Tag Archives: outbreak

Anti-COVID-19 measures could lead to large, delayed outbreaks of other diseases if we don’t prepare

The COVID-19 pandemic is understandably the focus of medical personnel and institutions, but all other infectious diseases haven’t left. However, the non-pharmaceutical interventions (NPIs) imposed against the former have also greatly reduced the cases of the latter.

Image via Pixabay.

New research from Princeton University showcases how measures such as compulsory mask-wearing and social distancing have “greatly” reduced the incidence of all infectious diseases such as influenza and respiratory syncytial virus (RSV). However, the authors argue that we should avoid letting this decrease lull us into a false sense of security, as we may simply be seeing a postponement of future outbreaks.

Temporary protection

“Declines in case numbers of several respiratory pathogens have been observed recently in many global locations,” said first author Rachel Baker, an associate research scholar at the High Meadows Environmental Institute (HMEI) at Princeton University.

“While this reduction in cases could be interpreted as a positive side effect of COVID-19 prevention, the reality is much more complex. Our results suggest that susceptibility to these other diseases, such as RSV and flu, could increase while NPIs are in place, resulting in large outbreaks when they begin circulating again.”

The NPIs applied against the pandemic could lead to an increase in respiratory syncytial virus infections in the future, the team explains. RSV is a virus endemic to the United States and a leading cause of lower respiratory tract infections in infants. The same is true for influenza, they add, albeit to a lower extent.

The team used an epidemiological model based on historic RSV data, factoring in recent downward trends in RSV cases. They then used this model to assess the possible impact of COVID-19 NPIs on RSV outbreaks in the United States and Mexico in the future. All in all, they found that even relatively short periods of NPI measures such as mask use could promote large RSV outbreaks in the future.

Such outbreaks were typically delayed a bit after the end of the NPI use phase; according to the model, we should expect cases to peak around the winter of 2021-2022.

“It is very important to prepare for this possible future outbreak risk and to pay attention to the full gamut of infections impacted by COVID-19 NPIs,” Baker said.

Seasonal influenza would follow the same pattern in the future, but the authors caution that it is much harder to project its behavior in the future due to its habit of evolving rapidly. Here, the availability of vaccines would make “a big difference” says Baker.

Bryan Grenfell, the Kathryn Briger and Sarah Fenton Professor of Ecology and Evolutionary Biology and Public Affairs at HEMI and co-author of the paper calls the drop in influenza and RSV cases “arguably the broadest global impact of NPIs across a variety of human diseases that we’ve seen”. Other diseases could be impacted by these measures as well over the long term, and better understanding these mechanisms can help us stay safe after the pandemic.

Exactly how NPIs influence outbreaks of infectious diseases depends on how they’re implemented and lifted, but also on biological factors — most notably the public “landscape of immunity and susceptibility”. After the 1918 influenza pandemic, the team explains, measles in London shifted from annual cycles to biennial outbreaks after NPI measures were lifted. The authors recommend the use of tools such as serology to better map this susceptibility in order to prevent such life-threatening changes in the future.

The paper “The impact of COVID-19 non-pharmaceutical interventions on the future dynamics of endemic infections” has been published in the journal Proceedings of the National Academy of Sciences.

Only around 6% of coronavirus infections worldwide are detected so far, German researchers estimate

A new paper published by researchers at the University of Göttingen suggests that the official numbers of COVID-19 cases is underestimating the reality in the field — dramatically so.

State Public Health Laboratory in Exton Tests for COVID-19.
Image credits Governor Tom Wolf / Flickr.

According to the team’s model, only 6% of all infections with the SARS-CoV-2 virus have been detected worldwide, placing the real number of infections, potentially, in the tens of millions. The authors say that their findings should serve as a warning against relying too heavily on the reported number of cases for policymakers.

While definitely worrying, the results are based largely on reports from cases in the Wuhan province, China. As there are growing concerns that the country has misreported data pertaining to the COVID-19 epidemic to the wider world to appease its own political machinations, having “concealed the extent of the coronavirus outbreak [by] under-reporting both total cases and deaths it’s suffered from the disease,” the findings are best taken with a grain of salt. While the exact figures reported on in this paper may suffer due to the unreliability of data, the larger general trends identified in this paper may still be sound.

A drop in a bucket

“These results mean that governments and policy-makers need to exercise extreme caution when interpreting case numbers for planning purposes,” Sebastian Vollmer, Professor of Development Economics at the University of Göttingen and co-author of the report, explained in an article for the University.

“Such extreme differences in the amount and quality of testing carried out in different countries mean that official case records are largely uninformative and do not provide helpful information,” adds Dr. Christian Bommer, the report’s second author. “Major improvements in the ability of countries to detect new infections and contain the virus are urgently needed.”

The duo drew data from a recent study published in The Lancet Infectious Diseases journal which estimated the mortality rate of COVID-19 and the time until death — i.e. the time between contracting the virus and a patient’s death. Based on these figures, they developed a mathematical model to help them estimate the quality of official case records, giving them an idea of how many cases are likely detected out of the total number spreading through society.

All in all, official numbers “dramatically understate” the true number of infections, the two report.

The team believes that some European countries such as Spain and Italy are seeing much higher casualty rates from the virus than others, for example Germany, because they have only detected a smaller number of their overall infections — and this lack of data artificially makes the virus seem more deadly here. According to their estimates, Germany has detected around 15.6% of infections compared to only 3.5% in Italy and 1.7% in Spain. the United States and the United Kingdom — two countries that have received widespread criticism from public health experts for their delayed response to the pandemic — are looking at ever lower detection rates, of 1.6% and 1.2% respectively. On the other end of the spectrum are countries such as South Korea, which appears to have detected about half of all its SARS-CoV-2 infections.

If these results are true, it would mean that there are currently in excess of ten million infected in the United States, over five million in Spain, around three million in Italy, and around two million in the UK. In Germany, the team estimated that the number of infections is close to 460,000. On the same day this report was published (31st of March), there was a total of about only 900,000 confirmed cases worldwide.

How accurate the team’s estimates are hinges on how accurate the official data made available by Chinese authorities is, in turn. Regardless of this, the report is a good reminder that the official figures currently at our disposal aren’t the reality on the ground, they’re just the best attempt we currently have at gauging it. In the absence of mass testing, it’s simply impossible to know how many are truly infected. Until such measures become possible, the report aims to caution policymakers and healthcare experts on the limits of the data they work with.

The report “Average detection rate of SARS-CoV-2 infections is estimated around six percent” is available on the University of Göttingen’s page.

Working remotely in the age of the coronavirus

The coronavirus outbreak is pushing for some (long overdue) shifts in social habits. One of the more central ones is remote work — or working from home.

Image via Wikimedia.

We have the technology to ensure that workers in several fields don’t need to endure a commute any longer, but most companies have been reticent to do so.

Whether that’s a savvy business choice emphasizing human contact, or simply the rigidity of habit, I don’t know — but the COVID-19 outbreak, while definitely tragic and very damaging so far, is promoting workplace change. Remarkably, many tech companies are rising up to help employers and employees keep up the good work without ever having to get together.

We here at ZME Science also decided to do our part in fighting the spread of the virus. We’ve instituted a work-from-home model for the time being (to be reviewed weekly, fingers crossed).

