WHO: Press Conference On Zika Research With Dr Marie-Paule Kieny (Audio)

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The WHO's Dr Marie-Paule Kieny held a press conference this morning in Geneva on the plans to develop pharmaceuticals and diagnostics for the Zika virus. During this 35 minute presser Dr. Kieny also fielded a wide variety of reporter's questions on the evidence of links between Zika and Microcephaly and GBS, as well as the evolution of the virus.

Dr. Kieny stressed that while a number of firms are researching a vaccine, it will likely be  18 months before widespread trials can begin.  There are hopes that a prophylactic treatment - as exists for malaria - could be developed sooner. 

Vector control is another issue the WHO is looking at, and they find that biological approaches like Wolbachia (see A Mosquito STD To Fight Dengue) or genetically modified mosquitoes (see Brave New Mosquito) to be promising avenues of research. 


As to the time to establish a link between Zika and Microcephaly and GBS, Dr. Kieny spoke in terms of a `few weeks to a few months'. There is a relatively large cohort of pregnant women in Columbia with Zika exposure whose births will be monitored, and we should have better answers in the next month or so.


You'll find Dr. Kieny's prepared remarks below (via email), but you'll glean far more from the 35 minute audio file.

Dr Kieny was speaking at a press conference in Geneva today 12 February 2016


The audio file of her press conference can be found:

Direct link: http://terrance.who.int/mediacentre/presser/WHO-RUSH_Zika_research_presser_KIENYm_UNOG_12FEB2016.mp3

Good morning:

As you know, our relatively poor knowledge of the Zika virus presents a series of challenges for R&D.  However, I am pleased to say that, based on our experience with R&D during the West Africa Ebola epidemic, WHO’s R&D response is proceeding very quickly for Zika.

After Ebola, WHO began to draw up a master plan for R&D to both prepare for health emergencies and to be able to mount a fast R&D response in case of need.  The R&D Blueprint – as the initiative is called – aims to accelerate the availability of medical countermeasures during epidemics and limit damage as much as possible.  We now have established critical paths for coordinated action, and industry interest in providing platform technologies for the development of medical products.

We have already identified a large number of manufacturers and research institutions either involved in the development of medical tools for Zika, or interested in embarking on such research.

Apart from what has already appeared in the press, numerous other groups are looking at the feasibility of initiating animal or human testing, particularly for vaccines and diagnostics.

For vaccines:

• The landscape is evolving very rapidly and numbers change daily.  About 15 companies/groups have been identified so far, most have only just started work.
• Two vaccine candidates seem to be more advanced: a DNA vaccine from the US National Institutes for Health, and an inactivated product from Bharat Biotech, in India.
• The current absence of standardized animal models and reagents is slowing down development.

In spite of this encouraging landscape, vaccines are at least 18 months away from large-scale trials. 

For Diagnostics:

• 10 biotech companies have been identified so far that can provide nucleic acid or serological tests.  Nucleic acid tests are based on a molecular technique used to detect a virus in the blood; serological tests measure the levels of antibodies as a result of exposure to a particular virus
• 10 other companies are at various stages of development.
• It is important to point out, however, that none of these tests have been independently validated and none have regulatory approval.
• The biggest task in the area of diagnostics will probably be to ensure an adequate reference method is used by manufacturers when generating their data, so that the performance of the various Zika diagnostics can be tested through an independent assessment. This will help prevent the distribution of poor quality or fake Zika tests that are sure to come up rapidly – as was the case with Ebola. 

Laboratory based Zika diagnostics (mostly non-commercial) are already playing an important role to better understand this outbreak, however, new validated and broadly available diagnostics are urgently needed to step up research, clinical management and surveillance. Although it is difficult to predict the time for the first commercial and independently validated tests to be available, we are talking weeks and not years.

WHO will continue working on landscape analyses for diagnostics and vaccines, as well as therapeutics, and innovative vector control measures.  These analyses will be published on our web site in the next two weeks.

Immediately after, we will convene independent experts to gauge which of these products seem the most promising as they move to the testing phase.

