H5N1

New tick-borne encephalitis virus hot spot in Northern Zealand, Denmark, October 2019

Via Eurosurveillance: New tick-borne encephalitis virus hot spot in Northern Zealand, Denmark, October 2019. The abstract:

During summer 2019, three patients residing by Tisvilde Hegn, Denmark were hospitalised with tick-borne encephalitis (TBE) after tick bites. A new TBE virus (TBEV) micro-focus was identified in tick nymphs collected around a playground in Tisvilde Hegn forest. Estimated TBEV prevalence was 8%, higher than in endemic areas around Europe. Whole genome sequencing showed clustering to a TBEV strain from Norway. This is the second time TBEV is found in Ixodes ricinus outside Bornholm, Denmark.

Sweden: Rising number of people picking up TBE–infection

Via Radio Sweden: Rising number of people picking up TBE–infection. Excerpt:

A record number of Swedes are taking the vaccine against TBE - Tick Borne Encephalitis. But the disease is still spreading in the country. 

TBE is a virus infection that affects the central nervous system. Sometimes the symptoms are mild, but it can also give high fever, headache, confusion, cramps and vomiting. More severe symptoms are seizures, hallucinations and trouble speaking.  

So far this year, 162 people have caught the disease, which according to the Public Health Agency is the second highest number ever this far into the summer. In the longer perspective, since 2005, the number of cases has increased on average by 5 percent annually, according to the agency.

UK: Lyme disease cases may be three times higher than estimated

Via The Guardian: UK Lyme disease cases may be three times higher than estimated. Excerpt:

Cases of Lyme disease in the UK may be three times higher than previous estimates, according to new research. 

After analysing the anonymous medical records of 8.4 million people from across the UK, scientists forecast that the total number of Lyme disease diagnoses in the UK could top 8,000 in 2019, compared with previous estimates of between 2,000 and 3,000 annual diagnoses. 

Lyme disease is a bacterial infection, which is passed on through being bitten by an infected tick. The small spider-like creatures feed off the blood of animals and are typically found in dense, moist vegetation.

Lyme disease has many symptoms, making it difficult to diagnose. Early symptoms can be similar to those of flu, and about a quarter of cases will develop a circular red rash around the bite. Full clinical diagnosis requires a blood test, but the study found that more than half of patients in 2012, the most recent year with complete data, were treated with only “suspected” or “possible” Lyme disease.  

If caught early, most cases can be successfully treated with antibiotics within four weeks, but the infection can lead to permanent damage to the joints and nervous system.

The research, published in the journal BMJ Open, found that half of cases occurred between June and August. Although there were diagnoses across all regions of the UK during the period studied, Scotland had the highest number of cases, at 27% of the total. The authors suggest this could be due to the region’s wetter climate and popularity with hikers. The south-west and south of England also recorded a higher than average number of cases. 

The data showed that the number of diagnoses increased almost tenfold over the period studied. This, the researchers said, was partly down to increased caution by GPs and greater public awareness. 

“The exact number isn’t so important,” said Dr Victoria Cairns, the lead author of the study. “The point is that it’s a lot, and it’s everywhere, and that’s why people should be informed.”  

Dr Anne Cruikshank, the Royal College of GPs’ clinical champion for Lyme disease, said: “These levels are not a big surprise to those of us who know about Lyme disease. I expect the 8,000 figure may be an underestimate, since the data shows that positive lab results have doubled every five years.”

Lyme disease: Is a solution on the way?

Via The Guardian: Lyme disease: is a solution on the way? Excerpt:

As a former martial arts world champion, who trained daily and enjoyed camping and hiking at weekends, Stephen Bullough had always prided himself on leading a healthy life.  

Like most people, he thought very little when he was bitten by a tick on a camping holiday close to home in Wigan in 2014, never suspecting that this tiny bite would unleash an infection in his body that would one day leave him permanently incapacitated.  

“He had a rash on his right arm, which we put down to ringworm, so we put a bit of cream on it and thought nothing of it,” remembers Angela, Stephen’s wife. “In 2015, he started to develop these cognitive problems, getting words wrong. We laughed about it at first, joking, ‘You’re getting old now.’”  

