H5N1

Garrett and Builder on MERS

Via Foreign Policy.com, Laurie Garrett and Maxine Builder write: The Middle East Plague Goes Global. This is a long, thoughtful article; I'm struck especially by the authors' concern about MERS as a highly mobile disease. Excerpt:

Fear of a MERS outbreak from migrant workers returning home has prompted other countries to take special precautions. In early June, the Philippine government began conducting thermal scans of incoming migrant workers from Saudi Arabia at the airport in Manila, and the Nepalese government wrote a letter to hospitals and laboratories, directing them to adopt precautionary measures when treating patients with respiratory illness. 

During the SARS epidemic, the WHO did release a travel advisory, and passengers going through Chinese airports were subjected to a temperature scan; thankfully, neither the Philippines nor Nepal has yet reported a case of MERS. 

But another reason for concern over disease outbreak in this region is the huge -- and continually growing -- population of Syrian refugees, currently estimated at 1.6 million individuals by the United Nations' refugee agency, UNHCR. Add to that the almost 4.25 million internally displaced Syrians, living in overcrowded and unsanitary conditions within the country, and the scale of the problem grows. 

During humanitarian crises, the WHO works with member states primarily in an advocacy and planning role, helping to minimize suffering and death, as well as protect the country's health system. In this capacity, the WHO has already articulated its concerns about the potential for disease outbreaks in Syria and neighboring countries, particularly within the crowded refugee camps that have sprung up in Lebanon, Jordan, and Turkey, noting that the warm summer months bring a heightened risk.

Pakistan: New threats to polio workers

Via The Express Tribune, a July 1 report datelined Haripur: Adding to the fray: Unknown outfit threatens polio team.

An unknown outfit by the name of Haqooq Tahafuz-e-Muslimeen (HTM) threatened polio teams under the jurisdiction of Basic Health Unit (BHU) Dingi of dire consequences. It termed polio vaccinations ‘un-Islamic’, said police and health officials on Sunday. 

Health authorities confirmed the report, however, they clarified the teams would continue administering polio vaccinations. 

According to Kot Najibullah police, they received a photocopy of a letter with the Haqooq Tahafuz-e-Muslimeen letterhead which had been sent to BHU Dingi. Police officials added the previously unknown outfit had warned the hospital staff to desist from administering polio drops to children. According to the letter, these vaccinations were against the teachings of Islam. 

The letter warned the hospital staff would be targets of HTM’s reaction if they did not desist from anti-polio campaigns. 

According to BHU Dingi EPI Technician Shafiq Khan, he and the medical officer in-charge Dr Jaweria Hashmi lodged a complaint with the Kot Najibullah police station. Shafiq said the polio campaign would continue without any interruption, but police escorts will be deployed with the teams for their security. 

Kot Najibullah SHO Ghazi Khan also confirmed the report, adding this was the first time he had heard about an outfit called Haqooq Tahafuz-e-Muslimeen. 

The letter could be an act of miscreants who want to spread panic in the area, he postulated. 

But to be on the safe side, the SHO said he had deployed two police officials with each of the polio teams under the jurisdiction of BHU Dingi.

Dr. Racaniello on filterable camels and other mysteries of MERS

On his virology blog, Dr. Vincent Racaniello has published TWiV 239: Filterable camels. Excerpt:

Matt joins Vincent, Alan, and Rich to summarize what we know and what we do not know about the MERS coronavirus.

Unlike the Kingdom of Saudi Arabia's Ministry of Health, Dr. Racaniello and friends are far from taciturn; the audio runs 102 minutes.

Egyptian summer

I picked up a tweet from Dr. Kelly Sennholz this afternoon saying that "The number of people protesting [in Egypt] today is the largest number in a political event in the history of mankind." 

For some details on that event, go to Daily News Egypt and Al Jazeera English. And keep checking Azza Sedky's Egypt blog, which now has a Reuters report saying that these enormous demonstrations are going on in 38º (100º Fahrenheit) temperatures.

WHO wants HIV patients treated sooner to save lives, halt spread

Via Reuters AlertNet: WHO wants HIV patients treated sooner to save lives, halt spread. Excerpt:

Doctors could save three million more lives worldwide by 2025 if they offer AIDS drugs to people with HIV much sooner after they test positive for the virus, the World Health Organisation said on Sunday. 

While better access to cheap generic AIDS drugs means many more people are now getting treatment, health workers, particularly in poor countries with limited health budgets, currently tend to wait until the infection has progressed. 

But in new guidelines aimed at controlling and eventually reducing the global AIDS epidemic, the U.N. health agency said some 26 million HIV-positive people - or around 80 percent of all those with the virus - should be getting drug treatment. 

