WHO: World On Verge Of An Effective Ebola Vaccine

Credit WHO

 

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Fresh off of its 12:00 GMT embargo, we have an article appearing in The Lancet detailing the results of a a Phase III clinical trial of the rVSV-ZEBOV candidate Ebola vaccine - and while preliminary - the results are very encouraging.

 

Utilizing a `ring vaccination’ strategy – where relatives and neighbors of known Ebola cases are vaccinated to halt further transmission -  early results suggest a high rate of protection.  

 

Of the contacts who were vaccinated immediately after a case emerged– none developed the disease after more than 10 days post vaccination. While of contacts who received a delayed vaccination 3 weeks after the first case was detected, 16 fell ill.

 

We’ve some excerpts from the abstract and a link to a full report in The Lancet,  followed by a press release from the World Health Organization. 

 

Efficacy and effectiveness of an rVSV-vectored vaccine expressing Ebola surface glycoprotein: interim results from the Guinea ring vaccination cluster-randomised trial

Ana Maria Henao-Restrepo, Ira M Longini, Matthias Egger, Natalie E Dean, W John Edmunds, Anton Camacho, Miles W Carroll, Moussa Doumbia, Bertrand Draguez, Sophie Duraffour, Godwin Enwere, Rebecca Grais, Stephan Gunther, Stefanie Hossmann, Mandy Kader Kondé, Souleymane Kone, Eeva Kuisma, Myron M Levine, Sema Mandal, Gunnstein Norheim, Ximena Riveros, Aboubacar Soumah, Sven Trelle, Andrea S Vicari, Conall H Watson, Sakoba Kéïta, Marie Paule Kieny*, John-Arne Røttingen*

ABSTACT

Findings Between April 1, 2015, and July 20, 2015, 90 clusters, with a total population of 7651 people were included in the planned interim analysis. 48 of these clusters (4123 people) were randomly assigned to immediate vaccination with rVSV-ZEBOV, and 42 clusters (3528 people) were randomly assigned to delayed vaccination with rVSV-ZEBOV.

In the immediate vaccination group, there were no cases of Ebola virus disease with symptom onset at least 10 days after randomisation, whereas in the delayed vaccination group there were 16 cases of Ebola virus disease from seven clusters, showing a vaccine efficacy of 100% (95% CI 74·7–100·0; p=0·0036). No new cases of Ebola virus disease were diagnosed in vaccinees from the immediate or delayed groups from 6 days post-vaccination.

At the  cluster level, with the inclusion of all eligible adults, vaccine effectiveness was 75·1% (95% CI –7·1 to 94·2; p=0·1791), and 76·3% (95% CI –15·5 to 95·1; p=0·3351) with the inclusion of everyone (eligible or not eligible for vaccination). 43 serious adverse events were reported; one serious adverse event was judged to be causally related to vaccination (a febrile episode in a vaccinated participant, which resolved without sequelae). Assessment of serious adverse events is ongoing.

Interpretation The results of this interim analysis indicate that rVSV-ZEBOV might be highly efficacious and safe in preventing Ebola virus disease, and is most likely effective at the population level when delivered during an Ebola virus disease outbreak via a ring vaccination strategy.

 

News Release WHO/ 37
31 July 2015

World on the Verge of an Effective Ebola Vaccine

Geneva, 31 July 2015 – Results from an interim analysis of the Guinea Phase III efficacy vaccine trial show that VSV-EBOV (Merck, Sharp & Dohme) is highly effective against Ebola. The independent body of international experts - the Data and Safety Monitoring Board – that conducted the review, advised that the trial should continue. Preliminary results from analyses of these interim data are published today in the British journal The Lancet.

 
“This is an extremely promising development,” said Dr Margaret Chan, Director-General of the World Health Organization. “The credit goes to the Guinean Government, the people living in the communities and our partners in this project. An effective vaccine will be another very important tool for both current and future Ebola outbreaks.”

While the vaccine up to now shows 100% efficacy in individuals, more conclusive evidence is needed on its capacity to protect populations through what is called “herd immunity”.  To that end, the Guinean national regulatory authority and ethics review committee have approved continuation of the trial.

  
“This is Guinea’s gift to West Africa and the world,” said Dr. Sakoba Keita, Guinea’s national coordinator for the Ebola response. “The thousands of volunteers from Conakry and other areas of Lower Guinea, but also the many Guinean doctors, data managers and community mobilisers have contributed to finding a line of defence against a terrible disease.”

“The “ring” vaccination method adopted for the vaccine trial is based on the smallpox eradication strategy,” said John-Arne Røttingen, Director of the Division of Infectious Disease Control at the Norwegian Institute of Public Health and Chair of the Study Steering Group. “The premise is that by vaccinating all people who have come into contact with an infected person you create a protective “ring” and stop the virus from spreading further.  This strategy has helped us to follow the dispersed epidemic in Guinea, and will provide a way to continue this as a public health intervention in trial mode.”

The Guinea vaccination trial began in affected communities on 23 March 2015 to evaluate the efficacy, effectiveness and safety of a single dose of the vaccine VSV-EBOV by using a ring vaccination strategy.  To date, over 4 000 close contacts of almost 100 Ebola patients, including family members, neighbours, and co-workers, have voluntarily participated in the trial.

The trial stopped randomisation on 26 July to allow for all people at risk to receive the vaccine immediately, and to minimize the time necessary to gather more conclusive evidence needed for eventual licensure of the product.  Until now, 50% of the rings were vaccinated three weeks after the identification of an infected patient to provide a term of comparison with rings that were vaccinated immediately.  This now stops.  In addition, the trial will now include 13 to 17-year-old and possibly 6 to 12-year-old children on the basis of new evidence of the vaccine’s safety.

“In parallel with the ring vaccination we are also conducting a trial of the same vaccine on frontline workers,” said Bertrand Draguez, Medical Director at Médecins sans Frontières.  “These people have worked tirelessly and put their lives at risk every day to take care of sick people.  If the vaccine is effective, then we are already protecting them from the virus.  With such high efficacy, all affected countries should immediately start and multiply ring vaccinations to break chains of transmission and vaccinate all frontline workers to protect them. ”

The trial is being implemented by the Guinean authorities, WHO, Médecins sans Frontières (MSF) and the Norwegian Institute of Public Health, with support from a broad partnership of international and national organizations.

“This is a remarkable result which shows the power of equitable international partnerships and flexibility,” said Jeremy Farrar, Director of the Wellcome Trust, one of the funders of the trial. “This partnership also shows that such critical work is possible in the midst of a terrible epidemic. It should change how the world responds to such emerging infectious disease threats. We, and all our partners, remain fully committed to giving the world a safe and effective vaccine. ”

“This record-breaking work marks a turning point in the history of health R&D,” said Assistant Director-General Marie-Paule Kieny, who leads the Ebola Research and Development effort at WHO.  “We now know that the urgency of saving lives can accelerate R&D.  We will harness this positive experience to develop a global R&D preparedness framework so that if another major disease outbreak ever happens again, for any disease, the world can act quickly and efficiently to develop and use medical tools and prevent a large-scale tragedy.”

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USGS: New Madrid Simulation Shows Risks For Memphis & Little Rock

Seismic Hazard Map – Credit USGS

 

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In 2011 – during the bicentennial of the four great New Madrid earthquakes of 1811-12 – FEMA and other federal agencies mounted the largest National Level Exercise (NLE) to that date, revolving around a catastrophic earthquake occurring in the New Madrid Seismic Zone (NMSZ) that would involve eight Central U.S. States: Alabama, Arkansas, Kentucky, Illinois, Indiana, Mississippi, Missouri, and Tennessee spread across 4 FEMA regions (IV, V, VI, and VII).

 

While sparsely populated 200 years ago during the last big seismic event, a similar quake today would endanger millions of people living in the central United States, and likely cause severe economic and social disruption across an even wider area of the nation.

