Agustus 2015 ~ PACITAN VISIT

Senin, 31 Agustus 2015

UNSW: Flu Vaccine Provides Significant Protection Against Heart Attacks

Photo Credit - CDC PHIL

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Roughly 18 years ago, a study looked at the rate of heart attacks in the United States, and found that Acute Myocardial Infarctions (AMIs) run as much 53% higher during the winter months than than during the summer.

While numerous theories have been offered (holiday stress, cold weather, over-indulgence during the holidays, etc.), a growing number of studies have suggested that Influenza - and other acute respiratory infections - can act as a trigger for heart attacks (see Study: Influenza And Heart Attacks).

Assuming that flu is a major trigger for heart attacks, then it stands to reason that the flu vaccine ought to provide some measurable level of protection against them. And over the years we’ve looked at a number of studies that have attempted to quantify that number.

In 2010 we saw a study in the CMAJ: Flu Vaccinations Reduce Heart Attack Risk that found that those over the age of 40 who get a seasonal flu vaccine each year may reduce their risk of a heart attack by as much as 19%. Questions were raised over the way this study was conducted (see Vaccine/Heart Attack Study Questioned), and so the results are in dispute.
In August of 2013 (see Study: Flu Vaccine May Reduce Heart Attack Risk), we looked at study out of Australia – published in the BMJ Journal Heart, that found compelling – but not exactly conclusive – evidence that flu shots may reduce the risk of heart attacks as much as 45%.
In October of 2013 (see JAMA: Flu Vaccine and Cardiovascular Outcomes) we looked at a meta analysis that found among patients who had previously had a heart attack, the receipt of a flu vaccine was linked to a 55% reduction in having another major cardiac event in the next few months.

Complicating matters, those who are most likely have cardiac events (> 65) are also the cohort least likely to derive optimal protection from the flu vaccine (see NFID: The Challenges Of Influenza In Older Adults). There is some evidence, however, that even when it doesn’t prevent infection, the flu vaccine may reduce the severity of illness (CDC: Flu Shots Reduce Hospitalizations In The Elderly).

Building on the 2013 Australian BMJ study mentioned above, researchers at the University of New South Wales have put together a new meta analysis which further supports the link between getting the flu jab, and reducing the risks of having a heart attack.

First the link to the study, and a press release, after which I’ll return with a bit more.

Acute myocardial infarction and influenza: a meta-analysis of case–control studies

Michelle Barnes, Anita E Heywood, Abela Mahimbo, Bayzid Rahman, Anthony T Newall, C Raina Macintyre

Published Online First 26 August 2015
Abstract

Objective Acute myocardial infarction (AMI) is the leading cause of death and disability globally. There is increasing evidence from observational studies that influenza infection is associated with AMI. In patients with known coronary disease, influenza vaccination is associated with a lower risk of cardiovascular events. However, the effect of influenza vaccination on incident AMI across the entire population is less well established.
Method The purpose of our systematic review of case–control studies is twofold: (1) to estimate the association between influenza infection and AMI and (2) to estimate the association between influenza vaccination and AMI. Cases included those conducted with first-time AMI or any AMI cases. Studies were appraised for quality and meta-analyses using random effects models for the influenza exposures of infection, and vaccination were conducted.
Results 16 studies (8 on influenza vaccination, 10 on influenza infection and AMI) met the eligibility criteria, and were included in the review and meta-analysis. Recent influenza infection, influenza-like illness or respiratory tract infection was significantly more likely in AMI cases, with a pooled OR 2.01 (95% CI 1.47 to 2.76). Influenza vaccination was significantly associated with AMI, with a pooled OR of 0.71 (95% CI 0.56 to 0.91), equating to an estimated vaccine effectiveness of 29% (95% CI 9% to 44%) against AMI.
Conclusions Our meta-analysis of case–control studies found a significant association between recent respiratory infection and AMI. The estimated vaccine effectiveness against AMI was comparable with the efficacy of currently accepted therapies for secondary prevention of AMI from clinical trial data. A large-scale randomised controlled trial is needed to provide robust evidence of the protective effect of influenza vaccination on AMI, including as primary prevention.

Some excerpts from the UNSW press release follow:

UNSW study finds flu jab provides significant protection against heart attacks

27 Aug 2015
Dan Wheelahan
If you’re over 50 and get the flu jab, you’ll not only help to keep the dreaded lurgy at bay but you could also reduce your risk of a heart attack.
That is the advice of UNSW researchers after their study estimated a vaccine effectiveness of 29% in preventing heart attacks which is on par with other heart attack preventative measures.
Previous studies have estimated the effectiveness of statins for the secondary prevention of heart attacks at 25%, anti-hypertensives (15-18%) and smoking cessation interventions (26%).
Researchers in the School of Public Health and Community Medicine (SPHCM) conducted a systematic review and meta-analysis of 16 international case control studies to estimate the association of influenza and vaccination with heart attacks.
They found significant associations between influenza infection and heart attacks, with heart attack patients twice as likely to have recently had the flu. Their review also confirmed existing evidence, including their own 2013 study, which found that the flu vaccination could lower the risk of a heart attack by 45%.
The study was published today in the journal Heart.
(Continue . . . )

Although the `street creds’ of the flu vaccine took a major hit last winter after the late arrival of a `mismatched’ H3N2 virus (see CDC: Updated Estimated Seasonal Flu Vaccine Effectiveness), most years the flu vaccine provides a `moderate’ level of protection. Something on the order of 40%-60% Vaccine Effectiveness (VE).

As we’ve discussed before, there is a pressing need for better flu vaccines (see CIDRAP: The Need For `Game Changing’ Flu Vaccines).While far from perfect - the flu shots we have remain the best preventative action you can take against the flu.

And while not conclusive (more research is needed), the evidence suggests it may also be one of the best preventative actions you can take against having a heart attack as well.

