Monday, 26 December 2016

Snapdate: influenza H7N9 cases in humans, by the numbers...

An updated chart.
[SNAPDATE'S are snap updates that don't have lots of detail and chat...although they almost always end up having lots of chat!]

A summary of the monthly, weekly and daily data graphing human avian influenza A(H7N9) virus infections in humans reported from the hotzone, China.

Daily weekly and monthly H7N9 numbers, taken from the
FluTrackers curated line list [1] and the World Health
Organization disease outbreak news reports
.
Click on image to enlarge.

References...

Friday, 23 December 2016

H7N9:2016 has been the most quiet year to date...

Influenza A(H7N9) virus, or 'H7N9', has had a quiet year when compared to past outbreaks.

All human cases to date have been linked to China. The majority of human cases have had some link with poultry - chickens or ducks - although we do hear of human-to-human transmission, this seems to be limited. H7N9 has been found in poultry from backyard farms and in live poultry markets (LPMs) in China - sometimes in the company of other influenza viruses, like H9N2.[1]

Cases and deaths each month over the 4 years we have known
about human cases of H7N9 infection.
Click on image to enlarge.

Despite the slow year,the 2016 graph above shows the usual December uptick in human cases. It will be what happens next that matters. Will be see a big January surge as in 2014, or a later Feb-April surge as in 2013 and 2015? Will live LPMs be quickly closed, disinfected, the animals destroyed and any outbreaks in 2017 squashed or will they remain open allowing more human cases as the virus spreads among market animals?

Time, and testing data - which China generates lots of but does not seem to enjoy publicly reporting - will tell.

In 2016 - 2 new regions were added for the first time - Tianjin municipality and Liaoning province - both in the north-eastern coastal region of China. 

In 2013, no sustained human-to-human transmission had been reported [2] - this remains true up until today.

References...

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911810/pdf/nihms749408.pdf
  2. http://www.nature.com/news/mapping-the-h7n9-avian-flu-outbreaks-1.12863

Sunday, 18 December 2016

Happy Festive Season to all who read this....

This post has been moved to the new Virology Down Under platform on Wordpress.

You can get to this specific post by clicking on the link below...

https://virologydownunder.com/happy-festive-season-to-all-who-read-this/

Please adjust your bookmarks.

Apologies for any inconvenience.

Sunday, 4 December 2016

Zika virus-positive microcephaly in Colombia...

The latest epidemiological report (epidemiological week 47) from Colombia, which includes data on Zika virus (ZIKV) disease (ZVD; 20NOV2016-26NOV2016), has been produced by the Colombian National Institute for Health team.[1]
NOTE: While these data were reported the past epidemiological week (EW), they may not be from that week. See earlier post about possible reporting lag.

As of this report, 60 (+0 from last EW) live births have been diagnosed with congenital ZIKV syndrome (CZVS; microcephaly/central nervous system disorder), confirmed as being ZIKV positive. That represents 1.0% of all confirmed ZIKV positive mothers-a slowly but steadily rising proportion.

The change in confirmed ZIKV infection numbers when detected in
association with a microcephaly diagnosis, Colombia, compared to the
preceding week's total (yellow bars, right-hand axis). Those diagnoses still in question and under investigation are shown as yellow dots (left-hand axis).
Data are from [1]. 
Click on graph to enlarge.
It has now been 415 days, or 1 year, 1 month and 18 days, since ZIKV was first confirmed in Colombia on 16th October 2015.[5] Keep in mind that when talking about microcephaly - we have to think back in time to what insult or infection might have occurred during pregnancy. The counts of ZIKV occurring this week will have zero impact on what happened back then. Also keep in mind that Colombia may be reporting things differently from Brazil.[3]

The cumulative curve of confirmed ZVD cases
(green circles, left-hand axis) and the change in confirmed ZVD case
numbers when compared to the preceding week's total
(green bars, right-hand axis). Data from [1].
Click on graph to enlarge.

No new laboratory confirmed ZIKV detections have been reported in Colombia for eh 20th week (green graph, above).


Brazil first reported positive (but unconfirmed) laboratory tests for ZIKV disease on 29th April 2015. Brazil then started to report a rise in foetal anomalies (an initial 141), in the form of microcephaly on 30th October 2015. This was 184 days - or about 6 months later.[4] However, the genetic analyses suggest ZIKV was in Brazil from around 2013. It had a lot longer to get established. Perhaps this is the difference between Brazil and Colombia, given reports a growing 2,180 ZIKV congenital syndrome diagnoses [2] compared to Colombia's 60.