 

This National Level Exercise tested initial incident response along with disaster recovery plans. According to FEMA’s NLE fact sheet, the exercise was designed to validate the following capabilities:

• Communications
• Critical resource logistics and distribution
• Mass care (sheltering, feeding and related services)
• Medical surge
• Citizen evacuation and shelter-in-place
• Emergency public information and warning
• Emergency operations center (EOC) management
• Long term recovery

 

While large quakes in the middle of the country are rare, the USGS, in Earthquake Hazard in the New Madrid Seismic Zone Remains a Concern, warns:

Continuing Preparedness Needed

The geologic record of repeated large earthquakes, the historical accounts of the 1811–12 large earthquakes, and the continuing earthquake activity in the area are compelling evidence that the New Madrid region has high earthquake hazard. The preponderance of evidence leads us to conclude that earthquakes can be expected in the future as frequently and as severely as in the past 4,500 years. Such high hazard requires prudent measures such as adequate building codes to protect public safety and ensure the social and economic resilience of the region to future earthquakes.

 

Complicating matters, earthquakes in the central and eastern part of the nation are generally felt over a much wider area than those on the west coast, due to differences in their underlying bedrock.  In 2012’s USGS: Eastern Earthquakes - Rare But Powerful, we looked at this phenomenon.

 

The following shake map from the USGS shows the areas reporting shaking from two recent quakes, a 6.0 in Central California, and the recent 5.8 Virginia quake. By an incredibly large margin, the smaller eastern quake was felt over a much bigger area.

 

All of which serves as prelude to yesterday’s release from the USGS that shows that computer simulations indicate a future New Madrid quake could produce major, prolonged ground shaking in metropolitan areas across several states, including Memphis, TN, Paducah, KY, Evansville, IN, and Little Rock, AR.

 

New Simulations of 1811-1812 New Madrid Earthquakes Show Strong and Prolonged Ground Shaking in Memphis and Little Rock

Released: 7/30/2015 2:00:00 PM

Computer simulations of earthquake shaking, replicating the quakes that occurred in 1811-1812 in the New Madrid seismic zone (NMSZ), indicate that future large earthquakes there would produce major, prolonged ground shaking. The 1811-1812 events were some of the largest in the United States since its settlement by Europeans, and the NMSZ spans portions of seven states: Illinois, Indiana, Missouri, Arkansas, Kentucky, Tennessee and Mississippi.

Scientists from the Universidad Nacional Autónoma de México, the U.S. Geological Survey, San Diego State University, AECOM (formerly URS Corporation), and the University of Memphis simulated a set of 20 hypothetical, yet plausible earthquakes located along two currently active faults in the NMSZ. The hypothetical earthquake scenarios range in magnitude from 7.0 to 7.7, and consider various possible epicenters.

”Based on our simulations, were the 1811-1812 earthquakes to repeat today, more than 8 million people living and working near the New Madrid seismic zone would experience potentially damaging ground shaking at modified Mercalli intensities ranging from VI to VIII,” said Leonardo Ramirez-Guzman, lead author of the paper that appears in the July 30 edition of the Bulletin of the Seismological Society of America.

“Strong ground shaking in the greater Memphis metropolitan area could last from 30 seconds to more than 60 seconds, depending on the magnitude and epicenter of a potential seismic event,” said Ramirez-Guzman, a professor at Universidad Nacional Autónoma de México and former USGS contract scientist.

The simulations also demonstrate the importance of fault rupture directivity (seismic energy focused along the direction of faulting), especially when combined with the wave channeling effects of the Reelfoot rift, a buried, northeast-southwest trending geologic valley in the NMSZ. In particular, future large earthquakes on the approximately 80-mile long NMSZ fault show strong shaking at vibration frequencies that pose a risk for mid-rise to high-rise buildings and tall bridges. This fault is thought to be responsible for the December 16, 1811 magnitude 7-7.7 earthquake. Some of the earthquake simulations showed strong shaking focused to the northeast as far as 100-200 miles away near Paducah, Kentucky and Evansville, Indiana, and to the southwest 150 miles toward Little Rock, Arkansas. An example of this earthquake shaking focusing effect can be seen here.

While it’s not possible to know which direction a fault will rupture once an earthquake starts, knowing that there is an increased chance of strong shaking along these geologically-defined corridors is a valuable aid in better characterizing seismic hazard and minimizing earthquake risk.

Earthquakes pose a significant risk to nearly 150 million Americans. The USGS and its partners in the multi-agency National Earthquake Hazard Reduction Program are working to improve earthquake monitoring and reporting capabilities via the USGS Advanced National Seismic System (ANSS). More information about ANSS can be found on the ANSS website.

Peak ground-motion variability for a magnitude 7.7 earthquake. Warmer colors indicate stronger ground motions. The stronger ground motions are extended further northeast and southwest caused by the channeling effect of the Reelfoot rift (RFR) The fault is displayed as a thick black continuous straight line, with the epicenter indicated by the triangle. (high resolution image 1.3 MB)

 

From my 10 years of living in the mostly rural Bootheel of Missouri, I know that most local residents are aware of the seismic history of the region, and are – in general – a fairly resilient lot.  As farmers and ranchers, they tend to be a bit more self sufficient than those who live in surrounding cities.

But as mentioned above, a rupture of the New Madrid fault could have serious effects on cities 100-200 miles away.

 

Areas where millions of people live and work in structures that were not designed with earthquake safety in mind, and where severe disruptions of essential services (water, power, EMS) – particularly during the winter – could make life extremely difficult.

 

All of which makes participating in this year’s Great Central U.S. Shakeout, and preparing your home and family for an earthquake, all the more important.  Those who live in other seismically active regions (worldwide) will want to visit Shakeout.org for information on your region’s activities.

 

 

For more recent blogs on earthquakes, and earthquake preparedness, you may wish to revisit:

 

OSU: Pragmatic Action - Not Fatalism - In Order To Survive The `Big One’

Shakeout.Org Twitter Chat On Earthquake Preparedness

USGS/OGS Joint Statement On Increased Earthquake Threat To Oklahoma

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Defra: Preliminary Analysis Of Germany’s HPAI H7N7 Outbreak

Credit Defra 

 

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The announcement earlier this week of highly pathogenic H7N7 Reported At Emsland Poultry Farm comes on the heels of several low path (LPAI) H7N7 detections in recent months in Germany, the Netherlands, and the UK. Of particular interest, this latest HPAI outbreak was detected less than a kilometer away from a farm that had reported LPAI H7N7 less than 3 weeks ago.

 

LPAI H7 viruses are often found in wild and migratory birds, and are viewed as the principal vector of the virus to domesticated poultry. 

 

The concern with these LPAI H5 and H7 viruses is that when they are not controlled - they have the potential to mutate into highly pathogenic strains. HPAI viruses have been generated in the lab by repeated passage of LPAI viruses through chickens (cite FAO) but exactly how and why this occurs naturally is poorly understood (see JVI  Emergence of a Highly Pathogenic Avian Influenza Virus from a Low Pathogenic Progenitor). .

While it hasn’t been documented often, the risk is considered great enough that all LPAI H5 and H7 outbreaks must be reported to the OIE, and immediate steps must be taken to contain and eradicate the virus. 

 

All of which brings us to a Defra preliminary analysis of last week’s HPAI H7N7 outbreak, that has buried in it sneak peek from a yet-to-be published report about the UK’s  most recent HPAI H7N7 outbreak.

 

. . on the 6th July, the UK reported an outbreak of H7N7 HPAI in laying hens. Investigations into this outbreak have revealed a mutation event occurred within the poultry premises, following an incursion of LPAI. The most likely source of infection was contact with wild birds, given the presence on the farm of nesting wild waterfowl and two ponds

 

As this report points out, this is a rare event:

 

In the last 10 years, there have been only four such documented events of mutation from LPAI to HPAI occurring all within chicken layers in Europe: UK in 2008, Spain in 2009 (SCoFCAH, 2010), Italy in 2013 and UK in 2015; all involved H7N7.

The question –  still under investigation - is whether this latest HPAI H7N7 outbreak in Germany has any connection with the LPAI outbreak earlier this month on a farm a kilometer away.  

