Engineering SARS-like virus that moves from bats to humans reignites debate

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MERS coronavirus

Severe Acute Respiratory Syndrome (SARS) first jumped from animals to humans in 2002-2003 and resulted in a worldwide outbreak, resulting in 8,000 reported cases of which nearly 800 ended in death.

Recent research shows that a SARS-like virus can jump from bats to humans, although whether it can move from human-to-human is unclear. New SARS-like Virus Can Jump Directly from Bats to Humans is a story at Bioscience Technology® that talks about the discovery reported in Nature Medicine.

Ralph Baric, Ph.D., a professor of epidemiology at the University of North Carolina Gillings School of Global Public Health and professor of microbiology and immunology the UNC School of Medicine and world-renowned expert in coronaviruses says it’s not if but rather when and how prepared we will be for an outbreak of one of nearly 5,000 CoVs in bat populations.

Lab-Made Coronavirus Triggers Debate – The creation of a chimeric SARS-like virus has scientists discussing the risks of gain-of-function research.  This story at The Scientist website discusses the effort of Baric’s team to engineer a virus with the surface protein of the SHC014 coronavirus. From the article: The results demonstrate the ability of the SHC014 surface protein to bind and infect human cells, validating concerns that this virus—or other coronaviruses found in bat species—may be capable of making the leap to people without first evolving in an intermediate host, Nature reported. They also reignite a debate about whether that information justifies the risk of such work, known as gain-of-function research. “If the [new] virus escaped, nobody could predict the trajectory,” Simon Wain-Hobson, a virologist at the Pasteur Institute in Paris, told Nature. But Baric and others argued the study’s importance. “[The results] move this virus from a candidate emerging pathogen to a clear and present danger,” Peter Daszak, president of the EcoHealth Alliance, which samples viruses from animals and people in emerging-diseases hotspots across the globe, told Nature.

Kawasaki disease might be carried from Asia to North America via wind

15_24.tifMore than a half century ago, music icon Bob Dylan wrote that “the answer, my friend, is blowin’ in the wind.” And while he certainly wasn’t writing about Kawasaki disease, it might be true that the answer about how the disease moves from Asia to Hawaii and the North American mainland could be that it’s blown there in the wind.
The mysterious Kawasaki disease might cross the Pacific on air currents high in the atmosphere, published at the website Nature, cites evidence that suggests a windborne spread is possible. If expert contentions that Kawasaki is spread this way, it would become the first viable human disease pathogen proven to cross thousands of miles of oceans by natural means.

Kawasaki disease, also known as Kawasaki syndrome, lymph node syndrome, and mucocutaneous lymph node syndrome, is an autoimmune disease in which the medium-sized blood vessels throughout the body become inflamed. Rarely fatal, it is seen primarily in children less than five years old. It affects many organ systems, mainly those including the blood vessels, skin, mucous membranes, and lymph nodes. Its rarest but most serious effect is on the heart, where it can cause fatal coronary artery aneurysms in untreated children. The disorder was first described in 1967 by Tomisaku Kawasaki in Japan.

Kawasaki Disease Wafts to Japan on the Wind – Air from China brings a major cause of childhood heart disease to Japan, study finds, at National Geographic, is a fascinating read that shows how interdisciplinary sciences can work together to sort our major medical mysteries. The research that contends seasonal winds might carry the disease across the ocean could allow for an early warning system for pediatric emergency rooms by letting them know when they should have a heightened awareness for cases of KD.

Rise of deadly drug-resistant bacteria presents tremendous challenges

oneCarbapenem-resistant enterobacteriaceae (CRE) or Carbapenemase-producing Enterobacteriaceae (CPE) are gram-negative bacteria that are almost completely resistant to the carbapenem class of antibiotics, generally considered the drug of last resort for such infections. Because of this high resistance, the bug has become a danger to the global population. Enterobacteriaceae are common commensals and infectious agents. Many experts fear that CRE is the new “superbug”. The bacteria can kill patients who get bloodstream infections. Tom Frieden, head of the Centers for Disease Control (CDC) has referred to CRE as “nightmare bacteria”.

Carbapenemase-producing Enterobacteriaceae in Europe: assessment by national experts from 38 countries, May 2015 provides some surveillance data from the European Union on the growth of CPE. It indicates that the epidemiological situation for CPE has worsened since 2010 and that CPE continued to spread in European hospitals. It also found that knowledge and awareness of the spread of CPE and the laboratory capacity for diagnosis and surveillance were heterogeneous among countries. These findings highlighted the urgent need for a coordinated European effort towards early diagnosis, active surveillance and guidance on infection control measures.

In 2013 the CDC published a piece titled Antibiotic Resistant Threats in the United States, 2013. From the foreword by Frieden: Antimicrobial resistance is one of our most serious health threats. Infections from resistant bacteria are now too common, and some pathogens have even become resistant to multiple types or classes of antibiotics (antimicrobials used to treat bacterial infections). The loss of effective antibiotics will undermine our ability to fight infectious diseases and manage the infectious complications common in vulnerable patients undergoing chemotherapy for cancer, dialysis for renal failure, and surgery, especially organ transplantation, for which the ability to treat secondary infections is crucial.

