Risk to the community of Zika virus after >insert detail< in Australia....unchanged at LOW

To my fellow Australians,

Despite this latest detection of Zika virus 

>insert day< 

in a 

>insert age, sex, whether pregnant, weeks pregnant, emotional status and any other information considered for inappropriate for publication by any group of reasonably minded people< 

in 

>insert street, hospital, city, state<, 

there has been no change to the level of risk to the Australian community.

>insert image of very distressed baby<

Overturn any water containers outside your house and sleep well.

Sweet dreams,

Virology Down Under.

#Zikasteria #ZeekOfNoTesting #Zikafied

Australia's response to Ebola virus disease in West Africa: is too little enough?

Written by Dr. Katherine E. Arden and Dr. Ian M. Mackay

The outbreak of Ebola virus disease (EVD) began in December 2013 in Guinea. It spread to Sierra Leone, Liberia, Nigeria and Senegal. The last two countries on that list were able to contain EVD because they had functioning healthcare systems with doctors and nurses, protective equipment and hospitals that work. The United States of America (US) had its first imported cases arrive 30th September. To some extent, these final three countries could “see it coming”. None of these preparations were in place or possible in Guinea, Sierra Leone or Liberia. They are hosting the largest EVD outbreak in recorded history.

Help wanted.

On August 8th, this epidemic was labelled by the World Health Organization (WHO) as a Public Health Emergency of International Concern (PHEIC). The time for help to arrive and be effective is now. Before 70% of the predicted hundreds of thousands of cases to become infected by this variant of Zaire ebolavirus die. Money is required, and Australia has now donated eight million dollars. Three weeks ago a one billion dollar cost was forecast; a ten-fold increase in a month.[6] But what is really needed urgently are people. People to create beds through the building of treatment facilities, people to staff those facilities to provide the best supportive care possible under the circumstances, people to be trained to safely care for the sick and dying and to trains others, people to track cases, people to help educate family members in how to care for a sick loved one, people to help the psychologically traumatised try and deal with the loss of their children, their parents, siblings, cousins and friends. People are what’s needed. The United Nations (UN), which includes Australia, unanimously adopted Resolution 2177(2014) on the 18th of September within which it provided some instructions to member states. One of those is:

“8.   Urges Member States, as well as bilateral partners and multilateral organizations, including the AU, ECOWAS, and European Union, to mobilize and provide immediately technical expertise and additional medical capacity, including for rapid diagnosis and training of health workers at the national and international level, to the affected countries, and those providing assistance to the affected countries, and to continue to exchange expertise, lessons learned and best practices, as well as to maximize synergies to respond effectively and immediately to the Ebola outbreak, to provide essential resources, supplies and coordinated assistance to the affected countries and implementing partners and calls on all relevant actors to cooperate closely with the Secretary-General on response assistance efforts;”

Australian Prime Minster Tony Abbott noted to the UN that “We were one of the first countries to arrive with help in Japan after the 2011 earthquake; and in the Philippines after the 2013 typhoon.”[5] Why haven’t we arrived in West Africa yet?

Australian Foreign Minister Julie Bishop said on 29th of September, that Australia has not been specifically asked by the WHO to provide healthcare professionals to help.[2] But we a member state of the UN and the WHO is the United Nations’ public health arm. In that article the Minister was quoted as saying that we were unable to repatriate infected Australians safely, with this being an integral reason behind our limited response to the Resolution. 

Lightbulb Moment.

Until the Foreign Minister’s comment, the importance of the US concept of building a smaller, healthcare worker-specific treatment facility in West Africa was perhaps lost on the two of us. Such an elitist construction looked bad to the people of the region and, without sufficient background, to others outside it. However, if such a facility reduces or removes the need to spend tens to hundreds of thousands of dollars per person [3] to send them home for treatment, then it seems like a brilliant plan. That money could be better spent, and the added healthcare should help attract more international healthcare workers to the region. In fact, why doesn’t Australia assemble the components and airlift a similar facility, flat-packed, to one of the regions in need of our help? This could be done in a jiffy with Australian military precision. Once built, this facility may well remove the need to repatriate any Australian healthcare professional who may get infected. This may be a better and faster solution than us trying to use British or US facilities or doing a deal with them to evacuate our people. 

