MENINGITIS, MENINGOCOCCAL - USA: (CALIFORNIA) LABORATORY-ACQUIRED, FATAL

MENINGITIS, MENINGOCOCCAL - USA: (CALIFORNIA) LABORATORY-ACQUIRED, FATAL
Date: Thu 3 May 2012

A young research associate killed by a highly virulent strain of meningococcal disease is believed to have contracted the bacteria from the San Francisco lab where he was working on a vaccine against it, public health officials said on Thursday.US Centers for Disease Control and Prevention experts are seeking to confirm what they already suspect: that the researcher, 25, died Saturday in an unusual case of a scientist being fatally infected with an agent from his own laboratory. Tom Skinner, a CDC spokesman in Atlanta, said it would test a biopsy sample from the researcher and a sample of the laboratory pathogen he was working with to create fingerprints for each. "If the fingerprints match, you know it's highly likely he acquired the infection from working in the lab," he said. "Someone getting sick and dying from the organism they're working with in the lab is exceedingly rare," he added. Meanwhile, dozens of people, including relatives, close friends, medical personnel who treated the researcher and some of his co-workers at the research department of the San Francisco Veterans Affairs Medical Center were being given antibiotics as a precaution.Harry Lampiris, chief of infectious disease at the San Francisco VA, said it is likely the researcher died as a result of his work with _Neisseria meningitidis_, a strain of bacteria that causes meningococcal disease, which leads to meningitis and bloodstream infections. "It's our responsibility to assume it's laboratory-associated until proven otherwise," he said.Since the 1960s, vaccines have been available for some strains of meningococcal disease. But scientists in the San Francisco lab have spent more than 20 years trying unsuccessfully to develop a vaccine against serogroup B, the strain that killed the researcher. "It's been like the Holy Grail to develop the vaccine against [serogroup] B," Lampiris said.The researcher died of multiple organ failure caused by meningococcal infection and septic shock, said Eileen Shields, a spokeswoman for the San Francisco Department of Public Health. He died less than a day after becoming ill. The disease can come on quickly with symptoms including high fever, headache, stiff neck, vomiting, rash, confusion and fatigue.Lampiris said coworkers described the researcher, who began work at the lab in October, as "a very talented, hard-working and fastidious individual. He was a very bright person who was probably at the beginning of a long research career," he said.Meningitis, an inflammation of the protective membranes covering the brain and spinal cord, commonly strikes infants and college students living in dormitories, Lampiris said. He said the researcher had not had contact with either group.About 1000 Americans each year suffer from meningococcal disease, and an estimated 10 to 15% die from it, Skinner said. He could not say how many of the cases resulted from serogroup B.The California Division of Occupational Safety and Health is investigating the circumstances of the researcher's death, along with its federal counterpart and the CDC, the city Public Health Department and the San Francisco VA.
http://www.promedmail.org/?p=2400:1000:4020501424682213:::::

Vietnam: Lang Son Province - Smuggling Over The Border - 7.2 tons of animal products Confiscated

05/05/2012
Destruction of large numbers like poultry, animal products floating

Nhan Dan Online-14 hours days 5-5, Division of Criminal Investigation Police (CSDTTP) on the environment, public security Lang Son province, in collaboration with Provincial Veterinary Department conducted more than nine thousand destruction of breeding birds, ( mainly ducks) smuggled unknown origin, not quarantined.

All breeding birds are Pham Tien Dung, (SN 1978), residing in lane 9, Vinh Ward Camp, Lang Son city transportation on cars bearing plates 29c-107-54 from the border to the Mountain Top area, The City, (Cao Loc), it was discovered, arrested on the morning of 5-5.

Thus, just over a month, private room on the environment CSDTTP Provincial Police have arrested 10 cases, collecting more than 7.2 tons of animal products including pig intestine organ, aquatic animals, poultry. .. and more than 16,800 varieties of poultry including chickens, ducks ... were smuggled from the border, not quarantined.

Deputy environmental CSDTTP, La Trung Kien, said animal products and poultry breeding, the people bordering transport across the trail, off road, backstage gate and then use the motor vehicle , car travel from four to six seats, break-bulk transport of many trips, gathering scattered to transport inland consumption is increasing.

Rights Chief Veterinary Department in Lang Son province, said Trinh Thi Nguyet, most animal products and poultry breeds are smuggled quarantine should not risk the spread of disease is very high. Dangerous than animal products, have been arrested when the stench, pass inspection are laced chemicals, residues stimulate more growth, affecting the health of consumers, carriers can offer diseases such as avian flu, swine streptococcus disease ...

Vietnam: Issued disease treatment "strange"

05/05/2012

Ministry of Health leadership to visit disease patients, "stranger"

The Health Ministry has sent several missions to find out the causes and cures the disease "strange".

From 19/04/2011 to present in the Ba Dien Commune, Ba Xa, Three Amazingly, Ba, Ba Ba Vinh district (Quang Ngai) with 176 appearance strange disease morbidity and mortality with 8 people symptoms: dermatitis, thick horns, desquamation, dryness, chapping of the hands, feet together with elevated liver enzymes (SGOT, SGPT). Under these circumstances the Health Ministry has sent several missions to find out the causes and cures the disease.

Based on clinical manifestations, histopathology images and results of treatment, initially identified this syndrome gastritis horn hands, feet, the cause is under investigation determined. On 05.04.2012, the Ministry of Health issued Decision No. 1454/QD-BYT issuing Guidelines Diagnosis and treatment of gastritis horn syndrome hands, the feet of patients.

