The Smoking Bat

Via ProMED-mail: SciDev.Net reports on a study tracing the 2007 Ebola outbreak in the Congo to the consumption of fruit bats.

For the new study, researchers led by Eric Leroy from the International Centre for Medical Research in Franceville, Gabon, interviewed locals about the background of the Ebola cases. They were told that the annual migration of the fruit bat Hypsignathus monstrosus was particularly large in 2007.
Bats are an important source of protein in the area as wild animals are in short supply. They are often shot and then sold covered in blood.
The researchers believe the source of the 2007 outbreak was a man who bought bats at market. He survived, experiencing only a low fever, but his four-year-old daughter died after developing a sudden fever accompanied by vomiting. A family friend who prepared the girl's body for burial was subsequently infected and went on to infect 11 members of her family, all of whom died.

Swine Flu VII: Already a Pandemic

Via ProMED-mail: Bloomberg.com reports that novel influenza A (H1N1) has already met the WHO's vacillating standards for a flu pandemic, and has also been vastly underreported.

One in 20 cases is being officially reported in the U.S., meaning more than 100,000 people have probably been infected nationwide with the new H1N1 flu strain, according to the Centers for Disease Control and Prevention. In the U.K., the virus may be 300 times more widespread than health authorities have said, the Independent on Sunday reported yesterday.

Most disturbing are the prospects for ongoing summer transmission:

“While we are seeing activities decline in some areas, we should expect to see more cases, more hospitalizations and perhaps more deaths over the weeks ahead and possibly into the summer,” Anne Schuchat, CDC’s interim deputy director for science and public health program, told reporters on a May 22 conference call.

Popcorn Lung Update

"Diacetyl, the chemical that makes food taste like artificial butter flavor" [The Pump Handle] is back in the news, with a not-so-open-to-the-public OSHA meeting of the SBREFA panel. The future of diacetyl use in the food industry remains unclear.

Wikipedia has more on Bronchiolitis obliterans or popcorn lung. The tale of the single civilian victim appeared previously on PlagueBlog. (PlagueBlog recommends against eating your weight in artificially-flavored popcorn in any given year.)

Vaccinia: An Adverse Event

Via ProMED-mail: the CDC reports* on an adverse event following military smallpox vaccination. The patient survived, though the linked report may cause the reader to doubt that he would, or would want to.

Progressive vaccinia (PV), previously known as vaccinia necrosum, vaccinia gangrenosum, or disseminated vaccinia, is a rare, often fatal adverse event after vaccination with smallpox vaccine, which is made from live vaccinia virus (1). During recent vaccination programs potential cases of PV were investigated, but none met standard case definitions (2). PV has not been confirmed to have occurred in the United States since 1987 (3). On March 2, 2009, a U.S. Navy Hospital contacted the Poxvirus Program at CDC to report a possible case of PV in a male military smallpox vaccinee. The service member had been newly diagnosed with acute mylegenous leukemia M0 (AML M0). During evaluation for a chemotherapy-induced neutropenic fever, he was found to have an expanding and nonhealing painless vaccination site 6.5 weeks after receipt of smallpox vaccine. Clinical and laboratory investigation confirmed that the vaccinee met the Brighton Collaboration and CDC adverse event surveillance guideline case definition for PV (4,5). This report summarizes the patient's protracted clinical course and the military and civilian interagency governmental, academic, and industry public health contributions to his complex medical management. The quantities of investigational and licensed therapeutics and diagnostics used were greater than anticipated based on existing smallpox preparedness plans. To support future public health needs adequately, the estimated national supply of therapeutics and diagnostic resources required to care for smallpox vaccine adverse events should be reevaluated.

* Keep in mind that this is PlagueBlog. When I say adverse, I mean adverse. Click at your own risk.

Rabies Pandemic Brewing in Arizona

Via ProMED-mail: National Geographic reports on a more virulent strain of rabies brewing in Arizona.