Which is more than enough reason that I’ll be rolling up my sleeve again this year for the flu shot.

Saudi MOH: Riyadh Adds 6 More MERS Cases

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The MERS outbreak in Riyadh isn’t showing any signs of abating on this last day of August, with 6 additional cases announced in the latest update. Five of the six are listed as `contacts with confirmed or suspected cases’ – likely part of the ongoing nosocomial outbreak – with one outlier with no known contact.

One case - a 33 y.o. female – is listed as a healthcare worker. Two recoveries and two deaths are also reported.

Based on the following ECDC chart – which is already 13 cases behind - August 2015 will go down as the third heaviest MERS month for the Saudis, and the most active month since June 2014. .

Credit ECDC 20th MERS Risk Assessment

Saudi MOH Statement On Past Week’s Riyadh MERS Outbreak

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Beneath the cryptic case line-listing that appears on the Saudi MOH’s daily MERS update is the promise that `More information on the exposure history will be posted on the weekly update’.

Given the parsimonious nature of these daily reports, additional information would indeed be welcome.

While the MOH does indeed post a weekly summary, these recaps rarely shed any light on the promised `exposure history’ of these cases, and instead (as seen below) highlights the MOH’s response and offers general reassurance to the public.

MOH: ‘34 MERS-CoV Cases Reported Last Week’
31 August 2015
In its weekly press release, the Ministry of Health (MOH) announced that 34 confirmed cases of the Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) have been reported over the past week, from August 23rd to 29th, 2015, corresponding to Dhul-Qi‘dah 8th to 14th, 1436H (the 35th International Week), including 33 cases in Riyadh, and one case in Najran.
“During the same period, 1.655 samples were tested for Coronavirus at the MOH laboratories across the Kingdom, including 15 cases at the MOH hospitals and 19 other cases at the other health sectors. The number of visits by Rapid Response Teams-IPC was 12, while the total number of visits by public health teams to persons in contact with positive cases was 34,” indicated the Ministry, adding that the number of persons, who were in contact with positive cases at homes was 295, and the number of visits by the Ministry of Agriculture (MOA) was one.
Besides, the Ministry announced that 606 cases, out of the total of 1.175confirmed cases, have been cured, at a rate of 1.6%. There are 57 other cases still receiving treatment, and 9 cases have been quarantined at home.
Within the same vein, the Command and Control Center (CCC) keeps on its efforts around the clock by carrying out epidemiological surveillance tasks, making sure that all governmental and private health facilities abide by infection control measures, as well as coordinating with the relevant governmental sectors, international health organizations, including the World Health Organization (WHO), and think-tanks to follow up all developments regarding Coronavirus.
Over and above, the Ministry keeps on its efforts and full coordination with the Ministry of Agriculture (MOA), to launch anti-Coronavirus awareness campaigns at the gathering places of camels to urge camels’ owners and shepherds to be careful and take protective measures when dealing with camels.
Finally, the MOH highlighted that it will remain committed to the preset preparations and cooperative efforts with other parties, including the Saudi community and healthcare staff, who represent the cornerstone in this regard.

Jordan Reports 5th MERS Case In A Week

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After going 8 months without reporting any coronavirus cases, on Wednesday of last week we learned of a Jordanian MERS case – described as a man in his 60s – who reportedly has since died. The following day another case - a 38 y.o. male – was announced.

While details are scant, both reportedly had recent travel out of the country. Their relationship, if any, has not been disclosed.

On Friday, we saw Media Reports Of Two Additional MERS Cases In Jordan (Updated), both listed as contacts of one of the first two cases. The Jordanian MOH website has remained silent on these cases, but over the weekend posted two long statements (in Arabic) on the control of MERS.

Committee Epidemiology confirms the safety measures to deal with Koruna

Health stresses the need to follow health guidelines to reduce the respiratory disease

Overnight we’ve a report from PETRA, the Jordanian News Agency, of a 5th case – which while not expressly stated, appears to be the result of nosocomial transmission.

New MERS case recorded in Jordan

By Petra - Aug 30,2015 - Last updated at Aug 30,2015
AMMAN — A new case of Middle East Respiratory Syndrome (MERS) coronavirus-related infection has been registered in the Kingdom, the Health Ministry said Sunday.
The diagnosed 56-year-old patient suffers from diabetes, blood pressure-related diseases and kidney failure, said Mohammad Abdullat, director of the ministry’s communicable diseases control department.
The patient also recently underwent open-heart surgery, Abdullat added. A team from the directorate is supervising the private hospital’s measures to prevent the spread of the infection and is also following up on the situation of the patient’s relatives and the medical staff who examined him. Since the MERS virus was first registered in Jordan in 2012, 17 cases have been recorded.

You’ll note that the claim that 17 cases have been recorded in Jordan differs from the count offered by the ECDC, which sat at 19 before this latest cluster began.

This difference of 7 cases appears to be due the Jordanians not including 7 cases retrospectively identified in 2014 as infected from the first known hospital cluster of April 2012 (see Serological Testing Of 2012 Jordanian MERS Outbreak).

Curious, as this study was conducted in cooperation with Jordanian MOH, and Jordan’s MERS investigation team.

Cara Membuat Oreo Goreng Pancake Resep Enak dan Renyah

Resep Oreo Goreng pancake untuk menu cemilan yang enak dan renyah. Salah satu pilihan menu yang bisa dicoba di rumah dari kreasi oreo adalah digoreng dengan balutan tepung. Menu ini sangat enak disajikan sebagai cemilan atau juga menu sarapan hingga hidangan makanan ringan menyambut tamu. Adonan tepung yang membalutnya juga memiliki banyak variasi seperti halnya adonan roti dan pancake begitu pula dengan aneka topping yang menghiasinya untuk memperkaya cita rasa.

