Author Archives: Melvin Sanicas

About Melvin Sanicas

Melvin is a curious lifelong learner. He studied biology, medicine, health economics, infectious diseases, clinical development, and public policy. He writes about global health, vaccines, outbreaks, and pathogens.

MYTH BUSTED: Coronavirus is not airborne

We have to distinguish what is possible in an experimental setting vs. what is happening in real life.

Many people are sharing the ‘news’ that WHO confirmed “COVID-19 is airborne”.

This is NOT TRUE. Here’s why.

Respiratory infections can be transmitted through droplets of different sizes: when the droplet particles are >5-10 μm in diameter they are called “respiratory droplets” and when they are <5μm in diameter, they are called “droplet nuclei”. Current evidence tell us that SARS-CoV-2, the coronavirus causing COVID-19, is primarily transmitted between people through respiratory droplets and contact routes.

Droplet transmission occurs when a person is in close contact (within 1 meter) with someone who has respiratory symptoms (e.g., coughing or sneezing) and is therefore at risk of having his/her mouth or nose or eyes exposed to potentially infective respiratory droplets.

Transmission also occurs through fomites (any object contaminated with or exposed to the infectious agent in the immediate environment around the infected person). So, the transmission of COVID-19 can occur by direct contact with infected people and indirect contact with surfaces in the immediate environment or with objects used on or coughed on by the infected person (cellphone, stethoscope or thermometer, etc.).

Airborne transmission refers to the presence of microbes in droplet nuclei particles <5μm in diameter and can remain in the air for long periods of time and be transmitted to others over distances greater than 1 meter.

For COVID-19, airborne transmission is possible in specific circumstances and settings in which procedures or support treatments that generate aerosols are performed; i.e., endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, non-invasive positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation.

Some publications show that COVID-19 virus can be detected in the air so news outlets have suggested that there has been “airborne transmission”.

One publication in the New England Journal of Medicine has evaluated virus persistence of the COVID-19 virus. This is an experimental study that generated aerosols using a three-jet collison nebulizer and fed into a Goldberg drum under controlled laboratory conditions. This is a high-powered machine that does not reflect normal human cough or lung conditions.

The finding of COVID-19 virus in aerosol particles up to 3 hours does not reflect a clinical setting in which aerosol-generating procedures are performed – this was an experimentally induced aerosol-generating procedure.

This is a device used to create aerosols, not a human being.

We should distinguish between what is POSSIBLE in an EXPERIMENT and what happens in REAL LIFE conditions. Again, the study was done using a machine that was built to create aerosols and placed in a closed machine used for aerosol survival studies.

Can old drugs be used to treat COVID-19?

Finding new uses for existing drugs is a good strategy, especially in our fight against COVID-19 for which there is no treatment.

These drugs have already been produced and tested in patients for different indications, which means we can save valuable time.

Some promising treatments

By attacking different parts of the virus, antivirals can prevent a virus from entering cells or interfere with its reproduction thereby stopping the infection.

Remdesivir works by interrupting the SARS-CoV-2 virus as it copies its genetic material, which in turn stops the virus from reproducing. What’s clever about remdesivir is that it disrupts the virus but not the human cell, so it has a targeted effect. The National Institutes of Health (NIH) has started a randomized controlled trial for the treatment of COVID-19 patients with the investigational antiviral drug remdesivir. The FDA has been working with the drug manufacturer, Gilead Sciences.

Kaletra is a combination of two antiviral drugs, lopinavir and ritonavir, used to treat HIV. One of the first major studies of 200 seriously ill patients from China found no benefit with the use of Kaletra. However, it may be possible that Kaletra could work if given earlier or if given to patients who are not severely ill. The World Health Organization (WHO) has included Kaletra in a major multi-country trial launched this week.

Medical authorities in China have said a drug used in Japan to treat new strains of influenza appeared to be effective in coronavirus patients. Zhang Xinmin, an official at China’s Science and Technology Ministry, said favipiravir, developed by a subsidiary of Fujifilm, had produced encouraging outcomes in clinical trials in Wuhan and Shenzhen involving 340 patients.

Patients who were given the medicine in Shenzhen turned negative for the virus after a median of four days after becoming positive, compared with a median of 11 days for those who were not treated with the drug. Favipiravir would need government approval for use on COVID-19 patients, since it was originally intended to treat flu.

Chloroquine and hydroxychloroquine are already widely available, as they are used to treat diseases like malaria and arthritis.

Both chloroquine and hydrochloroquine have been used for many decades to treat malaria, which is caused by a parasite, unlike the coronavirus, SARS-CoV-2 causing COVID-19. Reproduction of SARS-CoV-1 (the ‘original’ SARS virus in 2002-2003) in cell culture was shown to be blocked by chloroquine in 2005, by which time there were no human infections. Recently reproduction of the newly emerged SARS-CoV-2 in cells was found to be inhibited by chloroquine.

As a consequence, a derivative of the drug, hydroxychloroquine (a less toxic derivative) has been tested in patients with COVID-19. A clinical study conducted in Marseille, France to evaluate the efficacy of hydroxychloroquine in the treatment of COVID-19 was released on 18 March 2020. Patients included in the study were all over 12 years old and had laboratory-confirmed infections with SARS-CoV-2.

The control group received the standard treatment of care (no hydroxychloroquine / HCQ). The hydroxychloroquine treatment group received oral HCQ sulfate, 200mg three times a day for 10 days. The HCQ + Azithromycin treatment group received oral HCQ sulfate, 200mg three times a day for 10 days -Oral azithromycin, 500mg on day 1, followed by 250mg daily for 4 days. Viral loads in nasopharyngeal wash were measured daily. This was a small non-randomized trial but results are promising. On Day 6, 12.5% of control patients virologically cured, 57.1% of HCQ treated patients virologically cured and 100% of HCQ + Azithromycin patients virologically cured.

The current pandemic is, no doubt, one of the most important challenges in recent times. But we are more prepared than ever to deal with it. Some of the world’s brightest minds are on it, and we are already starting to see some results.

Anti-malaria drug being tested for efficacy against COVID-19

Chinese experts, based on the result of clinical trials, have confirmed that chloroquine phosphate, an antimalarial drug, has a certain curative effect on the novel coronavirus disease (COVID-19).

The experts suggested the drug be included in the next version of the treatment guidelines and applied in wider clinical trials as soon as possible, Sun Yanrong, deputy head of the China National Center for Biotechnology Development under the Ministry of Science and Technology (MOST), said at a press conference.

Chloroquine phosphate, which has been used for more than 70 years and is on the World Health Organization’s List of Essential Medicines, the safest and most effective medicines needed in a health system. Chloroquine was discovered in 1934 by Hans Andersag but was initially ignored for a decade because it was considered too toxic for human use. During World War II, United States government-sponsored clinical trials for antimalarial drug development showed unequivocally that chloroquine has a significant therapeutic value as an antimalarial drug.

Aside from preventing and treating malaria, chloroquine is also occasionally used for amebiasis that is occurring outside the intestines, rheumatoid arthritis, and lupus erythematosus.

Chloroquine was selected from tens of thousands of existing drugs after multiple rounds of screening, Sun said. According to her, the drug has been under clinical trials in over 10 hospitals in Beijing, as well as in south China’s Guangdong Province and central China’s Hunan Province, and has shown fairly good efficacy.

In the trials, the groups of patients who had taken the drug have shown better indicators than their parallel groups, in abatement of fever, improvement of CT images of lungs, the percentage of patients who became negative in viral nucleic acid tests and the time they need to do so, she said.

Patients taking the drug also take a shorter time to recover, she added. Sun gave an example of a 54-year-old patient in Beijing, who was admitted to the hospital four days after showing symptoms. After taking the drug for a week, he saw all indicators improve and the nucleic acid turn negative.

Zhong Nanshan, Chinese epidemiologist and pulmonologist who discovered SARS in 2003. 

So far, no obvious serious adverse reactions related to the drug have been found among the over 100 patients enrolled in the clinical trials, she said. The expert team, led by Zhong Nanshan, a renowned respiratory specialist and an academician of the Chinese Academy of Engineering, agreed that chloroquine phosphate can be used to treat more COVID-19 patients, Sun said.