A good global citizen.

Prime Minister Abbott noted “That is what you’d expect from a country such as Australia which always wants to be the best global citizen”.[4] We are currently not being the best global citizens that we could be.

Let’s not hide behind excuses. Do we want our national character to be stingy and afraid or strong, generous and willing to give a fair go to those in need? We pride ourselves on our innovative character. We can use this to find a way around problems, real or perceived, in answering the UN’s call for help. Help we are able to provide. 

It would be difficult, heartbreaking, hard work. We know that Aussies are more than capable of doing that. In fact, the more people on the ground, helping, the easier the burden would be. There may be some problems, and it would be naive to expect otherwise. That is why the UN has called for help. If there were no risk, and everything was simple and easy, this situation would not exist in the first place. Should a healthcare worker fall ill, there is a high chance they would die. A tragedy for their family, friends and workmates. And let’s be real, there are more risks to healthcare workers than just Ebola virus disease in these countries. There are scared and sometimes violent villagers, as well as plenty of other diseases like malaria to contend with. 

The lucky country.

Australians have the wealth, the innovation, the ability, the equipment and the skills in our excellent health care workers, engineers, keepers of the peace and logistical organisers. We have the willing volunteers. 

How much of our global village has to burn down before we do more than buy a bucket? Why must we focus on security threats, economic impact, terrorism and political stability when it is the humanitarian aspects that should our priority? Yes, this seems to be the only way to communicate with politicians. But is the way forward for us as a nation that something has to be become a direct threat to us and our lucky country way of life before we lend a hand? Is that who we want to be? Can we not expect a more human perspective from our leaders and ourselves? We think we can. 

References

1. http://www.who.int/mediacentre/news/statements/2014/ebola-20140808/en/
2. http://www.theguardian.com/world/2014/sep/29/australia-cannot-bring-health-workers-home-from-african-ebola-zones
3. http://www.cidrap.umn.edu/news-perspective/2014/09/very-few-aircraft-equipped-evacuate-ebola-patients
4. http://www.news.com.au/national/medecins-sans-frontieres-slams-australias-ebola-response/story-fncynjr2-1227061379772
5. http://www.pm.gov.au/media/2014-09-25/address-united-nations-general-assembly-united-nations-new-york
6. http://www.unmultimedia.org/radio/english/2014/09/one-billion-dollars-needed-to-contain-ebola-outbreak/#.VCv3i_na6-0

Influenza in Queensland, Australia: 1-Jan (Week 1) to 8-June (Week 23)

Map of Queensland's Hospital and Health service 

areas. Adapted from

http://www.health.qld.gov.au/maps/hhs_facilities.pdf.

Click on image to enlarge.

Waaaay back on 18-March we looked at how influenza notifications in Queensland (population ~5mill) were above the 5-year-to-date (YTD) average. 

"Woopty Doo" some, perhaps very few, of you said. "That number means nothing until you look back at it later". 

So, let's look back at it now that it's later. 

It was Autumn then and now its Winter which is Flu season and also the season when we get some more public info on a handful of other  respiratory viruses circulating here in Queensland thanks to the collatory (I don't care if a dictionary doesn't recognize it) genius of the crew at the State of Queensland, Queensland Health (SoQ|QH).

So what's happening with flu Down Under? For all the detailed detail, I recommend you check out the Open Access document, Statewide Weekly Influenza Surveillance Report that spans up to Week-23 (that's the week ending 8-June; we're in Week 25 now)

Turns out its still 2x (well,  1.987x but who;/s counting?) above the 5-year-to-date mean. No, this is not a "I told you so" - just that it's interesting to see that on this occasion at least, autumn trends predicted a winter event. Still, its only early winter. We've also had a very warm and dry autumn (see the Bureau of Meteorology for more on Autumn) for those who like to link weather and influenza activity.

I like to look at virus interactions as driving their own seasons. How is that possible I eerily hear you ask (I'm not listening to the "Oh what a load of..." comments by  the way, so sit back down and put up your hand)? Well, they don't do anything themselves of course, but my theory goes like this...