While our profession is definitely very conducive to remote working, we still needed to find the right tools to allow everyone to coordinate and stay in touch — and today we’re going to show you some of the apps and platforms we’ve considered and picked for the task.

Whether you’re an employer or an employee, we hope this list will help you find the right tools for you and your team to stay safe. Avoiding the commute is just the cherry on top.

Communication (written): Slack

If you find Facebook too distracting (I do), emails too tedious (they are), and Whatsapp groups too brutish for company work (yep), have no fear — Slack is here.

Slack is an awesome way to keep in touch, especially for larger teams. It has all the functionality you’d expect from any chat system. Channels are easy to set up both for groups and between individuals, and you get quite a bit of storage for free (10,000 messages per channel, I’m told).

You can also benefit from several tools that make it handy for work, such as seamlessly setting tasks, assigning them to individual people, or indicating that they are done — although these are downloadable extensions. I also quite like the simple but elegant design of the interface. It’s a good tool and the free version works excellently for smaller teams (or even bigger ones, as long as you don’t need fancy tools).

And, with a name like Slack, there’s bound to be some slacking, so you can feel like you’re sticking it to the man — in a responsible manner for a few minutes every day. Andrei, the de-facto admin of our Slack server, set up a few fun custom responses (a task which he says is simple and doesn’t require any coding) and also added some Pokemon emojis to use — which, of course, is fitting for our team. It’s not perfect, but it gets the job done well.

“Slack is very easy to customize, though limited”, Andrei told me, unaware that he would be quoted. “You need extensions [for more advanced features] and extensions are free for limited members, with few features […] the free version also only saves 10,000 messages in a channel.”

As you can see, I definitely have the best nicknames.

Communication (voice): Discord

A mainstay of gamers everywhere, Discord is basically Skype-but-not-awful. If your job involves a lot of actually talking to your team, I do recommend you look to Discord over alternatives such as Facebook Messenger or Skype since it’s pretty straight-forward to use, runs on a lot of platforms and operating systems, has plenty of functionality to improve the flow of communication, and provides very good call quality for relatively low hardware usage. The free version is more than enough for the job.

Do bear in mind that Discord is optimized for gaming, not company work. You’ll see traditional gaming-related features such as chat overlays or real-time displaying of what games you’re playing (probably best if you don’t play on the job, then). However, one upside to this is that Discord has a very robust built-in streaming functionality that lets you share your screen to the channel without tanking your computer or mobile.

To me, the voice technology that Discord uses seems superior than any other service I’ve tried so far. At the end of the day, it’s a gaming-oriented voice-over-IP platform that’s robust and versatile enough to use on the job; that’s pretty impressive.

Time Tracking

We tend to run things a bit fast and loose here on the understanding that if one of us doesn’t do their jobs properly, we’re all out of a job, and that doesn’t pay rent. It works, partially because we all put our backs into it, partly because we’re a small team.

We’re the lucky ones, however, and most jobs do not provide that level of leeway. Since both parties need to benefit from shifting to remote work (or, at least, to not suffer because of it), we looked at Employee Time Tracking as a way for companies to make sure their workers aren’t slacking on the job.

The platform has several tools built-in to check whether the work is being done, by whom it’s being done, and when. In the end, we decided not to use such a system because it doesn’t really gel with how we do things, but this is one of the more convenient and feature-full ones we found. Toggl, our social media expert tells us, is also very good, but I’ve never really used it myself.

Speed-testing apps

Working remotely means working online, and without a solid internet connection, that’s going to be a very miserable experience for you.

Services like Ookla’s Speedtest.net or Netflix’s Fast.com let you get an accurate measurement of how good your connection is at any point in time, helping you decide which cafe to work in (don’t work in cafes during the outbreak please) or letting you show your employer why you’re not getting much work done if that’s the case. Not much else to say here.

Docs and files

If it ain’t broken, don’t fix it.

Dropbox is still one of the most convenient file-sharing services out there. I bet you’re all familiar with it already so no need to spill more ink over it. The free version allows 2 TB of individual sharing.

Google Drive, Google Docs, and Google Sheets are pretty much at the heart of our work. We use Sheets to keep everything organized and avoid having multiple people working on the same story accidentally. All our editing is done through Docs, and it also serves as our ersatz archive for articles, edits, and comments from our editors.

SelfControl

If you lack it, there’s an app for it.

I do lack it, but sadly enough, I also lack a mac, and it’s not yet available for any other operating system. However, I did have fancy friends with fancy Apple computers in college and they did recommend SelfControl and spoke quite highly of it.

Boiled down, it’s an app that you can use to block your own access to websites you deem too tempting or distracting. It works on a schedule, so it will dutifully keep you bored and focused on your job for an interval of time of your choice. Deleting the app or restarting your mac won’t re-allow access, either.

Hopefully, it will soon be expanded to other platforms for procrastinators everywhere to enjoy/dread.

More out there

These are just the ones we’re currently using, and may or may not be helpful to you, it all depends on what you do and how.

Thankfully, no matter what your job is, there’s an app somewhere that’s just perfect for the task. Techagainstcoronavirus.com has the most comprehensive list of them I’ve been able to find so far, although it does have some dubious listings such as Twitch — nothing wrong with it, but way too tempting for me.

Remote working has come a long way. There’s a discussion to be made about whether remote working can effectively substitute on-site working, but for now, at least, we should all be doing our part and practice social distancing in our work.

If you’re an employer, you might consider using some of these platforms and apps to keep your employees at home and do your little part in protecting them and society at large from the coronavirus. Both will earn you a lot of brownie points.

A compound against SARS shows promise against the COVID-19 virus

Commonalities between the coronavirus responsible for the current outbreak and the SARS virus could point the way towards a treatment option, a new paper reports.

Graphical abstract of the study.
Image credits Hoffman et al., (2020), Cell.

SARS (severe acute respiratory syndrome) was capturing headlines and causing panic around the world back in 2003. The virus responsible for SARS — SARS-CoV — is a coronavirus related to the current SARS-CoV-2 virus that is at the root of the current global outbreak. SARS eventually resulted in more than 8,000 cases and 800 deaths, but was contained through a combination of “surveillance, prompt isolation of patients, strict enforcement of quarantine of all contacts, and in some areas top-down enforcement of community quarantine,” according to a study (A. Wilder-Smith, J. Chiew, J. Lee, 2020) published last week in The Lancet.

“By interrupting all human-to-human transmission, SARS was effectively eradicated. By contrast, by Feb 28, 2020, within a matter of 2 months since the beginning of the outbreak of coronavirus disease 2019 (COVID-19), more than 82,000 confirmed cases of COVID-19 have been reported with more than 2,800 deaths,” the study adds.

“Although there are striking similarities between SARS and COVID-19, the differences in the virus characteristics will ultimately determine whether the same measures for SARS will also be successful for COVID-19.”

The “striking similarities” the authors note here may, however, point us to a viable treatment option for the COVID-19 disease caused by the SARS-CoV-2 virus.

Birds of a feather get shot together

Published in the journal Cell, the new study explains that structural similarities between the two viruses allow for a substance already approved for clinical use against SARS to engage the COVID-19 virus and that natural antibodies against SARS “may offer some protection” against the current outbreak.