Froreo (fried oreo) atau oreo goreng yang enak dan renyah krenyes bisa kita praktekkan dalam resep oreo goreng kali ini dengan balutan adonan pancake sederhana.

RESEP OREO GORENG PANCAKE

100 gram tepung terigu
30 gram gula pasir
1 sdm tepung maizena
1 sdt baking powder
1/4 sdt garam
1 butir telur
100 ml susu cair
18 buah oreo biskuit
minyak untuk menggoreng
keju parut atau aneka topping sesuai selera

CARA MEMBUAT OREO GORENG PANCAKE :

Sebelumnya simpan dahulu biskuit oreo dalam freezer agar creamnya beku, minimal 2-3 jam atau lebih lama juga tak masalah.
Dalam satu wadah campur dan aduk rata tepung terigu, gula pasir, tepung maizena, garam dan baking powder.
Kocok lepas telur menggunakan kocokan telur (whisk), kocok biasa saja hingga kuning dan putih tercampur rata hanya sedikit buih. Masukkan susu, aduk rata lalu masukkan tepung terigu secara bertahap sambil aduk rata.
Panaskan minyak secukupnya dalam wajan datar, celupkan oreo satu per satu pada adonan tepung hingga rata. Goreng dalam minyak panas di atas api sedang hingga matang kecoklatan bagaian bawah lalu balik agar matang merata. Sajikan oreo goreng dengan parutan kejua atau aneka topping sesuai selera.

Cara membuat oreo goreng yang lebih praktis bisa juga mencoba resep oreo goreng tepung sederhana di bawah ini, akan tetapi untuk kerenyahannya tentu tidak seperti resep pertama di atas.

Oreo Goreng Tepung Sederhana

Bahan-bahan :

12 buah oreo aneka rasa
150 gram tepung terigu
150 ml susu cair
1 butir telur
15 gram gula halus
minyak goreng secukupnya
gula halus atau aneka topping sesuai selera

CARA MEMBUAT OREO GORENG TEPUNG :

Campurkan terigu, susu cair, telur dan gula halus lalu aduk rata hingga adonan tidak ada gumpalan.
Panaskan minyak, celupkan biskuit oreo ke dalam adonan tepung kemudian goreng hingga matang berwarna kuning kecoklatan. Angkat dan tiriskan bisa memakai tisu sebagai alasnya supaya minyak menyerap.
Tata dalam piring saji, taburi dengan gula halus atau sajikan selagi hangat dengan aneka topping sesuai selera.

J. Virol: Novel Reassortant Human-like H3N2 & H3N1 Influenza A Viruses In Pigs

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Swine are highly susceptible to a variety of flu viruses (human, swine, avian) - and are viewed as excellent `mixing vessels’, allowing viruses to reassort into new hybrid strains. Swine Influenza Viruses (SIVs) are not a reportable or regulated animal disease in the United States, but the USDA does conduct limited voluntary surveillance for SIV in the US.

The USDA describes this program thusly: `This surveillance is not conducted to define prevalence - the goal is to identify viruses that may be circulating in swine, and gain knowledge to contribute to improved animal health diagnostics and vaccines.’

Just shy of a year ago, in USDA IAV-S Surveillance Program Detects Novel H3N1 In US Swine, we learned that a new reassortant SIV had been detected in two states. While swine H3N1 has been known to circulate in pigs for nearly a decade (see EID Journal 2006 article Novel Swine Influenza Virus Subtype H3N1, United States) this latest variant was a combination of both human and swine influenza viruses.

The USDA sent out an email to all SIV (swine influenza virus) approved NAHLN (National Animal Health Laboratory Network) labs on September 14th (see H3N1 Identified in Swine in Two States), which described the virus as carrying `a novel human seasonal HA gene from contemporary human viruses and are distinct from our current swine H3 viruses.’

They warned:

A review of Genbank data indicates there may be more human-like H3 genes (in either H3N1 or H3N2) circulating in U.S. swine subtypes than what the USDA surveillance data has captured. Potential spread of H3N1 or H3N2 that carries the human-like H3 could have significant impact in swine herds due to poor herd immunity as well as potential public health ramifications. Preliminary findings by the USDA-ARS from testing of one of these H3N1 isolates with the human-like H3 gene in swine indicate the virus is fully virulent, causing typical influenza disease.

As we saw with the 2009 H1N1 pandemic virus, reassortant influenza viruses can kick around swine herds for years or even decades – picking up mutations or mixing with other viruses – without posing a threat to humans. Most end up evolutionary failures, but every once in awhile, a genetic winner emerges.

Over the past decade we’ve been watching a variety of swine variant viruses (H1N1v, H1N2v,H3N2v) making tentative leaps into human hosts, with a new case reported just last Friday. So far, these cases remain sporadic, and human-to-human transmission appears rare.

All of which brings us to a new study, published last week in the Journal of Virology (alas, behind a pay wall), that describes two distinct novel reassortants (H3N1 and H3N2) that possess human-like H3, and the internal genes from the 2009 H1N1 pandemic virus.

They describe both of these novel subtypes as “. . . virulent and can sustain onward transmission in pigs, and the naturally occurring mutations in the HA were associated with antigenic divergence from H3 IAV from human and swine’” and goes on to warn that ``. . . the potential risk of these emerging swine IAV to humans should be considered”.

The Abstract from PubMed.gov follows:

J Virol. 2015 Aug 26. pii: JVI.01675-15. [Epub ahead of print]
Novel reassortant human-like H3N2 and H3N1 influenza A viruses detected in pigs are virulent and antigenically distinct from endemic viruses.