 

If it turns out to be true - and we have really had two such `rare’ events in the span of a couple of weeks - it then begs the question as to whether these sorts of LPAI to HPAI `conversions’ are becoming more common . . .and why?.

 

 

Preliminary Outbreak Assessment
Highly Pathogenic Avian Influenza H7N7 in poultry in Germany

29 July 2015 Ref: VITT/1200 HPAI H7N7 in Germany

Disease Report Germany has reported an outbreak of highly pathogenic avian influenza, H7N7 in poultry in North West Germany (Lower Saxony) (European Commission, 2015; OIE, 2015). The holding was comprised of over 10,000 laying hens and clinical signs were first reported on 24/7/2015. Disease control measures are in place, including 3km and 10km protection and surveillance zones in line with Directive 2005/94/EC. The birds have been depopulated.

The outbreak was located less that 1km from a premises which had reported H7N7 LPAI on June 11th 2015 and this new IP tested negative in the course of disease investigations into LPAI. Further analyses may reveal the relationship if any between the two events.

Situation assessment In the last few months there have been several reported outbreaks of H7N7 avian influenza viruses in poultry in Europe. The UK had a low pathogenicity strain in February, Netherlands had two outbreaks of LPAI in March and April while Germany had two outbreaks of LPAI in both March and June. The June outbreak in Germany was in the same region as the latest HPAI incident.

Meanwhile on the 6th July, the UK reported an outbreak of H7N7 HPAI in laying hens. Investigations into this outbreak have revealed a mutation event occurred within the poultry premises, following an incursion of LPAI. The most likely source of infection was contact with wild birds, given the presence on the farm of nesting wild waterfowl and two ponds. The full epidemiology report will be available soon at www.gov.uk

It is of no surprise that H7 LPAI viruses have been detected this year, as these viruses are continually circulating in wild waterfowl and therefore there is a constant low risk of incursion of these viruses into poultry. However, the mutation of LPAI to HPAI viruses is a rare event.

Several factors may drive these mutation events: a “jump” from Anseriform birds into Galliform poultry; adaptation to Galliform poultry; repeated passage through the poultry; spread within the poultry (free range birds as opposed to caged birds where mixing between birds is reduced) that acquire LPAI virus immunity that then acts to exert selective pressure and possibly the age of the birds.

In the last 10 years, there have been only four such documented events of mutation from LPAI to HPAI  ccurring all within chicken layers in Europe: UK in 2008, Spain in 2009 (SCoFCAH, 2010), Italy in 2013 and UK in 2015; all involved H7N7. In the case of the UK mutation event in 2008, mallard ducks present at the premises and in contact with free range laying hens seemed to be the source for the LPAI incursion with subsequent mutation following sustained transmission within the flock. In Spain, the incursion of LPAI was believed to be from wild waterfowl on a nearby reservoir which was the water source for the farm and the mutation consequently occurred in one of four sheds of laying hens (SCoFCAH, 2010). In Italy the virus was introduced to free range hens as LPAI and mutated to HPAI during transmission within the flock.

It remains to be seen if the same event has occurred in Germany, but given the circulation of LPAI demonstrated recently, this would seem highly probable. Surveillance sampling in the event of an outbreak only gives a level of confidence for finding over a certain prevalence, therefore occasionally there may be a possibility that additional cases which have gone undetected if incursion at the time of sampling is relatively new.

(Continue . . . )

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WHO MERS Update – Saudi Arabia July 29th

 

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The World Health Organization has published a new MERS update describing eight recent MERS cases, and their likely route of infection (if known).  All but one are from Riyadh City (#8 is from Hofuf), and three of the cases are listed as contacts or family members of known cases.  A fourth case (#3) is listed as a possible nosocomial infection.

Possible camel exposure is cited for three cases (including the Hofuf case), although only one case is listed as having actual camel contact.

 

Although it may well be probative, exposure to camels or camel products in the 14 days prior to onset of illness does not automatically lock that in as the actual source of infection. Despite growing Evidence for Camel-to-Human MERS-CoV Transmission, how often that actually happens is unknown.

 

Previously, we’ve seen estimates that only 3% of cases are caused by direct zoonotic infection (see Dr. Tariq Madani: 97% Of MERS Cases From Human-to-Human Transmission).Assumptions and numbers that must be taken with a sizable grain of salt, as we’ve yet to see the kind of case-control study to support them.

 

While repeated promises have been made regarding this type of study (see KSA Announces Start To Long-Awaited MERS Case Control Study), for whatever reason, we’ve yet to see the results.

 

Last May, in WHO EMRO: Scientific Meeting Reviews MERS Progress & Knowledge Gaps we examined some of the glaring deficits in our understanding of this disease, a full three years after it first emerged in a Jordanian hospital.

 

Here then is the latest WHO update:

 

Middle East Respiratory Syndrome coronavirus (MERS-CoV) – Saudi Arabia

Disease outbreak news
29 July 2015

Between 16 and 25 July 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 8 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 1 death.

Details of the cases

• A 30-year-old male from Riyadh city developed symptoms on 22 July and was admitted to the hospital on the same day. The patient, who has no comorbidities, tested positive for MERS-CoV on 24 July. Currently, he is in stable condition in a negative pressure isolation room on a ward. The patient is a contact of a laboratory-confirmed MERS-CoV case (case n. 7 - see below). Investigation of history of exposure to other known risk factors in the 14 days prior to the onset of symptoms is ongoing.
• A 28-year-old, non-national male from Riyadh city developed symptoms on 22 July and was admitted to the hospital on 23 July. The patient, who has no comorbidities, tested positive for MERS-CoV on 24 July. Currently, he is in stable condition in a negative pressure room. The patient is a contact of a laboratory-confirmed MERS-CoV case (case n. 7 - see below). He has no history of dealing with or consumption raw camel meat. Investigation of history of exposure to other known risk factors in the 14 days prior to the onset of symptoms is ongoing.
• A 54-year-old, non-national male from Riyadh city developed symptoms on 20 July while admitted to hospital since 20 July due to unrelated chronic medical conditions. He tested positive for MERS-CoV on 22 July. Currently, the patient is in critical condition in ICU. Investigation of possible epidemiological links with laboratory-confirmed MERS-CoV cases who were hospitalized in the same hospital (case n. 5 – see below; case n. 2 – see DON published on 24 July) or with shared health care workers is ongoing.
• A 52-year-old female from Riyadh city developed symptoms on 17 July and was admitted to hospital on the same day. The patient, who had comorbidities, tested positive for MERS-CoV on 21 July and passed away on 22 July. She was a family member of a laboratory-confirmed MERS-CoV case (case n. 5 – see below).
• A 56-year-old male from Riyadh city developed symptoms on 13 July and was admitted to hospital on 15 July. The patient, who has comorbidities, tested positive for MERS-CoV on 19 July. Currently, he is in critical condition in ICU. The patient has a history of frequent contact with camels and consumption of their raw milk.
• A 60-year-old female from Raniah city developed symptoms on 12 July and was admitted to hospital on 19 July. The patient, who has comorbidities, tested positive for MERS-CoV on 21 July. Currently, she is in stable condition in a negative pressure isolation room on a ward. The patient lives in an area with several camel farms; however, she has no history of contact with camels or consumption of raw camel products. Investigation of history of exposure to other known risk factors in the 14 days prior to the onset of symptoms is ongoing.
• A 32-year-old, non-national male from Riyadh city developed symptoms on 15 July and was admitted to hospital on 19 July. The patient, who has no comorbidities, tested positive for MERS-CoV on 20 July. Currently, he is in critical condition in ICU. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.
• A 93-year-old male from Hofuf city developed symptoms on 12 July and was admitted to hospital on the same day. The patient, who has comorbidities, tested positive for MERS-CoV on 16 July. Currently, he is in stable condition in a negative pressure isolation room on a ward. The patient owns a camel farm; however, he has neither a history of contact with camels nor consumption of their raw milk. Investigation of history of exposure to other known risk factors in the 14 days prior to the onset of symptoms is ongoing.