Previous in vitro experiments showed that it can block virus infections by changing the acidity and basicity value inside the cell and interfering receptors of SARS coronavirus. It also shows immune-modulating activity, which may enhance its antiviral effect in vivo and is widely distributed in the whole body, including the lungs, after oral administration.

Chloroquine is also in trials as an antiretroviral for HIV-1/AIDS and is being considered in pre-clinical models as a potential agent against chikungunya and Zika.

UPDATE: New research suggests that remdesivir — broad-spectrum antiviral agent — and chloroquine “are highly effective in the control of 2019-nCoV infection in vitro.” Scientists at the University of Queensland Centre for Clinical Research recently announced that they are close to commencing a clinical trial with chloroquine in Australia by the end of the month.

How good hand-washing beats COVID-19 (and other contagious diseases)

Image via MSU Today.

The most important piece of advice we need to follow to help us stay safe from COVID-19 is this one: wash your hands.

SARS-CoV-2, the virus causing COVID-19, and other respiratory viruses spreads easily by droplets from breathing, coughing and sneezing. Because our hands touch many surfaces, they can pick up microbes, including viruses. Then by touching contaminated hands to your eyes, nose, or mouth, the pathogens can infect the body.

Coronaviruses, like this year’s novel coronavirus called SARS-CoV-2 that has infected over 110,000 worldwide are encased in a lipid envelope — basically, a layer of fat. Soap can break that fat apart and make the virus unable to infect you.

There are two ways to decrease the number of microbes on your hands.

Source

First strategy: decrease the overall biomass of microbes – that is, decrease the amount of bacteria, viruses and other types of microorganisms. We do this by washing out hands with soap and rinsing with water. When you wash your hands with soap and water, the soap chemically works to break down the oil, while the friction from rubbing does it mechanically. The more soap and the longer the hands are rubbed together, once rinsed away with water, the less oil and microbes are left on your hands. Public health experts agree that this method of hand washing, for at least 20 or more seconds at a time,

From the European Centre for Disease Prevention and Control (ECDC)

Second strategy: kill the microbes. We do this by using products with an antibacterial agent such as alcohols, chlorine, peroxides, chlorhexidine or triclosan. However, the efficacy on these agents can vary depending on the concentration of the antibacterial agent and on the particular microbe.

What about bar soap? Numerous studies have found that bacteria can stay on bar soap that stays wet because it gets used frequently. But studies that have shown that bacteria don’t seem to transfer to the next user. If the bar of soap looks slimy, rinse it off under water before you lather your hands, and try to store it so it will dry out between uses.

What if there’s no soap? If you’re in a public bathroom, and there’s no soap, just rubbing your hands together under the water does do some good. A 2011 study from researchers at the London School of Tropical Hygiene found that washing with water alone reduced bacteria on hands to about one-quarter of their prewash state. Washing with soap and water brought bacterial counts down to about 8% of where they were before washing.

What if there’s no soap or water? You can use hand sanitizers. Lipid membrane viruses like coronaviruses are killed by alcohol-based hand sanitizer as long as it is at least 62% alcohol. Make sure to use enough so that it covers all the surfaces on your hands. Rub that on until your hands feel dry, which should take about 20 seconds. Alcohol kills some bacteria and viruses by breaking down their protective membranes, which basically makes them fall apart. But it doesn’t work for all germs, such as norovirus, Clostridium difficile, which can cause life-threatening diarrhea, or Cryptosporidium, a parasite that causes a diarrheal disease called cryptosporidiosis. But it works very well for enveloped viruses such as Hepatitis B virus, influenza virus, and coronaviruses!

What about drying hands with paper towels? Paper towels have a beneficial effect beyond simply washing. Rubbing your hands with a paper towel removes even more germs than washing alone. Dry hands are also less likely to spread contamination than wet hands.

How often do you need to wash? A lot. The CDC says to wash your hands:

  • Before, during, and after preparing food;
  • Before eating;
  • Before and after taking care of someone sick;
  • Before and after treating a cut or other wound;
  • After going to the bathroom;
  • After changing diapers or helping a child in the bathroom;
  • After blowing your nose, coughing, or sneezing;
  • After touching an animal, or touching pet food or pet waste;
  • After handling pet food or pet treats;
  • After touching garbage.

With all the messaging in the news, on social media, and elsewhere about COVID-19 you’re probably doing a lot more hand washing than you’re used to. But regular and proper handwashing should be done all the time and not just during outbreaks.

And remember after washing, try to keep your hands clean. Avoid touching contaminated surfaces. Use a clean paper towel to open bathroom doors. Disinfect dirty surfaces that you use every day, like the touchscreen on your phone and your computer keyboard.

First antiviral drug approved to fight novel coronavirus

The first anti-viral drug for Coronavirus disease 2019 (COVID19), also known as 2019-nCoV acute respiratory disease, has been approved for marketing by the National Medical Products Administration since the outbreak. Developed by Zhejiang Hisun Pharmaceutical Company, the drug is expected to play an important role in preventing and treating the outbreak which has now infected 70,553 in China (1,772 deaths), the government said on its official WeChat account.

COVID-19, is an infectious disease caused by SARS-CoV-2 (2019 novel coronavirus), a virus closely related to the SARS virus. The disease was discovered during, and is the cause of, the 2019–20 coronavirus outbreak.

Three potential anti-COVID19 medicines have been officially announced by the Ministry of Science and Technology: Favilavir, Chloroquine Phosphate, and Remdesivir. They all initially showed more obvious curative effects and lower adverse reactions in clinical trials.

Favilavir, formerly known as Fapilavir, an antiviral that has shown efficacy in treating the novel coronavirus, was approved for marketing, the Taizhou government in Zhejiang province announced Sunday.

It is the first anti-novel coronavirus drug that has been approved for marketing by the National Medical Products Administration since the outbreak. Developed by Zhejiang Hisun Pharmaceutical Company, the drug is expected to play an important role in preventing and treating the epidemic, the government said on its official WeChat account.

Chloroquine Phosphate is in a class of drugs called antimalarials and amebicides. It is used to prevent and treat malaria. It is also used to treat amebiasis.

The other one with the most potential – so far – has been Remdesivir, which Gilead had already been developing as a treatment for Ebola disease and Marbug virus infections. It has subsequently also been found to show antiviral activity against other single-stranded RNA viruses such as respiratory syncytial virusJunin virusLassa fever virusNipah virus, Hendra virus, and coronaviruses (including MERS and SARS viruses).

Based on success against other coronavirus infections, Gilead provided Remdesivir to physicians that treated an American patient in Snohomish County, Washington infected with 2019-nCoV, and is providing the compound to China, to conduct a pair of trials in infected individuals with and without severe symptoms.

Chinese pharma BrightGene has successfully developed and manufactured copies of the drug, it has also maintained that it will not launch the drug until it has received licensing from Gilead, conducted clinical trials and obtained approval. A study of Remdesivir in COVID-19 has already begun enrolling patients in China, with a Gilead spokesman confirming that two clinical trials will be conducted in Wuhan, the city where the first cases of the novel coronavirus were observed.

China releases draft genome of new pneumonia outbreak virus

Seafood market in Wuhan where the virus is thought to have spread. Photo: Simon Song

Scientists anxious about China’s lack of transparency about a month-old outbreak of pneumonia in the city of Wuhan breathed a sigh of relief after health officials shared an update on the novel coronavirus (nCoV) pneumonia outbreak that has now caused 41 cases and one death. In addition, the World Health Organization (WHO) also released several interim guidance documents, including advice on travel, lab testing, and medical evaluation.

No human-to-human spread

Based on the current reports, there’s no obvious evidence of human-to-human spread yet. Wuhan officials said 41 patients have been diagnosed with nCoV pneumonia, and 2 have been discharged from the hospital. Seven had severe infections, and 1 patient died. The rest are in stable condition.

The patient who died was a 61-year-old man who had chronic liver disease and was a frequent customer at the market at the center of the investigation, according to a translation of a Chinese media report posted on Twitter by Hayes Luk, a microbiologist at the University of Hong Kong. So far 739 close contacts have been identified for monitoring, 419 of them medical staff. No related cases have been detected.

