H5N1

Canadian warship hit by outbreak of hand, foot and mouth disease

Via The Toronto Star: Canadian warship hit by outbreak of hand, foot and mouth disease. Excerpt:

A Canadian warship deployed at sea on a NATO mission has been hit by an outbreak of hand, foot and mouth disease, the Star has learned.  

Some 20 sailors aboard HMCS Charlottetown came down with the contagious disease in recent days, which can cause painful sores and lesions on the tongue and gums as well as on hands and feet. 

A military spokesperson confirmed the outbreak and said that personnel were being treated to ease the symptoms of hand, foot and mouth disease (HFMD).  

“Members with HFMD on board HMCS Charlottetown are being treated to help alleviate their symptoms as required,” Capt. Nicola LaMarre told the Star.  

The frigate sailed from Halifax on June 27 to take part in Operation Reassurance, Canada’s contribution to NATO deterrence deployments in Eastern Europe.  

In mid-July, the ship was in the Black Sea where it participated in NATO operations, including exercises to hone anti-submarine warfare skills. 

It’s back in the Mediterranean Sea and spent the weekend docked in Souda Bay, on the Greek island of Crete, for a scheduled port visit. 

As HMCS Charlottetown returned to sea Tuesday, there were just two active cases of hand, foot and mouth disease on the frigate, LaMarre said. 

“None of the cases of HFMD on board HMCS Charlottetown have caused serious illness or impacted operations. All of the members are being treated by the medical personnel on board the ship in accordance with established medical protocols,” she said. 

Canadian frigates, which sail with a crew of just over 200, don’t usually carry a doctor. Instead, medical care is provided by a physician’s assistant, who can consult with doctors onshore. There is no vaccination or specific treatment for hand, foot and mouth disease, though medication can be taken to relieve the symptoms. 

“Treatment is supportive and focuses on management of complications,” said LaMarre, of the Canadian Joint Operations Command, which oversees domestic and international military operations.  

The disease can be spread by close contact close personal contact, coughing or sneezing and touching infected surfaces, such as a door handle, making the confines of the frigate vulnerable.

ECDC: Enterovirus associated with severe neurological symptoms

ECDC has published Enterovirus detections associated with severe neurological symptoms in children and adults in European countries. Click or tap through to download the PDF. The abstract:

​The timing of the current enterovirus outbreaks closely follows the usual increase in summer, but reports suggest that seasonal enterovirus activity in the EU/EEA Member States started earlier than in previous years. Some Member States also report an increased frequency of severe disease associated with enterovirus infection.   

While it is difficult to interpret these observations in the absence of robust historical data, Member States should consider raising awareness of the importance of including enterovirus infection in the differential diagnosis of neurological and severe respiratory illness. Reporting of enterovirus clusters and outbreaks through the Early Warning and Response System (EWRS) in EU/EEA countries is encouraged. ​

Hong Kong enters peak season of hand, foot and mouth disease and enterovirus 71 infection

Via the Centre for Health Protection: Hong Kong enters peak season of hand, foot and mouth disease and enterovirus 71 infection. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health today (May 18) called on the public to maintain vigilance against hand, foot and mouth disease (HFMD) and enterovirus 71 (EV71) infection, as the latest surveillance data showed that Hong Kong is entering the traditional peak season of the disease.     

"The activity of both HFMD and EV71 infection is on the rise. The usual peak season is from May to July, with a possible smaller winter peak from October to December. Schools, institutions and play facilities should observe our guidelines and health advice against outbreaks to better protect young children who are more prone to both diseases," a spokesman for the CHP said.     

The number of institutional HFMD outbreaks increased from five (affecting 16 persons) in the week ending April 30 to 30 (124 persons) last week. As of yesterday (May 17), 13 (42 persons) had been reported this week. In the past four weeks, kindergartens and child care centres (KG/CCCs) reported most outbreaks (63 per cent), followed by secondary schools (20 per cent) and primary schools (17 per cent).     

As for EV71 infection in 2016, as of yesterday, three cases were recorded with no severe or death cases. In 2015, 56 cases including six with severe complications were filed. Regarding severe paediatric enterovirus infection other than EV71 and poliovirus, three cases had been recorded so far this year while eight were recorded in 2015, with no deaths in both years.     