Evolving faster than any other new rabies virus on record, a northern-Arizona rabies strain has mutated to become contagious among skunks and now foxes, experts believe.
The strain looks to be spreading fast, commanding attention from disease researchers across the United States.
It's not so unusual for rabid animals to attack people on hiking trails and in driveways, or even in a bar—as happened March 27, when an addled bobcat chased pool players around the billiards table at the Chaparral in Cottonwood.
Nor is it odd that rabid skunks and foxes are testing positive for a contagious rabies strain commonly associated with big brown bats.
What is unusual is that the strain appears to have mutated so that foxes and skunks are now able to pass the virus on to their kin—not just through biting and scratching but through simple socializing, as humans might spread a flu.
Usually the secondary species—in this case, a skunk or fox bitten by a bat—is a dead-end host. The infected animal may become disoriented and even die but is usually unable to spread the virus, except through violent attacks.

Swine Flu VI: A Vaccine

Via ProMED-mail: as this flu season draws to a messy end, Scientific American blogs about the prospects for a swine flu (Influenza A H1N1 etc.) vaccine for next season. Reuters reports that the WHO is optimistic about such a shift, although it is unclear what impact swine flu will have on regular seasonal flu vaccine production.

Marie-Paule Kieny, WHO director of the initiative for vaccine research, said the agency is discussing with drug companies whether and when to stop making seasonal flu vaccine production and shift to making one for the new H1N1 strain.

See my twitter updates for the latest swine flu news.

Swine Flu V: Sequence Analysis

Via ProMED-mail: sequence analysis indicates that swine flu may be entirely domestic and porcine, despite previous reports linking it to human and bird flus as well as Asian swine flu strains.

"...the NA and M genes are most closely related to corresponding genes from influenza viruses isolated in swine population in Eurasia."
However, the NA and M genes from 2 swine virus isolates from America are also closely related to the novel H1N1 virus (A/swine/Virginia/670/1987, A/swine/Virginia/67a/1987), if a reasonable nucleotide substitution rate is accepted. Thus, H1N1 from Mexico may be a swine flu virus strain of entirely American origin, possibly even of relatively ancient origin.

Swine Flu IV: The Return of the Typhoid Traveller

Via Healthmap on Twitter: ABC Australia reports on the search for fellow passengers of three New Zealander students with swine flu.

There are more updates on the pig farming connection, Israel's cases, Connecticut's suspected cases, and California's deaths and state of emergency in my twitter feed.

Swine Flu III: Mexico Timeline

Via Effect Measure by way of The Pump Handle: the blog Biosurveillance reports on Veratect's extensive timeline of swine flu in Mexico, starting with an incident in Canada on March 30th.

At Veratect, we operate two operations centers based in the United States (one in the Washington, DC area and one in Seattle, WA) that provide animal and human infectious disease event detection and tracking globally. Both operations centers are organizationally modeled after our National Weather Service using a distinct methodology inspired by the natural disaster and meteorology communities. Our analysts handle information in the native vernacular language and have been thoroughly trained in their discipline, which include cultural-specific interpretation of the information.
[...]
March 30
Veratect reported that a 47-year-old city attorney for Cornwall was hospitalized in a coma at Ottawa General Hospital following a recent trip to Mexico. Family members reported the individual voluntarily reported to the hospital after gradually feeling ill upon returning from his trip on 22 March.

Of special note are the pig farming connection on April 6th, the Semana Santa [Holy Week] connection under the heading "Large mass gatherings", and Veratect's new Twitter feed.

Swine Flu II

Although no pigs have become ill and no patients have reported contact with pigs, the new swine/avian/human influenza mix coming out of Mexico has been dubbed "swine flu." Since Mexican health officials first admitted the problem on Thursday, swine flu has been detected in California, Texas, Kansas, New York City, and Nova Scotia. Suspected cases are currently under investigation in British Columbia, France, Spain, Israel, and New Zealand, mainly in tourists returning from Mexico. No fatalities have been reported outside of Mexico (where the case count now stands at approximately 1500 with over 80 fatalities).

