Bird Flu Kills At Least One Nigerian

Reuters reports on the first human death from bird flu in Nigeria:

The 22-year-old died after feathering and disembowelling an infected chicken. She was from Lagos, the commercial capital of Africa's most populous country, Information Minister Frank Nweke said.
Test [sic] on three other victims, one of them the woman's mother, were inconclusive.
Nigeria was the first African nation to detect the H5N1 virus in poultry last year and had conducted tests on 14 people suspected of having the virus.

The WHO is taking it in stride:

World Health Organisation spokesman Gregory Hartl said a human case of bird flu in Nigeria was to be expected because of the experience in other countries, such as Indonesia, with huge poultry populations where chickens and hens live in close proximity to humans.
"It does not change anything from a public health point of view," Hartl said. "It had to happen sooner or later."

Cat Flu

Via ProMED-mail: New Scientist reports on the implications of widespread H5N1 infection among Indonesia's cats.

Chairul Anwar Nidom of Airlangga University in Surabaya, Indonesia, told journalists last week that he had taken blood samples from 500 stray cats near poultry markets in four areas of Java, including the capital, Jakarta, and one area in Sumatra, all of which have recently had outbreaks of H5N1 in poultry and people.
Of these cats, 20 per cent carried antibodies to H5N1. This does not mean that they were still carrying the virus, only that they had been infected - probably through eating birds that had H5N1. Many other cats that were infected are likely to have died from the resulting illness, so many more than 20 per cent of the original cat populations may have acquired H5N1.
[...]
Osterhaus emphasises that the cat infections still pose a potential threat. "We know the 1918 pandemic was a bird flu virus that adapted to mammals in some intermediate mammalian host, possibly pigs," he says. "Maybe for H5N1 the intermediate host is cats." If similar percentages of cats are infected at every outbreak location, there must have been many thousands of cat infections since the virus emerged, compared to 267 confirmed cases in humans. Every sick cat is a chance for the virus to adapt, and with renewed outbreaks this year in birds, people or both in China, Indonesia, Japan, South Korea, Hong Kong, Vietnam, Thailand, Egypt and Nigeria, it is getting plenty of such chances.

A Cure for Cancer?

Via GeekPress: NewScientist.com reports on dichloroacetate (DCA), a cheap, unpatented potential cancer drug:

Evangelos Michelakis of the University of Alberta in Edmonton, Canada, and his colleagues tested DCA on human cells cultured outside the body and found that it killed lung, breast and brain cancer cells, but not healthy cells. Tumours in rats deliberately infected with human cancer also shrank drastically when they were fed DCA-laced water for several weeks.
DCA attacks a unique feature of cancer cells: the fact that they make their energy throughout the main body of the cell, rather than in distinct organelles called mitochondria. This process, called glycolysis, is inefficient and uses up vast amounts of sugar.

Playing with the Spanish Flu

Nature has a Web focus on the 1918 flu virus. For a free account of the latest on Frankenstein's reconstituted flu virus, see this press release from the University of Wisconsin-Madison:

By infecting monkeys with the virus, the team was able to show that the 1918 virus prompted a deadly respiratory infection that echoed historical accounts of how the disease claimed its victims.

Shocking! But wait, there's more:

Importantly, the new work shows that infection with the virus prompted an immune response that seems to derail the body's typical reaction to viral infection and instead unleashes an attack by the immune system on the lungs. As immune cells attack the respiratory system, the lungs fill with fluid and victims, in essence, drown.

Somehow I doubt anyone spent the last 90 years believing that the victims were drowning in liquid flu virus. But on a more optimistic note,

The same excessive immune reaction is characteristic of the deadly complications of H5N1 avian influenza, the strain of bird flu present in Asia and which has claimed nearly 150 human lives, but has not yet shown a capacity to spread easily among people.
"What we see with the 1918 virus in infected monkeys is also what we see with H5N1 viruses," Kawaoka says, suggesting that the ability to modulate immune response may be a shared feature of the most virulent influenza viruses.

At least these guys are playing with Frankenstein's Flu at biosafety level 4 this time:

In the new study, conducted in a high-level biosafety laboratory (BSL 4) at the Public Health Agency of Canada's National Microbiology Laboratory, seven primates were infected with the reconstructed 1918 virus. Clinical signs of disease were apparent within 24 hours of infection, and within eight days, euthanization was necessary. The rapid course of the disease mirrors how quickly the disease ran its course in its human victims in 1918.

Gastroenteritis in Boston

Via ProMED-mail: the Boston Public Health Commission advises Bostonians to wash their hands during the current outbreak of Norwalk-like illnesses.

In addition to the increases seen in emergency rooms, an outbreak of GI illness has occurred at Simmons College in Boston. As of December 15, eighty-one (81) students and staff have reported experiencing nausea, vomiting diarrhea and stomach cramps. Many of the affected individuals have reported being ill for approximately two days after symptoms began. The outbreak at the school appears to be on a downward trend with only a few new cases having been reported in the last several days. Early implementation of control measures including education on hand washing, availability and use of hand sanitizer, and increased frequency of restroom cleaning appears to have decreased the transmission of illness at Simmons.

New Giant Microbes

GIANTmicrobes has some exciting new plushie microbes, including a cute curly Lyme disease and a red-eyed rabies virus.

Among their older products, E. coli is cute and timely, while TB is intriguingly horizontal.

Yo no quiero Taco Bell

Via ProMED-mail: The New York Times reports on the spreading Taco Bell E. coli outbreak.

Even as health officials and food distributors zeroed in yesterday on a California farm as the possible source of the contaminated green onions that have sickened Taco Bell customers, the E. coli outbreak widened considerably, with cases reported for the first time in New York City, Delaware, South Carolina and Utah.
In all, the number of cases that have been reported ballooned, to at least 169 yesterday, with most concentrated on Long Island and in New Jersey.
In New York, health officials said they were investigating 103 confirmed or suspected cases in 10 counties, up from 49 on Wednesday. Nearly three-quarters of the cases were found on Long Island, but cases were reported for the first time in New York City as well as Westchester, Rockland, St. Lawrence and Herkimer Counties.
In New Jersey, 12 new cases were reported, bringing the total to 55. There were no new cases reported in Pennsylvania, where seven people have been sickened thus far. In Delaware, one case was confirmed and another was suspected. According to federal health officials, “the vast majority of patients reported eating” at a Taco Bell.

Big Whoop

Via ProMED-mail: The Boston Globe reports eight more staff members at Children's Hospital in Boston have been diagnosed with whooping cough, for a total of 33 to date.

Disease investigators have said they believe whooping cough was carried into Children's by a 19-month -old patient. They continue to investigate whether a 3-year-old girl who has the illness contracted it at the hospital or before she arrived there.
Barry said the eight additional cases reported yesterday do not reflect recent infections. Instead, she said, most of those staff members began displaying symptoms in mid-October. So far, no hospital workers or patients have faced life-threatening complications as a result of the outbreak.

Adopt A Microbe

Via Boing Boing: Adopt A Microbe.

Hola. I'm C. jejuni.
I am a curved Gram Negative rod.

You can find me in lots of domestic animals.
I am part of the normal bacterial flora of poultry and cattle.

The illustrations alone are a riot.

Eyes Without a Face

In Wired this month: Face Blind, an article about prosopagnosia.

Developmental prosopagnosia came to light in large part because of Internet groups. Before that, most people born with the condition assumed they were just bad with faces. It's not the type of thing most would go to a doctor about, and even if they did, their physician probably couldn't help, because many doctors are unaware of it. In many ways, this is a neurological condition discovered by Yahoo.

The Survivor

Via ProMED-mail: Regarding a recent case of symptomatic rabies, the aptly-named Wish TV reports on the Indiana State Department of Health's wild optimism.

"Historically it's a near fatal disease and so it's always touch and go, but given treatment today we're hopeful that this individual is going to survive this case," said Dr. Judith Monroe, Indiana State Department of Health.