Genetic findings

Chinese scientists submitted the gene sequencing data for posting on Virological.org, a hub for prepublication data designed to assist with public health activities and research. The post was communicated by Edward Holmes with the University of Sydney, on behalf of a Chinese group led by Yong-Zhen Zhang with Fudan University in Shanghai.

Vineet Menachery, PhD, with the University of Texas Medical Branch posted on Twitter that nCoV appears to be a group 2B coronavirus, which puts it in the same family as the SARS (severe acute respiratory syndrome) virus.

Kevin Olival, VP for research of the EcoHealth Alliance in New York City, published a phylogenetic tree on Twitter and concurred that the new virus “definitely clusters” with the SARS-related coronaviruses.

https://twitter.com/arambaut/status/1215994825679474688

Andrew Rambaut, PhD, administrator of Virological.org and professor of molecular evolution at the University of Edinburgh, said on Twitter that nCoV is 89% similar to SARS-related bat coronavirus in the Sarbecovirus group of betacoronaviruses. “But that doesn’t mean it comes from bats. MERS-CoV is 88% identical to the nearest known bat virus, and MERS is endemic in camels.”

He said that although bat viruses span coronavirus diversity and bats are a dominant host in much of the evolutionary history, the link to bats was a distraction when looking for the source of human MERS-CoV (Middle East respiratory syndrome coronavirus) cases.

Coronaviruses are a large family of viruses with some causing less-severe disease, such as the common cold, and others more severe disease such as MERS and SARS. Some transmit easily from person to person, while others do not. According to Chinese authorities, the virus in question can cause severe illness in some patients and does not transmit readily between people. Globally, novel coronaviruses emerge periodically in different areas, including SARS in 2002 and MERS in 2012. Several known coronaviruses are circulating in animals that have not yet infected humans. As surveillance improves more coronaviruses are likely to be identified.

WHO response, guidance, travel advice

In line with standard protocols for any public health event, an incident management system has been activated across the three levels of WHO (country office, regional office, and headquarters) and the Organization is prepared to mount a broader response, if needed. The WHO also provided preliminary guidance to help countries prepare for nCoV cases, including travel and trade advice. The WHO urges international travelers to practice usual precautions and calls for no restriction on international travel.

According to the WHO, the outbreak had not spread. The seafood market in Wuhan is now closed and no cases have been reported elsewhere in China or internationally.

“The evidence is highly suggestive that the outbreak is associated with exposures in one seafood market in Wuhan. At this stage, there is no infection among health care workers, and no clear evidence of human to human transmission.”

WHO’s coronavirus page has been updated to include case definition, laboratory guidance, infection prevention and control, risk communications, a readiness checklist, and a disease commodity package.

Shrew-transmitted Borna virus linked to killer brain infections

Rubbenstroth D, Schlottau K, Schwemmle M, Rissland J, Beer M (2019) Human bornavirus research: Back on track! PLoS Pathog 15(8): e1007873.

In a recent Lancet Infectious Diseases publication, researchers describe eight human fatalities in Germany caused by Borna disease virus 1 (BoDV-1) and suggest that wider testing for the disease may be useful in regions where the virus occurs in the wild.

The study was based on data collected from the brain tissue of 56 patients who died of an unidentified virus and presented with encephalitis (inflammation of the brain). Six of those patients had BoDV-1, and two were likely infected. The newly confirmed cases raise the number of published BoDV-1 deaths in the endemic area to 14.

All patients in which the virus has been newly diagnosed died between 1999 and 2019, and they all lived in southern Germany. However, the authors cannot rule out that it could be behind milder cases of encephalitis, especially in regions of central Europe where the infected host animal species occur in the wild. It was thought it might play a role in psychiatric disorders, such as depression or schizophrenia, but until the virus was reported in four cases in 2018, its links to unexplained encephalitis were rarely investigated.

Originally identified in sheep and horses in Europe, BoDV has since been found to occur in a wide range of warm-blooded animals including birds, cattle, cats, and primates and has been found in animals in Europe, Asia, Africa, and North America. The virus name is derived from the town of Borna in Saxony, Germany, which suffered an epidemic of the disease in horses in 1885.

Credit: Pixabay.

BoDV-1-infected bicolored white-toothed shrews can be found in Germany, Austria, Switzerland, and Liechtenstein, but how the disease virus jumps from shrews to humans is not yet understood. Symptoms in infected people start with a fever, headache, and confusion, and continue with signs of brain disease such as an unsteady gait, memory loss, seizures, and a progressive loss of consciousness. In the new cases, symptoms deteriorated rapidly following patients’ admission to hospital, leading to deep coma and death. All eight patients died within 16 to 57 days of admission.

“Our findings indicate that Borna disease virus infection has to be considered a severe and potentially lethal human disease transmitted from a wildlife reservoir. However, it’s not a newly-emerging disease, but one that appears to have occurred unnoticed in humans for at least decades, and may have caused other unexplained cases of encephalitis in regions where the virus is endemic in the host shrew populations,” says Professor Barbara Schmidt from Regensburg University Hospital, Germany.

Writing in an accompanying commentary, Tomoyuki Honda, Ph.D. from Osaka University, Japan, said the study “has several implications for the pathology and epidemiology of bornavirus infection. It is time to relaunch human bornavirus research based on a theoretical framework that integrates the knowledge from these confirmed human bornavirus cases.”

People are less likely to catch common cold if they’re already infected with influenza

Flu and the common cold are both respiratory illnesses, but they are caused by different viruses. It can be difficult to tell the difference between them based on symptoms alone because they have similar symptoms. In general, colds are usually milder than flu and are more likely to have a runny or stuffy nose while influenza (the flu) can have very serious associated complications.

A new study by scientists from the Medical Research Council-University of Glasgow Centre for Virus Research found that people were less likely to catch either influenza or a common cold-causing rhinovirus if they were already infected with the other virus. Understanding how these distinct viruses hinder each other could be useful to improve forecasting models that predict respiratory disease outbreaks and strategies for controlling disease spread.

It has been observed before that common cold infections appear to be less frequent in the influenza season and vice versa. The study, published in the journal Proceedings of the National Academy of Sciences, is the first study with enough samples to provide strong evidence for this interaction at both the population and individual level.

Samples from 44,230 cases of acute respiratory illness, in 36,157 patients, were tested for 11 types of respiratory viruses over nine years in NHS Greater Glasgow and Clyde. Using this data, the researchers found that 35% tested positive for a virus and, of those, 8% were co-infected with more than one type of virus. The study looked at how 11 viruses interacted and found relationships between some of the other virus pairs, but these were not consistent at both the individual host and population level, which the study did find for influenza A and rhinovirus.

The most striking interaction they found was between influenza A viruses and rhinoviruses, a type of virus that can cause the common cold. Computer modeling of the data found that the inhibitory interactions between influenza and rhinoviruses appeared to occur within individual people as well as at a population level. Patients with influenza A were approximately 70% less likely to also be infected with rhinovirus than were patients infected with the other virus types.

The first author of the paper, Dr Sema Nickbakhsh from MRC-University of Glasgow Centre for Virus Research at the University of Glasgow, said: “One really striking pattern in our data is the decline in cases of the respiratory virus rhinovirus, which is typically a mild common cold-causing virus, occurring during winter, around the time that flu activity increases. In the same way as lions and spotted hyenas compete for food resources in the Masai Mara, we believe respiratory viruses may be competing for resources in the respiratory tract. There are various possibilities we’re investigating, such as these viruses are competing for cells to infect in the body, or the immune response to one virus makes it harder for another unrelated virus to infect the same person.”

Viruses from the same species – for example, different strains of influenza – could be expected to compete or generate an overlapping immune response in the body, but the researchers say what makes these findings interesting is the interaction between completely different types of viruses.