“A TMPRSS2 inhibitor approved for clinical use blocked entry and might constitute a treatment option,” the authors explain. “Finally, we show that the sera from convalescent SARS patients cross-neutralized SARS-2-S-driven entry. Our results reveal important commonalities between [the two viruses] and identify a potential target for antiviral intervention.”

TMPRSS2, or transmembrane protease serine 2, is an enzyme (protein) in the serine protease family that “is associated with […] processes such as digestion, tissue remodeling, blood coagulation, fertility, inflammatory responses, tumor cell invasion, and apoptosis [cellular death],” according to Sciencedirect. According to the findings, the COVID-19 virus relies on this enzyme to reproduce (by multiplying its genes inside infected cells). The authors further report that the virus enters human cells by using ACE2 (angiotensin converting enzyme 2) receptors on its viral casing.

This process is the same one used by the SARS virus. A more exciting finding was that a TMPRSS2-inhibiting compound already approved for use against SARS successfully prevented the COVID-19 virus from infecting human cells. In addition, the team found that serum derived from the blood of former SARS patients — which contains natural antibodies against it — is “moderately effective” in protecting individuals from infection with the COVID-19 virus.

“Although confirmation with infectious virus is pending, our results indicate that neutralizing antibody responses raised against SARS-S could offer some protection against SARS-CoV-2 infection, which may have implications for outbreak control,” they explain.

While the findings are definitely encouraging, there are still unknowns left to sort out. For example, the higher infection rates seen in COVID-19 compared to SARS could mean that the new coronavirus is better able to bind to the ACE2 receptors in cells in the upper respiratory tract. More research is needed, and fast, to elucidate these issues, the team explains, but they are hopeful that their findings lay the groundwork for such efforts in the future.

The paper “SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor” has been published in the journal Cell.

Surprisingly few infants contracted the COVID-19 coronavirus

The coronavirus outbreak seems to be largely avoiding infants, according to a new study.

Image credits U.S. Army / Sgt. 1st Class Raymond Moore.

New research looking into the cases of infants admitted to Chinese hospitals with the coronavirus (COVID-19) reports that, between December 8 and February 6, only nine such cases were recorded. As of February 14th, over 63,000 cases of coronavirus infections were recorded in China, making the number of infant cases surprisingly small in comparison. As of last week, the virus tallied over 45,000 infections worldwide and led to the deaths of over 1,000 people.

Must be this old to ride

The infants in this study were 1 to 11 months old and were admitted to the hospital with fever, coughs, or other mild respiratory symptoms, the team explains. None of them suffered any subsequent complications from the virus. Given the disproportionately low number of infant infections recorded, the authors propose that they may be less susceptible to the virus or have a lower risk of being exposed. Alternatively, it could be the case that infants contract the virus just as easily as everyone else but only develop a mild case and don’t require medical supervision.

All of the infants identified had at least one infected family member and became sick after their relatives fell ill. However, another study showed that infected mothers do not pass the virus to their children before or during birth through cesarean section. Samples of amniotic fluid from these mothers, as well as throat swabs from the newborns, showed no sign of COVID-19. Umbilical cord blood and breast milk were also found to be free of the virus. However, the authors of the second study caution that all the participants were already in their third semester, so it remains possible that the virus can spread to a fetus in the earlier stages of the pregnancy. Similarly, they all gave birth by c-section, so it is unknown whether vaginal delivery also insulates the newborn from the virus.

SARS and MERS, two coronaviruses related to the current outbreak of COVID-19, also seemed to ‘avoid’ infants. They didn’t pass to the newborns during birth and few cases of infant infections were recorded in general.

The paper “Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China” has been published in the journal JAMA.

WHO officially declares coronavirus outbreak a global health emergency

The World Health Organization (WHO) declared a global health emergency on Thursday, Jan. 30 in light of the Wuhan coronavirus spreading from China to many other parts of the world.

Until very recently, the United Nations health organization had downplayed the seriousness of the threat posed by the Wuhan coronavirus. However, as an increasing number of cases surfaced across the globe, from Germany to the U.S., the WHO was forced to face the reality of the outbreak.

As of Jan 31, 2020, 1:40 pm EST, there are 9,776 confirmed cases worldwide of the Wuhan novel coronavirus, 213 deaths, and 187 recoveries. Follow the outbreak’s development in real-time using our China coronavirus outbreak map.

“Our greatest concern is the potential for the virus to spread to countries with weaker health systems,” WHO chief Tedros Adhanom Ghebreyesus told a briefing in Geneva.

“We must all act together now to limit further spread… We can only stop it together.”

Declaring a global health emergency gives the WHO the power to offer recommendations meant to curtail the spread of disease, such as travel restrictions.

At the moment, the coronavirus outbreak that originated in the Chinese city of Wuhan has spread to more than 15 other countries. Although the WHO has not recommended travel and trade restrictions with China, many countries have taken the initiative urging their citizens not to visit China until the situation stabilizes. Some, like Hong Kong, Nepal, and Mongolia, have closed their border entirely to mainland travelers.

In Singapore, all Chinese passport holders not residing in the island state will be barred from entering or transitioning through the republic. Israel barred all flights from China, while Russia said it was closing its far eastern border with China over the outbreak. North Korea has closed its borders entirely to all foreign tourists.

Globally, more than a dozen airlines, including United Airlines, have suspended routes to mainland China.

China itself has quarantined over a dozen cities and barred overseas travel by tour groups. The quarantined area in China covers 50 million people, including several thousand foreigners who are now trapped in Wuhan after it was sealed off last week.

On Wednesday, Japan and the U.S. became the first countries to airlift some of their citizens out of Wuhan. A second American flight is planned in the coming days. Similar operations are planned by the UK, France, Australia, and New Zealand, as soon as they get the okay that their citizens are cleared of any infection.

On the same day that the WHO declared a global health emergency, the outbreak claimed 38 new deaths — the highest one-day death count since the virus was detected in December 2019. All but one death were in the Hubei province of China.

Recent genetic studies suggest that the virus moved from bats to humans in a “wet market” in Wuhan, China. These markets sell food but also living animals alongside other products. Yesterday, Chinese authorities have declared a temporary ban on the trade of wild animals both in markets and online. Scientists at Britain’s Imperial College estimate that each coronavirus patient infects 2.6 people — which would make it about as contagious as the average influenza outbreak.

More from the editor:

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.

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.

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.

Measles outbreak.

After a 300% surge in global cases, WHO and UNICEF directors say we’re facing a ‘measles crisis’

The directors of the World Health Organization (WHO) and The United Nations Children’s Fund (UNICEF) are personally convinced — we’re facing a global measles crisis.

Measles outbreak.

Image credits Twitter Trends 2019 / Flickr.

Whether or not their respective agencies will issue an official warning is still under discussion. However, Henrietta Fore, the executive director of UNICEF, and Tedros Adhanom Ghebreyesus, the director general of WHO, issued a shared statement declaring their personal opinion that the world is beset by a measles crisis. The duo cite data showing a 300% overall increase in cases of this disease globally.