By "near-fatal" Dr. Monroe means "only one person has ever survived": see Recovery of a Patient from Clinical Rabies --- Wisconsin, 2004.

The Smoking Spinach Bag

Via ProMED-mail: The AP reports that health officials have pinned the E. coli outbreak on the prime suspect, spinach from the Salinas Valley.

A bag of tainted Dole baby spinach found in the refrigerator of a New Mexico patient was a "smoking gun" that allowed investigators to zero in on farms in the Salinas Valley.
The spinach tested positive for the same strain of E. coli linked to the outbreak. Dole is one of the brands of spinach recalled late last week by Natural Selection Foods LLC of San Juan Bautista, California.

Spinach Recall

I saw them taking away the bagged spinach at Whole Foods today. See the New York Times article or the FDA warning against bagged spinach:

The U.S. Food and Drug Administration (FDA) is issuing an alert to consumers about an outbreak of E. coli O157:H7 in multiple states that may be associated with the consumption of produce. To date, preliminary epidemiological evidence suggests that bagged fresh spinach may be a possible cause of this outbreak.
Based on the current information, FDA advises that consumers not eat bagged fresh spinach at this time. Individuals who believe they may have experienced symptoms of illness after consuming bagged spinach are urged to contact their health care provider.

Spam Sushi Poisoning

Via ProMED-mail: the Honolulu Star Bulletin reports on a rash of food poisoning on Maui caused by spam musubis:

Since July, nine people have become ill probably from food poisoning associated with Spam musubis sold at four stores in Central Maui, officials said yesterday.
Most of the ill have been children, ranging from ages 3 to 9, and two of them received emergency medical care, officials said.

What's Cooking in America has more than you ever wanted to know about spam musubi, including a recipe and pictures of the mold:

A favorite Hawaiian way to eat Spam is in the form of a musubi (pronounced moo-soo-bee, with no accent). It is a fried slice of spam on rice pressed together to form a small block, then wrapped with a strip of seaweed. A special kitchen gadget, known as the Spam Musubi Maker, is responsible for the proliferation of this treat. It is a special plexiglas mold with the outline of a single Spam slice. The Spam musubi is eaten as a sandwich, and it is perhaps the Island's favorite "to go" or snack food. Spam musubi is literally everywhere in Hawaii, including local convenience stores, grocery stores, school cafeterias, and even at the zoo. Eating a Spam musubi seems to serve as a rite of passage for newcomers anxious to attain "local" status.

Typhoid Rocky

The News & Star reports on the danger posed to native British red squirrels by American grey squirrels who carry parapoxvirus:

A deadly squirrel disease which only affects reds could see the species disappear from some of its last remaining English strongholds within a decade, new research revealed today.
Previously scientists believed that grey squirrels were wiping out native reds simply by taking over their habitats, but an international study has blamed a virus which they transmit to the red population, killing them within a fortnight.

A Gene for Schizophrenia

Via Gene Expression: EurekAlert! on a gene that causes schizophrenia:

Earlier research [at Mount Sinai and elsewhere] suggests that schizophrenia is associated with changes in myelin, the fatty substance or white matter in the brain that coats nerve fibers and is critical for the brain to function properly. Myelin is formed by a group of central nervous cells called oligodendrocytes, which are regulated by the gene oligodendrocyte lineage transcription factor 2 (OLIG2). Patients with schizophrenia are known to have insufficient levels of oligodendrocytes, however the source of this [deficiency] has not been identified, explains study co-author Joseph D. Buxbaum, PhD, the G. Harold and Leila Y. Mathers Research Professor of Geriatrics and Adult Development, Professor of Psychiatry and Neuroscience, and Co-Principal Investigator of the Siliva O. Conte Center for the Neuroscience of Mental Disorders.
Dr. Buxbaum and a team of Mount Sinai researchers collaborated with researchers from the Cardiff University School of Medicine in the United Kingdom to analyze DNA in blood samples taken from 673 unrelated patients with schizophrenia and compared their genetic information to 716 patients who did not have the disease. The controls were matched for age, sex, and ethnicity; none were taking medications at the time of the study.
The study showed that genetic variation in OLIG2 was strongly associated with schizophrenia. In addition, OLIG2 also showed a genetic association with schizophrenia when examined together with two other genes previously associated with schizophrenia--CNP and ERBB4--which are also active in the development of myelin. The expression of these three genes was also coordinated. Taken together the data support an etiological role for oligodendrocyte abnormalities in the development of schizophrenia.

Don't Sue the Messenger

ProMED-mail reprints The Jakarta Post on yet another howler from Indonesia:

The parents of 3 young children from North Sumatra's Karo regency who were earlier reported as exhibiting classic bird flu symptoms plan to sue the provincial administration and the central government for saying their children most likely had bird flu.

I believe this is the same area where angry poultry workers drank chicken blood to protest earlier diagnoses. Suing is, at least, more sanitary.

Tick Time

The Associated Press reports that Lone Star ticks have been spotted in Maine and New Hampshire.

The ticks, which are named for a small white spot on their backs, used to be found only in the Southeast, but they have been reported in growing numbers in Rhode Island, Connecticut and Cape Cod in recent years.
Scientists don't believe they are established in Maine and New Hampshire yet: The few that have been found are probably straying travelers, and there's no clear evidence yet that they are surviving the winter and living out their entire life cycle in northern New England.

Should you meet a migrant or a local tick, the CDC has illustrated instructions for safe tick removal.

Johne's Disease in Western Australia

The Australian reports an outbreak of Johne's Disease in Western Australian cattle after a twelve year lull:

Bovine Johne's Disease was confirmed yesterday [July 10th] in a beef herd near Albany, about 400km south of Perth.
It is the first case of its kind in Western Australia since 1994, but Animal Health Australia said the disease was known to have infected about 1350 cattle herds in NSW, Victoria, South Australia and Tasmania.
The highly infectious disease, which is most common in dairy cows, wastes the animal's intestines, preventing the absorption of minerals and proteins.

Johne's Disease is caused by Mycobacterium avium paratuberculosis and is suspected of causing Crohn's Disease in humans. The University of Wisconsin School of Veterinary Medicine has a webpage devoted to the controversy:

The triggering event for Crohn's disease is thought to occur early in life and then be followed by a 15-30 year incubation or latency period. Johne's disease also has a long interval between infection with M. paratuberculosis and onset of clinical signs (2-10 years). Clinical signs in both diseases are seldom seen before sexual maturity. Interestingly, a strong inverse relationship was found between Crohn's disease and gastric cancer using data from 26 countries.

PARA, the Paratuberculosis Awareness & Research Association, has more information on the bacterial theory:

In the early 1900's, the disease we call today "Crohn's disease" was characterized as an infectious disease, specifically intestinal tuberculosis. However, by the early 1930's, definitive classification (proof) that this disease was infectious was not forthcoming. More specifically, when Dr. Burrill B. Crohn failed to prove an infectious cause in 1932, the disease became formally known as "Crohn's disease" (named after Dr. Crohn) and the search for an infectious cause was largely discontinued.

Kuru in the 21st Century

Via ProMED-mail: A paper in The Lancet [registration required even to see the abstract] establishes the incubation period for Kuru, the famous cannibal prion disease, and makes some ominous predictions about the future of mad cow disease:

We identified 11 patients with kuru from July 1996, to June 2004, all living in the South Fore. All patients were born before the cessation of cannibalism in the late 1950s. The minimum estimated incubation periods ranged from 34 to 41 years. However, likely incubation periods in men ranged from 39 to 56 years and could have been up to 7 years longer. PRNP [the prion protein gene] analysis showed that most patients with kuru were heterozygous at polymorphic codon 129, a genotype associated with extended incubation periods and resistance to prion disease.

Interpretation

Incubation periods of infection with human prions can exceed 50 years. In human infection with BSE prions, species-barrier effects, which are characteristic of cross-species transmission, would be expected to further increase the mean and range of incubation periods, compared with recycling of prions within species. These data should inform attempts to model variant CJD epidemiology.