Hunting the Nightmare Bacteria is a stellar piece done by the Frontline franchise at PBS and is well worth the time to watch as it details the challenges presented by the rise of deadly drug-resistant bacteria.

Iowa trio’s hospital infection control blog offers insider perspectives

oneA wonderful infection control blog can be found at Controversies in Hospital Infection Prevention – Wherein we ponder vexing issues in infection prevention and control, inside and outside the hospital. The posts are topical and come from a talented group of infection control specialists in Iowa.

A post from Nov. 7 is one of many that have caught our eye. CIA Simple Sabotage Field Manual was created in the 1940s to help CIA agents “harass and demoralize the enemy. Posted by Dr. Diekema, he says he “thought some of the tactics might be familiar to those who work to implement change within hospitals and healthcare systems.”

He provides the list of 8 methods for “General Interference with Organizations and Production” that offers examples of what not to do.  Among them:

  • Bring up irrelevant issues as frequently as possible.
  • When possible, refer all matters to committees, for “further study and consideration”. Attempt to make the committees as large of possible—never less than five.
  • Refer back to matters decided upon at the last meeting and attempt to re-open the question of the advisability of that decision.

Here are brief bios, taken from the site, on the primary bloggers at the site:

Dan Diekema practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa. He splits his time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital.

Michael Edmond is a healthcare epidemiologist, focusing on ways to improve the quality and safety of healthcare. As a physician, he sees patients with all types of infections in both the inpatient and outpatient settings.

Eli Perencevich is an infectious disease physician and epidemiologist in Iowa City, Iowa. When he’s not writing posts for the blog, he studies methods to halt the spread of resistant bacteria in our hospitals including novel ways to get everyone to wash their hands.

Here is their Facebook link

Study examines the variables that affect movement of bioaerosols

threeBioaerosols are a suspension of airborne particles that contain or were released from living organisms, and they come in a variety of sizes. Air currents and their size primarily determine how quickly they move. Gravity plays an important role as does air density and currents. Bioaerosols can consist of viruses, bacteria, fungal spores and plant pollen. In Modeling environmental contamination in hospital single- and four-bed rooms, how they move around single and four-bed rooms is examined and contrasted.

The research focuses on the combined interaction between deposition of airborne microorganisms, room design, and human behavior by considering the question: Are single-bed patient rooms more effective than their four-bed counterparts at reducing the risk of infection from environmental contamination? The study compares hospital single- and four-bed room environments by modeling likely contamination on the hands of healthcare workers resulting from pathogens released from an aerosol source and deposited on surfaces.

The results support the hypothesis that “single-patient rooms reduce the risk of healthcare acquired infection, highlighting that this benefit may extend to risk of infection because of environmental contamination not just the more obvious airborne and direct contact transmission routes. The findings also suggest that ventilation design and room layout may affect environmental contamination and subsequent contact transmission risks in multi-bed environments. This has implications for those designing wards as well as operational aspects in terms of the most suitable location for infectious or susceptible patients.”

The study helps to answer questions about the best approach to hospital design and to what degree single rooms might be incorporated as a means of controlling infection.

Also:

Study shows people can be infectious even before onset of flu symptoms

oneThe Dynamic Relationship between Clinical Symptomatology and Viral Shedding in Naturally Acquired Seasonal and Pandemic Influenza Virus Infections takes a look at a piece authored by Jeffrey C. Kwong titled Symptoms and viral shedding in naturally acquired influenza infections. Notably, it says that “viral shedding in influenza A virus infections peaked on the first 1-2 days of clinical illness, and decreased gradually to an undetectable levels by day 6-7, matching closely with the dynamics of clinical illness. Viral shedding in influenza B virus infections rose up to 2 days prior to symptom onset and persisted for 6-7 days after onset with a bimodal pattern.” The results suggest that while “clinical illness profiles may serve as a proxy for clinical infectiousness in influenza A virus infections, patients may potentially be infectious even before symptom onset or after clinical improvement in influenza B virus infections.”

It makes you wonder, how many emergency rooms screening patients at the door? And how do they respond to the results?

Hand hygiene is simply a part of the bigger picture in infection control programs

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While hand hygiene is a critical part of infection control programs, hand hygiene alone won’t do the trick. It is only a necessary piece of a broader approach to an effective infection control program. In a study titled Preventing the Transmission of Multidrug-Resistant Organisms: Modeling the Relative Importance of Hand Hygiene and Environmental Cleaning Interventions, hand hygiene is examined in relation to environmental cleaning to weigh the relative impact of each. The study developed an agent-based model of patient-to-patient – via the hands of transiently colonized healthcare workers and incompletely terminally cleaned rooms – in a 20-patient intensive care unit. Nurses and physicians were modeled and had distinct hand hygiene compliance levels on entry and exit to patient rooms. The study simulated the transmission of Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci for one year using data from the literature and observed data to inform model input parameters.

