H5N1

Dutch scientists defend patenting of deadly Saudi coronavirus™

A series of links sent by Lucie Lecomte this evening has shown me that MERS is rapidly turning into a squabble about who owns the virus. Via BusinessWeek.com: Dutch Scientists Defend Patenting of Deadly Saudi Coronavirus. Excerpt:

Dutch scientists who took out a patent on the novel coronavirus that’s killed 22 people since emerging in Saudi Arabia last year defended the move after the Saudi Health Ministry said the patent was hindering the fight against the outbreak. 

Albert Osterhaus and Ron Fouchier, virologists at Erasmus Medical Center in the Netherlands, said patenting the virus was a “normal thing to do,” and that they have shared it freely with more than 40 labs worldwide, in a phone interview from Rotterdam yesterday. 

“We’re still sharing this virus with everyone who wants to do public health research,” Osterhaus said. The suggestion that the patent was impeding progress in public health was “definitely not the case,” he said. 

Saudi Deputy Health Minister, Ziad Memish, told the World Health Assembly in Geneva earlier yesterday that the virus was sent from the country without proper permission, and that scientists outside the country had signed contracts with companies that make antivirals and vaccines, delaying the development of a diagnostic test. The assembly is the top decision-making body of the World Health Organization. 

Osterhaus said no agreements have been signed with any companies, and “diagnostic tests were developed instantly and were made freely available immediately to anyone who asked for them.”

For more on this issue, see this post at CIDRAP, as well as this morning's report on CBC Radio's The Current, and this post at Medical Daily.

WHO warns countries not to hoard secrets of coronavirus

Thanks to Lucie Lecomte for sending the link to this Reuters report: WHO warns countries not to hoard secrets of coronavirus.

The World Health Organization (WHO) warned countries with possible cases of the SARS-like novel coronavirus on Thursday that they must share information and not allow commercial labs to profit from the virus, which has killed 22 people worldwide. 

Saudi Arabia, where the first case occurred, has said the development of diagnostic tests for the disease has been delayed by a foreign laboratory's patent rights on the SARS-like virus. 

"Making deals between scientists because they want to take IP (intellectual property), because they want to be the world's first to publish in scientific journals, these are issues we need to address," WHO Director General Margaret Chan told health ministers attending the WHO's annual conference in Geneva. 

"No IP will stand in the way of public health actions." 

The virus was identified in September last year, three months after a scientist took a sample from Saudi Arabia to the Erasmus Medical Center in the Netherlands. 

"There was a lag of three months where we were not aware of the discovery of the virus," Saudi Arabia's Deputy Health Minister Ziad Memish told the Geneva meeting. 

He said it was taken out of the country without permission and Saudi Arabia only learned of its discovery from ProMED, a U.S.-based internet-based reporting system. 

The Rotterdam-based Erasmus lab then patented the process for synthesizing the virus, meaning that anyone else who wanted to use their method to study it would have to pay the lab. 

The patenting had delayed the development of diagnostic kits and serologic tests for the disease, Memish said. 

"The virus was sent out of the country and it was patented, contracts were signed with vaccine companies and anti-viral drug companies and that's why they have a MTA (Material Transfer Agreement) to be signed by anybody who can utilize that virus and that should not happen." 

Earlier on Thursday, Saudi Arabia announced another death from the virus in its central al-Qassim region, bringing the total number of deaths in the kingdom to 17. 

Jordan, Qatar, Tunisia, the United Arab Emirates, France and Britain have all had cases of the virus. 

"BURNING HOUSE" 

Chan told the health ministers "you are the boss" and urged them to ensure scientists shared their specimens with WHO's network of collaborating laboratories.

Dr. Carroll on Haiti, health politics, and the lesson of Marie-Claude Toussaint

One of the great rewards of running this blog is that it has introduced me to some truly remarkable people like Dr. John Carroll, who for years has worked in Haiti fighting everything from cholera to heart disease. 