But a year later, Bullough began to experience sudden seizures and muscle weakness, leaving him with severe difficulties walking. Over the past three years, his condition has rapidly deteriorated, leaving him unable to see, permanently bed-bound and often suffering multiple seizures at a time.  

“Last May, he had a massive seizure and then his whole body was convulsing,” says Angela. “That’s the day he went blind and has never walked or seen since. He then started having back-to-back seizures; he’s in hospital once a month because they just won’t stop, regardless of how many drugs they give him. One weekend, he had 40 seizures.” 

Bullough was eventually diagnosed with Lyme disease, an illness caused by various species of bacteria in the genus Borrelia that live in the guts of ticks. Once transmitted to humans, it can attack the immune system and lead to serious health complications such as arthritis, meningitis, neurological problems, even heart failure. While Lyme disease can sometimes be treated with antibiotics if detected early, not everyone responds and for patients such as Bullough who have developed chronic symptoms, there is currently no cure.

This is particularly concerning as Lyme disease appears to be on the rise, something scientists have attributed to climate change, creating conditions in which tick populations can thrive. While the disease is currently estimated to affect between 2,000 and 3,000 new people every year in the UK, the National Institute for Health and Care Excellence (Nice) suspects the real figure is far higher. 

But for scientists, one of the most tragic aspects of Bullough’s story, as with those of many other patients, is that it could potentially have been avoided. In the late 1990s, the first preventive human vaccine, called LYMErix, was developed and 1.4m doses had been administered by the end of 2001. The data suggests it was highly effective, protecting against the disease in almost 90% of cases. 

LYMErix wasn’t perfect. It was relatively expensive, did not work in young children, only protected against one strain of Lyme disease and was only available in the US. But it appeared to be the first step towards eradicating the disease for good. Anti-vaccine fear saw it vanish from the market, however, and with that, all scientific research and investment in the field ceased.

The death knell for LYMErix proved to be a theory that the vaccine could induce autoimmune reactions in humans. This was partially based on a study from 2000 that found the vaccine contributed to arthritis in hamsters, as well as entirely hypothetical concerns from the US Food and Drug Administration (FDA) panel, which approved LYMErix, that the immune system might overreact and begin to attack healthy tissue along with the Borrelia bacteria. 

These ideas were subsequently disproved, but the fear continued to spread. In 1998, the now retracted Lancet study linking the MMR vaccine to autism had been published and the modern anti-vaccine movement was gathering momentum. 

Class action lawsuits were filed against LYMErix’s manufacturer after several incidents of arthritis were reported. But while the evidence suggested that these incidents were unconnected to the vaccine, sales began to plummet and in 2002, the product was withdrawn altogether. 

“The consequences have been that, until recently, no manufacturer has wanted to touch this,” says Gregory Poland, who is head of the Mayo Clinic’s Vaccine Research Group in Minnesota. “Some of the anti-vax campaigners had published a statement saying that no matter what kind of Lyme vaccine they develop, we will organise mass protests and lawsuits. In the US, it takes about 10 to 15 years of research and about a billion dollars to develop a vaccine and get it licensed. Since LYMErix, nobody’s been willing to risk that.”

Lyme-infected ticks are so common in parts of Canada, testing no longer done

Via The Globe and Mail: Lyme-infected ticks are so common in parts of Canada, testing no longer done. Excerpt and then a comment:

Lyme disease has settled so deeply into parts of Canada many public health units now just assume if you get bitten by a tick, you should be treated for Lyme disease.  

In Ottawa, where more than two-thirds of the ticks tested in some neighbourhoods carry the bacteria that causes Lyme disease, the public-health unit no longer bothers to test ticks at all. 

Dr. Vera Etches, the unit’s top doctor, said that in 2016 and 2017 more than one-fifth of black-legged ticks tested in Ottawa came back positive for Lyme. 

“That’s a threshold,” she said. “Once you know that more than 20 per cent of the ticks in your area carry Lyme disease bacteria then we don’t need to check in on that. That is what we now call an ’at-risk area.’ ”

That means if a tick is found on a person, and is believed to have been there for more than 24 hours, then the patient should get antibiotics to prevent Lyme infection, even without any testing of the tick. It takes 24 hours before bacteria in the tick’s gut move to its salivary glands and are transferred to a person. 