The results, which you can view at the link above, show that hand hygiene absolutely should remain a priority but also indicate that environmental cleaning also holds an important beneficial position in any hospital infection control program. This includes for hospitals overall or for individual hospital units that have either high hand hygiene compliance levels or low terminal cleaning thoroughness.

Also, here’s a study that indicates even less-than-stellar hand hygiene programs can impact health outcomes.

Bird flu strains, old and new, are showing up throughout the world

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H5N1

The bird flu is still going strong, and new strains have joined those previously known.

The Food and Agriculture Organization (FAO) of the United Nations reported last month that a fourth wave of H7N9 has begun and threatens poultry-related livelihoods and public health, and it urges countries to prepare for an expected increase in virus activity. Fourth wave of H7N9 avian influenza threatens livelihoods, public health discusses the threat and notes that FAO is calling on countries to intensify biosecurity along the poultry value chain. To assist in this regard, FAO has just published two new additions to its series of guidelines for addressing H7N9:

  1. biosecurity improvement in live bird markets; and
  2. risk communication messaging

For the full set of FAO guidelines, visit here.

China reports two additional H7N9 avian influenza cases in September. According to the NHFPC, the cases comprise a male poultry worker aged 53 in Jinhua with onset on September 21, and a female farmer aged 55 in Huzhou who had poultry exposure with onset on September 18. Both are now in a serious condition. Avian influenza (AI) is caused by those influenza viruses that mainly affect birds and poultry, such as chickens or ducks. These AI viruses are distinct from human seasonal influenza viruses. Since the AI viruses does not commonly infect human, there is little or no immune protection against them in the human population. People mainly become infected with AI through direct contact with infected birds and poultry (live or dead), their droppings or contaminated environments.

Other strains, some not previously reported, also are active.

  • Korea confirms new bird flu case, according to a report from the Yonhap News Agency. The Ministry for Agriculture, Food and Rural Affairs said ducks at a poultry farm in Yeongam, 384 kilometers south of Seoul, tested positive for the H5N8 strain of avian influenza (AI). All 27,000 ducks were culled on Monday as a precautionary measure, after some birds showed signs of being sick before they were to be shipped out, it said.
  • The China Post reports in a story under the headline of H5N2 bird flu returns, thousands of birds culled that officials in Changhua (Taipei, Taiwan) steeled themselves to cull 20,060 chickens on a farm where the highly pathogenic H5N2 avian flu virus was found, yesterday, according to the Bureau of Animal and Plant Health Inspection and Quarantine.
  • In a report titled A/H5N6 bird flu outbreak hits Nam Dinh, Nam Dinh Province’s Agriculture and Rural Development Department in Viet Nam said recently, that for the first time, the A/H5N6 virus has appeared and that 3,300 poultry have died of the bird flu virus in Hien Khanh and Truc Phu communes.

Taking a look at Norovirus and ways to lessen the blow this season

Norwalk VirusNorovirus is the most common cause of viral gastroenteritis in humans, affecting all ages. It generally is transmitted person-to-person, fecally through contaminated food/water or via aerosolization of the virus and subsequent contamination of surfaces. Reports list the number affected each year at 2.5 million and up, causing 200,000 deaths worldwide. Those in developing countries and the very young and old are most likely to be susceptible.

Below are links to some articles and studies that discuss – among other things – prevention, spread and those who are most susceptible to Norovirus. They are worth taking a look at as we head into prime season for gastroenteritis.

Fighting the spread of Acinetobacter baumannii in healthcare systems is critical

three pikAcinetobacter baumannii is a gram-negative bacterium. It can be an opportunistic pathogen in humans, affecting people with compromised immune systems, and is becoming increasingly important as a hospital-derived (nosocomial) infection. Studies have shown that although A. baumannii might be infrequently isolated from the natural environment, the infection is more likely nosocomially acquired, likely due to its ability to persist on artificial surfaces for extended periods. It is especially prevalent at the multiple facilities to which injured soldiers are exposed during the casualty-evacuation process. It has become a serious issue in our veteran and military healthcare systems, and it is highly resistant to antimicrobials. It seems likely that it is only a matter of time before it moves more aggressively from the military healthcare system into civilian hospitals. Continued efforts to find successful preventive measures and effective treatments are imperative.

Acinetobacter baumannii: Epidemiology, Antimicrobial Resistance, and Treatment Options notes that “despite a reputation for relatively low virulence, multi-drug resistant Acinetobacter infection poses a formidable threat to patients. The cause of many outbreaks, this organism is increasingly endemic in the health care setting. . . . Treatment options are severely limited, and it doesn’t appear there have been . . . controlled trials to guide therapeutic choices. . . . Given the lack of good therapeutic options, the development of new therapies, well-controlled clinical trials of existing regimens and antimicrobial combinations, more research, and greater emphasis on the prevention of health care-associated transmission of multidrug-resistant Acinetobacter infection are essential.”

Acinetobacter in Healthcare Setting, at the Centers for Disease Control website, discusses the symptoms, transmission, prevention and treatment of Acinetobacter.