Another paper in PNAS also indicates that many more people than the current victims may eventually come down with a new and unknown variant of mad cow disease:

All neuropathologically confirmed cases of variant Creutzfeldt-Jakob disease (vCJD), characterized by abundant florid plaques and type 4 disease-related prion protein (PrP^Sc) in the brain, have been homozygous for methionine at polymorphic residue 129 of PRNP. The distinctive neuropathological and molecular phenotype of vCJD can be faithfully recapitulated in Prnp-null transgenic mice homozygous for human PrP M129 but not V129, where a distinct prion strain is propagated. Here we model susceptibility of 129MV heterozygotes, the most common PRNP genotype, in transgenic mice and show that, remarkably, propagation of type 4 PrP^Sc was not associated with characteristic vCJD neuropathology. Depending on the source of the inoculum these mice can develop four distinct disease phenotypes after challenge with bovine spongiform encephalopathy (BSE) prions or vCJD (human-passaged BSE) prions. vCJD-challenged mice had higher attack rates of prion infection than BSE-challenged recipients. These data argue that human PRNP 129 heterozygotes will be more susceptible to infection with vCJD prions than to cattle BSE prions and may present with a neuropathological phenotype distinct from vCJD.

Attack of the Killer Tomatoes

New Scientist reports on genetically modifying tomatoes with viral DNA to create cheap, edible vaccines for hepatitis B and HIV:

Mice fed a solution containing the tomatoes in powdered form developed high levels of antibodies in their blood to both viruses. Equally important, the researchers found antibodies on mucosal surfaces, where the viruses can gain entry to the body through sexual contact. "That's where you want it to be protective," says Rose Hammond of the US Department of Agriculture's Agricultural Research Service in Beltsville, Maryland, which is collaborating with the Russian researchers.

Yet More Measles

The Boston Globe reports that the number of measles cases in Boston has risen to fourteen:

The patient, a woman in her early 20s, has recovered from the disease and is back at work at Hill Holiday, a communications company in the John Hancock Tower, where the outbreak began. No other suspect cases have been identified within Hill Holiday. For more information on measles, visit www.bphc.org, the Boston Public Health Commission's website, or www.state.ma.us/dph, the Department of Public Health's website.

Plague Central

Not surprisingly, the WHO reports on an outbreak of pneumonic plague in the Democratic Republic of the Congo:

Ituri is known to be the most active focus of human plague worldwide, reporting around 1000 cases a year. The first cases in this outbreak occurred in a rural area, in the Zone de Santé of Linga, in mid-May.

Pneumonic plague, while apparently common during the Black Death (1347-51), has been rare in later outbreaks. Thanks to an anonymous source for the tip.

Bonus link: See Snopes debunk "Ring Around the Rosie."

Born Free-Range

Via ProMED-mail: The Guardian reports on the ongoing bird flu debate over whether industrial poultry or wild birds are largely responsible for spreading the disease:

Grain's alternative theory for the emergence of H5N1 - which got backing in an editorial in the Lancet medical journal last month - starts with the observation that bird flu has coexisted pretty peacefully with wild birds, small-scale poultry farming and live markets for centuries without evolving into a more dangerous form of the disease. An explanation for this is that outdoor poultry flocks tend to be low-density, localised, and offer plenty of genetic diversity in breeding stock. By contrast, the hi-tech, intensive poultry farm, where as many as 40,000 birds can be kept in one shed and reared entirely indoors without ever seeing the light of day, is just like an overcrowded nursery of wheezy toddlers when the latest winter bug comes knocking - an ideal environment for spreading the disease and for encouraging the rapid mutation of a mild virus into a more pathogenic and highly transmissible strain, such as H5N1. "What we are saying is that H5N1 is a poultry virus killing wild birds, not the other way around," says Devlin Kuyek, from Grain.

More Measles in Boston

The Boston Metro reports a new case of measles in an employee of Investors Bank & Trust Co. at the John Hancock Tower. The outbreak, which health officials have traced to a visitor from India, is still confined to IBT. The Mass. Dept. of Public Health Measles Alert [PDF] has not been updated.

Patient 7 Died on the Lam

Bloomberg reports on the ominous details of the seventh case from the bird flu cluster in Sumatra:

It's less clear how [Patient 7] Ginting's son was infected, Dick Thompson, leader of the WHO's pandemic and outbreak communications team, said by phone yesterday from the Indonesian capital, Jakarta. Based on neighbors' accounts, it's possible the boy entered his aunt's house during her illness, he said.
Ginting helped care for his 10-year-old son at the Adam Malik Hospital in Medan up until the boy's death on May 13, the WHO said. Two days later, after returning to his home in Kubu Sembelang, Ginting began coughing.
Ginting was examined three days later by local health-care workers, who observed avian flu-like symptoms. The WHO's Grein recommended on May 18 that he be isolated and treated in the hospital with the Roche Holding AG antiviral drug, Tamiflu.
Instead Ginting fled local health authorities and sought care from a witch doctor, I Nyoman Kandun, director general of disease control with the Indonesian Health Ministry, told reporters in Jakarta on May 22.
Disease trackers located Ginting late on May 21 in a nearby village. Blood samples and swabs of his nose and throat for viral particles were taken that day and flown to a laboratory in Jakarta. Ginting died the following day after tests confirmed he had H5N1, the WHO said on May 23.

For the difficult choice between Tamiflu and Ting Tang Walla Walla Bing Bang, PlagueBlog endorses the Tamiflu. But wait, it gets so much worse:

Dozens of poultry farmers and sellers from the deceased man's district slaughtered chickens and drank the blood in Medan on 22 May in a demonstration of their frustration at being branded by authorities as having been infected with avian flu. Footage of the protests was broadcast on Trans TV television.
The Sumatra experience shows the government and international health authorities need to do a better job educating communities and garnering their trust, said Cheng. The deceased man's wife highlighted the family's suspicion and lack of understanding when she said in a 17 May interview that she believed Tamiflu poisoned her son.

PlagueBlog recommends cooking chicken blood thoroughly before drinking it, especially in areas where avian influenza is endemic.

Measles in Boston

The Boston Metro reports that measles has broken out in the Hancock Tower:

Three people who work in the John Hancock Tower have been stricken with the highly-contagious measles, according to the Boston Public Health Commission.
All of the employess work for the same company and public health authorities have been working with officials there to try to identify co-workers who have been exposed to the measles. A second round of vaccinations are being offered to employees who are uncertain whether or not they were vaccinated in the past.

The Family Cluster Expands

The World Health Organization reports that a seventh case, and sixth fatality, has been added to the family cluster of avian influenza in North Sumatra, Indonesia. The evidence points toward person-to-person transmission. On the bright side:

Full genetic sequencing of two viruses isolated from cases in this cluster has been completed by WHO H5 reference laboratories in Hong Kong and the USA. Sequencing of all eight gene segments found no evidence of genetic reassortment with human or pig influenza viruses and no evidence of significant mutations. The viruses showed no mutations associated with resistance to the neuraminidase inhibitors, including oseltamivir (Tamiflu).

Renu MoistureLoc Permanently Recalled

The American Academy of Ophthalmology reports on the permanent recall of Renu's MoistureLoc brand contact lens solution, following a study that found a positive correlation between MoistureLoc and Fusarium keratitis, a fungal infection of the cornea. No other Renu products or similar competing brands were implicated.

In a letter to the Academy, Bausch & Lomb specifically mentions alexidine, a disinfecting agent added to MoistureLoc. MultiPlus and Multi-Purpose do not include alexidine.
The letter states that alexidine is safe and effective, but under certain extreme conditions - such as the solution is allowed to evaporate, the solution is not regularly replaced in the lens case, when the bottle is kept open in between uses or when the case is not cleaned properly or changed regularly - "the concentration of polymers included in the formula to enhance comfort may make the solution more likely to be contaminated with Fusarium in the environment."