Govt bans sale of chicken in markets every Monday

DCC South has already instructed kitchen market committee to take action
DHAKA, May 3: The government has banned sale of chicken at kitchen markets on every Monday to prevent an outbreak of ‘Bird flu’ again in the country, said a senior official of the Health ministry. Dhaka City Corporation (DCC) South already instructed the kitchen market management committee to take action to make “Chicken Free Monday” to prevent ‘Bird flu’ which already affected some poultry traders in Dhaka City market as well as 45 students of Kurigram Nursing Institute.
Prof Mahmudur Rahman, director of the Institute of Epidemiology, Disease Control and Research (IEDCR) told The Independent on Thursday, “It will help to prevent rapid spreading of bird flu, which came back to the country as well as some to other parts of the world.” IEDCR recently confirmed the presence of the virus, commonly known as ‘Bird flu’ in the capital’s different kitchen markets after three workers were reported positive with H5N1.DCC also instructed the police and law enforcing agencies to restrict the vehicles carrying poultry in Dhaka after Sunday 12 at night to ensure “Chicken Free Monday.”
They also instructed the poultry traders and market management committee to clean the poultry markets by disinfecting, which is very important to seize the virus transmission.
Epidemiologists also suggested steps to improve sanitation of slaughterhouses as it will be difficult to change the tradition of selling live-birds in the country.
Chief health officer of DCC (South) Abdullah-Al-Harun told The Independent, “Chicken Free Monday” will help to prevent spreading of the virus. He added, “We are also instructing all the poultry traders to clean their baskets (khacha) being used to keep chicken.”
He said, a small committee from DCC as well as from IEDCR and Live Stock department will start to monitor the kichen markets whether they are following the instruction or not.
The first human case of getting infected with this virus in Bangladesh was detected in May 2008 after an outbreak in a poultry farm in March 2007.
The high official of DCC also said that the poultry traders are also instructed to gather all the wastages in specific dustbins so that they don’t get mixed up with normal wastages.

Poultry traders are also requested to take the trade license from DCC and the workers who handling chiken at the markets should use masks, hand gloves, approns and gumboots.
Drive to clean Dhaka’s kitchen markets has not started yet, despite health experts’ serious call to disinfect those after H5N1 avian influenza lurched from poultry farms to slaughterhouses.
The detection also prompted health experts to call for a change in what they term ‘dangerous’ practice of selling and slaughtering poultry just anywhere in the market or open spaces without taking any sanitary measures.
Visiting different markets on Thursday, it is found that DCC markets are not disinfected.
Workers have been seen working in filthy environment strewn with chicken giblets and wings in the blood and mud-strained floor.
But the experts are worried at the latest detection as four strains of flu virus - H5N1, H1N1, H3N2 and H9N2 are circulating in the air and the UN Food and Agriculture Organisation in Aug last year warned of a possible major resurgence of bird flu as a mutant strain of H5N1 virus is spreading in Asia including Bangladesh.
Experts also suggested for a separate room for chicken slaughtering. Slaughterhouses should be isolated from public. Due to lack of bio-security measures such as using solid fences and nets to quarantine infected flocks, and disinfecting footwear, experts say H5N1 is widespread in Bangladesh’s poultry farms.IEDCR that oversees human infections, advises people wash egg shells and suggests consuming well-cooked poultry products.
IEDCR also urged not to litter giblets and dead birds just anywhere and maintain personal hygiene, cough into the crook of elbow and wash hands with soap often.http://webcache.googleusercontent.com/search?q=cache:dHAwrRX3MTUJ:theindependentbd.com/paper-edition/frontpage/129-frontpage/107765-govt-bans-sale-of-chicken-in-markets-every-monday.html+Govt+bans+sale+of+chicken+in+markets+every+Monday+independent&cd=1&hl=en&ct=clnk&gl=us&client=firefox-beta

Jordan unknown disease still has not been identified

But the W.H.O. ,CDC and jordan know what it was..







Hospital Blue: the return of the proportion of auditors to their normal daily

  

  04/05/2012 at pm 10:30 (GMT +2)

  Citizens are reviewing emergency department in a hospital in the blue of the first government on Wednesday - (Photo: Osama Rifai)

•  Blue - eased "phobia" infection "pandemic" blue between blue state auditors hospital after their return gradually over the past days to review the various clinics and departments, after weeks of failure to do so for fear of taking infection disease, "mysterious".   According to hospital director Dr. Marwan Iqbal Habashneh the patients to the hospital returned to normal day to various sections of the hospital.
    Habashneh and that "the competent staff at the hospital ended the sterilization process more than once, he did not register new cases confirmed or suspected.
    The sense of panic dominated the past few weeks to many people in the province of the blue due to the clarity of the type of "virus", which appeared last month in the hospital, and left one death and 11 injured.
  

The panic seemed to clear erode the Board of the hospital clinics for the benefit of the private sector because of their fear of hospitalization, while the concerns of citizens emerged dramatically in the streets, who have used the masks in the areas surrounding the hospital and in the alleys and narrow streets and public places and private markets.
  Also caused the panic, which found no explanation of "convincing" for many citizens to cancel many of the patients to hospital appointments in blue and some other hospitals and primary health centers and comprehensive.  And Prince Faisal Hospital has seen the government in the District of sidewalk up numbers reviewers and a rise of more than 20%, according to its director, Dr. Talal slaves because of the fear of some of the reviewers go to the hospital blue.

However, the source of medical reviewers refer back to the hospital to the lack of alternatives for patients who did not find seemed to check out the blue hospital either for their economic conditions or the lack of another hospital.
  He added that the hospital most of the auditors are unable to conduct laboratory tests or X-ray clinic or visit a private doctor.
  According to official studies, lives a quarter of the province of blue below the poverty line, while the province has four pockets of poverty within the upper limits of the Ad-(52.2%), pyrene (42.3%), blue (40.3%), Jordan (29%).