Contact tracing of household and healthcare contacts is ongoing for these cases.

The National IHR Focal Point for the Kingdom of Saudi Arabia also notified WHO of the death of 2 MERS-CoV cases that were reported in previous DONs on 24* July (case n. 4) and on 23 June (case n. 2).

Globally, since September 2012, WHO has been notified of 1,382 laboratory-confirmed cases of infection with MERS-CoV, including at least 493 related deaths.

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CDC Study: Pathogenesis & Transmissibility Of HPAI H5 In Mice & Ferrets

 

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Its effects on poultry are well established, but determining the pathogenesis (progression of disease) and degree of transmissibility of our recently arrived HPAI H5 viruses among mammals is a  high priority.  While it’s been encouraging that we’ve seen hundreds of poultry outbreaks over the past 18 months without seeing any human cases, a more precise measurement of their pandemic potential is needed.

 

Despite this lack of human cases, we have seen reports of dogs being infected with H5N8 (see MAFRA: H5N8 Antibodies Detected In South Korean Dogs (Again)).   The ability to infect canines does not automatically make it a human threat, but it does raise some concerns (see Study: Dogs As Potential `Mixing Vessels’ For Influenza).

 

Earlier this year, in Virology: Pathogenesis Of Avian A/H5N8 In Ferrets, we saw that that ferrets intranasally inoculated  with the Korean H5N8 strain suffered no mortality or serious respiratory symptoms, but that ferrets intratracheally infected showed `dose-dependent mortality’.

 

Yesterday the CDC published a new study in the Journal of Virology (the bulk of which, alas, is behind a pay wall) that further explores both the pathogenicity (in mice) and transmissibility (in ferrets) of both the North American H5N8 and H5N2 viruses.

  

The CDC has provided a lengthy summary, and for the most part the news remains good.  Some highlights:

• The severity of disease in inoculated mice was dose dependent, with severe disease only in mice given a very high dose of the virus.  And while the virus was detected in the lungs, laboratory mice experienced a less severe, more moderate disease than seen when exposed to the Asian H5N1 virus.
• Illness in ferrets was described as mild, and the virus did not spread to flu naïve ferrets placed in the same cage as infected ferrets, suggesting the risk of human-to-human transmission is low.
• H5Nx viruses replicated in human lung and airway cell cultures - but not as vigorously as with the Asian H5N1 virus – comparable to what is seen with seasonal H1N1.

 

While none of this precludes the possibility that human infection with one of these viruses might occur, this does reinforce the CDC’s assessment that these viruses currently pose a low risk to human health.   Influenza viruses are always changing, however, and new reassortants could appear, so ongoing vigilance is required.

 

More from the CDC below:

 

New CDC Laboratory Study Suggests U.S. H5 Bird Flu Viruses Currently Pose Low Risk to People

A new CDC study describes findings from a series of CDC laboratory experiments designed to improve understanding of the human health risk posed by two H5 bird flu viruses detected in birds in the United States: H5N2 and H5N8. Findings of this study indicate that the H5N2 and H5N8 bird flu viruses detected in the United States were less lethal in mammals and replicated (made copies of themselves during infection) at a lower level than the H5 bird flu viruses from Asia that have caused infections, serious illness and deaths in people. Overall findings suggest that these new U.S. bird flu viruses are unlikely to easily infect or spread between people in their current form and are likely to be associated with mild to moderate illness compared to the more severe illness associated with Asian H5 viruses. These U.S. bird flu viruses would need to undergo additional changes in order to pose a pandemic health risk to people.

This study, published today in the Journal of Virology, involved a combination of laboratory tests, some of which included animals and others that involved human lung cells grown in the laboratory via cell culture. CDC often uses such tests to infer how newly detected flu viruses can impact human health. These studies are part of a routine public health risk assessment process that CDC undertakes whenever a new virus with pandemic potential is identified.

Experiments conducted in this study include the following: tests in mice to determine the severity of disease associated with these viruses, tests in ferrets to determine characteristics of how these viruses spread between mammals and within the body, and tests using cell culture to measure the ability of these viruses to grow in human airway/lung cells (specifically human airway epithelial Calu-3 cells) in a laboratory setting.

Results in mice showed that mice infected with these viruses did not experience severe disease unless given very high doses of the virus. Virus was detectable in the lungs of mice, though, which is a characteristic that can be associated with more serious illness. However, compared to Asian H5 viruses, these U.S. H5 bird flu viruses demonstrated less severe, more moderate disease characteristics. Health researchers consider mice to be a reliable model for how disease associated with H5 bird flu viruses develops and progresses in mammals.

Transmission experiments involving ferrets showed that these U.S. H5 bird flu viruses did not spread between flu naïve ferrets (i.e., ferrets that had never been exposed to flu viruses previously) placed in the same cage as infected ferrets. This indicates that the virus is unlikely to spread efficiently among people, if they were to become infected by close contact with H5N2- or H5N8-infected poultry. Also, illness in the infected ferrets was generally mild, and the viruses did not spread systemically to multiple organs, which is a characteristic associated with more severe disease. These results are consistent with previous studies of H5N8 bird flu viruses in South Korea, which also showed low to moderate virulence in mammals. Ferrets are considered an excellent model for studying flu transmission and they also exhibit signs of disease that are similar to people infected with the flu.

Researchers also evaluated the ability of these bird flu viruses to replicate in human lung cells in laboratory experiments involving cell culture. The ability of a virus to infect human lung and airway cells is a trait that can be associated with more severe illness. These tests showed that H5N2 and H5N8 viruses replicated in human lung and airway cells at significantly lower levels compared to the Asian H5N1 viruses that have caused human deaths in Asia and elsewhere. While replication did occur, it was at a level comparable to human seasonal H1N1 flu virus.

Outbreaks in birds of H5N2, H5N8 and a new H5N1 bird flu virus were detected in the United States first in late 2014. Both of the bird flu viruses involved in this study were detected in Washington State: the H5N8 bird flu virus was obtained from an infected gyrfalcon and the H5N2 virus was obtained from a northern pintail duck. Most of the U.S. poultry outbreaks reported this year have been associated with the H5N2 virus, resulting in the loss of nearly 50 million chickens and turkeys on over 200 farms since the virus was first identified in December 2014. No human infections with these viruses have been detected at this time.

These findings reaffirm CDC’s current assessment that these viruses pose a low risk to the general public. CDC will continue to closely monitor and assess the risk of these viruses to human health as part of its routine pandemic preparedness responsibilities and activities.

 

 

 

Pathogenesis and transmission of novel HPAI H5N2 and H5N8 avian influenza viruses in ferrets and mice

Joanna A. Pulit-Penaloza, Xiangjie Sun, Hannah M. Creager, Hui Zeng, Jessica A. Belser, Taronna R. Maines and Terrence M. Tumpey

A novel highly pathogenic avian influenza (HPAI) H5N8 virus, first detected in January 2014 in poultry and wild birds in South Korea, has spread throughout Asia and Europe, and caused outbreaks in Canada and the United States by the end of the year. The spread of H5N8 and the novel reassortant viruses, H5N2 and H5N1 (H5Nx), in domestic poultry across multiple states in the U.S. pose a potential public health risk. To evaluate the potential of cross-species infection, we determined the pathogenesis and transmissibility of two Asian-origin H5Nx viruses in mammalian animal models. The newly isolated H5N2 and H5N8 viruses were able to cause severe disease in mice only at high doses. Both viruses replicated efficiently in the upper and lower respiratory tracts of ferrets; however clinical symptoms were generally mild and there was no evidence of systemic dissemination of virus to multiple organs. Moreover, these influenza H5Nx viruses lacked the ability to transmit between ferrets in a direct contact setting. We further assessed viral replication kinetics of the novel H5Nx viruses in a human bronchial epithelium cell line, Calu-3. Both H5Nx viruses replicated to a level comparable to a human seasonal H1N1 virus, but significantly lower than a virulent Asian-lineage H5N1 HPAI virus. Although the recently isolated H5N2 and H5N8 viruses displayed moderate pathogenicity in mammalian models, their ability to rapidly spread among avian species, reassort, and generate novel strains underscores the need for continued risk assessment in mammals.

