Officials are investigating norovirus outbreaks involving dozens of cases linked to raw oysters from British Columbia.
Tag Archives: pandemic
Frontiers Pub. Health: The Zoonotic Threat From Four Types Of Respiratory Viruses
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Zoonotic diseases – those which originated in or are normally hosted by non-human species – but can infect humans – have been with us for many thousands of years. But their ability to spread, and opportunities to adapt to humans, likely only really took off as humans began to cluster together in communities.
- Tuberculosis probably jumped to humans when we began to domesticate goats and cattle 5000 years ago.
- Measles appears to have evolved from canine distemper and/or the Rinderpest virus of cattle.
- And Influenza, as most of you know, is native to aquatic birds.
The list of zoonotic diseases is long and continues to expand, and includes such notable nasties as SARS, MERS, Babesiosis, Borrelia (Lyme), Nipah, HIV, Plague, Rabies, Hendra, Malaria, Dengue, Zika, Hantavirus, Ebola, Bartonella, Leptospirosis, Q-Fever, several flavors of avian flu and many, many others.
Over the years we’ve looked at this growing trend, which was largely predicted back in the mid 1990s by noted anthropologist and researcher George Armelagos of Emory University (see The Third Epidemiological Transition (Revisited)).
Around the same time (1995), the CDC began publishing the EID Journal, a highly respected peer-reviewed journal on emerging pathogenic threats. Today emerging disease threats, and neglected tropical diseases, are a hot topic in scores of respected journals.
In 2014, in Emerging zoonotic viral diseases L.-F. Wang (1, 2) * & G. Crameri wrote:
The last 30 years have seen a rise in emerging infectious diseases in humans and of these over 70% are zoonotic (2, 3). Zoonotic infections are not new. They have always featured among the wide range of human diseases and most, e.g. anthrax, tuberculosis, plague, yellow fever and influenza, have come from domestic animals, poultry and livestock.
However, with changes in the environment, human behaviour and habitat, increasingly these infections are emerging from wildlife species.
While the public health burden from non-respiratory diseases (i.e. Dengue, Zika, Lyme, Malaria, rabies, Ebola, etc.) is very high, respiratory viruses – due to their ability to spread quickly, and sometimes even globally – are among the most concerning.
We’ve an excellent mini-review of zoonotic respiratory disease threats, published earlier this month in Frontiers In Public Health, that looks four specific types of emerging or re-emerging threats; influenza viruses, coronaviruses, enteroviruses (EVs), and adenoviruses (Ads).
Not a complete list, of course. But these four groups are viewed as having particularly good growth prospects.
I’ve only included a few excerpts, so follow the link to read the full article.
Emily S. Bailey1,2*, Jane K. Fieldhouse1,2, Jessica Y. Choi1,2 and Gregory C. Gray1,2,3,4
1Duke Global Health Institute, Duke University, Durham, NC, United States
2Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, United States
3Global Health Research Center, Duke-Kunshan University, Kunshan, China
4Emerging Infectious Diseases Program, Duke-NUS Medical School, SingaporeDuring the last two decades, scientists have grown increasingly aware that viruses are emerging from the human–animal interface. In particular, respiratory infections are problematic; in early 2003, World Health Organization issued a worldwide alert for a previously unrecognized illness that was subsequently found to be caused by a novel coronavirus [severe acute respiratory syndrome (SARS) virus].
In addition to SARS, other respiratory pathogens have also emerged recently, contributing to the high burden of respiratory tract infection-related morbidity and mortality. Among the recently emerged respiratory pathogens are influenza viruses, coronaviruses, enteroviruses, and adenoviruses.
As the genesis of these emerging viruses is not well understood and their detection normally occurs after they have crossed over and adapted to man, ideally, strategies for such novel virus detection should include intensive surveillance at the human–animal interface, particularly if one believes the paradigm that many novel emerging zoonotic viruses first circulate in animal populations and occasionally infect man before they fully adapt to man; early detection at the human–animal interface will provide earlier warning. Here, we review recent emerging virus treats for these four groups of viruses.