Less measles, please

“We are in the middle of a global measles crisis,” they together declared in a recent opinion piece for CNN.

By the time you finish reading this, we estimate that at least 40 people — most of them children — will be infected by this fast-moving, life-threatening disease.”

Measles is one of the most virulent diseases humanity has ever encountered. Before an effective vaccine was developed to guard us against the threat, it is estimated that virtually all children contracted this potentially-fatal disease by the time they turned 15.

So, you’ll be thrilled to know that measles is coming back in force around the world. In some areas, like Africa for example, measles cases have increased by a staggering 700% compared to 2018. The Democratic Republic of the Congo, Ethiopia, Georgia, Kazakhstan, Kyrgyzstan, Madagascar, Myanmar, Philippines, Sudan, Thailand, and Ukraine are currently in the throes of measles epidemics, they add.

Measles Trends.

Image via the CDC.

This data would certainly support the two’s opinion, especially when you factor in that the WHO estimates under 10% of all measles cases globally are reported. Even countries with high vaccination rates, like the US, Thailand, and Israel are seeing a surge in measles cases, likely due to localized gaps in vaccination coverage that impair herd immunity. With measles outbreaks in New York, Washington, California, and New Jersey, the United States has already counted more cases of this disease than all the 12 months of 2018 combined.

Fear of vaccines is at least part of the problem. Earlier this year, the WHO listed fear of vaccines as one of the most dire threats to public health in 2019. In areas like New York, whose recent measles outbreak has more to do with people refusing vaccines rather than a lack of access to them, vaccine fear is a leading cause of the disease’s spread.

“We welcome initial steps taken by digital companies such as Facebook, Amazon and YouTube to quarantine these vaccine myths,” Fore and Ghebreyesus write, “but it will take much more — not only from these online platforms but from governments, individuals and the health community — to make sure all children get their vaccines at the right time.”

It is estimated that measles vaccinations have saved some 20 million lives since the year 2000. The directors want to see vaccination efforts continue to bear fruit, but warn that unless we take a collective stand for science, health, and for vaccines, we will see many deaths caused by this disease in the near future.

An unofficial warning call has been issued. The only question now is: will we let it turn into an official, full-blown crisis?

Preliminary measles data for 2019 was published online by the World Health Organisation here.

Do not enter sign.

New York county declares state of emergency over measles and bans unvaccinated kids from public areas

New York’s Rockland County has declared a state of emergency this Tuesday. Officials also issued a directive barring unvaccinated children from all public spaces.

Do not enter sign.

Unvaccinated children will be banned from entering public spaces for the next 30 days.
Image credits Nicholas Jackson.

The outbreak began last October and has afflicted 153 people so far, mostly children. In a bid to prevent further infections, the county barred unvaccinated children from public spaces for 30 days, or until they receive their vaccines. Anti-vaccine parents tried to take the decision down in federal court but their case was dismissed.

State of emergency

“We must not allow this outbreak to continue indefinitely,” said County Executive Ed Day in a statement announcing the emergency declaration. “Every action we have taken since the beginning of this outbreak has been designed to maximize vaccinations and minimize exposures.”

“We are taking the next step in that endeavor today. We must do everything in our power to end this outbreak and protect the health of those who cannot be vaccinated for medical reasons and that of children too young to be vaccinated.”

Last September, a traveler arrived in Rockland from Israel, which is also struggling with outbreaks of the highly infectious virus. It has since spread through the local communities, particularly among the county’s insular Orthodox Jews, authorities note, and other groups with low average vaccination rates. Currently, Rockwell is one of six locations in America going through a measles outbreak.

Starting from midnight on Wednesday, March 27, anyone aged 18 or younger who has not been vaccinated against measles will not be allowed to access public spaces in Rockland for 30 days — or until they get the shot. In their directive, authorities define public spaces as areas where “more than 10 persons are intended to congregate for purposes such as civic, governmental, social, or religious functions, or for recreation or shopping, or for food or drink consumption, or awaiting transportation, or for daycare or educational purposes, or for medical treatment. A place of public assembly shall also include public transportation vehicles, including but not limited to, publicly or privately owned buses or trains.”

“We’re not punishing the people who are doing the right thing already and following the rules. We just want to encourage everyone to do the right thing so we can stop this outbreak,” said John Lyon, Rockland County Executive Ed Day’s director of strategic communications.
The step is “extremely unusual. [We] don’t believe it’s been done anywhere in the country before.”

So it’s pretty comprehensive. The prohibition was decided upon after county health officials announced six new exposure sites in Spring Valley and Monsey, including several supermarkets, public transport areas, and other social hotspots says USA Today. It also follows an order the county issued last December which barred unvaccinated children from schools in the 10952 and 10977 ZIP codes that were not at a minimum 95% vaccination rate. Taken together, the two are intended to stymie the spread of the measles virus by limiting potential exposure to those most at risk: the unvaccinated.

These measures didn’t go unchallenged. Earlier this month, ArsTechnica reports, anti-vaccination parents took the ban to court. It violated their religious freedom, they argued, as they had used religious exemptions to opt their children out of the standard vaccination programme. However, their case was denied, and the judge did not agree to issue a temporary injunction that would let the children return to school.

Personally, I think that was the right move on the part of the judge. Some of the parents, however, seem not to agree:

“As this outbreak has continued, our inspectors have begun to meet resistance from those they are trying to protect. They have been hung up on or told not to call again. They’ve been told ‘we’re not discussing this, do not come back,’ when visiting the homes of infected individuals as part of their investigations,” Day noted in his announcement.

“This type of response is unacceptable and irresponsible. It endangers the health and wellbeing of others and displays a shocking lack of responsibility and concern for others in our community.”

So far this year, the Centers for Disease Control and Prevention has confirmed 314 cases of measles across 15 states. This figure stood at 372 cases total in 2018 and 120 in 2017.

Day said the timing of this ban was meant to coincide with family gatherings during the upcoming holidays of Passover and Easter. Noncompliance will incur penalties of six months in jail or a $500 fine, although law enforcement will not be deployed at any location seeking proof of vaccination, Day adds.

 

Credit: Wikimedia Commons.

Norovirus spread in a Thanksgiving feast

 

Credit: Wikimedia Commons.

Credit: Wikimedia Commons.

Thanksgiving, or Thanksgiving Day, is a public holiday celebrated on the fourth Thursday of November in the United States. The holiday is the perfect opportunity to catch up with friends and family, eat some turkey and indulge in some pumpkin pie before the Christmas season. But Thanksgiving does not always go as planned especially if you get sick with the flu or gastroenteritis (sometimes called “stomach flu”) or food poisoning. Any of these common illnesses can put a quick end to Thanksgiving festivities.

A study looking into 18 gastrointestinal illness complaints in people who ate Thanksgiving Day dinner at a restaurant in Tennessee in 2017 found that contamination happened after one customer vomited in a private dining room and an employee used disinfectant spray (labeled as effective against norovirus) to clean the area. The employee then, after washing hands, served family-style platters of food and cut pecan pie. The investigation by the US Centers for Disease Control and Prevention (CDC), Vanderbilt University Medical Center, and Tennessee Department of Health was published in the latest issue of Morbidity and Mortality Weekly Report (MMWR).

