H5N1

WHO DON: Nipah virus infection - Bangladesh

A disease outbreak news report from WHO: Nipah virus infection - Bangladesh. Excerpt:

Situation at a Glance  

Outbreaks of Nipah virus (NiV) infection are seasonal in Bangladesh, with cases usually occurring annually between December and April corresponding with the harvesting and consumption of date palm sap. Since 1 January and as of 9 February 2024, two laboratory-confirmed cases of NiV have been reported from the Dhaka division of Bangladesh. Both cases have died.  

WHO assesses the overall risk at the national levels to be moderate due to the severity of the disease, the limitation of treatment, the shared natural habitat of bats and zoonotic transmission partners, and the fact that there are no licensed vaccines to prevent NiV infection.  

Description of the Situation  

On 30 January and 7 February 2024, the Bangladesh National Focal Point (NFP) for the International Health Regulations (IHR) notified the World Health Organization (WHO) of two epidemiologically unlinked cases of NiV infection.  

First case confirmed on 21 January 2024  

The first patient is a 38-year-old male from Manikganj district, Dhaka division. The patient developed a fever followed by respiratory distress, restlessness, and insomnia on 11 January 2024 and was admitted to a local hospital on 16 January. He was transferred to the intensive care unit of a hospital in Dhaka City on 18 January where he was intubated due to worsening of symptoms.  

On 21 January, blood and throat samples were collected and the patient tested positive by reverse transcription polymerase chain reaction (RT-PCR) for NiV RNA from the throat sample and by enzyme-linked immunosorbent assay (ELISA) for anti-NiV Immunoglobulin M (IgM) from serum. On 27 January, the case was transferred to another hospital in Dhaka city, where he died on 28 January.   

The case had a history of consuming raw date palm sap on 31 December 2023. As of 30 January 2024, a total of 91 contacts had been identified, including 11 family members, 20 from the community, and 60 healthcare personnel from different hospitals. However, none of the contacts tested positive for NiV by PCR or anti-NiV IgM by ELISA.   

Second case confirmed on 31 January 2024  

The second patient is a three-year-old female from Shariatpur district, Dhaka division. The patient visited a healthcare facility on 30 January 2024 with a two-day history of fever, altered consciousnesses, and seizures. The case was diagnosed with encephalitis and shock and was transferred to the isolation ward of another hospital in Dhaka city on the same day. Blood and throat samples were collected on 30 January and on 31 January, the case was laboratory-confirmed with NiV infection by RT-PCR for NiV RNA from the throat sample and by ELISA for anti-NiV IgM from serum and died on the same day.    

The case had a history of regularly consuming fresh raw date palm sap. As of 7 February 2024, 67 contacts were identified, including three family members, 21 from the community and 46 healthcare personnel from different hospitals. All identified contacts tested negative for NiV by PCR or anti-NiV IgM by ELISA.  

Since the report of the first case in 2001, human infections have been reported almost every year, with case fatality rate varying between 25% (in 2009) and 92% (in 2005). Clusters of cases are mainly reported in the country’s central and northwest districts. 

Impacts of poverty and lifestyles on mortality: A cohort study in predominantly low-income Americans

Via the American Journal of Preventive Medicine: Impacts of poverty and lifestyles on mortality: a cohort study in predominantly low-income Americans. The full article is paywalled, but here's the abstract:

Introduction  

Low socioeconomic status has been linked to increased mortality. However, the impacts of poverty, alone or combined with health behaviors, on mortality and life expectancy have not been adequately investigated.  

Methods  

Data from the Southern Community Cohort Study was used, including nearly 86,000 participants recruited during 2002-2009 across 12 US southeastern states. Analysis was conducted from February 2022 to January 2023.  