Has reached the population density in the province to 205 persons / km 2, the highest in the Kingdom, estimated population density of 60 persons / km 2, while the population is distributed to 52 urban areas with the most important of Reed City and the sidewalk, and a proportion of the population in urban areas 96% of the proportion of population of the province's 900 thousand people.
  The hospital was closed during the blue last month temporarily sections of intensive care and intensive twice because of an injury Mredihama mysterious virus, and that is a precaution and to carry out disinfection and sterilization in them, then re-opened,.
  And the number of workers in a hospital in the blue government refrained from carrying out their duties after a steady drumbeat of news about the death of their colleague nurse Balawi emotions, which was hit by the epidemic, according to medical sources at the hospital.
  The sources confirmed that a state of fear Antapt hospital staff and reviewers at the announcement of the death of one of the injured, the center of strong interest to wear protectors medical as a precaution to prevent infection.
  He was 9 of the blue hospital staff had recovered fully and left the Prince Hamzah Hospital after receiving treatment following the injury to "the unknown disease. ..  http://translate.googleusercontent.com/translate_c?hl=en&langpair=ar%7Cen&rurl=translate.google.com&twu=1&u=http://www.alghad.com/index.php/article2/548477/%25D9%2585%25D8%25B3%25D8%25AA%25D8%25B4%25D9%2581%25D9%2589-%25D8%25A7%25D9%2584%25D8%25B2%25D8%25B1%25D9%2582%25D8%25A7%25D8%25A1-%25D8%25B9%25D9%2588%25D8%25AF%25D9%2587-%25D9%2586%25D8%25B3%25D8%25A8%25D9%2587-%25D8%25A7%25D9%2584%25D9%2585%25D8%25B1%25D8%25A7%25D8%25AC%25D8%25B9%25D9%258A%25D9%2586-%25D8%25A7%25D9%2584%25D9%258A%25D9%2588%25D9%2585%25D9%258A%25D9%2587-%25D8%25A7%25D9%2584%25D9%2589-%25D9%2585%25D8%25B9%25D8%25AF%25D9%2584%25D8%25A7%25D8%25AA%25D9%2587%25D8%25A7-%25D8%25A7%25D9%2584%25D8%25B7%25D8%25A8%25D9%258A%25D8%25B9%25D9%258A%25D9%2587.html&usg=ALkJrhj6J00t6BbkbrnB1p8PWmUSRh-zJA

Vietnam: Quang Ninh #H5N1 #Birdflu Outbreak

Thursday, 03/05/2012 (GMT +7)

After the PPC decision announced bird flu in Hai Tien commune, Mong Cai City People's Committee has issued decisions checkpoints established livestock and poultry in five villages of the commune.

Fasteners by Hai Tien commune leaders to key chief officers of the departments and functions as a member of the city. Key tasks of the test, control and prohibit units, individual transport and trade of animals and animal products out into the service, limited means and passersby; strict handling of applications and individuals that violate the Ordinance on Veterinary Medicine in the period from late May through 4-2012 prescribed time that the disease is not spread further.

Lab Security Standards Raise Chances of Mutant-Bird-Flu Catastrophe

• May 2, 2012

• Fears that bioterrorists could learn from controversial experiments that make H5N1 avian influenza more virulent have overshadowed a more pressing danger: accidental releases, laboratory infections and disgruntled workers.

  Dozens of all-too-human mistakes have occurred in just the last decade inside high-security laboratories, and many experts say new H5N1 flu strains engineered to infect mammals have not been handled with the care required to minimize chances of unintentional catastrophe.

  In fact, research on less-threatening pathogens is conducted at higher security levels than research on the new bird flu and other strains made artificially more virulent.

  Accidental infections and disgruntled workers “are by far the most realistic threats associated with these viruses,” said Rutgers University microbiologist Richard Ebright, a vocal critic of the new research. “But almost all of the discussion to date has focused on whether to publish the details. That only addresses lower-order risks.”

  H5N1 engineering is conducted so that scientists can study what might happen in nature, giving them early warnings of what to expect in future pandemics. Virologists, epidemiologists and public health experts have argued for years over this strategy’s scientific value and potential risks, but those debates went largely unnoticed by the public.

  That changed late in 2011 when two federally funded research teams, one led by University of Wisconsin virologist Yoshihiro Kawaoka and the other by Dutch virologist Ron Fouchier, submitted scientific papers describing how they’d tweaked H5N1 into strains contagious enough to easily infect ferrets, a standard research model for human flu infection.

  Until now, H5N1 has struggled to gain human traction, requiring close contact with infected animals or people, though it’s deadly when it happens: Mortality estimates range from 60 to 80 percent. That number may be inflated by unreported low-grade infections that aren’t fatal, but even lower estimates are plenty scary. The flu pandemic of 1918 had just a 2.5 percent mortality rate and killed 50 million people.

  Vaccines and medicines are better now, but as demonstrated by the swine flu pandemic of 2009 and 2010, highly infectious influenza is extraordinarily difficult to control. With this in mind, a federal U.S. biosecurity watchdog in November flagged the Kawaoka and Fouchier studies for further precautionary review. After a storm of public outrage and scientific misgivings, the researchers announced a 60-day pause on their research, with formal publication delayed until the flu community agreed it was safe.

  'We are creating a risk that is much greater than that posed by nature.'
  During this time, researchers who supported Kawaoka and Fouchier, and even some of their critics, discussed objections in terms of bioterror and whether the findings’ details should be published. They debated wheather rogue researchers might use them to design weaponized influenza strains.

  The May 2 publication of Kawaoka’s study in Nature, and the Dutch government’s green-light of Fouchier’s paper, signal that bioterror fears have been allayed. According to the prevailing view, potential benefits outweigh the risks. The conclusion is that for bioterrorists to use the findings would be very hard, while scientists can learn from them immediately.

  But many epidemiologists and public health experts say poor handling inside laboratories, rather than bioterror, is the real threat. More than 100 accidents in high-security labs took place between 2003 and 2009, involving everything from flu-infected ferret bites to dropped vials of encephalitis, slips with Ebola needles and lost shipments of bubonic plague. The 1977 “Russian flu” epidemic may have involved a lab escape. Less accidentally, anthrax used in the 2001 attacks almost certainly originated in U.S. military laboratories.