Dr. Carroll has faced many obstacles, and not just in Haiti; I gather he has some long-running battles with health agencies in his home base of Peoria, Illinois. Tonight in the Peoria Journal Star he completes his account of the Deconstruction of a Haitian Heart. Excerpt:

Is there anything to learn from the medical saga of Marie-Claude Toussaint? Should this be just a “feel good” story? Are there any take home lessons? 

I think this is much more than a “feel good” story and it has many lessons to teach. 

First of all miracles do happen. Look above at the white flower growing from the concrete in front of the malnutrition center in the “worst slum in the western hemisphere”. This sure seems miraculous to me. And try to convince anyone in Naperville that Marie wasn’t a miracle. 

Another lesson with Marie is that all life is precious and needs to be protected before birth and after birth. Being Haitian should not bar Marie from living a full and healthy life. Our patient Marie developed rheumatic fever as a child. She had a strep throat that was never diagnosed and never treated with penicillin. Marie was one of 11 siblings and her parents had no money for things like this. Because of her untreated strep throat she developed rheumatic fever which went on to destroy her heart valves. 

In the poor areas of the world, like Haiti, acute rheumatic fever and rheumatic heart disease are estimated to affect nearly 20 million people and is the leading cause of cardiovascular death during the first five decades of life. Worldwide, there are 470,000 new cases of rheumatic fever and 233,000 deaths due to rheumatic heart disease each year. This would be like Peoria having about 20 new cases of rheumatic fever each year.

As a lifelong atheist, I can tell you this about God's personality: He has a witty way of putting me in the service of profound believers like Dr. Carroll and my Muslim pen pals in Iran. I take the joke in the affectionate way it was (I hope) intended.

Saudi Arabia: Syrian was latest MERS death

Via Arab News, a few new details on the 17th MERS death in Saudia Arabia: Expat dies of coronavirus infection in Qassim. Excerpt:

An expatriate residing in the central province of Qassim has died of the novel coronavirus infection, the Ministry of Health has announced. 

The latest fatality brings to 17 the total number of laboratory-confirmed coronavirus deaths in the kingdom. This was the first coronavirus case of a non-Saudi patient in the kingdom, the MOH said. 

In its latest update posted on its website late on Wednesday, the MOH said the patient was admitted at a hospital a few days ago due to severe acute respiratory syndrome and passed away on Tuesday. 

No other details were provided, but a statement by the World Health Organization (WHO) quoted a report it received from the Saudi MOH saying "the patient was a 63-year-old man with an underlying medical condition who was admitted to a hospital with acute respiratory distress on 15 May 2013 and died on 20 May 2013." 

A source at the Ministry of Health told Arab News that the latest victim was a male Syrian and that the MOH hospital where he was admitted was in the city of Buraidah. 

The WHO statement, quoting the MOH report, said the fatal case in Qassim is not related to the cluster of cases reported from Al-Ahsa in the eastern part of the country. 

Investigation into contacts of the case is ongoing, it said.

MSF: Treating cholera patients in northern Niger

Via MSF: Treating Cholera Patients in Northern Niger. Excerpt:

Cholera has broken out in northern Niger, in an area now inhabited by large numbers of Malian refugees who fled conflict in their homeland. 

Doctors Without Borders/Médecins Sans Frontières (MSF) has treated all of the nearly 250 people affected by the cholera outbreak in northern Niger that was declared by the country’s health authorities on May 11. MSF has also opened two cholera treatment centers in the regions of Mangaïzé and Ayorou, north of the capital, Niamey. Six people have died in the outbreak thus far, however. 

“As soon as the first cases appeared, MSF rushed to open a cholera treatment center,” says Dr. Benoit Kayembé, MSF’s head of mission in Niger. “We currently have 100 beds in Ayorou and another 50 in Mangaïzé. As well as treating people with the disease, which mainly involves rehydrating them, our teams are leading health awareness campaigns in the affected villages. The teams are also treating water points in these communities and actively looking for further cases of cholera.” 

Fear That Disease May Spread Southwards 

“Some of the patients come from the camps of Malian refugees, but the majority are from local communities,” adds Kayembé. 

