CDC & EID Journal On The Recently Discovered Bourbon Virus

Bourbon Virus – Credit CDC

 

# 9733

 

A couple of months ago I wrote about the Kansas DOH Statement On A New, Possibly Tickborne Virus detected in a Bourbon County man (hence the name) who died from what appeared (based on blood work and symptoms) to be a tickborne disease last summer. 

 

After the `usual suspects’  (i.e. Ehrlichiosis , SFTS, and even the recently discovered `Heartland Virus’) were eliminated, the CDC began searching for a new virus in the patient’s samples.  

 

They eventually isolated a novel strain of the Thogotovirus –variants of which have been found in ticks in Africa and southern Europe. This week the CDC’s EID Journal  published a research paper on that virus (see below), and the CDC has put up a new Bourbon Virus FAQ.

 

Volume 21, Number 5—May 2015

Research

Novel Thogotovirus Species Associated with Febrile Illness and Death, United States, 2014

Abstract

A previously healthy man from eastern Kansas, USA, sought medical care in late spring because of a history of tick bite, fever, and fatigue. The patient had thrombocytopenia and leukopenia and was given doxycycline for a presumed tickborne illness. His condition did not improve. Multiorgan failure developed, and he died 11 days after illness onset from cardiopulmonary arrest. Molecular and serologic testing results for known tickborne pathogens were negative. However, testing of a specimen for antibodies against Heartland virus by using plaque reduction neutralization indicated the presence of another virus. Next-generation sequencing and phylogenetic analysis identified the virus as a novel member of the genus Thogotovirus.

<SNIP>

Discussion

(EXCERPT)

The discovery of Bourbon virus, in addition to recent discoveries of tick-associated Heartland and severe fever with thrombocytopenia syndrome viruses (19,20), suggests that the public health burden of these pathogens has been underestimated. As nonselective molecular methods of pathogen identification (i.e., NGS sequencing) become more widely used, ideally in combination with classical microbiologic techniques, it is anticipated that similar discoveries will be made in the future.

It is currently not known how many human infections and disease cases might be attributable to this novel pathogen. On the basis of limited information for our case-patient, health care providers might consider Bourbon virus as a potential infectious etiology in patients in whom fever, leukopenia, and thrombocytopenia develop without a more likely explanation and who have shown negative results for other tickborne diseases (e.g., ehrlichiosis, anaplasmosis, or Heartland virus disease) or have not responded to doxycycline therapy. Work is planned to identify additional human infections with this novel virus, as well as to explore its potential geographic distribution. Also, more comprehensive virologic characterizations and field work are ongoing to better understand the biology of, and to identify potential vectors and reservoirs for, Bourbon virus. These data will be critical to further characterize the epidemiology and illness caused by Bourbon virus and to implement potential prevention and control measures.

 

This from the CDC’s Division of Vector-Borne Diseases (DVBD)

 

Bourbon virus

Bourbon Virus

Frequently Asked Questions

What is Bourbon virus?

Bourbon virus belongs to a group of viruses called thogotoviruses. Viruses in this group are found all over the world. A few of these viruses can cause people to get sick.

How do people get infected with Bourbon virus?

We do not yet fully know how people become infected with Bourbon virus. However, based on what we know about similar viruses, it is likely that Bourbon virus is spread through tick or other insect bites.

Where have cases of Bourbon virus disease occurred?

As of February 12, 2015, only one case of Bourbon virus disease had been identified in eastern Kansas in late spring 2014. The man who was infected later died. At this time, we do not know if the virus might be found in other areas of the United States.

What are the symptoms of Bourbon virus?

Because there has been only one case identified thus far, scientists are still learning about possible symptoms caused by this new virus. In the one person who was diagnosed with Bourbon virus disease, symptoms included fever, tiredness, rash, headache, other body aches, nausea, and vomiting. The person also had low blood counts for cells that fight infection and help prevent bleeding.

Who is at risk for infection with Bourbon virus?

People likely become infected with Bourbon virus when they are bitten by a tick or other insect. Therefore, people who do not take steps to protect themselves from tick or insect bites when they work or spend time outside may be more likely to be infected.

How can people reduce the chance of becoming infected with Bourbon virus?

There is no vaccine or drug to prevent or treat Bourbon virus disease. Therefore, preventing bites from ticks and other insects may be the best way to prevent infection. Here are ways to protect yourself from tick and other bug bites when you are outdoors:

• Use insect repellents
• Wear long sleeves and pants
• Avoid bushy and wooded areas
• Perform thorough tick checks after spending time outdoors

Additional information on reducing exposure to ticks is available on the CDC Ticks website.

How do I know if I have been infected with Bourbon virus?

Currently, no laboratory tests are routinely available to tell if a person is infected with Bourbon virus. Tests that will help a doctor diagnose Bourbon virus infection are being developed. See your healthcare provider if you have any symptoms that concern you. 

What is the treatment for Bourbon virus disease?

Because there is no medicine to treat Bourbon virus disease, doctors can only treat the symptoms. For example, some patients may need to be hospitalized and given intravenous fluids and treatment for pain and fever. Antibiotics are not effective against viruses, including Bourbon virus. 