References...

  1. http://www.ins.gov.co/boletin-epidemiologico/Boletn%20Epidemiolgico/2016%20Bolet%C3%ADn%20epidemiol%C3%B3gico%20semana%2047.pdf
  2. http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=37143&lang=en
  3. http://virologydownunder.blogspot.com.au/2016/06/the-elephant-squeaked.html
  4. http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=35139&Itemid=270&lang=en
  5. http://www.nejm.org/doi/full/10.1056/NEJMoa1604037#t=article

Friday, 18 November 2016

The reality of the post-truth world's impact on science communication...

So:
 We tweet 2each other. 
We write 4each other. 
We're considered elite. 
We don't understand our community. 
We can't reach them. 

Cool. [sarcasm]

P.S.
Post-truth is now defined by the Oxford dictionary...

ADJECTIVE

Relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief:

‘in this era of post-truth politics, it's easy to cherry-pick data and come to whatever conclusion you desire’


‘some commentators have observed that we are living in a post-truth age’

Thursday, 17 November 2016

Another virus found to remain infectious on hard surfaces...

That headline doesn't bring in the readers. But - as far as we can tell having not been to the Nov 13-17 conference at which the preliminary data were presented during a seminar- it sums up the main finding of a new study on Zika virus (ZIKV).[1,2,4]

A 2016 Puerto Rico strain of the Asian lineage of ZIKV added to blood or a salt/protein solution was dried onto hard, solid surfaces. 

ZIKV was able to be recovered from those surfaces up to 8 hours later when in the presence of blood, but not the salty solution. 
Blood protected the virus. 

ZIKV recovery was achieved after rehydrating the dried material and adding dilutions to cells in culture (Vero E6 cells). There was no news on infectivity at warm temperatures or on cloth, tissues or other porous surfaces on which enveloped viruses like ZIKV usually don't do so well. By the way, when I say "recovered", I mean virus coudl be grown using lab conditions, producing more infectious virus. So the findings show that enough ZIKV remained infectious (or that it retained some infectivity) to start a new infection in lab cultures, despite being held outside the host cells it needs to replicate. 

Can ZIKV virus "live for hours" on surfaces? It's a virus - so it doesn't do much of anything outside of the living cell it completely depends upon for energy and raw materials ("dietary requirements"!). 

The main takeaway is not that the study defined a new route of ZIKV transmission to add to mosquitoes, sex, intrauterine transmission and transfusion.[11] This might have been your interpretation if you'd read...


.."The Zika virus is able to infect people even after sitting out on a counter for several hours, according to new research" [6]..

The study is really about the observations that some disinfecting agents (bleach and peracetic acid) may not work well when the virus is spilt onto these surface in the presence of blood. Isopropyl alcohol and quaternary ammonium/alcohol agents were still effective though.[3] West Nile virus (WNV) and bovine viral diarrhoea virus (BVDV) responded similarly. This is not a new finding for viruses in general, but it's a good one to have. This can be used as a reference for risk assessments for a lab that works with ZIKV or for healthcare facilities that may be dealing with ZIKV infected patients and needing to know how to effectively clean up spills or contaminated rooms.

Should we worry about this new finding?

Does the finding that a ZIKV spill can remain infectious on surfaces add new knowledge to our understanding of the risks of acquiring ZIKV infection? Not as far as we know because we have very limited evidence that ZIKV can infect a human through their epithelial surfaces (mucous membranes) - like we did have for Ebola virus for example. Such a route of infection - from surface to mucous membrane -is the the implied risk here. In other words, getting enough of those spilt infectious viruses into your eye, mouth or onto/into your nether regions. Its possible, but not likley and we have little evidence that its happens. 

We also have little evidence that ingesting something contaminated with infectious ZIKV or breathing it in can result in an infection. 

As ever, little evidence does not equate to zero evinced - we just have few actual data either because theses are such rare events or because we really haven't looked much (my bet).

Rare ZIKV transmission events do happen...

We have seen documented some unusual/infrequent ZIKV transmission events. Laboratory acquired infections [5,12] for example and that case of a severely immunocompromised/chronically ill adult passing ZIKV to his healthy adult son, perhaps via mucous membrane exposure to a high ZIKV load.[8,9] 

Infection of Dengue virus following exposure of a healthcare worker's mucous membranes to an infected IgM-positive patient's blood has also been described previously.[10] 

This route of transmission is certainly in need of some serious study. That said, transmission was not what this study was investigating. 

