MPR: Poultry AI Vaccines Are Not A `Cure-all’

 

# 10,406

 

Overnight MPR (Minnesota Public Radio) published a story on the desire of many turkey producers to vaccinate their flocks against the HPAI H5 avian flu this fall (something which has yet to be approved by the USDA), while at the same time examining a number of `downsides’ to introducing avian flu vaccines to North American flocks.

 

The report is a good read, features comments by CIDRAP Director Dr. Michael Osterholm and University of Minnesota avian flu researcher Dr. Carol Cardona (among others) - and unlike most media stories this summer - explores more than just the negative impact that vaccine use would have on poultry exports.

 

While the most immediate concern expressed by government officials has been the refusal of some countries to import vaccinated poultry products – which could cost the poultry industry billions of dollars in lost revenue – there are other serious concerns regarding AI vaccine use.

 

• First, China, Egypt, and Indonesia – the three biggest consumers of HPAI poultry vaccines (cite Impact of vaccines and vaccination on global control of avian influenza by David Swayne) – are just as firmly entrenched with bird flu today as they were a decade ago when the decision was made to use them.
• Worse, the diversity of HPAI flu viruses has grown markedly while using AI vaccines, a phenomenon we explored last month in PLoS Bio: Imperfect Poultry Vaccines, Unintended Results and last April in New Scientist: The Downsides To Using HPAI Poultry Vaccines.
• In last November’s EID Journal: Subclinical HPAI In Vaccinated Poultry – China researchers found evidence to suggest that `imperfect’  vaccines were driving the evolution of new clades, and and the creation of subtypes, while last February, in Recombinant H5N2 Avian Influenza Virus Strains In Vaccinated Chickens – its authors reaffirmed that `AIVs can continue genetic evolution under vaccination pressure’.

 

Simply put, while vaccines can often protect poultry against illness - with increasingly diverse and rapidly evolving avian flu viruses - they cannot always prevent infection.  The end result being that subclinical infections can go undetected, viruses continue to circulate, and new variants or reassortants continue to emerge. 

 

Historically, the USDA has remained focused on prevention and containment when it comes to HPAI viruses in this country, and it is obvious they would rather not to have to go down the avian flu vaccine path if they can avoid it.

 

They will, however, come under tremendous industry pressure to authorize their use if avian flu returns with a vengeance this fall or winter.  While there are probably situations where the geographically limited, temporary use of a poultry vaccine might be advisable - the track record of large scale reliance on AI poultry vaccines hasn’t been enviable.

 

Follow the link below to read the whole MPR article.  Highly recommended.

 

 

MN turkey growers want bird flu vaccine, but it's no cure-all

Business Lorna Benson · Aug 11, 2015

Minnesota Board of Animal Health staff tested chickens in a backyard flock for avian influenza in April 2015. While initial tests in chickens are encouraging, the bird flu vaccine has plenty of downside. Courtesy Minnesota Board of Animal Health

Minnesota turkey farmers are clamoring to vaccinate their flocks this fall against avian influenza. But while initial tests in chickens are encouraging, experts say the vaccine has plenty of downside.

Minnesota has lost more than 9 million turkeys and chickens to avian flu and the requirement to kill surviving birds to stop the disease from spreading. By the time the virus retreated in early June, the flocks of 108 Minnesota poultry farms had been wiped out. So there's not much debate among the state's turkey farmers about whether a vaccine should be used if the deadly virus returns.

"In Minnesota we're pretty much unanimous that this is something we would use, if we have it," said Steve Olson, executive director of the Minnesota Turkey Growers Association.

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Saudi MOH: Four More MERS Cases In Riyadh

 

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Riyadh’s MERS outbreak shows no signs of slowing, with four more (critical) cases announced today by the Ministry of Health. Over the past 9 days 25 cases have been reported out of Saudi Arabia, with 24 of those from the capital city.

 

We’ve seen a few cases attributed to possible camel exposure, but most have involved human-to-human transmission – mostly in family clusters, or in healthcare environments. In some cases the source of infection has not been identified, an epidemiological challenge we’ve discussed often in the past (see WHO EMRO: Scientific Meeting Reviews MERS Progress & Knowledge Gaps).