  Such events have been downplayed during the current the engineered-flu controversy. Public regulatory debates over the research have largely excluded such views. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, and a member of the federal biosecurity committee that reviewed the research, wrote in an open letter that its public hearings provided “a very ‘one sided’ picture of the risk-benefit.” Nature’s “independent review” of risks associated with publishing Kawaoka’s research doesn’t even mention accidental release.

  Supporters of the controversial experiments say the researchers are careful. But dozens of labs and hundreds if not thousands of researchers may eventually handle the new flu strains and others like them. “There’s too high a probability of escape if there are 40 or 50 labs working on something,” said Lynn Klotz, a senior science fellow at the Center for Arms Control and Non-Proliferation. In a commentary published in January inNature, Klotz estimated a 1 percent chance of accidental release per year at each lab working on SARS, the 1918 influenza or the new H5N1 strains. “We are creating a risk that is much greater than that posed by nature. Laboratories need stronger precautions,” wrote Klotz.

  Research on H5N1 and the new strains was conducted at what’s known as Biosafety Level 3, or one step down from the moon-suited, multiple-air locked, ultra-high-security of Biosafety Level 4, which is typically reserved for highly lethal pathogens for which there’s no known cure. That’s precisely what engineered H5N1 strains might turn out to be: While Kawaoka’s strains proved non-lethal to ferrets, there was no way to know that before the experiments began.

  Of the pathogens currently handled at BSL-4, including hemorrhagic fevers, ebola, tick-borne encephalitis and hantavirus, few are contagious. They primarily threaten people who work directly with them. “If they get out into the environment, most of them are fortunately not very transmissible,” said disease epidemiologist Stephen Morse of Columbia University. With more-contagious pathogens, “you’d want to be very concerned about lab accidents and how they’re being handled in the laboratory.”

  “They should use Biosafety Level 4. It’s what BSL-4 was developed for,” said geneticist Steven Salzberg of Johns Hopkins University. “The avian flu people have been saying this disease is incredibly dangerous, kills about 60 percent of the people it infects, and could infect hundreds of millions of people if it goes pandemic — but they don’t say it needs BSL-4? How could they say those two things?”

  

  Doctors test incoming passengers for swine flu at Shanghai's Pudong airport in 2009. Photo: Kyle Simourd/Flickr

  According to Ian Lipkin, a virus surveillance expert and director of Columbia University’s Center for Infection and Immunity, handling procedures are balanced against the obstacles they raise against conducting research in the first place.

  “Some people are concerned. They may push to have this work done at higher levels of containment and restrict the investigation to a few key laboratories. That’s not been decided yet. But the push back, which has happened in the past with SARS, is that doing so would slow down the pace at which research can be pursued,” Lipkin said.

  Biosafety recommendations are set by the federal Centers for Disease Control, National Institutes of Health and Department of Agriculture, and formalized in a document known as Biosafety in Microbiological and Biomedical Laboratories, or BMBL. According to the NIH and CDC, there are no plans to change the recommendations for how engineered H5N1 should be handled.

  Deborah Wilson, director of the NIH’s Division of Occupational Health and Safety, said “this virus is safely worked with under enhanced BSL-3 conditions.” And Amy Patterson, director of the NIH’s Office of Science Policy, said both Kawaoka and Fouchier’s labs were inspected in 2011 and found to be secure.

  A policy that may be changing, however, is the classification of H5N1 under the Select Agent Program, a system established after 9/11 to limit access to especially dangerous pathogens. Researchers who work with select agents must register their projects, and receive background checks and extra federal oversight. It’s a cumbersome process, and researchers have asked that less-dangerous pathogens be moved into a second, less-restrictive category, with only “tier 1″ pathogens receiving continued close monitoring.

  According to Ebright and others, engineered H5N1 will not be tier 1, vastly increasing the number of people allowed to work with it and reducing oversight upon those people. “There are over 400 institutions and 15,000 people with access to select agents,” said Ebright. “After the stratification goes into effect, the non-tier 1 number would grow larger. How much larger? That’s driven entirely by funding.”

  Ebright emphasized that, while Kawaoka and Fouchier’s manipulations of H5N1 are high-profile, they represent a multi-laboratory, long-term research effort coordinated by the NIH and CDC to engineer more virulent strains of H5N1, the 1918 flu and SARS. Concerns about the new flu strains should be multiplied across these programs.

  “If it hadn’t been generated in these labs, it would have been done in a half-dozen other labs that received funding for this project,” Ebright said. “This research was funded to increase national security, but by its very nature, it creates risks to U.S. health, agriculture, economic security and national security. The risks are not unforeseen. They are completely foreseeable.”

  Update 5/3: The quote from Michael Osterholm’s letter to the National Institutes of Health was added to the article.

  
  

Washington State on Target For major Pertussis Epidemic

Public health officials in Washington state have confirmed more than 1,100 cases of whooping cough so far this year in what is on track to become the worst epidemic of the disease to hit the state in seven decades.

No deaths have been reported from this year's outbreak but 20 infants have been hospitalized with the bacterial infection, which poses a special risk to young children, said Tim Church, a spokesman for the state Health Department.

[continued - click on title]

New Pigeon Disease Found in Sydney Australia

It has been recently revealed in a report that there has been a pigeon disease found in Sydney. Following the same revelation, pigeon owners in the vicinity are being warned by the government for protecting their birds from the paramyxovirus, which has been found in western parts of Sydney.

The NSW Department of Primary Industries revealed how there were a number of strange symptoms found in western Sydney, and the disease was detected. The relief is that the disease isn't so dangerous as to affect humans. It ca however prove to be fatal for the birds.

The symptoms of the same are revealed to be loss of appetite, partial paralysis in the wings of the birds, trembling wings and trembling head, and so on.

"The property has been placed in quarantine and tracing is now underway to confirm the origin of the virus. It is believed that the virus may have been transmitted following the introduction of a new pigeon into the flock from Victoria late last month", said the NSW Chief Veterinary Officer, Ian Roth.