At the same time, WHO is developing what is called “target product profiles” for these medical tools – for example, what may be the best characteristics for a vaccine to immunize women of child-bearing age?

In terms of diagnostics, we need to understand which type of product – nucleic acid, serologic, rapid test, etc. – will best serve our purposes.  We should have target product profiles ready in the next weeks.

In the area of therapeutics, studies are being carried out on medicines and other therapies that could prevent infection in vulnerable groups, especially pregnant women, as is done for malaria.   This seems for the moment a more viable and faster option than a curative treatment.

For vector control, innovative methods seem promising options – biological approaches for example, such as the controlled release of bacteria to prevent viral replication in mosquitoes; or genetic approaches, such as the release of genetically modified mosquitoes to reduce the mosquito population.

In terms of what happens afterwards, when potential products reach an advanced stage of testing and show promising data: we have in place the WHO Emergency Assessment and Listing procedure for the use of experimental products during an epidemic.  This accelerated assessment process was established during the Ebola epidemic and aims to ensure that products meet acceptable levels of quality, safety and efficacy – even if evaluation is fast-tracked - before they are rolled out in countries.

We will also provide support to countries wishing to register proven products to compress the time it takes to carry out ethical and regulatory reviews, so that these tools become available rapidly.
 
Thank you 

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Kisah Semut dan Belalang

Seekor semut yang pikirannya tersusun dalam rencana teratur, sedang mencari-cari madu ketika seekor capung hinggap menghisap madu dari bunga itu. Capung itu melesat pergi untuk kemudian datang kembali.

Kali ini Si Semut berkata,
“Kau ini hidup tanpa usaha, dan kau tak punya rencana. Karena kau tak punya tujuan nyata ataupun kira-kira, apa pula ciri utama hidupmu dan kapan pula berakhir?”
Kata Si Capung,
“Aku bahagia, dan aku mencari kesenangan, ini jelas ada dan nyata. Tujuanku adalah tanpa tujuan. Kau boleh merencanakan sekehendakmu; kau tak bisa meyakinkanku bahwa ada yang lebih berharga daripada yang kulakukan ini. Kaulaksanakan saja rencanamu, dan aku rencanaku.”
Semut berpikir,
“Yang tampak padaku ternyata tak tampak olehnya. Ia tahu apa yang terjadi pada semut. Aku tahu apa yang terjadi pada capung. Ia laksanakan rencananya, aku laksanakan rencanaku.”
Dan semutpun berlalu, sebab ia telah memberikan teguran sebaik-baiknya dalam masalah itu.
Beberapa waktu sesudah itu, mereka pun bertemu lagi.
Si Semut menemukan kedai tukang daging, dan ia berdiri di bawah meja tumpuan daging dengan bijaksana, menunggu saja apa yang mungkin datang padanya.
Si Capung, yang melihat daging merah dari atas, menukik dan hinggap diatasnya. Pada saat itu pula, parang tukang daging berayun dan membelah capung itu menjadi dua.
Separoh tubuhnya jatuh di lantai dekat kaki semut itu. Sambil menangkap bangkai itu dan mulai menyeretnya ke sarang, semut itu berkata kepada dirinya sendiri.
“Rencananya tamat sudah, dan rencanaku terus berjalan. Ia laksanakan rencananya -sudah berakhir, Aku laksanakan rencanaku -mulai berputar. Kebanggaan tampaknya penting, nyatanya hanya sementara. Hidup memakan, berakhir dengan dimakan. Ketika aku katakan hal ini, yang mungkin dipikirkannya adalah bahwa aku suka merusak kesenangan orang lain.”
Catatan
Kisah yang hampir serupa ditemukan juga dalam karya Attar, Kitab Ketuhanan, meskipun penerapannya agak berbeda. Versi ini dikisahkan oleh seorang darwis Bokhara dekat makam Al-Syah, yakni Bahaudin Naqsibandi, enam puluh tahun yang lalu. Sumbernya adalah buku catatan seorang Sufi yang disimpan dalam Masjid Agung di Jalalabad.