MSF is currently the only medical organization treating people infected by cholera in the region. Its teams are worried about the proximity of the affected area to the Niger River, which flows from northern Niger towards the capital, and could well carry the disease along with it. 

“We can expect to see cases spreading towards Niamey,” says Kayembé. “The region already suffered from cholera last year. Having so many people displaced within the region makes it easy for cholera to spread to other parts of the country.”

In many regions of the world, and notably in sub-Saharan Africa, fighting over the scraps in poor countries is so violent and vicious that the poor flee into more poverty—made more ingrained by starvation and disease. 

H7N9 found to spread through the air

The South China Morning Post has promptly picked up the Science report mentioned here earlier today: H7N9 bird flu found to spread through the air. Excerpt:

The H7N9 bird flu virus can be transmitted not only through close contact but by airborne exposure, a team at the University of Hong Kong found after extensive laboratory experiments. 

Though the virus appears to have been brought under control recently, the researchers urged the Hong Kong authorities to maintain strict surveillance, which should include not only poultry but humans and pigs. 

"We also found that the virus can infect pigs, which was not previously known," said Dr Maria Zhu Huachen, a research assistant professor at HKU's School of Public Health. 

There have been 131 confirmed human infections, with 36 deaths, the World Health Organisation said. All but one of the cases was on the mainland. The virus appears to have been brought under control largely due to restrictions at bird markets and there have been no new confirmed cases since May 8. 

But Zhu said that although there was no evidence of sustained human-to-human transmission, their study provided evidence that H7N9 was infectious and transmissible in mammals. 

In the study, to be published today in the journal Science, ferrets were used to evaluate the infectivity of H7N9. It was found the virus could spread through the air, from one cage to another, albeit less efficiently. 

Inoculated ferrets were infected before the appearance of most clinical symptoms. This means there may be more cases than have been detected or reported. 

"People may be transmitting the virus before they even know that they've got it," Zhu said. 

Additional tests using pigs, a major host of influenza viruses, showed that they could also get infected with H7N9. Zhu warned that H7N9 may combine with pig viruses to generate new variants. 

On a more positive note, it was found that the virus is relatively mild. 

"Most of the fatal H7N9 cases had underlying medical conditions, so there are probably some other factors that contribute to this kind of fatality," Zhu said.

CIDRAP: Unusual pathogens ruled out in Alabama illness cluster

Via CIDRAP, Lisa Schnirring wraps up the story: Unusual pathogens ruled out in Alabama illness cluster. Excerpt:

Test results on a cluster of Alabama patients hospitalized with similar respiratory symptoms indicated no unusual pathogens but instead a variety of common respiratory viruses and bacteria, state health officials announced today. 

Don Williamson, MD, Alabama's state health officer, said in a statement from the Alabama Department of Public Health (ADPH)."This is good news. Testing has ruled out avian flu and novel coronavirus." 

At a press briefing today Williamson said 10 patients at a hospital in Dothan, in the southeastern corner of the state  have been identified as part of the cluster, and so far tests results are available for 7 of them. Two patients have died, according to earlier reports. 

Three of the seven patients had influenza A, four had rhinovirus, and three had bacterial pneumonia of different types, Williamson told reporters, indicating co-infection in at least some of the patients. Six of seven patients had pneumonia on x-ray findings, and the seventh one was intubated, which suggests lower-respiratory involvement, he said. 

Investigations found no common exposures or links between the patients. Williamson said it's uncommon to see flu in the spring, but it's not unheard of. 

He said unusual cases, especially a cluster of them, trigger a closer look by public health officials. Williamson said health officials followed the proper procedures for reporting unexpected findings and patients who had common symptoms.

If nothing else, this was a good "this is not a test" test of the region's public health alert systems.

The origins of MERS in Jordan

Thanks to Marion Koopmans for tweeting the link to this report in the Eastern Mediterranean Health Journal: Novel coronavirus infections in Jordan, April 2012: epidemiological findings from a retrospective investigation. The abstract:

In April 2012, an outbreak of acute respiratory illness occurred in a public hospital in Zarqa city, in Jordan; 8 health care workers were among the 11 people affected, 1 of who later died. The cause of the outbreak was unknown at the time and an epidemiological investigation including laboratory testing carried out immediately after the outbreak was inconclusive. 