What should I do if I think someone might be infected with Bourbon virus?

See your healthcare provider if you have any symptoms that concern you. 

Can Bourbon virus cause animals to become ill?

Scientists do not yet know what animals can get infected or become sick from Bourbon virus. Studies are ongoing to look at this. See your veterinarian if your pet or livestock have any symptoms that concern you.

(Continue . . .)

 

There is a growing realization that the public health burden of tick and other vector borne diseases is likely much greater than previously appreciated.

• In 2013, the CDC revised their Estimate Of Yearly Lyme Disease Diagnoses In The United States, indicating that the number of Lyme Disease diagnoses in the country is probably closer to 300,000 than the 30,000 that are officially reported each year to the CDC.
• A little over two years ago (see New Phlebovirus Discovered In Missouri) we learned about the new `Heartland Virus’ which made headlines when it was detected in two Missouri farmers with no epidemiological links and living 60 miles apart. Since then the number of cases – while small – has continued to grow (see MMWR: Heartland Virus Disease — United States, 2012–2013).
• SFTS or Severe Fever with Thrombocytopenia Syndrome - which was first discovered in China in 2009, but has also been found in Japan and Korea - is genetically similar to the recently discovered Heartland Virus (see EID Journal: Two Dispatches On SFTS).

 

The CDC lists a growing number of other diseases carried by ticks in the United States, including: Anaplasmosis, Babesiosis , Ehrlichiosis,  , Rickettsia parkeri Rickettsiosis, Rocky Mountain Spotted Fever (RMSF), STARI (Southern Tick-Associated Rash Illness), Tickborne relapsing fever (TBRF), Tularemia, and 364D Rickettsiosis.

 

Whether a new and emerging threat, or simply the result of our ability to finally recognize a long-time foe, we are becoming more cognizant of the dangers posed by ticks. With no vaccines to protect us, it makes sense to take additional precautions against ticks and other vector-borne diseases.

 

The following CDC website offers advice on: Preventing Tick Bites

 

And for some more Tick-borne disease related blogs, you may wish to revisit:

 

PHAC: Lyme Disease Risk Increasing In Canada

EID Journal: Novel Bunyavirus In Livestock – Minnesota

Referral: Maryn McKenna On Babesia And The Blood Supply

NEJM: Emergence Of A New Bacterial Cause Of Ehrlichiosis

CDC FAQ On Experimental Ebola Treatments & Vaccine Development

 

# 8918

 

 

Although there are no FDA  approved specific treatments for Ebola infection,  it has been widely reported that two Americans afflicted with the virus have been given – and may have benefited from - an experimental drug cocktail called ZMapp (see CIDRAP News Report Experimental Ebola drug may have helped 2 US patients).

 

While early results are encouraging, ZMapp is extraordinarily difficult to produce in quantity, and in very short supply. According to a WaPo report from last night (see Can we give that experimental Ebola drug to West African victims?), NIH Director Anthony Fauci is quoted as saying:

 

“The number of doses that are available right now, today…is less than a handful. It really is going to be a supply problem. It would take months to produce a significant amount more.”

 

And of course, with only anecdotal (and very preliminary) data from two human recipients, there are no guarantees that this drug will prove both safe and effective in the long run across a larger cohort of patients. There has also been talk of a the development of a a vaccine against Ebola, with hopes to begin enrollment for  a Phase I clinical trial as early as this fall, although years of testing likely lay ahead. 

 

Given the extraordinary interest in ZMapp, and other experimental treatments and vaccines for Ebola, the CDC published a FAQ last night on the subject.

 

Questions and Answers on experimental treatments and vaccines for Ebola

This FAQ addresses questions the public has about potential treatments and vaccines for Ebola.

For further information on drug development, approval process, and research please contact the appropriate agency:

FDA media office: fdaoma@fda.hhs.gov
NIH media office: niaidnews@niaid.nih.gov
CDC media office: media@cdc.gov
ASPR media office: Gretchen.Michael@hhs.gov

What is ZMapp?

ZMapp, being developed by Mapp Biopharmaceutical Inc., is an experimental treatment, for use with individuals infected with Ebola virus. It has not yet been tested in humans for safety or effectiveness. The product is a combination of three different monoclonal antibodies that bind to the protein of the Ebola virus.

How effective is the experimental treatment?

It is too early to know whether ZMapp is effective, since it is still in an experimental stage and has not yet been tested in humans for safety or effectiveness. Some patients infected with Ebola virus do get better spontaneously or with supportive care. It's important to note that the standard treatment for Ebola remains supportive therapy.

This consists of the following measures:

• balancing the patients' fluids and electrolytes;
• maintaining their oxygen status and blood pressure; and
• treating them for any complicating infections.

Why aren't more people getting ZMapp?

At this time, very few courses of this experimental treatment have been manufactured. Since the product is still in an experimental stage, it is too early to know whether ZMapp is effective. The manufacturer of this experimental treatment continues to research and evaluate the product's safety and effectiveness. It has not yet been tested in humans for safety or effectiveness and much more study is needed.