In addition, surveillance of HFMD based at Accident and Emergency Departments and sentinel KG/CCCs also recorded a corresponding increase in HFMD activity.     

"Apart from ongoing health education for schools and students, our Port Health Office has reinforced health advice to schools receiving cross-boundary students (CBS) and operators of cross-boundary school coaches in a briefing on transportation arrangements for CBS held by the Education Bureau on May 5. Good ventilation and environmental hygiene inside compartments are essential in preventing infectious diseases," the spokesman said.

Viruses: One ring to rule them all?

Via Macromolecules: Cooperative Orthogonal Macromolecular Assemblies with Broad Spectrum Antiviral Activity, High Selectivity, and Resistance Mitigation. The abstract, with my bolding, and then a comment:

Treatment of viral infections continues to be elusive owing to the variance in virus structure (RNA, DNA, and enveloped and nonenveloped viruses) together with their ability to rapidly mutate and garner resistance. 

Here we report a general strategy to prevent viral infection using multifunctional macromolecules that were designed to have mannose moieties that compete with viruses for immune cells, and basic amine groups that block viral entry through electrostatic interactions and prevent viral replication by neutralizing the endosomal pH. 

We showed that cells treated with the antiviral polymers inhibited TIM receptors from trafficking virus, likely from electrostatic and hydrogen-bonding interactions, with EC50 values ranging from 2.6 to 6.8 mg/L, depending on the type of TIM receptors. 

Molecular docking computations revealed an unexpected, and general, specific hydrogen-bonding interactions with viral surface proteins, and virus and cell binding assay demonstrated a significant reduction in infection after incubating virus or cells with the antiviral polymers. 

Moreover, the mannose-functionalized macromolecules effectively prevented the virus from infecting the immune cells. Representative viruses from each category including dengue, influenza, Chikungunya, Enterovirus 71, Ebola, Marburg, and herpes simplex were surveyed, and viral infection was effectively prevented at polymer concentrations as low as 0.2 mg/L with very high selectivity (>5000) over mammalian cells. 

The generality of these cooperative orthogonal interactions (electrostatic and hydrogen-bonding) provides broad-spectrum antiviral activity. As the antiviral mechanism is based on nonspecific supramolecular interactions between the amino acid residues and mannose/cationic moieties of the macromolecule, the ability to form the virus–polymer and polymer−cell assemblies can occur regardless of viral mutation, preventing drug resistance development.

In case the abstract is less than clear to you, here's the story in Popular Science that led me to this report.

I confess my first reaction was: What about the countless viruses we know nothing about, some of which might even be useful—even essential to our wellbeing? And my second reaction was: 

One ring to rule them all, One ring to find them, One ring to bring them all, and in the darkness bind them.

When evolution has wired you to look for simple, dramatic solutions, those are the solutions you look for. I wish we'd been wired to look for better definitions of what a real problem is, and then to look for real solutions.

 

That said, if this is indeed the one ring to rule them all, and it stops viral disease dead, I will rejoice. Especially if old age is found to be caused by a virus inadvertently wiped out in the purge. And even if, newly rejuvenated, I then have to deal with the billions around the world who are no longer conveniently dying of viral diseases.

Hong Kong: CHP issues warning against HFMD, EV71

Via the Centre for Health Protection: Public urged to stay vigilant against hand, foot and mouth disease and enterovirus 71 infection. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health today (December 1) called on  members of the public to maintain vigilance against hand, foot and mouth disease (HFMD) and enterovirus 71 (EV71) infection, as the latest surveillance data showed that the HFMD activity further increased and remained at a very high level in Hong Kong.        

"The CHP recorded an increasing number of institutional outbreaks of HFMD in the past few weeks, from 23 cases in the week ending November 14 to 64 in the week ending November 28," a spokesman said.        

"Sentinel surveillance among private medical practitioners and general outpatient clinics also reported an increase in the HFMD activity recently. From the week ending November 14 to the week ending November 21, the weekly consultation rates of HFMD based at sentinel private medical practitioners increased from 2.4 to 3.7 (per 1,000 consultations) while the weekly consultation rates of HFMD based at sentinel general outpatient clinics increased from 0.4 to 1.2.        

"Surveillance of HFMD based at the Accident and Emergency Departments in public hospitals and sentinel child care centres/kindergartens also remains at a high level of activity."        

