Jordan: 3rd MERS Fatality Of 2015

 

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The last we heard, the current Jordanian MERS cluster stood at 6 cases, and 2 deaths (see WHO Update On Jordanian MERS Cluster).  Today, the Jordanian News Agency PETRA, and other media outlets, are reporting a third fatality and state the count now stands at seven.

The Jordanian Ministry of Health website provides no details on any of these cases, and so we are forced to rely primarily on fairly thin media reporting.

 

This third fatality is listed as 77 years of age, and suffering from lung cancer.   It is likely this is the third case we first learned about a week ago who was described as `78 years old and suffering from cancer’.   Both the WHO and ECDC updates listed him as being 76 years of age, with `chronic health problems.   

 

Neither account exactly matches today’s report, but are `close’.    

 

Alternatively, it is possible this 3rd fatality is the 7th case of this cluster.   Given the parsimonious nature of the press releases, matching up details on these cases is an `iffy’ proposition.

 

Hopefully the next update from the WHO will fill in some of  the missing details.

 

Jordan recorded a third death Balchorona

Amman, September 5 (Petra) - The Ministry of Health reported Saturday's third death virus Koruna to Jordanian citizen at the age of 77 years he was suffering diagnosed with the disease previously. He Communicable Diseases director Dr Mohamed Abdullat that the deceased was admitted to a private hospital in the capital, and had been suffering from lung cancer.

He added that the ministry has registered 7 HIV infections since the first case of this year died, including 3 cases. - (Petra) OM / Abuallbh 05/09/2015 - 22:19

 

The Jordanian count of cases differs from that kept by other agencies, as they are not counting 7 cases retrospectively identified through serological testing from the first hospital outbreak in April of 2012 (see Serological Testing Of 2012 Jordanian MERS Outbreak).

 

Hence, the ECDC and others show Jordan (as of the 2nd of September) as having 25 cases, and 8 deaths . . . while the Jordanians claimed only 18 cases.

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Saudi MOH Reports 4 More MERS Cases In Riyadh

 

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The Saudi summer MERS surge rolls on with new cases reported for the 34th day running, bringing the number of cases reported by the MOH since August 3rd to 152.  The exact number of cases in Saudi Arabia is somewhat murky due to their decision exclude some asymptomatic cases from their `official’ count.

 

While the vast majority of these cases have emanated from in and around Riyadh – and most are associated with hospital outbreaks – we’ve seen sporadic cases reported in a number of other locations around the country the past few weeks.

 

One of today’s cases is a healthcare worker, with exposure to a confirmed or suspected MERS case.   For two of the other three, their exposure risk history is under review.  Despite three years of dealing with MERS, Saudi hospitals are still struggling to contain the spread of the virus.

 

One death of a previously announced case was also reported. 

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Ebola Reston Discovered In Philippine Lab Monkeys

Ebola Virus - Credit CDC

 

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Although it doesn’t appear to present any kind of serious human health risk, a big story this morning is the announcement of the discovery of Ebola Reston among laboratory monkeys being kept at an unnamed research laboratory in the Philippines.   

 

Ebola Reston is one of five known Ebola virus species, and the only one found to be endemic outside of Africa.

 

Unlike its African cousins, Ebola Reston – while capable of infecting humans – is not known to produce illness or death in man.  It can, however, produce serious illness in non-human primates, and can infect  pigs (generally asymptomatically).

 

Ebola Reston was first discovered in crab-eating macaques, imported from the Philippines, at a research laboratory in Reston, Virginia (USA) (hence the name) in 1989. This discovery was recounted somewhat sensationally in the book, The Hot Zone, by Richard Preston.

 

First, what we know about this latest discovery (which isn’t much), then I’ll return with some more background on this fascinating virus.

 

 PH monkeys infected with Ebola not lethal to humans

Saturday, September 05, 2015

MANILA — Several monkeys at a research and breeding facility in the Philippines have been infected with an Ebola virus strain that is non-lethal to humans, health officials said Saturday.

The facility's 25 workers have been tested for possible infection but all have been found negative for the Ebola Reston variety, said Health Secretary Janette Garin.

She said the virus was detected last week after the monkeys were observed to be suffering from measles, which could have lowered their resistance to Ebola.

(Continue . . . )

 

Excerpts from Today’s MOH Press Conference – Credit Rappler.

 

As mentioned above, details are scant.  The MOH did not disclose the name or location of the lab, how long these laboratory animals had been in captivity, how they might have been exposed to the virus, or whether or not animals had been recently shipped to or from this laboratory.

