Jumat, 08 Januari 2016












#10,867


Although I've written on the recently announced MCR-1 colistin-resistance gene several times over the past couple of months (see The Lancet: Dissemination Of The MCR-1 Colistin Resistance Gene  Return of the Plasmids), the real `go to' person on all things antibiotic resistant is journalist, author, and blogger Maryn McKenna.


Maryn is not only the author of the award winning SUPERBUG: The Fatal Menace of MRSA, she has spent more time blogging on these issues than anyone I know. 

Late yesterday The Lancet published several new letters on recent MCR-1 findings around the globe, and Maryn has the analysis.  Follow the link to read:


A Blog by Maryn McKenna

Last-Ditch Resistance: More Countries, More Dire Results












 


#10,865



If you want to draw your reader's attention to an infectious disease story, including the `M' word - `Mutation' - in the headline is a surefire technique. For most people, the `M' word evokes a sense of dread - a belief that something `bad' has happened.

A concept, I suspect, that has been fostered by scores of grade-B Sci-Fi movies over the past 60 years that always seem to use `mutations' as the genesis of their `monsters'. 

The truth is, viruses are constantly mutating.  It's what they do.  It's part of the evolutionary process.  RNA viruses - like influenza and MERS - are particularly prone to `duplication errors' during replication, and are constantly introducing mutations.


Most are of little consequence, and do nothing to affect transmissibility, replication, host range, or virulence. Some prove detrimental, making the virus less `fit' than its predecessors, and they end up as evolutionary failures. 

Only rarely does a mutation enhance a virus in a way to make it deadlier, more transmissible, or a greater threat. 

That isn't to say it doesn't ever happen.   A few examples include:


But when a new mutation is observed, scientists rarely know immediately what effects it will have on a virus. Determining that can take months of observation and research.   Complicating matters, mutations don't happen in a vacuum.

Changes often occur in multiple regions of the virus simultaneously, and different combinations may yield different outcomes.


Last summer, during the height of Korea's MERS outbreak, initial reports stated that the Korean MERS Sequences Closely Match Middle Eastern Virus. `Closely' isn't the same as `exactly', of course, and figuring out what - if any - impact minor changes might have isn't easy.


Overnight the Korean and International press is filled with reports announcing a `mutation' in the Korean MERS strain, and that it may have contributed to the virus's rapid spread.


By Kim Se-jeong

The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) which swept Korea last year underwent a mutation not found in the strains of MERs samples collected in Saudi Arabia, according to the Korea Centers for Disease Control and Prevention (KCDC), Friday.


The mutation may have affected the virulence of the virus as it has shown different patterns of spreading and infection in Korea from those in Saudi Arabia, such as an unusually fast human-to-human transmission.

While investigators suspected a mutation at the time of the epidemic, health authorities denied it.

This is the first official confirmation of the mutation.
(Continue . . . )

Showing some restraint, this article only used the word `mutation' 7 times (counting the headline).   Sparking all this ballyhoo is a dispatch, appearing in the EID journal, which finds:


Volume 22, Number 1—January 2016


Dispatch


Variations in Spike Glycoprotein Gene of MERS-CoV, South Korea, 2015


Dae-Won Kim1, You-Jin Kim1, Sung Han Park, Mi-Ran Yun, Jeong-Sun Yang, Hae Ji Kang, Young Woo Han, Han Saem Lee, Heui Man Kim, Hak Kim, A-Reum Kim, Deok Rim Heo, Su Jin Kim, Jun Ho Jeon, Deokbum Park, Joo Ae Kim, Hyang-Min Cheong, Jeong-Gu Nam, Kisoon Kim, and Sung Soon KimComments to Author 

Author affiliations: Korea Centers for Disease Control and Prevention, Cheongju-si, South Korea
Suggested citation for this article

Abstract

An outbreak of nosocomial infections with Middle East respiratory syndrome coronavirus occurred in South Korea in May 2015. Spike glycoprotein genes of virus strains from South Korea were closely related to those of strains from Riyadh, Saudi Arabia. However, virus strains from South Korea showed strain-specific variations.

(SNIP)

Conclusions

Accurate genome sequencing can identify spatiotemporal patterns that help understand dynamics of rapid spread of MERS-CoV infection. We report S glycoprotein gene sequences of MERS-CoV from 8 patients and a strain cultured in Vero cells. Genetic information obtained is useful for understanding the evolutionary history of MERS-CoV.

On the basis of our phylogenetic analyses, virus sequences of strains isolated in South Korea in 2015 form a unique clade. Genetic variations elucidated in this study show an unreported sequence in the RBD, which suggests that MERS-CoV circulating in South Korea during the outbreak in 2015 has higher genetic variability and mutation rates. However, we cannot conclude that deleterious effects promoting spread of infection will occur because of these mutations. Additional genetic information will resolve precise characteristics of the MERS-CoV obtained during the outbreak in South Korea.
(Continue . . .)