As of November 30, there were 56 EV71 infections recorded in 2015 as compared with 68 cases in the same period of 2014. Among the 56 cases recorded in 2015, six cases developed severe complications.        

"HFMD occurs throughout the year and the peak season is usually from May to July in Hong Kong. There were also smaller winter peaks in the past few years but the persistently high HFMD activity reported this year is unusual," the spokesman noted.        

The CHP has sent letters to all doctors and institutions including childcare centres, kindergartens and primary and secondary schools alerting them to the current situation regarding HFMD and EV71 infections, providing advice on prevention and control, and reminding them to report suspected HFMD outbreaks to the CHP.        

Meanwhile, the CHP is investigating an HFMD outbreak in a secondary school in Ap Lei Chau, involving 18 boys and two girls aged from 12 to 18.        

The 20 affected students have developed fever, rash on their hands and feet as well as oral ulcers since November 19. All of them sought medical attention while none required hospitalisation. All are now in stable condition.

Hong Kong: CHP investigates hand, foot and mouth disease outbreak at residential child care centre

Via the Centre for Health Protection: CHP investigates hand, foot and mouth disease outbreak at residential child care centre. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health is today (June 23) investigating an outbreak of hand, foot and mouth disease (HFMD) at a residential child care centre in Causeway Bay, and hence appealed to the public to maintain strict personal and environmental hygiene.      

The affected persons comprise of 26 children, 15 boys and 11 girls aged from 9 to 35 months, and a staff member. They have developed fever, oral ulcers and rash on their hands or feet since June 14. All of those affected sought medical attention, while three children were admitted to Pamela Youde Nethersole Eastern Hospital for management and two of them have been discharged. They are all currently in stable condition.      

The rectal swab of an affected child tested positive for enterovirus (EV) upon laboratory testing by the CHP's Public Health Laboratory Services Branch.      

Officers of the CHP have conducted a site visit and advised the staff of the residential child care centre on necessary infection control and preventive measures. The centre has been put under medical surveillance. Investigations are ongoing.      

"HFMD is common in children and is usually caused by EVs such as Coxsackie virus and EV71. It is clinically characterised by maculopapular rash or vesicular lesions occurring on the palms, soles and other parts of the body such as the buttocks and thighs. Vesicular lesions and ulcers may also be found in the oral cavity. Sometimes patients present mainly with painful ulcers at the back of the mouth, namely herpangina, without rash on the hands or feet," a spokesman for the CHP explained.

Hong Kong enters peak season for hand, foot and mouth disease and enterovirus 71 infection

Via the Centre for Health Protection: Hong Kong enters peak season for hand, foot and mouth disease and enterovirus 71 infection. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health today (May 14) called on the public to maintain vigilance against hand, foot and mouth disease (HFMD) and enterovirus 71 (EV71) infection, as the latest surveillance data shows that Hong Kong is entering the peak season for both.      

"The CHP recorded an increasing number of institutional outbreaks of HFMD in the recent two weeks. There were nine and 10 institutional HFMD outbreaks in the week ending May 9 and the first four days (May 10-13) of this week respectively as compared with between zero and four outbreaks per week in previous months.      

"As for EV71 infection in 2015, the CHP recorded 17 cases as of May 13, among which one patient developed a severe complication. Fourteen of the cases were recorded in recent four weeks," the spokesman said.      

"The summer peak season for HFMD and EV71 is usually from May to July. The local activity is expected to increase in the next few weeks.      

"HFMD activity in neighbouring areas has also increased. According to the number of cases of HFMD, Guangdong has entered into the peak season of the disease since early May. In Taiwan, the latest information shows that it is entering into the peak season of HFMD as  disease activity has been increasing in recent four weeks," the spokesman added.      

The CHP has sent letters to childcare centres, kindergartens and primary and secondary schools alerting them to the current situation regarding HFMD and EV71 infections, providing advice on prevention and control, and reminding them to report suspected HFMD outbreaks in their institutions to CHP.        

"Starting from this Friday (May 15), 'EV SCAN', a weekly update on HFMD and EV71 infection, will be published on the CHP website to summarise the latest statistics of these diseases," the spokesman added.        

Letters were sent today to all doctors on the latest situation with regard to HFMD and EV71 infection in Hong Kong so as to enhance case detection, clinical diagnosis and management, as well as dissemination of health advice.