Dr Pablo Murcia, who led the research, said: “Traditionally people have studied viruses in isolation – you study only flu or rhinovirus – but we’ve shown here that we need to also be studying these viruses together like it’s an ecosystem. My team are now doing experiments to try and understand how respiratory viruses, including influenza and rhinovirus, interact. If we understand how viruses interact and how certain viral infections may favor or inhibit each other, then maybe we can develop better ways to target viruses. Studying interactions between viruses could help to explain why different viruses circulate in different seasons or why they affect different age groups, and within the body why certain types of viruses infect different parts of the respiratory tract, like the nose or the lungs.”

An example of how these viruses could also affect each other’s spread at a population level is the scenario where a person infected with one virus is more likely to stay home and consequently not catch another virus. Limitations of the study include: 1) the correlations observed cannot show what is causing these interactions and 2) samples were only taken from people with symptoms of a respiratory infection, so it may not capture how the viruses behave in people who do not develop symptoms.

Measles infected 10 million, claimed over 142,000 lives last year

After decades of progress against measles, the highly contagious yet vaccine-preventable disease is making a slow and steady comeback. The World Health Organization (WHO) and the U.S. Centers for Diseases Control and Prevention said in a new report that there were nearly 10 million cases of measles and 142,000 deaths, with outbreaks on every continent.

“Our finding is that in 2018, there’s been an increase in both the cases and the deaths that have occurred from measles,” Dr. Kate O’Brien, director of WHO’s immunization program, said in a video release. “In other words, we’re backsliding.”

Poor vaccination coverage and large pockets of unvaccinated children have resulted in devastating measles outbreaks in many parts of the world – including in countries that had high coverage rates or had previously eliminated the disease. In some cases, conflict, security or a breakdown in services are making it hard to reach children in remote or hard-to-reach areas. In others, parents are not vaccinating their children due to complacency, mistrust or misinformation about vaccines. This year, for example, the United States reported its highest number of cases in 25 years, while four countries in Europe — Albania, Czechia, Greece, and the United Kingdom — lost their measles elimination status in 2018 following protracted outbreaks.

Samoa and the Asia Pacific

The latest region to be affected is Asia Pacific, where measles is being reported even in places where the disease had been eliminated such as Australia, Japan, and New Zealand. In Samoa, the Government has declared a state of emergency, and all schools are temporarily closed. According to the latest data released by the Government, measles had already claimed 63 lives, mostly young children.

More than 4,300 cases have been reported among a relatively small population, and new cases are being reported daily. According to estimates from UNICEF and WHO, vaccination coverage in Samoa plummeted from 58 percent in 2017 to just 31 percent in 2018, largely due to misinformation and mistrust among parents.

Five countries account for almost half of measles cases in 2018

Democratic Republic of the Congo (DRC): Immunization services have been hampered since 2018 because of poor infrastructure, violence and insecurity, attacks on health centers, lack of access to healthcare, shortages of vaccines and lack of trust in health workers.

The situation has further deteriorated in 2019, with more than a quarter of a million people infected this year alone, more than three times the number of measles cases in 2018 and more than the number of cases and deaths attributed to Ebola in the country. Most of the 5,000 reported deaths so far this year were among children under five. UNICEF has provided the Ministry of Health with 8 million doses of bundled measles-containing vaccines, and distributed over 1,300 medical kits – containing antibiotics, rehydration salts, Vitamin A and other medicines – to all affected health zones to treat children with complications.

Liberia: The outbreak began in 2017 due to low vaccine coverage. In 2018, the country had recorded the highest number of cases, with outbreaks reported in 5 out of 15 counties, and recorded about 3,948 suspected cases including 16 deaths. The recurrent outbreaks continued through 2019, even though the number of cases has declined.

Madagascar: From August 2018 to November 2019, there were 244,607 cases of measles, and 1,080 died due to measles, of which 91 percent were children under 14 years old. Although the rate of new cases is significantly decreasing, some districts are still reporting cases. UNICEF has helped purchase 8.7 million doses of measles vaccine and supported the government to distribute these vaccines at the local level.

Somalia: In 2018, low vaccination coverage, and crowded living conditions created ideal conditions for the spread of measles and other vaccine-preventable diseases. The number of cases has substantially reduced this year compared to 2018, thanks to immunization campaigns supported by UNICEF and partners of the Measles & Rubella Initiative.

Ukraine: Since the start of the outbreak in 2017, over 115,000 people have been infected with 41 deaths, including 25 children. In 2018 alone, there were over 54,000 cases and 16 deaths. Cases remained at alarming levels in 2019. Over 58,000 cases were registered until 6 November 2019, with 20 deaths. UNICEF has increased its support to the Ministry of Health to vaccinate more children by training health care workers and promoting vaccines. UNICEF has also provided support to accelerate routine immunization across the country and address vaccine hesitancy.

In the Americas, Brazil listed 11,887 cases, most of which were reported in Sao Paulo. Two outbreaks in New York state in the US have been declared over, though the WHO says other outbreaks are occurring throughout the country.

Measles is among the most infectious diseases and can be prevented with two doses of vaccine. Even with the implementation of routine immunization, measles continues to circulate globally due to sub-optimal vaccination coverage and population immunity gaps. Any community with less than 95% population immunity is at risk for an outbreak. If an outbreak response is not timely and comprehensive, the virus will find its way into more pockets of vulnerable individuals and potentially spread within and beyond the affected countries. As long as measles continues to circulate anywhere in the world, no country can be assured to avoid importation. 

New vaccine is incredibly efficient at preventing typhoid

Caused by the bacterium Salmonella Typhi, typhoid is a major cause of fever in children in low- and middle-income countries and is responsible for nearly 11 million cases and more than 116,000 deaths a year worldwide.

It is usually spread through contaminated food or water. Once Salmonella Typhi bacteria are eaten or drunk, they multiply and spread into the bloodstream. Symptoms include prolonged high fever, fatigue, headache, nausea, abdominal pain, and constipation or diarrhoea. Some patients may have a rash. Severe cases may lead to serious complications or even death. Salmonella Typhi lives only in humans.

In 2018, the World Health Organization (WHO) recommended the introduction of typhoid conjugate vaccine (TCV) for infants and children over six months of age in typhoid-endemic countries, and added it to its list of pre-qualified vaccines.

Prior to TCV, two vaccines have been used for many years to protect people from typhoid fever, an injectable vaccine based on the purified antigen for people aged over 2 years and a live attenuated oral vaccine in capsule formulation for people aged over 5 years. These vaccines do not provide long-lasting immunity and are not approved for children younger than 2 years old.

Although TCV has been shown to protect against the disease in studies involving healthy volunteers in the UK, no efficacy studies in endemic populations had been completed. Now, the Typhoid Vaccine Acceleration Consortium (TyVAC), which includes researchers from the University of Oxford, the University of Maryland School of Medicine, and PATH has completed a large field study in Nepal and published the interim analysis in the New England Journal of Medicine.

The study involved 20,000 children aged 9 months to 16 years of age, who were randomly given one of two vaccines: half received TCV and half received the Group A meningococcal (MenA) vaccine – the latter acted as the control group.

Blood tests showed that typhoid occurred in 7 participants who received TCV and 38 receiving Men A vaccine. The researchers noted that these were preliminary results, and that the study will continue to follow-up the participants for two years.

Dr. Andrew Pollard, Professor of Paediatric Infection and Immunity at Oxford University’s Department of Paediatrics, said: “This is the first study to show that a single dose of TCV is safe, immunogenic, and effective, which provides clear evidence that vaccination will help efforts to control this serious disease and is a strong endorsement of the WHO policy for vaccine implementation.”

“The efficacy of these results in an endemic population adds to a growing body of evidence supporting the use of TCV to reduce disease and save lives in populations that lack clean water and improved sanitation,” said Dr. Kathleen Neuzil, MD, MPH director of the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine and director of TyVAC.

These results show the vaccine has the potential to significantly reduce the burden of typhoid in high-risk populations. This is especially timely with the recent spread of extensively drug-resistant typhoid, which threatens child health in affected regions.

Pakistan’s current typhoid outbreak is the first-ever reported outbreak of ceftriaxone-resistant typhoid and represents an alarming trend in the spread of drug-resistant typhoid. Not only is the strain resistant to ceftriaxone, the standard treatment in many parts of the world, but it is also resistant to most antibiotics commonly used for typhoid, making it increasingly challenging and costly to treat.

