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

 

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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.

 

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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 

 

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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

 

 

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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

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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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