 

The risks to human health are believed low with Ebola Reston, although there is relatively limited experience dealing with this virus. 

 

In the October 2014 CDC Review of Human-to-Human Transmission of Ebola Virus described the 1989 Reston laboratory outbreak and subsequent infection of personnel.

 

Similarly, an outbreak of Reston virus (Reston ebolavirus species, which does not cause EVD in humans) infection occurred in a quarantine facility housing non-human primates in separate cages and the transmission route could not be confirmed for all infected primates. Multiple animal handlers developed antibody responses to Reston virus suggesting asymptomatic infection was occurring in humans with direct animal contact and implicating animal handling practices in transmission between primates

 

The World Health Organization hedges its bets slightly with Ebola Reston by stating:

 

Among workers in contact with monkeys or pigs infected with Reston ebolavirus, several infections have been documented in people who were clinically asymptomatic. Thus, RESTV appears less capable of causing disease in humans than other Ebola species.

However, the only available evidence available comes from healthy adult males. It would be premature to extrapolate the health effects of the virus to all population groups, such as immuno-compromised persons, persons with underlying medical conditions, pregnant women and children. More studies of RESTV are needed before definitive conclusions can be drawn about the pathogenicity and virulence of this virus in humans.

 

While Ebolaviruses are known to infect a wide variety of mammals (humans, primates, pigs, etc.) they are believed to originate from a bat host.   Earlier this summer Dr. Ian Mackay looked at the latest research into this connection in Evidence that Reston ebolavirus resides in live bats in the Philippines...

In late 2008 Ebola Reston made another high profile appearance when it was reported for the first time in pigs, again from the Philippines.  This from the FAO.

 

First detection of Ebola-Reston virus in pigs

23-12-2008

FAO/OIE/WHO offer assistance to the Philippines

Manila/Roma, 23 December 2008 - Following the detection of the Ebola-Reston virus in pigs in the Philippines, FAO, the World Organization for Animal Health (OIE) and the World Health Organization (WHO) announced today that the government of the Philippines has requested the three agencies send an expert mission to work with human and animal health experts in the Philippines to further investigate the situation.

An increase in pig mortality on swine farms in the provinces of Nueva Ecija and Bulacan in 2007 and 2008 prompted the Government of the Philippines to initiate laboratory investigations. Samples taken from ill pigs in May, June and September 2008 were sent to international reference laboratories which confirmed in late October that the pigs were infected with a highly virulent strain of Porcine reproductive and respiratory syndrome (PRRS) as well as the Ebola-Reston virus.

(Continue . . .)

 

Roughly a month later, we learned that several farm workers in contact with infected pigs tested positive for antibodies to the Ebola-Reston virus.  None displayed any signs of illness.

 

Ebola Reston in pigs and humans in the Philippines

3 February 2009 - On 23 January 2009, the Government of the Philippines announced that a person thought to have come in contact with sick pigs had tested positive for Ebola Reston Virus (ERV) antibodies (IgG). On 30 January 2009 the Government announced that a further four individuals had been found positive for ERV antibodies: two farm workers in Bulacan and one farm worker in Pangasinan - the two farms currently under quarantine in northern Luzon because of ERV infection was found in pigs - and one butcher from a slaughterhouse in Pangasinan. The person announced on 23 January to have tested positive for ERV antibodies is reported to be a backyard pig farmer from Valenzuela City - a neighbourhood within Metro Manila.

(Continue . . .)

 

In 2011 researchers showed that pigs were also highly susceptible to Ebola-Zaire, which can be up to 90% fatal in humans (see  Replication, Pathogenicity, Shedding, and Transmission of Zaire ebolavirus in Pigs).  Exactly how pigs fit into the ecology of Ebola – either in Africa or the Philippines – is uncertain.

Hopefully we’ll get more information on this latest lab outbreak in the days and weeks ahead, and that it leads to a better understanding of the risks (or lack, thereof) of infection from this virus.

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Bangor University - United Kingdom

Bangor University Merit Scholarships

Undergraduate Merit Scholarships

Amount	Eligibility	How to apply
£6,000	All international students will receive £2,000/year for all three years of study	All applicants will be automatically considered for these scholarships. NOadditional scholarship application needed
£15,000	All outstanding international students (e.g. 1st class division holders) will receive £5,000/year scholarship for all three years of study

Postgraduate Taught Merit Scholarships

Amount	Eligibility	How to apply
£2,500	All international students will be automatically considered for these scholarships; £2,500 - Bangor Campus £2,000 - London centre	All applicants will be automatically considered for these scholarships. NOadditional scholarship application needed
£5,000*	All outstanding international students (e.g. 1st class honours degree holders) will be automatically considered for a £5,000 scholarship
Full tuition fee waiver*	Candidates must have already received an Offer Letter from Bangor University with minimum £5,000 scholarship already awarded.	Candidates who meet the eligibility criteria will be sent an application pack by email. (Deadline: 31st March)

*Please note that these scholarships does not apply to London Centre programmes.

