Queensland influenza sees a shift in age...

Image adapted from Geoscience Australia,

The Australian Government.[3]

The media Down Under have been doing their thing this influenza season...

• Vaccine delay to cause horror flu season, say experts
• Qld sniffles through highest flu count
• CHART: Australia could be in for its worst flu season on record
• Flu cases tracking at record levels

...lots of inflammatory (pun intended) headlines to make us all fear just about everything and everyone. Blah.

Nonetheless, it is flu season down here - and hopefully you gave vaccination a try this year, or you got your annual shot. Top marks if so! If you can safely and pretty painlessly dodge a preventable disease, save yourself some misery, avoid making your kids sick - who will require time off to be looked after, not make Aunty Robyn crook as a dog and not put Grandad's ailing ticker under extra stress...why wouldn't you? 

VDU Figure 1. Figure 2 from the State of
Queensland (Queensland Health) report
found here.[1]Click on image to enlarge

Thanks to the excellent and publicly available wealth of data presented by the epidemiologists of the State of Queensland (Queensland Health), I talked about influenza in Queensland and the distribution of types (i.e. Flu A or B) and subtypes (e.g. H3N2 or H1N1) last year.[2]

In 2014, influenza A viruses were the big bad, but in 2015, as we can see in VDU Figure 1 (orange), influenza B viruses are ruling the mean streets.

VDU Figure 2. Appendix 1 from the State of
Queensland (Queensland Health) report
found here.[1]Click on image to enlarge

From the look of VDU Figure 2, the influenza season remains in full swing (hint-get that vaccination if you haven't already). 

VDU Figure 2 also shows that things are not tracking all that unusually for a Queensland influenza season when you compare this year to curves from the past 5 years. So I'd suggest taking those media headlines with a box of tissues!

However, something stood out to me when looking at the latest report so I went back and cut-and-pasted the age and sex graphs from the past few consecutive weeks to make VDU Figure 3. Sure enough, there was a particular spike in the 5-9 and 10-19 year old age bands (yellow arrows in graph boxed in red). Even allowing for changed y-axis scale in the first 4 graphs (dates are listed in each graph's legend) these 2 bands seem to have risen just in the past reporting week. 

Still, the overall pattern of rising case numbers, a dip in the 20-29 year old age band, then a rise before a consistent drop off is retained. Is this the result of school kids returning from school holidays on the 23rd of July, sharing their viruses, incubating an infection and becoming ill? If so - will we see a rise in parent - age age bands in the report after next's? Let's watch and see!

VDU Figure 3. Figure 4s from previous weeks of State of Queensland (Queensland Health) report found here.[4]
Images excised from PDFs and pasted together using 
Adobe Photoshop CC 2015.0.0
Click on image to enlarge

References....

1. https://www.health.qld.gov.au/ph/documents/cdb/influenza-qld-150802.pdf
2. http://virologydownunder.blogspot.com.au/2014/03/influenza-viruses-in-queensland.html
3. http://www-a.ga.gov.au/web_temp/1531782/61756.pdf
4. https://www.health.qld.gov.au/ph/cdb/sru_influenza.asp
5. http://education.qld.gov.au/public_media/calendar/holidays.html

Ebola - the lesser transmission risks are still risks...

The United Nations (UN) Foundation blog has used some pretty strong language in their latest post of the 5 Things to Know on Ebola This Week.

Number 2 on their list stated (by highlighting)...

First detected case of Ebola transmitted through sexual intercourse
Earlier research suggested that three months of abstinence or condom use among male survivors would suffice to prevent the transmission of Ebola through intercourse. But an Ebola patient in Liberia who died last week had just one known risk factor: her boyfriend was an Ebola survivor, treated last September. This is the first case detected of the Ebola virus being transmitted through sexual intercourse, which has necessitated updated recommendations. Read the full story here: http://unfoundationblog.org/ebola/5-things-to-know-on-ebola-this-week-10/#sthash.2HkUbbYT.dpuf

While there is reported to be ongoing testing (and presumably virus genotyping), I've yet to hear publicly the outcome of such testing. 

Perhaps the results are known behind closed doors and perhaps that testing has firmly pointed to a sexual transmission route. The UN post above certainly seems very sure and it also seems that this event has triggered an update to recommendations. There is solid literature about the presence of infectious Ebola virus in seminal fluids so the possibility shouldn't be far beyond belief.[4]

Another possible, albeit also unproven, transmission route is urine. This fluid seems to me to be a far more likely source of trouble. One cannot abstain from urination. So why worry about urine as a risk for transmission of Ebola virus? An EVD case study last year showed very nicely that infectious Ebola virus could be cultured from urine for about 12 days longer than it could be from blood.[1] Viral RNA has also been found in urine for four weeks.[1,2] 

Perhaps urine should be a more noteworthy concern for its potential to remain infectious after blood test become negative. This concern might be greater wherever toilet and hand-washing facilities and sewers, are minimal or poorly maintained.

Urine and seminal fluids are not considered to be major transmission routes for Ebola virus. But let's not forget that it was probably an unlikely transmission event, and route - a single jump from an animal to a human - that triggered >25,000 EVD cases in this epidemic. Even a rare risk must be given serious consideration when such a large public health impact can realistically result.

References...

1. Kreuels B, Wichmann D, Emmerich P et al. A Case of Severe Ebola Virus Infection Complicated by Gram-Negative Septicemia. N Engl J Med. 2014 Oct 22. 371:2394-2401
2. Lyon GM, Mehta AK, Varkey JB et al. Clinical Care of Two Patients with Ebola Virus Disease in the United States.  N Engl J Med. 2014 Nov 12. 371:2401-2409
3. Ebola Virus Disease (EVD). Key questions and answers concerning water, sanitation and hygiene. World Health Organization. http://apps.who.int/iris/bitstream/10665/137181/1/WHO_EVD_WSH_14_eng.pdf?ua=1
4. Mackay IM, Arden KE. Ebola virus in the semen of convalescent men. Lancet Infect Dis. 2015 Feb;15(2):149-50.

Middle East respiratory syndrome coronavirus (MERS-CoV): Age and Sex [UPDATED]

THIS PAGE IS NO LONGER UPDATED

This data visualization has been added to the single
MERS-CoV page now be found at..
http://virologydownunder.blogspot.com.au/2014/07/middle-east-respiratory-syndrome_17.html

A new static page on which I will update the MERS-CoV numbers as they relate to the age and sex of the people laboratory confirmed as infected.

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