TCVs have the potential to overcome many of the challenges that impeded uptake of earlier vaccines, including longer-lasting protection, fewer doses, and suitability for children under two years of age, allowing for inclusion in routine childhood immunization programs.

Measles cases spike globally with a 26% increase from last year

The World Health Organization (WHO) on Wednesday released an update on global measles cases, noting a spike in the number of cases confirmed.

As of Nov. 5, there were more than 440,200 measles cases worldwide reported to WHO, a 26% increase from 350,000 cases in 2018. In 2017, the World Health Organization (WHO) reported 110,000 measles deaths globally, mostly among children under the age of five. The potentially deadly illness, which can be easily prevented with vaccinations, continues to spike globally, with multiple large outbreaks being reported across Africa, Europe, Latin America and the Middle East.

DR Congo posts huge numbers

The most shocking numbers were posted in the Democratic Republic of Congo (DRC), which registered a total of 250,270 cases on November 17, an increase of 8,000 cases over the week prior. Some 5,110 measles-related deaths were registered in the DRC. Elsewhere in Africa, Chad reported 25,596 cases as of November 17, affecting 94% of the country’s districts. Whereas the DRC is currently issuing vaccinations, Chad has yet to do so.

© UNICEF/Thomas Nybo
A nurse prepares to vaccinate an infant during a regularly-scheduled immunization clinic in North Kivu province, Democratic Republic of the Congo

Outbreaks in every corner of the world

In the Americas, Brazil listed 11,887 cases, most of which were reported in Sao Paulo. Two outbreaks in New York state in the US have been declared over, though the WHO says other outbreaks are occurring throughout the country.

Paul Martinka | Bill de Blasio and Dr. Oxiris Barbot during a press conference

In Europe, Ukraine far outpaced other countries, reporting some 56,802 cases, followed by Kazakhstan with 10,126 cases, Georgia with 3,904 cases, Russian Federation with 3,521 cases, Turkey with 2,666 cases, and Kyrgyzstan with 2,228 cases of measles. Some of these outbreaks (e.g. Georgia, Russian Federation, Turkey) have resolved.

A measles epidemic in Samoa has killed 39 people, with the WHO blaming an anti-vaccine messaging campaign for leaving the Pacific island nation vulnerable to the spread of the virus. The UN health agency warned that a steep decline in vaccination rates in Samoa had paved the way for a “huge outbreak”, with almost 3,000 in a country of just 200,000 people.

Measles is among the most infectious diseases and can be prevented with two doses of vaccine. Even with implementation of routine immunization, measles continues to circulate globally due to sub-optimal vaccination coverage and population immunity gaps.

Any community with less than 95% population immunity is at risk for an outbreak. If an outbreak response is not timely and comprehensive, the virus will find its way into more pockets of vulnerable individuals and potentially spread within and beyond the affected countries. As long as measles continues to circulate anywhere in the world, no country can be assured to avoid importation. 

Scientist Ian Mackay, who specializes in virology at the University of Queensland, said the rhetoric peddled on social media was “not correct”. Some claim a suggested alternative to getting vaccinated is high doses of Vitamin A, which experts say cannot prevent getting the measles infection and is not based on evidence. “The only way to prevent getting measles — the disease — is to have the vaccine, and have both doses of it,” he said.

“No other personal medications or vitamin concoction or magical oil will prevent that virus from spreading. It’s only vaccination.”

The World Health Organisation’s Nikki Turner said online misinformation claiming children could be treated with vitamins had “no scientific evidence” behind them, and that such claims were “conning” people from getting correct treatment, the Samoa Observer reported last week.

Over 100 schools hit by the winter vomiting bug

It’s that time of the year again: Black Friday, Thanksgiving, influenza, and norovirus. The winter cold months are the perfect environment for some pathogens to spread.

Norovirus, also called the “winter vomiting bug”, is a very contagious virus that causes vomiting and diarrhea. Norovirus is spread by coughing, sneezing and close contact, or touching the same surfaces. People infected with norovirus can shed billions of norovirus particles and only a few virus particles can make other people sick.

About 60 schools in north-east England have been hit by a suspected outbreak of norovirus. Some schools in the region had to close down last week and undergo a ‘deep clean’, after hundreds of staff and pupils were hit with vomiting, diarrhea and flu-like symptoms.

Public Health England (PHE) said it was not able to give an exact figure of the number of schools that have been affected, nor their location. However, figures published by PHE suggested norovirus rates are 26 percent higher than they usually are at this time of year.

Between October 28 and November 10, a total of 332 people were infected by the highly contagious bug. A total of 18 outbreaks caused hospital wards to close or to restrict admissions across England and Wales. PHE said it expects these types of bugs to go around schools and workplaces during this time of year, as norovirus is predominantly a ‘winter pathogen’.


On the other side of the Atlantic, Mesa County Valley School District 51 – a school district in Colorado, United States – announced the closing of the entire school district through the end of this school week. All 46 schools in the district reported several students and teachers have gotten sick with vomiting and diarrhea. Although the cause has not yet been clearly identified yet, experts believe this is most likely norovirus.

Noroviruses are thought to be the most common cause of acute gastroenteritis (diarrhea and vomiting). On average, noroviruses cause 19 to 21 million cases of acute gastroenteritis, 1.7–1.9 million outpatient visits and 400,000 emergency department visits in the U.S. per year, according to the CDC.

Young children, the elderly, and people who have a weakened immune system are particularly susceptible to catching noroviruses. The spread of the virus can be hard to control because it’s contagious before symptoms appear.

The Think Noro public health campaign advises:

N“No visits to hospitals, care homes and GP surgeries if you are suffering from symptoms of Norovirus – send someone else to visit loved ones until you are better.”

O“Once you’ve been symptom-free for at least 48 hours, you’re safe to return to work, school or visit hospitals and care home.”

R“Regularly wash your hands with soap and warm water, especially after using the toilet, and before eating or preparing food.”

O“Only hand-washing will prevent the spread of Norovirus – alcohol hand gels DON’T kill the virus.” Hand sanitizers are not effective against norovirus; soap is your best weapon.

There is still no licensed vaccine against norovirus, but there are promising candidates in the pipeline.

Rare genetic mutations and the fruit fly explain how Zika causes microcephaly

In the early part of 2016, the World Health Organization’s Emergency Committee (EC) under the International Health Regulations (2005) (IHR 2005) discussed the clusters of microcephaly and Guillain-Barré Syndrome (GBS) cases that have been temporally associated with Zika virus transmission.

Brazil, France, the United States of America, and El Salvador provided information on a potential association between microcephaly and other neurological disorders with Zika virus. The recent cluster of microcephaly cases was considered a Public Health Emergency of International Concern (PHEIC). Several months later, the WHO confirmed in a scientific consensus that the Zika virus is linked with microcephaly as well as Guillain-Barré syndrome.

Three years and several studies later, researchers at Baylor College of Medicine revealed one way how in utero Zika virus infection can lead to microcephaly in newborns. The team discovered that the Zika virus protein NS4A interrupts the growth of the brain by taking control of a pathway that regulates the generation of new neurons.

Rare genetic mutations helped explain how Zika causes microcephaly

Zika virus protein NS4A interacts with ANKLE2, a protein linked to hereditary microcephaly.

“The current study was initiated when a patient presented with a small brain size at birth and severe abnormalities in brain structures at the Baylor Hopkins Center for Mendelian Genomics (CMG),” said Dr. Hugo Bellen, professor at Baylor, investigator at the Howard Hughes Medical Institute and Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital.

This patient and others in a cohort at CMG had not been infected by Zika virus in utero. They had a genetic defect that caused microcephaly. CMG scientists determined that the ANKLE2 gene was associated with the condition.

