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.