The restaurant served 676 people that day but health officials were provided with contact, seating time and location information for over 100 customers who had reservations. Subsequently, health officials were able to enroll 137 (20% of the 676) in a case-control study. Stool specimens confirmed norovirus in two patients as well as in an environmental sample collected from the underside of a table leg near where the customer vomited. Of the foods that customers ate, only pecan pie was significantly associated with illnesses, but only 16 of 34 patients had eaten it.

The investigators concluded that norovirus probably spread through the restaurant by multiple routes and that inadequate employee hand washing probably facilitated foodborne transmission through servings of pecan pie. The point-source norovirus outbreak occurred after the infected customer vomited, transmission near the vomiting event likely occurred by aerosol or fomite. Norovirus spread throughout the restaurant could have occurred by aerosol, person-to-person, fomite, or foodborne routes.

According to the CDC, norovirus is responsible for 58% of foodborne illnesses in the US. In recent years, the majority of foodborne norovirus outbreaks occurred in restaurants, often related to an infected employee practicing poor hand hygiene and subsequently serving food. Norovirus cannot be completely inactivated by many common sanitizers and disinfectants used at manufacturer recommended concentrations or contact times. Norovirus infection can recur even after thorough cleaning and disinfection. Every year, foodborne norovirus illness costs about $2 billion, mainly due to lost productivity and healthcare expenses in the United States.

Norovirus.

Norovirus outbreak strikes in Maine, but it’s likely under control

Roughly a hundred people have been infected by a highly contagious norovirus in Maine, the CDC reports.

Norovirus.

Norovirus.
Image credits CDC.

On Friday, the Maine Center for Disease Control and Prevention reported identifying 97 cases associated with a norovirus outbreak. The source seems to be the Woods Pond Beach, according to Bridgton Town Manager Bob Peabody, as all infectees either swam there or came into contact with someone who did.

These individuals reported experiencing symptoms such as vomiting, diarrhea, fever, and cramps over several days. The symptoms generally lasted a few days. Authorities in the town of Bridgeton closed down the beach on July 6th, following the first reported infections, to identify and deal with the source of the infections.

Norovirus causes gastrointestinal disease and can spread in a multitude of ways. You can contract the virus by eating contaminated food, touching an infected surface and then touching your mouth, or by having contact with someone who is infected. It’s especially virulent in areas where large numbers of people share limited space — such as hospitals, schools, or more famously, at the Winter Olympics in Korea. In the Maine outbreak, beachgoers who put their heads under water or swallowed water while swimming were at greater risk of infection, but several people who were not at the beach also caught got sick after caring for someone who was ill.

“It’s highly contagious, so it would appear that there’s a human element there, that somebody had it and was at the beach,” Peabody told the Portland Press Herald. “I think the message is, if you’re sick or your children are sick, don’t go to the beach.”

Water samples taken on July 9th from the pond and the sinks in a public bathroom on the beach were tested for E. coli — the results showing that the swimming water contained safe levels of the bacteria. However, water from the taps was found to be above the safe limit. The sinks themselves were removed and hand sanitizers were installed as an extra precaution before the beach was re-opened for public access on July 10th.

Hot weather generally makes dipping spots much more prone to contamination, as a large number of people hit the beaches to cool off. A single carrier can infest the water (bacteria such as norovirus can be spread by infected individuals vomiting in the water, for example), and bacteria have a much easier time thriving in hot waters.

“We’re seeing the effects of climate change and temperature on lakes,” said Colin Holme, executive director of the Lakes Environmental Association, explained for the Portland Press Herald. “These problems could be more frequent in the future because the temperature is going to rise and people are going to seek the water in relief.”

Authorities recommend that beachgoers wash their hands and practice good hygiene both before and after taking a dip. If you’re going to the beach with an infant, you should change their swim diapers frequently, preferably in a bathroom away from the water, and dispose of them in a trash container. Swimmers, in general, should also avoid swallowing water.

Ebola virus.

Congo’s Ebola outbreak is likely over, official confirmation to come in 21 days

The devastating Ebola outbreak in the Democratic Republic of the Congo (DRC) is probably over, health officials report.

Ebola virus.

Scanning electron micrograph of Ebola virus budding from the surface of a Vero cell (African green monkey kidney epithelial cell line).
Image and captions credits to NIAID / Flickr.

On May 8, 2018, the Democratic Republic of Congo’s health minister declared an outbreak of Ebola. The highly deadly disease had killed over 11,000 people in West Africa between 2014 and 2016, so everybody was, understandably, Not Very Excited. However, I’m sure everyone will be jubilating for this tidbit: the outbreak in Congo is almost assuredly over.

Ebo-naaaah

The outbreak in DRC was the most severe since the 2014-2016 event, but it’s probably over. As of Wednesday, all individuals who came into contact with the last-confirmed infectee have passed the 21-day incubation period of Ebola without showing any signs of infection themselves. Because of this, health officials don’t need to monitor anyone on a daily basis. However, they want to be extra-safe — so they will keep monitoring the situation for another three weeks before officially declaring the outbreak over.

A total of 38 cases were confirmed during the outbreak and 14 deaths. A further 15 deaths may be tied to the outbreak, but the link can’t be confirmed as of yet. All suspected cases over the past three weeks have turned out to be negative.

Before the outbreak can be officially declared over, two incubation periods (42 days) must pass without any new confirmed case.

The outbreak was first declared on May 8, as a cluster of cases was confirmed in the deep rainforests of DRC’s Equateur province. The virus made its way to Mbandaka — a city of 1.2 million and an important local transport hub along the Congo and Ruki rivers, both heavily navigated — three weeks after the first cases were confirmed.

Although Ebola is endemic to Congo’s jungles — so health officials here are world-leading experts in containing the virus —  it was a nerve-wracking time for health officials, as Ebola is very hard to contain in densely populated areas. The possibility of it spreading down the two rivers further complicated containment efforts.

“This outbreak has been the most challenging and complex outbreak the country has ever had to face, mainly because it started in two rural zones at the same time and quickly reached a city of more than 1 million inhabitants directly connected to Kinshasa, our capital city where 12 million Congolese live,” DRC’s minister of health, Oly Ilunga, told The Washington Post.

“Yet thanks to a rapid national and international mobilization as well as a great government-led coordination of the response, we managed to contain this outbreak in just seven weeks.”

The minister further explained that authorities tracked and monitored over 1,706 people confirmed or suspected to have contacted infected individuals. The process (known as ‘contact tracing’) required authorities to establish a vast surveillance network to track people’s movements from town to town and report any cases of fever that could be Ebola.

In this particular outbreak, however, tracing teams also worked to identify candidates for an experimental Ebola vaccine that had only been used once before, in the waning days of the West African epidemic. Over 3,300 people were ultimately administered the vaccine. Ilunga considers the vaccine nothing short of a “game-changer.”

The news certainly calls for celebration — but they are far from a definite end to the disease.

“As Ebola is a virus whose natural reservoir is located in the Equatorial Forest, we must prepare ourselves for the 10th Ebola outbreak,” said Ilunga.

“Moreover, with the greater mobility of the population, we can expect to have other outbreaks in urban zones in the future. We must learn the lessons from this response and strengthen our system in order to detect and respond even more efficiently to the next outbreak.”