After three days, the preventive treatment won’t work so patients then wait for symptoms or enough time for antibodies to evolve to show up on a test. It can take more than a month before symptoms appear. They’re mostly similar to the effects of influenza, including fever and aches, as well as – usually but not always – a rash. It typically takes just about as long for the immune system’s antibodies to show up on a lab test.  

If left untreated, Lyme disease can cause serious illnesses such as meningitis, but Etches is quick to point out that because it is caused by a bacteria, it’s treatable with drugs.  

“It’s a good-news story, actually, that there is antibiotics that work to treat Lyme disease,” she said.  

Most public-health offices in Canada used to test ticks submitted by the public, as well as conducting their own surveillance by actively seeking out tick populations and testing them. Some, including Ottawa’s, have decided now that Lyme is endemic, they should shift to public education and prevention as well as treatment. 

Lyme disease was named after the town of Lyme, Conn., where the first case was diagnosed in 1975. It is caused by bacteria that are traded back and forth among black-legged ticks and migratory birds and small mammals like mice and chipmunks. Ticks bite birds and small mammals infected with the bacteria and get infected and then spread the disease when they bite their next victims.

Before 10 years ago, most of the cases diagnosed in Canada were in people bitten by ticks while travelling in the United States. But climate change has led to southern Canada seeing milder winters, which means the ticks that migrate to Canada on the backs of migratory birds are now surviving the winter in larger numbers, spreading the Lyme-causing bacteria more rapidly.  

Canada started keeping track of Lyme disease cases in 2009, when 144 cases were confirmed or considered probable. Only 79 of those cases were believed to have been contracted in Canada.  

In 2017, more than 1,400 cases were confirmed or probable across the country, more than two-thirds of them in Ontario and most of them believed to have been contracted locally. 

National statistics for 2018 are not yet available but in Ontario, the number actually fell significantly, from 967 in 2017 to 612 in 2018. Etches said that was because 2018 was hotter and drier than 2017, and ticks thrive in wet, cool weather.

Cool, wet weather is common here on the BC coast, and we have a lot of ticks. Lyme doesn't seem to have reached us yet, but it will eventually.

I'm more concerned about my dog than about myself; we're in the woods every day, but I don't go crashing through the underbrush the way she does.

So here is my sole, unsolicited and unpaid-for product endorsement: A couple of years ago my wife gave me a TickKey. Two days later I found a tick on our dog, and the TickKey removed it quickly and with no mess. We've been lucky since then, but when the next one turns up (and it will), I'll know what to do—whether the tick is on her or on me. If you live in tick country, you should have this gadget on your key ring.

Extraordinary increase in West Nile virus cases and first confirmed human Usutu virus infection in Hungary, 2018

Via Eurosurveillance: Extraordinary increase in West Nile virus cases and first confirmed human Usutu virus infection in Hungary, 2018. The abstract:

Background 

During the 2018 WNV transmission season, similarly to other endemic areas in Europe, a large number of human West Nile virus (WNV) infections were reported in Hungary. 

Aims 

We summarise the epidemiological and laboratory findings of the 2018 transmission season and expand experiences in flavivirus differential diagnostics.  

Methods 

Every patient with clinical suspicion of acute WNV infection was in parallel tested for WNV, tick-borne encephalitis virus and Usutu virus (USUV) by serological methods. Sera, whole blood and urine samples were also tested for the presence of viral nucleic acid. 

Results 

Until the end of December 2018, 215 locally acquired and 10 imported human WNV infections were notified in Hungary. All reported cases were symptomatic; most of them exhibited neurological symptoms. In a large proportion of tested individuals, whole blood was the most appropriate sample type for viral nucleic acid detection, but because whole blood samples were not always available, testing of urine samples also extended diagnostic possibilities. In addition, the first human USUV infection was confirmed in 2018 in a patient with aseptic meningitis. Serological cross-reactions with WNV in different serological assays were experienced, but subsequent molecular biological testing and sequence analysis identified Europe lineage 2 USUV infection. 

Conclusion 

Careful interpretation and simultaneous application of different laboratory methods are necessary to avoid misdiagnosis of human USUV cases. Expansion of the laboratory-confirmed case definition criteria for detection of viral RNA in any clinical specimens to include urine samples could increase diagnostic sensitivity.