Bird Flu on the Move

Via ProMED-mail: Although the suspected Romanian case has been disproved, avian influenza has recently been confirmed in Djibouti, the first human case in the Horn of Africa, and in 5 members out of eight suspected cases in one family in Indonesia.

The WHO has sent a team to the area near Medan. The agency said it was on alert for signs the virus is mutating into one that can be easily transmitted between people, a development that could signal the start of a pandemic in which millions could die.
Such a mutation could occur anywhere there is bird flu, the WHO says.
Mr Kandun said authorities were still trying to identify the source of the virus in the cluster case in Kubu Simbelang village in Karo regency, about 50km south of Medan.
But an Indonesian agriculture official who declined to be named told Reuters tests had shed no light on the case.
"There is a big question mark. Blood samples from all kinds of animals from chickens, ducks, geese, birds, pigs, cats and dogs turned out negative so far. Manure has also been checked.
The result is negative," the Jakarta-based official said.

Playing Lifeboat

Via GeekPress: National Geographic News rethinks who should be vaccinated against pandemic influenza.

Under the current plan, the ill elderly top the list, while healthy people age 2 to 64 are last in line.
This plan was based on recommendations from the National Vaccine Advisory Committee and the Advisory Committee on Immunization Policy.
It operates under several assumptions, including a prediction of how the virus will kill.
"The greatest risk of hospitalization and death—as during the 1957 and 1968 pandemics and annual influenza—will be in infants, the elderly, and those with underlying health conditions," the authors write.
Now Ezekiel Emanuel and Alan Wertheimer of the National Institutes of Health's Department of Clinical Bioethics in Bethesda, Maryland, have proposed an alternative scheme.

Human Genetics of Bird Flu

Reuters reports on the genetics of human bird flu cases:

Kida explained that people infected with H5N1 have a carbohydrate receptor on cells lining their throats. The receptor — called alpha 2,3 — is predominantly found in birds and avian influenza viruses like to bind to this class of receptors to replicate and cause disease.
Human influenza viruses, however, prefer to bind to another receptor called alpha 2,6, which is dominant in humans.
“I think people who are infected with avian strains are special. They must have alpha 2,3 receptors,” Kida said.
Although humans have some amount of alpha 2,3, Kida said alpha 2,6 was by far more “dominant” in most people.

Veterinary Vaccines for Humans

Via ProMED-mail: The New York Times reports on the possibility of using bird flu vaccine intended for domestic chickens on human beings:

Presumably, if the A(H5N1) avian flu turns into a pandemic, modern medicine will show more common sense. But at the moment, the common-sense response — an avian flu vaccine for humans — is in very short supply. A few million doses exist, earmarked for clinical trials and protection of the vaccine workers needed to make more.
Meanwhile, billions of doses, using crude versions of the same technology, exist for chickens. In desperation, could chicken vaccine be used on humans?
Several experts asked about it were aghast at the idea.

The article goes on to discuss nasty impurites, nastier adjuvants, and the low dosage and limited protection of bird vaccines compared to human vaccines.

State of the Flu

Last week's Science was a special issue on Influenza: The State of Our Ignorance.

Duvenhage Virus: The New Rabies

ProMED-mail reported last week on the death of a 77-year-old South African man who contracted Duvenhage virus from a bat scratch. Duvenhage is a Lyssavirus related to rabies:

Duvenhage virus was 1st discovered in 1970 when a man developed fatal rabies-like disease after being bitten indoors at night by an unidentified insectivorous bat about 80 km from the present incident. The only 2 other isolations of Duvenhage virus were made from bats: in 1981, it was obtained from a _Miniopterus schreibersi_ insectivorous bat which had been caught in daylight by a cat in Makhado town (formerly Louis Trichardt) in Limpopo province, about 250 km to the north of the present incident, and in 1986, the virus was obtained from an insectivorous bat, _Nycteris thebaica_, caught near a mine shaft across the border from Limpopo province in Zimbabwe.

Mumps on the Rise

Last Wednesday Reuters reported on the spread of mumps to eight midwestern states and 1100 cases:

The outbreak is the largest mumps epidemic in the United States in more than 20 years, the U.S. Centers for Disease Control and Prevention said.
Most are in Iowa, where 815 cases have been recorded, the CDC said.
An additional 350 mumps cases have been reported in Minnesota, Kansas, Illinois, Nebraska, Wisconsin, Missouri and Oklahoma, officials said. Investigators are reviewing possible cases in seven other states that were not named.

FDA Notice about Fungal Keratitis

The FDA Notifies You about the increased risk of eye infections with Fusarium associated with Renu MoistureLoc and possibly other Renu contact lens solutions:

Dear Healthcare Practitioner:
This is to inform you of a recent increase in the number of reports in the United States of a rare but serious fungal infection of the eye in soft contact lens wearers. The infection, a fungal keratitis caused by the Fusarium fungus, may cause vision loss requiring corneal transplants.
Both the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) are investigating this situation. At this time, Bausch and Lomb has agreed to stop shipping the ReNu MoistureLoc brand contact lens solution. This Notification will be updated as more information becomes available.

Thanks to JAD for alerting me to the related AP story.

Mumps Popping Up All Over

CNN reports on a mumps epidemic in Iowa:

"We are calling this an epidemic," said Iowa state epidemiologist Dr. Patricia Quinlisk, explaining that mumps has spread to more than one-third of the state and does not appear to be confined to certain age groups or other sectors of the population.

Thanks to JAD for the tip.

A Virus for Prostate Cancer

Via Gene Expression: An article in the March issue of PLoS Pathogens, "Identification of a Novel Gammaretrovirus in Prostate Tumors of Patients Homozygous for R462Q RNASEL Variant", connects yet another cancer to a viral agent.

Prostate cancer is the most frequent cancer and the second leading cause of cancer deaths in US men over the age of 50. Several genetic factors have been proposed as potential risk factors for the development of prostate cancer, including a viral defense gene called RNASEL. A common genetic variant in this gene, R462Q, was recently implicated in up to 13% of prostate cancer cases. Given the antiviral role of RNASEL, the authors sought to examine if a virus might be present in prostate cancers associated with the R462Q variant. Using a DNA microarray designed to detect all known viral families, the authors identified a novel virus, named XMRV, in a subset of prostate tumor samples. Polymerase chain reaction testing of 86 prostate tumors for the presence of XMRV revealed a strong association between the presence of the virus and being homozygous for the R462Q variant. Cloning and sequencing of the virus showed that XMRV is a close relative of several known xenotropic murine leukemia viruses. This report presents the first documented cases of human infection with a xenotropic retrovirus. Future work will address the potential connection between XMRV infection and the increased prostate cancer risk in patients with the R462Q RNASEL variant.

Gene Expression also links a second article about Borna disease virus and neurological disease.

Fusarium keratitis

Via ProMED-mail: an outbreak of the rare fungal eye infection fusarium keratitis has "spread" from Singapore to South Florida.

In a typical year, Bascom Palmer sees an average of 21 patients with fusarium infections, virtually all among people with eye trauma that lets the fungus penetrate the cornea, the eye's clear protective coating. Only a few patients infected since 2000 have been lens wearers, Alfonso said. But so far this year, the center already has seen 21 cases, 12 among lens wearers.

Measles Breaking Out All Over

Via ProMED-mail: a large measles outbreak (genotype D6) around Kiev in the Ukraine has spread to Russia, Belarus, Spain, the US, and most recently Venezuela.

Dr. Jon K. Andrus, chief of PAHO's Immunization Unit, said, "As long as measles eradication is not pursued globally, imported or import-related measles cases will continue to occur in the Americas. However, the experience in several countries shows that, when high coverage with measles-containing vaccine exists, reliable detection and aggressive follow-up of suspect cases will limit the consequences of measles virus importations."