Did the NIH play a role in getting the experimental therapy to the two U.S. patients in Liberia?

This experimental treatment was arranged privately by Samaritan's Purse, the private humanitarian organization, which employed one of the Americans who contracted the virus in Liberia. Samaritan's Purse contacted the Centers for Disease Control and Prevention (CDC), who referred them to the National Institutes of Health (NIH). NIH was able to provide the organization with the appropriate contacts at the private company developing this treatment. The NIH was not involved with procuring, transporting, approving, or administering the experimental treatments.

Will patients in West Africa be able to access this experimental treatment? How much supply is there?

The product is still in an experimental stage, and the manufacturer reports that there is a very limited supply, so it cannot be purchased and is not available for general use. The manufacturer has been planning for phase 1 clinical trials and does not have the capacity to manufacture large quantities of the treatment. The drug has not gone through clinical trials, meaning its safety and effectiveness has not yet been tested in humans. The manufacturer of the experimental treatment continues to research and evaluate the product's safety and effectiveness.

Is ZMapp available under the Food and Drug Administration's expanded access to investigational drugs?

Currently there are only experimental treatments for Ebola virus infection in the earliest stages of development. When a drug is not approved, the FDA can authorize access to potentially promising products through other mechanisms, such as through an emergency Investigational New Drug (IND) application. In order for an experimental treatment to be administered in the U.S., such a request must be submitted to and authorized by the FDA. The FDA cannot comment on the specifics of ongoing drug development programs and cannot reveal information that is not otherwise public concerning submissions covering such programs such as IND applications submissions. The FDA stands ready to work with companies and investigators treating these patients.

Is ZMapp a vaccine?

No. ZMapp is being developed as a therapeutic product for treatment of people infected with Ebola virus, but not to prevent infection in the same manner as a vaccine. The best way to prevent infection currently is with stringent infection control measures.

What's the difference between therapy and vaccine?

Vaccines are usually given to people before they are exposed to a virus or bacteria that causes a disease. A vaccine stimulates the immune system to generate antibodies and cellular immunity that can fight off an infection if it were to occur. Typically, therapeutics are provided to people who are already infected with the virus. With the experimental ZMapp treatment, the monoclonal antibodies bind to the virus, so that the human immune system can clear the virus.

Are there Ebola vaccines available for use or in development?

There are currently no FDA approved vaccines for Ebola. The NIH's National Institute of Allergy and Infectious Diseases is working on developing an Ebola vaccine. NIH recently announced they are expediting their work, and aiming to launch phase 1 clinical trials of an Ebola vaccine in the fall. NIH is also supporting the Crucell biopharmaceutical company in its development of an Ebola/Marburg vaccine as well as Profectus Biosciences in its development of an Ebola vaccine. Additionally, NIH and the Thomas Jefferson University are collaborating to develop a candidate Ebola vaccine based on the established rabies vaccine.

Is the U.S. government involved in the development of ZMapp?

The U.S. government, specifically, the NIH's National Institute of Allergy and Infectious Diseases, the Department of Defense's Defense Threat Reduction Agency (DTRA), and the HHS' Biomedical Advanced Research and Development Authority (BARDA), has provided support for the development of this experimental treatment.

Are there other companies developing experimental treatments or vaccines?

Two other companies, Tekmira and Biocryst Pharmaceuticals, receive funding from the Department of Defense's Defense Threat Reduction Agency and have therapeutic candidates for Ebola in early development. The Department of Defense is working with a company called Newlink to develop an Ebola vaccine candidate. BioCryst, with NIH support, is working to develop an antiviral drug to treat Ebola virus that is expected to begin Phase 1 testing later this year.

WHO: Updated Ebola Factsheet

Ebola Virus - Credit CDC

 

# 8412

 

My thanks to Gregory Hartl – spokesperson for the World Health Organization – for tweeting the announcement that a new Ebola Factsheet has been published on their website.

While the virus was first identified in 1976, there have been fewer than 3 dozen outbreaks studied, and so doctors and researchers are still learning about these emerging pathogens. 

I’ve only excerpted the first two sections, follow the link to read it in its entirety.

 

Ebola virus disease

Fact sheet N°103
March 2014

---

Key facts

• The Ebola virus causes Ebola virus disease (EVD; formerly known as Ebola haemorrhagic fever) in humans.
• EVD outbreaks have a case fatality rate of up to 90%.
• EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests.
• The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
• Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus.
• No specific treatment or vaccine is available for use in people or animals.

---

The Ebola virus causes Ebola virus disease (EVD) in humans, with a case fatality rate of up to 90%.

Ebola first appeared in 1976 in 2 simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo. The latter was in a village situated near the Ebola River, from which the disease takes its name.

Genus Ebolavirus is 1 of 3 members of the Filoviridae family (filovirus), along with genus Marburgvirus and genus Cuevavirus. Genus Ebolavirus comprises 5 distinct species:

• Bundibugyo ebolavirus (BDBV)
• Zaire ebolavirus (EBOV)
• Reston ebolavirus (RESTV)
• Sudan ebolavirus (SUDV)
• Taï Forest ebolavirus (TAFV).