Climate crisis seriously damaging human health, report finds

Via The Guardian: Climate crisis seriously damaging human health, report finds. Excerpt:

A report by experts from 27 national science academies has set out the widespread damage global heating is already causing to people’s health and the increasingly serious impacts expected in future. 

Scorching heatwaves and floods will claim more victims as extreme weather increases but there are serious indirect effects too, from spreading mosquito-borne diseases to worsening mental health. 

“There are impacts occurring now [and], over the coming century, climate change has to be ranked as one of the most serious threats to health,” said Prof Sir Andrew Haines, a co-chair of the report for the European Academies’ Science Advisory Council (Easac).

However, there were also great benefits from action to cut carbon emissions, the report found, most notably cutting the 350,000 early deaths from air pollution every year in Europe caused by burning fossil fuels. “The economic benefits of action to address the current and prospective health effects of climate change are likely to be substantial,” the report concluded. 

The World Health Organization director general, Tedros Adhanom Ghebreyesus, warned in November that climate breakdown was already a health crisis. “We cannot delay action on climate change,” he said. “We cannot sleepwalk through this health emergency any longer.” In December, a WHO report said tackling the climate crisis would save at least a million lives a year, making it a moral imperative to act.

The new Easeac report, The Imperative of Climate Action to Protect Human Health in Europe, assessed the scientific evidence of the effects of global heating on health. Extreme weather such as heatwaves, floods and droughts have direct short-term impacts but also affect people in the longer term. “Mental health effects include post-traumatic stress disorder, anxiety, substance abuse and depression,” the report said.

The scientists were also concerned by the effect of extreme weather on food production, with studies showing a 5-25% cut in staple crop yields across the Mediterranean region in coming decades. But the report said even small cuts in meat eating could lead to significant cuts in carbon emissions, as well as benefits to health. 

The report anticipates the spread of infectious diseases in Europe as temperatures rise and increase the range of mosquitoes that transmit dengue fever and ticks that cause Lyme disease. Food poisoning could also rise, as salmonella bacteria thrived in warmer conditions, the report said. It even found research suggesting antibiotic resistance in E coli increases in hotter conditions.  

“We are exposing the whole of the world population to changes in climate, and this is clearly very concerning as we are moving to some extent into uncharted territory,” said Haines, professor of environmental change and public health at the London School of Hygiene and Tropical Medicine.

A new segmented virus associated with human febrile illness in China

Thanks to Mary Marshall for sending the link to this NEJM article: A New Segmented Virus Associated with Human Febrile Illness in China. The abstract:

BACKGROUND In 2017, surveillance for tickborne diseases in China led to the identification of a patient who presented to a hospital in Inner Mongolia with a febrile illness that had an unknown cause. The clinical manifestation of the illness was similar to that of tickborne encephalitis virus (TBEV) infection, but neither TBEV RNA nor antibodies against the virus were detected. 

METHODS We obtained a blood specimen from the index patient and attempted to isolate and identify a causative pathogen, using genome sequence analysis and electron microscopy. We also initiated a heightened surveillance program in the same hospital to screen for other patients who presented with fever, headache, and a history of tick bites. We used reverse-transcriptase–polymerase-chain-reaction (RT-PCR) and cell-culture assays to detect the pathogen and immunofluorescence and neutralization assays to determine the levels of virus-specific antibodies in serum specimens from the patients. 

RESULTS We found that the index patient was infected with a previously unknown segmented RNA virus, which we designated Alongshan virus (ALSV) and which belongs to the jingmenvirus group of the family Flaviviridae. ALSV infection was confirmed by RT-PCR assay in 86 patients from Inner Mongolia and Heilongjiang who presented with fever, headache, and a history of tick bites. Serologic assays showed that seroconversion had occurred in all 19 patients for whom specimens were available from the acute phase and the convalescent phase of the illness. 

CONCLUSIONS A newly discovered segmented virus was found to be associated with a febrile illness in northeastern China.

Measles and drug-resistant bacteria on the rise in Finland

Via Yle Uutiset: Measles and drug-resistant bacteria on the rise in Finland.