In fact eradication is being pursued in the Ukraine, but according to ProMED-mail, it has a checkered past:

The reasons for the outbreak and the predominance of illness among people aged 15 years and older are unclear, but it is consistent with what has been observed in Belarus, Kazakhstan and the Russian Federation, where a high proportion of measles cases are among persons 20-30 years of age. This older age profile could be due to lack of previous vaccination as a result of the extensive number of contraindications accepted in the former Soviet Union; falsified records; ineffective vaccine due to inadequate cold chain or poor quality control during vaccine production; a duration of immunity that is shorter than vaccines used in western Europe; or some other factor.

Thimerosal

Via GNXP: The Journal of American Physicians and Surgeons (Spring 2006) documents Early Downward Trends in Neurodevelopmental Disorders Following Removal of Thimerosal-Containing Vaccines:

Contemporaneously with the epidemic rise in neuro-developmental disorders (NDs), first observed in the United States during the 1990s, the childhood immunization schedule was expanded by the U.S. Centers for Disease Control and Prevention (CDC) to include several additional thimerosal-containing vaccines (TCVs). On July 7, 1999, a joint recommendation was made by the American Academy of Pediatrics (AAP) and the U.S. Public Health Service (PHS) to remove thimerosal from vaccines. A two-phase study was undertaken to evaluate trends in diagnosis of new NDs entered into the Vaccine Adverse Event Reporting System (VAERS) and the California Department of Developmental Services (CDDS) databases on a reporting quarter basis, from 1994 through 2005. Significant increasing trends in newly diagnosed NDs were observed in both databases 1994 through mid-2002. Significant decreasing trends in newly diagnosed NDs were observed in both databases from mid-2002 through 2005. The results indicate that the trends in newly diagnosed NDs correspond directly to the expansion and subsequent contraction of the cumulative mercury dose to which children were exposed from TCVs through the U.S. immunization schedule.

Flu News for Humans

CIDRAP News reports on the WHO's flu-fighting plans:

WHO has convened experts three times since December to consider a draft protocol for early containment of a pandemic flu, the document states.
To further that effort, an international stockpile of antivirals has been created with industry donations. Three million treatment courses will be ready by May for use only in an intervention to contain the virus at it source, the WHO said.
Success would depend on prompt response to suspicious clusters of human influenza cases, WHO acknowledged. The mass dispensing of antivirals would need to start within 21 days after detection of the first case of efficient human-to-human transmission. Accomplishing that implies succeeding at a number of earlier steps, including detecting the clusters, communicating quickly and accurately from the local to the international level, and quickly obtaining outside assistance in investigation and response.

Also in the flu news, New Scientist reports on why bird flu in humans is so deadly yet hard to catch:

The H5N1 virus binds to sugars on the surface of cells deep in human lungs, but not to cells lining the human nose and throat. So report the two research teams, led by Thijs Kuiken at Erasmus University in Rotterdam, and Yoshihiro Kawaoka at the Universities of Tokyo, Japan and Wisconsin at Madison, US.
This fits the few autopsies that have been performed on H5N1 victims, who had damage to the alveoli – the delicate sacs deep in the lungs, where oxygen enters the blood.
Flu normally travels between people by being sneezed out and breathed in through the nose and throat. Both groups concluded that poor binding of the H5N1 high in the respiratory tract might be why the virus has so far not been able to spread easily between people – a major factor keeping it from becoming pandemic.

Importing Bird Flu

Reuters reports that Nigeria has traced its bird flu outbreak to illegal poultry imports:

The virus known as H5N1 has spread to seven of the country's 36 states and the capital city since it was first detected in northern Nigeria on Feb. 8, but 90 percent of infected farms bought day-old chicks from one farm in Kano state, minister Frank Nweke said.
"There is a very strong basis to believe that avian flu may have been introduced into Nigeria through illegally imported day-old chicks," he said in a statement.
"Further investigations into the activities of farms where birds have tested positive to the highly pathogenic avian flu revealed that 90 percent of them patronised the Sovet Farms Ltd in Kano."
Customs agents impounded almost 200 smuggled cartons of hatching eggs at the country's main international airport in Lagos in January, he added.

Poultry vs. Migratory Birds

As bird flu spreads across Europe and Africa, the question of the vector remains unanswered. One camp notes that poultry farms have been the hardest hit, while backyard chickens who are more exposed to migratory bird routes remain surprisingly healthy. Bird flu, they say, follows domestic fowl along agricultural trade routes, not wild birds on their migratory routes. See, for example, GRAIN's "Fowl play: The poultry industry's central role in the bird flu crisis".

The other camp documents the migratory paths along which H5N1 has spread--from China north to Siberia and then west to either Europe or Africa. A typical story is Unless we act now, bird flu may win in the International Herald Tribune:

For at least a decade H5N1 has circulated among a small pool of migrating birds, mostly inside China, and occasionally broken out in other animals and people. Last May, however, more than 6,000 avian carcasses piled up along the shores of Lake Qinghai, in central China, one of the world's most important bird breeding sites. Most of the dead included species that hadn't previously evidenced influenza infection.
The Lake Qinghai moment was the tipping point in the bird flu pandemic. The virus mutated, evidently becoming more contagious and deadly to a broader range of bird species, some of which continued their northern migration to central Siberia. By June, Russia's tundra was, for the first time, teeming with H5N1-infected birds, intermingling with southern European species that became infected before flying home, via the Black Sea.

The Plague of Athens Identified

Via ProMED-mail: the BBC and others report on DNA analysis of dental pulp from an ancient graveyard. Salmonella enterica serovar Typhi was found, indicating death by typhoid fever:

The team said in their research: "For an infectious disease to be considered as a likely cause of the Plague of Athens, it must, above all have existed at that time.
"Infectious diarrhoeas and dysentery as described by the ancients, imply that typhoid fever was an endemic problem in the ancient world."
The team added that it was the first time microbiological evidence associated with the plague had been analysed.
Previously assumptions about the cause had been based on the narrations of a the 5th Century Greek historian Thucydides.
Earlier research rejected the idea that typhoid caused the plague because of the symptoms described by Thucydides did not fit with the modern day typhoid.
But the researchers said inconsistencies [may be] explained by the possible evolution of typhoid fever over time.

The researchers also checked for typhus (Rickettsia prowazekii), a better match for the symptoms, without result.

Bird Flu Migrates to Nigeria, Greece, and Italy

Reuters reports that the WHO is hoping to prevent human cases of bird flu in Nigeria, after an outbreak in poultry which has already spread to Lagos. Reuters also reports on the recent deaths of wild swans in Greece and Italy:

Greece and Italy said on Saturday they had found swans with the H5N1 bird flu virus, the first known cases in the European Union of wild birds with the deadly strain of the disease.
As the slow creep of the virus around the globe continued, Romania said more infections were suspected in birds in the Danube delta and Bulgaria said the lethal strain had been confirmed among swans in wetlands close to the Romanian border. The region is a haven and transit point for migrating birds.
Nigeria started testing people who have fallen ill close to where the virus has been found among birds, in the first outbreak in Africa of a disease that has spread seemingly inexorably across the Eurasian landmass from China and Vietnam.

Third Transfusion-Related vCJD Case

Reuters reports on the third case of human-to-human transmission of mad cow disease via blood transfusion in Britain:

"The patient developed symptoms of vCJD about eight years after receiving a blood transfusion from a donor who developed symptoms of vCJD about 20 months after donating this blood. The patient is still alive and is under the care of doctors at the National Prion Clinic," the agency said in a statement.
Professor Peter Borriello, Director of the HPA's Center for Infections said: "The occurrence of a third case of vCJD infection in a small group of patients like this suggests that blood transfusion from an infected donor may be a relatively efficient mechanism for the transmission of vCJD, although much still remains unknown.