IntroductionDuring the last two decades, scientists have grown increasingly aware that viruses are emerging from the human–animal interface. In order to combat this increasingly complex problem, the One Health approach or initiative has been proposed as a way of working across disciplines to incorporate human, animal, and environmental health. Of particular concern are emerging respiratory virus infections; in a recent seminar given by the National Institute of Health on emerging and re-emerging pathogens, nearly 18% were respiratory viruses (1).
Among the recently emerged respiratory pathogens contributing to the high burden of respiratory tract infection-related morbidity and mortality, displayed graphically in Figure 1, are influenza viruses, coronaviruses, enteroviruses (EVs), and adenoviruses (Ads). In this report, we summarize the emerging threat characteristics of these four groups of viruses.
MJA & EID Journal On The Rise Of Buruli Ulcer In Australia
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| Skin Ulceration – Credit CDC |
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There is a popular Internet meme which says everything in Australia wants to kill you . . . which isn’t precisely true. Some things there only want to maim you.
Or so it seems.
While there are plenty of indigenous threats, in recent years a little understood skin infection – primarily reported in tropical Africa, Asia, and South America – has been increasingly reported in (often) temperate regions of Australia.
It is called Buruli ulcer (aka Mycobacterium ulcerans disease), and while the pathogen is known – it is caused by a bacteria from the same family as Tuberculosis and Leprosy – how it is transmitted remains a mystery.
The World Health Organization fact sheet on this disease has just been updated:
(Mycobacterium ulcerans infection)
Fact sheet
Updated April 2018
Key facts
- Buruli ulcer is a chronic debilitating disease caused by Mycobacterium ulcerans.
- It often affects the skin and sometimes bone, and can lead to permanent disfigurement and long-term disability.
- At least 33 countries with tropical, subtropical and temperate climates have reported Buruli ulcer in Africa, South America and Western Pacific regions. In Australia, an increasing number of cases have been reported since 2013.
- Partial data from 13 countries for 2017 shows 2206 cases compared to 1920 in 2016; Australia and Nigeria reporting most cases.
- Most patients in Africa are children aged under 15 years and most patients in Australia are adults.
- The mode of transmission is not known and there is no prevention for the disease.
Another mystery surrounding this infection is that cases are becoming more severe. This from the January 2018 EID Journal.
Research
Increased Severity and Spread of Mycobacterium ulcerans, Southeastern AustraliaAlex Y.C. Tai
, Eugene Athan, N. Deborah Friedman, Andrew Hughes, Aaron Walton, and Daniel P. O’Brien
Author affiliations: Barwon Health, Geelong, Victoria, Australia
Abstract
Reported cases of Mycobacterium ulcerans disease (Buruli ulcer) have been increasing in southeastern Australia and spreading into new geographic areas. We analyzed 426 cases of M. ulcerans disease during January 1998–May 2017 in the established disease-endemic region of the Bellarine Peninsula and the emerging endemic region of the Mornington Peninsula. A total of 20.4% of cases patients had severe disease.
Over time, there has been an increase in the number of cases managed per year and the proportion associated with severe disease. Risk factors associated with severe disease included age, time period (range of years of diagnosis), and location of lesions over a joint. We highlight the changing epidemiology and pathogenicity of M. ulcerans disease in Australia.
Further research, including genomic studies of emergent strains with increased pathogenicity, is urgently needed to improve the understanding of this disease to facilitate implementation of effective public health measures to halt its spread.
Yesterday The Medical Journal of Australia published two articles – a case report and an editorial – on Mycobacterium ulcerans infection, which you’ll find links to below:
Michael J Loftus, Nicola Kettleton-Butler, Denton Wade, R Michael Whitby and Paul DR Johnson
Med J Aust 2018; 208 (7): 290-291. || doi: 10.5694/mja17.01158
Published online: 16 April 2018
Daniel P O’Brien, Eugene Athan, Kim Blasdell and Paul De Barro
Med J Aust 2018; 208 (7): 287-289. || doi: 10.5694/mja17.00879
Published online: 16 April 2018
While M. ulcerans is found in the environment (soil and water), it has also been detected (by PRC) in mosquitoes and other biting insects, and is known to affect small mammals (particularly possums), making for a number of plausible routes of transmission.