It remains to be seen how the disease can be controlled in the time to come.

Report details changes that may boost H5N1 spread in mammals

Robert Roos News Editor
May 3, 2012 (CIDRAP News) – The first of two controversial H5N1 avian influenza studies to see print suggests that just four mutations in one of the virus's surface proteins may be enough to equip it to spread among mammals, but the findings are freighted with qualifiers.

After months of debate and discussion, Nature yesterday published the report by Yoshihiro Kawaoka, DVM, PhD, and colleagues describing a lab-derived hybrid virus, with elements of H5N1 and pandemic H1N1, that spread among ferrets via respiratory droplets. Kawaoka works at the University of Wisconsin.

The authors say their findings answer the "fundamental question" of whether flu viruses wearing the H5 hemagglutinin (HA) surface protein found in H5N1 can spread in mammals.

However, the virus did not kill any of the ferrets or even make them severely ill. Moreover, the authors caution that they don't know if the four mutations that supported transmission in the hybrid would accomplish the same thing in an H5N1 virus containing no foreign genes. Their reassortant virus contained seven genes from 2009 H1N1 and just one—the HA—from H5N1.

The results "indicate that H5 HA can convert to an HA that supports efficient viral transmission in mammals; however, we do not know whether the four mutations in the H5 HA identified here would render a wholly avian H5N1 virus transmissible," the report states. "The genetic origin of the remaining seven viral gene segments may also critically contribute to transmissibility in mammals."

At the same time, the researchers say one of the four key mutations they identified has already been seen in circulating H5N1 viruses on three continents, so it would take only three more to create an HA that supports mammalian transmission. They assert that their findings, by alerting scientists to potentially dangerous H5N1 mutations, will help surveillance.

Publication caps long process
The Kawaoka study is one of two H5N1 transmissibility studies that sparked concern and controversy when they were first described in general terms last fall. The other was led by Ron Fouchier, PhD, of Erasmus Medical Center in the Netherlands, whose report is expected to be published soon in Science.

Out of fear that someone could exploit the findings to create and release a highly dangerous virus, the US National Science Advisory board for Biosecurity (NSABB) recommended in December that both studies be stripped of key details before publication. But after the authors—especially Fouchier—provided some additional information and clarifications, the board recommended on Mar 30 that the full versions of both studies be published, and federal health officials endorsed the recommendation.

Kawaoka told CIDRAP News that he and his team revised their report twice. In response to the initial NSABB recommendation, they expanded their discussion of the benefits of the research and of the biosafety and biosecurity measures used, he said.

"After my presentation at the WHO H5N1 consultation in Geneva in February, the consensus was that including even more detail in these areas would be worthwhile," Kawaoka said.

Meanwhile, a companion editorial published in Nature today said the "essential scientific elements in the Kawaoka paper were unchanged between the first and second NSABB deliberations."

Introducing HA mutations
As the Kawaoka report explains, HA is the protein that enables flu viruses to attach to host cells to start the infection process. The H5 HA prefers to bind to sialic acids found on avian cell receptors, called alpha2,3 sialic acids, whereas the HA in human-adapted viruses such as H1N1 prefers to attach to alpha2,6 sialic acids.

Kawaoka's team started with a 2004 strain of H5N1 from Vietnam. The article describes a complex process whereby the team induced random mutations in the HA of this virus and then identified those that caused increased binding to alpha2,6 (human type) receptors. The researchers then used reverse genetics techniques to create reassortants consisting of the mutant H5 HAs and seven other genes from the pandemic H1N1 virus.

The reasons the team used the 2009 H1N1 virus included the "high genetic compatibility" of that virus with H5N1 and the fact that both viruses can infect pigs, which can serve as viral mixing vessels, the report explains. "The coexistence of H5N1 and 2009 pandemic H1N1 viruses could provide an opportunity for the generation of transmissible H5 avian-human reassortants in mammals," it says.

The team then infected ferrets intranasally with several different hybrid viruses and placed them in cages next to uninfected ferrets to identify mutations that were associated with respiratory-droplet transmission. In an initial round, a reassortant with three mutations (N158D, N224K, and Q226L) was found to be transmissible, with five of six contact ferrets showing serologic evidence of infection, and with actual virus recovered from two of those.

'A fine balance'
In further experiments, viruses with these three mutations spontaneously added a few more mutations, including one (T318I) that was found to make transmission more efficient.

The experiments also showed that viruses that combined a nonmutant H5 with H1N1 did not spread, nor did a hybrid virus that contained an H5 with only two mutations.

As for severity of illness, none of the ferrets infected with the reassortant viruses died, and most showed only modest weight loss (less than 10%), the researchers say. Ferrets infected with a 2009 H1N1 virus (with no H5N1 elements) lost more weight, but the difference was not significant. (Natural H5N1 viruses usually cause fatal illness in ferrets.)

The team determined that three of the four key mutations (N158D, N224K, and Q226L) contributed to the ability to bind to human receptors, while the fourth (T318I) lowered the pH at which the protein could release genetic material into an infected cell, according to a "News and Views" article accompanying the report. In addition, the N158D and T318I mutations made the HA more heat-stable, which in turn contributed to the virus's ability to spread by airborne droplets, the article says.

The authors concluded that "a fine balance of mutations affecting different functions in HA (such as receptor-binding specificity and HA stability) may be critical to confer transmissibility in ferrets."

Overall, the team said, "the transmissible H5 reassortant virus preferentially recognized human-type receptors, replicated efficiently in ferrets, caused lung lesions and weight loss, but was not highly pathogenic and did not cause mortality."

The scientists also sought to determine if the US government's H5N1 vaccine and the antiviral oseltamivir (Tamiflu) would be effective against the transmissible virus.