Oysters, Olympics, Ocean liners and Outbreaks

oysters

Credit: Pixabay

The US Food and Drug Administration (FDA), federal and state health authorities, along with Canadian public health officials, are investigating multi-province and multi-state norovirus outbreaks linked to raw oysters from British Columbia. Currently, there is no word on how many illnesses and states are involved in the US part of the outbreak; however, potentially contaminated raw oysters harvested in the south and central parts of Baynes Sound, British Columbia, Canada, were distributed to California, Illinois, Massachusetts, New York, and Washington. It is possible that additional states received these oysters either directly from Canada or through further distribution within the U.S.

According to the Public Health Agency of Canada (PHAC), 172 cases so far have been reported in three provinces — British Columbia, Alberta, and Ontario. The US Centers for Disease Control and Prevention (CDC) said contaminated oysters and other shellfish are common causes of norovirus outbreaks and therefore, it recommends cooking oysters and other shellfish thoroughly (to 145°F or higher) before eating.

Norovirus is the most common cause of acute gastroenteritis (AGE), resulting in roughly 1 in 5 cases worldwide, across all settings and age groups — it’s well-known for causing outbreaks where people share close quarters, such as during conventions, at the Olympics, and on cruise ships.

The virus was a prominent headliner at the recently concluded Winter Olympics in Pyeong Chang, South Korea. Last year at the World Athletics Championships in London, the virus rapidly spread through one hotel, and several athletes withdrew from events after suffering symptoms including vomiting. Norovirus is the same bug that caused hundreds of illnesses at Chipotle restaurants in 2015 and 2017. In 2017, the CDC recorded nine norovirus outbreaks on cruise ships that affected hundreds of people.

Norovirus causes 19 to 21 million illnesses, 400,000 emergency room visits, and 570 to 800 deaths, mostly in young children and the elderly, each year in the United States alone. Norovirus kills over 200,000 annually and can be a significant economic drain to societies where outbreaks of the virus are frequent. Globally, it is estimated to cost approximately $4.2 billion in health care costs and over $60 billion in societal costs. According to the US Department of Agriculture, which monitors foodborne illnesses, norovirus is five times as deadly and eight times as costly as the E. coli virus. These cost estimates are conservative as many norovirus cases go unreported. In contrast, rotavirus, a diarrheal disease that kills babies but rarely endangers patients over the age of five, was estimated to cost $2 billion annually before a vaccine was made.

Norovirus sheds from the feces of infected people and animals, and just 10 viral particles are enough to cause an infection. Norovirus can cling to hard surfaces and people can become sick from eating contaminated food or drinking contaminated water. The virus affects members from all age groups and is usually characterized by inflammation of the stomach, diarrhea, and vomiting. There are different methods to treat the infection and correct diagnosis will, in most cases, lead to a full recovery. However, despite the majority of people recovering after a few days of discomfort, the virus has the potential to be highly fatal, especially to young children and the elderly.

There is currently no specific medication or vaccine for norovirus infection, although several vaccine strategies, mostly using virus-like particle antigens (VLPs), are in development and have shown proof of efficacy, the most advanced being the adjuvanted bivalent intramuscular norovirus virus-like particle (VLP) vaccine. Without a vaccine, the single best way to avoid infection is to practice good handwashing habits, especially after using the restroom and before eating. Rigorous handwashing before eating or touching the face could theoretically reduce the size of the outbreak by 100 percent

The United States slides towards measles epidemics (again) because people don’t vaccinate

Non-medical vaccination exemptions and wide misinformation on their efficiency are pulling America back into endemic measles outbreaks, a paper reports.

Back of female with measles.

Back of female with measles.
Image credits Wellcome Trust.

The US took great pains (in the form of strict, nationwide vaccination campaigns) to eliminate measles back in 2000. Luckily, these efforts proved fruitful. Outbreaks did spring up here and there, mostly from people who travel to and from other countries, but they numbered a few dozens, upwards to a few hundred cases yearly. Which is a really small number. Overall, however, the measles virus was considered to no longer be endemic (present in the country) since the turn of the millennia.

But rejoice not! The US is slowly inching back to pre-2000 days, when the measles virus roamed free and deadly, researchers from the Stanford and Baylor College of Medicine warn. At the heart of the issue are non-medical vaccine exemptions and non-medical delays, coupled with wide public misinformation about vaccines.

A high toll

The two researchers, Nathan Lo, Bs. and Dr. Peter Hotez, MD., PhD., report that a 5% decrease in measles-mumps-and-rubella (MMR) vaccination rates among kids aged 2-11 would triple measles cases in the age group and end up draining the public health system some $2.1 million in additional costs. But wait, it gets even better/worse — ages 2-11 make up only about a third of measles cases in current outbreaks, but it was the only age interval the researchers had sufficient data to work with. They fully expect those numbers to become much higher once enough data to model “social mixing and immunization status of adults, teens, and infants under two” becomes available.

“The results of our study find substantial public health and economic consequences with even minor reductions in MMR coverage due to vaccine hesitancy and directly confront the notion that measles is no longer a threat in the United States,” they write.

The duo says they conducted this study out of concern for growing vaccine hesitancy and use of non-medical exemptions — both largely driven by shoddy data or outright lies pertaining to the safety of vaccines, and the downplaying of just how dangerous these diseases can be.

And measles is up there on the dangerous scale. The virus is ridiculously infectious, and can keep on floating in the air hours after a carrier coughed or sneezed. Those infected develop high fevers, skin rashes, inflamed eyes, and flu-like coughs and runny nose. About 30% of cases also come with highly desirable complications such as pneumonia, brain swelling, even blindness. While this does make it really simple to spot someone sick so you can stay away, carriers can spread the virus days before symptoms pop up.

Get your kid vaccinated!

So if the Eyeball Mk.1 we all come pre-equipped with can’t spot the danger, what do we do to stay safe? Well, we immunize the herd. So to speak. Basically, the idea behind herd immunity is to make such a large proportion of the population (around 90 to 95% of everybody) immune to the virus that it simply won’t be able to spread around effectively. There aren’t enough viable carriers to take spread it around.

It’s an all for one and one-starts-an-epidemic scenario. If immunity levels drop below that percentage, a single infected individual has a much higher chance of starting an outbreak — which, in turn, will have a much easier time infecting huge numbers of people. The bad news is that in many areas of the US, immunity levels are just shy of falling below that range, and vaccination rates still keep going down. Some 18 states allow parents to forego vaccination on the ground of personal beliefs, and almost all (except Mississippi and West Virginia) allow for religious and/or philosophical exceptions, according to the NCLS.

So, to get a feel for what these exceptions will do in the long run, the duo mathematically modeled the way measles spreads based on the virus’ known behavior, data on current vaccination rates from the CDC, and the “social mixing patterns” of kids aged 2-11. To get a rough estimate of the costs these outbreaks will take on the health system, they factored in stuff like medical staff wages, the cost of laboratory analyses, and money spent on outbreak surveillance. Each measles case, they estimate, costs about $20,000.