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RESEP CUMI ASIN KECAP PEDAS SAUS TERIYAKI

Resep cumi asin kecap pedas enak dan praktis dengan tambahan bumbu saus teriyaki. Olahan cumi asin atau cumi yang dikeringkan atau diawetkan ini bisa menjadi salah satu menu hidangan favorit keluarga. Cara memasak cumi asin yang enak dengan bumbu yang sederhana bisa menggunakan resep praktis di bawah ini dengan bumbu kecap pedas dan saus teriyaki.

Tips mencuci asin cumi, merendam air panas serta memasaknya dengan singkat merupakan cara mudah agar cumi asin tidak keras dan alot serta mengurangi rasa asin. Untuk rasa pedas yang spesial menggunakan cabe gendot atau bisa menggunakan cabe lainnya seperti cabe hijau atau sesuai selera.

RESEP CUMI ASIN KECAP PEDAS
Bahan dan bumbu :

• 150 gram asin cumi
• 3 buah cabe gendot atau cabe lainnya dipotong kecil-kecil
• 3 butir bawang merah diiris tipis
• 2 siung bawang putih diiris tipis
• 2 sendok makan saus teriyaki
• 2 sendok makan kecap manis
• 1/2 sendok teh garam atau sesuaikan selera
• 1/2 sendok teh merica
• 1/2 sendok teh kaldu bubuk atau penyedap
• 100 ml air
• minyak untuk menumis secukupnya

CARA MEMASAK CUMI ASIN KECAP PEDAS

1. Cuci bersih dengan air mengalir kemudian rendam asin cumi pakai air panas yang baru dididihkan, diamkan sejenak sekitar 10 menit.  Setelah itu cuci bersih kembali dan potong-potong sesuai selera.
2. Panaskan minyak secukupnya, tumis bawang merah, bawang putih dan cabe gendot hingga harum. Masukkan potongan cumi lalu tuang air, garam, merica dan kaldu bubuk sambil aduk rata.
3. Setelah mendidih, masukkan kecap dan saus teriyaki lalu aduk rata dan masak sebentar hingga matang menyerap dan kuah agak menyusut. Angkat masakan tumis cumi asin dan siap untuk disajikan.

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NYC DOH: Investigating A South Bronx Legionella Outbreak

Legionella Bacteria - Photo Credit CDC PHIL

 

#10,371

 

The New York City Department issued a press release today regarding an extended outbreak of Legionella among residents of the South Bronx, which has thus far infected 31 people, killing 2. The source of this outbreak has yet to be be determined.  The Health Department advises:

 

New Yorkers with respiratory symptoms, such as fever, cough, chills and muscle aches, are advised to promptly seek medical attention.

 

First, the press release, then some background on the disease.

 

FOR IMMEDIATE RELEASE
Press Release # 030-15
Wednesday, July 29, 2015

Health Department Investigating Outbreak of Legionnaires' Disease in the South Bronx

31 cases of Legionnaires' disease have been reported since July 10 New Yorkers with respiratory symptoms, such as fever, cough, chills and muscle aches, are advised to promptly seek medical attention

The Health Department is currently investigating an outbreak of Legionnaires' disease in the South Bronx. Thirty-one cases have been reported since July 10. There have also been two deaths reported in patients with Legionnaires' disease in these neighborhoods. The Health Department is actively investigating these deaths and their relationship to the outbreak. The Health Department is testing water from cooling towers and other potential sources in the area to determine the source of the outbreak. New Yorkers with respiratory symptoms, such as fever, cough, chills and muscle aches, are advised to promptly seek medical attention.

“We are concerned about this unusual increase in Legionnaires’ disease cases in the South Bronx,” said Health Commissioner Dr. Mary Bassett. “We are conducting a swift investigation to determine the source of the outbreak and prevent future cases. I urge anyone with symptoms to seek medical attention right away.”

Legionnaires' disease is caused by the bacteria Legionella. Additional symptoms include: headache, fatigue, loss of appetite, confusion and diarrhea. Symptoms usually appear two to 10 days after significant exposure to Legionella bacteria. Most cases of Legionnaires’ disease can be traced to plumbing systems where conditions are favorable for Legionella growth, such as whirlpool spas, hot tubs, humidifiers, hot water tanks, cooling towers, and evaporative condensers of large air-conditioning systems.

Legionnaires' disease cannot be spread from person to person. Groups at high risk for Legionnaire’s disease include people who are middle-aged or older – especially cigarette smokers – people with chronic lung disease or weakened immune systems and people who take medicines that weaken their immune systems (immunosuppressive drugs). Those with symptoms should call their doctor and ask about testing for Legionnaire’s disease.

For more information about Legionnaires’ disease, please visit the Health Department website.

 

.

Nearly 40 years ago, iIn July of 1976, while many of us in the healthcare field were waiting for the expected arrival of a swine flu pandemic (see Deja Flu, All Over Again), another medical crisis was brewing  at the Bellevue Stratford Hotel in Philadelphia.

 

This was the scene of the gathering of hundreds of veterans belonging to the American Legion, celebrating this country’s bicentennial.  Within a couple of days of their arrival, scores fell ill with a serious flu-like illness.

 

At first, many believed this was the first arrival of the expected flu pandemic, but soon it became evident that this was something else entirely.  But exactly what it was would take months to determine.

 

During this outbreak, 221 people were treated and 34 died.

 

But it wouldn’t be until early in 1977 that a definitive cause would be isolated by the CDC – a Gram negative, aerobic bacteria found growing in the hotel’s air-conditioning cooling tower – that provoked a serious form of pneumonia.

 

Dubbed `Legionnaire's Disease’ by the press, this bacterium was named Legionella, and the pneumonia it produces Legionellosis.

 

While `discovered’ in 1976 and identified the following year, Legionella had been with us, and causing serious illness, for a long time. It had caused earlier outbreaks, including one in Austin, Minnesota in 1957 (Osterholm et al., 1983) and at Saint Elizabeth’s Hospital in Washington, D.C. in 1965.  

 

The cause of these outbreaks wasn’t identified, however, until retrospective studies were conducted after the Philadelphia outbreak.

  

We now know Legionella to be a major cause of infectious pneumonia, and that it sometimes sparks large outbreaks of illness.  According to the CDC between 8,000 and 18,000 Americans are hospitalized with Legionnaire's Disease each year, although the actual number of infected is likely higher.

 

The bacteria thrives in warm water, such as is often found in air-conditioning cooling towers, hot tubs, and even ornamental water fountains. Improper maintenance or poor design can lead to the bacteria blooming. 

 

When water is sprayed into the air the bacteria can become airborne, and if inhaled by a susceptible host, can cause a serious (and sometimes fatal) form of pneumonia.

 

In one of the oddest examples, in 2010 we saw a study (see Wiper Fluid And Legionella) that linked the use of plain water in windshield wiper reservoirs to an increased risk of infection.

 

The idea being that plain water, kept warm and dark under the hood near the engine, is apparently conducive to the growth of Legionella, and can become aerosolized when you clean your windshield, and subsequently inhaled.

 

While large outbreaks of Legionella are often traced to specific causes, quite often the source of the infection for sporadic cases remains a mystery.  

 

For more information on the disease, the CDC maintains a fact sheet at Patient Facts: Learn More about Legionnaires' disease.

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The UK’s Space Weather Preparedness Strategy

Credit NASA 

 

# 10,370

 

Although it may sound like the plot of a bad made-for-TV sci-fi movie, the threat from solar storms is quite real, and is taken very seriously by governments around the globe.  Like great earthquakes (8.0+), and Cat 5 hurricanes, truly destructive solar flares are extremely rare – but they do occur.