Research/PhD Merit Scholarships

Amount	Eligibility	How to apply
£7,500	All international students will receive £2,500/year for all three years of study	All applicants will be automatically considered for these scholarships. NOadditional scholarship application needed
£15,000	All outstanding international students (e.g. 1st class division holders) will receive £5,000/year scholarship for all three years of study

• The above scholarships are available for both September and January intake courses.
• Applicants will be considered for ONLY ONE of the above scholarships.
• Candidates who are fully sponsored by a third party will not be entitled to these Scholarships
• The above scholarships are offered in the form of a reduction in tuition fee only.

For more information, please contact/visit your nearest JM Office today

                  

                                                                                                                                   Article is courtesy of  Bangor University

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CDC: Making a Candidate Vaccine Virus For HPAI Avian Flu

 

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When the H1N1 swine flu appeared in the spring of 2009, a candidate vaccine virus (CVV) was quickly produced, and within 6 months the first human vaccines began to ship.  It was a remarkable feat – one where success was far from guaranteed – but one made easier as the 2009 H1N1 virus was essentially a `strain change’  from the seasonal vaccine.

 

Producing a vaccine against an avian flu virus is a far more complex process, both legally and logistically.

 

Experimental H5 and H7 avian flu vaccines have proved poorly immunogenic in the past – requiring unusually large amounts of antigen (up to 12x normal), spread across two shots several weeks apart - to induce a good immune response. They also often fail to grow well in eggs, further complicating the manufacturing process.

 

Two years ago the NIH announced the start of a year-long Phase II Clinical Trials On H7N9 Vaccine Candidates, and as we saw with earlier H5N1 vaccines,  it was announced this summer that an unadjuvanted vaccine produced extremely poor results (see JAMA: Immune Response Of H7N9 Vaccine With & Without Adjuvant).

 

With a growing roster of HPAI H5 viruses (H5N1, H5N8, H5N2, H5N6) spreading globally - and continuing to mix and potentially reassort with other avian viruses - there is understandable concern that one of these viruses could someday pose a pandemic threat.  

 

Last March the World Health Organization’s  Weekly Epidemiological Record (WER) published a new review of currently circulating zoonotic influenza viruses, and their recommendations included the development of two new vaccine virus candidates.

 

Both candidates were H5’s; one based on the recent changes observed in Egypt’s H5N1 virus, and the other based on the recent introduction of H5N8 into North America.

 

Without discussing the status of any current vaccine projects in the works, today the CDC has published an extremely informative primer on the steps it takes to produce an Candidate Vaccine Virus for an HPAI avian flu. I’ve only excepted the opening, so follow the link below to read it in its entirety, after which I’ll be back with a postscript.

 

 

Making a Candidate Vaccine Virus (CVV) for a HPAI (Bird Flu) Virus

 

On this Page

• Production of the candidate vaccine virus (CVV)
• Quality Assessment
• Determination of Attenuation
• Request for CVV Exclusion from the USDA Select Agents List
• Distribution to Vaccine Manufacturers and Other Stakeholders

A candidate vaccine virus (CVV) is an influenza (flu) virus that has been prepared by CDC or another public health partner that can be used by vaccine manufacturers to produce a flu vaccine. In addition to preparing CVVs for seasonal flu vaccine production, CDC routinely develops CVVs for novel avian influenza (bird flu) viruses with pandemic potential as part of pandemic preparedness activities. Some novel bird flu viruses with pandemic potential are "highly pathogenic avian influenza" (HPAI) viruses, which means they are deadly to domestic poultry, including chickens. Data collected through global and animal flu surveillance informs the selection of CVVs, and experts choose CVVs against bird flu viruses in nature ("wild type" viruses) that pose a risk to human health.

The creation of a CVV for a novel bird flu virus is a multistep process that takes on average around two months from start to finish. Creating a bird flu CVV is usually more complicated than the process for creating a seasonal flu CVV. There are five steps involved in the creation of a bird flu CVV, including the following:

1. Production of the candidate vaccine virus (CVV) ;
2. Quality assurance;
3. Determination of attenuation;
4. Request for USDA Select Agent exclusion; and
5. Distribution of the CVV to vaccine manufacturers and other stakeholders.

