Mackay On Ebola, Pigs, Primates and People

 

Credit CDC PHIL

 

 

# 8964

 

Yesterday Dr. Ian Mackay et al. produced a terrific overview called Ebola virus may be spread by droplets, but not by an airborne route: what that means which I blogged about here.  

 

Today Ian is back with another in-depth look at Ebola transmission, this time taking on the much-discussed laboratory experiments that some online pundits have claimed `proves’ airborne transmission.

 

Ian quite adeptly goes over what we know – and more importantly, what we don’t know – about Ebola transmission.  Both in the lab, and in the wild.  And along the way provides a lesson in critical thinking.

 

At this point, I’m going to do the smart thing and step out of the way and invite you to read:

 

Ebola, pigs, primates and people

This is a companion piece to my collaborative article, Ebola virus may be spread by droplets, but not by an airborne route: what that means, posted a couple of days ago. I suggest you read the both together.

In this post, I'd like to make sure we all understand that an airborne route of Ebola virus infection has been used to deliberately infect non-human primates (NHPs). It is possible and it can be done. Okay? I'm not covering up any secret knowledge or trying to conceal facts that only we few evil-society-of-science types know. I don't secretly work for an agency aiming to delude you dear readers into feeling falsely safe about the risks associated with being near an Ebola virus infected person (which most reading this will likely never be). Frankly, I'm learning this as I go.

(Continue . . . )

VDU Blog: A Deeper Look At The MacIntyre MERS-CoV Paper

Credit FAO

 

 

# 8898

 

 

Yesterday, in  Debating A Controversial MERS Paper, we looked at a rebuttal in the online academic forum The Conversation - by researchers @influenza_bio, @MackayIM, @maiamajumder, @neva925, @stgoldst & @kat_arden -  of a controversial paper by Professor Raina MacIntyre  that suggested that the  `human release’  of MERS-CoV could be behind the erratic outbreaks we’ve seen in the Middle East.

At just over a thousand words, this rebuttal was geared for the general reader, and so a lot of details were glossed over.

 

Today Dr. Mackay and company have posted a much longer analysis of the MacIntyre paper – one that runs well over 3,000 words – which dissects the MacIntyre paper more thoroughly. 

 

While acknowledging that bioterrorism is always `possible’, they argue that – based on the evidence – it  is an extremely unlikely scenario for MERS.

 

Follow the link below to read:

 

Virus variability, dopey data and insufficient infection control do not support the theory that bioterrorism is behind the ongoing MERS-CoV outbreak.

A collaborative note from (alphabetically): @influenza_bio, @MackayIM, @maiamajumder, @neva925, @stgoldst, @kat_arden

Debating A Controversial MERS Paper

Coronavirus – Credit CDC PHIL

 

# 8891

 

Last week, Professor Raina MacIntyre, Head of the School of Public Health and Community Medicine and Professor of Infectious Disease Epidemiology at UNSW, published a paper called The discrepant epidemiology of Middle East respiratory syndrome coronavirus (MERS-CoV), where she suggested that the unusual patterns of the MERS coronavirus outbreaks  might  indicate deliberate human release.

 

Professor MacIntyre went on to explain why a bio terror source ought to be at least considered in  MERS coronavirus: animal source or deliberate release?, published last week in The Conversation.

 

While best known for her work in respiratory virus transmission studies, over the past year we’ve looked at research from Dr. MacIntyre looking at whether the Flu Vaccine May Reduce Heart Attack Risk and just last month she and co-author Lauren M Gardner looked at some of the paradoxes presented by the MERS coronavirus. (see BMC Research Notes: Unanswered Questions About MERS-CoV.)

 

Dr. MacIntyre’s  latest paper, however, has been greeted with a good deal of skepticism, particularly among researchers and virologists, both on twitter, and in the media (see CIDRAP News Report).  

 

Today, a sextet of scientists and researchers – including well known infectious disease bloggers Dr. Ian Mackay and Maia Majumder - provide a rebuttal to Professor MacIntyre’s controversial hypothesis. Joining them are Dr.  Lisa Murillo from Los Alamos, Dr.  Katherine Arden from the University of Queensland, Dr. Nicholas G. Evans and Stephen Goldstein, both from the University of Pennsylvania.

 

Follow the link below to read their rationale, as published in The Conversation,  in its entirety.

 

 

30 July 2014, 5.40am BST

Middle East respiratory virus came from camels, not terrorists

When you hear hooves, shout camel, not bioterrorist. Delpixel/Flickr

The Middle East respiratory syndrome coronavirus (MERS-CoV) is a tiny, spiky package of fat, proteins and genes that was first found in a dying man in the Kingdom of Saudi Arabia in 2012.