In other words, researchers found enough genetic variance among the small subset of the Korean viruses they sequenced to place them into a new clade. Two mutations were in the receptor binding domain of the virus's spike protein.

Interesting, but their significance is far from clear. 

To determine that may take months, or even years. By the time we know what they mean, additional changes to the virus may have rendered the point moot. Or not.  We'll see.

But at least for now, the ability to invoke the  `M' word in headlines will probably sell a lot of newspapers. 

Dr. Ian Mackay on his VDU blog this morning goes into more detail on Korean MERS research, and these reported changes to the virus.  Follow the link below to read:


Research on MERS in South Korea seems fractured...




Cara Membuat Puding Susu Jagung Resep Enak Lembut
Resep Puding Susu Jagung Enak dan Lembut - Puding susu sederhana yang terbuat dari kombinasi jagung manis ini merupakan variasi puding jagung tanpa santan yang sangat enak dan lembut. Puding susu segar yang lembut sehingga lumer di mulut, terbukti sangat digemari mulai dari anak-anak hingga lansia. Cita rasanya yang enak dan lezat sangat menjanjikan untuk dijadikan sebagai menu dessert favorit keluarga.

Proses cara membuat puding susu jagung cukup mudah dan praktis, serta hanya menggunakan bahan-bahan yang sederhana. Seperti halnya susu cair, bisa menggunakan susu kental manis atau susu bubuk yang dicairkan atau memakai susu cair kemasan, bahkan susu murni segar hingga susu kedelai pun dapat dijadikan pilihan.
Puding Susu Jagung
Persiapan Bahan Puding Susu Jagung
  • 1 bungkus agar-agar putih
  • 800 ml susu cair
  • 2 buah jagung manis
  • 100 gram gula pasir
  • 1/2 sdt garam
  • 20 gram tepung maizena dilarutkan dengan 4 sdm susu cair
  • pewarna kuning sesuai selera
Cara Membuat Puding Susu Jagung
  1. Rebus jagung manis hingga matang, angkat dan tiriskan, lalu pipil jagungnya setelah cukup dingin. Blender pipilan jagung bersama susu cair hingga halus, kemudian saring.
  2. Setelah disaring, campurkan dengan agar-agar putih, gula pasir dan garam dalam sebuah panci. Aduk-aduk rata hingga tidak ada yang menggumpal, tambahkan pewarna makanan sesuai selera serta aduk rata.
  3. Masak adonan tadi sambil terus diaduk hingga mendidih, masukkan larutan maizena serta terus diaduk sampai adonan mengental dan tercampur rata serta mendidih kembali.
  4. Angkat dan tuang dalam cetakan, karena tekstur puding yang lembut, sebaiknya gunakan cetakan kecil saja atau cup/gelas. Dinginkan dalam kulkas hingga mengeras lalu siap untuk disajikan.

Kamis, 07 Januari 2016














#10,864


Earlier this week in Oman: MOH Announces 7th MERS Case, we learned of a new Coronavirus infection, but few details were provided. Today the World Health Organization has posted an update which provides the onset dates (Dec 25th), hospitalization date (Jan 1st), and possible exposure (camels) on this 44 year old male patient. 



Middle East respiratory syndrome coronavirus (MERS-CoV) – Oman

Disease outbreak news
7 January 2016
 
On 3 January 2016, the National IHR Focal Point of Oman notified WHO of 1 additional case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

Details of the case

A 44-year-old male from the North Batinah Governorate developed symptoms on 25 December and, on 1 January, was admitted to hospital. On 3 January, the patient, who has no comorbidities, tested positive for MERS-CoV. Currently, he is in stable condition in a negative pressure isolation room on a ward. The patient has a history of exposure to dromedary camels in the 14 days prior to the onset of symptoms. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Contact tracing of household contacts is ongoing for the case. Investigation of camels is also ongoing.
Globally, since September 2012, WHO has been notified of 1,626 laboratory-confirmed cases of infection with MERS-CoV, including at least 586 related deaths.















#10,863


Although the number of new outbreaks continues at a much reduced rate over last month, the French MOA continues to identify sporadic new HPAI outbreaks across the nation's southwest.  

While the impacts have been relatively small, they involve five new strains of avian flu, all said to be of `European lineage', and not descended from the more dangerous Asian H5N1 virus.