If that sounds vaguely familiar, you may recall that armadillos have been linked to the spread of Leprosy in North America (see Video: Florida DOH On The Link Between Armadillos & Leprosy).
While the number of Australian cases remains small, and the infection can usually be treated with antibiotics (albeit with sometimes serious side effects), the outcomes are not always positive.
This is also a reminder that vast oceans and long distances are no longer barriers to the spread of infectious diseases, and once exotic pathogens have a way of making inroads into new regions.
Connecticut: Two Cases Of Fatal H1N1 In Cats
Oops!
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Until about 15 years ago, cats were thought not to be susceptible to human or avian flu viruses. All of that changed in 2003 when zoos in South-East Asia that kept large cats found out to their dismay what happens when you feed H5N1 infected chicken carcasses to tigers and leopards.
The following comes from a World Health Organization GAR report from 2006.
H5N1 avian influenza in domestic cats
28 February 2006
(EXCERPTS)
Several published studies have demonstrated H5N1 infection in large cats kept in captivity. In December 2003, two tigers and two leopards, fed on fresh chicken carcasses, died unexpectedly at a zoo in Thailand. Subsequent investigation identified H5N1 in tissue samples.
In February 2004, the virus was detected in a clouded leopard that died at a zoo near Bangkok. A white tiger died from infection with the virus at the same zoo in March 2004.
In October 2004, captive tigers fed on fresh chicken carcasses began dying in large numbers at a zoo in Thailand. Altogether 147 tigers out of 441 died of infection or were euthanized. Subsequent investigation determined that at least some tiger-to-tiger transmission of the virus occurred.
In 2006, virologist C. A. Nidom of the Institute of Tropical Disease, Airlangga University demonstrated that of 500 cats he tested in and around Jakarta, 20% had antibodies for the H5N1 bird flu virus.
Findings that prompted the FAO in 2007 to warn that: Avian influenza in cats should be closely monitored.
Since then we’ve seen ample evidence that cats – including pets – can be infected with both avian and human flu viruses.
During the 2009 H1N1 pandemic we saw several reports of feline infection, and in late 2010 we saw a study (see EID Journal: Pandemic H1N1 Infection In Cats) that looked at the pathogenesis of novel H1N1 in domestic felines.
Experimental Pandemic (H1N1) 2009 Virus Infection of Cats
DOI: 10.3201/eid1611.100845
van den Brand JMA, Stittelaar KJ, van Amerongen G, van de Bildt M, Leijten LL, Kuiken T, et al. Experimental pandemic (H1N1) 2009 virus infection of cats. Emerg Infect Dis. 2010 Nov; [Epub ahead of print]
Conclusions
Intratracheal infection of domestic cats with pandemic (H1N1) 2009 virus resulted in mild-to-moderate clinical signs and virus replication throughout the respiratory tract that caused diffuse alveolar damage.
Pathogenic changes in the respiratory tract in cats were similar to those that occur in humans, macaques, and ferrets (7,11–13). Seroconversion of sentinel cats indicated cat-to-cat transmission.
While we saw a rare zoonotic transmission of avian H7N2 from a cat to a human in New York City in late 2016 (see EID Journal: Avian H7N2 Virus in Human Exposed to Sick Cats) – along with vigorous with cat-to-cat transmission – companion animals are far more likely to contract seasonal flu from humans (reverse zoonosis) than to give it to people.
Which brings us to a rare report this week of two fatal H1N1 infections in cats from a single household in Connecticut. Reportedly, both cats had pre-existing conditions, and the owner of the cats had recently been sick with a flu-like illness.
Details on this case can be found in two local reports:
Sadly, some in the media still insist on calling seasonal A(H1N1) `swine flu’, particularly since there really is a swine H1N1 on our radar. But I digress . . .
From PetMD we get this following:
H1N1 Influenza Infection in Cats
The H1N1 variant of the influenza virus, previously known somewhat inaccurately as “swine flu”, is contagious to cats as well as to people. In addition, this virus is also known to be able to infect dogs, pigs, and ferrets. Though the spread of this particular influenza virus is no longer considered to be an epidemic of emergency proportions, it does continue to spread worldwide.