BDBV, EBOV, and SUDV have been associated with large EVD outbreaks in Africa, whereas RESTV and TAFV have not. The RESTV species, found in Philippines and the People’s Republic of China, can infect humans, but no illness or death in humans from this species has been reported to date.

Transmission

Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.

Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.

Among workers in contact with monkeys or pigs infected with Reston ebolavirus, several infections have been documented in people who were clinically asymptomatic. Thus, RESTV appears less capable of causing disease in humans than other Ebola species.

However, the only available evidence available comes from healthy adult males. It would be premature to extrapolate the health effects of the virus to all population groups, such as immuno-compromised persons, persons with underlying medical conditions, pregnant women and children. More studies of RESTV are needed before definitive conclusions can be drawn about the pathogenicity and virulence of this virus in humans.

(Continue . . . )

 

For more additional background\ on Ebola, you may wish to revisit some of these earlier blogs:

 

A Brief History Of Ebola 

When Viruses Jump Cages

When Viruses Jump Species

WHO Updated FAQ On H7N9 – Feb 14th

 

# 8300

 

The World Health Organization has released an updated FAQ (Frequently Asked Questions) document on the H7N9 virus – the second such update in just over two weeks (see January 29th H7N9 FAQ).   As more is learned about this emerging virus, updates like this are very important.

A quick comparison of the January 29th  vs. the February 14th FAQ shows that while much remains the same across the 23 Q&A sections, sections 7. How are people becoming infected with H7N9 virus? and 12. Is the source of human infection poultry and live poultry markets?,  contain an interesting change.

 

In the past, transmission has been described as:

 

Although there have been clusters* of infection (infections in people in close proximity to one another), the virus does not appear to transmit easily from one person to another and further, onward, or sustained human-to-human transmission has not been reported despite investigations and follow up of cases and close contacts of cases.

 

While maintaining the same description as above, the new FAQ adds:

A minority of cases appear to have resulted from limited person to person transmission.

 

While hardly a bombshell, given recent reports out of China, this is nonetheless an important change in the FAQ. Follow the link below to read the entire updated FAQ.  Due to its size, I’ve only included a few excerpts (bolding mine). 

 

Frequently Asked Questions on human infection caused by the avian influenza A(H7N9) virus

Update as of 14 February 2014

(EXCERPT)

6. Is the H7N9 virus different from influenza A(H1N1) and A(H5N1) viruses?

Yes. All three viruses are influenza A viruses but they are distinct from each other. H7N9 and H5N1 viruses are considered animal influenza viruses that sometimes infect people. H1N1 viruses can be divided into those that normally infect people and those that normally infect animals.

7. How are people becoming infected with H7N9 virus?

The available epidemiological and virological information strongly indicates that most known human H7N9 infections result from direct contact with infected poultry, or indirect contact with infected poultry (for example, by visiting wet markets and having contact with environments where infected poultry have been kept or slaughtered). A minority of cases appear to have resulted from limited person to person transmission. Because H7N9 infections do not cause severe disease in poultry, this infection can spread “silently” among poultry. Under such circumstances, the exact exposure for individual cases of human infection may be difficult to establish.

Although there have been clusters* of infection (infections in people in close proximity to one another), the virus does not appear to transmit easily from one person to another and further, onward, or sustained human-to-human transmission has not been reported despite investigations and follow up of cases and close contacts of cases.

* A “cluster” is defined as two or more persons with onset of symptoms within the same 14-day period and who are associated with a specific setting, such as a classroom, workplace, household, extended family, hospital, other residential institution, military barracks or recreational camp.

8. How can infection with H7N9 virus be prevented?

It is always prudent to follow basic hygienic practices to prevent infection. They include ensuring hand and respiratory hygiene and taking food-safety precautions.

Hand hygiene

• Wash your hands before, during, and after you prepare food; before you eat; after you use the toilet; after handling animals or animal waste; when your hands are dirty; and before and after providing care to anyone in your home who is sick. Hand hygiene will also prevent the spread of infections to yourself (from touching contaminated surfaces) and in hospitals to patients, health care workers and others.
• Wash your hands with soap and running water when hands are visibly dirty; if hands are not visibly dirty, wash them with soap and water or use an alcohol-based hand cleanser.

Respiratory hygiene

• When coughing or sneezing, the person should cover her/his mouth and nose with a medical mask, tissue, or a sleeve or flexed elbow; throw the used tissue into a closed bin immediately after use; perform hand hygiene after contact with respiratory secretions.

Food safety

• (see below)

<SNIP>

12. Is the source of human infection poultry and live poultry markets?

Most known human infections results from direct or indirect contact with infected poultry or contaminated environments. A minority of cases appear to have resulted from limited person to person transmission. It cannot yet be confirmed that infected poultry are the only source of infection; and other possible animal or environmental sources of infection cannot be excluded.

(Continue . . .)