Several years ago, Dr. Bellen and colleagues discovered in the fruit fly model that the ANKLE2 gene was associated with neurodevelopmental disorders. In a subsequent fruit fly study, the researchers demonstrated that overexpression of Zika protein NS4A causes microcephaly in the flies by inhibiting the function of ANKLE2, a cell cycle regulator that acts by suppressing the activity of VRK1 protein. Since very little is known about the role of ANKLE2 or VRK1 in brain development, Bellen and his colleagues applied a multidisciplinary approach to tease apart the exact mechanism underlying ANKLE2-associated microcephaly.

The fruit fly helps clarify the mystery

This image shows the two lobes of the brain of a fruit fly larva with hundreds of neurons, colored green, and stem cells, colored magenta. 

To figure out how Ankle2 mutations were influencing brain formation, the researchers went back to flies. Normally, Ankle2 works with a series of other genes to control the division of neuroblasts — stem cells that give rise to neurons. These cells are crucial for proper brain development.

Mutations in the Ankle2 gene, though, messed with neuroblast division. Larval flies with the mutation had fewer neuroblasts and smaller-than-expected brains. Further analyses revealed more details about how Ankle2 regulates asymmetric neuroblast division. They found that Ankle2 protein interacts with VRK1 kinases, and that Ankle2 mutants alter this interaction in ways that disrupt asymmetric cell division.

The Zika connection

In the future, a drug that protects this protein could stop Zika’s damaging developmental effects, says Dr. Hugo Bellen.

“For decades, researchers have been unsuccessful in finding experimental evidence between defects in asymmetric cell divisions and microcephaly in vertebrate models. The current work makes a giant leap in that direction and provides strong evidence that links a single evolutionarily conserved Ankle2/VRK1 pathway as a regulator of asymmetric division of neuroblasts and microcephaly. Moreover, it shows that irrespective of the nature of the initial triggering event, whether it is a Zika virus infection or congenital mutations, the microcephaly converges on the disruption of Ankle2 and VRK1, making them promising drug targets.”

Diabetes rising worldwide: one in 11 adults affected

Diabetes is one of the world’s fastest growing chronic diseases with over 463 million adults (that’s 1 in 11 adults) around the world living with this chronic medical condition according to new data published in the 9th Edition of the International Diabetes Federation (IDF) Diabetes Atlas. The latest Atlas also reports that the global prevalence of diabetes has reached 9.3%, with more than half (50.1%) of adults undiagnosed. A further 1.1 million children and adolescents under the age of 20, live with type 1 diabetes.

A decade ago, in 2010, the global projection for diabetes in 2025 was 438 million. With over five years still to go, that prediction has already been surpassed by 25 million. IDF estimates that there will be 578 million adults with diabetes by 2030, and 700 million by 2045.

Diabetes itself is not a major problem unless the blood glucose is uncontrolled and either rises too high or drops too low. If diabetes is not managed correctly (meaning blood glucose is not properly regulated), sufferers are likely to become progressively sick and debilitated.

Over time, diabetes can damage the heart, blood vessels, kidneys, eyes and nerves. For diabetics, maintaining blood sugar levels in a normal range — not too high or too low — is a lifelong challenge. Half of the people with diabetes die of cardiovascular disease (primarily heart disease and stroke), and 10–20 percent of people with diabetes die of kidney failure. Diabetes is also a major cause of blindness and lower limb amputation.

IDF estimates that approximately 4.2 million adults will die as a result of diabetes and its complications in 2019. This is equivalent to one death every eight seconds.

Flu season is quickly approaching and patients with diabetes are particularly at high risk of serious flu-related complications that can result in hospitalization or even death. Diabetics are twice as likely to die from heart disease or stroke as people without diabetes and six times more likely to be hospitalized. 

Flu infection can cause changes in blood sugar and prevent people with diabetes from eating properly, which further affects blood glucose. Moreover, diabetes can make the immune system less able to fight infections. Diabetes patients with flu face very serious health risks such as ketoacidosis (a condition when the body cannot use sugar as a fuel source because there is no insulin or not enough insulin) and Hyperosmolar Hyperglycaemic State (HHS).

It is important for people with diabetes to follow the sick day guidelines if they become ill. Flu vaccination is especially important for people with diabetes because they are at high risk of developing serious flu complications. Flu vaccination has also been associated with reduced hospitalizations among people with diabetes (79%). Diabetics who get the flu should ask their doctors about prescription antiviral medications that can ease symptoms and shorten the duration of the illness. For best results, antivirals should be taken within 48 hours of the onset of flu symptoms.

For the Nth time – measles is bad. Here’s why…

Measles is a highly contagious virus that initially causes a runny nose, sneezing and fever and later leads to a blotchy rash starting on the face and spreading to the rest of the body. The majority of the people infected will recover, but measles can cause diarrhea and vomiting, which can lead to dehydration, middle ear infection (otitis media), which can lead to hearing loss, or pneumonia or potentially fatal encephalitis (swelling in the brain).

When people get an infection, their immune system produces antibodies to fight the infection. After the body gets rid of the infection, special immune cells remember that specific pathogen and help the body mount a faster defense if that same pathogen invades the body again. But not with measles. The virus reboots children’s immune system and the “amnesia” makes them vulnerable to other pathogens that they might have been protected from a previous infection.

In one study [M.J. Mina et al., Science, 366:599–606, 2019], measles infection in unvaccinated children in a community in the Netherlands was associated with up to a 70% decline in antibodies to other pathogens following infection. After cases of severe measles, unvaccinated children lost a median of 40% (range 11-62%) of their already existing pathogen-specific antibodies and after a case of mild measles, children lost a median of 33% (range 12-73%) of these pre-existing antibodies.

On the other hand, kids vaccinated retained over 90% of their antibody repertoires over the same period. The researchers examined blood from 77 unvaccinated children infected with measles in the Netherlands during a 2013 outbreak and compared these samples with the blood of 115 uninfected children and adults using the VirScan system, a tool that detects antiviral and antibacterial antibodies in the blood. Samples were taken prior to and after measles infection.

The team found that rather than a simple loss of total IgG, the most common type of antibody found in blood circulation, there is a restructuring of the antibody repertoire after measles. This is the first study to measure the immune damage caused by the virus and is further evidence for the “immune amnesia” hypothesis (that by depleting antibody repertoires, measles partially obliterates immune memory to previously encountered pathogens).

The same investigators also infected macaques with measles and monitored their antibodies against other pathogens for five months. The measles-infected monkeys lost 40–60% of their antibodies against pathogens they have previously encountered suggesting that measles infection wipes out long-lived plasma cells in the bone marrow that can create pathogen-specific antibodies.

A separate, independent team published a related study [V. N. Petrova et al., Sci Immunol, 4:2019] showing that measles infection causes incomplete reconstitution of the naïve B cell (not exposed to an antigen) leading to immunological immaturity and compromised immune memory to previously encountered pathogens due to depletion of memory B lymphocytes that persist after measles infection. The study provides a clear biological explanation for the observed increase in childhood deaths and secondary infections several years after an episode of measles.

These two new studies emphasize the importance of measles vaccination and suggest that given these findings, booster shots against other illnesses, such as hepatitis or polio, may be necessary for children infected with measles.

In 2017, the World Health Organization (WHO) reported 110 000 measles deaths globally, mostly among children under the age of five. The actual number of people infected with measles is most probably higher given that the WHO only collects data on cases confirmed through lab testing or clinical visits excluding thousands who do not seek medical attention.

With the global trend of vaccine hesitancy, skeptical parents are refusing to get their children vaccinated due to false concerns about their safety. These 2 new studies add strong evidence and undoubtedly confirm what scientists and public health experts have known all along: measles bad, vaccines good. This time let’s remember… let’s not have amnesia that measles can cause immune amnesia.

Potentially fatal tick-borne brain disease found in the UK for first time

Tick-borne encephalitis virus (TBEV) has been found in the UK for the first time. The virus has been discovered as part of ongoing research by Public Health England and the Emerging and Zoonotic Infections National Institute for Health Research (NIHR) Health Protection Research Unit at the University of Liverpool.

Experts described the risk of infection as “very low,” but called on members of the public to be aware of ticks, small parasitic arachnids that are related to spiders and mites.