Details on these viruses (HPAI H5N1, H5N2, H5N9 and LPAI H5N2, H5N3), and how they all emerged more or less simultaneously in France, have been slow to emerge.  The last DEFRA Update On France's HPAI Outbreak (Dec 24th) cited this lack of information as hampering their ability to produce a full threats analysis.

The most recent outbreak comes from the Pyrénées Atlantiques, and is the first reported there since December 20th.


- An outbreak was declared on Jan. 6, 2016 on a farm of 10,000 chickens and 4,000 ducks in the town of Gabat

Here is the latest (translated) update from the French MOA. 



What is the current situation in France? (updated on 01/07/2016 at 15h)

In total, to date, 67 of highly pathogenic avian influenza outbreaks in poultry were detected in 7 southwestern departments of France.
ANSES gave its opinion delivered on 14 December 2015, on the potential danger to humans from the avian influenza strain identified, including the results of the complete sequencing of the H5N1 strain detected in the first home in the Dordogne. She confirmed the absence for this dangerous H5N1 strain of the key markers for human.
Find below the details of homes by department below:

In the Dordogne, 13 homes

In the Landes, 28 homes

In Haute-Vienne, a home

In Gers, 10 homes

In the Pyrénées Atlantiques, 11 homes

In the Hautes-Pyrénées, 3 fireplaces

In the Lot: a home
















# 10,862


The H5N6 virus was first reported 20 months ago in Southern China, and during the first 19 months China reported a total of four human infections.  While the virus has been sporadically reported in poultry in both Vietnam and Laos, no human infections have been reported outside of China.

Two weeks ago, Guangdong Province reported a human infection (see Hong Kong Notification: Fatal H7N9 Case In Guangdong Province), followed just last week with Guangdong Province Reports 2nd H5N6 Case In A Week. 


Today Hong Kong's CHP is reporting a 3rd case in neighboring Guangdong Province.  While three cases does not an epidemic make, this sudden increase in reported cases is certainly something to watch.



CHP notified of additional human case of avian influenza A(H5N6) in Guangdong

 

The Centre for Health Protection (CHP) of the Department of Health (DH) was notified of an additional human case of avian influenza A (H5N6) by the Health and Family Planning Commission of Guangdong Province today (January 7), and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

It involves a man aged 25 in Longgang, Shenzhen, currently hospitalised for treatment in serious condition.?

From 2014 to date, a total of seven human cases of avian influenza A(H5N6) have been reported by the Mainland health authorities.


(Continue . . .)


It is worth noting that a couple of days ago Hong Kong announced H5N6 Detected In Dead Egret, making the 4th such detection in wild or migratory birds in the new territories.

H5N6 is one of the new reassortant viruses to come out of China since 2013, a list that includes H7N9, H5N8 (and its reassortants), and H5N6.

Of these, H7N9 has infected the most humans (roughly 700), while H5N8 - which has not infected humans - has spread the furthest afield (making it to Europe, Taiwan, Japan, and North America). 


Of these three, H5N6 is the biggest unknown, having been studied the least.  That, of course, could start to change if this virus begins to pose a serious public health threat.  For some previous studies, you may wish to revisit:

FAO-EMPRES Report On The Emergence And Threat Of H5N6

H5N6 Rising: Infecting Birds, Humans, & Even Cats

EID Journal: Influenza A(H5N6) Virus Reassortant, Southern China, 2014

Credit CDC
















#10,861


When we talk about the number of dengue, malaria, tuberculosis, MERS, or avian flu cases - or of any other disease - the understanding is that the numbers we have are almost certainly incomplete, and nearly always a major under count.


As an example, during the first wave of H7N9 in China in the spring of 2013, 133 cases were identified by Chinese authorities, but estimates (see Lancet: Clinical Severity Of Human H7N9 Infection) ranged from 12 to 200 times that number. 


Our estimate that between 1500 and 27 000 symptomatic infections with avian influenza A H7N9 virus might have occurred as of May 28, 2013, is much larger than the number of laboratory-confirmed cases.

Similarly, in CID Journal: Estimates Of Human Infection From H3N2v (Jul 2011-Apr 2012), during a time when only 13 cases were registered by the CDC, researchers estimated there were as many as 2055 (90% range, 1187–3800) illnesses from H3N2v virus infections.


Saudi Arabia has reported 1280 MERS infections to date, yet a seroprevalence study published last April in the Lancet (see Presence of Middle East respiratory syndrome coronavirus antibodies in Saudi Arabia: a nationwide, cross-sectional, serological study  by Drosten & Memish et al.,  projected 44 951 (95% CI 26 971–71 922) individuals older than 15 years might be seropositive for MERS-CoV in Saudi Arabia.

The list goes on.  For every West Nile infection reported in the United States there are likely 100 that go unreported. And this is true for one of the most advanced public health systems in the world.