Toxoplasma

Technovelgy speculates about Toxoplasma Parasite Mind Control in rats and people:

Oxford scientists discovered that the minds of the infected rats have been subtly altered. In a series of experiments, they demonstrated that healthy rats will prudently avoid areas that have been doused with cat urine. In fact, when scientists test anti-anxiety drugs on rats, they use a whiff of cat urine to induce neurochemical panic. However, it turns out that Toxoplasma-ridden rats show no such reaction. In fact, some of the infected rats actually seek out the cat urine-marked areas again and again. The parasite alters the mind (and thus the behavior) of the rat for its own benefit. [...]
Dr. Torrey got together with the Oxford scientists, to see if anything could be done about those parasite-controlled rats who were driven to hang around cat urine-soaked corners (waiting for cats). According to a recent press release, it turns out that haloperidol restores the rat's healthy fear of cat urine. In fact, antipsychotic drugs were as effective as pyrimethamine, a drug that specifically eliminates Toxoplasma.

From the press release from Imperial College London:

Research published today in Procedings of the Royal Society B, shows how the invasion or replication of the parasite Toxoplasma gondii in rats may be inhibited by using anti-psychotic or mood stabilising drugs.
The researchers tested anti-psychotic and mood stabilising medications used for the treatment of schizophrenia on rats infected with T. gondii and found they were as, or more, effective at preventing behaviourial alterations as anti-T. gondii drugs. This led them to believe that T. gondii may have a role in the development of some cases of schizophrenia.

From the I Saw It On Ebay department...

Via GeekPress: YUMLUM's knitwear art gallery includes conjoined teddies for your conjoined twins.

Transmission of devil facial-tumor disease

ProMED-mail reports on a "brief communication" in the latest Nature, Allograft theory: Transmission of [Tasmanian] devil facial-tumour disease:

Scientists suspect infected animals pass on the malignant cells when they bite each other during a fight or courtship.
Pearse and a colleague found the tumors had 13 rather than the normal 14 chromosomes. The chromosomes were abnormal, but their arrangement was identical in tumors taken from different animals. They suspect the low genetic diversity of the animals might reduce their immune response to the cancerous cell transferred during biting.
-- ProMED-mail. DEVIL FACIAL TUMOR DISEASE - AUSTRALIA (TASMANIA). ProMED-mail 2006; 1 Feb: 20060201.0328. http://www.promedmail.org. Accessed 1 February 2006.

Gory pictures are available from the Tasmanian Department of Primary Industries, Water & Environment.

More Bird Flu in Iraq

The WHO reports that the original suspected case of avian influenza in Iraq has been confirmed, her uncle has also died of "a severe respiratory disease," and another woman from the area is also a suspected case.

An international team, including representatives of other UN agencies, is being assembled to assist the Ministry of Health in its investigation of the situation and its planning of an appropriate public health response. WHO staff within Iraq have been directly supporting the government’s operational response, which was launched shortly after the girl’s death.
Iraq is the seventh country to report human H5N1 infection in the current outbreak. The first human case occurred in Viet Nam in December 2003.

The Money Trail

Via J.A.D.: MedPage Today reviews a Nature article about tracking people by their money:

The model is based on an analysis of data collected by a popular Internet game -- found on the Web site www.wheresgeorge.com -- in which participants enter the serial numbers of bills in their possession.
Over time, as different people enter the same bill, the game builds up a picture of how the money is moving, said Dirk Brockmann, Ph.D., of the Max Planck Institute for Dynamics and Self-Organization here.
But since paper money -- like viruses -- travels with people, the game also allowed the researchers to model how humans move through the world, without actually tracking them, Dr. Brockmann said

Bird Flu Suspected in Iraq

Reuters reports on a suspected case of bird flu in Sulaimaniya, Iraq, near the Turkish border:

Tijan Abdel-Qader died on arrival at the main hospital on Tuesday after falling ill 15 days earlier in her home town of Raniya, in Kurdistan close to the Turkish and Iranian borders, Kurdish regional health minister Mohammed Khashnow said.
"The doctors in Sulaimaniya suspected this might be a case (of bird flu)," he told Reuters. "They have sent samples to Amman and we will know the results next week."
Raniya is close to Lake Dukan, which draws many migratory birds to the region and where Iraqi officials had been taking measures to try to prevent domestic fowl from being infected.

Asymptomatic Bird Flu

The New York Times reports on several Turkish children who have tested positive for H5N1 but show little or no symptoms of bird flu. The transmission route to these city dwellers is questionable at best:

On the human side, the five cases in Ankara hospitals are different from those elsewhere in Asia. Four of the five display only mild symptoms, or no symptoms at all. Also, although all five have had some recent contact with birds, Dr. Rodier said, they are people who live on the fringes of a major city, not farmers or people who keep birds in their backyards.
The group includes two sets of brothers: the two who show no symptoms at all, and a set from the distant suburbs who developed mild symptoms after contact with gloves that had been used to dispose of a dead duck.

Bird Flu in Ankara

ProMED-mail has been tracking the breakout of avian influenza in humans in Turkey, which has spread beyond the original three child deaths in Dogubeyazit, Van to several confirmed cases in Ankara.

Although the number of independently confirmed cases is given variously as 2 to 4, another 12 people are considered as "highly probable" and 32 others as "probable" cases of bird flu; so far, the parents of infected children have tested negative; and in the case of 2 of the Ankara patients, contact with gloves used to handle dead wild ducks are the suspected source of the virus.

Shades of 1918

Haaretz has the latest on an epidemic of pneumonia among Israeli military recruits. The Spanish Flu also began as a mysterious, deadly pneumonia at American boot camps. ProMED-mail suggests a diagnosis of Streptococcus pneumoniae. Of course they'd tell us if bird flu were involved...

The Allies of World War I frequently called it the "Spanish Flu". This was mainly because the pandemic received greater press attention in Spain than in the rest of the world, because Spain was not involved in the war and there was no wartime censorship. [--Wikipedia]

A Different Kind of Mad Cow

ProMED-mail reports on a different kind of mad cow disease:

The Rogers County Health Department held a special clinic Saturday [31 Dec 2005] to begin treating people identified as at risk for contracting rabies after drinking raw milk from a rabid cow.
Oklahoma State Department of Health officials announced last week that people who drank raw, un-pasteurized milk or cream sold by Swan Bros. Dairy in Claremore from 4-19 Dec 2005 may have been exposed.
So far, 45 people have begun receiving a regimen of rabies vaccinations, officials said.

Bird Flu Vaccine

The AP reports on a bird flu vaccine recently tested by Sanofi pasteur (Sanofi-Aventis):

After inoculating 300 healthy volunteers with a vaccine candidate for H5N1, the bird flu strain of most concern, immune responses were "at levels consistent with requirements of regulatory agencies for licensure of seasonal influenza vaccine" in a significant number of volunteers, the company said in a statement.

Benzene

ProMED-mail reports on the medical consequences of the benzene spill in China as it makes its way toward Russian border towns and more Chinese cities:

Benzene exposure increases the risk of leukemia. Toxic metabolites may also play a role in affecting bone marrow. Consequently, hematopoiesis is affected and aplastic anemia is very likely. Inhalation of benzene vapors has been linked to lung cancer.
Clinical signs associated with ingestion of benzene, short term exposure, include nausea, vomiting, diarrhea, chest pain, difficulty breathing, irregular heartbeat, headache, drowsiness, symptoms of drunkenness, disorientation, visual disturbances, bluish skin color, lung congestion, lung damage, liver damage, paralysis, convulsions, and coma. However, long term ingestion of benzene has resulted in impotence and cancer.
Gastric lavage may be the best means of evacuating the gastric track in the event of benzene ingestion. However, the residences in the affected towns may not know when or if they have consumed benzene in the water.
Although there is a large risk of exposure, we know nothing about the actual dose that these people may be exposed to.