Front. Immunol., 26 September 2018 | https://doi.org/10.3389/fimmu.2018.02174

Tick-borne encephalitis (TBE) virus is an infection that causes no symptoms in most people. However, within one or two weeks of being bitten, some may complain of flu-like symptoms such as headaches, fever, fatigue and joint pain. In approximately one in ten cases, encephalitis or meningitis may follow, leading to severe headaches, light sensitivity, and dizziness, as well as problems with concentration, speech and walking. In rare cases, the virus can cause paralysis in the arms and legs and even death.

The infection is endemic in Scandinavia, mainland Europe, and parts of China and Japan. Ticks live in forests and grassy areas. It has now been detected in Thetford Forest, in eastern England, and the border between the southern counties of Hampshire and Dorset.

Earlier this year a European visitor became ill after being bitten by a tick in the New Forest area. This is a highly probable case of TBE. The patient, who was reported to PHE through the European Early Warning and Response System has since made a full recovery. No further cases in the UK have been identified. In 2017, there were 3,079 reported cases of TBE in Europe, including 9 associated fatalities.

https://www.youtube.com/watch?v=RhWlHsQnncw

The number of infections is increasing in Europe due to climate change and an increase in outdoor leisure pursuits, according to PHE. It is also possible that migratory birds introduced TBE-infected ticks to the UK, or they could have arrived along with pets traveling from endemic countries in Europe to the UK, according to PHE.

“Ticks carry a number of infections including Lyme disease, so we are reminding people to be ‘tick aware’ and take tick precautions, particularly when visiting or working in areas with long grass such as woodlands, moorlands and parks,” said Nick Phin of PHE.

Ticks are most active from May to October, although in some parts of Europe tick season could start as early as February if temperatures rise above 8 degrees Celsius. 

Experts recommend a TBE vaccine if you’re visiting a country where the infection is common and you’re planning to do outdoor activities when you get there. Two injections of the vaccine can protect you for about a year. A third injection can protect you for about 3 years. The first injection should be given at least 1 month before traveling.

Lyme disease remains a far more prevalent tick-borne health risk and health officials recommend that hikers walk on clearly defined paths and avoid brushing against vegetation where ticks may be present. Avoiding deep vegetation and sticking to paths will reduce the risk of tick bites, as will covering your skin and using insect repellants.

In 2018, a US congressional advisory committee said tick-related illnesses had become “a serious and growing threat to public health” and in July the US House of Representatives ordered an investigation into whether the Department of Defense had experimented with ticks and other insects as biological weapons.

Polio Type 3 eradicated globally

Humanity has eradicated another enemy (after smallpox in May 1980, and rinderpest or ‘cattle plague’ in October 2010). The independent Global Commission for the Certification of Poliomyelitis Eradication (GCC) has declared wild poliovirus type 3 to be globally eradicated. Announced on World Polio Day, this is a major milestone in the global effort to eradicate all poliovirus strains and ensure that no child will ever again be paralyzed by any poliovirus anywhere.

“This achievement is another giant step towards freeing the world from the crippling disease. The WHO European Region has massively contributed to this since it was declared polio free in 2002,” says Dr Nedret Emiroglu, Director of Health Emergencies and Communicable Diseases, WHO/Europe. “However, despite progress, there is still much left to be done across the globe. Continued work to reach every last child with the polio vaccine, strengthening routine immunization and surveillance, and ensuring safe containment of polio viruses, will be key to keeping polio at bay and protecting the gains achieved.”

Type 2 has been gone since 1999 leaving only Type 1, in Pakistan and Afghanistan. But vaccine resistance there has led to 88 cases so far this year, after only 33 all last year. So while the defeat of Type 3 is a welcome success, the WHO is still calling polio a Public Health Emergency of International Concern – and the emergency is now reaching a crunch point. “We face a very hard twelve months,” says Dr Michel Zaffran, director of polio eradication for the World Health Organization.

That isn’t only due to problems in Pakistan. The Type 2 vaccine virus replicates rapidly in humans, provoking strong immunity which is one of the reasons why wild Type 2 polio has long been wiped out while the other two types persisted.

The oral polio vaccine (OPV) contains an attenuated (weakened) vaccine-virus, activating an immune response in the body. When a child is immunized with OPV, the weakened vaccine-virus replicates in the intestine for a limited period, thereby developing immunity by building up antibodies. During this time, however, the vaccine-virus is also excreted and in areas of inadequate sanitation — this excreted vaccine-virus can spread in the immediate community (and this can offer protection to other children through ‘passive’ immunization), before eventually dying out. On rare occasions, if a population is seriously under-immunized, an excreted vaccine-virus can continue to circulate for an extended period, allowed to survive and mutate. In very rare instances, the vaccine-virus can genetically change into a form that can paralyse – this is what is known as a circulating vaccine-derived poliovirus (cVDPV).

Since 2017, circulating vaccine-derived poliovirus has caused more cases of paralysis than the actual wild poliovirus. To address this challenge, the entire world switched to a live vaccine with only polio Types 1 and 3 in 2016. Kids born since 2016, however, can transmit outbreaks of Type 2 vaccine virus, because they have not been given the live Type 2 vaccine.

There have been more outbreaks than predicted in 2016: ten in Africa this year, including countries such as Zambia, China and the Philippines. In the Philippines, a massive polio vaccine campaign was recently launched with community health workers and volunteers going door-to-door to give kids droplets of the oral vaccine. After being polio-free for almost two decades, polio is back in the Philippines. 

Philippine Health Secretary Francisco Duque III, second from left, administers anti-polio vaccine to a child during the launch of a campaign to end the resurgence of polio Friday, Sept. 20, 2019 at suburban Quezon city, northeast of Manila, Philippines. Philippine health officials declared a polio outbreak in the country on Thursday, nearly two decades after the World Health Organization declared it to be free of the highly contagious and potentially deadly disease. (AP Photo/Bullit Marquez)

The outbreaks can be stopped with live, type 2 vaccines, says Zaffran. The problem is that it seeds more reverted vaccine virus. A novel Type 2 vaccine virus, genetically modified to be even less likely to revert, might be the solution to the vaccine-derived poliovirus dilemma. Earlier this year, virologists in Antwerp reported that the vaccine was safe, well-tolerated, and successfully induced immunity in 30 people – who were isolated for a month in a custom-built “poliopolis” that kept the virus from escaping. Further trials are being done but the new vaccine virus is already being used by an Indonesian firm, Biofarma, to make live Type 2 vaccine.

Another challenge is donor fatigue. “We know that the last mile has proved to be the toughest phase of eradication,” says Zaffran. The Global Polio Eradication Initiative (GPEI) is now seeking $3.27 billion for its next four years of work, with a donor “pledging moment” scheduled for November 19 in Abu Dhabi.

New parasite species causing drug-resistant disease in Brazil

A new species of parasite causing symptoms like visceral and cutaneous leishmaniasis but resistant to currently available treatments have been identified by researchers from Universidade Federal de São Carlos, Universidade Federal de Sergipe, Universidade de São Paulo, US National Institutes of Health, and Fundação Oswaldo Cruz in patients treated at the University Hospital in Aracaju, state of Sergipe in Brazil. At least one person has died from complications associated with infection by the parasite.

Phylogenomic analysis showed that the recently discovered parasite does not belong to the genus Leishmania, which comprises over 20 species of parasites that are transmitted to humans by the bites of the infected female phlebotomine sandfly – a tiny insect vector. There are three main forms of leishmaniasis: cutaneous, visceral (VL) or kala-azar, and mucocutaneous. VL is the most severe form of the disease and can be fatal if misdiagnosed or untreated. Cases of VL in Brazil account for >90% of annual reported cases in Latin America.

“From the phylogenetic standpoint, the species analyzed in this study is closer to Crithidia fasciculata, a mosquito parasite that cannot infect humans or other mammals. We managed to infect mice with it, and for this reason we believe it’s a new protozoan, which we propose to call Cridia sergipensis,” said João Santana da Silva, a professor at the University of São Paulo’s Ribeirão Preto Medical School (FMRP-USP).

The first case was confirmed in a 64-year-old man, first treated in 2011 for classic symptoms of visceral leishmaniasis: fever, enlarged spleen and liver, and decreased production of all types of blood cells (pancytopenia).