 

WHO: Updated Q&A On MERS Coronavirus

Coronavirus – Credit CDC PHIL

 

 

# 7992

 

 

A hat tip to Lisa Schnirring at CIDRAP NEWS for tweeting this update to the World Health Organization’s FAQ document on the MERS Coronavirus.   This comes just a day after we saw the OIE: Updated Q&A On MERS Coronavirus, which urged caution on pinning the transmission of the virus on camels.

 

Like the OIE, the WHO says that the finding of the virus in a camel earlier this month – while an important development – does not necessarily implicate camels directly in the chain of transmission to humans (… much more detail follows).

I’ve only excerpted a couple of items below, so follow the link to read the entire update.

Frequently Asked Questions on Middle East respiratory syndrome coronavirus (MERS-CoV)

19 November 2013

What is coronavirus?

Coronaviruses are a large family of viruses that cause illness in humans and animals. In people, coronaviruses can cause illnesses ranging in severity from the common cold to Severe Acute Respiratory Syndrome (SARS).

The novel coronavirus, first detected in April 2012, is a new virus that has not been seen in humans before. In most cases, it has caused severe disease. Death has occurred in about half of cases.

This new coronavirus is now known as Middle East respiratory syndrome coronavirus (MERS-CoV). It was named by the Coronavirus Study Group of the International Committee on Taxonomy of Viruses in May 2013.

Where are MERS-CoV infections occurring?

Nine countries have now reported cases of human infection with MERS-CoV. Cases have been reported in France, Germany, Italy Jordan, Qatar, Saudi Arabia, Tunisia, the United Arab Emirates, and the United Kingdom. All cases have had some connection (whether direct or indirect) with the Middle East. In France, Italy, Tunisia and the United Kingdom, limited local transmission has occurred in people who had not been to the Middle East but who had been in close contact with laboratory-confirmed or probable cases.

How widespread is MERS-CoV?

How widespread this virus may be is still unknown. WHO encourages Member States to continue to closely monitor for severe acute respiratory infections (SARI) and to carefully review any unusual patterns of SARI or pneumonia. WHO will continue to share information as it becomes available.

What are the symptoms of MERS-CoV?

Common symptoms are acute, serious respiratory illness with fever, cough, shortness of breath and breathing difficulties. Most patients have had pneumonia. Many have also had gastrointestinal symptoms, including diarrhoea. Some patients have had kidney failure. About half of people infected with MERS-CoV have died. In people with immune deficiencies, the disease may have an atypical presentation. It is important to note that the current understanding of illness caused by this infection is based on a limited number of cases and may change as we learn more about the virus.

(Continue . . . )

 

OIE: Updated Q&A On MERS Coronavirus

Coronavirus – Credit CDC PHIL

 

 

# 7988

 

My thanks to Helen Branswell for tweeting this updated Q&A on the MERS virus from the OIE, the World Organization For Animal Health..

 

While some in the news media have jumped on the notion that people are contracting this virus directly from camels, the OIE says there is insufficient evidence to support that theory – recommending instead to keep an open mind - and not get too far ahead of what is actually known.

 

I’ve excerpted just a few segments (bolded underlined  emphasis are mine) – primarily those dealing with the issue of finding the virus in camels – so by all means, follow the link to read it in its entirety.

 

 

Update November 2013 - Questions and Answers MERS coronavirus (CoV)

(EXCERPTS)

What is the source of MERS CoV?
OIE together with its partner organizations the World Health Organization (WHO), the Food and Agriculture Organization (FAO) and national animal health authorities of affected countries is closely following investigations into a possible animal source of MERS CoV.

The current epidemiological investigation includes researching potential sources of exposure to the virus which are numerous and include other humans, the environment, food and water, as well as animals. Detailed information collected from relatives and other persons in contact with people infected with MERS CoV can help to provide important clues about the source of their infection.

To date, no formal proof has been highlighted on a potential animal origin. Exposure sources and modes of transmission also remain to be clarified.

Can animals become infected with MERS CoV?

Although experimental infection of animal cultured cells and recently monkeys with MERS CoV has been possible, to date the MERS CoV has not been naturally detected in animals.

Are animals responsible for MERS CoV infections in people?

To date there is no evidence that people have become infected through contact with animals. However there is also a possibility that MERS CoV may have evolved from other coronaviruses that have been circulating in certain animals. Additional public health investigations are needed to establish the source of exposure for human infections with MERS CoV when the source has not been identified as another human. So far, three patterns of infection have been reported by WHO:

• community acquired cases (the exposure sources remains unknown and might include an animal, food or environmental source)

• hospital acquired infections

• infection acquired through close human to human contact (household).

Did MERS CoV come from bats? 

Although a relative to this virus had already been detected in bat species, and a fragment of viral genetic material matching the MERS CoV was recently found in one bat from Saudi Arabia, more evidence is needed to directly link the MERS CoV to bats or any other animal species.

What about the suspicion that camels play a role in MERS?

Currently there is no strong evidence to consider that camels are a source of infection for human cases of MERS. Based on available epidemiological data it is difficult to explain the relationship between positive serological results in camels and cases of human infections with MERS CoV. Indeed, to date, there is no potential similarity between the strain of MERS CoV isolated in humans and the suspicions shown in camels. It is important to remain open minded about all potential sources of exposure for human cases until more information is available.