When there are enough of us in the community infected by one virus (say respiratory syncytial virus [RSV]) and our immune-thing-a-me-whats-it is all fired up and producing an inflammatory response to rid us off said pestilence, that responsey thing offers a kind of "Shield's Up" effect. 

For a short while we feel like rubbish but we also don't let other viruses get in as easily because we're in an "antiviral state". Enough of us in that state and we get a kind of short-term herd immunity (a fairy died) - where the number of people fully susceptible to another virus (say, an influenza virus) is too small for it to get a good toehold in us and the population. This pattern among seasonal respiratory viruses is most often observed, in my experience, for viruses with an RNA genome like RSV, rhinoviruses and influenza viruses. 

Thankfully for my hypothesis, the data from SoQ|QH show a nice example of this pattern of viruses interacting with viruses within us, projected to the level of the community. 

A snippet from the State of Queensland, Queensland 

Health Statewide Weekly Influenza Surveillance 

Report  for 1-January-2014 to 8-June-2014.
Edited by Ian M Mackay, VDU.

Click to enlarge. 

Let's have a look at the adjacent figure I've mixed around from reference [1]. Hopefully I haven't broken any copyright laws in hacking pasting as I have.

Part A shows the notifications for influenza viruses in Queensland. Peaks and troughs, As and Bs. Cool

Part B shows some of the respiratory viruses, including RSV which has been having a bonza season this past autumn by the looks of things.

Can you see the pattern?

Part C is a cobbled together composite I made in Photoshop/Illustrator by laying B over A and making B partly transparent. It's a bit rough and has had the axis labels and legend trimmed off for clarity, but it makes the point. What it shows (to me anyway) is that when RSV numbers go up, influenza virus notifications head downwards. 

Is this due to RSV influencing influenza or influenza exerting its muscle on RSV? Can't tell from this sort of analysis. 

The fact that RSV can rise in the presence of influenza virus may speak to its dominance. But take a step back. Remember we're taking about people not cells in a dish. It may be that 2 distinct populations are at play initially; perhaps younger children with RSV versus older children and adults with influenza. Once infected people reach a critical mass, that virus may win out and "push put" the other.What's happening in a single household - kids bringing home one virus, parents another perhaps? That would be intriguing to know with these concepts in mind using molecular methods and longitudinal regular sampling of whole families, regardless of symptoms.

Statistically, when I've looked at this with other data, that negative association, more obvious and frequent between influenza virus and rhinoviruses, does reach significance. You can read one of my group's hospital-based studies in [4] and a collaborative community study in [5]. Rhinovirus seasons usually bracket influenza season. So I offer a different view of how seasonal viruses are seasonal. With the sources of variability I discuss above as well as genetics and differences in everyone's past virus exposures and immune-thing-a-me-whats-it status to each virus, some cross-protective, some not, some having got really sick last year, some not...its not hard to see how those virus seasons can shift around from year to year as well.

Yet another reason to test for viruses, and to include more than just 1 or 2 viruses in that testing; the more you test, the more you can observe and learn.

By the way, interferon-the major player in causing these virus:virus interactions, got its name because it could block a secondary viral infection much like those that I've described above, but on a population level.

Now, try and get some funding to do any research on that. I hate you if you do by the way (yes, I failed miserably).

References...

1. Statewide Weekly Influenza Surveillance Report, 1-January to 8-June 2014.
   http://www.health.qld.gov.au/ph/documents/cdb/influenza-qld-140101-140608.pdf
2. Queensland in autumn 2014: A warm autumn; coastal rainfall but dry inland of the Great Dividing Range
   http://www.bom.gov.au/climate/current/season/qld/summary.shtml
3. Do rhinoviruses reduce the probability of viral co-detection during acute respiratory tract infections.
   http://www.ncbi.nlm.nih.gov/pubmed/19376742
4. Community-wide, contemporaneous circulation of a broad spectrum of human rhinoviruses in healthy Australian preschool-aged children during a 12-month period.
   http://www.ncbi.nlm.nih.gov/pubmed/22829638

MERS-CoV in Australian camels? The search is underway...

http://www.flickr.com/photos/xikita/48647105/in/photostream/

CC BY 2.0

I have been asked a few times about whether Australia is testing its large feral camel population (approx 300,000 animals [3,6,7]; Australia also exports camels [5]) for the Middle East respiratory syndrome coronavirus (MERS-CoV). 

