSITY OF CALIFORNIA - DAVIS, followed by a link to, and some excerpts from the full EID article. </p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><b><span style="color: #2b00fe; font-size: large;"><a href="https://www.eurekalert.org/news-releases/1035886">Avian influenza virus is adapting to spread to marine mammals</a></span></b></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">Findings raise concerns about wildlife conservation and ecosystem health</span></blockquote><p><span style="color: #2b00fe;"><a href="https://www.eurekalert.org/releaseguidelines" style="background: rgb(255, 255, 255); box-sizing: border-box; font-family: "Open Sans", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 14px; text-decoration-line: none; transition: all 0.1s linear 0s;"></a></span></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">The highly pathogenic avian influenza virus H5N1 has adapted to spread between birds and marine mammals, posing an immediate threat to wildlife conservation, according to a study from the University of California, Davis, and the National Institute of Agricultural Technology (INTA) in Argentina.</span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;"><a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article">The study</a>, published in the journal Emerging Infectious Diseases, is the first genomic characterization of H5N1 in marine wildlife on the Atlantic shore of South America.</span></blockquote><p><span style="color: #2b00fe;"> <b>(SNIP)</b></span></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">Genome sequencing revealed that the virus was nearly identical in each of the samples. The samples shared the same mammal adaptation mutations that were previously detected in a few sea lions in Peru and Chile, and in a human case in Chile. Of note, the scientists found all these mutations also in the tern, the first such finding.</span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">“This confirms that while the virus may have adapted to marine mammals, it still has the ability to infect birds,” said first author Agustina Rimondi, a virologist from INTA. “It is a multi-species outbreak.”</span></blockquote><span style="color: #2b00fe;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="color: #2b00fe;">We know this because the virus sequence in the tern retained all mammal-adaptation mutations. <b>Such mutations suggest a potential for transmission between marine mammals</b>.</span></blockquote><p><span style="color: #2b00fe;"> <a href="https://www.eurekalert.org/news-releases/1035886"><b>(Continue . . . )</b></a></span></p><br /><br /><blockquote><span style="color: #2b00fe;">Research Letter<br /><b><span style="font-size: large;"><a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article">Highly Pathogenic Avian Influenza A(H5N1) Viruses from Multispecies Outbreak, Argentina, August 2023</a></span></b><br /><br /><span style="font-size: x-small;">Agustina Rimondi<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#comment"><img border="0" src="https://wwwnc.cdc.gov/eid/content/images/icon/email.gif" /></a> , Ralph E.T. Vanstreels, Valeria Olivera, Agustina Donini, Martina Miqueo Lauriente, and Marcela M. Uhart</span><br /><br /><b>Abstract</b><br /><br />We report full-genome characterization of highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b virus from an outbreak among sea lions (August 2023) in Argentina and possible spillover to fur seals and terns. Mammalian adaptation mutations in virus isolated from marine mammals and a human in Chile were detected in mammalian and avian hosts.<br /><br /><br />In February 2023, the first case of highly pathogenic avian influenza (HPAI) A(H5N1) in Argentina was detected in a wild goose near the border with Bolivia and Chile (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725-app1.pdf">Appendix</a> Figure 1) (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#r1">1</a>). In contrast with Peru and Chile, where extensive mortality of seabirds and marine mammals had been attributed to the virus in the preceding months (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#r2">2</a>,<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#r3">3</a>), the initial spread of HPAI H5N1 in Argentina was largely limited to backyard and industrial poultry (94 outbreaks), causing the death or disposal of 2.2 million birds. Argentina declared itself free from the disease in poultry on August 8, 2023; before then, HPAI H5N1 detections in wildlife in Argentina had been scarce (7 events during February–April) and limited to aquatic birds (Anatidae, Laridae, and Rallidae) (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#r1">1</a>,<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#r4">4</a>). </span></blockquote><blockquote><span style="color: #2b00fe;">However, soon thereafter, the national animal health services confirmed HPAI H5N1 in South American sea lions (Otaria byronia) from Río Grande, southernmost Argentina. Over subsequent weeks, the virus was detected in sea lions northward along the Argentina coast, and sporadic cases also occurred in South American fur seals (Arctocephalus australis). The most affected site was Punta Bermeja (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725-app1.pdf">Appendix</a> Figure 1), the largest sea lion colony in Argentina, where an estimated 811 sea lions died over 2 months; minimal numbers (<5) of fur seals and terns were also affected (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#r1">1</a>,<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#r4">4</a>).