 

A Solar Flare is the brief, sudden release of radiation energy (X-Ray, Gamma Rays, & energetic particles (protons and electrons)) from the surface of the sun, generally in the vicinity of an active sunspot.

 

Solar flares are rated as either C Class (minor), M Class (Moderate), or X Class (extreme), and while the electromagnetic radiation they release can reach earth in only about 8 minutes time, their effects are mostly limited to disrupting communications and potentially damaging satellites.

 

A CME (Coronal Mass Ejection) is the ejection of a massive amount of plasma (electrons and protons & small quantities of helium, oxygen, and iron) from the the sun that may last for hours. Some of this plasma falls back into the sun, but trillions of tons can escape and if aimed in their direction, impact surrounding planets.

 

A CME may arrive on earth – 93 millions miles distant from the sun – anywhere 12 to 72 hours after it is observed, and spark a Geomagnetic Storm.  The quicker it arrives, the more powerful it is apt to be.  

 

While they pose no direct physical danger to us on the earth’s surface (we are protected by the earths magnetic field and atmosphere), a large CME can wreak havoc with electronics, power generation, and radio communications. Two recent examples: In 1989 space weather caused a major  power outage in Quebec, and in  2003 a solar storm damaged a number of satellites and also caused some power outages in Europe.

 

Back in 2010 we looked at the granddaddy of all known solar storms, the Carrington Event of 1859, and have since looked at preparations for the next one by our own government, including Solar Storms, CMEs & FEMA  & NASA Braces For Solar Disruptions.  

 

In 2009 the National Academy of Sciences produced a 134 page report on the potential damage that another major solar flare could cause in Severe Space Weather Events—Understanding Societal and Economic Impacts. Among their conclusions:

These assessments indicate that severe geomagnetic storms pose the risk for long-term outages to major portions of the North American grid. While a severe storm is a low-probability event, it has the potential for long-duration catastrophic impacts to the power grid and its affected users. The impacts could persist for multiple years with a potential for significant societal impacts and with economic costs that could be measurable in the several trillion dollars per year range.

 

In November of 2012 the U.S. National Intelligence Council released a report called "Global Trends 2030: Alternative Worlds" that tries to anticipate the global shifts that will likely occur over the next two decades (see Black Swan Events).  Making their top 10 list (coming in at #7) was:

 

7. Solar Geomagnetic Storms

"Solar geomagnetic storms could knock out satellites, the electric grid, and many sensitive electronic devices. The recurrence intervals of crippling solar geomagnetic storms, which are less than a century, now pose a substantial threat because of the world's dependence on electricity," the report says.

 

And in 2013 Lloyds issued a risk assessment for the insurance industry called Solar storm Risk to the north American electric grid which calls another `Carrington’ class event inevitable, and the effects likely catastrophic, but the timing is unknowable.

 

While unquestioningly rare events, in 2012 we came unnervingly close to seeing a solar disaster when the largest CME in more than 150 years leapt from the surface of the sun – but fortunately not in Earth’s direction.  This from NASA.

 

Near Miss: The Solar Superstorm of July 2012

July 23, 2014: If an asteroid big enough to knock modern civilization back to the 18th century appeared out of deep space and buzzed the Earth-Moon system, the near-miss would be instant worldwide headline news.

Two years ago, Earth experienced a close shave just as perilous, but most newspapers didn't mention it. The "impactor" was an extreme solar storm, the most powerful in as much as 150+ years.

"If it had hit, we would still be picking up the pieces," says Daniel Baker of the University of Colorado. 

A ScienceCast video recounts the near-miss of a solar superstorm in July 2012. Play it

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From a preparedness perspective, that wasn’t a `near miss’ . . .  it was a  `near hit’, and only reinforces the view that a having a major CME impact the earth is just a matter of when, not if. 

 

The UK first added severe space weather to the National Risk Register in 2012 (see updated UK: 2015 Civil Risks Register). Yesterday the UK’s Department for Business Innovation & Skills released a  Space Weather Preparedness Strategy  PDF report that:

 

. . .  sets out the UK-wide strategy for preparing for, and responding to, the demands of a severe space weather event. It covers the areas which might be affected by the risk, including:

• electrical power
• transport
• satellite navigation and timing
• telecommunications
• government (both at central and local levels)

It also covers how to co-ordinate planning across sectors.

 

 

Although UK-centric, this document provides a excellent insight into the planning that governments are putting into mitigating this threat.  As this document points out, a CME impact would affect some countries more severely than others, with higher latitude regions at the greatest risk of seeing major damage.

 

Our dependence upon our modern infrastructure, just in time deliveries, and a continuous supply of electricity makes all of us particularly vulnerable to any sudden interruption. While governments prepare for, and work to harden our infrastructure against,  major threats . . . individuals, families,  communities, and businesses have a role to play as well.

 

Which is why agencies here in the United States -  like the HHS, CDC, FEMA, Ready.gov and others - work each day to convince citizens of the importance of being prepared for the unexpected, and why I devote a fair amount of this blog to everyday preparedness.

 

I certainly don’t advocate lying awake at night worrying about solar flares (I certainly don’t!).  But I do believe that we all need to be prepared to deal with a variety of disaster scenarios.

 

The simple truth is, if you are well prepared to deal with an earthquake, pandemic, or a hurricane . . you are automatically in a better position deal with any other disaster, including low probability-high impact events like massive solar storms. 

 

September is National Preparedness Month, and as we do every year, we’ll be devoting a good deal of blog space to that subject.  But preparedness isn’t something you should wait to get started on.  A solar storm, a great earthquake, or an epic tsunami may not happen again for decades – but it could just as easily happen tomorrow.

 

For more information on emergency preparedness, some of my preparedness blogs include:

 

When 72 Hours Isn’t Enough

The Gift Of Preparedness: 2013

In An Emergency, Who Has Your Back?

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Louisiana: 2nd Public Water System Reports Naegleria

 

 

# 10,369

 

For the second time this summer, a public utility in Louisiana has reported finding Naegleria Fowleri – the amoebic parasite that causes an almost always fatal brain infection (PAM aka Primary amebic meningoencephalitis) – in the water being supplied to a small community in Ascension Parish. 

 

You may recall that last week we saw the St. Bernard Parish Water Supply Tests Positive for Naegleria Fowleri (Again).

 

Until a few years ago, nearly all of the Naegleria infections reported in the United States were linked to swimming in warm, stagnant freshwater ponds and lakes (see Naegleria: Rare, 99% Fatal & Preventable) 

 

In 2011, however,  we saw two cases reported in Neti pot users from Louisiana, prompting the Louisiana Health Department to recommend that people `use distilled, sterile or previously boiled water to make up the irrigation solution’ (see Neti Pots & Naegleria Fowleri).

While extraordinarily rare in the United States, every year Pakistan reports a dozen or more infections from this `killer amoeba’ , as chlorination of their water supplies is often inadequate, and for many, nasal ablutions are part of their daily ritual.

In 2013, we saw a 4 year-old  infected through contact with the municipal water supply while visiting St. Bernard Parish,  Louisiana. Subsequently we saw the St. Bernard Parish Water Supply Tests Positive For Naegleria Fowleri, prompting an emergency increase in chlorination and yearly checks of local water supplies.

 

While the water supply remains safe for drinking, until the water can be treated and tests come back showing the parasite gone, residents are warned to avoid certain activities which might introduce the parasite into their sinuses.

 

 

DHH Confirms Naegleria Fowleri Ameba in Ascension Consolidated Utility District 1

Drinking water is safe to consume, but State urges public to take precautions

Tuesday, July 28, 2015  |  Contact: Media & Communications: Phone: 225.342.1532, E-mail: dhhinfo@la.gov

Baton Rouge, La.—Tuesday, the Louisiana Department of Health and Hospitals (DHH) confirmed the presence of the Naegleria fowleri ameba in the Ascension Consolidated Utility District 1 at the site 9295 Brou Road. The water system, which serves approximately 1,800 residents in a small community north of Donaldsonville in Ascension Parish, was tested by DHH as part of the State's new public drinking water surveillance program. DHH notified the water system and local officials Tuesday afternoon. The Department asked the water system to conduct a 60-day chlorine burn to ensure that any remaining ameba in the system are eliminated. Parish officials today confirmed that the system would conduct the burn out of an abundance of caution.