The Associated Press reports that the WHO has declared the outbreak in North America to be a "public health emergency" with "pandemic potential."

The CDC has a page up summarizing the current investigation.

A ProMED poster notes that like this one, the Spanish Flu first appeared at the end of the flu season, but came back with a vengeance for the next one:

The 1st cases of that agent showed up in May 1918 in an army base in Kansas -- it went quiet over the summer -- and started ravaging the globe in early fall that year.

Also, someone is maintaining a Google map of the outbreak.

Swine-Bird Flu

Via an unnamed source: The BBC reports on a rash of deaths in Mexico from a new strain of flu with both swine and bird elements.

Fifty-seven people had died in Mexico City from flu-like symptoms, [WHO spokeswoman Fadela Chaib] said, and another three in San Luis Potosi in central Mexico. There are around 800 suspected cases, she said.
Health Minister Jose Angel Cordova said the virus had "mutated from pigs and then at some point was transmitted to humans".
The strain of flu had been confirmed in at least 16 deaths, with 44 others being tested, the government said.
It urged people to take preventative measures such as not shaking hands or sharing crockery.
In the US, experts say the seven people who fell ill across two states were suffering from a new form of swine flu that combined pig, bird and human viruses.
"This is the first time that we've seen an avian strain, two swine strains and a human strain," Dave Daigle, a spokesman for the CDC, told AFP.
The CDC said none of the seven victims had been in contact with pigs, which is how people usually catch swine flu.

Norovirus Lockdown

Via an unnamed source: the Boston Globe reports that a norovirus outbreak has closed Babson College in Wellesley, Mass.

About 100 students have fallen ill since Wednesday. The decision to close the school was made [Sunday] after the virus escalated amongst the students, said Dr. Marcia Testa-Simonson, vice chair of the Wellesley Board of Health.
[...] The school is closed and students who live on campus are asked to stay on campus. The school is aiming to reopen Wednesday, said Mary Suresh, director of the Wellesley Health Department.

Scabies at Logan

Via an unnamed source: WBZ TV reports on a small scabies outbreak among TSA workers at Logan Airport in Boston.

TSA officials say all their workers wear gloves so the public should not be concerned about getting scabies.
It is still unclear how the employees got scabies in the first place.
According to the CDC, scabies is caused by an infestation of the skin by human itch mites that burrow under the skin and lay eggs.

It's unclear to PlagueBlog how the gloves that failed to protect the TSA workers are supposed to have protected the public.

90% Mortality Rates

Via ProMED-mail: The Hartford Courant reports a 90% mortality rate for the state's bats from white-nose syndrome.

Jenny Dickson, the Connecticut Department of Environmental Protection wildlife biologist supervising the detection and control of white-nose syndrome in the state, said Tuesday that visits to two sample caves in Litchfield County in the past two weeks revealed veritable bat catacombs. Dickson's team of wildlife experts found thousands of dead bats floating like dead fish in standing water, or stacked on top of each other along the flat ledges of the cave walls.
"It was grim, and you don't have to be a scientist to realize the implications for the environment inside those caves," said Dickson. "This is a massive, unprecedented die-off, with significant potential impacts on nature, especially insect control."

Bats from all over the Northeast migrate through Connecticut, so expect more mosquitoes this summer.

In other 90% mortality news, a German researcher pricked herself instead her intended mouse victim with a needle full of Ebola-Zaire last week. She's still in isolation, showing no symptoms and being treated with an experimental vaccine. See the AAAS blog for more information.

Norovirus in Massachusetts

Via Universal Hub: the Massachusetts Office of Health and Human Services reports a rise in norovirus infections in the state.