The incidence of measles in Finland has increased over the last year, says the National Institute for Health and Welfare (THL). While 11 cases of measles were diagnosed in the country in 2017, the number rose to 16 in 2018. All infections were contracted abroad.  

According to THL, the increase in the number of infections reflects the spread of the disease elsewhere in the world, including Europe. "Over the past 12 months, tens of thousands of measles cases have been reported in European countries," Taneli Puumalainen, senior physician at THL, said. 

In Finland, measles was introduced by those who had been abroad and then spread, mostly to family members. The biggest risk of a broader spread of measles last year was in Ostrobothnia, Western Finland, where an unvaccinated child contracted the disease in an area where the vaccination coverage was low.  

Puumainen reminded travellers to check their vaccinations at least one month before a trip.  

Drug resistance is a cause for concern 

The prevalence of drug-resistant bacteria also increased in Finland in 2018 according to THL. In particular, the number of Enterococci cases tripled from 66 to 205. Resistant Enterobacteriaceae cases increased by more than half from 48 to 73.  

Although the figures are growing, they are still small, according to THL. The situation in Finland, when assessed globally, is estimated to be very good thanks to an effective treatment system and hospital hygiene, explained Puumalainen. 

"Drug-resistance to microbes should be a matter of concern. It is a big global problem that has a large impact on the price and effective use of antimicrobials in the future," said Puumalainen. 

TBE vaccination recommended in summer 

In 2018, the number of reported cases of tick-borne encephalitis (TBE) was 79, which was the same as the year before. While most infections were contracted in known risk areas, the incidence of the disease has been increasing for several years, according to THL. 

TBE vaccination is recommended for those who will be outdoors in nature during summer for at least four weeks. Residents and travellers in risk areas are eligible for a vaccine as part of a national vaccine program. The list of risk areas is mainly includes clearly defined parts of archipelago regions in Finland, but this year the southwestern part of Lake Lohja in Uusimaa was also included by the national vaccine program. The most common tick-borne disease, borreliosis, however, does not have a vaccine.  

On the whole, the situation regarding infectious diseases in Finland is stable, according to Puumalainen who pointed out there were no major epidemics or events threatening public health over the past year.

Europe at risk from spread of tropical insect-borne diseases

Via The Guardian: Europe at risk from spread of tropical insect-borne diseases. Excerpt:

Insect-borne diseases such as dengue fever, leishmaniasis and encephalitis are on the rise and are now threatening to spread into many areas of Europe, scientists have warned.  

Outbreaks of these illnesses are increasing because of climate change and the expansion of international travel and trade, the European Congress of Clinical Microbiology and Infectious Diseases was told in Amsterdam on Saturday. 

Even previously unaffected areas in higher latitudes and altitudes, including some parts of northern Europe, are at risk of outbreaks unless action is taken to improve surveillance and data sharing, the researchers said. An adult female mosquito seen under a microscope. 

“Climate change is not the only, or even the main, factor driving the increase in vector-borne diseases across Europe, but it is one of many factors alongside globalisation, socioeconomic development, urbanisation and widespread changes to land use which need to be addressed to limit the importation and spread,” said the lead author Professor Jan Semenza, of the European Centre for Disease Prevention and Control in Stockholm. 

This point was backed by Giovanni Rezza, of the Istituto Superiore di Sanità in Rome. “Lessons from recent outbreaks of the West Nile virus in North America and the chikungunya virus in the Caribbean and Italy highlight the importance of assessing future vector-borne disease risks,” he said.  

Global warming has allowed mosquitoes, ticks and other disease-carrying insects to proliferate, adapt to different seasons and invade new territories across Europe over the past decade, with accompanying outbreaks of dengue in France and Croatia, malaria in Greece, West Nile fever in south-east Europe and chikungunya in Italy and France. 

Worryingly, the authors said, this might only be the tip of the iceberg. “Mediterranean Europe is now a part-time tropical region, where competent vectors like the tiger mosquito are already established,” added Rezza. And in future, hotter and wetter weather could provide ideal conditions for the Asian tiger mosquito, which spreads the viruses that cause dengue and chikungunya, to breed and expand across large parts of Europe, including the south and east of the UK and central Europe.