 

Since then, we have learnt a little more about the virus. We know that nearly 90% of infections have originated in the Kingdom of Saudi Arabia. It is lethal in about a third of known cases, most of whom are older males, often with one or more pre-existing diseases of the heart, lung or kidney. So far it has claimed nearly 300 lives.

 

Camels have emerged as the most likely source of human MERS-CoV infections. In fact, blood samples collected between 1992 and 2013 show camels have been fighting MERS-CoV for at least 20 years.

 

But, in an unusual twist, research published last week calls on us to seriously consider, or at least acknowledge, that bioterrorism might explain the emergence of MERS-CoV in people. Raina MacIntyre, Professor of Infectious Disease Epidemiology at UNSW Australia, suggests that “deliberate release” may explain the paradoxical pattern of ongoing MERS-CoV infections.

(Continue . . .)

 

Although one can never totally eliminate the possibility that there is a human hand behind the spread of MERS, I confess that after reading Dr. MacIntyre’s paper last week,  I came away far less than convinced.  

 

While I briefly considered blogging the story, I saw that it had already been covered by CIDRAP News, and was being heartily debated on Twitter, and decided there was little of substance I could add.

A decision I’m glad of now, since others (far more qualified than myself) have now weighed in on the issue.   

Three Graphic Posts From Mackay

Credit VDU Blog

# 8821

 

I’ve been remiss in not mentioning that Professor Ian Mackay is back after taking a short break, with several new posts utilizing some impressive presentation software to create interactive maps on Ebola and MERS.

Follow the links below to view:

 

Ebolavirus disease (EVD) cases, clusters and outbreaks mapped out...

Mucking about with MERS and maps...

MERS-CoV in June/July...

Referral: Dr. Mackay Muses On MERS

Credit Dr. Ian Mackay VDU Blog

 

 

# 8391

 

Professor Ian Mackay, writing on his VDU Blog, has three new posts on the MERS Coronavirus in the wake of yesterday’s announced new cases in the Middle East (see CIDRAP NEWS Five new MERS cases reported in 3 countries).

 

On Ian’s mind is the relative frequency of reported prior camel contact among non-Saudi MERS cases compared to those from KSA.

 

Follow the links to read his thoughts on the matter in their entirety. Taken in order of appearance, they are:

 

MERS in the UAE....[UPDATED]

For the second time this month, there has been a case of Middle East respiratory syndrome coronavirus (MES-CoV) infection confirmed in the United Arab Emirates (UAE; Abu Dhabi to be precise).

What added to my confusion (as you'll know if you were following me on Twitter this morning) was that both cases, apart from being from Abu Dhabi, were also 68-year old males and both have had camel contact.

(Continue . . . )

MERS in Kuwait...

It's a "MERS-in.." kinda day.

The World Health Organization today announced a fatal case of confirmed MERS-CoV infection diagnosed in Kuwait [1].
Summary of the case details:

1. The infected person was a 60-year old male
2. A Syrian national
3. Hospitalised 13-Feb-2014
4. Died 6-Mar-2014
5. Lab confirmed 9-Mar-2014
6. He had comorbidities

(Continue . . . )

MERS in camels...

The top pie chart shows the distribution of all human cases containing the word "camel" in their case notes, by the site where the human was likely to have acquired their MERS-CoV infection. The bottom bar graph shows those data in terms of the proportion of cases at that site for which "camel" contact was possible.

Click on chart to enlarge.

Thanks very much to Nicholas Evans (@neva9257 via Twitter) for asking me to back up my gut feeling about there having been more camel-links among MERS-CoV cases outside the Kingdom of Saudi Arabia (KSA) compared to inside.

I live to serve and so using those data I have to hand I've made a couple of charts. I'll keep these updated from now on too.

I'd be grateful if anyone wanted to shout out human cases where camel contact was mentioned. I currently have 8 in total on my list of 201 lab confirmed MERS-CoV cases. (see the figure up there for where my cases are sourced). There may be many I have missed though.

(Continue . . . )

 

As always, Ian’s graphics and commentary are first rate and worthy of your time.

 

Highly recommended.

Dr. Mackay On H7N9 Market Closures & Case Reporting Out Of China

 

# 8301

 

Over night Dr. Ian Mackay on his VDU blog has been busy, posting a pair of blogs on the (apparent) effects of market closures in China on the spread of H7N9, and other possible reasons behind the recent drop in case reports. 

 

In the second blog listed, he articulates some of the concerns that many flu watchers have over the recent decline in reporting out of China.

Follow the links to read:

 

Zhejiang province leads the way in H7N9 cases and their decline 3-weeks after market closures...

Click on image to enlarge.

It's the Province in China that has seen more H7N9 cases confirmed in human than any other Province (39% of all cases have originated here).

It reached 50 cases faster in 2014 than 2013.

It closed its markets back in 24-Jan. And for a little while it kept finding new cases.

But the past 2-days have see no new cases announced from Zhejiang province. Eerily reminiscent of 2013 sudden disappearance of cases announcements.