These steps are described below.

(Continue . . . )

 

 

Having a proven Candidate Vaccine Virus already tested and approved can save months of valuable time if mass production and distribution of a vaccine is ever required. But even with all of that work already done, one shouldn’t expect to be rolling up their sleeve anytime in the opening months of novel flu pandemic.

Add in the probable need for two shots (4 weeks apart), and the logistics of production and delivery are effectively doubled.

 

While having a viable vaccine is an important part of the pandemic preparedness toolkit, in the opening months of any global outbreak we’ll be depending on primarily on Nonpharmaceutical Interventions (NPIs) like social distancing, school closures, hand hygiene & masks along with neuraminidase (NA) inhibiting antiviral drugs (NAIs) like oseltamivir (Tamiflu ®) and Zanamivir (Relenza ®) to help mitigate its impact.

 

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CDC FluView: Novel H3N2v Case In Michigan

 

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For the second week in a row the CDC is reporting on a novel swine variant flu infection (see last week’s CDC FluView: 1 Novel H1N1v Case Reported From Iowa), this time involving an H3N2v (variant) virus in a patient from Michigan.  The details, scant though they may be, are provided in today’s FluView report.

 

Novel Influenza A Viruses:

One human infection with a novel influenza A virus was reported by the state of Michigan. The person was infected with an influenza A (H3N2) variant (H3N2v) virus and was hospitalized in June 2015 as a result of their illness, but has fully recovered. 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 rarely reported – partly due to limited surveillance and testing – swine variant influenza infections are probably more common than we know.  Illness due to these strains is usually mild to moderate, and the symptoms look like any other flu.

 

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.

 

This year we’ve received word of 5 cases (3 - H1N1v & 2 - H3N2v), with three of those reported in the past six weeks.  Not an alarming number, but worth noting, as we are heading into the heart of the State and Local agricultural fair season. 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.

The CDC explains their concerns over these types of infections in their FAQ.

 

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.

 

While we’ve not seen sustained or efficient spread of these swine variant viruses in humans - like all flu viruses - swine variant viruses are capable of evolving, reassorting, and adapting to their hosts.  Just last week we looked at a study that examine two recently discovered swine variant strains (see J. Virol: Novel Reassortant Human-like H3N2 & H3N1 Influenza A Viruses In Pigs).

 

They described 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”.

 

Although avian flu gets most of the headlines – mostly due to their high fatality rate – swine flu viruses are considered more likely to jump to humans, simply because they fall in the same H1, H2, and H3 subtypes as `humanized’ flu strains of the past 130 years.   

 

The 2009 H1N1 pandemic virus evolved in pigs, and so easily could the next pandemic virus.

 

For some more recent blogs on swine and swine variant influenza, you may wish to revisit:

 

Eurosurveillance: Seroprevalence Of Cross-Reactive Antibodies To Swine H3N2v – Germany

JID: Evolutionary Dynamics Of Influenza A Viruses In US Exhibition Swine

Live Markets & Novel Flu Risks In The United States

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Saudi MOH: 6 New MERS Cases (3 in Riyadh, 2 in Namas, 1 in Kharj)

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The Saudi summer surge in MERS cases continues today, with reports of two cases from a new location (Namas), along with additional reports from both Riyadh and Al Kharj. Al-Namas is located in Asir Province, roughly 400 km from both Najran and Mecca, and 900 km from Riyadh.

 

A bit curious, as both cases in Namas are listed as contacts of a confirmed or suspected case, yet these are the first cases from this area we’ve seen reported.  Hopefully we’ll get an indication of the source of their exposure in an upcoming WHO update.

From Riyadh, one case is listed as a Healthcare worker with contact with a confirmed MERS patient. Of the other two, one is listed as not having any known contact, while the other is under review.

 

During the month of August MERS cases were primarily centered around Riyadh, but in recent days we’ve seen a growing number reported outside of the capital city. 

Yesterday’s WHO Statement On The 10th Meeting Of the IHR Emergency Committee On MERS took note of the approaching Hajj, stating:

 

Moreover, the current outbreak is occurring close to the start of the Hajj and many pilgrims will return to countries with weak surveillance and health systems. The recent outbreak in the Republic of Korea demonstrated that when the MERS virus appears in a new setting, there is great potential for widespread transmission and severe disruption to the health system and to society.

 

For those intending to make this year’s pilgrimage, the CDC has some important health advice (see  CDC Traveler’s Advice: Umrah, The Hajj and MERS).

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