The water system was not in compliance with the requirements for chloramine disinfectant levels set forth by the 2013 by emergency rule and additional requirements in 2014 by the Louisiana Legislature at the location where the sample tested positive for the ameba. Three other sites on the system tested negative for the ameba, but did meet the requirement for disinfectant.

Tap water in from the Ascension Consolidated Utility District 1 is safe for residents to drink, but the Department urges residents to avoid getting water in their noses. Naegleria fowleri is an ameba that occurs naturally in freshwater.

As Naegleria fowleri infections are extremely rare, testing for this ameba in public drinking water is still relatively new and evolving. Fewer than 10 deaths in the United States have been traced back to the ameba, with three occurring in Louisiana over the last several years.

DHH conducts sampling of public drinking water systems for Naegleria fowleri each summer when temperatures rise. So far, DHH has tested 12 other systems for the ameba. One positive result was identified on July 22 in St. Bernard Parish. St. Bernard Parish is currently conducting a chlorine burn throughout their water system to eliminate any remaining ameba.

Naegleria fowleri causes a disease called primary amebic meningoencephalitis (PAM), which is a brain infection that leads to the destruction of brain tissue. In its early stages, symptoms of PAM may be similar to bacterial meningitis.

DHH Safe Drinking Water Program staff sampled four sites along the Ascension Consolidated Utility District 1. One of the four sites tested positive for the ameba. One positive test was located at 9295 Brou Road. Chlorine levels at the site of the positive sample were below the 0.5 mg/l requirement.  The Department requested that the water system conduct a 60-day free chlorine burn in the water system. The chlorine burn will help reduce biofilm, or organic buildup, throughout the water system and will kill the ameba. The parish has agreed to conduct this precautionary measure. 

Precautionary Measures for Families

According to the CDC, every resident can take simple steps to help reduce their risk of Naegleria fowleri infection. Individuals should focus on limiting the amount of water going up their nose. Preventative measures recommended by the CDC include the following:

• DO NOT allow water to go up your nose or sniff water into your nose when bathing, showering, washing your face, or swimming in small hard plastic/blow-up pools.
• DO NOT jump into or put your head under bathing water (bathtubs, small hard plastic/blow-up pools); walk or lower yourself in.
• DO NOT allow children to play unsupervised with hoses or sprinklers, as they may accidentally squirt water up their nose. Avoid slip-n-slides or other activities where it is difficult to prevent water going up the nose.
• DO run bath and shower taps and hoses for five minutes before use to flush out the pipes. This is most important the first time you use the tap after the water utility raises the disinfectant level.
• DO keep small hard plastic/blow-up pools clean by emptying, scrubbing and allowing them to dry after each use.
• DO use only boiled and cooled, distilled or sterile water for making sinus rinse solutions for neti pots or performing ritual ablutions.
• DO keep your swimming pool adequately disinfected before and during use. Adequate disinfection means:
  - Pools: free chlorine at 1 to 3 parts per million (ppm) and pH 7.2 to 7.8, and
  - Hot tubs/spas: free chlorine 2 to 4 parts per million (ppm) or free bromine 4 to 6 ppm and pH 7.2 to 7.8.
• If you need to top off the water in your swimming pool with tap water, place the hose directly into the skimmer box and ensure that the filter is running. Do not top off the pool by placing the hose in the body of the pool.

Residents should continue these precautions until testing no longer confirms the presence of the ameba in the water system. Residents will be made aware when that occurs. For further information on preventative measures, please visit the CDC website here: http://www.cdc.gov/parasites/naegleria/prevention.html.

 

 

Although several states promote Naegleria awareness each summer, one of the best resources available online is http://amoeba-season.com/, a USF Philip T. Gompf Memorial Fund project, which was set up by a pair of Florida doctors who tragically lost their 10 year-old son to this parasite in 2009.  

You can also follow this site on twitter at @AmoebaSeason.

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Saudi MOH Reports Another Riyadh MERS Case

 

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The recent spate of MERS cases emanating from the Riyadh region continues, with the 7th case reported in the last 9 days from the capital city.   Today the Saudi MOH reports on a 67 year old Saudi male listed in critical condition, with (as yet) no risk exposure identified.

 

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WHO Influenza At The Human-Animal Interface – July 17th

# 10,367

 

The chart above shows not only the magnitude,  but the abrupt change of pace, of the past 8 month’s H5N1 activity. Egypt alone has reported roughly 180 cases-  which dwarfs anything we’ve seen previously. This chart also illustrates the seasonality of H5N1, with distinct summer troughs reported every year.

This time of year, avian flu activity is at its nadir in the Northern Hemisphere. But just as American and European officials are anticipating the return of H5N8/H5N2 to via migratory birds this fall, Egypt is girding for another round of H5N1 this winter.

The most recent WHO Influenza at the Human-Animal Interface report -  dated July 17th, but published in the past 24 hours – indicates only two new H5N1 cases were reported by Egyptian authorities in the past 30 days – plus China reported a single H5N6 (fatal) infection. . 

 

Summary and assessment as of 17 July 2015

Human infection with avian influenza A(H5) viruses

From 2003 through 17 July 2015, 844 laboratory-confirmed human cases of avian influenza A(H5N1) virus infection have been officially reported to WHO from 16 countries. Of these cases, 449 have died. Since the last WHO Influenza update on 23 June 2015, two new fatal laboratory-confirmed human cases of avian influenza A(H5N1) virus infection were reported to WHO from Egypt. A 40-year-old male from Sohag governorate had an onset of illness on 14 June, was hospitalized on 16 June, but passed away on 22 June 2015. The likely source of exposure to the virus for this case was either direct exposure to poultry or indirect exposure via a contaminated environment. A five and a half-year-old male from Aswan governorate, with illness onset on 16 June was hospitalized on 24 June, but passed away on 27 June 2015. This case had a history of exposure to poultry. Both cases were given oseltamivir one day after hospitalization.

In addition, one laboratory-confirmed human case of avian influenza A(H5N6) virus infection was reported to WHO from China. A 37-year-old female from Yunnan province had an onset of illness on 6 July, was hospitalized on 9 July, but passed away on 10 July. There was no evidence of human-to-human transmission of this virus among the close contacts of this case.

Various influenza A(H5) subtypes, such as influenza A(H5N1), A(H5N2), A(H5N3), A(H5N6) and A(H5N8), continue to be detected in birds in West Africa, Asia, Europe, and North America, according to reports received by OIE. Although these influenza A(H5) viruses might have the potential to cause disease in humans, so far no human cases of infection have been reported, with exception of the human infections with influenza A(H5N1) viruses and the four human infections with influenza A(H5N6) virus detected in China since 2014.

Overall public health risk assessment for avian influenza A(H5) viruses: Whenever avian influenza viruses are circulating in poultry, sporadic infections and small clusters of human cases are possible in people exposed to infected poultry or contaminated environments, therefore sporadic human cases would not be unexpected.

With the rapid spread and magnitude of avian influenza outbreaks due to existing and new influenza A(H5) viruses in poultry in areas that have not experienced this disease in animals recently, there is a need for increased vigilance in the animal and public health sectors. Community awareness of the potential dangers for human health are essential to prevent infection in humans. Surveillance should be enhanced to detect human infections if they occur and to detect early changes in transmissibility and infectivity of the viruses.

 

Human infections with avian influenza A(H7N9) viruses in China

A total of 677 laboratory-confirmed cases of human infection with avian influenza A(H7N9) viruses, including at least 275 deaths1, have been reported to WHO. The majority of recently reported human cases are associated with exposure to infected live poultry or contaminated environments, including markets where live poultry are sold. Influenza A(H7N9) viruses continue to be detected in poultry and their environments in the areas where human cases are occurring. There  have been no major genetic changes in the viruses isolated from recent patients compared to previously-isolated viruses from humans. Information to date suggests that these viruses do not transmit easily from human to human.