(Continue . . .)

 

 

H7N9 case announcements dropping: is Wave 2 under control? [UPDATED]

Its a very tough question to answer. There has been public pressure by China's poultry-farming groups on China to take measures to stem the industry's financial losses. These have been driven by the public concern that H7N9 can seriously afflict people and in about a fifth of recorded instances, kill them.

(Continue . . .)

VDU: Update H7N9 Maps, Charts (And A MERS-CoV Bonus)

Credit Dr. Ian Mackay – VDU Blog

 

 

# 8247

 

Dr. Ian Mackay has been very busy the past couple of days updating his H7N9 charts and maps, with his latest post below:

 

H7N9 snapdate: new charts for sex and age distribution and region of acquisition...

Two new charts.

Click on image to enlarge.

Firstly, the "age pyramid", a revised and combined version of the age and sex distribution charts for 265/267 H7N9 cases to date. This one comes with many thanks to Shane Granger for helping me learn a new trick. Please follow him @gmggranger or visit his chart-tacular blog, Random Analytics at http://gmggranger.wordpress.com/.

(Continue . . . )

For more graphical goodness, you’ll want to check out Ian’s H7N9 post from yesterday:

 

H7N9 snapdate: charts bonanza...[UPDATED]

 

And just to prove that Ian isn’t a Johnny One-note, check out his two most recent blogs on the MERS Coronavirus:

 

MERS-CoV antibodies in dromedary camels from Dubai, UAE, as far back as 2005...

A date with Middle East respiratory syndrome coronavirus (MERS-CoV)..

Zhejiang Province Announces Two Additional H7N9 Cases

Zhejiang Province – Credit Wikipedia

 

 

# 8161

 

While the H7N9 virus has been reported in roughly a dozen provinces and large municipalities since last spring, Zhejiang Province – by a substantial margin – has reported the greatest number of cases.  Dr. Ian Mackay, on his Virology Down Under Blog, has just updated his terrific  H7N9 by area of case acquisition... chart (see below), which illustrates the distribution of known cases.

 

 

Given these trends, it isn’t surprising to find that – for the fourth day in a row – Zhejiang Province is announcing new cases.   Here is the announcement from the Zhejiang Ministry of Health website.

 

Zhejiang Province, two cases of human infection with the H7N9 new bird flu cases

Release date :2014 -01-12
Source: Ministry of Health and Family Planning Commission
Views: 196
January 12, 2014

Zhejiang Provincial Health and Family Planning Commission on January 12 informed that as at 15:00 on the 12th province confirmed two new cases of human infection H7N9 avian influenza.

Certain patients were male, 78 years old, Yiwu. January 11 was infected with H7N9 bird flu confirmed human cases, is now critically ill in a hospital in Hangzhou treatment.

Mengmou patient, male, 34 years old, temporary, Yinzhou District, Ningbo City, January 12 was infected with H7N9 bird flu confirmed human cases now are severe, in Ningbo, a hospital for treatment.

 

Today’s announcement brings to 7 the number of new cases announced from Zhejiang province since the first of the year.

 

While only Zhejiang province has reported new cases today, it isn’t clear whether all of the other provinces are updating their websites during the weekend. 

 

Tomorrow may provide us with a better indication as to the number of new cases.

Referral: Dr. Ian Mackay On H7N9 Activity In 2013

 

Weekly Accumulation Chart – Credit Dr. Ian Mackay

 

# 8112

 

After a sudden avalanche of cases during the spring, the number of new H7N9 cases in China declined over the summer, and has only recently begun to rise again with the arrival of winter.  

 

Today  Professor Ian Mackay has updated his H7N9 activity chart for the year (see above) on his VDU Blog  and provides some thoughts on what we’ve seen out of this virus so far.

 

Influenza A(H7N9) virus case accumulation for 2013...

Sure a full 12-months of H7N9 in humans hasn't passed yet, but 2013 is coming to a close.

I have 148 H7N9 cases worldwide including deaths and the asymptomatic boy from Beijing who seems to still be off the official tallies for some reason. WHO have not had an official tally of fatal cases in their recent 2 disease outbreak news posts, the last with a tally was 6-Nov in which 45 deaths were recorded with 6 cases remaining in hospital and 88 having been discharged. Hong Kong's Centre for Health Protection (CHP) maintains a running tally of mainland China cases With the recent death of a Hong Kong man the tally of fatal cases rest around 46 (PFC of 31.1%).

(Continue . . . .)

Dr. Mackay On MERS Cluster In Camels

 

Photo Credit Wikipedia

# 8015

While I’ve been occupied trying to determine if one can put their Thanksgiving dinner in a blender and then drink it through a straw (I’m 36 hours post-wisdom teeth extraction),  Dr Ian Mackay has doing something considerably more productive.  He’s been hot on the story of Qatari camels testing positive for the MERS virus.