Infectious fluids such as blood, saliva, breast milk, urine or semen may come into contact with epithelial surfaces in a range of ways. 

Studies that do set out to focus on this interaction and measure how often an infection results from this contact, are needed. 


References...

  1. Research finds Zika virus can live for hours on hard, non-porous surfaces
    https://www.eurekalert.org/pub_releases/2016-11/aaop-rfz111116.php
  2. Zika virus can survive on hard surfaces for hours, researchers say
    http://www.upi.com/Health_News/2016/11/15/Zika-virus-can-survive-on-hard-surfaces-for-hours-researchers-say/9781479267969/
  3. Study: Zika virus can linger on hard surfaces
    http://www.cidrap.umn.edu/news-perspective/2016/11/study-zika-virus-can-linger-hard-surfaces
  4. Inactivation of Zika Virus on a Hard Non-porous Surface
    https://annual.aapsmeeting.org/event/member/309446
  5. http://www.achd.net/pr/pubs/2016release/060916_zika.html
  6. Zika can survive for hours on hard, nonporous surfaces
    http://www.cnbc.com/2016/11/15/zika-can-survive-for-hours-on-hard-nonporous-surfaces.html
  7. Zika virus can live for hours on hard, non-porous surfaces
    https://www.sciencedaily.com/releases/2016/11/161115164220.htm
  8. Scientists just documented the first case of Zika spreading through physical contact
    http://www.sciencealert.com/scientists-just-documented-the-first-case-of-zika-spreading-through-physical-contact
  9. Fatal Zika Virus Infection with Secondary Nonsexual Transmission
    http://www.nejm.org/doi/full/10.1056/NEJMc1610613?query=featured_home&
  10. Transmission of Dengue Virus without a Mosquito Vector: Nosocomial Mucocutaneous Transmission and Other Routes of Transmission
    http://cid.oxfordjournals.org/content/39/6/e56
  11. Zika Virus Disease Cases - 50 States and the District of Columbia, January 1-July 31, 2016.
    https://www.ncbi.nlm.nih.gov/pubmed/27631604
  12. http://www.cdc.gov/zika/transmission/

Wednesday, 9 November 2016

Time to pick ourselves up, learn from our mistakes and do better...

We've all learned some hard lessons in the past 24 hours. We've seen something happen that we can't really comprehend. But such is life. Life is always teaching, always surprising. And we should always be learning from it, from others and from ourselves. We should teach others - both the good and the bad.

Most who read this will be lucky people. Never forget the luck you were born into-nor deny it. Others are not so lucky and they wake up to that every day. 

Don't blame others for the place we find ourselves in. Be a better person yourself. Teach your children to be good people, to be accepting, forgiving and giving people. Be inclusive. Study, be kind. Don't give in to anger and hatred - they are easy to sow but hard to repair and in the end make nobody happy.

Make the world a better place and remember to bring everyone along with you. Boy, girl, any colour, shade, height, nationality or belief. Help others see the things you see and learn to appreciate what they see and share with you. Understand the patterns and changes in their lives and help them view our global community for the joys its tribes can bring - we share many things.

But do rage against the threats to progress and social justice that we now face all over the world. Do not stop calling out that which harkens back to darker days and ways of life otherwise we will find ourselves waking into those days.

We can be better than this and we should always strive to be.

Sunday, 23 October 2016

Microcephaly cases under investigation for links to Zika virus in Colombia keep accruing...

Diagnoses of Zika virus infection linked to microcephaly continue to very slowly rise in Colombia, rising by 11 since the end of July 2016 - with 1 new case in this most recent reporting week to reach a total of 47.[1] 

Brazil reports 2,033 cases of Zika virus congenital syndrome (CZVS) as of 20-OCT-2016, among a background of 109,596 "confirmed" cases.[2] However, a confirmed case listed by Brazil includes confirmed and probable cases as described by the Pan American Health Organization (PAHO) definition.[3]

Meanwhile the number of microcephaly (?CZVS or just head size?) cases that remain under investigation in Colombia continue to accumulate. 

Up until  mid-June, these numbers used to be in double digits, but they have risen dramatically (yellow dots in graph above) since then to reach over 300 and continue to climb steadily. How many of these will be added to the microcephaly/CZVS total is unclear.

References...

  1. http://www.ins.gov.co/boletin-epidemiologico/Boletn%20Epidemiolgico/Forms/public.aspx
  2. http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=36621&lang=en
  3. http://www.paho.org/hq/index.php?option=com_content&view=article&id=11117&Itemid=41532&lang=en