<br /><br />In collaboration with provincial authorities and park rangers, we collected swab samples (oronasal, rectal, tracheal, lung, and brain) from 16 deceased sea lions, 1 fur seal, 1 great grebe (Podiceps major), and 1 South American tern (Sterna hirundinacea) discovered at Punta Bermeja on August 26, 2023. A sampled adult male sea lion was seen alive showing clinical signs consistent with HPAI infection (inability to stand or walk, muscular tremors and spasms, difficulty breathing, and abundant oral mucus). We tested the samples by real-time reverse transcription PCR targeting influenza A virus (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#r5">5</a>) and confirmed that all were positive. On the basis of viral RNA yields, we selected brain samples from 4 sea lions, 1 fur seal, and 1 tern for full-genome sequencing (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725-app1.pdf">Appendix</a> Figure 2). We used maximum-likelihood tree phylogenetic analysis (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#r6">6</a>) and mutational analysis to compare the sequences (GenBank accession nos. OR987081–128) with representative HPAI H5N1 strains from South America.<br /><br />Phylogenetic trees (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725-f1">Figure</a>; <a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725-app1.pdf">Appendix</a> Figure 2) showed that <b>the viruses we identified belong to HPAI H5N1 clade 2.3.4.4b and are closely related to H5N1 viruses that circulated in South America during 2022–2023.</b> Our finding supports the hypothesis that, after introduction from North America into Peru in November 2022, HPAI H5N1 viruses continued spreading across the continent and into Argentina. Of note, the <b>viruses from Punta Bermeja did not cluster with the hemagglutinin and neuraminidase sequences available from HPAI H5N1 first detected in a wild goose in Argentina</b>. Instead, all gene segments from the viruses were closely related to virus sequences from sea lions in Chile and Peru (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#r2">2</a>; C. Pardo Roa, unpub. data, <a href="https://www.biorxiv.org/content/10.1101/2023.06.30.547205v">https://www.biorxiv.org/content/10.1101/2023.06.30.547205vExternal Link</a>); 6 gene segments (all except polymerase basic protein 1 and nucleocapsid protein) also clustered with the virus isolated from a human in Chile (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#r7">7</a>). T</span></blockquote><blockquote><span style="color: #2b00fe;">hat finding suggests that <b>viruses from Punta Bermeja may have been derived from a separate HPAI H5N1 introduction into Argentina. </b>Because of the lack of genomic data for HPAI H5N1 viruses circulating in Argentina during February–July 2023, the finer scale pathways (local geographic routes and host species involved) of how these viruses arrived at Punta Bermeja remain unclear. Even so, the viruses that we report did not cluster with those from birds in Uruguay, Brazil, or Bird Island (Antarctica), possibly suggesting separate pathways of virus spread.<br /><br />On the basis of previous comparisons with HPAI H5N1 isolates from other countries in South America, <b>we identified 9 mutations already present in viruses infecting sea lions in Peru and Chile but not in the goose/Guangdong reference strain or in viruses from birds and mammals from North America in 2022 </b>(<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725-t1">Table</a>). Specifically, we found <b>Q591K and D701N mutations i</b>n polymerase basic 2 associated with increased pathogenicity to mammals (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#r8">8</a>). The virus we detected in the tern from South America also has those mutations, but they were absent from previously reported HPAI H5N1 viruses from avian hosts in South America (except for A/sanderling/Arica y Parinacota/240265/2023, which has the D701N mutation). </span></blockquote><blockquote><span style="color: #2b00fe;"><b>That finding further supports the hypothesis that HPAI H5N1 viruses from sea lions from Peru and Chile acquired mammalian adaptation mutations that improved their ability to infect pinnipeds while possibly retaining the ability to infect avian hosts</b>.</span></blockquote><blockquote><span style="color: #2b00fe;">Given the rapid and widespread dissemination of the viruses among pinnipeds in South America and the substantial associated mortalities (<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#r3">3</a>,<a href="https://wwwnc.cdc.gov/eid/article/30/4/23-1725_article#r9">9</a>),<b> it seems likely that pinniped-to-pinniped transmission played a role in the spread of the mammal-adapted HPAI H5N1 viruses in the region. </b>It is alarming that the HPAI H5N1 viruses infecting pinnipeds and seabirds in Argentina share the same mammalian adaptation mutations as the virus from the affected human in Chile, which highlights the potential threat posed by these viruses to public health.<br /><br /><span style="font-size: x-small;">Dr. Rimondi is a scientist at the National Institute of Agricultural Technology in Argentina and a postdoctoral fellow from Alexander von Humboldt Foundation from Germany working on HPAI H5N1 at the Robert Koch Institute. Her primary research interests focus on molecular epidemiology and host–pathogen interactions of avian influenza viruses.</span></span></blockquote><p><br /></p><p>This isn't the first time that we've seen the<i> possibility</i> of seal-to-seal transmission discussed, but proving it has been difficult. While not definitive proof, this latest study certainly adds scientific credence to the idea, and reminds us that HPAI H5Nx continues to evolve in the wild. </p><p>While it is still possible there is some species barrier that prevents HPAI H5 from posing a pandemic threat - it continues to expand both its geographic and host range - making it too unpredictable to ignore. </p>Michael Costonhttp://www.blogger.com/profile/07982161449334601397noreply@blogger.com