The guidelines, which set a global standard for when people with human immunodeficiency virus (HIV) should start antiretroviral treatment, were drawn up after numerous studies found that treating HIV patients earlier can keep them healthy for many years and also lowers the amount of virus in the blood, significantly cutting their risk of infecting someone else. 

"We are raising the bar to 26 million people," said Gottfried Hirnschall, the WHO's HIV/AIDS department director. "And this is not only about keeping people healthy and alive but also about blocking further transmission of HIV." 

Some 34 million people worldwide have the HIV virus that causes AIDS and the vast majority of them live in poor and developing countries. Sub-Saharan Africa is by far the worst affected region. 

But the epidemic - which has killed 25 million people in the 30 years since HIV was first discovered - is showing some signs of being turned around. The United Nations AIDS programme UNAIDS says deaths from the disease fell to 1.7 million in 2011, down from a peak of 2.3 million in 2005 and from 1.8 million in 2010. 

Swift progress has also been made in getting more HIV patients into treatment, with 9.7 million people getting life-saving AIDS drugs in 2012, up from just 300,000 people a decade earlier, according to latest WHO data also published on Sunday. 

Indian generics companies are leading suppliers of HIV drugs to Africa and to many other poor countries. Major Western HIV drugmakers include Gilead Sciences, Johnson & Johnson and ViiV Healthcare, which is majority-owned by GlaxoSmithKline. 

"IRREVERSIBLE DECLINE"?

Margaret Chan, the WHO's director general, said the dramatic improvement in access to HIV treatment raised the prospect of the world one day being able to beat the disease. 

"With nearly 10 million people now on antiretroviral therapy, we see that such prospects - unthinkable just a few years ago - can now fuel the momentum needed to push the HIV epidemic into irreversible decline," she said in a statement. 

The WHO's guidelines encourage health authorities worldwide to start treatment in adults with HIV as soon as a key test known as a CD4 cell count falls to a measure of 500 cells per cubic millimetre or less. 

The previous WHO standard was to offer treatment at a CD4 count of 350 or less, in other words when the virus has already started to damage the patient's immune system.

Egypt, June 30, 2013

You may be aware that something momentous is going on in Egypt today, with demonstrations involving hundreds of thousands of people. A good place to track events is the blog Egypt, run by my friend and colleague Azza Sedky.

One dead and dozens sick as temperatures hit 51C in blistering US heatwave

Via The Independent: One dead and dozens sick as temperatures hit 51C in blistering US heatwave. Excerpt:

Cities and towns across the western United States took emergency measures on Saturday to cope with a heatwave, after dozens of people were taken ill and the region sweltered in dangerous triple-digit temperatures. 

At least one heat-related death was reported by authorities in Las Vegas, where a man in his 80s was found dead inside a house without air-conditioning. 

The victim suffered from other medical issues, but paramedics suspect heat was a contributing factor in his death, Tim Szymanski, Las Vegas Fire and Rescue spokesman said. 

Extreme temperatures enveloped most of California, Nevada and parts of southern Arizona as a large high-pressure system continued to trap hot air across the area, National Weather Service meteorologist Todd Lericos explained. 

Lericos said that the stifling conditions are likely to continue throughout the weekend and linger into the next week. “It involves pretty much the entire West Coast at this point,” he added. 

Corpus Christi hit 107F, or 42C, as triple-digit temperatures extended as far east as Texas. Salt Lake City saw highs of 41C. 

Many people have been hospitalized or treated for dehydration, exhaustion and heat stroke in Los Angeles County, the country fire department said on Saturday. 

During an outdoor concert in Las Vegas on Friday, 34 people were taken to the hospital, and another 170 suffered nausea and fatigue from the heat. 

The annual Running with the Devil Marathon scheduled for Saturday in the Mojave Desert outside of Las Vegas, a competition in which runners are deliberately “challenged to contend with high heat,” was cancelled. 

In California, Nevada and Arizona, air-conditioned cooling stations were set up in community centres, homeless shelters and libraries. US officials advised residents to avoid prolonged exposure to the searing temperatures whenever possible. 

Additional border agents were posted, said Brent Cagen, spokesman for the Tucson sector of the US Border Patrol, after at least three people who attempted to illegally cross the border into Arizona were found dead earlier this week, likely succumbing to the heat.

Click through the NWS link and you'll see a map of the US with an extraordinary stretch of territory under "extreme heat warming."