 

Ian has two blogs, which I’ve linked to in reverse order. In addition to Ian’s insights you’ll find comments by both Marion Koopmans, DVM, PhD, head of virology at the Laboratory for Infectious Diseases at the RIVM in the Netherland and Prof Andrew Rambaut, of the Institute of Evolutionary Biology, University of Edinburgh.

Highly recommended.

 

Clustered camel coronavirus cases...

and

Dutch researchers in collaboration with Qatar are at work sequencing MERS-CoV from camels...

MERS-CoV: CIDRAP & Dr. Mackay On The Saudi Camel Connection

 

 

# 7963

 

The big infectious disease news yesterday was the preliminary finding of a MERS-like infection in a sick camel owned by a Saudi who is presently being treated for the MERS coronavirus (see KSA MERS Investigation: Testing The Beast, Not The Beauty). 

 

Additional testing is underway to determine just how closely the virus in the camel matches the virus in the patient.  If the genetic sequences prove closely related, then we may have an important new clue in how this virus is being spread.

 

Last Night Robert Roos of CIDRAP NEWS put together an excellent overview of the story, and what we know so far.

 

Reports: MERS-CoV found in Saudi patient's camel

Robert Roos | News Editor | CIDRAP News

|

Nov 11, 2013

iStockphoto

Media reports today said the Middle East respiratory syndrome coronavirus (MERS-CoV) has been detected in a camel linked to a human case in Saudi Arabia. If confirmed, the finding will mark the first time the virus has clearly been found in an animal and will strengthen the suspicion that camels are a source of human infections.

(Continue . . )

 

Dr. Ian Mackay weighs in as well, with an entry on his Virology Down Under blog, where he raises a number of intriguing questions including (assuming the human and camel viruses match), who infected whom?  

 

Follow the link below to read:

 

Camel cough, coronavirus caught? [UPDATED]

Are camels the main source of human infection
by the Middles East respiratory syndrome
coronavirus (MERS-CoV)?

I awoke to find the world has learned of a camel that tested positive using a Middle East respiratory syndrome coronavirus PCR. According to the Kingdom of Saudi Arabia's Ministry of Health announcement (on the Arabic language and not English language page), the camel was owned by by the a recent case (43M from Jeddah, reported on 7th of Nov- FluTracker's #156) and was showing signs of disease. The fact that it was ill may suggest it was the sources, but we don't yet know which illness came first, the camel or the man. We do know (from CIDRAP/WHO) that 43M became ill on Oct-27 and has been in hospital since Nov-3.

(Continue . . .)

 

 

We discussed reverse zoonosis – the passing of an infection from a human to another species – a little over a year ago in Companion Animals & Reverse Zoonosis.  While it doesn’t get much attention, it probably happens more often than we know.

 

During the 2009 H1N1 pandemic, the virus – which evolved in pigs – jumped to humans and spread rapidly. But humans also passed it on to new swine herds around the world, and to other animals as well.  We saw reports of dogs, cats, turkeys, cheetahs, and pet ferrets falling ill with the virus (see  US: Dog Tests Positive For H1N1, USDA Listing Of Animals With H1N1).

 

It is one of the reasons why people who work with, or raise swine are urged to get the seasonal flu vaccine each year, to prevent infecting pig herds with humanized flu strains – a possible route to creating a new reassortant flu virus.   The following comes from the CDC.

 

Influenza Vaccination of Swine Workers

(Excerpt)

However, influenza vaccination of swine workers – regardless of whether or not they have a high risk condition – is important to reduce the risk of transmitting seasonal influenza viruses from ill people to pigs. Seasonal influenza vaccination of workers might also decrease the potential for people or pigs to become co-infected with both human and swine influenza viruses. Such dual infections could result in genetic reassortment of the two different influenza A viruses and lead to a new influenza A virus that has a different combination of genes, and which could pose significant public health concern. Employers should consider providing swine workers with access to annual seasonal influenza vaccination that follow the recommendations for the general public for Preventing Seasonal Flu With Vaccination.

 

While one might reasonably assume that it is more likely that the Saudi patient acquired the virus from his camel – instead of the other way around – the possibility of reverse zoonosis cannot be ignored.   And of course, if the patient did contract the virus from his camel, where did the camel contract the virus?

 

More questions than answers at this point, but yesterday’s announcement is a tantalizing hint that progress is being made in unraveling the mysteries of the MERS coronavirus.

The Lancet: Transmission And Evolution Of MERS-CoV In Saudi Arabia

Coronavirus – Credit CDC PHIL

 

# 7795

 

This Lancet study, which was embargoed until early yesterday evening, has already generated a good deal of knowledgeable commentary, so rather than re-inventing the wheel, I’ll provide links and excerpts from the study, the press release, Dr. Ian Mackay’s commentary, and CIDRAP’s coverage.

