Pandemic

Second French coronavirus case confirmed
A second diagnosis of the new SARS-like coronavirus has been confirmed in France, the Health Ministry said on Sunday, in what appeared to be a case of 

human-to-human transmission.

Reuters,

12 May, 2013

The new infection was found in a 50-year-old man who had shared a hospital room with France's only other known sufferer, the ministry said in a statement.

Health experts are concerned about clusters of the new coronavirus strain, nCoV, which was first spotted in the Gulf and has spread to France, Britain and Germany.

There has so far been little evidence of direct and sustained human-to-human transmission of nCoV - in contrast to the pattern seen in the related Severe Acute Respiratory Syndrome (SARS) virus, which killed 775 people in 2003.

The first nCoV case in France, confirmed on May 8, is a 65-year-old man who fell ill after returning from Dubai late last month.

Both French patients are in hospital in the northern city of Lille, where the younger man was transferred to intensive care on Sunday as his breathing deteriorated.

His case suggests that airborne transmission of the virus is possible, though still unusual, said Professor Benoit Guery, head of the Lille hospital's infectious diseases unit.

"Fortunately, this remains a virus that is not easily transmitted," Guery told the BFMTV channel. "I don't think the public should be concerned - it has been out there for a year and we have 34 cases globally."

He said the second French case had occurred because the first patient presented "quite atypical" symptoms and had not been isolated immediately.

Health officials screened 124 people who had come into contact with him and carried out laboratory tests on at least five, including three medical staff.

All came back negative except the fellow patient, who had been in "close and prolonged contact" when they shared a hospital room in nearby Valenciennes between April 27 and 29, the ministry said.

The Next Pandemic: Not if, but When

NY Times,

9 May, 2013

TERRIBLE new forms of infectious disease make headlines, but not at the start. Every pandemic begins small. Early indicators can be subtle and ambiguous. When the Next Big One arrives, spreading across oceans and continents like the sweep of nightfall, causing illness and fear, killing thousands or maybe millions of people, it will be signaled first by quiet, puzzling reports from faraway places — reports to which disease scientists and public health officials, but few of the rest of us, pay close attention. Such reports have been coming in recent months from two countries, China and Saudi Arabia.

You may have seen the news about H7N9, a new strain of avian flu claiming victims in Shanghai and other Chinese locales. Influenzas always draw notice, and always deserve it, because of their great potential to catch hold, spread fast, circle the world and kill lots of people. But even if you’ve been tracking that bird-flu story, you may not have noticed the little items about a “novel coronavirus” on the Arabian Peninsula.

This came into view last September, when the Saudi Ministry of Health announced that such a virus — new to science and medicine — had been detected in three patients, two of whom had already died. By the end of the year, a total of nine cases had been confirmed, with five fatalities. As of Thursday, there have been 18 deaths, 33 cases total, including one patient now hospitalized in France after a trip to the United Arab Emirates. Those numbers are tiny by the standards of global pandemics, but here’s one that’s huge: the case fatality rate is 55 percent. The thing seems to be almost as lethal as Ebola.

Coronaviruses are a genus of bugs that cause respiratory and gastrointestinal infections, sometimes mild and sometimes fierce, in humans, other mammals and birds. They became infamous by association in 2003 because the agent for severe acute respiratory syndrome, or SARS, is a coronavirus. That one emerged suddenly in southern China, passed from person to person and from Guangzhou to Hong Kong, then went swiftly onward by airplane to Toronto, Singapore and elsewhere. Eventually it sickened about 8,000 people, of whom nearly 10 percent died. If not for fast scientific work to identify the virus and rigorous public health measures to contain it, the total case count and death toll could have been much higher.

One authority at the Centers for Disease Control and Prevention, an expert on nasty viruses, told me that the SARS outbreak was the scariest such episode he’d ever seen. That cautionary experience is one reason this novel coronavirus in the Middle East has attracted such concern.

Another reason is that coronaviruses as a group are very changeable, very protean, because of their high rates of mutation and their proclivity for recombination: when the viruses replicate, their genetic material is continually being inaccurately copied — and when two virus strains infect a single host cell, it is often intermixed. Such rich genetic variation gives them what one expert has called an “intrinsic evolvability,” a capacity to adapt quickly to new circumstances within new hosts.

But hold on. I said that the SARS virus “emerged” in southern China, and that raises the question: emerged from where? Every new disease outbreak starts as a mystery, and among the first things to be solved is the question of source.

In most cases, the answer is wildlife. Sixty percent of our infectious diseases fall within this category, caused by viruses or other microbes known as zoonoses. A zoonosis is an animal infection transmissible to humans. Another bit of special lingo: reservoir host. That’s the animal species in which the zoonotic bug resides endemically, inconspicuously, over time. Some unsuspecting person comes in contact with an infected monkey, ape, rodent or wild goose — or maybe just with a domestic duck that has fed around the same pond as the wild goose — and a virus achieves transcendence, passing from one species of host into another. The disease experts call that event a spillover.