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RESEP ES GABUS BUSA HUNKWE ENAK BERLAPIS

Resep Es Gabus - Sering disebut juga Es Busa merupakan varian jajanan warung atau jajanan sekolah yang populer di masanya bahkan masih diminati hingga sekarang. Olahan dari tepung hunkwe ini rasanya memang sangat enak dan segar, sepintas keras karena es beku tetapi lembut dan empuk atau bertektur seperti gabus atau busa saat digigit. Aneka rasa pada masing-masing warna semakin memikat sehingga untuk dijual pun bisa diandalkan.

Cara membuat es gabus memang cukup mudah dibuat sendiri di rumah, tetapi sensasinya sangat dapat memuaskan penikmatnya. Bentuk dan tekstur serta lapisan warna-warninya seperti kue lapis sebelum dibekukan, tetapi setelah dibekukan empuk dan krenyesnya sering juga disebut sebagai es kue, es lapis, es roti, hingga es pelangi karena tampilan aneka warnanya yang menarik.

Selain variasi warna, es busa gabus juga biasa diolah dengan aneka rasa lainnya, seperti coklat, pandan, variasi buah, mutiara maupun kacang hijau dan lain sebagainya. Jajanan es ini sering dipasangan dengan es mambo, salah satunya bisa dilihat pada Resep Es Mambo Coklat.

Persiapan Bahan Bikin Es Gabus Busa

• 150 gram tepung hunkwe
• 250 gram gula pasir
• 1200 ml santan dari 1 butir kelapa
• 1 sdt garam
• 1 sdm pasta mangga atau sesuai selera

Cara Membuat Es Gabus (Es Busa)

1. Pertama-tama kita bagi terlebih dahulu bahan-bahan es gabus menjadi 2 bagian, atau bisa disesuaikan dengan berapa lapisan yang diinginkan. Untuk masing-masing lapisan, siapkan mangkuk atau wadah lalu campur dan aduk rata tepung hunkwe beserta sedikit saja santan sekedar untuk melarutkan.
2. Sementara itu setelah bahan dibagi, kita awali dengan lapisan pertama. Panaskan santan, gula dan garam untuk warna putih (tambahkan pasta atau pewarna kue untuk warna lainnya) sambil diaduk rata hingga mendidih, baru kemudian masukkan larutan hunkwe tadi. Aduk terus hingga mengental, lalu matikan api dan tuang adonan ke dalam loyang serta ratakan.
3. Lanjutkan membuat lapisan berikutnya dengan cara yang sama, kemudian tuang ke loyang di atas adonan pertama serta ratakan. Diamkan adonan hingga dingin terlebih dahulu, setelah cukup dingin keluarkan dari loyang dan potong-potong.
4. Bungkus dengan palstik dan lipat, simpan dalam freezer semalam atau hingga beku dan mengeras. Es gabus atau es busa telah siap untuk disantap dingin.

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DRC: Reports Of A Large Monkeypox Outbreak

DRC

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Last month, in Monkeypox Outbreak Reported In Central African Republic we looked at what was apparently a small outbreak of the virus - now quashed according to local reports - in the Bangassou district, an area on the north bank of the Mbomou River which serves as a border with the Democratic Republic of Congo (DRC). 

Over the past 24 hours, reports of several outbreaks of Monkeypox have been coming out of the DRC (although their Health Ministry site makes no mention of it), including 51 recent cases in Bas-Uéle (350 km from the CAR outbreak).

While small monkeypox outbreaks are not unusual in central Africa (the DRC reported 20 cases in September 2015), today's report suggests a much larger, and wider spread outbreak. Reportedly nearly 200 cases have emerged in the past few weeks. 


This report from the L'Observateur Nation.

Aketi / Bas Uélé: Reappearance of the outbreak of monkeypox

L'Observateur Nation

The outbreak of monkeypox, a viral disease similar to smallpox surfaced in Aketi territory of the province of Bas-Uélé, where 51 new cases were recorded in the first week of February current. 