 

First stop, the Lancet study, which – using genomic analysis - finds evidence of multiple spillovers of MERS from an (as yet, unknown) animal host into the human population in Saudi Arabia.

 

 

Copyright © 2013 Cotten et al. Open Access article distributed under the terms of CC BY-NC-ND Published by Elsevier Ltd. All rights reserved.

The Lancet, Early Online Publication, 20 September 2013

doi:10.1016/S0140-6736(13)61887-5

Transmission and evolution of the Middle East respiratory syndrome coronavirus in Saudi Arabia: a descriptive genomic study

Matthew Cotten PhD b †, Simon J Watson PhD b †, Prof Paul Kellam PhD b m †, Abdullah A Al-Rabeeah FRCS a, Hatem Q Makhdoom PhD c, Abdullah Assiri MD a, Jaffar A Al-Tawfiq MD d, Rafat F Alhakeem MD a, Hossam Madani PhD c, Fahad A AlRabiah MD g, Sami Al Hajjar MD g, Wafa N Al-nassir MD h, Ali Albarrak MD i, Hesham Flemban MD j, Hanan H Balkhy MD k, Sarah Alsubaie MD l, Anne L Palser PhD b, Astrid Gall Dr Med Vet b, Rachael Bashford-Rogers MChem b, Prof Andrew Rambaut Prof e f, Prof Alimuddin I Zumla FRCP a m n †, Prof Ziad A Memish FRCP

Summary

Background

Since June, 2012, Middle East respiratory syndrome coronavirus (MERS-CoV) has, worldwide, caused 104 infections in people including 49 deaths, with 82 cases and 41 deaths reported from Saudi Arabia. In addition to confirming diagnosis, we generated the MERS-CoV genomic sequences obtained directly from patient samples to provide important information on MERS-CoV transmission, evolution, and origin.

Methods

Full genome deep sequencing was done on nucleic acid extracted directly from PCR-confirmed clinical samples. Viral genomes were obtained from 21 MERS cases of which 13 had 100%, four 85—95%, and four 30—50% genome coverage. Phylogenetic analysis of the 21 sequences, combined with nine published MERS-CoV genomes, was done.

Findings

Three distinct MERS-CoV genotypes were identified in Riyadh. Phylogeographic analyses suggest the MERS-CoV zoonotic reservoir is geographically disperse. Selection analysis of the MERS-CoV genomes reveals the expected accumulation of genetic diversity including changes in the S protein. The genetic diversity in the Al-Hasa cluster suggests that the hospital outbreak might have had more than one virus introduction.

Interpretation

We present the largest number of MERS-CoV genomes (21) described so far. MERS-CoV full genome sequences provide greater detail in tracking transmission. Multiple introductions of MERS-CoV are identified and suggest lower R0 values. Transmission within Saudi Arabia is consistent with either movement of an animal reservoir, animal products, or movement of infected people. Further definition of the exposures responsible for the sporadic introductions of MERS-CoV into human populations is urgently needed.

 

The press release, from the Wellcome Trust Sanger Institute, provides more background and detail (excerpts follow).

 

 

Genome sequencing identifies multiple chains of MERS Co-V infection in humans

Genome sequencing has identified several infection transmission chains of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in humans. The study published in the Lancet, which produced the largest number of MERS-CoV genomes described to date, provides evidence that MERS-CoV transmission patterns are more complicated than previously considered.

<SNIP>

The findings suggest that human-to-human transmission is more complicated than expected, and indicates that additional sources of the virus, either human or animal, are involved. One possibility is that there may be undetected (and possibly asymptomatic) people who could be carrying and spreading the virus.

 

"The genome differences we discovered in some infected people were too great to be explained by replication errors occurring in the virus as it is passed from human to human during a single chain of infection," explained Professor Paul Kellam, senior author from the Sanger Institute. "Instead our findings suggest that different lineages of the virus have originated from the virus jumping across to humans from an animal source a number of times."

 

As yet no animal with MERS-CoV has been identified in the Middle East or elsewhere and studies based on small sequence fragments suggest that a common ancestor of the virus may have existed in bats many years ago. Field studies of all the likely reservoir species, including camels, bats, goats, sheep, dogs, cats, rodents and others in the Kingdom of Saudi Arabia and other middle-eastern countries are on-going.

(Continue . . .)

 

 

Next stop, Ian Mackay’s Virology Down Under Blog, where we get a virologist’s take on these findings, and a concise bullet list of the highlights (I’ve only included the first 3 of 8).

 

Molecular epidemiology of Middle East respiratory syndrome coronavirus (MERS-CoV)

And a newcomer to the MERS-CoV birthday celebrations! What great timing to have this released today.
The Lancet paper accompanying those recent partial and full genome sequences has been released form its cage. It's a collaborative effort by authors affiliated with the Global Centre for Mass Gatherings Medicine (Ministry of Health Saudi Arabia), Welcome Trust Sanger Institute (United Kingdom) and many other locations.