 

All of today’s cases are listed as contacts of previously announced cases, but details are not provided. 

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mBio Letter: Statins Suggested As Possible Treatment For MERS

Photo Credit WHO

 

# 10,404

 

Over the past decade we’ve seen statins proposed as a potential treatments for an often deadly side effect seen in severe flu called a `cytokine storm’, and while the jury is still out on their effectiveness (we’ve seen very few studies, and mixed results), there is a certain elegance to the theory behind their use.

 

Cytokines are a category of signaling molecules that are used extensively in cellular communication. They are released by immune cells that have encountered a pathogen, and are designed to alert and activate other immune cells to join in the fight against the invading pathogen.

 

This cascade of immune cells rushing to the infection can - if it races out of control - literally kill the patient. Their lungs can fill with fluid (which makes a terrific medium for a bacterial co-infection), and cells in the lungs (Type 1 & Type II Pneumocytes) can sustain severe damage.

 

Statins have an anti-inflammatory effect, and theoretically should help dampen down this runaway cytokine storm, and are one of several immunomodulatory treatment strategies under review.

 

Dr. David Fedson – former Professor of Medicine at the University of Virginia School of Medicine and formerly Director of Medical Affairs, Aventis Pasteur MSD - has long championed the idea that we should be looking at relatively cheap, easy to produce statins for pandemic flu, which he believes may help modulate the immune response (see Dr. David Fedson: The Case For Using Statins In A Pandemic).

The problem is, while some studies on statins and pneumonia have yielded promising results, not all of the research is in agreement. Complicating matters, since many statins are now generic, there is little financial incentive for drug companies to fund expensive research.  A few earlier blogs on the subject include:

 

Study: Statins, Influenza, & Mortality

Another Study On Statins And Pneumonia

Statins Revisited

 

Unlike with novel influenza – which can sometimes be successfully treated with antivirals like oseltamivir (Tamiflu ®) -  there is currently no established treatment (beyond supportive care) for MERS cases.  Convalescent serum is under review, but even if that proves successful, it would not be widely available during a major outbreak.  

 

With a mortality rate (among those sick enough to be hospitalized) near 40%, and the possibility of seeing larger outbreaks in the future, there is a genuine need for some kind of pharmaceutical treatment option. Even if it only reduced mortality rates.

 

Today the journal mBio carries a letter recommending statins be looked at as a possible treatment for MERS-CoV infection.  The author outlines his rationale (which you can read by following the link) in some depth, but I’ve only excerpted his opening and closing paragraphs. 

 

Statins May Decrease the Fatality Rate of Middle East Respiratory Syndrome Infection

Shu Yuan

LETTER

The recent paper by Totura and colleagues (1) revealed that Toll-like receptor 3 (TLR3) signaling contributes to a protective innate immune response to severe acute respiratory syndrome coronavirus (SARS-CoV) infection. Despite the importance of SARS-CoV and Middle East respiratory syndrome CoV (MERS-CoV) as public health threats, there are currently no drugs available to treat these coronaviruses, with current evidence suggesting that the antiviral drugs ribavirin and interferon (IFN) are only slightly efficacious in ameliorating SARS-CoV or MERS-CoV infections (2). Now human-to-human infections of MERS-CoV are more frequently reported, with a total case fatality rate of 37.7% (2). Therefore, a feasible but effective treatment is needed urgently, especially treatment with FDA-approved drugs, including some over-the-counter (OTC) drugs.

(SNIP)

Among TLR-MYD88 antagonists, statins are the most common FDA-approved drugs (atorvastatin will be sold as an OTC drug). Statins do not affect the MYD88 level significantly under normal conditions but maintain (stabilized) MYD88 at the normal level during hypoxia or after hydrogen peroxide treatments (8, 9). Furthermore, atorvastatin at 10 µM significantly attenuated NF-κB activation within 24 h, whereas at lower doses of 0.1 and 1 µM, the treatment time had to be prolonged for up to 48 h for a significant inhibition to occur (10). Thus, an early and high dose of a statin (such as a single dose of 40 mg atorvastatin per day, equaling a 0.1 µM plasma concentration) might be an idea for treatment of MERS-CoV infections. Given that 3- to 10-times-higher levels of inflammatory cytokines and chemokines were observed after MERS-CoV infection than after no infection (3), statins may not be very effective for late-stage patients. Timely administration of statins may be crucial to surviving MERS-CoV infection.