Also known as monkey pox, the disease has already killed two people, alerted Tuesday, February 9 aware of the area Medical Officer Aketi, Dr Innocent Akonda. In the process, he says that thirteen cases are diagnosed in the Bombongolo health area, fifteen in that of Aboso and twenty-one other in the twelve other health areas of the territory.

According to several local sources, the situation is alarming and requires immediate intervention. With the new cases, the health area is already 195 cases including 8 deaths, said Dr. Innocent Akonda.

For Dr. Innocent Akonda, this highly contagious disease spread in the Aketi health area because of several difficulties that do not facilitate the fight against the monkeypox virus.

These difficulties became almost a brake for better medical care to the population, he has cited the lack of qualified medical personnel and lack of adequate sanitation.

(Continue . . . )

Credit CDC

Monkeypox is a rare virus, endemic in monkeys and rodents in central Africa, that produces a remarkably `smallpox looking'  illness in humans. although not as deadly. Human monkeypox was first identified in 1970 in the DRC, and since then has sparked small, sporadic outbreaks in the Congo Basin and Western Africa.

The name `monkeypox’  is a bit of a misnomer. It was first detected (in 1958) in laboratory monkeys, but further research has revealed its host to be rodents or possibly squirrels.

Humans can contract it in the wild from an animal bite or direct contact with the infected animal’s blood, body fluids, or lesions, but consumption of undercooked bushmeat is also suspected as an infection risk.

Human-to-human transmission is also possible.  This from the CDC’s Factsheet on Monkeypox:

The disease also can be spread from person to person, but it is much less infectious than smallpox. The virus is thought to be transmitted by large respiratory droplets during direct and prolonged face-to-face contact. In addition, monkeypox can be spread by direct contact with body fluids of an infected person or with virus-contaminated objects, such as bedding or clothing.

According to the CDC there are two distinct genetic groups (clades) of monkeypox virus—Central African and West African. West African monkeypox is associated with milder disease, fewer deaths, and limited human-to-human transmission.

In 1996-97, an unusually large outbreak occurred in the Democratic Republic of Congo (see Eurosurveillance Report), infecting more than 500 in the Katako-Kombe and Lodja regions.  Mortality rates were lower for this outbreak (1.5%) than earlier ones, but this was the biggest, and longest duration outbreak on record.

Somewhat famously, in 2003 the United States saw an outbreak (of the milder, West African clade) that affected 47 confirmed and probable cases across six states—Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin - all of whom had contact with infected prairie dogs purchased as pets.

These pets became infected when an animal distributor imported hundreds of small animals from Ghana, which in turn infected prairie dogs that were subsequently sold to the public (see MMWR Update On Monkeypox 2003).

While still considered a geographically limited threat, in 2010 a study that appeared in PNAS warned that the incidence of human monkeypox infection was increasing, and that it posed a potential risk well beyond localized outbreaks in Africa.


Given the size, and quick spread of this latest outbreak, we'll continue to check in on it in the days and weeks ahead.

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How To Really Show Your Love This Valentine's Day

Credit CDC

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Each year the United States sees – on average – 60 to 80 major disasters (see FEMA list), and thousands of Americans are beset by smaller emergencies each day, and yet most remain woefully unprepared to deal with the unexpected. 

Which is why I promote preparedness gifts for the holidays (see Holiday Preparedness Stocking Stuffers) each year in this blog. 

While maybe not to the exclusion of jewelry or flowers, a first aid kit, a flashlight, a water filter, or a weather radio make wonderful birthday, anniversary, and Valentines gifts, and show you really care. 

For a list of some of the preparedness items I've given over the years, you might wish to revisit #NatlPrep - The Gift Of Preparedness.

To validate your Valentine's theme, the APHA (American Public Health Association) has a growing list of free e-cards that incorporate preparedness advice into the traditional Valentine’s Day message.


I've reprinted a couple I really like, but follow the link below to view, and send, an appropriate card from their much larger selection.

Get ready with one of our free e-cards!
 
If you're a fan of APHA's Get Ready campaign, we know you love to be prepared as much as we do. To help you spread the message, we created some Get Ready e-cards so that you can share the importance of preparedness with your loved ones.