Overall public health risk assessment for avian influenza A(H7N9) viruses: Overall, the public health risk from avian influenza A(H7N9) viruses has not changed since the assessment of 23 February 2015.

 

The WHO has also updated their latest Cumulative number of confirmed human cases for avian influenza A(H5N1) reported to WHO, 2003-2015, but the version I downloaded has some formatting problems, with the rightmost total’s column truncated.

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EID Journal: Influenza A(H6N1) In Dogs, Taiwan

 

 

# 10,366

 

Up until a little over a decade ago, dogs were generally thought to be immune to influenza virus infection.  In 2004, however, the equine H3N8 flu virus mutated enough to adapt to a canine host, and began to spread among greyhounds in Florida (see EID Journal article Influenza A Virus (H3N8) in Dogs with Respiratory Disease, Florida).

 

Since then canine H3N8 has been sporadically reported across much of the United States.  It is considered a `canine specific’ virus, and there have been no reports of human infection.

But we’ve also seen evidence that other influenza viruses – including human and avian varieties – can infect canines.

 

• In 2008,  CDC’s EID Journal carried a report on a newly emerging canine flu jumping from an avian source in Korea (see Transmission of Avian Influenza Virus (H3N2) to Dogs).
• During the 2009 pandemic we saw reports of dogs infected the H1N1 virus, and in the middle of the last decade we saw several reports indicating that dogs were susceptible to the H5N1 bird flu virus (see Study: Dogs And H5N1).
• More recently Korea reported H5N8 Antibodies Detected In South Korean Dogs (Again).
• And the Korean H3N2 virus which emerged in 2008 finally showed up in the United States a few months ago (see CDC’s Key Facts On The New H3N2 Canine Flu).

 

As often happens, the more we look, the more we find. The expanding host range for influenza viruses (which now includes humans, equines, swine, birds, bats, camels, guinea pigs, and a variety of land and marine mammals) and the genetic diversity of influenza viruses (currently with 8 hemagglutinin & 11 neuraminidase subtypes identified), continues to surprise. 

 

Last summer, in Study: Dogs As Potential `Mixing Vessels’ For Influenza - we looked at the ability of different influenza strains (canine, equine and human)  to infect, and replicate in, canine tracheal tissues.  And last February, in Virology J: Human-like H3N2 Influenza Viruses In Dogs - Guangxi, China, we looked at the discovery two H3N2 CIVs possessing high homology with human/swine influenza viruses.

 

While novel influenza infections among Mongolian Bactrian Camels and Peruvian guinea pigs pose fairly limited exposure risks to human populations, infection of companion animals like dogs and cats are another matter entirely.

 

Something that the American Society for Microbiology warned about last summer, in a press release on a study of canine influenza viruses:

Evolution of Equine Influenza Led to Canine Offshoot Which Could Mix With Human Influenza

CONTACT:  Jim Sliwa
jsliwa@asmusa.org

WASHINGTON, DC – June 19, 2014 – Equine influenza viruses from the early 2000s can easily infect the respiratory tracts of dogs, while those from the 1960s are only barely able to, according to research published ahead of print in the Journal of Virology. The research also suggests that canine and human influenza viruses can mix, and generate new influenza viruses.

(Continue . . . )

In this same vein, today we have a report - published in the EID Journal - detailing the discovery and isolation of Avian H6N1 in dogs in Taiwan.

 

H6N1 has been around for decades in Chinese poultry - it possesses similar internal genes to H5N1 and H9N2 (cite 2002 J Virol  Molecular evolution of H6 influenza viruses from poultry in Southeastern China by Webster, Webby, Shortridge  et al.) - and it has been speculated that it may have even been involved in the genesis of H5N1 in Hong Kong in 1997.

While viewed as having some pandemic potential in the  1990s, once H5N1 emerged as a serious threat in 2003, H6N1’s  threat receded back into the shadows. When Taiwan’s CDC Reported the first Human Infection With Avian H6N1 two years ago, however, interest in H6N1  quickly rose.

• Last May,in the EID Journal: Seropositivity For H6 Influenza Viruses In China, researchers reported a low - but significant - level of antibodies,  particularly among live bird handlers, to the avian H6 virus in China.
• And also last May, in Study: Adaptation Of H6N1 From Avian To Human Receptor-Binding, we saw a report citing changes the authors suggest are slowly moving the H6N1 virus towards preferential binding to human receptor cells instead of avian receptor cells

All of which makes H6N1 a virus of interest, and serves as prelude to today’s EID Journal article, which finds evidence of H6N1 infection in a small number of dogs sampled in Taiwan.

 

Influenza A(H6N1) Virus in Dogs, Taiwan

Hui-Ting Lin¹, Ching-Ho Wang¹, Ling-Ling Chueh, Bi-Ling Su, and Lih-Chiann Wang

Author affiliations: National Taiwan University, Taipei, Taiwan

Abstract

We determined the prevalence of influenza A virus in dogs in Taiwan and isolated A/canine/Taiwan/E01/2014. Molecular analysis indicated that this isolate was closely related to influenza A(H6N1) viruses circulating in Taiwan and harbored the E627K substitution in the polymerase basic 2 protein, which indicated its ability to replicate in mammalian species.

Infections with influenza viruses are rare in dogs. However, interspecies transmission of an equine influenza A(H3N8) virus to dogs was identified during a respiratory disease outbreak in Florida, USA, in 2004 (1). Influenza A(H6N1) virus is the most common naturally occurring avian influenza virus in Taiwan (2). Therefore, to determine to the prevalence of influenza A virus infection in dogs in Taiwan, we performed serologic analysis, 1-step reverse transcription PCR (RT-PCR) screening, and virus isolation.

The Study

A total 474 serum specimens were collected in Taiwan during October 2012–October 2013. Two hundred eighty-one specimens were collected from household (owned) dogs at the National Taiwan University Veterinary Hospital in Taipei. The remaining 193 serum specimens were obtained from free-roaming dogs in rural areas.

All serum specimens were tested for antibodies against influenza A virus by using a species-independent blocking ELISA (Influenza A Virus Antibody Test Kit; Idexx, Westbrook, ME, USA). All antibody-positive serum specimens were further tested by using a hemagglutination inhibition (HI) assay. HI was determined according to procedures recommended by the World Organisation for Animal Health. Chicken erythrocytes (1%) were used. Serum samples were treated with receptor-destroying enzyme (Denka Seiken, Tokyo, Japan) before conducting the assay to destroy nonspecific inhibitors (3). A/chicken/Taiwan/2838V/2000 (H6N1) and A/chicken/Taiwan/1209/03 (H5N2) viruses were used as antigens.

(SNIP)

Conclusions

Avian influenza A(H6N1) viruses have been widespread in chickens in Taiwan since 1972 (13–15). These viruses are clustered in a unique lineage that differs from viruses circulating in Hong Kong and southeastern China since 1997 (13). Unlike avian species, H6 subtype virus infections are rare in mammals.

In this study, 9 of 474 dog serum specimens were positive for influenza A virus by ELISA, and 4/185 (2.1%) dogs had RT-PCR−positive results for this virus. A/canine/Taiwan/E01/2014 was isolated from 1 dog that was co-infected with canine distemper virus. On the basis of molecular analysis of A/canine/Taiwan/E01/2014, HA, NA, PB1, PB2, NP, and NS genes showed high homology (>97% nucleotide identity) with avian H6N1 subtype virus isolates that are currently prevalent in Taiwan. PA and M genes of A/canine/Taiwan/E01/2014 showed 99% nucleotide identity with A/chicken/Taiwan/2593/2013 (H5N2).

Phylogenetic analysis showed that 8 eight virus genes were derived from H6N1 subtype viruses isolated in Taiwan. All 8 influenza virus genes found in the dog probably originated from avian sources. We speculate that a complete avian influenza virus had infected this dog. However, additional analysis is required to verify this hypothesis.

 

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