War on MERS: Deadly virus prompts global battle plans

Via The Los Angeles Times, a June 29 report: War on MERS: Deadly virus prompts global battle plans. Excerpt:

ATLANTA — In a war room of sorts in a neatly appointed government building, U.S. officers dressed in crisp uniforms arranged themselves around a U-shaped table and kept their eyes trained on a giant screen. PowerPoint slides ticked through the latest movements of an enemy that recently emerged in Saudi Arabia — a mysterious virus that has killed more than half of the people known to have been infected. 

Here at the Centers for Disease Control and Prevention, experts from the U.S. Public Health Service and their civilian counterparts have been meeting twice a week since the beginning of June to keep tabs on the Middle East respiratory syndrome coronavirus. MERS-CoV, as the pathogen is known, attacks the lungs and causes fevers, severe coughs and rapid renal failure. 

Since it was first isolated in June 2012 in the city of Jeddah, MERS has infected at least 77 people and killed at least 40 of them. The number of confirmed cases has quadrupled since April, and people as far away as Tunisia and Britain have been sickened. 

Most troubling to health experts are reports of illnesses in patients who have not been to the Middle East. The virus has not yet emerged in the U.S., and maybe it never will. But when the pilgrimage season begins in July, perhaps 11,000 American Muslims will travel to the Arabian Peninsula, if past trends persist. 

In the meantime, millions more will fly between continents, citizens of today's globalized world. "A person from New York could go to Saudi Arabia for business and carry the virus home on the way back," said Matthew Frieman, a virologist at the University of Maryland School of Medicine in Baltimore. "There's zero reason why that couldn't happen."

China: Monitoring H7N9 through surveillance for ILI

Via Emerging Infectious Diseases: Monitoring Avian Influenza A(H7N9) Virus through National Influenza-like Illness Surveillance, China. The conclusion of this report deserves attention:

The spectrum of illness caused by other avian influenza viruses varies tremendously and can also vary by age group. Previous human infections with avian influenza A(H7) viruses (i.e., subtypes H7N3, H7N2, and H7N7) have been generally mild, causing conjunctivitis, with the exception of very occasional cases of pneumonia and a single fatal case in the Netherlands in a highly exposed veterinarian (5–10). In contrast, avian influenza A(H5N1) virus has an overall case fatality rate of 60%, and persons with confirmed cases are usually severely ill (11). 

Recent reviews of avian influenza A(H5N1) virus seroprevalence studies found little evidence that large numbers of human infections are going undetected (12–14). Among the 82 human influenza A(H7N9) virus infections reported as of April 17, 2013, a total of 38 (46%) were in persons >65 years of age (2). We did not find evidence of widespread mild disease, suggesting that the reported cases reflect the true distribution of infection and not a surveillance artifact. 

Our study had several limitations. The 554 CNISN sentinel hospitals are located in urban areas, so the surveillance system may not detect influenza A(H7N9) virus infections in rural areas. In addition, most sentinel hospitals are tertiary care hospitals, and their patient populations are not representative of the general population with ILI. The distribution of those patients who had specimens tested is not necessarily random and may not reflect the population of those with ILI. Last, our system lacks a straightforward way to calculate rates of disease because it lacks denominators. 

The emergence of a reassortant between avian influenza A(H7N9) virus and seasonal influenza subtype viruses, with possible increased human transmissibility, is possible during the upcoming summer influenza season in southern China. Careful monitoring and rapid characterization of influenza A(H7N9) viruses and unsubtypeable viruses from infected humans will be critical. 

Enhanced surveillance studies of mild and severe respiratory disease and seroprevalence studies in focal areas are necessary to further characterize the epidemiology and clinical spectrum of this emerging virus.

Do face masks protect against flu in air travel?

Via Emerging Infectious Diseases: Protection by Face Masks against Influenza A(H1N1)pdm09 Virus on Trans-Pacific Passenger Aircraft, 2009. The abstract:

In response to several influenza A(H1N1)pdm09 infections that developed in passengers after they traveled on the same 2 flights from New York, New York, USA, to Hong Kong, China, to Fuzhou, China, we assessed transmission of influenza A(H1N1)pdm09 virus on these flights. 

We defined a case of infection as onset of fever and respiratory symptoms and detection of virus by PCR in a passenger or crew member of either flight. Illness developed only in passengers who traveled on the New York to Hong Kong flight. 

We compared exposures of 9 case-passengers with those of 32 asymptomatic control-passengers. None of the 9 case-passengers, compared with 47% (15/32) of control-passengers, wore a face mask for the entire flight (odds ratio 0, 95% CI 0–0.71). The source case-passenger was not identified. 

Wearing a face mask was a protective factor against influenza infection. We recommend a more comprehensive intervention study to accurately estimate this effect.