They found that serum from humans immunized with the H5N1 vaccine reacted more strongly to the lab-derived virus than to a wild-type virus, suggesting that the vaccine could provide some protection. In addition, the virus turned out to be "highly susceptible" to oseltamivir, suggesting that the drug would be useful.

Big question marks
The authors say they don't know if the four key mutations that conferred transmissibility in ferrets would also "support sustained human-to-human transmission." Components of the seven H1N1-derived gene segments in the virus, such as the neuraminidase gene, may have "critically contributed" to its airborne droplet transmissibility, they caution.

However, they observe that one of the four mutations, N158D, which causes loss of a glycosylation site, has been found in many H5N1 viruses in the Middle East, Africa, Asia, and Europe. "Therefore, only three nucleotide changes are needed for the HA of these viruses to support efficient transmission in ferrets."

Knowledge of the four key mutations will help those who conduct surveillance in H5N1-endemic countries to recognize "key residues that predict the pandemic potential of isolates," the authors predict. (In the debate over publication of Kawaoka's and Fouchier's findings, however, some experts have said that surveillance is too sparse and spotty to take advantage of such findings.)

"Although a pandemic H5N1 virus may not possess the amino acid changes identified in our study," the authors conclude, "the findings described here will advance our understanding of the mechanisms and evolutionary pathways that contribute to avian influenza virus transmission in mammals."

Pandemic possibilities
In the accompanying Nature News & Views piece, Hui-Ling Yen, PhD, and J. S. Malik Peiris, PhD, of the University of Hong Kong's Centre of Influenza Research write that the findings "demonstrate that H5N1 viruses do have the potential to cause a human pandemic."

Although the transmissible virus is a laboratory creation, "it should not be considered an experimental artifact," according to Yen and Peiris. "Natural emergence of an H5N1-H1N1 hybrid virus is plausible," because some H5N1 and H1N1 viruses trade genes in lab experiments, and the viruses could mix in pigs in many parts of the world.

Some other experts offered different views on what the findings imply about the risk of natural emergence of an H5N1 pandemic strain.

Philip K. Russell, MD, a veteran vaccinologist, infectious disease researcher, and former director of the Walter Reed Army Institute of Research, said the findings do not greatly change his views on the pandemic risk.

Russell told CIDRAP News he was very concerned about the risk of an H5N1 pandemic when the virus emerged and spread widely, but his concern has ebbed as the virus has failed to gain human transmissibility even as it has continued to cause rare human cases.

"I think it's still a remote possibility," he said. "I don't think these finding change my views that much, because the experiment has gone on in nature, and that keeps on saying it's probably not going to jump. But those [Kawaoka] experiments do indicate that yes, it's possible."

Russell added that continued surveillance of H5N1 viruses is important. "And I think this genetic information would be useful in improving our surveillance," he said. "If we see some viruses popping up with the right constellation of mutations, we could increase our level of concern and maybe increase our vaccine preparedness."

Masato Tashiro, MD, PhD, director of the WHO Collaborating Center for Reference and Research on Influenza at Japan's National Institute of Infectious Diseases in Tokyo, offered a different view of the study's implications for pandemic risk.

He said many policymakers have underestimated the risk of an H5N1 pandemic. The findings by Kawaoka and Fouchier, he said, suggest that an "H5N1 pandemic will occur, although several experts said it will not." Also, the findings show that "only a few mutations will result in a pandemic virus."

These mutations have not been observed together in nature as yet, but they have been seen separately "in many human isolates of H5N1 as well as avian isolates, especially of clade 2.2, recently prevalent in Egypt," Tashiro said.

He also said the study implies that an H5N1 virus would not lose its pathogenicity in gaining mammalian transmissibility. "The highly pathogenic properties may be essentially retained by the pandemic virus, although the change in the receptor binding specificity may reduce the pathogenicity to some extent," he commented.

He noted that the airborne-transmissible virus in the study did not kill the ferrets, but it did cause some lung pathology. Other reassortant viruses containing more H5N1 genetic material could be more pathogenic than Kawaoka's hybrid, he said.

Tashiro agreed with Russell that the findings will be an aid to surveillance and risk assessment: "The pandemic risk assessment of the virus isolates can be done more efficiently focusing on these mutations."

Nature assessed risk of publishing
At Nature's behest, a biodefense agency outside the United States conducted an assessment and concluded that the benefits of publishing Kawaoka's study outweighed the risks. The assessment was posted online by the journal.

The assessment states, "There is no doubt that this information could be used by an exceptionally competent laboratory to provide the foundation for a programme to develop a pandemic strain of this virus. There is no evidence that this reassortant virus would be fully pathogenic in humans."

On the other hand, the information in the study offers several benefits, according to the assessment. It will help scientists understand the pandemic potential of flu viruses, the risks posed by the deliberate manipulation of pathogens, and the characteristics needed for an effective flu vaccine, the anonymous author wrote.

Russell agreed that the risks of publishing the full study details outweigh the benefits. He said he sees little risk of bioterrorists exploiting the information, given the scientific sophistication they would need. "If there is a danger, it's a danger of escape from the lab," he added, but he said Kawaoka's team "did it right."

Tashiro commented that the risk of someone using the findings to create and unleash a very dangerous virus "cannot be excluded—but the risk of a naturally occurring pandemic virus is more realistic." And even without Kawaoka's study, information about potentially dangerous mutations could be gathered from many already published papers, he said.

Lessons about publishing
In an editorial, Nature's editors commented that the long debate over whether to publish only a redacted version of Kawaoka's (and Fouchier's) studies was worthwhile. The NSABB had initially recommended finding a way to provide the full details of the studies to selected scientists with a need to know.

"Having now considered these matters in depth, the editors of this journal have decided that we will not consider either alternative for papers in Nature in the foreseeable future," the editorial says.

"A paper that omits key results or methods disables subsequent research and peer review. Furthermore, after much internal and external deliberation, we cannot imagine any mechanism or criterion by which to sensibly judge who should or should not be allowed to see the work. Nor do we believe that any restricted information distributed to university laboratories would stay confidential for long."