(Continue . . . )

WHO Updated MERS-CoV FAQ

Coronavirus - Photo Credit WHO

# 7557

 

The World Health Organization, partially in response to yesterday’s announcement in the Lancet: Camels Found With Antibodies To MERS-CoV-Like Virus, has updated their Frequently Asked Questions page on the MERS Coronavirus.

 

The entire FAQ – which is frequently updated with the latest information - is worth reading, but I’ve excerpted the portion addressing the camel study below:

 

Frequently Asked Questions on Middle East respiratory syndrome coronavirus (MERS-CoV)

 

9 August 2013

 

(EXCERPT)

 

What is the significance of recent findings of virus antibodies in camels?

The recent study by Reusken and colleagues (link to the article) suggests that MERS-CoV or a virus very similar to the MERS-CoV has been recently circulating among camels. More study is needed to know whether the virus is actually the identical to that found in humans. To do this, it is important to recover the MERS virus itself from a camel.

 

The paper provides a very important clue to the source of the virus and a direction for further investigation. The most critical question remains to be answered, that is, the type of human exposures that result in infection. Most human cases do not have a history of direct contact with camels; if camels or other animals are the source, the route of transmission to humans may be indirect.

 

It is premature to rule out the possibility that other animals might serve as a reservoir or an intermediate host for the MERS-CoV. There continues to be a need for well planned, structured investigations carried out in conjunction with exposure investigations in humans.

(Continue . . .)

WHO: Updated H7N9 FAQ

 

 

 

# 7213

 

While a lot of the questions still cannot be answered with much more than - `we don’t know yet’ - the World Health Organization has updated their extensive H7N9 FAQ page, with the latest information available.

 

Sometimes the hardest things for officials to do is to admit the limits of their knowledge of, or ability to control, a potentially risky situation.

 

WHO has, quite commendably, been consistently straightforward and open about what they know – and don’t know – about this emerging viral threat.

I’ve only posted the link, and a small fraction of the FAQ. Follow the link to read it in its entirety.

 

 

Frequently Asked Questions on human infection caused by the avian influenza A(H7N9) virus

Update as of 30 April 2013

Note that this document supersedes the previous version. Updates will be posted as new information becomes available.

1. What is the avian influenza A(H7N9) virus?

Avian influenza A H7 viruses are a group of influenza viruses that normally circulate among birds. The avian influenza A(H7N9) virus is one subgroup among the larger group of H7 viruses. Although some H7 viruses (H7N2, H7N3 and H7N7) have occasionally been found to infect humans, no human infections with H7N9 viruses have been reported until recent reports from China.

2. What are the main symptoms of human infection caused by avian influenza A(H7N9) virus?

Thus far, most patients with this infection have had severe pneumonia. Symptoms include fever, cough and shortness of breath. However, information is still limited about the full spectrum of illness that infection with avian influenza A(H7N9) virus might cause.

3. How many human cases of avian influenza A(H7N9) virus have been reported in China to date?

New cases that are reported are now being compiled and posted daily. The most current information on cases can be found in Disease Outbreak News.

4. Why is this virus infecting humans now?

We do not know the answer to this question yet, because we do not know the source of exposure for these human infections. However, analysis of the genes of these viruses suggests that although the viruses have evolved in birds, they may infect mammals more easily than other avian viruses.

<SNIP>

7. How are people becoming infected with the avian influenza A(H7N9) virus?

At this point it is not known how persons are becoming infected. Some of the confirmed cases had contact with animals or with environments where animals are housed. The virus has now been found in chickens, ducks, and captive-bred pigeons at live bird markets near locations where cases have been reported. The possibility of an animal source of the infection is being investigated, as is the possibility of person-to-person transmission.

<SNIP>

12. Is the source of infection poultry and live poultry markets?

Although some evidence points to live poultry as a source of infection, it cannot yet be confirmed that live poultry is the primary or the only source of infection. Neither is there enough evidence to exclude other possible animal or environmental sources of infection.

<SNIP>

16. Is the general population at risk from the avian influenza A(H7N9) virus?

We do not yet know enough about these infections to determine whether there is a significant risk of community person to person spread. This possibility is the subject of epidemiological investigations that are now taking place.

17. Are health care workers at risk from the avian influenza A(H7N9) influenza virus?

Health care workers often come into contact with patients with infectious diseases. Therefore, WHO recommends that appropriate infection prevention and control measures be consistently applied in health care settings, and that the health status of health care workers be closely monitored. Together with standard precautions, health care workers caring for those suspected or confirmed to have avian influenza A(H7N9) infection should use additional precautions (see:
http://www.who.int/csr/resources/publications/swineflu/WHO_CDS_EPR_2007_6/en/index.html ).

18. What investigations have begun?

Local and national health authorities are taking the following measures, among others:
• Enhanced surveillance for pneumonia cases of unknown origin to ensure early detection and laboratory confirmation of new cases;
• Epidemiological investigation, including assessment of suspected cases and contacts of known cases;
• Close collaboration with animal health authorities to determine the source of the infection.