Results  

During a median follow-up of 12.1 years, 19,749 deaths were identified. A strong dose-response relationship was found between household incomes and mortality, with a 3.3-fold (95%CI = 3.1 - 3.6) increased all-cause mortality observed for individuals in the lowest income group (< $15,000/year) compared with those in the highest group (≥ $50,000/year). Within each income group, mortality monotonically increased with declining healthy lifestyle score. Risk was significantly lower among those in the lowest income but healthiest lifestyle group, compared to those with the highest income but unhealthiest lifestyle (HR = 0.82, 95%CI = 0.69 - 0.97). Poor white participants appeared to experience higher all-cause mortality than poor Black participants. Life expectancy was more than 10.0 years shorter for those in the lowest income group compared with those in the highest income group.  

Conclusions  

Poverty is strongly associated with increased risk of death, but the risks could be modestly abated by a healthier lifestyle. These findings call for a comprehensive strategy for enhancing a healthy lifestyle and improving income equality to reduce death risks, particularly among those experiencing health disparities due to poverty.

Scientists confirm first cases of bird flu on mainland Antarctica

Via The Guardian, very bad news: Scientists confirm first cases of bird flu on mainland Antarctica. Excerpt:

Bird flu has reached mainland of Antarctica for the first time, officials have confirmed.  

The H5N1 virus was found on Friday in two dead scavenging birds called skuas near Primavera Base, the Argentinian scientific research station on the Antarctic peninsula.  

Additional suspected cases have been reported in brown skua, south polar skua and kelp gull in Hope Bay, also on the Antarctic peninsula, according to data from the Scientific Committee on Antarctic Research.  

“This discovery demonstrates for the first time that the highly pathogenic avian influenza virus has reached Antarctica, despite the distance and natural barriers that separate it from other continents,” said a Spanish government report on Sunday.  

These are the first confirmed cases on the continent itself, which shows the virus is spreading in the region, most likely via migratory birds. This H5N1 outbreak is thought to have killed millions of wild birds globally since 2021, and has spread to every continent except Oceania.  

Avian flu reached the wider Antarctic region in October last year when it was reported on sub-Antarctic islands. The virus was first detected on the British overseas territory of South Georgia and the South Sandwich Islands, about 1,000 miles (1,600km) away from the continent of Antarctica. It was also found in the Falkland Islands, which is 600 miles north-west of South Georgia.

Initially it was reported in birds such as gulls, skuas and terns, but has since been found in albatross, penguins and southern fulmars. It has also spread to Antarctic mammals, with mass deaths of elephant seals and fur seals. The virus is also ripping through wildlife populations in the Arctic. In December, it was confirmed that the first polar bear had died of H5N1. “ 

There are many reports now of highly pathogenic avian influenza (HPAI) affecting several species in the Antarctic regions this season,” said Matthew Dryden from the UK Health Security Agency. “It may not have been reported on the Antarctic mainland until now because of the difficulties of accessing and sampling wildlife [there].”  

The dead birds from mainland Antarctica were found by Argentinian scientists and sent to scientists from the Centro de Biología Molecular Severo Ochoa in Madrid, who were working at the Spanish Antarctic base on Deception Island.  

“The problem is how long is it going to take before it transmits to other species like penguins. We need to monitor that,” said Antonio Alcamí, a researcher from the Spanish National Research Council who works at the Centro de Biología Molecular Severo Ochoa CSIC, who is based at the Spanish Antarctic base and tested the carcasses. “I’m afraid I think it probably will transmit into penguins. The skuas live pretty close, and so there are many opportunities for transmission, but we will see.”

Previous outbreaks in South Africa, Chile and Argentina have shown that penguins are susceptible to the virus. Since H5N1 arrived in South America, more than 500,000 seabirds have died of the disease, with penguins, pelicans and boobies among the most heavily affected.  

Researchers wrote in a pre-print research paper in November last year: “If the virus does start to cause mass mortality events across penguin colonies, it could signal one of the largest ecological disasters of modern times.”  

Diana Bell, the emeritus professor of conservation biology at the University of East Anglia, said the news was “sadly not surprising, given its previously reported presence on Antarctic islands in birds and elephant seals. It seems unlikely that the penguins there will not be infected.”