Rajão DS¹, Gauger PC², Anderson TK¹, Lewis NS³, Abente EJ¹, Killian ML⁴, Perez DR⁵, Sutton TC⁶, Zhang J², Vincent AL⁷.
Author information

Abstract

Human-like swine H3 influenza A viruses (IAV) were detected by the USDA surveillance system. We characterized two novel swine human-like H3N2 and H3N1 viruses with HA genes similar to human seasonal H3 strains and the internal genes closely related to 2009 H1N1 pandemic viruses. The H3N2 NA was of the contemporary human N2 lineage, while the H3N1 NA was of the classical swine N1 lineage.
Both viruses were antigenically distant from swine H3 viruses that circulate in the U.S. and from swine vaccine strains, and also showed antigenic drift from human seasonal H3N2. Their pathogenicity and transmission in pigs were compared to a human H3N2 with common HA ancestry. Both swine human-like H3 viruses efficiently infected pigs and transmitted to indirect contacts, whereas the human H3N2 was much less efficient.
To evaluate the role of genes from the swine isolates on their pathogenesis, reverse genetics-generated reassortants between the swine human-like H3N1 and the seasonal human H3N2 were tested in pigs. Gene segment contribution to virulence was complex with the swine HA and internal genes showing effect in vivo. The experimental infections indicate that these novel H3 viruses are virulent and can sustain onward transmission in pigs, and the naturally occurring mutations in the HA were associated with antigenic divergence from H3 IAV from human and swine.
Consequently, these viruses could have a significant impact on the swine industry if they cause more widespread outbreaks, and the potential risk of these emerging swine IAV to humans should be considered.
IMPORTANCE:

Pigs are important hosts in the evolution of influenza A viruses (IAV). Human-to-swine transmissions of IAV have resulted in the circulation of reassortant viruses containing human-origin genes in pigs, greatly contributing to the diversity of IAV in swine worldwide. New human-like H3N2 and H3N1 viruses that contain a mix of human and swine gene segments were recently detected by the USDA surveillance system. The human-like viruses efficiently infected pigs and resulted in onward airborne transmission, likely due to multiple changes identified between human and swine H3 viruses. The human-like swine viruses are distinct from contemporary U.S. H3 swine viruses and from the strains used in swine vaccines, which could have a significant impact on the swine industry due to lack of population immunity. Additionally, public health experts should consider appropriate risk assessment for these emerging swine H3N1 for the human population.
Copyright © 2015, American Society for Microbiology. All Rights Reserved.

While avian influenza has been getting the bulk of our attention the past couple of years, swine influenza viruses – while usually less virulent - are also worrisome because they probably have less of a `leap’ to make in order to adapt to human physiology.

For more on swine as potential `flu factories’, you may wish to revisit:

Live Markets & Novel Flu Risks In The United States

Keeping Our Eyes On The Prize Pig

EID Journal: Influenza A Viruses of Human Origin in Swine, Brazil

H5N2: The Other Biosecurity Concern

Saudi MOH: 3 New MERS Cases, 4 Deaths

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The Saudi MOH update today indicates two more MERS cases in Riyadh, one of whom is a healthcare worker, and both are listed as contacts of previously confirmed cases.

A third case, listed as a 67 y.o. male from Hail – located some 700 km north of Riyadh – is listed as a contact of a previous case. A tad curious since this is the first case we’ve seen from Hail in quite some time.

The report goes on to list 4 deaths from Riyadh, and 3 recent recoveries.

J.Virol.: Experimental Infectivity Of H3N8 In Swine

Credit ECDC – 125 years of Pandemic History

# 10,465

The H3N8 subtype of influenza A is of particular interest to influenza researchers for several reasons.

First, as the chart above illustrates, H3N8 is strongly suspected to have sparked human epidemics and a pandemic around the turn of the 20th century.
Second, avian H3N8 remains endemic in birds.
Third, about 50 years ago H3N8 jumped unexpectedly to horses in Miami, and since the 1970s appears to have supplanted the old equine H7N7 and is now the only equine-specific influenza circulating the globe.
Fourth, in 2004 the equine H3N8 virus mutated enough to jump to canines, and began to spread among greyhounds in Florida (see EID Journal article Influenza A Virus (H3N8) in Dogs with Respiratory Disease, Florida).
Fifth, in 2011 avian H3N8 was found in marine mammals (harbor seals), and 2012’s mBio: A Mammalian Adapted H3N8 In Seals, provided evidence that this virus had recently adapted to bind to alpha 2,6 receptor cells, the type found in the human upper respiratory tract.
Sixth, the mBio findings were further confirmed last year in when Nature Communications: Respiratory Transmission of Avian H3N8 In Ferrets, confirmed that this `virus has an increased affinity for mammalian receptors, transmits via respiratory droplets in ferrets and replicates in human lung cells.’

Add in that in the short history of studying influenza, only H1, H2, and H3 subtypes have taken hold in the human population (see Are Influenza Pandemic Viruses Members Of An Exclusive Club?), and there are many who believe what went around 110 years ago could possibly come around again.

All of which makes the findings of the following study particularly interesting.

Cross-species infectivity of H3N8 influenza virus in an experimental infection in swine

J Virol. 2015 Aug 26. pii: JVI.01509-15. [Epub ahead of print]

Solórzano A¹, Foni E², Córdoba L³, Baratelli M³, Razzuoli E⁴, Bilato D⁵, Martín Del Burgo MÁ⁶, Perlin DS¹, Martínez J⁷, Martínez-Orellana P³, Fraile L⁸, Chiapponi C², Amadori M⁵, Del Real G⁶, Montoya M⁹

Abstract

Avian influenza A viruses have gained increasing attention due to their ability to cross the species barrier and cause severe disease in humans and other mammal species as pigs. H3 and particularly H3N8 viruses, are highly adaptive since they are found in multiple avian and mammal hosts. H3N8 viruses have not been isolated yet from humans; however a recent report showed that equine influenza A viruses (IAV) can be isolated from pigs, although an established infection has not been observed so far in this host.