A few highlights of the largest MERS-CoV molecular epidemiology study to date, which includes some great transmission figures and trees (hat tip to the graphics people at Lancet):

• Genetic diversity analyses 3 distinct genotypes were identified from human cases in Riyadh
• The Al-Ahsa hospital cluster may have had more than 1 viral introduction
• Other clusters and stand alone cases can be represented as distinct genotypes of MERS-CoV, possibly indicating multiple different virus acquisitions from different sources

(Continue . . . .)

 

 

And last, but certainly not least, Robert Roos and Lisa Schnirring produced a report for CIDRAP news last night, that provides an excellent overview for us.

 

Study suggests multiple MERS-CoV introductions

Robert Roos | News Editor | CIDRAP News

Sep 19, 2013

One of the big mysteries about the Middle East respiratory syndrome coronavirus (MERS-CoV) is whether it jumped from animals to humans just once or has made that jump a number of times. A study released today indicates that the second scenario seems more likely, given the genetic diversity in virus samples from 21 Saudi Arabian patients.

Researchers from Saudi Arabia, the United Kingdom, and the United States sequenced the genomes of the 21 isolates and found too much diversity to support the idea that the virus crossed from animals to humans just once and then traveled from person to person to spark all the other cases, according to their report in The Lancet and related press releases.

The findings also suggest that human-to-human transmission is more complicated than expected and raise the possibility that people with undetected infections are spreading the virus, the authors say.

(Continue . . .)

J. Clinical Virology: H7N9 - Age & Sex Specific Morbidity & Mortality

Distribution of H7N9 Cases In China – Credit CDW

 

# 7777

 

 

Flublogia’s resident virologist, Dr. Ian Mackay (author of the Virology Down Under blog & Associate Professor University of Queensland) has co-authored a study which has just been published in the Journal of Clinical Virology, that looks at the age & sex mortality & morbidity figures from the first wave of H7N9 that occurred in China last spring.

 

They point out, that like the MERS-CoV in the Middle East, the morbidity & mortality of avian H7N9 has been heavily skewed towards older (>50) males – in stark contrast to the pattern we’ve seen with the H5N1 virus, which has demonstrated a marked proclivity for younger victims. 

 

 

Age-Specific and Sex-Specific Morbidity and Mortality from Avian Influenza A(H7N9)

Joseph P. Dudley,  Ian M. Mackay

 

 

Ian (who is about to embark on a short vacation), has posted a preview of this paper on his own blog. Follow the link below to read:

 

Age and sex morbidity and mortality from avian influenza A(H7N9) virus

Click to enlarge. The majority of cases of H7N9 that occurred
worldwide earlier in 2013. Taken from Virology Down Under's
H7N9 page.

In a study co-written by yours truly using a lot of data collected for Virology Down Under, Dr Joseph Dudley and I have just described, in the Journal of Clinical Virology, the age-specific and sex-specific morbidity and mortality from the avian influenza A(H7N9) virus outbreak earlier in the year.

(Continue . . . )

Mackay On The Eurosurveillance MERS Antibodies In Camels Study

Photo Credit Wikipedia

 

 

# 7735

 

Dr. Ian Mackay, in his Virology Down Under Blog takes an in-depth look at yesterday’s Eurosurveillance Journal report on the development of a safer (only requires a BSL-2 lab) pseudoparticle neutralization assay (ppNT) test specific to the spike protein of the MERS coronavirus.

 

Using this novel test (and comparing results to conventional microneutralization tests) researchers found a high prevalence (93.6%) of MERS-like antibodies in Egyptian camels, not unlike what we saw from Oman last month (see  Camels Found With Antibodies To MERS-CoV-Like Virus).

 

Follow the link below to read Dr. Mackay’s analysis.

 

More MERS molecular masterfulness: Egyptian camels contain lots of anti-MERS-CoV antbodies

 

The Eurosurveillance journal article may be read at:

 

Seroepidemiology for MERS coronavirus using microneutralisation and pseudoparticle virus neutralisation assays reveal a high prevalence of antibody in dromedary camels in Egypt, June 2013

 

by RA Perera, P Wang, MR Gomaa, R El-Shesheny, A Kandeil, O Bagato, LY Siu, MM Shehata, AS Kayed, Y Moatasim, M Li, LL Poon, Y Guan, RJ Webby, MA Ali, JS Peiris, G Kayali

 

You’ll find another excellent summary available from Robert Roos at CIDRAP.

 

Study reveals more signs of MERS-CoV in camels

Robert Roos | News Editor | CIDRAP News |

Sep 05, 2013

 

Note: I’m still away from my desk, and my blogging schedule will be limited until Sunday.  I would invite you to visit Crofsblog, Virology Down Under, and FluTrackers for the latest infection disease news.