They then checked and calibrated their model based on data from past measles outbreaks from the US and UK. After they made sure their model works, they pushed up the vaccine exemption rate from 1% to 8% to see what would happen. Unsurprisingly, larger the exemption rates led to more cases and bigger outbreaks. Eliminating the exemptions however would take MMR coverage in the US to 95%, a very comfy percentage when talking about herd immunity.

In other words, when you chose not to vaccinate your kid, you’re putting both his health and that of others at risk. Stop believing what stupid stuff people say, believe, or write on shady websites over what your physician spent years learning in med school.

And most importantly, vaccinate your kids!

JAMA Pediatrics, 2017. DOI:10.1001/jamapediatrics.2017.1695 (About DOIs).

The paper “Public Health and Economic Consequences of Vaccine Hesitancy for Measles in the United States” has been published in the journal JAMA Pediatrics.

New study shows how Zika might re-emerge and strike the United States

Brazilian officials have just declared the end of the Zika pandemic, but we aren’t rid of that problem yet.

There’s a year-round community of mosquitoes around Miami which can help propagate Zika in and through the US. Image credits: Smallbones.

Researchers are preparing themselves for a potential new wave of Zika outbreaks so that this time, the diseases doesn’t catch us by surprise. A new study conducted by researchers from The Scripps Research Institute (TSRI) showed how the virus entered the United States several times and might do the same once more.

They basically sequenced the virus’ genome at several points during the pandemic, to create a family tree and understand how it spread. This is a state-of-the-art technique, which only recently became possible.

“Without these genomes, we wouldn’t be able to reconstruct the history of how the virus moved around,” said TSRI infectious disease researcher and senior author of the study, Kristian G. Andersen, who also serves as director of infectious disease genomics at the Scripps Translational Science Institute (STSI). “Rapid viral genome sequencing during ongoing outbreaks is a new development that has only been made possible over the last couple of years.”

He and his colleagues learned that Zika was transmitted through Florida at least four (and up to forty) times, which is worrying but can also help researchers better prepare in the future. This likely happened due to the environment around Miami, which is suitable for Aedes aegypti mosquitoes, the main species that transmits Zika virus. In fact, Miami hosts year-round populations of this mosquito, and it is also a major international hub, bringing in more international traffic than any other city in the US. So you have two things you don’t really want together, and that’s how you could end up with Zika in the US.

But researchers also show how to fight this possibility: eliminate the mosquitoes.

“We show that if you decrease the mosquito population in an area, the number of Zika infections goes down proportionally,” said Andersen. “This means we can significantly limit the risk of Zika virus by focusing on mosquito control. This is not too surprising, but it’s important to show that there is an almost perfect correlation between the number of mosquitoes and the number of human infections.”

It’s not clear how Zika will evolve in the future, or what its consequences will be. After all, until recently, we didn’t even know how bad it can be, but one thing’s for sure: we’ve clearly underestimated this disease. Scientists aren’t idling, and they’re understanding Zika more and more. Hopefully, policymakers will heed their call and start preparations before a new pandemic gets underway.

Journal Reference: Nathan D. Grubaugh et al — Genomic epidemiology reveals multiple introductions of Zika virus into the United States. Naturedoi:10.1038/nature22400

ebola virus artistic depiction

World Health Organization confirms second Ebola case in new outbreak

The World Health Organization (WHO) confirmed a second Ebola case on Sunday, in the Democratic Republic of Congo — with many other cases remaining uncertain.

ebola virus artistic depiction

A 3D medical animation still of Ebola Virus. Image credits: Scientific Animations.

Health officials are trying to find 125 people who have been linked to the 19 suspected or already confirmed cases. Three people from the 19 have already lost their lives, and the there is a growing concern that more unreported cases still exist. It’s unclear how the first victim contacted the disease, though the WHO says past outbreaks have usually been linked with infected bush meat such as apes.

Last year, the Ebola outbreak killed more than 11,300 people, most of them in Guinea, Sierra Leone and Liberia. Congo, however, has had a different experience with the disease. Despite the fact that it was first detected there in 1976, Congo has had several smaller outbreaks but was relatively successful at containing them, avoiding massive loss of life. This is the 8th outbreak to ever hit the country, more than any other country in the world.

“Our country must confront an outbreak of the Ebola virus that constitutes a public health crisis of international significance,” the ministry said in a statement. “Our country is full of people well-trained in this matter and our health professionals also helped contain similar epidemics in other countries,” it added.

Still, this doesn’t mean that Congo is safe from large-scale outbreaks or that there’s no need to worry about the disease spreading to other countries. Treatment options are limited in Congo and neighboring areas. However, the WHO has an agreement with a drug developer which created an Ebola vaccine. They are now working to establish if deploying the vaccine is warranted.

“There are 300,000 doses of Ebola vaccine available if needed to stop this outbreak becoming a pandemic,” said GAVI’s chief executive Seth Berkley. “The vaccine has shown high efficacy in clinical trials and could play a vital role in protecting the most vulnerable.”

Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe disease, often fatal in humans (with a survival rate of about 50%). The virus can be transmitted from wild animals to humans (which is how outbreaks generally start), but also from human to human. Limiting the expanse of the disease in wild animals would also help prevent future human outbreaks. Professional help is almost always required for disease containment, but even simple measures such as rehydration, basic hygiene, and symptomatic treatment can significantly improve survival rate. At the moment, there is no licensed treatment to eliminate the virus, though several studies are reporting progress.

1962 vaccine breakthrough prevented 4.5 billion cases of polio, measles, rabies, hepatitis A, and many others

Despite what some quackery claims, vaccines save lives — lots of them. Leonard Hayflick of the University of California, San Francisco, who isolated a cell strain used in vaccines, wanted to see how many lives he helped save. The figures are truly impressive.

Prevented 4.5 billion cases of disease and saved more than 10 million lives

This man and his colleagues saved millions of lives. But you’ve probably never heard of him. S. Jay Olshansky, professor of epidemiology in the UIC School of Public Health. Image credits: UIC.

In 1963, vaccination against polio, measles, mumps, rubella, varicella, adenovirus, rabies and hepatitis A became more common thanks to a new cell culture line. Before that, vaccine cultures were very difficult to grow. Scientists tried using monkeys, but there was a great risk of infection with other monkey viruses, so this approach was dropped, leaving people without vaccines and highly vulnerable to infections. This all changed in 1962 when Hayflick and Paul Moorhead isolated a cell culture line called WI-38. WI-38 was invaluable to the day’s researchers, especially those studying virology and immunology since it was a readily-available cell line of normal human tissue which could be used to develop vaccines.

Thanks to it, vaccination became much more common after 1963. With the emergence of vaccines, the incidence of polio was reduced by 99.9% and some regions of the world have been certified polio-free. Vaccines relying on the cell strain helped combat a number of other diseases. Hayflick wanted to see just how much of a difference he’d made, so he approached Jay Olshansky, professor of epidemiology and biostatistics at the University of Illinois at Chicago School of Public Health.

“Given the acknowledged large, positive global health impact of vaccines in general, I was curious what contribution my discovery of WI-38 in 1962 had in saving lives and reducing morbidity, since a large number of viral vaccines in use today are made with my cell strain or its derivatives,” Hayflick said.