To gain insight into the possibility of H3N8 avian IAV to cross the species barrier into pigs, in vitro experiments and an experimental infection in pigs with four H3N8 viruses from different origins (equine, canine, avian and seal) were performed. As positive control, a H3N2 swine influenza virus A was used. While equine and canine viruses hardly replicated in the respiratory apparatus of pigs, avian and seal viruses replicated substantially and caused detectable lesions in inoculated pigs without previous adaptation. Interestingly, antibodies against HA could not be detected after infection by hemaglutination inhibition test (HAI) with the avian and seal virus.

This phenomenon was observed not only in pigs but also in mice immunized with the same virus strains. Our data indicated that H3N8 IAV from wild aquatic birds have the potential to cross the species barrier and establish successful infections in pigs that might spread unnoticed using HAI as diagnostic tool.

IMPORTANCE SECTION:

Although natural infection of humans with an avian H3N8 influenza A virus has not yet been reported, this influenza A virus subtype has already crossed the species barrier. Therefore, we have examined the potential of H3N8 from canine, equine, avian and seal origin to productively infect pigs.

Our results demonstrated that avian and seal viruses replicated substantially and caused detectable lesions in inoculated pigs without previous adaptation. Surprisingly, we could not detect specific antibodies against HA in any H3N8-infected pigs. Therefore, special attention should be focused towards viruses of the H3N8 subtype as they could behave as stealth viruses in pigs.

While H3N8 doesn’t currently appear to be established in swine populations, for much of the world testing of pigs is rarely (if ever) done. In 2009 we did see evidence of H3N8 detected in Chinese swine in the middle of the last decade (see Isolation and molecular characterization of equine H3N8 influenza viruses from pigs in China).

For more background on this increasingly promiscuous virus, you may wish to revisit:

EID Journal: Equine H3N8 In Mongolian Bactrian Camel

Study: Dogs As Potential `Mixing Vessels’ For Influenza

Saudi MOH Announces 2 Additional MERS Cases

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The number of new MERS cases being reported out of Riyadh has dropped in recent days, which may be an indication that the affected hospitals are starting to get a handle on containing the outbreak. Today Riyadh only reports 1 new case, while once again we see a sporadic case from Najran.

The Najran case had already expired by the time his was announced by the MOH.

Whether this is a sign that the outbreak in Riyadh is ending – or is just a temporary lull – August 2015 will go down as the third heaviest MERS month for the Saudis, and the most active month since June 2014. .

Credit ECDC 20th MERS Risk Assessment

This spike is notable also because the hot summer months have not previously been associated with heavy MERS activity on the Arabian peninsula. The seasonality of MERS outbreaks – previously believed to favor spring outbreaks – has proven less predictable during 2015.

CDC FluView: 1 Novel H1N1v Case Reported From Iowa

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For the 4th time this year, the CDC is reporting the detection of a novel swine variant virus in a human. Human infections with these swine-origin viruses are only rarely reported, but presumably happen more often than we know because testing for novel viruses is very limited.

The first two swine variant infections this year were H1N1v (see here and here), while the third case reported just a month ago, was H3N2v.

The CDC describes Swine Variant viruses in their Key Facts FAQ.

What is a variant influenza virus?

When an influenza virus that normally circulates in swine (but not people) is detected in a person, it is called a “variant influenza virus.” For example, if a swine origin influenza A H3N2 virus is detected in a person, that virus will be called an “H3N2 variant” virus or “H3N2v” virus.

Up until about six years ago the CDC only received 1 or 2 swine variant infection reports each year. In 2010, that number jumped to 8, and in 2011 to 12. In 2012 we saw more than 300 cases – mostly mild - and nearly all associated with exposure to pigs at state and local agricultural fairs.

Of the 376 swine variant infections reported in the United States, that vast majority (350+) have been of the H3N2v variety. Far behind, in second place, is H1N1v. A bit surprisingly, of the 4 cases discovered this year, 3 have been of the less common H1N1v variety.

This update from today’s FluView report.

Novel Influenza A Viruses:

One human infection with a novel influenza A virus was reported by the state of Iowa. The person was infected with an influenza A (H1N1) variant (H1N1v) virus and was hospitalized as a result of their illness. No human-to-human transmission has been identified and the case reported close contact with swine in the week prior to illness onset.
Early identification and investigation of human infections with novel influenza A viruses are critical so that risk of infection can be more fully appreciated and appropriate public health measures can be taken. Additional information on influenza in swine, variant influenza infection in humans, and strategies to interact safely with swine can be found at http://www.cdc.gov/flu/swineflu/index.htm.

While occasional cases are not particularly alarming, we keep an eye on these viruses because they belong to the same subtypes as do human flus (H1, H2 & H3), and presumably would need less of an evolutionary leap to adapt to humans than avian flu strains.

The CDC’s FAQ states:

Why are human infections with variant viruses of concern?

Influenza viruses that infect pigs may be different from human influenza viruses. Thus, influenza vaccines made against human influenza viruses are generally not expected to protect people from influenza viruses that normally circulate in pigs. In addition, because pigs are susceptible to avian, human and swine influenza viruses, they potentially may be infected with influenza viruses from different species (e.g., ducks and humans) at the same time. If this happens, it is possible for the genes of these viruses to mix and create a new virus that could spread easily from person-to-person. This type of major change in the influenza A viruses is known as antigenic shift. Antigenic shift results when a new influenza A virus to which most people have little or no immune protection infects humans. If this new virus causes illness in people and can be transmitted easily from person-to-person, an influenza pandemic can occur. This is what happened in 2009 when an influenza A H1N1 virus with swine, avian and human genes emerged in the spring of 2009 and caused the first pandemic in more than 40 years.

With the fall county and state fair season getting full swing, we’ll be watching to see if more cases are detected this fall.