19. Does this influenza virus pose a pandemic threat?

An animal influenza virus that develops the ability to infect people could theoretically carry a risk of causing a pandemic. However, whether the avian influenza A(H7N9) virus could actually cause a pandemic is unknown. Other animal influenza viruses that have been found to infect people occasionally have not gone on to cause a pandemic.

(Continue . . .)

 

CDC FAQ: H7N9 and You

 

# 7167

 

 

Yesterday the CDC released a number of guidance documents for clinicians and public health officials on the emerging H7N9 virus (see here & here). Today, they’ve updated and expanded their Q&A page for the public.

 

Admittedly, no one knows how big of a threat this emerging virus could eventually pose to the world. It could fade away, sputter along as it has been for months or even years, or it could escalate over time.

 

While not wanting to alarm the public, the CDC is being commendably frank and open over their concerns that this virus could one day make it out of China, and even to the United States.

 

Is it possible that human cases of H7N9 flu will be found in the United States?

 

Yes. The most likely scenario for this right now would be H7N9 infection in a traveler from China. Many people travel between China and the United States. CDC issued a health alert for public health officials and clinicians in the United States to be on the look-out for flu symptoms in travelers who are returning from countries with bird flu. CDC has issued guidance for isolating, testing, and treating such patients. However, since this virus does not seem to be spreading easily from person-to-person, a few cases in the United States with travel links to China would not change the risk of infection for the general public in the United States.

And they address the pandemic potential of this emerging virus as well.

 

Is CDC worried that an H7N9 pandemic will start?

This is a serious public health situation and it’s possible that a pandemic could start if this virus were to change to spread easily between people. CDC is preparing for that possibility.

 

 

This FAQ is likely to become a `living document’, changing – perhaps daily -  as more information comes in and our understanding of this virus matures.  I’ve only posted some excerpts, follow the link to read it in its entirety.

 

H7N9 Flu and You

A new strain of H7N9 bird flu has been found in birds and people in China. No ongoing person-to-person spread of this virus has been found at this time. Here are some common questions and answers about this new virus.

What is H7N9?

“H7N9” is the designation for one subtype of influenza viruses that is sometimes found in birds, but that does not normally infect humans. Like all influenza A viruses, there also are different strains of H7N9. Beginning at the end of March 2013, China reported human and bird (poultry) infections with a new strain of H7N9 that is very different from previously seen H7N9 viruses.

Is this new strain of H7N9 infecting humans?

Yes. While H7N9 viruses had never before been detected in people, in the first two weeks of April, China reported more than 70 cases of human infection with this new H7N9 virus.

How are people getting infected?

This virus has been found in birds (poultry) in China in some of the same areas where human infections have happened. Since this virus does not normally spread in people, the working assumption is that people have been infected with the virus after having contact with infected poultry.

How do people get infected with bird flu viruses?

Human infections with bird flu viruses are rare, but have happened in the past, usually after close contact with infected birds (both live and dead) or environments contaminated with bird flu virus.

 

Infected birds can shed a lot of flu virus, for example, in their droppings or their mucus. If someone touches an infected bird or an environment contaminated with virus and then touches their eyes, nose or mouth, they may be infected with bird flu virus. There is some evidence that infection may also occur if the flu virus becomes airborne somehow, such as when an infected bird flaps it wings. If someone were to breathe in airborne virus, it’s possible they could get infected.

Is infection with this virus serious?

Most of the reported cases of human infection with this virus have had very serious illness. There also are reports of some milder illness and one possible report of a person who tested positive for the virus who did not have any symptoms.

What are the symptoms of illness with this virus?

Symptoms have started with high fever and cough. A lot of the cases have progressed to very serious illness, including severe pneumonia, acute respiratory distress syndrome (ARDS), septic shock and multi-organ failure leading to death.

Is this virus spreading from person-to-person?

Chinese health authorities are investigating this situation very carefully. They are following up on close contacts of infected people to find out if they have gotten infected. This is important to find out whether there has been person-to-person spread of this virus. So far, hundreds of close contacts have been checked and there has not been any evidence of ongoing spread of this virus from person-to-person.

 

Is it possible that this virus will spread from person-to-person?

Yes. Based on what we know about human infections with other bird flu viruses, it’s possible and even likely that there will be some limited person-to-person spread with this virus. The important factor will be to determine whether this virus gains the ability to spread easily from one person to another. Sustainable human to human spread is needed for a pandemic to start. Health officials are watching the situation closely for this.

Is there a vaccine to protect against this new H7N9 virus?

No, right now there is no vaccine to protect against this virus. CDC and others are working to develop a vaccine candidate virus that could be used to make a vaccine if it is needed.

(Continue . . . )

WHO: FAQ On H7N9

 

Credit WHO Influenza at the Human-Animal Interface (HAI)

 

# 7058

 

My thanks to Giuseppe Michieli on FluTrackers for picking up this recently published FAQ from the World Health Organization on the emerging H7N9 virus.

 

As more is learned, some of these answers may change, but for now this represents their current thinking.