Imai M, Watanabe T, Hatta M, et al. Experimental adaptation of an influenza H5 HA confers respiratory droplet transmission to a reassortant H5 HA/H1N1 virus in ferrets. (Letter) Nature 2012 (published online May 2) [Full text]

See also:

May 2 Nature editorial

May 2 Nature News & Views extract

Study risk assessment posted May 2 by Nature

Jan 25 CIDRAP News story "Virus in one controversial H5N1 study wasn't lethal"

New Foot-and-Mouth Disease Vaccine Soon to be Licensed

May 3, 2012
U.S. scientists have spent several years developing a vaccine for foot-and-mouth disease (FMD), one of the world’s most contagious animal viruses that could cost the U.S. economy more than $50 billion, experts estimate.

The vaccine is expected to be licensed within the next several months.

“This is probably one of the most important innovations in the last 60 years in foot-and-mouth disease,” says Luis Rodriguez, research leader of the foreign animal disease research unit at the Plum Island (NY) Animal Disease Center, where the vaccine has been developed under top security.

FMD vaccines already exist – the problem is they are of limited use because veterinarians cannot distinguish vaccinated animals from infected animals – both test positive for the disease.

In contrast, the new vaccine will feature an antibody test that will enable veterinarians to tell the difference between field infection and vaccination, researchers explain.

And the vaccine will be safe to manufacture in the United States because it does not use the whole live virus and cannot replicate, says Larry Barrett, director of Plum Island.

“In the United States, you can only work on FMD in an island environment, which is why we came here 60 years ago,” he says. “They wouldn’t allow us on the mainland.”

The vaccine works by triggering an immune response. A part of the foot-and-mouth disease virus is placed in a harmless vector – a defective human virus.

Then the vaccine is injected into the animal, providing immunity to fight FMD.

“The animal actually makes the vaccine inside its body by producing the FMD protein necessary to create an immune response,” Rodriguez explains.

“It’s a very good innovation – the most effective way to date and very promising technology. I think it’s going to revolutionize the way we look at FMD vaccines around the world today,” he says.

Research is also underway to develop new vaccines at the Institute for Animal Health in the United Kingdom (UK).

New FMD vaccines in the UK are using only the proteins, not the live genome part of the virus, which is why they are safe to produce, scientists say.

In developing their vaccine, the British team is producing the protective virus in insect cells instead of a defective virus. As with the vaccine developed at Plum Island, it is extremely stable and can be deployed rapidly to stem an outbreak, Rodriguez says.

The hope is that the new FMD vaccine will offer extended duration of immunity that will make its use suitable for countries where the disease is endemic.

“In some cases, current vaccines are only effective for three to four months, which means livestock need to be vaccinated three or four times a year. The cost of gathering the animals alone is significant – it’s just not practical,” he says.

This report was extracted from the BBC.

Peculiar, MO - Hand, foot and mouth disease reported in Ray-Pec district

May. 03, 2012
The Raymore-Peculiar School District alerted its families today that at least five students recently have been diagnosed with hand, foot and mouth disease.

The district is taking additional measures to sanitize and disinfect its schools, officials said, and they are urging families to do the same at home.

The disease, spread person-to-person by virus, is not the same disease as the farm animal disease often known as foot and mouth disease, the nursing supervisor told families in a letter.

The disease that has infected some students usually begins with a fever, poor appetite and often a sore throat. It may lead to painful sores in the mouth and a non-itchy skin rash on hands and feet.

Read more here: http://www.kansascity.com/2012/05/03/3591565/hand-foot-and-mouth-disease-reported.html#storylink=cpy

Human SCARB2-Dependent Infection by Coxsackievirus A7, A14, and A16 and Enterovirus 71

Published ahead of print 21 March 2012

1. Seiya Yamayoshi^a,
2. Setsuko Iizuka^b,
3. Teruo Yamashita^c,
4. Hiroko Minagawa^c,
5. Katsumi Mizuta^d,
6. Michiko Okamoto^e,*,
7. Hidekazu Nishimura^e,
8. Kanako Sanjoh^f,
9. Noriko Katsushima^g,
10. Tsutomu Itagaki^h,
11. Yukio Nagaiⁱ,
12. Ken Fujii^a and
13. Satoshi Koike^a

+ Author Affiliations

1. ^aNeurovirology Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
2. ^bShimane Prefectural Institute of Public Health and Environmental Science, Matsue, Shimane, Japan
3. ^cAichi Prefectural Institute of Public Health, Nagoya, Aichi, Japan
4. ^dYamagata Prefectural Institute of Public Health, Yamagata, Japan
5. ^eVirus Research Center, Sendai Medical Center, Sendai, Miyagi, Japan
6. ^fSanjoh Clinic, Shinjo, Yamagata, Japan
7. ^gKatsushima Pediatric Clinic, Yamagata, Japan
8. ^hYamanobe Pediatric Clinic, Higashimurayama, Yamagata, Japan
9. ⁱNagai Children's Clinic, Sendai, Miyagi, Japan

ABSTRACT

Human enterovirus species A (HEV-A) consists of at least 16 members of different serotypes that are known to be the causative agents of hand, foot, and mouth disease (HFMD), herpangina, and other diseases, such as respiratory disease and polio-like flaccid paralysis. Enterovirus 71 (EV71) and coxsackievirus A16 (CVA16) are the major causative agents of HFMD. CVA5, CVA6, CVA10, and CVA12 mainly cause herpangina or are occasionally involved with sporadic cases of HFMD.

We have previously shown that human scavenger receptor class B, member 2 (SCARB2) is a cellular receptor for EV71 and CVA16. Using a large number of clinical isolates of HEV-A, we explored whether all clinical isolates of EV71 and other serotypes of HEV-A infected cells via SCARB2.