 

Once again, the theory behind its use seems reasonable, but we’ll have to wait for real-world results before we know whether statins are really an effective treatment option for MERS.

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USGS: Nearly Half Of U.S. Population Exposed to Potentially Damaging Earthquakes

2014 Update of the United States National Seismic Hazard Maps

 

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In 2006 the USGS calculated that earthquakes posed a significant risk to 75 million Americans living in 39 States.  Since then, populations have changed and/or shifted and ongoing research has uncovered new seismic risks (see USGS: Updated U.S. Seismic Risk Hazard Maps), and geologists have a better understanding of the extent of ground shaking from these quakes.

A new study, published today in the journal Earthquake Spectra, nearly doubles – to 143 million - the number of Americans who live or work in areas susceptible to potentially damaging ground shaking.

First a link and excerpts from a USGS science brief on the paper, after which I’ll be back with a little more.  Follow the link below for additional details, along with  more maps and charts.

 

Nearly Half of Americans Exposed to Potentially Damaging Earthquakes

Categories: Featured, Natural Hazards
Posted on August 10, 2015 at 9:30 am
Last update 11:44 am By: Kishor Jaiswal, 303-273-8584, kjaiswal@usgs.gov and Jessica Robertson, 703-648-6624, jrobertson@usgs.gov

More than 143 million Americans living in the 48 contiguous states are exposed to potentially damaging ground shaking from earthquakes. When the people living in the earthquake-prone areas of Alaska, Hawaii and U.S. territories are added, this number rises to nearly half of all Americans.

Scientists with the USGS published this research online today in the journal Earthquake Spectra.

“The new exposure estimate is nearly double the previous 2006 estimate of 75 million Americans in 39 states, and is attributed to both population growth and advances in science,” said William Leith, who is the USGS senior science advisor for earthquake and geologic hazards and a co-author of this study. “Populations have grown significantly in areas prone to earthquakes, and USGS scientists have improved data and methodologies that allow for more accurate estimates of earthquake hazards and ground shaking.”

High Versus Some Potential for Damage

About 143 million people live and work in areas with some potential for damaging shaking, a level that could at least lead to damage in structures. Approximately 57 million people are in areas with a moderate chance of such shaking, and 28 million people in areas that have a high potential to experience damaging shaking.

The USGS shaking calculations consider the chance of an earthquake occurring in a 50-year time frame, as that is the typical lifetime of a building. This time frame is thought to be reasonable for life-safety considerations when designing buildings and other structures.

Which States Have the Strongest Shaking Potential?

When one considers very strong ground shaking levels, the 10 states with the highest populations exposed (in descending order) are California, Washington, Utah, Tennessee, Oregon, South Carolina, Nevada, Arkansas, Missouri and Illinois. Although this level of shaking is estimated to occur relatively infrequently, it could cause significant damage and causalities. The difference between those areas at risk from moderate versus strong shaking depends on a variety of factors, including the location of fault lines and the seismicity rates of the area.

Start with Science

These new estimates are derived from the recently updated U.S. National Seismic Hazard Maps, which identify where future earthquakes will occur, how often they will occur, and how strongly the ground will likely shake as a result. Researchers analyzed high-resolution population data and infrastructure data to determine populations exposed to specific levels of earthquake hazard. The population data are from LandScan, and the infrastructure data are from the Homeland Security Infrastructure Program (HSIP) database.

(Continue . . . )

 

Of particular note, since research is still ongoing, this study didn’t consider earthquakes due to human activity – such as `Fracking’ - nor does it take into consideration the amplification of ground shaking due to soil type, which could exacerbate the effects of some earthquakes.