Frequently Asked Questions on human infection with A(H7N9) avian influenza virus, China

Updated 2 April 2013

1. What is the concern about A(H7N9)?

Many influenza viruses are animal – porcine, avian or other species – viruses which normally do not cross the species barrier. The cases of A(H7N9) are of concern because these are the first reported cases of this avian influenza virus in humans. See Disease Outbreak News for updates.

2. Can A(H7N9) avian influenza virus be transmitted from person to person?

At this point in time, there has been no evidence of human to human transmission among contacts of or between the confirmed cases. The ongoing investigation is exploring all the possible sources of infection, including the possibility of human-to-human transmission.

It is very important to further investigate the extent of the outbreak, the source of infection, the mode of transmission, the best clinical treatment and necessary prevention and control measures and to be vigilant so as to be able to identify additional cases should they appear.

3. Is this infection related to more than 16,000 pig carcasses recently found dumped in rivers around Shanghai?

While the dead pigs were part of the overall investigation, there was no evidence of any connection.

4. Is the general population at risk from the A(H7N9) avian influenza virus?

At this point in time, there has been no evidence of human to human transmission among contacts of or between the confirmed cases. The risk associated with A(H7N9) avian influenza virus to the general population in China and beyond is being investigated and will be shared to the public when information becomes available.

5. What action has been taken? What support is WHO providing?

The Chinese government is responding to the event and has taken the following actions and measures:

• Enhanced surveillance;
• Reinforced case management and treatment;
• Epidemiological investigation and close contact tracing;
• Laboratory strengthening;
• Training of health care professionals and issuing of guidelines; and
• Enhanced communications.
  

These are the first reported cases of A(H7N9) in humans. That makes it a unique event, which the World Health Organization is taking seriously. WHO is working closely with the national authorities to better understand the situation. and will communicate important updates as they become available.

6. How can individuals prevent A(H7N9) avian influenza infection?

Basic hygiene practices and food safety measures are prerequisites to prevent the transmission of many infectious diseases, including A(H7N9).

 

• Wash your hands often, especially: before, during, and after you prepare food; before you eat; after you use the toilet; after handling animals or animal waste; when your hands are dirty; and, more frequently, when someone in your home is sick.
• Hand hygiene is also necessary to prevent transmission in clinical settings to other patients and health care workers. Pathogens are removed by the mechanical action of hand washing. Alcohol disinfects (kills the pathogens).
• Cover your mouth and nose with a tissue when coughing or sneezing.
• In environments where any highly pathogenic avian influenza virus may be present, hand hygiene, which includes hand washing and the use of alcohol-based hand rubs, is critical to prevent possible viral inoculation of the nose, mouth and conjunctiva by contaminated hands.

WHO: FAQs On Japan’s Nuclear Concerns

 

# 5436

 

The World Health Organization has posted a series of FAQs (Frequently Asked Questions) regarding various aspects of the radiological dangers coming from the Fukushima nuclear plant.

 

This FAQ is currently divided into 9 sections:

 

1. Current risk
2. Ionizing radiation
3. Human exposure to ionizing radiation
4. Travel advice
5. Health effects
6. Public health actions
7. Personal protective measures
8. Food safety
9. WHO's response

 

 

One of the shorter sections involves the current risk, which I’ve reproduced below.  Follow the links to read all of them.

 

 

FAQs: Japan nuclear concerns

23 March 2011

Current risk

What is the current risk of radiation-related health problems in Japan for those residing near the reactor in comparison to those in other parts of Japan?

• Radiation-related health consequences will depend on exposure, which is dependant on several things, including: the amount and type of radiation released from the reactor; weather conditions, such as wind and rain; a person’s proximity to the plant; and the amount of time spent in irradiated areas.
• The Government of Japan’s recent actions in response to events at the Fukushima Daiichi nuclear power plant are in line with the existing recommendations for radiation exposure. The Government has evacuated individuals who were living within a 20-kilometre radius around the Fukushima Daiichi plant. Those living between 20 km and 30 km from the plant are being asked to shelter indoors. People living farther away are at lower risk than those who live nearby.
• As and if the situation changes, the Government of Japan may change their advice to the public; WHO is following the situation closely.

 

 

In one of the longer sections, on food safety, the following Q&A is included.

 

What are the potential health effects of consuming contaminated food?

• Consuming food contaminated with radioactive material will increase the amount of radioactivity a person is exposed to and could increase the health risks associated with exposure to radiation. The exact effect will depend on which radionuclides have been ingested and the amount. According to data reported so far, radioactive iodine is the main contaminant and concentrations in some food samples have been detected at levels above the Japanese regulatory limits. Radioactive iodine has a half-life of eight days and decays naturally within weeks. If ingested, it can accumulate in the body, particularly the thyroid gland, increasing the risk of thyroid cancer, particularly in children.
• The ingestion of potassium iodide is an established method to prevent the accumulation of radioactive iodine in the thyroid.
• Radioactive caesium has also been detected in some foods. The situation has to be monitored carefully as ingestion of food contaminated with radioactive caesium can also have long-term health effects.

 

 

 

 

 

My thanks to Sharon Sanders of FluTrackers for finding and posting these links.