Researchers have established that the SARS virus emerged from a bat. The virus may have passed through an intermediate species — another animal, perhaps infected by cage-to-cage contact in one of the crowded live-animal markets of the region — before getting into a person. And while SARS hasn’t recurred, we can assume that the virus still abides in southern China within its reservoir hosts: one or more kinds of bat.

Bats, though wondrous and necessary animals, do seem to be disproportionately implicated as reservoir hosts of new zoonotic viruses: Marburg, Hendra, Nipah, Menangle and others. Bats gather in huge, sociable aggregations and have long life spans, circumstances that may be especially hospitable to viruses. And they fly. Traveling nightly to feed, shifting occasionally from one communal roost to another, they carry their infections widely and spread them to one another.

As for the novel coronavirus in Saudi Arabia, its reservoir host is still undiscovered. But you can be confident that scientific sleuths are on the case and that they will look closely at Arabian bats, including those that visit the productive date-palm groves at the oases of Al Ahsa, near the Persian Gulf.

What can we do? The first obligation is informed awareness. Early reports arrive from afar, seeming exotic and peripheral, but don’t be fooled. One emergent virus, sooner or later, will be the Next Big One. It may show up first in China, in Congo or Bangladesh, or maybe on the Arabian Peninsula; but it will globalize. Most people on earth nowadays live within 24 hours’ travel time of Saudi Arabia. And in October, when millions of people journey to Mecca for the hajj, the Muslim pilgrimage, the lines of connections among humans everywhere will be that much shorter.

We can’t detach ourselves from emerging pathogens either by distance or lack of interest. The planet is too small. We’re like the light heavyweight boxer Billy Conn, stepping into the ring with Joe Louis in 1946: we can run, but we can’t hide.

David Quammen, a contributing writer for National Geographic, is the author, most recently, of “Spillover: Animal Infections and the Next Human Pandemic.”

Bird flu: US safe from two new viruses - so far

More than 50 travelers just back in the United States from China who had flu-like symptoms have been tested for the H7N9 bird flu virus, federal health officials say. So far, none has tested positive.

NBC,

12 May, 2013

But the fact that they’re being tested at all shows just how worried the U.S. government is about this new strain of bird flu, which threatens at the same time as a still-mysterious coronavirus from the Middle East. The test kits had to be specially made up and distributed under an emergency provision.

“While no cases of H7N9 have been detected at this time in the U.S., 54 people with flu-like symptoms after travel to China have been tested. All have 54 tested negative for H7N9; while six tested positive for seasonal influenza A, and three tested positive for seasonal influenza B,” the Centers for Disease Control and Prevention says in its latest update on the virus.

Emergency operations centers are running 24/7, keeping an eye on both situations. While it's not unusual for the centers to be operating around the clock, it is rare to have two pandemic threats at once to plan for, says Edward Gabriel, who heads preparedness and response issues at the health and Human Services Department.

"We want the latest and best information that we can get," Gabriel told NBC News. "We also need to look and see where it is moving to. To try to isolate its motion is a pretty significant thing."

If either virus turns into a form that spreads easily from person to person, a pandemic could follow within weeks. Both seem especially deadly in their current form: H7N9 seems to have about a 20 percent fatality rate, while the new coronavirus appears to have killed more than half its victims.

“In the case of the two latest threats — the H7N9 influenza virus and the new coronavirus — the number of infected people is small, and the infections are occurring thousands of miles away from the United States. Yet we should be seriously concerned about both,” Mike Osterholm, an infectious disease expert at the University of Minnesota, wrote in the New York Times on Friday.

“Our public health tools to fight these viruses are limited. We have no vaccines or effective drugs readily available to stop or treat the new coronavirus in the Middle East,” Osterholm adds.

CDC

Influenza A H7N9 as viewed through an electron microscope. Both filaments and spheres are observed in this photo.

The H7N9 flu can spread silently, as people transmit influenza before they’re sick themselves. If the flu did mutate into a pandemic form, it would probably take at least six months to make enough vaccines to protect large numbers of people.

“It may take longer than it takes the virus to spread,” says Dr. John Treanor, a flu vaccine expert at the University of Rochester Medical Center. “The technology that we have today is such that the bulk of the pandemic disease may have already taken place before a vaccine is in place and can be used,” he added.

“The virus can spread very, very quickly. You are in a race against time.”

That happened in 2009, when the new strain of H1N1 swine flu broke out to cause the first pandemic of a new flu in 40 years. Companies raced to make vaccine but it was months before it was ready.