Symptoms and Types
Symptoms may range from very mild to extremely severe and some infected cats may show no signs of disease at all.
The most common symptoms seen include:
- Coughing
- Sneezing
- Lethargy
- Lack of appetite
- Runny eyes
- Runny nose
- Fever
- Labored breathing
Some cats infected with H1N1 influenza have not survived, but the majority of infected cats suffer mild to moderate symptoms.
While the risks are low, you may want to reconsider the next time you are down with the flu and are tempted to curl up with a beloved pet.
For more on companion animals and flu (of all types), you may wish to revisit:
Nature: Fatal Swine Acute Diarrhoea Syndrome Caused By An HKU2-related Coronavirus Of Bat Origin
Pandemic watching getting closer to source of primary vectors – next we will nail that it is human interventions that create the imbalances which give rise to viral outbreaks that are nature’s way of re-balancing the system
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| How Bat Viruses Jump Species |
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Until SARS emerged from China roughly 15 years ago (see SARS and Remembrance), only four coronaviruses (Alpha coronaviruses 229E and NL63, and Beta coronaviruses OC43 & HKU1) were known to infect humans.
These viruses generally produced mild upper respiratory illnesses in humans, are probably responsible for 15%-30% of the `common colds’ around the world, and only rarely migrate to the lower respiratory tract (cite).
In 2003 SARS-CoV emerged, followed in 2012 by the MERS-CoV virus, both causing severe, often fatal respiratory illness in humans. Both are zoonotic viruses spread via intermediary hosts, and are believed to be of bat-origin.
There are many other coronaviruses that infect other non-human species – including horses, cattle, and swine – but they are particularly common among bats.
In 2017 researchers from EcoHealth Alliance published a letter in Nature (Host and viral traits predict zoonotic spillover from mammals) providing the first comprehensive analysis of viruses known to infect mammals.
From their website summary:
The study shows that bats carry a significantly higher proportion of viruses able to infect people than any other group of mammals; and it identifies the species and geographic regions on the planet with the highest number of yet-to-be discovered, or ‘missing’, viruses likely to infect people. This work provides a new way to predict where and how we should work to identify and pre-empt the next potential viral pandemic before it emerges.
Last summer, in EID Journal: A New Bat-HKU2–like Coronavirus in Swine, China, 2017, we looked at the recent discovery of a new HKU2-like coronavirus in Chinese pigs showing symptoms of PED (Porcine Epidemic Diarrhea), which they tentatively dubbed porcine enteric alphacoronavirus (PEAV).
HKU2 is one of a number of coronaviruses discovered in the wild (in this case, in Horseshoe bats) by Hong Kong researchers in the years immediately following the SARS epidemic.
Fast forward to yesterday, and we get a letter (alas, behind a pay wall) in Nature that further describes this (or a very similar) virus isolated from pigs in Guangdong Province, and also finds a close match in nearly 10% of local bats they tested.
To help fill in the gaps we also have accompanying press releases from the NIH, and EcoHealth Alliance.
Letter
Fatal swine acute diarrhoea syndrome caused by an HKU2-related coronavirus of bat origin
Peng Zhou, Hang Fan,[…] Jing-Yun Ma
Nature (2018)
doi:10.1038/s41586-018-0010-9
Download CitationPublished online:04 April 2018
Abstract
Cross-species transmission of viruses from wildlife animal reservoirs poses a marked threat to human and animal health1. Bats have been recognized as one of the most important reservoirs for emerging viruses and the transmission of a coronavirus that originated in bats to humans via intermediate hosts was responsible for the high-impact emerging zoonosis, severe acute respiratory syndrome (SARS)2,3,4,5,6,7,8,9,10.
Here we provide virological, epidemiological, evolutionary and experimental evidence that a novel HKU2-related bat coronavirus, swine acute diarrhoea syndrome coronavirus (SADS-CoV), is the aetiological agent that was responsible for a large-scale outbreak of fatal disease in pigs in China that has caused the death of 24,693 piglets across four farms.
