H5N1

McKenna on drug resistance and MRSA in pork

Via Maryn McKenna's Superbug: Drug Resistance in Pork: More Going On Than Appears. Excerpt:

A paper released recently, by the University of Iowa team that is the lone US research group tracking “pig MRSA” ST398, caused a ripple. (It came out while I was at ScienceOnline and it’s taken me a while to catch up.) 

The paper compares the occurrence of MRSA, drug-resistant staph, on various cuts of retail pork from pigs that were raised either conventionally in confinement, with routine use of antibiotics, or in an alternative rearing scheme with no antibiotics. (NB: Not “organic,” despite what some headlines said; that’s a separate issue of USDA licensure.) The team found that both conventionally raised and antibiotic-free meat carried MRSA, both the human-associated kind and the pig-adapted kind. 

The TL;DR over the past week has been: There’s just as much resistant bacteria on drug-free meat as there is on conventional meat, so why spend the money — or raise the alarm over farm antibiotic use? 

My interpretation is a little more nuanced. But my takeaway is that, in its underlying data, the study proves what campaigners against ag antibiotic use keep saying: that once you use antibiotics indiscriminately and drive the emergence of resistant organisms, you have no way of predicting where that resistance DNA will end up. 

A recap: The team, which is led by Tara Smith, PhD, collected 395 samples of pork (300 conventional, 95 raised without antibiotics) from supermarkets in Minnesota, Iowa, and the New Jersey suburbs of New York City. 

• They found S. aureus, staph bacteria, on 256 of them (202 conventional, 54 alternative.) 

•Of those isolates, 230 (183 conventional, 47 alternative) were MSSA or drug-sensitive staph. 

•Of the remaining 26 (19 conventional, 7 alternative) MRSA or drug-resistant strains, 7 (5 conventional, 2 alternative) were of types usually associated with the livestock strain, which is usually called ST- or CC- 398. 

For those keeping score at home, that’s an overall prevalence of MRSA on pork of of 6.6 percent, which is the highest ever found in the small number of such studies done in the United States.

Experts call on Indonesian public to swat dengue fever

Via The Jakarta Globe: Experts Call On Indonesian Public to Swat Dengue Fever. Excerpt:

Experts are calling for Indonesians to piggyback on a government campaign and take more responsibility for preventing the spread of dengue hemorrhagic fever in the disease’s most infectious month. 

Haryono, the founder of the anti-dengue Pikoli Foundation, said individuals could do a great deal to help eradicate the disease. 

“If the whole society, at the same time, eliminates mosquito breeding places, we can cut mosquito diseases by 70 percent,” he said. “No eggs means no larvae. No larvae means no mosquitoes.” 

In 2010, after a near-death experience with dengue fever, Haryono found himself questioning health services when he was released from the hospital early. 

After realizing that poor people could not afford hospital bills and that the public had little awareness of the issue, he was motivated to create the Pikoli Foundation. 

“The government needs to involve society,” he said. “Many countries fail to eradicate mosquito-borne diseases because they don’t involve society.” 

Experts believe it comes down to public awareness. 

“People should know about dengue because this is an epidemic in Indonesia,” Indonesian Doctors Association (IDI) chairman Prijo Sidipratomo said. 

The anti-mosquito 3M campaign — “Mengubur, Menutup dan Menguras” (“Drain, Seal and Bury”) — has gotten lots of publicity on billboards and televisions around Indonesia, but Prijo said this was not enough to prevent one of the most deadly diseases in the country. 

“The attitude of the people is not good,” he said. “Sometimes they don’t care.” 

Last year 49,863 cases of dengue feer were recorded in 30 provinces in Indonesia, an incidence rate of 2,099 per 100,000 people. Yet this is a notable decrease from 2010, when there were 156,086 recorded cases in 33 provinces (6,570 per 100,000).

H5N1 controversy: CIDRAP summarizes the debate

Via CIDRAP, Robert Roos covers a turbulent day: NSABB: Studies show how H5N1 can jump natural barrier. Excerpt from a long report:

The core of a US biosecurity advisory board's concern about two controversial, as-yet-unpublished studies on H5N1 viruses is that the studies have shown how to remove the apparent natural barrier that keeps the viruses from spreading efficiently in mammals, members of the board said in statements published today. 