 

Even though the half of all Americans live in a seismically active region of the country, few are really prepared to deal with the aftermath of a major quake.  As a bare minimum, everyone should have a well thought out disaster and family communications plan, along with a good first aid kit, a `bug-out bag’, and sufficient emergency supplies to last at least 72 hours.

 

In When 72 Hours Isn’t Enough, I highlighted  a colorful, easy-to-follow, 100 page `survival guide’ released by Los Angeles County, that covers everything from earthquake and tsunami preparedness, to getting ready for a pandemic.

The guide may be downloaded here (6.5 Mbyte PDF).

While designed specifically for the nearly 10 million residents of Los Angeles County, this guide would be a valuable asset for anyone interested in preparing for a variety of hazards. And in Los Angeles, the advice is to have emergency supplies (food, water, etc) to last up to 10 days. In my humble opinion, 2-weeks in an earthquake zone isn’t overkill.

Working to improve earthquake awareness, preparation, and safety is Shakeout.org, which promotes yearly earthquake drills and education around the country (see NPM13: A Whole Lotta Shakeouts Going On).  If you live in one of these seismically active areas, I would encourage you to take part in these yearly drills.

The start of National Preparedness Month is only three weeks away, so now is an opportune time to become better prepared as an individual, family, business owner, or community to deal with all types of disasters   I would invite you to visit the following preparedness sites.

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

 

 

And for some recent blogs on earthquake hazards in the United States, you may wish to revisit:

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

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

USGS: Eastern Earthquakes - Rare But Powerful

Estimating The Economic Impact Of A San Andreas Quake)

Revised Risk Of `The Big One’ Along San Andreas Fault

 

 

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EID Journal: Asymptomatic MERS Infections Possibly Linked to Infected Camels

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In mid-May of this year, in  WHO: Asymptomatic MERS-CoV Case – UAE, we learned of an asymptomatic camel transport truck driver who tested positive for the MERS virus, and was in hospital isolation.   Contact tracing was underway and within a couple of days a second asymptomatic case was announced by the Abu Dhabi Health Authority (HAAD) .

While most MERS known MERS infections are serious – and among hospitalized cases the fatality rate in Saudi Arabia runs roughly 44% – we know that some people experience few, if any symptoms.  

 

Since only contacts of known cases are routinely tested (and with a bias towards testing symptomatic cases), it is likely there are more asymptomatic cases out there than we know about.  It has even been suggested that they may be responsible for at least part of the `silent’ spread of the disease, although little is known about the ability for asymptomatic cases to infect others (see Study: Possible Transmission From Asymptomatic MERS-CoV Case).

 

Today the CDC’s EID Journal carries a Dispatch on these two asymptomatic cases.  While it doesn’t answer the question of human to human asymptomatic transmission of the virus, it does add to the growing weight of evidence supporting camel-to-human transmission. 

 

It also suggests that people exposed to infected camels can be asymptomatically infected, which highlights the need for more aggressive and proactive testing of high risk groups.

 

Dispatch

Asymptomatic MERS-CoV Infection in Humans Possibly Linked to Infected Camels Imported from Oman to United Arab Emirates, May 2015

Zulaikha M. Al Hammadi¹, Daniel K.W. Chu¹, Yassir M. Eltahir, Farida Al Hosani, Mariam Al Mulla, Wasim Tarnini, Aron J. Hall, Ranawaka A.P.M. Perera, Mohamed M. Abdelkhalek, J.S.M. Peiris, Salama S. Al Muhairi , and Leo L.M. Poon

Abstract

In May 2015 in United Arab Emirates, asymptomatic Middle East respiratory syndrome coronavirus infection was identified through active case finding in 2 men with exposure to infected camels. Epidemiologic and virologic findings suggested zoonotic transmission. Genetic sequences for viruses from the men and camels were similar to those for viruses recently detected in other countries.

Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV) was first detected in humans in 2012 (1). Before 2015, most human infections occurred on the Arabian Peninsula. However, the recent occurrence of MERS in South Korea indicates that this pathogen can cause major outbreaks in other regions (2). Dromedaries are believed to be a source of MERS-CoV (3,4), but only a few case reports provide virologic and epidemiologic evidence that directly supports zoonotic transmission of the virus from dromedaries to humans (5–7). We report the detection of epidemiologically linked MERS-CoV infection in 2 men who had direct contact with infected dromedaries (8,9).