Notably, the outbreak began in Guangdong province in the vicinity of the origin of the SARS pandemic. Furthermore, we identified SADS-related CoVs with 96–98% sequence identity in 9.8% (58 out of 591) of anal swabs collected from bats in Guangdong province during 2013–2016, predominantly in horseshoe bats (Rhinolophus spp.) that are known reservoirs of SARS-related CoVs.
We found that there were striking similarities between the SADS and SARS outbreaks in geographical, temporal, ecological and aetiological settings. This study highlights the importance of identifying coronavirus diversity and distribution in bats to mitigate future outbreaks that could threaten livestock, public health and economic growth.
From the NIH we get:
New coronavirus emerges from bats in China, devastates young swine Identified in same region, from same bats, as SARS coronavirus.
What
A newly identified coronavirus that killed nearly 25,000 piglets in 2016-17 in China emerged from horseshoe bats near the origin of the severe acute respiratory syndrome coronavirus (SARS-CoV), which emerged in 2002 in the same bat species. The new virus is named swine acute diarrhea syndrome coronavirus (SADS-CoV).
It does not appear to infect people, unlike SARS-CoV which infected more than 8,000 people and killed 774. No SARS-CoV cases have been identified since 2004.
The study investigators identified SADS-CoV on four pig farms in China’s Guangdong Province. The work was a collaboration among scientists from EcoHealth Alliance, Duke-NUS Medical School, Wuhan Institute of Virology and other organizations, and was funded by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health. The research is published in the journal Nature.
The researchers say the finding is an important reminder that identifying new viruses in animals and quickly determining their potential to infect people is a key way to reduce global health threats.
SADS-CoV began killing piglets on a farm near Foshan in Guangdong Province in late October 2016. Investigators initially suspected porcine epidemic diarrhea virus (PEDV) as the cause. PEDV is a type of coronavirus common to swine that had been identified at the Foshan farm. Detection of PEDV ceased by mid-January 2017, yet piglets continued to die, suggesting a different cause. Scientists say separating sick sows and piglets from the rest of the herd helped stop the outbreak of SADS-CoV by May 2017.
Investigators confirmed the connection of SADS-CoV to bats by identifying the new virus in the small intestine of piglets from the outbreak. They then determined that the genetic sequence of SADS-CoV is similar to that of a bat coronavirus discovered in 2007 and looked for evidence of SADS-CoV in bat specimens collected from 2013 to 2016 in Guangdong Province. The new virus appeared in 71 of 596 specimens (11.9 percent).
The researchers also tested 35 farm workers who had close contact with sick pigs, none of whom tested positive for SADS-CoV.
Currently six coronaviruses are known to cause disease in people, but so far only two of them — SARS-CoV and Middle East Respiratory Syndrome coronavirus — have caused large outbreaks of fatal illness in people.
And from EcoHealth Alliance:
EcoHealth Alliance Announces Discovery of New Bat-Origin Virus Impacting Pig Farms in Southern China
NEW YORK – April 4, 2018 – EcoHealth Alliance, a nonprofit organization working at the intersection of animal, environmental, and human health on a global scale, announced that–in collaboration with local partners–it has discovered a novel coronavirus in China called Swine Acute Diarrhea Syndrome (SADS-CoV). The virus has, so far, has caused the deaths of 24,693 piglets between 2016 and 2017 on several farms in the southern Chinese province of Guangdong, where the human pandemic SARS emerged in 2002.
Published today by the journal Nature, the virus’ discovery solves the mystery of mass pig die-offs on four farms in Guangdong Province. Particularly harmful to newborn piglets, SADS-CoV causes severe and acute diarrhea, acute vomiting, and eventually death due to rapid weight loss. It has a fatality rate as high as 90 percent for piglets five days or younger, but that drops in older pigs.
The very good news here is – for now, anyway – there is no indication that this recently discovered virus can infect humans.
While the addition of yet another porcine diarrhea coronavirus (see SECD: Another Emerging Coronavirus Threat) may seem mostly a concern for pig farmers and the pork industry, coronaviruses – having a large RNA genome – tend to evolve over time (see slide below).