Ebola Bats

Via ProMED-mail: In the current issue of Nature, scientists consider Fruit bats as reservoirs of Ebola virus:

The first recorded human outbreak of Ebola virus was in 1976, but the wild reservoir of this virus is still unknown. Here we test for Ebola in more than a thousand small vertebrates that were collected during Ebola outbreaks in humans and great apes between 2001 and 2003 in Gabon and the Republic of the Congo. We find evidence of asymptomatic infection by Ebola virus in three species of fruit bat, indicating that these animals may be acting as a reservoir for this deadly virus.

SciAm on the Upcoming Flu Pandemic

Via Slashdot: This month's Scientific American has an article on Preparing for a Pandemic:

The threat of a flu pandemic is more ominous, and its parallels to Katrina more apt, than it might first seem. The routine seasonal upsurges of flu and of hurricanes engender a familiarity that easily leads to complacency and inadequate preparations for the "big one" that experts admonish is sure to come.

Murder Most Contagious

CTV reports on a man in Ontario charged with two counts of first-degree murder for transmitting HIV to two women who have since died.

That precedent was set in 1998, when the Supreme Court of Canada ruled that a B.C. man was who failed to disclose his HIV-positive status before having consensual sex with two women was nevertheless guilty of aggravated assault.
When the two women died, that meant the assault charges were automatically bumped up to first-degree murder.

Bird Flu Reaches the Middle East

CTV reports a confirmed case of H5N1 influenza in a flamingo in Kuwait.

Mohammed al-Mihana of Kuwait's Public Authority for Agriculture and Fisheries said tests showed the flamingo had the deadly H5N1 flu strain, while a second bird -- an imported falcon -- had the milder H5N2 variant.
[...] There have been worries about outbreaks of bird flu in the Middle East because the region sits on important migratory routes. Migratory birds earlier spread the virus to Russia, Turkey and Romania.

Wave-Like Spread of Ebola Zaire

PLoS Biology published an article this month about the spread of Ebola:

In the past decade the Zaire strain of Ebola virus (ZEBOV) has emerged repeatedly into human populations in central Africa and caused massive die-offs of gorillas and chimpanzees. [...] Phylogenetic analyses place the earliest known outbreak at Yambuku, Democratic Republic of Congo, very near to the root of the ZEBOV tree, suggesting that viruses causing all other known outbreaks evolved from a Yambuku-like virus after 1976. The tendency for earlier outbreaks to be directly ancestral to later outbreaks suggests that outbreaks are epidemiologically linked and may have occurred at the front of an advancing wave.

Not in My Front Yard

Here in Boston, Maura Hennigan is running for mayor. She is against the construction of a biosafety level four lab in the city of Boston:

Over 150 scientists, including two Nobel laureates from Harvard have openly opposed the Biolab by sending a letter to Tom Menino. These 150 scientists, physicians, public health specialist, and academics oppose the Biolab being built in a densely populated urban area; there are 50,000 people within one mile and more than one million people within 10 miles of the proposed site.

The election is Tuesday, November 8th.

Typhoid Helga

Via ProMED-mail: Eurosurveillance reports on a tuberculosis outbreak at a Stockholm nursery school:

A female assistant at a nursery in a wealthy suburb of Stockholm was diagnosed with smear positive advanced pulmonary tuberculosis in August 2005. She had lost weight and been coughing for several months before diagnosis. The chest x ray showed bilateral cavitary lesions. Infection with an isoniazid-resistant strain of Mycobacterium tuberculosis was confirmed on culture.
All children and adults with a presumed exposure at the nursery were listed and examined. One three year old boywas found to be ill with fever, was admitted to hospital immediately, and diagnosed with primary tuberculosis with hilar adenopathy.
In total 141, children were exposed and of these, 35 (25%) had a TST ≥ 10mm and/or an abnormal chest x ray. Out of 20 children with an abnormal chest x ray, eight had bronchoalveolar infiltrates with hilar adenopathy and 12 hilar adenopathy only. One seven year old girl had a disseminated tuberculosis.

Pandemic Prep

Dr. Grattan Woodson provides detailed advice [pdf] for preparing for the coming bird flu pandemic.

This monograph is dedicated to, and written for my patients. I wrote it both to inform them about this health threat, and to provide them with some practical guidance on how they can survive the pandemic.

Tamiflu Resistance Paper

Via ProMED-mail: The BBC reports on the case of bird flu resistance to oseltamivir (Tamiflu) and Nature publishes a paper about it online.

Bird Flu in Europe?

The Guardian reports on three duck deaths in Romania that are suspected to be due to H5N1.

The Romanian government warned that it feared that the ducks were infected with the strain, and strong security measures were put in place in the village of Ceamurlia, in eastern Romania, where the birds died late last month. Restrictions were placed on the movement of people and animals into and out of the village near the Black Sea and there were plans to vaccinate people. Nearly all the domestic fowls in the village have been slaughtered.

Reuters reports on 2,000 turkey deaths in Turkey from bird flu, but details are scarce. The cause may not be H5N1.

Spanish Flu Rises Again

Nature reports on a CDC researcher's reconstruction of the Spanish Flu, killer of a hundred million people back in 1918 according to some estimates.

When they used the strain to infect mice they found it was extremely virulent, and after 4 days had generated 39,000 times more virus particles in the animals' lungs than a modern flu strain. "I didn't expect it to be as lethal as it was," says Tumpey.

Neither did those hundred million people...

Tamiflu Resistance

Reuters reports that bird flu is proving resistant to Tamiflu:

"Manufacturers should think about producing an injectable form of Relenza because resistance to Tamiflu has been seen in Japan and Vietnam."

Thanks to JAD for the link.

From the Don't Eat the Guano files...

The New York Times reports that two groups of researches have independently identified the Chinese horseshoe bat as the natural reservoir for the SARS virus.

The bats apparently are healthy carriers of SARS, which caused severe economic losses, particularly in Asia, as it spread to Canada and other countries. In Asia, many people eat bats or use bat feces in traditional medicine for asthma, kidney ailments and general malaise.

Thanks to an unnamed source for the link.

Rise in Bird Flu Cases

Channel NewsAsia reports 57 suspected cases of avian influenza in Indonesians. Other sources report 54 cases; either number is an increase over the last count of 42 suspected cases.

The Coming Flu Pandemic

Via an anonymous source: ABC News reports on the coming flu pandemic.

The prospects have become so bleak that in planning meetings held in New York City, veteran emergency responders have walked away.
"They just don't know how we're going to get through," says Osterholm of those responders. "If we have a repeat of the 1918 life experience, I can't imagine anything to be closer to a living hell than that experience of 12 to 24 months of pandemic influenza."

Dog Flu II

The New York Times reports on canine flu, a H3N8 strain related to equine influenza:

Dr. Cynda Crawford, an immunologist at the University of Florida's College of Veterinary Medicine who is studying the virus, said that it spread most easily where dogs were housed together but that it could also be passed on the street, in dog runs or even by a human transferring it from one dog to another. Kennel workers have carried the virus home with them, she said.
How many dogs die from the virus is unclear, but scientists said the fatality rate is more than 1 percent and could be as high as 10 percent among puppies and older dogs.
Dr. Crawford first began investigating greyhound deaths in January 2004 at a racetrack in Jacksonville, Fla., where 8 of the 24 greyhounds who contracted the virus died.

Virtual Plague

The BBC reports on a virtual "corrupted blood" plague infecting the World of Warcraft. Despite attempts to eradicate the infection, the problem continues:

Blizzard tried to control the plague by staging rolling re-starts of all the servers supporting the Warcraft realms and applying quick fixes.
However, there are reports that this has not solved all the problems and that isolated pockets of plague are breaking out again.

Thanks to an unnamed source for the tip.

The Plague Mice

ABC News reports that at least three mice infected with Yersinia pestis have been missing from the Public Health Research Institute in Newark, NJ for at least two weeks. The FBI Joint Terror Task Force and the CDC are investigating.

"We're satisfied that there is no public safety risk, and there doesn't seem to be any nexus to criminal activity or terrorism," he added.
Nevertheless, federal authorities, including the FBI, have criticized the lab for lax procedures that resulted in a potential public health menace.
"This is the black death," said Richard Ebright, a microbiologist at Rutgers University. "This is the disease that killed a quarter of Europe's population."