Hong Kong enters peak season for hand, foot and mouth disease and enterovirus 71 infection

A news release from the Centre for Health Protection: Hong Kong enters peak season for hand, foot and mouth disease and enterovirus 71 infection. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health today (May 14) called on the public to maintain vigilance against hand, foot and mouth disease (HFMD) and enterovirus 71 (EV71) infection, as the latest surveillance data shows that Hong Kong is entering the peak season for both.      

"In this week as of yesterday (from May 11 to 13), the CHP has recorded 13 institutional HFMD outbreaks, higher than the number recorded in the preceding three weeks, which ranged from one to four outbreaks per week.      

"Sentinel surveillance among private medical practitioners also detected a significant increase in HFMD activity recently. In addition, as of yesterday, the CHP has recorded 20 cases of EV71 infection in 2014, which is higher than the total number of cases recorded in 2013 (12 cases). One case of EV71 infection this year developed severe complications," the spokesman said.      

"The summer peak season for HFMD and EV71 is usually from May to July. The local activity is expected to increase in the next few weeks," the spokesman added.      

The CHP has sent letters to child care centres, kindergartens and primary and secondary schools alerting them to the current situation regarding HFMD and EV71 infections, providing advice on prevention and control, and reminding them to report suspected HFMD outbreaks in their institutions to CHP.

China: Hand-foot-and-mouth disease kills 2 children in Shanghai

Via Xinhua: Hand-foot-and-mouth disease kills 2 children in Shanghai. Excerpt:

Hand-foot-and-mouth disease (HFMD) killed two children within three days in Jinshan District of Shanghai, the district's health and family planning commission said on Friday. 

Wang Jianshe, chief of pediatrics at Jinshan Hospital Affiliated to Shanghai Fudan University, said a child, two and a half year old, was sent to the hospital on Monday and died on Tuesday afternoon.The second death, of a four-year-old child, occurred on Thursday night. 

Wang said both children had fever and were in critical conditions when they were admitted hospital. They died quickly despite emergency treatment. 

HFMD is caused by a group of viruses known as enterovirus (EV), including EV71, which causes severe complications that can lead to death.

An effective vaccine against enterovirus 71

Via NEJM: Efficacy, Safety, and Immunogenicity of an Enterovirus 71 Vaccine in China. The abstract:

BACKGROUND 

Enterovirus 71 (EV71) is one of the major causative agents of outbreaks of hand, foot, and mouth disease or herpangina worldwide. This phase 3 trial was designed to evaluate the efficacy, safety, and immunogenicity of an EV71 vaccine. 

METHODS 

We conducted a randomized, double-blind, placebo-controlled, multicenter trial in which 10,007 healthy infants and young children (6 to 35 months of age) were randomly assigned in a 1:1 ratio to receive two intramuscular doses of either EV71 vaccine or placebo, 28 days apart. The surveillance period was 12 months. The primary end point was the occurrence of EV71-associated hand, foot, and mouth disease or herpangina. 

RESULTS 

During the 12-month surveillance period, EV71-associated disease was identified in 0.3% of vaccine recipients (13 of 5041 children) and 2.1% of placebo recipients (106 of 5028 children) in the intention-to-treat cohort. The vaccine efficacy against EV71-associated hand, foot, and mouth disease or herpangina was 94.8% (95% confidence interval [CI], 87.2 to 97.9; P<0.001) in this cohort. 

Vaccine efficacies against EV71-associated hospitalization (0 cases vs. 24 cases) and hand, foot, and mouth disease with neurologic complications (0 cases vs. 8 cases) were both 100% (95% CI, 83.7 to 100 and 42.6 to 100, respectively). 

Serious adverse events occurred in 111 of 5044 children in the vaccine group (2.2%) and 131 of 5033 children in the placebo group (2.6%). In the immunogenicity subgroup (1291 children), an anti-EV71 immune response was elicited by the two-dose vaccine series in 98.8% of participants at day 56. An anti-EV71 neutralizing antibody titer of 1:16 was associated with protection against EV71-associated hand, foot, and mouth disease or herpangina. 

CONCLUSIONS 

The EV71 vaccine provided protection against EV71-associated hand, foot, and mouth disease or herpangina in infants and young children.