WSJ: Saudi MERS-CoV Concerns As Hajj Approaches

Credit Wikipedia

 

# 7625

 

 

Middle East correspondent Ellen Knickmeyer, writing for the Wall Street Journal today, has a report on Saudi Arabia’s MERS-CoV response as the Hajj approaches.  Included are reactions from tourists visiting the Saudi Kingdom, along with comments on the flow of information from Dr. Ian Mackay.

 

Follow the link to read:

 

September 2, 2013, 12:52 PM

Saudi’s MERS Concerns Grow as Hajj Season Approaches

Saudi Arabia continues to report sporadic new cases and deaths from a lethal new coronavirus, as hajj season in October — when the kingdom expects more than 3 million pilgrims from 187 countries –- approaches.

(Continue . . . )

Referral: Mackay On Respiratory Viruses In Health Care Workers

Photo Credit PHIL (Public Health Image Library)

# 7607

 

A topic we’ve touched on a number of times before (see EID Journal: Nosocomial Transmission Of 2009 H1N1 & A Hospital Is No Place For A Sick Person) is the carriage and transmission of respiratory viruses by healthcare workers to patients.

 

Today, Dr. Ian Mackay takes a look at a study on more than 300 ill and asymptomatic HCWs that screened them for a variety of respiratory viruses.  Follow the link below to read the intriguing findings:

 

Healthcare workers may stay on the job when ill and can be shedding viral RNA...

Tuesday, 27 August 2013

 

 

The asymptomatic carriage and shedding of viruses comes as less than a complete surprise, as we’ve seen evidence of this in the past (see The Very Common Cold, PLoS One: Influenza Viral Shedding & Asymptomatic Infections).

 

But as Ian points out, the more they test the more we learn.

 

One of the revelations that came out of CIDRAP’s 2009 H1N1 conference in Minneapolis (see CIDRAP On Business’s Biggest Concern) was group polling that showed that Hospitals were among the least likely to make it easy for employees to stay home if they were sick.

 

As a paramedic, I know that my colleagues and I worked `sick’ often, as I wrote back in 2009:

 

EMT’s and paramedics were a scarce resource, and since everyone was working at least a 56-hour-week . . .  trying to find someone to fill a shift was a major hassle.

 

So we worked with colds, with the flu, with aching backs, and Lord knows what else  . . . because the system required it.  And there were real (unwritten) punitive downsides to calling in sick. 

 

Thirty years later, it appears that many HCWs are still penalized if they are unwilling to work `sick’.  Sick leave for HCWs often comes out of an accrued PTO (Paid Time Off) account which combines vacation, holiday, and sick time off. 

 

Workers accrue hours based on shifts worked, and their seniority.

 

Employees who haven’t sufficient hours `banked’ (or part-time workers who aren’t usually enrolled in PTO plans), must take unpaid leave if they fall ill.

 

Live polling of the attendees at the 2009 CIDRAP conference indicated that industries other than Health Care, such as manufacturing, were more likely to give employees paid time off for the flu and for taking care of sick family members.

 

Obviously, working `sick’ is a risk to both patients and colleagues alike.

 

It is a sad commentary that those who are most likely to get sick `in the line of duty’ are among the least likely to enjoy a liberal paid sick leave policy.

Referral: Mackay On MERS, Bat Samples & Prospective Screening

 

Credit Wikipedia

 

# 7600

 

 

Dr Ian Mackay is on a roll this morning, with no fewer than four new entries his Virology Down Under blog.  While you’ll want to read all of them, I’d like to call your attention to two of them in particular.

 

First, Ian shares correspondence with Dr. Ian Lipkin – Director of the Center for Infection and Immunity at Columbia University’s Mailman School of Public Health and world renowned virus hunter – whose lab recently found a match to the MERS-CoV in a sample from bat samples collected in Saudi Arabia (see Detection Of MERS-CoV In Saudi Arabian Bat).

Prof Lipkin: There is no more sequence coming from that bat sample

Many thanks to Prof Ian Lipkin's indulgence of my eMail questions.

Also, check out the TWiV webcast by Prof Lipkin.

(Continue . . .)

Second, Ian expands on comments he’s made in the past regarding the importance of prospective testing – and not just for MERS-CoV and H7N9 – but for a variety of respiratory pathogens.

 

Editor's rant: Why testing the few may not benefit the many...

Prospective screening without regard for whether the person is sick. That's what I think we need more of, in order to truly understand respiratory viruses and acute respiratory infections (ARIs).

 

And I don't just mean the scary ones like MERS-CoV or influenza A(H5N1) virus or H7N9 or H7N7 (zoonotic flu).

(Continue . . .)

 

Both of these articles are highly recommended.