Imagine the disease data `gap' from countries where surveillance and reporting capabilities are far less robust or where the political will to report these types of findings is lacking. For many countries there is little `up side' to reporting diseases like MERS or avian flu, and so they simply look the other way. 

The lack of reported MERS cases in sub-Saharan Africa, or relatively low numbers of human cases in bird flu endemic regions, yields far less reassurance when you consider those factors.

All of which brings us to a new report in the EID journal that takes retrospective look at the testing and diagnosis of suspected dengue cases in Brazil (where reporting is mandatory) over a  2 year period - and finds that even among those hospitalized and tested - the number of cases is badly under reported. 

You can read the methods, materials, and math below, but the bottom line is they found that official counts likely captures less than 10% of the actual number of cases.  

Since this study period, two new mosquito-borne viruses - Chikungunya and Zika - have been introduced into the region, have already likely produced millions of additional illnesses, and will further complicate the process of diagnosis and treatment going forward.


Volume 22, Number 2—February 2016


Letter


Accuracy of Dengue Reporting by National Surveillance System, Brazil

To the Editor: Dengue is an underreported disease globally. In 2010, the World Health Organization recorded 2.2 million dengue cases (1), but models projected that the number of symptomatic dengue cases might have been as high as 96 million (2). Brazil reports more cases of dengue than any other country (1); however, the degree of dengue underreporting in Brazil is unknown. We conducted a study to evaluate dengue underreporting by Brazil’s Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação [SINAN]). 

From January 1, 2009, through December 31, 2011, we performed enhanced surveillance for acute febrile illness (AFI) in a public emergency unit in Salvador, Brazil. The surveillance team enrolled outpatients >5 years of age with measured (>37.8°C) or reported fever. Patients or their legal guardians provided written consent. The study was approved by the Oswaldo Cruz Foundation Ethics Committee, Brazil’s National Council for Ethics in Research, and the Yale Institutional Review Board.

(BIG SNIP)

We estimated that overall, there were 12 dengue cases per reported case in the community, but in months of low dengue transmission, this ratio was >17:1 (Table). Comparable results have been observed in Nicaragua, Thailand, and Cambodia (68). By applying the estimated multiplication factor to the study period’s mean annual incidence of 303.8 reported dengue cases/100,000 Salvador residents (9), we estimated that the actual mean annual dengue incidence for Salvador was 3,645.7 cases/100,000 residents.

We showed that dengue surveillance substantially underestimated disease burden in Brazil, especially in what are considered low-transmission periods. Dengue underreporting has been attributed to passive case detection, which fails to identify persons with dengue who do not seek health care (1). We also showed that surveillance failed to detect dengue cases among symptomatic patients seeking health care.

Novel surveillance tools, such as active syndromic surveillance and point-of-care testing, should be applied to improve estimates of dengue incidence. Furthermore, given the recent emergence of chikungunya and Zika virus in Brazil (10), improved surveillance and laboratory diagnostics are needed to avert misclassification and mismanagement of cases.


Monaise M.O. Silva, Moreno S. Rodrigues, Igor A.D. Paploski, Mariana Kikuti, Amelia M. Kasper, Jaqueline S. Cruz, Tássia L. Queiroz, Aline S. Tavares, Perla M. Santana, Josélio M.G. Araújo, Albert I. Ko, Mitermayer Galvão Reis, and Guilherme S. RibeiroComments to Author 
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Hadith Prophet Muhammad

It is narrated on the authority of Amirul Mu’minin, Abu Hafs ‘Umar bin al-Khattab, radiyallahu ‘anhu, who said: I heard the Messenger of Allah, sallallahu ‘alayhi wasallam, say: “Actions are (judged) by motives (niyyah) , so each man will have what he intended. Thus, he whose migration (hijrah) was to Allah and His Messenger, his migration is to Allah and His Messenger; but he whose migration was for some worldly thing he might gain, or for a wife he might marry, his migration is to that for which he migrated.” [Al-Bukhari & Muslim]

Abu Hamzah Anas bin Malik, radiyallahu ‘anhu, who was the servant of the Messenger of Allah, sallallahu ‘alayhi wasallam, reported that the Prophet, sallallahu ‘alayhi wasallam, said: “None of you truly believes (in Allah and in His religion) until he loves for his brother what he loves for himself.” [Al-Bukhari & Muslim]

About History

The urgent of reading history is that we become aware of his past life, progress and destruction of a nation, understand the wisdom behind the nation's history, feel the love, angry, sad, all within the scope of history. Because history is an art. Art is beauty. So people who do not know history, its own history, at least then he would not know the beauty of the wheel of life that applies to every person.

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