Removal of this barrier creates the potential for a catastrophic pandemic if such mutant viruses were released by bioterrorists or by accident, said members of the National Science Advisory Board for Biosecurity (NSABB), which has focused mainly on the perceived risk of bioterrorism. The board has recommended withholding details of the studies from publication. 

"The artificial evolution of a new mammal-adapted H5N1 virus, as reported in these two papers, has removed the natural barriers that might have existed. Accomplishing this in the lab, however, doesn't mean that it can occur naturally," said Paul Keim, PhD, acting chair of the NSABB, in a question-and-answer interview published in Nature. 

A statement signed by all the NSABB members was published simultaneously in Nature and Science. The findings of the two studies are "very important because, before these experiments were done, it was uncertain whether avian influenza A/H5N1 could ever acquire the capacity for mammal-to-mammal transmission," the statement says. 

"Now that this information is known, society can take steps globally to prepare for when nature might generate such a virus spontaneously." 

Although NSABB members have talked to reporters in recent weeks, today's publications were the first formal statements from the board since its recommendation against full publication was announced by the US National Institutes of Health (NIH) on Dec 20. The Department of Health and Human Services (HHS) endorsed the board's recommendation and forwarded it to Science and Nature, the journals considering publishing the studies.

Dengue in Brazil: "We expect a big epidemic in 2012"

Via Folha.com: Rio confirma casos dengue tipo 4 e diz esperar epidemia da doença. [Rio confirms type 4 dengue cases and says it expects an epidemic of the disease] Excerpt, with my translation:

A Secretaria Municipal de Saúde e Defesa Civil do Rio informou nesta terça-feira que foram confirmados na semana passada os seis primeiros casos de dengue do tipo 4 nas zonas norte e oeste da capital fluminense. Na mesma semana, foram notificados 21 casos pela secretaria, totalizando 1.234 este ano. 

The Rio Municipal Secretariat of Health and Civil Defence announced this Tuesday that the first six cases of type 4 dengue were confirmed last week in the northern and western zones of the capital. In the same week the secretariat confirmed 21 cases, making a total of 1,234 this year.

Já a Secretaria Estadual de Saúde informou que foram notificados em todo o Estado 2.711 casos da doença, número que não inclui os casos registrados no município do Rio. 

The State Secretariat of Health reported that 2,711 dengue cases were reported in the state, a number that does not include those recorded in the municipality of Rio.

O superintendente de Vigilância em Saúde da Prefeitura do Rio, Márcio Garcia, diz acreditar que a notificação da presença do vírus tipo 4 no município só reforça a possibilidade de uma nova epidemia de dengue na cidade. 

Márcio Garcia, superintendent of health surveillance in Rio Prefecture, said that the presence of type 4 in the municipality strengthens the possibility of a new epidemic of dengue in the city.

"Nós já estávamos preparados para a presença da dengue do tipo 4, isso só faz fortalecer a nossa expectativa de viver uma grande epidemia no ano de 2012".

"We are now prepared for the presence of type 4 dengue, which strengthens our expectations of experiencing a big epidemic in 2012."

Malaysia: Six dengue deaths in one month

Via New Straits Times: Six dengue deaths in one month. Excerpt:

This month alone, six people, including two students, died of haemorrhagic dengue, Health director-general Datuk Dr Hasan Abdul Rahman said.   

Expressing concern, Dr Hasan said the death toll had doubled from the three cases reported in the same period last year.   

He said of the six victims, between the ages of 9 and 50, three  died in Selangor, another two in Kuala Lumpur and one in Negri Sembilan.    

"Five cases were reported in dengue hot spots."      

The public's attitude must change in order to fight the growing dengue menace,  he said after launching a Ridsect anti-dengue  competition at Sekolah Menengah (P) Seri Aman here yesterday.   

The  programme, jointly organised with the Education Ministry, is aimed at creating awareness among students and the younger generation on the  dengue menace.   