The Massachusetts Department of Public Health (DPH) has seen a significant number of gastrointestinal illness outbreaks across the state this winter, which are likely caused by norovirus infections. Noroviruses are a group of particularly strong viruses that cause nausea, vomiting, and diarrhea in people who get infected.
Noroviruses are easily spread through food, by person-to-person contact, or though contact with contaminated surfaces such as countertops and door knobs. The virus is spread through an infected person’s stool or vomit -- contamination that can be spread further without careful attention to hand washing and environmental cleaning.

There's a list of tips for avoiding infection, but they may not go far enough. In particular, PlagueBlog recommends avoiding dirty diapers and oysters altogether. There is no safe handling procedure for such items.

Cold on the Trail of the Tylenol Killer

Via Universal Hub: Boston.com reports that the FBI and state police searched a Cambridge condo today in connection with the 1982 Tylenol tampering deaths.

The first-floor condominium belongs to James W. Lewis, 62, of 170 Gore St., who spent 12 years in federal prison for trying to extort $1 million from the painkiller's manufacturers but was never charged in the murders. The authorities spent most of the day inside the six-story blonde brick building and also searched a storage facility at an undisclosed location in the city.
The Chicago office of the FBI said in a statement late today that agents, the Illinois State Police, and several local police departments were "conducting a complete review of all evidence developed in connection with the 1982 Tylenol murders," which prompted dramatic changes in the way almost all food and medical products are packaged.

Bubonic Justice

Via ProMED-mail: UPI reports that at least 40 al-Qaeda militants have died in a plague outbreak near Algiers.

Al-Qaida leaders said they fear the plague has spread to other cells or to Taliban fighters in Afghanistan.
The epidemic began in the hideouts of the al-Qaida in the Land of the Islamic Maghreb in Algiers, sources told The Sun. The group fled to Bejaia and Jijel provinces.

As they say, Allah hu Akbar.

Anthrax Redux

Via ProMED-mail: The New York Times reports on the life and spores of the late Dr. Bruce Edwards Ivins.

Focused for years on the wrong man, the bureau missed ample clues that Dr. Ivins deserved a closer look. Only after a change of leadership nearly five years after the attacks did the bureau more fully look into Dr. Ivins’s activities. That delay, and his death, may have put a more definitive outcome out of reach.
Brad Garrett, a respected F.B.I. veteran who helped early in the case before his retirement, said logic and evidence point to Dr. Ivins as the most likely perpetrator.
“Does that absolutely prove he did it? No,” Mr. Garrett said. With no confession and no trial, he said, “you’re going to be left not getting over the top of the mountain.”

And doubts will persist:

In November, four of Dr. Ivins’s closest co-workers wrote a glowing obituary of their “valued collaborator” for Microbe, the leading microbiology journal. It did not mention the anthrax accusations and was a singular protest by the four scientists against the F.B.I.’s conclusion.
“His colleagues and friends will remember him not only for his dedication to his work,” the obituary said, “but also for his humor, curiosity and great generosity.”

ProMED-mail Internet-a-thon

Like 2008 itself, the ProMED-mail 2008 Internet-a-thon is drawing to a close:

Your financial support enables ProMED to continue providing you and 48,000 others in 187 countries worldwide with reliable, independent reporting of emerging infectious diseases and outbreaks as they happen.

Plagueblog recommends that you support this noble cause.

Holiday Cookie Dough Warning

Via ProMED-mail: the New Zealand Food Safety Authority reports on a salmonella outbreak apparently caused by (raw) contaminated flour.

“It is possible for low levels of bacteria to be on wheat or other points of the flour milling process, and studies indicate that about one percent of flour on average contains Salmonella.”
“Flour is a raw ingredient and intended to be consumed cooked. Although flour is not expected to be a sterile product, we support the company’s precautionary decision to withdraw the product. The affected batches of these brands can be safely used to cook if proper care is taken. If people have used these brands in their baking - for biscuits, cakes, breads or other Christmas treats - they can be reassured that the cooking will have killed the bacteria and that these home baked foods are safe to eat.”

In other words, bake those cookies before you eat any.