I put that specific inquiry to Mr Gary Crameri, the Stream Leader for Emerging Zoonotic Disease at the Commonwealth Scientific and Industrial Research Organisation's (CSIRO) Australian Animal Health Laboratory (AAHL)[1]. You can also see a little more about Gary and MERS-CoV here [2]

And, as per comments below, it looks like Australia is now in a good position to study many aspects of the MERS-CoV. 

We are indeed the lab doing this work MERS is one of the many viruses we research and is of particular interest to us given its relationship to SARS and our global role as a WHO Collaborating Centre for SARS. We are currently investigating MERS as part of our national mission to research and understand the processes by which new diseases emerge and spread.

Some background on CSIRO AAHL.[1]

AAHL has a national responsibility to protect Australia’s animals and people by delivering science that will further our understanding and management of infectious diseases. This work includes diagnostic and surveillance activities, which currently includes MERS in bats and camels. Our research also includes comparative immunology and genome sequencing to study the evolution and transmission pathways of new viruses to help us manage the risks such viruses pose to both animals and people.

AAHL officially opened a new biosecure immunology laboratory yesterday [4] and work has begun there on the MERS virus to study how different hosts’ immune system responds to the virus.

More information about what and how and why will follow in the future.

References...

1. http://www.csiro.au/aahl
2. http://theconversation.com/sars-mers-preparing-for-the-next-coronavirus-pandemic-16359
3. http://www.abc.net.au/news/2013-11-21/feral-camel-culling-report/5105884
4. http://www.csiro.au/en/Portals/Media/New-antivirals-closer-with-opening-of-new-laboratory.aspx
5. http://news.bbc.co.uk/2/hi/middle_east/2038834.stm
6. http://www.australian-information-stories.com/camels-in-australia.html
7. http://www.paddymchugh.com/camels.html
8. http://www.abc.net.au/landline/stories/s584460.htm

Parechovirus infections in babies in New South Wales, Australia

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EV-A71 in cases of Acute Flaccid Paralysis (AFP), Australia.

ProMED describes a report from researchers at the Australian National Enterovirus Reference Laboratory on 5 cases of AFP positive for EV-A71 between Jan-May 2013. The viruses, found in stool samples from ill children, were identified as belonging to the more virulent genogroup, C4a, by VP1 sequencing.

Members of genogroup C4 were described by van der Sanden and colleagues as being restricted to epidemics in the Asian Pacific region.

All Australian bat species, including 1 of the 50 species of microbats (order Chiroptera [bats], suborder Microchiroptera) common in Australia, are considered susceptible to ABLV.

Chief Biosecurity Queensland officer Dr Thompson noted that a dead bat had been found on the property housing the Australian Bat Lyssavirus (ABLV) infected horse, but were not closely associated with any colonies.

All 6 human contacts of the horse have been given preventative treatment including rabies vaccine and rabies immunoglobulin, both of which cross-protect against serious disease caused by ABLV.

The main advice for humans to mitigate risk of infection is to avoid handling bats and flying foxes without appropriate vaccination. Even then, it would be best to report ill or strangely behaving (ill) bats to the authorities. Bats have been the source of a number of virus discoveries (not preventable by specific vaccines) in recent years including influenza virus (H17N10)and coronaviruses (numerous bat-CoVs and possible the MERS-CoV).

Matrix-targeted real-time PCR for H7N9.

A belated congratulations to my fellow Group Leader here at the Qpid lab, A.Prof David Whiley on the implementation and media coverage of his sensitive real-time RT-PCR to detect H7N9 for implementation by Pathology Queensland's microbiology laboratory. 

It targets the matrix gene segment, which as far as we know, is unique among the H7N9 assays in use to date.