Dr Hasan said: "It only takes 10 minutes a week for house owners  to check for Aedes breeding spots in their  compound."   

Though there was a 15 per cent drop in cases reported until Jan 28, the number of deaths was high.   

Some 1,868 cases were reported since early this year, compared with 2,048 cases last year.

MSF: Mortality rate in Central African Republic at emergency level

Via MSF Canada: Mortality rate in Central African Republic at emergency level. Excerpt:

The Central African Republic (CAR) is in the grip of a chronic medical emergency.  

Four mortality studies conducted by Médecins Sans Frontières (MSF) in the past 18 months reveal crude mortality rates in some regions are at three times the emergency threshold level, which is considered a humanitarian crisis. 

These rates constitute an “out of control” situation, even though the areas with the highest mortality rates are not affected by conflict or a high number of displaced people. 

In a new report by MSF, Central African Republic: State of Silent Crisis, the organization concludes that existing levels of medical assistance are not enough to meet the scale of the medical needs. The report outlines the need for more actors, conducting larger medical operations that reach more people in need of assistance. 

The Central African Republic has the second lowest life expectancy in the world at 48 years, and the fifth highest death rate from infectious and parasitic disease. In much of CAR mortality rates are the result of seasonal epidemics, economic downturns, as well as conflict, displacement and a poor health system. 

"A health system torn apart by years of political and military instability, major organizational problems, and a lack of security in the northern and eastern regions of the country.... all these factors have had a catastrophic effect on the health of the population and show, to a large extent, how the extremely high mortality rates have come about,” says Olivier Aubry, MSF head of mission in CAR.  

“For example, last July, in Carnot, the under- five mortality rate was three times as high as the under-five mortality rate in Kenya’s Dadaab refugee camp, where people who fled from Somalia live in dire conditions. In Carnot, the crisis was unknown.” 

And yet, the report argues, the commitment by the government and by the international community is going in the wrong direction. The government has been scaling down its investments in health, as have international donors, while humanitarian assistance has failed to reduce the widespread medical crisis. 

Despite the great need, both the government and international donors appear to be disengaging from health provision in the country.

H5N1 controversy: The ferret is already out of the bag

The Washington Post takes note of the debate: Recommendation to censor bird flu research driven by fears of terrorism. Excerpt and then a comment:

Citing fears of an “unimaginable catastrophe,” a government-appointed board on Tuesday explained why it recently recommended censoring details of new research on deadly H5N1, or avian, influenza. 

“Our concern is that publishing these experiments in detail would provide information to some person, organization, or government that would help them to develop similar ... viruses for harmful purposes,” the 23 voting members of the National Science Advisory Board for Biosecurity wrote in a statement published jointly by the journals Science and Nature. 

The potential harm of publishing the work in full exceeded the potential benefits, the board wrote, adding its decision was unanimous.

 “We do not believe that widespread dissemination of the methodology in this case is a responsible action,” they wrote. 

The board compared the new research on H5N1 to the development of the atomic bomb in the 1940s. In that decade, physicists also confronted the dilemma of how much of their work to make public.

The argument by analogy with the A-bomb is a shaky one. Having recruited top physicists into the Manhattan Project, J. Robert Oppenheimer accepted the top-secret regime on them imposed by General Leslie Groves. But he worried that the silence in the physics journals would give the game away.

He was right. As Richard Rhodes points out in one of his remarkable histories of nuclear weapons, a young Soviet physicist, home on leave from the front, devoured a batch of newly arrived US physics journals. The absence of reports by Oppenheimer et al. was all he needed; he pushed all the way to an interview with Stalin, who immediately launched a Soviet nuclear-weapons program.

So the ferret is already out of the bag. Just as the atomic bomb was discussed well before World War II even broke out, the mutation of H5N1 has been so widely debated that anyone interested in using Fouchier and Kawaoka to weaponize H5N1 is doubtless already working hard but discreetly. (And dementedly.) 

Such researchers would also have to develop and test and distribute an effective vaccine before they dared to launch a weaponized H5N1, and that procedure would draw a great deal of attention...some of it from those fine young men in the US Navy Seals. 