Following the discovery of novel coronavirus infection (nCoV) in the Arabian peninsula in September 2012, stored respiratory and serum samples of patients from this outbreak were retested and the diagnosis of nCoVwas confirmed in 2 deceased patients. This paper describes the epidemiological findings of retrospective investigation carried out in November 2012 and highlights the likelihood of nosocomial transmission of nCoV infection in a health-care setting. A total of 2 laboratory-confirmed and 11 probable cases were identified from this outbreak of whom 10 were HCWs and 2 were family members of cases.

Ferrets, pigs susceptible to H7N9

A news release from NIH/NIAID: Ferrets, Pigs Susceptible to H7N9 Avian Influenza Virus. Excerpt:

Chinese and U.S. scientists have used virus isolated from a person who died from H7N9 avian influenza infection to determine whether the virus could infect and be transmitted between ferrets. 

Ferrets are often used as a mammalian model in influenza research, and efficient transmission of influenza virus between ferrets can provide clues as to how well the same process might occur in people. The research was supported, in part, by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health. 

The researchers dropped H7N9 virus into the noses of six ferrets. A day later, three uninfected ferrets were placed inside cages with the infected animals, and another three uninfected ferrets were placed in cages nearby. All the uninfected ferrets inside the cages became infected, while only one of three placed in nearby cages became infected. 

The team concluded that the virus can infect ferrets and be transmitted between ferrets both by direct contact and, less efficiently, by air. The scientists detected viral material in the nasal secretions of the ferrets at least one day before clinical signs of disease became apparent. 

The potential public health implication of this observation is that a person infected by H7N9 avian influenza virus who does not show symptoms could nevertheless spread the virus to others. 

The researchers also infected pigs with the human-derived H7N9 virus. In natural settings, pigs can act as a virtual mixing bowl to combine avian- and mammalian-specific influenza strains, potentially allowing avian strains to better adapt to humans. New strains arising from such mixing have the potential to infect humans and spark a pandemic, so information about swine susceptibility to H7N9 could help scientists gauge the pandemic potential of the avian virus. 

Unlike the ferrets, infected pigs in this small study did not transmit virus to uninfected pigs, either through direct contact or by air. All the infected ferrets and pigs showed mild signs of illness, such as sneezing, nasal discharge, and lethargy, but none of the infected animals became seriously ill.

The findings were published by H. Zhu et al. in Infectivity, transmission and pathogenesis of human-isolated H7N9 influenza in ferrets and pigs, published online today in Science.

Pakistan: Second child contracts polio in Waziristan since Taliban ban

Via Dawn.com: Second child contracts polio in Waziristan since Taliban ban. Excerpt:

Islamabad: A second child has contracted polio in a restive Pakistani tribal region near the Afghan border after the Taliban banned vaccinations there nearly a year ago, a UN official said Thursday. 

The first polio case was detected in the North Waziristan region, also known as the strong bastion of Taliban and al Qaeda linked militants, earlier this month, with officials expecting a “bigger outbreak” of the disease. 

“This is the second child, a 36-month-old boy getting paralysed after contracting polio,” the World Health Organisation’s senior coordinator for polio eradication in Pakistan, Elias Durry, told AFP. 

Tribesmen in North Waziristan had endorsed the Taliban ban and stopped authorities from vaccinating children under a nationwide campaign in June last year. 

“The problem is that it is just a tip of the iceberg,” Durry said, adding, “This is what will happen if we have children without polio vaccination.” 

He said: “We fear there will be more cases in North Waziristan, its neighbourhood and other tribal regions and northwestern districts if the vaccine is not administered to the children.” He said there were approximately 161,000 children in North Waziristan district alone who have not been administered with a polio vaccine since June last year. 

The Taliban have alleged that the vaccination campaign is a cover for espionage.