The Study

A 29-year-old man (contact 1) transported 8 dromedaries from Oman to United Arab Emirates on May 7, 2015 (Table 1). The same day, as part of a national policy for controlling MERS, samples were collected from the dromedaries at a screening center located at the United Arab Emirates border. The samples were tested by reverse transcription PCR (RT-PCR) on May 10 and found to be positive for the MERS-CoV open reading frame (ORF) 1A and upstream of E genes (10). This finding led local public health authorities to conduct active surveillance on humans who had contact with the infected dromedaries.

A sputum sample collected from contact 1 on May 10, 2015, was tested by RT-PCR on May 12 and found to be positive for MERS-CoV; the man was admitted to a hospital the same day. Follow-up respiratory samples obtained on May 13 and 14 were still RT-PCR–positive, but a sample obtained on May 18 was negative. The patient was asymptomatic at hospital admission and throughout his hospital stay (Technical Appendix[PDF - 95 KB - 3 pages]).

Contact 2 was a 33-year-old man who worked at the screening center mentioned above. He had direct contact with the same group of infected dromedaries during the sampling procedures. A nasal aspirate sample was obtained from the man on May 14, 2015, and found to be RT-PCR positive for MERS-CoV. Contact 2 was hospitalized on May 18. A follow-up sample obtained on May 18 was RT-PCR negative for MERS-CoV. Contact 2 was asymptomatic throughout his hospitalization (Technical Appendix[PDF - 95 KB - 3 pages]).

Samples from 32 other persons were also tested by RT-PCR (Technical Appendix[PDF - 95 KB - 3 pages]). None tested positive.

(Continue . . .)

 

After detailing the research findings, and listing some of the limitations of their study, the authors conclude by writing:

 

MERS-CoV genomic sequences determined in this study are similar to those of viruses detected in 2015 in patients in Saudi Arabia and South Korea with hospital-acquired infections. The infected dromedaries in this study were imported from Oman, which suggests that viruses from this clade are widely circulating on the Arabian Peninsula. Sequence analyses of MERS-CoVs found in South Korea and China do not suggest that viruses from this clade are necessarily more transmissible variants (15). However, given that a single introduction of MERS-CoV from this clade caused >180 human infections in hospital settings (2) and that viruses of this clade are causing other human infections in Saudi Arabia, further phenotypic risk assessment of this particular MERS-CoV clade should be a priority.

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Saudi MOH: Riyadh MERS Cases Increase By 4

# 10,401

 

The number of MERS cases out of Riyadh continues to escalate with 20 cases reported over just the past 8 days.  While many of the recent cases have been attributed to either family or nosocomial transmission, three of today’s four cases do not list a known exposure.

The latest figures list 20 people currently infected in Saudi Arabia, with 3 in home isolation and 17 hospitalized.

We’ve seen `camel contact’  mentioned several times recently as a possible source of infection for a few of these cases, and the prevailing theory is that camels `reseed’ the virus into the community from time to time, sparking fresh outbreaks. 

Most cases, however, almost certainly come from human-to-human transmission; either among family members, or in healthcare settings.  Admittedly, the source of many human infections is never determined.

Despite repeated advice from the MOH (see KSA MOH Reiterate Camel Warnings On MERS) to:

• Avoid contact with camels, especially if they are sick, and their body fluids secretions.
• If you must be in contact with camels, wear a disposable mask over your mouth and nose, gloves, and a protective medical gown.
• Boil fresh camel milk, if not pasteurized.
• Cook camel meat (including liver) well before consumption.

For many Saudis, accepting that camels – a beloved national symbol that literally made settlement of that arid region possible – could carry a disease deadly to humans . . .  is nearly impossible.  Hence the MOH advice is frequently ignored.

 

Unless and until an effective MERS vaccine can be developed and widely deployed among camels, MERS is a problem that is unlikely to go away.

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