While infections have been generally mild (with a few exceptions), fairgoers should consider taking a little extra care washing their hands, particularly around the animal exhibits. The CDC’s webpage Take Action to Prevent the Spread of Flu Between People and Pigs at Fairs provides additional advice.

For more on swine variant influenza, you may wish to revisit:

Keeping Our Eyes On The Prize Pig
Waiting For The Next Flu To Drop
Fair Biosecurity & H3N2 In North Dakota Show Pigs

ECDC Rapid Risk Assessment On MERS-CoV – August 28th

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With the rise in MERS cases in Saudi Arabia over the past month, and now four MERS cases reported in Jordan – the concerns over whether this year’s Hajj will help spread the virus are understandably rising.

Today the ECDC released their 20th Rapid Risk Assessment on the virus, warning that sporadic importations of the virus into EU countries can be expected, along with the risks of further nosocomial transmission.

As this report indicates, we don’t have a complete picture of what is going on with MERS in Saudi Arabia, or any other countries in the Middle East. The number, and role of asymptomatic carriers is likewise unknown.

The full RRA can be downloaded as a PDF File, and is well worth doing for its detailed epidemiological analysis and graphics. Below you’ll find the press release/summary.

Updated Rapid Risk Assessment on MERS in light of Riyadh hospital outbreak

28 Aug 2015

A large nosocomial outbreak of MERS in Riyadh, Saudi Arabia has triggered an update of ECDC’s rapid risk assessment, in order to assess whether this event changes the risk of international spread or increases the risk to EU citizens living in or travelling to Saudi Arabia. The update also includes an assessment of the risk of infection and introduction into the EU associated with pilgrims visiting Saudi Arabia during the forthcoming Hajj.

Given the substantial number of people travelling between the Middle East, which continues to report the majority of MERS cases, and EU countries, imported, sporadic cases to Europe can be expected.

Over 110 new cases and 30 deaths have been reported globally so far for August 2015 alone, almost all of them from Saudi Arabia. When compared to previous years, the increase in reported MERS cases in August is unexpected and is mainly explained by a large, ongoing outbreak linked to one Riyadh hospital.

The extent to which other healthcare facilities in Riyadh are affected is unknown, as is the number of asymptomatic individuals who may be infected with MERS-CoV.

The role of hospitals as amplifiers of MERS-CoV infection is well known, so the strict and timely application of comprehensive infection prevention and control measures is imperative.

Sporadic, imported cases can be expected in EU/EEA Member States, and is associated with a risk of nosocomial spread. This highlights the need for awareness among healthcare workers, early detection through functioning testing algorithms, preparedness planning and stringent infection control precautions.

Media Reports Of Two Additional MERS Cases In Jordan (Updated)

(See update at bottom)

#10,460

Earlier this week we learned of two Jordanian MERS cases – reportedly a man in his 60s and a 38 y.o. male – both with recent travel out of the country. Yesterday the media reported the death of the 60-something patient.

Today, there are fresh media stories indicating two additional cases have been detected, although I have found no official statement to that effect.

The ages and conditions are different, and these media reports have incremented the number of Jordanian cases to 16, both of which strongly suggests these represent the 3rd and 4th case reported this week.

The relationship – if any – between any of these patients has not been mentioned. Unlike the first two cases, today’s report contains no indication of recent travel abroad by these cases.

As always, Caveat Lector. I’ll continue to look for more information, but here is one of the recent reports.

Registration of two cases of new Pfyrus "Corona" in Jordan

Announced here today for the registration of new HIV Koruna two goals in Jordan, bringing the total number of casualties since the first appearance of the disease in 2012 to 16 injured.
It quoted Jordan News Agency of communicable diseases at the Ministry of Health of Jordan, Dr. Mohammed Abdullat saying that scored the body of a citizens Jordanians of the first of them 78 years old and suffering from cancer and his health is nothing wrong and the second 47-year-old Mkhalt injury installed describing his health as good.
The Jordanian Ministry of Health has registered two goals new virus "Corona" on Monday and Tuesday after the last stop for more than a year for the registration of the disease casualties in Jordan

UPDATED 11:45 EDT 8/28

My thanks to Sharon Sanders of FluTrackers for this updated report from the Jordanian News Agency PETRA. It indicates that these two new cases were detected through epidemiological contact tracking of the original cases.

Health Balchorona recorded two goals, bringing the total number to 16 cases
Oman August 28 (PETRA)-the total number of HIV infections in koruna Jordan since the first case of the disease in 2012 to 16 injured after registering new infections on Thursday, according to the Director of communicable diseases at the Health Ministry Dr Mohammad Al-abdallat.
Abdallat said in a statement issued by the Ministry's Information Center said on Friday: "the latest from citizens first reaches 78 years and is suffering from cancer and his condition is critical and 47-year-old is the second contacts for injuring the health status, describing proven good.
He added that the discovery of the injury came as a result of contact follow-up epidemiological survey Directorate teams dates of follow-up and monitoring of contacts were finally discovered.
The Health Ministry has recorded new HIV infections koruna on Monday and Tuesday after more than a year of record casualties in Jordan.
-(PETRA) a t/h a 28/8/2015-02:44 pm

Meanwhile the ECDC tweeted the following advice about a half hour ago, with a graphic showing the number of travelers expected to transit between Europe and Saudi Arabia over the next couple of months.

NEJM: Ebola in the United States — Public Reactions and Implications

# 10,559

Eleven months ago America woke up to learn that the first imported Ebola case had been hospitalized and isolated - after first seeking treatment in a local emergency room three days earlier – in a Dallas hospital. Ten days later, the first of two nurses to contract the virus – Nina Pham – tested positive.

The first few weeks of October were chaotic, with the 24/7 news cycle pounding the Ebola story for ratings, politicians using the crisis to grab headlines and votes, and internet conspiracy sites speculating in the most lurid way that we would all soon be infected.