The H5N1 manuscript redaction controversy

Via mBio, an online science journal: The H5N1 Manuscript Redaction Controversy. Excerpt:

In an attempt to inform the ongoing discussion, mBio has commissioned three views on the H5N1 redaction controversy, written by Keim, Racaniello, and Webster. Our goal in publishing these views is to provide a venue for differences of opinion that will inform the debate. 

We note that the overwhelming majority of, if not all, participants in this controversy are well-informed and well-meaning individuals who hope to help and protect both society and science by espousing and promoting their views. 

We believe that a healthy debate will lead to the best decisions and help avoid great mistakes. We are also fully aware that some aspects of the ongoing debate have echoes in past philosophical debates, since the issues in question are in essence questions of value, belief, judgment, and principle. 

Consequently, we urge comity, respect, civility, self-examination, consideration, kindness, and generosity as we all navigate through this uncharted territory. In that spirit, we encourage our readership to contribute to the debate by using the commenting feature at the end of the “full text” versions of the online

The NSABB statement on H5N1 research

Science has published Adaptations of Avian Flu Virus Are a Cause for Concern. It's a PDF. Excerpt:

The life sciences have reached a crossroads. The direction we choose and the process by which we arrive at this decision must be undertaken as a community and not relegated to small segments of government, the scientific community, or society. Physicists faced a similar situation in the 1940s with nuclear weapons research, and it is inevitable that other scientific disciplines will also do so.

Along with our recommendation to restrict communication of these particular scientific results, we discussed the need for a rapid and broad international discussion of dual-use research policy concerning influenza A/H5N1 virus with the goal of developing a consensus on the path forward. There is no doubt that this is a complex endeavor that will require diligent and nuanced consideration. There are many important stakeholders whose opinions need to be heard at this juncture. This must be done quickly and with the full participation of multiple societal components.

We are aware that the continuing circulation of the highly pathogenic avian influenza A/H5N1 virus in Eurasia—where it is constantly found to cause disease in animals of particular regions—constitutes a continuing threat to humankind. A pandemic, or the deliberate release of a transmissible highly pathogenic influenza A/H5N1 virus, would be an unimaginable catastrophe for which the world is currently inadequately prepared. It is urgent to establish how best to facilitate the much-needed research as well as minimize potential dual use. 

Dr. Vincent Racaniello is already tweeting some responses. It's going to be a lively day. 

Chad: Why polio is so hard to eliminate

Via IRIN Africa: CHAD: Why polio is so hard to eliminate. Excerpt:

Poor-quality emergency immunization campaigns and low routine polio immunization coverage are helping the polio virus to spread in Chad, with 132 cases reported in 2011 - five times the number in 2010. More commitment is needed across the board, especially from local health authorities, to try to get immunizations right, say aid agencies. 

The current outbreak in Chad has been ongoing since 2007, classifying Chad as a “re-established transmission zone” according to the World Health Organization (WHO). 

Polio is endemic in Nigeria, Pakistan, India and Afghanistan - in other words, transmission of the disease in these places has never been broken. 

While a dysfunctional health system is linked to poor routine immunization coverage, “the primary reason [for the upsurge] is operational,” said Oliver Rosenbauer, spokesperson for the Global Polio Eradication Initiative at WHO in Geneva. 

“It is not to do with insecurity or lack of infrastructure… The outbreak response has not been sufficient to stop it [the outbreak]… They continue to miss too many children.” 

 Why children missed 

Immunizers have missed children for a variety of reasons: In some cases government and agency staff or volunteers inaccurately mapped out where they lived; or may have ordered too few vaccines or too few ice packs to cover each district, said WHO. 

Often communities are not well-sensitized in advance so families remain reluctant to bring their children forward, some resist on religious grounds, or they simply may not know that they can immunize a child even if he or she is sick, said WHO and UNICEF’s West Africa communication for development specialist Irina Dincu. 

Human error also plays a role, added Dincu, explaining that an ill-trained vaccinator may rest en route, breaking the cold chain, or a team may miss a few houses in a village.