Browse our cards below. When you find one you'd like to send, click on the image. From there, you can share the card with friends and family!

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ECDC EFSA Report: Antimicrobial Resistance On The Rise In The EU

Credit CDC PHIL

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While pandemics and outbreaks of novel diseases like avian flu, MERS, and Zika make the immediate headlines, in terms of long term threats, there is little that can match the potential harm from the rise of antibiotic resistant bacteria around the globe.

It's a threat that has prompted both CDC Director Thomas Frieden and WHO Director General Margaret Chan to warn that the world faces a `post-antibiotic' era.  

Although today's report from the ECDC/EFSA is technically current through the end of 2014, it contains references to the recently discovered MCR-1 Colistin resistance gene (see The Lancet: Dissemination Of The MCR-1 Colistin Resistance Gene and Referral: McKenna On The Latest MCR-1 Finding) which is turning out to already be surprisingly widespread.  

A discovery made all the more concerning because, like the NDM-1 gene, MCR-1 resistance can be transferred laterally via plasmids - tiny snippets  of DNA - that can shuttle from one bacterial strain to another (see MCR-1: The Return Of The Plasmids).

First the press release, then the abstact and link to the full report:

Antimicrobial resistance on the rise in the European Union, ECDC and EFSA warn


11 Feb 2016

​Bacteria in humans, food and animals continue to show resistance to the most widely used antimicrobials, says the latest report on antimicrobial resistance in zoonotic bacteria in Europe. Resistance to ciprofloxacin, an antimicrobial that is critically important for the treatment of human infections, continues to be very high in Campylobacter, thus reducing the options for effective treatment of severe foodborne infections. In addition, multi-drug resistant Salmonella bacteria continue to spread across Europe.

The report also found evidence of resistance to the antimicrobial colistin in Salmonella and E. coli  among poultry in the EU. “This is worrying because it means that this last-resort drug may soon no longer be effective for treating severe human infections with Salmonella” said Mike Catchpole, Chief Scientist for ECDC.

Besides the high levels of resistance shown throughout Europe, there are significant regional differences. The highest levels of antimicrobial resistance are observed in eastern and southern Europe. “In northern Europe, there is lower resistance in bacteria from poultry, particularly in countries with low use of antimicrobials in animals,” said Marta Hugas, Head of EFSA’s Biological Hazards and Contaminants unit.

Turning the tide on antimicrobial resistance is at the top of ECDC’s agenda. In 2015, the eighth European Antibiotic Awareness Day was launched, with more than 40 countries participating. This European health initiative coordinated by ECDC aims to support Member States in their efforts to promote prudent use of antimicrobials. 

(Continue . . . )

At 200+ pages, the following PDF file isn't exactly light reading, but the following report provides a remarkable amount of data on the rise and spread of antimicrobial resistance in the EU.

The European Union summary report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2014 

European Food Safety Authority
European Centre for Disease Prevention and Control
Abstract 
 
The data on antimicrobial resistance in zoonotic and indicator bacteria in 2014, submitted by 28 EU Member States (MSs), were jointly analysed by EFSA and ECDC. Resistance in zoonotic Salmonella and Campylobacter species from humans, animals and food, and resistance in indicator Escherichia coli as well as meticillin-resistant Staphylococcus aureus in animals and food was assessed.

‘Microbiological’ resistance was assessed using epidemiological cut-off (ECOFF) values; for some countries, quantitative data on human isolates were interpreted in a way which corresponds closely to the ECOFF-defined ‘microbiological’ resistance. In Salmonella from humans, high proportions of isolates were resistant to ampicillin, sulfonamides and tetracyclines, whereas resistance to third-generation cephalosporins and to fluoroquinolones remained generally low, although it was markedly higher in some serovars commonly associated with broilers and turkeys.