The patient was given the standard treatment and improved but suffered a relapse a few months later. He was then administered liposomal amphotericin B, the best drug available for these cases, responded, but suffered another relapse some months later. Unfortunately, the patient died after the relapses and an operation to remove his spleen, as recommended in severe cases that do not respond to treatment. A biopsy of the skin lesions found cells full of parasites, which were isolated and cryopreserved for analysis.

The group initially thought the patient had been infected atypically by Leishmania infantum but molecular tests available to identify this pathogen were all inconclusive in the analyses performed on the parasites isolated from the patient. They then opted to do a whole-genome analysis of the parasites isolated from the patient in order to find out exactly what they were dealing with.

The bioinformatics analysis that revealed the phylogenetic similarity between the new species and C. fasciculata was conducted by José Marcos Ribeiro at the National Institute of Allergy & Infectious Diseases (NIAID) and Sandra Regina Costa Maruyama, a researcher in the Department of Genetics and Evolution at the Federal University of São Carlos. The team also performed a whole-genome analysis of parasites isolated from two other patients in Aracaju who were not responding to treatment, confirming that they too belonged to the new species.

According to Maruyama, initial results gathered from an analysis of fragments of the genome identified as key to the characterization of the species suggest that most of the protozoans present in the isolates match the profile of Cridia sergipensis.

Maruyama and co-investigators would like to know whether Cridia sergipensis alone can cause severe and potentially fatal disease or whether the cases observed resulted from co-infection. Another research priority is to discover how Cridia sergipensis emerged and how it is transmitted to humans. The team also plans to search for compounds (or existing drugs) that can kill the new parasite efficiently.

A vaccine against Ebola gets European green light

The human medicines committee (CHMP) of the European Medicines Agency (EMA) has recommended granting a conditional marketing authorisation in the European Union for Ervebo (rVSVΔG-ZEBOV-GP), the first vaccine to protect individuals (18 years and older) from Ebola virus infection.

The Ebola virus causes hemorrhagic fever and spreads from person to person through direct contact with body fluids. Death rates in patients who have been infected with the virus have varied from 25% to 90% in past outbreaks. The largest outbreak to date occurred in West Africa in 2014 to 2016 with over 11,000 deaths. The current outbreak in the Democratic Republic of Congo (DRC), caused by Ebola Zaire, has shown case fatality rates around 67%.

Over 3,000 people have been infected with the Ebola virus during the ongoing outbreak, which was declared a public health emergency of international concern by the World Health Organization (WHO) in July 2019. There are currently no licensed treatments for Ebola, but scientists announced in August that they were a step closer to being able to treat Ebola after two experimental drugs showed survival rates of as much as 90% in a clinical trial in Congo.

“This is an important step towards relieving the burden of this deadly disease,” said Guido Rasi, EMA’s Executive Director. “The CHMP’s recommendation is the result of many years of collaborative global efforts to find and develop new medicines and vaccines against Ebola. Public health authorities in countries affected by Ebola need safe and efficacious medicines to be able to respond effectively to outbreaks and save lives.”

The clinical development of Ervebo was initiated in response to the 2014-2016 Ebola outbreak in cooperation with public health stakeholders, including national institutes of health, ministries of health in countries such as Guinea and DRC, WHO, the US Centers for Disease Control and Prevention, the Public Health Agency of Canada, Médecins Sans Frontières and others.

Ervebo has been tested in approximately 16,000 individuals involved in several clinical studies in Africa, Europe and the United States where it has been proven to be safe, immunogenic (i.e. able to make the immune system respond to the virus) and effective against the Zaire Ebola virus that circulated in West Africa in 2014-2016. Preliminary data suggest that it is effective in the current outbreak in DRC. Additional efficacy and safety data are being collected through the Expanded Access Protocol and should be included in post-marketing safety reports, which are continuously reviewed by EMA.

Ervebo was supported through EMA’s PRIority MEdicines (PRIME) scheme, which provides early and enhanced scientific and regulatory support to medicines that have a particular potential to address patients’ unmet medical needs. Ervebo was granted eligibility to PRIME in June 2016 for active immunisation against Ebola.

The US Food and Drug Administration (FDA) fast-tracked the vaccine’s application for approval in September and decision is expected in March 2020. Seven other experimental Ebola vaccines are at earlier stages of development.

The Ebola outbreak in the eastern Democratic Republic of the Congo (DRC) is finally waning. Since the outbreak began in August 2018, almost 3,250 people have been infected and more than 2,150 have died. But the decrease in infections is not a reason to relax efforts to contain the virus, according to WHO director-general Tedros Adhanom Ghebreyesus. Health authorities in Kinshasa said last week they planned to introduce an experimental second Ebola vaccine, developed by drugmaker Johnson & Johnson, in the country’s eastern provinces in November.

Meanwhile, Japan imported the Ebola virus and four other deadly pathogens (Marburg and Lassa viruses and viruses that cause South American hemorrhagic fever and Crimean-Congo hemorrhagic fever) to prepare diagnostic tests for the 2020 Olympics, according to a report in Nature.

Molecules in mucus subdue microbes to make them harmless

More than 200 square meters of our bodies — including the digestive tract, lungs, and urinary tract — are lined with mucus. Far from being a gross waste product, this slippery secretion produced by, and covering, the mucous membranes serves an important physiological purpose.

It has been established that mucus is the body’s security bouncer physically trapping pathogens, toxins, and fine particles like dust and pollution. The cells of the immune system in the mucus then attack and neutralize the invading germs before they get the opportunity to spread throughout the body and cause infection. In some instances, mucus is coughed up or expelled – which is the body’s way of forcing the pathogens out of the body. Mucus also lubricates the eyes so they can blink and the throat so it can swallow. It also serves as a lubricant under the skin’s surface to help minimize friction between the organs.

New research at the Massachusetts Institute of Technology (MIT) and published in Nature Microbiology shows one of mucus’s unexpected beneficial properties: mucus contains sugars that can interfere with bacteria’s communication and behavior, effectively stopping the formation of dangerous, tough biofilms and making them harmless.

The research was funded by the National Institute of Biomedical Imaging and Bioengineering, the National Institutes of Health, the National Science Foundation, the National Institute of Environmental Health Sciences, and the MIT Deshpande Center for Technological Innovation.

Katharina Ribbeck and her colleagues study compounds called mucins in mucus. Mucins are long polymers, or molecular chains, densely studded with sugars. They “look like mini bottlebrushes,” Ribbeck said, except bristling with sugar molecules where whiskers would be.

“What we have in mucus is a therapeutic gold mine,” said Ribbeck, the Mark Hyman, Jr. Career Development Professor of Biological Engineering at MIT. “These glycans have biological functions that are very broad and sophisticated. They have the ability to regulate how microbes behave and really tune their identity.”

Ribbeck and others have shown that mucus can stop microbes from binding to surfaces. Researchers focused on how glycans were interacting with an opportunistic microbial pathogen called Pseudomonas aeruginosa, the bacterium commonly causing serious infections in people with weak immune systems and cystic fibrosis patients.

They found that when bacteria were exposed to glycans isolated from mucus, they were disarmed; the microbes stopped attaching to or killing host cells, halted production of toxic molecules, and microbial genes that are involved in bacterial communications weren’t expressing. The new study is the first to “identify that the glycan component” — that is, the sugars grafted to the mucins — “is responsible for suppressing antagonistic microbial behaviors.”

They now plan to study the impact of individual glycans out of hundreds that can be found in mucus. They also want to investigate how glycans affect other kinds of pathogens like Candida albicans and Streptococcus bacteria. They already know that glycans can stop Streptococcus from sharing genes, a primary way that drug resistance spreads among microbes.

“What we find here is that nature has evolved the ability to disarm difficult microbes, instead of killing them. This would not only help limit selective pressure for developing resistance, because they are not under pressure to find ways to survive, but it should also help create and maintain a diverse microbiome,” Ribbeck says.

Scientists, including Ribbeck, are also looking into the development of artificial mucus, which might be a new approach to fighting pathogens that does not involve traditional antibiotic drugs.