Since his arrival to Flublogia back in April, Dr. Mackay has nicely filled the scientific void left behind when Revere pulled down the shades at  Effect Measure in 2010.

 

Ian brings a level of expertise and understanding of virology, lab procedures, and testing that Crof and I could never begin to approach.

 

So if if Ian’s VDU website isn’t already on your daily list of sites to visit, it should be.

Referral: Mackay On EID - Geographic Co-distribution Of H7N9 & H5N1

 

# 7584

 

A `twofer’ from Dr. Ian Mackay, who has blogged twice in the past 24 hours in his Virology Down Under  Blog on the recently published EID Journal letter:

 

Geographic Co-distribution of Influenza Virus Subtypes H7N9 and H5N1 in Humans, China

Liya Wang¹, Wenyi Zhang¹, Ricardo J. Soares Magalhaes¹, Archie C.A. Clements¹, Wenbiao Hu¹, Fan Ding¹, Hailong Sun, Shenlong Li, Qiyong Liu, Zeliang Chen, Yansong Sun, Liuyu Huang, and Cheng-Yi Li

 

Follow the links below to read Ian’s commentary.

 

Part 1:

H7N9 and H5N1 may have emerged from birds around Taihu Lake

Part 2:

Taihu lake & influenza viruses Part II: people, pigs, poultry and migratory birds

H7N9 Vaccine Challenges

 

 

#7579

 

 

Last June (see CIDRAP: NVAC Weighs H7N9 Vaccine Options) we learned that BARDA (the HHS' Biomedical Advanced Research and Development Authority) had given authorization to several vaccine manufacturers to go ahead with clinical trials on potential H7N9 vaccines.

 

Yesterday, Helen Branswell of the Canadian Press wrote a detailed update on where these clinical trials stand now, and what lies ahead. I would invite you to read her article in its entirety, and when you return, I’ll have more.

 

Can a usable H7N9 vaccine be made? Pending research should offer clues soon

By Helen Branswell, The Canadian Press August 18, 2013

TORONTO - Can a usable vaccine against the H7N9 bird flu virus be made? Studies that are about to start should offer clues soon, says the director of the U.S. government program spearheading the work.

 

Four flu vaccine manufacturers have started or will soon start clinical trials on H7N9 vaccines, with four more expected to conduct trials in the late fall or early winter, says Dr. Robin Robinson. The work will cost the U.S. government about $100 million.

(Continue . . .)

 

Providing some more background is Dr. Ian Mackay, who writes on China’s recent H7N9 vaccine development work, the use of adjuvants, and other related issues, in his Virology Down Under blog.

 

H7N9 vaccine update...[UPDATED]

Hat tip to Dr. Nicholas Kelly for JAMA link reminder.

Earlier in the month, Zou Yong, quality directer of China based Sinovac Biotech Ltd  the Chinese Center for Disease Control and Prevention, noted that preliminary work on an adjuvanted (see below) H7N9 vaccines was complete and are ready for safety stability and clinical trials. It has already completed been through animal testing and the vaccine seems to work in our furry little friends.

(Continue . . . )

 

As Dr. Mackay mentions in his blog, in early May we saw an analysis of some of the problems inherent in creating and deploying an  H7N9 vaccine published in JAMA, penned by CIDRAP’s  Michael T. Osterholm, PhD, MPH; Katie S. Ballering, PhD; and Nicholas S. Kelley, PhD.

 

Major Challenges in Providing an Effective and Timely Pandemic Vaccine for Influenza A(H7N9)

Michael T. Osterholm, PhD, MPH; Katie S. Ballering, PhD; Nicholas S. Kelley, PhD

JAMA. 2013;():1-2. doi:10.1001/jama.2013.6589.

Published online May 9, 2013

 

While work is being done on an H7N9 vaccine, and there are hopes that a practical one can be created, we are still a long way from having any quantity of commercial vaccine available to the public.

Which means, should the H7N9 virus threaten this fall or winter, we will be looking to NPIs (Non Pharmaceutical Interventions like social distancing, school closures, hand hygiene & masks) and neuraminidase (NA) inhibiting antiviral drugs  (NAIs) like oseltamivir (Tamiflu ®) and Zanamivir (Relenza ®) to help mitigate its impact. 

 

The creation of a safe, immunogenic H7N9 vaccine is only the first challenge. It must be mass produced, and then deployed in an orderly and efficient manner.

 

Difficult decisions will have to be made on vaccine prioritization, and global distribution.

 

If, as expected, it will require 2 shots - 4 weeks apart to confer a reasonable level of immunity, the logistics of delivering the vaccine grow even greater.

 

None of which is to suggest that the pursuit of a vaccine is a futile one.

 

While an H7N9 vaccine may not be available during the opening months of a pandemic, it would be extremely valuable in limiting the effects of the virus down the line.