Understandably, the American public’s concern (and distrust) grew with each passing day. Fighting for their attention was a three-ring circus of media hype, disinformation, and paranoia – one we looked at in A Look Down The Ebola Rabbit Hole and All The Ebola News Not Fit To Print.

Complicating matters, around the same time that the CDC was releasing `worst-case’ estimates of 550,000 and 1.4 million Ebola cases in Liberia and Sierra Leone by the end of January cases in Africa, they were also trying to minimize the American public’s fear of the virus.

Except from CDC Infographic

As an example, in August of 2014 the CDC released a reassuring infographic (see above) that - among other things - stated that `You can’t get Ebola through Air’, which immediately set off an internet firestorm of disbelief and derision. While `technically correct’ (Ebola is not an airborne virus) - it overly simplified the threat - which I considered a communications misstep (see The Ebola Sound Bite & The Fury).

In response to the `airborne’ debate Dr. Ian Mackay produced a series of excellent blogs on how the Ebola virus can be transmitted (see VDU Blog: Droplets vs Airborne - Demystifying Ebola Transmission and Mackay On Ebola: Blood, Sweat & Tears).

But the vast majority of Americans were getting their information from ratings-hungry news organizations, or social media outlets, not from science based blogs. The public’s trust in official statements took yet another hit when, in late October, the CDC Announced Stricter PPE Recommendations For Ebola - after two Dallas nurses were infected.

Of course, Ebola did not spread in the United States, and after an early false start, hospitals did figure out how to safely treat patients. Just as the CDC predicted. Gradually, the public’s level of concern subsided.

But the experience showed how fragile public’s trust of the government can be, and how important it is to get the messaging `right’. As we’ve discussed so often in the past, overly simplistic or reassuring messaging can easily backfire (see Sandman & Lanard On Ebola Crisis Communications Lessons).

Looking back on all of this, and how things might be handled better the next time a public health crisis like Ebola arrives on our shores, is a perspective article that appeared yesterday in the New England Journal of Medicine. A good read, and after you return, I’ll have a bit more.

Perspective
Ebola in the United States — Public Reactions and Implications
Gillian K. SteelFisher, Ph.D., Robert J. Blendon, Sc.D., and Narayani Lasala-Blanco, Ph.D.
N Engl J Med 2015; 373:789-791August 27, 2015DOI: 10.1056/NEJMp150629
Although there had been only two cases of Ebola transmission inside the United States and both patients had survived, a November 2014 opinion poll revealed that the U.S. public ranked Ebola as the third-most-urgent health problem facing the country — just below cost and access and higher than any other disease, including cancer or heart disease, which together account for nearly half of all U.S. deaths each year (see Table S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org).
(Continue . . . )

The timing of Ebola’s arrival in the United States – 2 months before the mid-term elections – undoubtedly added to the public’s level of enmity, but the degree of distrust of science seems to grow worse with each passing year.

While many scientists decry this trend as a return to a backwards `flat earth’ mentality, it is sadly at least partially earned.

Back in early 2012, in Science at the Crossroads, I wrote about this decline the public’s trust in science. While I cited a number of reasons for this disturbing trend, prime among them has been the abrupt rise in the number of scientific papers that have been retracted – sometimes for outright fraud - over the past decade.

In a presentation made in March 2012 (see Dysfunctional Science) before a committee of the National Academy of Sciences, journal editors Arturo Casadevall and Ferric C. Fang warned that the number of retraction notices for scientific journals has increased more than 10-fold over the last decade, while the number of journals articles published has only increased by 44%.

Add in the parade of FDA approved drugs that we’ve seen withdrawn for safety reasons after years of use, allegations of biased industry funded clinical trials (see RCTs: All That’s Gold Standard Doesn’t Glitter), and a string of high profile government lab `incidents’ involving Ebola, H5N1, anthrax and smallpox and it’s little wonder that a white lab coat doesn’t engender as much confidence as it once did.

These recent lab accidents have led to calls from major journals to improve biosafety, and to even consider blocking certain types of potentially dangerous experiments unless a substantial benefit can be shown that offsets the risks. (see The Laboratory Bio-Safety Backlash Continues and Thebulletin.org: Making Viruses Deadlier – An Accident Waiting To Happen.).

While scientists engaged in this type of work insist that the risks are negligible (see Scientists For Science: GOF Research `Essential’ & Can be Done `Safely’), many others (see Updating The Cambridge Working Group) are less convinced.

Meanwhile a perplexed and increasingly worried public watches on, not knowing which side to believe.

As a child of the space age, raised on the science writings of Willy Ley and Isaac Asimov, I am about as `pro-science’ as they come, and will continue to promote it in this blog. But I also realize that science has some serious work to do if hopes to regain its previous high standing with the public.

And for everyone’s sake, that’s a change that needs to come sooner rather than later.

Saudi MOH Reports 2 New MERS Cases In Riyadh

#10,558

The Saudi MOH reports the lowest number of new cases in more than 10 days, with only 2 new MERS infections reported in Riyadh today. While a good sign, we’ll have to wait a few days to see if this is a trend.

Of the two, only one is listed as a having had contact with a known MERS case. Additionally, one death was reported.

Cara Membuat Sup Jagung Cream Kental Resep Sederhana

Resep Sup Jagung Kental campur jamur yang menggugah selera. Sup dari bahan jagung manis bisa menjadi hidangan hangat favorit baik sebagai menu sarapan di pagi hari, malam hari, cuaca dingin ataupun santapan yang menyegarkan disaat-saat santai berkumpulnya keluarga di rumah.

Soup cream jagung atau sup jagung dengan kuah kental yang gurih merupakan bagian dari variasi cara membuatnya selain kombinasi bahan-bahan yang dipakai untuk menambah selera dan cita rasanya sehingga menjadi lebih spesial. Seperti halnya pada berbagai macam menu masakan, juga terdapat banyak variasi yang bisa kita kreasikan dalam menu makanan sehat ini.