In Salmonella and Escherichia coli isolates from broilers, fattening turkeys and meat thereof, resistance to ampicillin, (fluoro)quinolones, tetracyclines and sulfonamides was frequently detected, whereas resistance to third-generation cephalosporins was uncommon. For the first time, presumptive extended spectrum beta-lactamase (ESBL)-/AmpC-/carbapenemase production in Salmonella and Escherichia coli was monitored in poultry. The occurrence of ESBL-/AmpC-producers was low, and carbapenemase-producers were not detected. Resistance to colistin was observed at low levels in Salmonella and Escherichia coli from poultry and meat thereof.

In Campylobacter from humans, a high to very high proportion of isolates were resistant to ciprofloxacin and tetracyclines, whereas resistance to erythromycin was low to moderate. Resistance to fluoroquinolones in some MSs was extremely high; in such settings, the effective treatment options for human enteric Campylobacter infection may be significantly reduced. High resistance to ciprofloxacin and tetracyclines was observed in Campylobacter isolates from broilers and broiler meat, whereas much lower levels were recorded for erythromycin.

Co-resistance to critically important antimicrobials in both human and animal isolates was generally uncommon, but very high to extremely high MDR levels were observed in some Salmonella serovars. A minority of Salmonella isolates from animals belonging to a few serovars (notably Kentucky and Infantis) exhibited high-level resistance to ciprofloxacin.

© European Food Safety Authority and European Centre for Disease Prevention and Control, 2016

 

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NEJM: Probable Hospital Cluster of H7N9 - China, 2015

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Despite having been identified in more than 700 patients since 2013 (and suspected to have infected many more), we've seen surprisingly few clusters of H7N9 reported by China's surveillance system.

That isn't to say there have been none. 

We've seen a handful of household clusters over the years (see 2014 WHO H7N9 FAQ   &  EID Journal: H7N9 In Two Travelers Returning From China - Canada, 2015), and last November we looked at a report (see Study: Probable Nosocomial Transmission Of H7N9 In China) describing a small (n=2) cluster in a hospital ward in Zhejiang Province last February.


Today we've a short correspondence, appearing in the NEJM, describing a second nosocomial cluster that occurred in Shantou, Guandong province at roughly the same time. 

In this case, two doctors attending a patient admitted with respiratory symptoms (later determined to be  H7N9) were infected.

The index patient (M,28), who had frequent contact with poultry, was admitted to a Shantou hospital with respiratory symptoms on January 25th. Seven days later his attending physician (Pt #2, M,33) fell ill, followed 4 days later by a second attending physician in the same department (Pt #3, M,35).


All three were confirmed infected with H7N9 by RT-PCR, and while all recovered, the index patient was shown to be still shedding the virus 42 days after his initial onset of symptoms. Sequence and phylogenic analysis showed the three hospital isolates formed an independent clade that carried two unique nucleotide polymorphisms.


Follow the link below to read the full report and supplemental materials. I'll have a short comment when you return. 

Correspondence

Probable Hospital Cluster of H7N9 Influenza Infection

N Engl J Med 2016; 374:596-598

February 11, 2016 DOI: 10.1056/NEJMc1505359

Although no sustained H7N9 transmission has been reported in the community (very few secondary infections detected in contacts of known cases) - since only the `sickest of the sick’ are ever tested - there’s a pretty good chance that a substantial number of mild cases go unnoticed.

One study conducted after the first wave in the spring of 2013 – where just 134 cases were recorded – estimated the real number of cases ran into the thousands (see Lancet: Clinical Severity Of Human H7N9 Infection).

The H7N9 virus continues to evolve and diversify over time (see EID Journal: H7N9’s Evolution During China’s Third Wave – Guangdong Province), and many researchers worry that it may eventually adapt well enough to human physiology to pose a genuine pandemic threat.

It may be entirely coincidental, but the day-to-day reporting of H7N9 out of China virtually stopped in early March of last year – at roughly the same time China was dealing with these two hospital clusters  -  something I blogged about in H7N9: No News Is . . . . Curious on March 19th.   

Although the limited data we've seen suggests this year's outbreak may be lighter than the past two years, this report illustrates that is can sometimes take up to a year for some of the grittier details to filter out of China.

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