Cows Eating People

Via ProMED-mail: The BBC reports on a new theory of the origin of Bovine Spongiform Encephalopathy--cows eating human remains.

Some raw materials for fertiliser and feed imported from South Asia in the 60s and 70s contained human bones and soft tissue, the Lancet reports.
Bone collectors could have picked up the remains of corpses deposited in the Ganges river to sell for export.
If infected with prion diseases, they could have been the source for BSE.

Post-Hurricane Diseases II

Despite their earlier optimism, the CDC reports five deaths from Vibrio vulnificus.

The patients, evidently evacuees, appear to have been infected with Vibrio vulnificus bacteria, a water-borne pathogen that is related to the bacteria that cause cholera and is common in water off the Gulf of Mexico.

Post-Hurricane Diseases

The CDC has an encouraging report on infectious disease after a hurricane:

Unless a disease is brought into a disaster area from elsewhere, any outbreaks that occur are almost always from diseases that were already in the disaster-affected area before the disaster struck.

A Vaccine Against All Flus

BBC News reports on a UK company that's developing a one-time vaccine against all flu strains:

Current flu vaccines work by giving immunity to two proteins called haemagglutinin and neuraminidase, which are found on the surface of flu viruses.
However, these proteins keep mutating which means doctors have to keep making new vaccines to keep up.
Scientists at Acambis' laboratory in the US, together with Belgian researchers at Flanders Interuniversity Institute for Biotechnology, are focusing their efforts on a different protein, called M2, which does not mutate, as well as other technology that they cannot disclose yet for commercial reasons.

Pig Strep

CNN reports on the mysterious outbreak of Streptococcus suis among humans in China:

While not uncommon in pigs, streptococcus suis is seldom seen in people and never dozens of cases all at once -- raising bigger questions about whether the germ has mixed with some other bacteria or virus.

Thanks to JAD for the tip.

Bird Flu Confirmed in Indonesia

Via ProMED-mail: Reuters reports that Indonesia has confirmed three deaths from avian influenza.

Last month, Indonesia reported its first human case in a poultry worker, but the man did not develop symptoms and is healthy.
The agriculture ministry has reported sporadic H5N1 virus outbreaks killing more than nine million fowl in 21 provinces, out of a total of 33, across the archipelago since late 2003.
Indonesian policy favours vaccinating animals rather than culling to stop the spread of bird flu, due to lack of funds to compensate farmers.
The World Health Organisaton has questioned the effectiveness of vaccines and say culling is the best weapon.
The virus has already jumped species in Indonesia and was discovered in pigs in May on densely populated Java island.

Tularemia on Martha's Vineyard

Via ProMED-mail: the Vineyard Gazette reports an unusual case of oropharyngeal tularemia contracted by a landscaper on Martha's Vineyard who handled a dead rabbit.

Tularemia is a powerful but rare bacterial disease. Rabbits are the most common carriers in addition to rodents such as squirrels, voles and muskrats, but a bite from a dog tick is the most typical way the disease is transmitted to people.
On the Vineyard, though, the pneumonic cases have dominated, making the Island the only place in the United States to experience an outbreak of pneumonic tularemia.

Q Fever

The AP reports on a mysterious case of Q fever in Texas.

From the Don't Kiss The Chickens department....

Via ProMED-mail: the CDC has revised their bird flu travel warning again.

Avoid all direct contact with poultry, including touching well-appearing, sick, or dead chickens and ducks. Avoid places such as poultry farms and bird markets where live poultry are raised or kept, and avoid handling surfaces contaminated with poultry feces or excretions.

Record Red Tide in Maine

The AP reports that Maine has joined Massachusetts with record red tide levels:

Toxin levels in some shellfish tested in Maine have reached record highs as the red tide maintains its grip.
The red tide outbreak is also reaching into waters where it has never appeared before.
Marine experts say a number of gulls and ducks have been dying along the Maine coast -- possibly from eating tainted clams and mussels.

Boston TB Scare

Via ProMED-mail: Channel 5 reports on a tuberculosis scare involving a surgical intern and possibly 1600 exposed patients at four local hospitals. State health officials are investigating.

Anyone who thinks they may have been exposed should contact their physician, the hospital or the Boston Public Health Commission at 617-534-5611.

Mad Cow News

Via ProMED-mail: Portugal reports its first case of variant Creutzfeldt-Jakob disease, not surprising for the country ranked third in mad cows. The United States thinks about reporting its second mad cow.

Elephant Ebola

ProMED-mail has some interesting speculation about elephants being the unknown natural reservoir of Ebola, Marburg, and other filoviruses.

The WHO has the lastest numbers on the Marburg epidemic:

As of 5 June, the Ministry of Health in Angola has reported 423 cases of Marburg haemorrhagic fever. Of these cases, 357 were fatal. The vast majority of cases have occurred in Uige Province, where 412 cases and 346 deaths have been reported.

Ebola and Marburg Vaccine

Thanks to Veronica for this breaking news: vaccines have been developed for Ebola and Marburg.

New vaccines against two killer viruses, Ebola and Marburg, have been proven 100 percent effective in monkey tests, scientists reported on Monday.

Red Tide

On the disaster watch, ProMED-mail reports red tides in both Florida and Massachusetts. The record red tide recently spread from Cape Cod to Martha's Vineyard.

The toxic algae bloom already has forced officials to shut down shellfish beds from Maine to Cape Cod so that people do not eat infected clams, mussels and oysters.
The closures off Edgartown meant the outbreak, possibly caused by an unusually cold and wet winter and spring, was continuing south, scientists said.
"It's an unprecedented closure," said Shelley Dawicki, spokeswoman at the Woods Hole Oceanographic Institution. "We don't know how far it's going to spread." [AP]

Bird Flu Blog

Via ProMED-mail: Avian Flu, a blog devoted to the coming bird flu pandemic, joins Fludemic on the flu-blogging beat.

Ebola in the Congo

The BBC reports nine deaths and a quarantine in effect in the Congo town of Etoumbi. The epidemic has been attributed to consumption of bushmeat, and is not the first in the region. In 2003, 120 people died in one Ebola epidemic.

Marburg Tops 300

The WHO reports a current total of 311 Marburg deaths in Angola out of 337 cases (92% mortality). On the bright side,

No cases have been reported outside Uige for the past five weeks.

Bird Flu Jumps to Pigs

Via ProMED-mail: Reuters and the AP report that an Indonesian researcher found the H5N1 strain of influenza in pigs living near infected birds.

Pigs, which are genetically similar to people, often carry the human influenza virus. Experts worry that pigs infected with both bird flu and its human equivalent could act as a ``mixing bowl,'' resulting in a more dangerous, mutant virus that might spread to people more easily - and then from person to person.

Dog Flu

Yesterday the Metro reported that dog racing at Wonderland (Boston, MA) had been shut down due to a mysterious canine epidemic. Autopsies on three dogs indicated pneumonia.

Today the CDC is on the case as well as the Boston Herald, warning locals that they and their pets may also be in danger.

Plagueblog recommends against living in close proximity to animals. Get some fish instead.

Marburg Numbers Rise

CIDRAP News reports an unexpected increase in the number of Marburg cases and deaths in Angola:

The tally yesterday stood at 313 cases, including 280 deaths, with another 208 people under observation, the World Health Organization (WHO) and the Angolan health ministry announced yesterday, according to a report by Agence France-Presse (AFP). The WHO had reported 275 cases with 255 deaths as of Apr 27, which included only 9 new cases in the preceding week.

More Marburg

The AP reports a death toll of 257 in Angola's Marburg outbreak. The story also mentions the first recovery:

But while the number of fatalities had risen, Espirito-Santo said that for the first time an infected patient had recovered and was discharged from an isolation ward at the Uige provincial hospital.