Ayam, beberapa jenis sayuran bahkan telur biasa menjadi bahan campuran pelengkapnya, sebelumnya bisa dilihat pada Resep Sup Jagung Manis Ayam Telur. Selain telur, kita juga bisa menggunakan susu yang telah diterapkan dalam cara membuat sup jagung cream kental yang enak dan sederhana kali ini.

RESEP SUP JAGUNG KENTAL
Sedangkan pilihan jenis sayurnya adalah jamur kancing segar (champignon) sehingga rasanya semakin lezat dan lebih bercita rasa. Langkah-langkah pembuatannya juga cukup praktis sehingga sup jagung kental ini dapat dengan mudah untuk kita realisasikan sendiri di rumah.

Bahan dan bumbu :

350 gram jagung manis diserut atau pipil
100 gram jamur kancing dibelah dua
100 gram daging ayam direbus lalu potong dadu
3 sendok makan tepung maizena dilarutkan dengan sedikit air
750 ml air
250 ml susu cair/ susu bubuk full cream diseduh dengan air
1 sendok teh garam
1/2 sendok teh merica
1 buah bawang bombay dicincang kasar
4 siung bawang putih dicincang halus
1/2 sendok teh pala bubuk
minyak secukupnya untuk menumis

CARA MEMBUAT SUP JAGUNG KENTAL

Panaskan sedikit minyak, setelah cukup panas kemudian tumis bawang putih, bawang bombay dan pala bubuk hingga harum. Masukkan jamur, potongan daging ayam rebus dan serutan jagung lalu aduk-aduk rata.
Tuang susu cair, masak sambil diaduk-aduk hingga mendidih serta jamur dan jagungnya matang kemudian masukkan larutan tepung maizena. Setelah mendidih kembali dan kuah menjadi kental, matikan api lalu angkat dan siap dituang dalam mangkuk atau piring saji untuk kita hidangkan selagi panas atau hangat.

UAC International

Who is eligible?

International student who have taken one of the following qualifications:

Year 12 in 2015.
An Australia Year 12 in or outside of Australia in 2015.
An International Baccalaureate Diploma in 2015 or May 2016.
A New Zealand National Certificate of Educational Achievement (NCEA) Level 3 in 2015 & not an Australia citizen, New Zealand citizen, or permanent resident of Australia.

All other international students apply directly to the institutions.

Participating Institutions

Institutions-specific information, including admissions requirements, special requirements, bridging courses, charges & fees, & student services & facilities can be found at the link given below.

Key Dates (Times indicated below are based on Sydney Time)

Applications

See "Offers" below - need to apply & change course to be considered in each offer round.

Applications opened	Wed 5 Aug 2015
Applications close	midnight Wed 29 Jun 2016
UAC International processing charge	A$71

Year 12 results & ATARs

NSW HSC results released by BOSTES	Wed 16 Dec 2015
ATARs released on this website	Thu 17 Dec 2015
ATAR Advice Notice received from UAC	from Fri 18 Dec 2015

Interstate Year 12 /IB/NZ NCEA results

Queensland results released by Queensland Curriculum and Assessment Authority	Fri 18 Dec 2015
SA and NT results released by SACE Board of South Australia	Thu 17 Dec 2015 (tbc)
Tasmanian results released by Tasmanian Qualifications Authority	Mon 21 Dec 2015
Victorian results released by Victorian Tertiary Admissions Centre	Mon 14 Dec 2015
WA results released by Tertiary Institutions Service Centre	Wed 30 Dec 2015
International Baccalaureate results released by IB Cardiff, UK	Wed 6 Jan 2016
NZ NCEA results released by New Zealand Qualifications Authority	from Tue 12 Jan 2016

Offer Dates

All offers released at 7.30am on UAC website. Change of courses must be made through Check &Change & be submitted by midnight on the relevant closing date.

Semester 1

Unconditional offers released on	Apply and pay by midnight on	Change your courses by midnight on
Thu 24 Sep 2015	Sat 19 Dec 2015	Sun 20 Sep 2015
Fri 18 Dec 2015	Sun 13 Dec 2015	Mon 14 Dec 2015
Wed 6 Jan 2016	Thu 31 Dec 2015	Fr 1 Jan 2016
Sat 9 Jan 2016	Mon 4 Jan 2016	Tue 5 Jan 2016
Thu 21 Jan 2016	Sun 17 Jan 2016	Mon 18 Jan 2016
Fri 5 Feb 2016	Sun 31 Jan 2016	Mon 1 Feb 2016

Semester 2

Unconditional offers released on	Apply and pay by midnight on	Change your courses by midnight on
Fri 11 Mar 2016	Sun 6 Mar 2016	Mon 7 Mar 2016
Fri 8 Apr 2016	Sun 3 Apr 2016	Mon 4 Apr 2016
Fri 6 May 2016	Sun 1 May 2016	Mon 2 May 2016
Fri 3 Jun 2016	Sun 29 May 2016	Mon 30 May 2016
Fri 17 Jun 2016	Sun 12 Jun 2016	Mon 13 Jun 2016
Thu 7 Jul 2016	Wed 29 Jun 2016	Wed 29 Jun 2016

International Apply

UAC's apply is available between 7.30am & midnight (Sydney time) 7 days a week.

Application cost = A$71. (for more information, check UAC Charges & Fees)

For an overview of the application process, watch How to Apply through UAC as an International Year 12 Student on youtube.

For any inquiry, please feel free to contact your nearest JM Office today!

Senin, 31 Agustus 2015

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What is a variant influenza virus?

Why are human infections with variant viruses of concern?

Jumat, 28 Agustus 2015

UAC International

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Participating Institutions

Key Dates (Times indicated below are based on Sydney Time)

International Apply

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