There are drugs to fight flu – a pill called Tamiflu and an inhaled powder called Relenza. Neither is a cure, however, and both need to be given very quickly to do much good at all.

Right now, H7N9 seems mostly confined to China and the spread has slowed. The World Health Organization reports 32 people have died out of 131 lab-confirmed cases.

“The drop-off in newly reported H7N9 cases in China may be the result of containment measures reportedly taken by Chinese authorities, including closing live bird markets, a venue where the risk of exposure to bird flu viruses can be high," the CDC says. “However it may also be a result of changing seasons, or a combination of both.”

Researchers in Hong Kong did a computer analysis of the outbreak and estimate that at least 200-500 more people have likely been infected with H7N9. The virus seems to cause serious illness mostly in people over 65 – doctors are not sure why yet.

“We estimated that risk of serious illness after infection is 5.1 times higher in persons 65 years and older versus younger ages,” Ben Cowling and colleagues at Hong Kong University wrote in the journal Eurosurveillance.

The evidence suggests that most of the patients got infected directly by birds, probably in poultry markets. So Cowling’s team took all the data and estimated how many younger people were likely to have been infected without knowing they had H7N9. 

"Our results suggest that many unidentified mild influenza A(H7N9) infections may have occurred, with a lower bound of 210–550 infections to date," they wrote. This would mean the virus isn’t that widespread, but which also confirms its high fatality rate.

The coronavirus, which some are dubbing Middle East Respiratory Syndrome Coronavirus, or MERS, is a little different story. WHO says 33 infections have been reported, with 18 deaths. Experts are watching cases in France, where one patient who traveled from Dubai was confirmed to have the virus.

A man who shared a hospital room with the 65-year-old man also has the virus, French officials said Sunday -- something that shows the virus and and does spread in hospitals.

Officials were relieved that three health care workers who cared for the 65-year-old patient and who got sick have tested negative for the virus.

Also Sunday, WHO Assistant Director-General Keiji Fukuda could probably be passed between people in close contact, but there was no evidence of sustained "generalized transmission in communities."

Some reports suggest an outbreak in Saudi Arabia also affected people in the same hospital.

This worries Dr. Eric Toner of the Center for Health Security at the University of Pittsburgh Medical Center. SARS – severe acute respiratory syndrome – also spread mostly in hospitals. SARS spread to 29 countries in 2003, killing 775 people and making 8,000 sick before it was stopped.

“These cases, whether confirmed or not, should be a wake-up call,” Toner writes in his blog.

The good news is that SARS was stopped using good hospital hygiene. Face masks, gloves and careful disinfection prevented its spread. And SARS only spread once people were noticeably ill, unlike flu, which people can spread before they feel sick and after they feel better.

The bad news is that hospitals may have forgotten this lesson. “SARS was stopped by healthcare workers being aware of the disease, having a high index of suspicion of anyone with fever and respiratory symptoms who had recently been in an affected region, and quickly implementing infection control measures with any suspect case,” Toner says.

“Until now, all cases of MERS originated in the Middle East, but as the confirmed French case demonstrates, the virus is only a plane ride away from other parts of the world. In the 10 years since the SARS outbreak, many hospitals have become lax in their attention to respiratory precautions.”

Gabriel says he’s working to make sure this isn’t the case with U.S. hospitals. 

“Hygiene practices are now better than they ever have been,” Gabriel said. “We send out reminders daily.”

Sri Lanka: Ministry warns of Influenza A and B virus outbreak

The Health Ministry yesterday warned of a possible influenza A and B virus outbreak and appealed to the people to rush patients in the risk group to the nearest hospital if cough and fever continued for more than a day after treatment.

Daily Mirror ,

11 May, 2013

Health Services Director General Dr. Mahipala identified expectant mothers, those over 65 years of age and children less than two years and those with non-communicable diseases such as diabetes, kidney failure and coronary heart diseases as those vulnerable.

The Health Ministry sprung to accelerate its influenza preventive drive when the number of deaths from influenza rose to four yesterday when another expectant mother with diabetes died at the Castle Street Maternity Hospital and the number of patients rose to 538 island-wide.

Dr. Mahipala said 108 PSR (Percutaneous Steriotactic Radiofrequency) tests conducted from among 538 specimens received by the Medical Research Institute (MRI) in April were positive for influenza. 13 of the 44 samples obtained from expectant mothers were also positive for influenza.

Dr. Mahipala said the influenza A or B was not fatal but could harm the respiratory system and lungs. Therefore early treatment is extremely vital and said 87out of 221 samples analyzed by MRI in the first week of May were also found to be positive for influenza.