Cell Culture in a tiny Petri dish. Image credits: Wiki Commons.

Together, they analyzed the number of cases of disease and deaths prevented by vaccines developed using WI-38, as described in studies published from 1960 to 2015. They assumed the prevalence rate would have been similar and considered when vaccines were introduced in different parts of the world. Their conclusions? Vaccines based on the WI-38 strain prevented over 4.5 billion disease cases worldwide, 200 million in the US alone. This ended up saving 10 million people.

Anti-vaxxing threatens the next generation

It’s truly baffling that despite all this, some groups are still trying to combat vaccines. Anti-vaccination (usually abbreviated as anti-vaxxing) is a fringe trend that’s becoming dangerously powerful, threatening to undo decades of scientific progress — as well as the health of the next generation.

“Vaccination is a particularly important issue to think about now, given the rise of an anti-vaccine movement that has the potential to reverse the health gains achieved through one of the most powerful interventions in medical history,” Hayflick said. “The anti-vaccination movement endangers the health of an entire generation of children.”

In this cartoon called The Cow-Pock—or—the Wonderful Effects of the New Inoculation, the British satirist James Gillray caricatured a scene at the Smallpox and Inoculation Hospital at St. Pancras, showing cowpox vaccine being administered to frightened young women, and cows emerging from different parts of people’s bodies. The cartoon was inspired by the controversy over inoculating against the dreaded disease, smallpox. Opponents of vaccination had depicted cases of vaccinees developing bovine features and this is picked up and exaggerated by Gillray. Quite reminiscent of the anti-vaxxing movement.

Researchers stress that measles outbreaks like the ones in California from 2014 and 2015 were, at least in part, caused by anti-vaxxing. Basically, they explain, when a minority refuses to vaccinate their children, they don’t only risk their health — but also the health of many other people.

“The reduced number of children being vaccinated in the U.S. isn’t just a problem for those children,” said Olshansky. “It’s a problem for the country because it lowers herd immunity.”

Vaccines can prevent outbreaks of disease and save lives, not only by protecting vaccinated people but also by preventing the spread of diseases. The so-called herd immunity is achieved when almost everyone from a community is vaccinated. Even if a minority can and does contract the disease, it can’t really spread because there’s nowhere to spread — everyone else is vaccinated. But if that minority starts growing, then it offers a lot of wiggle room for the disease, and this is exactly what’s happening now in the US. Studies have shown that vaccination rates for measles, mumps, and rubella in the U.S. are now as low as 50 to 86 percent. If anti-vaxxing develops even more, we’ll see more and more outbreaks.

“If the anti-vaccination movement gains any additional traction, developed and developing nations will have taken a dangerous step backward in protecting public health, especially of children,” Hayflick said.

The ultimate irony

“It is ironic that in the anti-vaccination community, the very people who are denying protection to their children by foregoing vaccination are healthy and alive today because they, and possibly their parents, were vaccinated,” Olshansky said.

Vaccines help kill diseases. Rubella incidence in USA 1966-93 from CDC summary morbidity report. Image via CDC.

It’s even more ironic that the entire anti-vaxxing movement started gaining traction from one single study published in 1998 — which has since been shown to be fraudulent and misleading. Richard Horton, at the time editor of the journal in which the study was published (The Lancet) publicly describing Wakefield’s research as “fatally flawed”. A retraction was issued, with ten of the authors of that study declaring:

“We wish to make it clear that in this paper no causal link was established between (the) vaccine and autism, as the data were insufficient.”

Yet anti-vaxxing thrives. Billions of prevented diseases, millions of saved lives, and people want to just throw that away. The Lancet, which is one of the world’s most prestigious medical journals, published a paper which called anti-vaxxing a “privilege of the fortunate.” Basically, vaccines were so successful that people have forgotten how threatening outbreaks can be and are considering giving them up.

“As often happens, vaccination would soon become the first victim of its own success; with measles gone from high-income countries, the fear of measles disease waned from the collective memory of a new generation of parents who were fortunate enough to have been vaccinated as children. The mild side-effects of the vaccine, such as fever or pain, are now perceived by some people as a greater disturbance than the disease itself.”

This is why I think this paper is so crucial — because it shows just how much vaccines have done for mankind. The developed world is now enjoying a golden age in terms of resistance to outbreaks, why backtrack on that, when there’s still work to do? An estimated 1.4 million children under 5 worldwide still die each year due to lack of access to vaccines, yet the world’s privileged want to give them up. It’s an irony which has every chance of becoming a catastrophe.

Journal Reference: S. J. Olshansky, L. Hayflick — The Role of the WI-38 Cell Strain in Saving Lives and Reducing Morbidity. doi: 10.3934/publichealth.2017.2.127

Zika articles made open-source to accelerate research

Nature, the Lancet and many other medical publishers and researchers have announced that all Zika-related scientific articles will be published freely in the wake of the recent outbreak.

“We announce that Nature journals will make all papers relating to Zika virus free to access until further notice,” a statement reads. “Nature journals will also now encourage authors who haven’t already deposited their relevant sequence information in public archives to do so on submission to help drive the shift towards fast data sharing during public-health emergencies.”

The seemingly benign Zika virus that seemed to only cause mild symptoms turned out to be not so benign after all. Thousands of pregnant women infected with the virus gave birth to babies suffering from drastic abnormalities, especially microcephaly – a congenital condition associated with incomplete brain development. The outbreak has reached pandemic levels in South America and threatens to spread more and further.

The thing is, we don’t know why or how Zika causes these conditions, nor any other potential effects; there is also no vaccine.

In order to hasten the process of developing methods of prevention and treatment, facilitating research is paramount, but unfortunately, scientific information is not always free. Access to journals can be really expensive, especially when you only want to access to a few very specific articles. In the face of crisis (at the very least), this information should flow freely.

“The arguments for sharing data, and the consequences of not doing so, have been thrown into stark relief by the Ebola and Zika outbreaks,” the statement continues.

“In the context of a public health emergency of international concern, there is an imperative on all parties to make any information available that might have value in combatting the crisis.”

The signatories will make all content concerning the Zika virus free to access (print and online) and encourage publishers to share any significant results as soon as possible.

Signatories to the Statement:

Academy of Medical Sciences, UK

Bill and Melinda Gates Foundation

Biotechnology and Biological Sciences Research Council (BBSRC)

Bulletin of the World Health Organization

Canadian Institutes of Health Research

The Centers for Disease Control and Prevention

Chinese Academy of Sciences

Chinese Centre for Disease Control and Prevention

The Department of Biotechnology, Government of India

The Department for International Development (DFID)

Deutsche Forschungsgemeinschaft (DFG)

eLife

F1000

Foundation Meriuex

Fundação Oswaldo Cruz (Fiocruz)

The Institut Pasteur

Japan Agency for Medical Research and Development (AMED)

The JAMA Network

The Lancet

Médecins Sans Frontières/Doctors Without Borders  (MSF)

National Academy of Medicine

National Institutes of Health, USA

National Science Foundation

The New England Journal of Medicine (NEJM)

PLOS

Science Journals

South African Medical Research Council

Springer Nature

UK Medical Research Council

Wellcome Trust

ZonMw – The Netherlands Organisation for Health Research and Development