Already well adapted to pigs – who share a high degree of physiology with humans (if that bothers you, think how the pig feels) – it is not much of a stretch to see one of these viruses someday becoming a zoonotic threat.
In recent years we’ve seen a series of reports on bat viruses that pose potential zoonotic threats – making this an excellent time to be a Chiropterist.
Some recent blogs include:
Emerg. Microbes & Infect.: Novel Coronaviruses In Least Horseshoe Bats In Southwestern China
PNAS: SARS-like WIV1-CoV Poised For Human Emergence
Sci Rpts: Avian & Human Influenza Compatible Receptor Cells In Little Brown Bats
In world first, UK reports high-level gonorrhea resistance
Antibiotic courses for sinusitis often exceed guidelines, study says
Hmmm. Latest version of sinusitis are not responding to normal doses. Several co-workers have had two to three week infections that only responded to repeated courses. Seems “the bridge too far” is already working its way through the population. Ugh!
The findings represent an opportunity to reduce unnecessary use of the drugs.
Too many hospitalized kids get preventive antibiotics
Packaged coconut recalled amid multistate Salmonella outbreak
Flu numbers form the US…Peaky McPeakFace
Flu cases in the US from Week 4 to Week 8, 2018.[1]
Graphs from https://www.cdc.gov/flu/weekly/pastreports.htm
This year’s annual influenza (flu) H3N2 epidemic in the United States (US) has peaked. It’s been a big season in the US and the United Kingdom and in Canada, as it was a record-breaking one in Australia.
Referring to my earlier post that showed about a 3-week lag before the bars on the CDC graphs (laboratory-confirmed influenza infected people) settled in,[2] we can say that the past 3 reports show the beginning of a definite downward trend in total laboratory confirmed influenza cases.
Because the peak was so high (lots of infected and ill people) this season, it will take a while for the epidemic to cool down; there will still be lots of human cases (influenza infected and ill people) for weeks to come.
The graphs above show a few things that combine to show the peak of lab confirmed cases is behind us.
- I’ve used a red star to mark the current week bar (which week is listed under the graph).
- The blue triangle marks Week 4’s bar in each graph
- From Week 5 I’ve drawn an orange dashed line just above Week 4’s bar.
- The sharp-eyed among you will have noticed that the y-axis remains stable from Week 5, at 20,000 positive specimens
- The orange line lets us see that in Week 5, Week 4’s graph is still rising, From Week 6, Week 4’s bar remains at a stable peak (that roughly 3-week settling in period again).
- The orange dotted line tracks let’s you see Week 5’s, 6’s and 7’s data settle in, in reference to the stable Week 4 peak. Just for interest.
- From Week 8 we can see that Week 5 and Week 6 have remained below Week 4’s peak; Week 6’s total is less than Week 5 and Week 7’s less than Week 6’s (although these haven’t passed the magic 3-week mark yet.
This is the case for lab-confirmed cases. Whether the actual number of infected people who were not ill enough to get tested has also peaked is unknown. You can get an estimate by looking at “influenza-like illness” (ILI) numbers (ill people but not necessarily lab-tested) although this can be a trap in the absence of other virus testing, because other viruses can cause ILI.
But, if you hypothesize that the number of people who are ill with the lab-confirmed flu is a representative sample of the whole community who are infected, you would also expect that the peak has passed in general.
I’m hoping we see some more information about the vaccine issues in the wash-up to this season. In particular, were cell-line-based vaccines more effective than egg-based vaccines? And what might be done to improve vaccine uptake among those most at risk of severe influenza; the young (with the hospitalization rates), the elderly and those with underlying disease. The US has a range of vaccine available is they may be in a good position to look into this.
Whats next? The southern hemisphere flu season is coming!!
References…
- Influenza: Past Weekly Surveillance Reports
https://www.cdc.gov/flu/weekly/pastreports.htm - Flu may not be peaking even if it looks like it is right now…and here’s why
http://virologydownunder.com/flu-may-not-be-peaking-even-if-it-looks-like-it-is-right-now-and-heres-why/





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