He advised the public to rush influenza patients to the nearest hospital immediately and use a mask when talking to them as influenza virus contaminates air when the patients speak and cough.

A circular sent out by the DGHS has instructed health authorities to give a short training to health staff of their respective establishments on handling and treatment of influenza patients, Dr. Mahipala stressed. (SAJ)

Bird flu outbreak affects tourism to China

The Voice of Russia

12 May, 2013

The number of Russian tourists travelling to China has reduced amid the H7N9 bird flu outbreak, the country`s chief sanitary inspector Gennady Onishchenko said.

He added that risks remain that the virus could reach Russia with migrants or birds.

However, tests carried out in some Siberian towns and in the Far Eastern district went out negative, Mr. Onishchenko said

Study identifies influenza viruses circulating in pigs and birds that could pose a risk to humans

In the summer of 1968, a new strain of influenza appeared in Hong Kong. This strain, known as H3N2, spread around the globe and eventually killed an estimated 1 million people

Medical Press,

10 May, 2013

A new study from MIT reveals that there are many strains of H3N2 circulating in birds and pigs that are genetically similar to the 1968 strain and have the potential to generate a pandemic if they leap to humans.

The researchers, led by Ram Sasisekharan, the Alfred H. Caspary Professor of Biological Engineering at MIT, also found that current flu vaccines might not offer protection against these strains.

"There are indeed examples of H3N2 that we need to be concerned about," says Sasisekharan, who is also a member of MIT's Koch Institute for Integrative Cancer Research. "From a pandemic-preparedness point of view, we should potentially start including some of these H3 strains as part of influenza vaccines."

The study, which appears in the May 10 issue of the journal Scientific Reports, also offers the World Health Organization and public-health agencies' insight into viral strains that should raise red flags if detected.

Influenza evolution

In the past 100 years, influenza viruses that emerged from pigs or birds have caused several notable flu pandemics. When one of these avian or swine viruses gains the ability to infect humans, it can often evade the immune system, which is primed to recognize only strains that commonly infect humans.

Strains of H3N2 have been circulating in humans since the 1968 pandemic, but they have evolved to a less dangerous form that produces a nasty seasonal flu. However, H3N2 strains are also circulating in pigs and birds.

Sasisekharan and his colleagues wanted to determine the risk of H3N2 strains re-emerging in humans, whose immune systems would no longer recognize the more dangerous forms of H3N2. This type of event has a recent precedent: In 2009, a strain of H1N1 emerged that was very similar to the virus that caused a 1918 pandemic that killed 50 million to 100 million people.

"We asked if that could happen with H3," Sasisekharan says. "You would think it's more readily possible with H3 because we observe that there seems to be a lot more mixing of H3 between humans and swine."

Genetic similarities

In the new study, the researchers compared the 1968 H3N2 strain and about 1,100 H3 strains now circulating in pigs and birds, focusing on the gene that codes for the viral hemagglutinin (HA) protein.

After comparing HA genetic sequences in five key locations that control the viruses' interactions with infected hosts, the researchers calculated an "antigenic index" for each strain.

This value indicates the percentage of these genetic regions identical to those of the 1968 pandemic strain and helps determine how well an influenza virus can evade a host's immune response.

The researchers also took into account the patterns of attachment of the HA protein to sugar molecules called glycans. The virus' ability to attach to glycan receptors found on human respiratory-tract cells is key to infecting humans.

Seeking viruses with an antigenic index of at least 49 percent and glycan-attachment patterns identical to those of the 1968 virus, the research team identified 581 H3 viruses isolated since 2000 that could potentially cause a pandemic.

Of these, 549 came from birds and 32 from pigs. The researchers then exposed some of these strains to antibodies provoked by the current H3 seasonal-flu vaccines. As they predicted, these antibodies were unable to recognize or attack these H3 strains.

Of the 581 HA sequences, six swine strains already contain the standard HA mutations necessary for human adaptation, and are thus capable of entering the human population either directly or via genetic reassortment, Sasisekharan says.

"One of the amazing things about the influenza virus is its ability to grab genes from different pools," he says. "There could be viral genes that mix among pigs, or between birds and pigs."

"The findings from this study will raise our awareness for potential H3N2 flu pandemics and will at the same time help us to monitor, prevent and prepare for such events," says Yizhi Jane Tao, an assistant professor of biochemistry and cell biology at Rice University who was not part of the research team.

Sasisekharan and colleagues are now doing a similar genetic study of H5 influenza strains. The H3 study was funded by the National Institutes of Health and the National Science Foundation.

More information: "Antigenically intact hemagglutinin in circulating avian and swine influenza viruses and potential for H3N2 pandemic"

www.nature.com/sre… ep01822.html Journal reference: Scientific Reports

Provided by Massachusetts Institute of Technology