We tested this possibility by infecting L-SCARB2 cells, which are L929 cells expressing human SCARB2, by infecting human RD cells that had been treated with small interfering RNAs for SCARB2 and by directly binding the viruses to a soluble SCARB2 protein.

We showed that all 162 clinical isolates of EV71 propagated in L-SCARB2 cells, suggesting that SCARB2 is the critical receptor common to all EV71 strains. In addition, CVA7, CVA14, and CVA16, which are most closely related to each other, also utilized SCARB2 for infection. EV71, CVA14, and CVA16 are highly associated with HFMD, and EV71 and CVA7 are occasionally associated with neurological diseases, suggesting that SCARB2 plays important roles in the development of these diseases. In contrast, another group of viruses, such as CVA2, CVA3, CVA4, CVA5, CVA6, CVA8, CVA10, and CVA12, which are relatively distant from the EV71 group, is associated mainly with herpangina. None of these clinical isolates infected via the SCARB2-dependent pathway.

HEV-A viruses can be divided into at least two groups depending on the use of SCARB2, and the receptor usage plays an important role in developing the specific diseases for each group.

SA (4.8 years old) Undergo Maintenance in the Bubble Dr M Djamil Padang #H5N1 #BIRDFLU

  Thursday, May 3, 2012 19:10:22  

   

  KBRN, Padang: Provincial General Hospital Padang M Djamil received another patient suspect bird flu.  Patient initials SA 4.8 year-old who allegedly contracted the bird flu virus, and is currently undergoing treatment in the isolation room.
  Public relations department of M Djamil Padang Gustavianof said Thursday (3/05), SA began to be referred to the hospital since May 1 last Monday, because of a flu with high fever. Described, patients suspected of infected with H5N1 bird flu virus, because the patient's home in the Village Ulak Karang, the city of Padang found 15 chickens died suddenly.  Suspect bird flu was strengthened because of the distance between the chicken coop and a place to live only 3 meters.
 . "The symptoms of bird flu suspect to exist, it's being ditipkan U.S. parent to grandmother's house. . In the house there is a chicken coop which was about 3 meters from the house, and there are 15 chickens that died suddenly at home to everything ", said Gustavianof.
 . However, to ensure the allegations in question, the Dr M Djamil Padang rongten still awaiting results from a team of doctors, as well as the certainty of the results of blood and saliva samples of patients who had been sent to a laboratory in Jakarta.
  "We're not sure that the bird flu ya know!, There is still a process to make sure.  Patients we treat in accordance with the procedure, rongten already done, blood and saliva samples have been sent to a lab in Jakarta, according to the procedure.  All are still waiting for results ", he said.

  Gustafianof added, expected results of blood and saliva samples of SA patients suspect bird flu, will be completed within one week.  Location of residence of patients suspected of contracting bird flu virus H5NI, sterilized by current Department of Health and Animal Husbandry Department of Padang.
 Dodik/BCS) Meanwhile, during the period of 2012, Dr M Djamil Padang has received two suspect cases of bird flu, one of these cases occurred in March last, and was declared negative. (Dodik /   BCS)   http://translate.googleusercontent.com/translate_c?hl=en&ie=UTF8&prev=_t&rurl=translate.google.com&sl=id&tl=en&twu=1&u=http://rri.co.id/index.php/detailberita/detail/16970&usg=ALkJrhhXBSTgf7Jc_JVBkEQYhTjUIvKB7A

Avian influenza – situation in Indonesia – update #H5N1 #BIRDFLU

 

2 May 2012 -The Indonesian IHR National Focal Point of the Ministry of Health has notified WHO of a new case of human infection with avian influenza A(H5N1) virus.
The case is a 2 year-old male from Riau Province. He developed fever on 17 April 2012 and was hospitalized on 21 April 2012 but he died on 27 April 2012.
Epidemiological investigation is ongoing. Preliminary findings indicate that the case’s parents are quail egg vendors.
The case was confirmed by the National Institute of Health Research and Development (NIHRD), Ministry of Health.
To date, of the 189 cases reported in Indonesia since 2005, 157 have been fatal.

http://www.who.int/csr/don/2012_05_02/en/index.html

Suspect #BIRDFLU Patient in Padang #H5N1

Padang residents restless bird flu

 May 3, 2012 at 7:36 pm

  Padang, (kasehat) - Some residents in the city of Padang admitted again troubled by the outbreak of bird flu virus. Thursday (3/5), a toddler named Solomon Abel (4) suspected of contracting bird flu.  Currently, Sulaiman intensive care in a special isolation room bird flu in Dr M Djamil Padang. Known, who is the son of Solomon one of the doctors at the private hospital in Padang was hospitalized on Tuesday (1/5).   He was hospitalized after experiencing symptoms of a fever for three days.
 "He was examined because of fever accompanied by cough, and after our x-rays, child suspected of having pneumonia," said Dr M Djamil Humass Padang, Gustavianof to Kasehat.com, Thursday (3/5).
 According Gustavianof, the child suspect bird flu, because before a fever he had direct contact with poultry belonged to her grandmother.  "Listen to the story, when his parents were going to Jakarta, Solomon left behind with her ​​grandmother in North Padang Reef Ulak.  When there the birds belonged to her grandmother suddenly died suddenly.  And the child has direct contact, "he said.
A number of residents who met Kasehat.com admitted worried about the bird flu virus. Yanti Princess (35), who also claimed to Padang residents Ulakkarang infected with bird flu to worry about. "Hopefully, not the bird flu outbreak here," said the mother of this household.   http://translate.google.com/translate?hl=en&sl=id&u=http://kasehat.com/2012/05/03/warga-padang-resah-flu-burung/&ei=CpOiT8u1BaS62wXsq9DaCA&sa=X&oi=translate&ct=result&resnum=3&ved=0CDgQ7gEwAg&prev=/search%3Fq%3Dflu%2Bburung%26hl%3Den%26client%3Dnews%26tbs%3Dsbd:1,qdr:d%26tbm%3Dblg