General Pandemic Information and News

As our investigative methods become more precise, and more data is acquired and analyzed, we occasionally find that long held scientific beliefs need to be questioned - and sometimes revised.
> >Over the past two decades, we've looked at many examples
> >in the infectious disease world where new evidence has forced
> >conventional wisdom to change.
A few recent examples include:

• Prior to 2003 and the outbreak and spread of SARS,  coronaviruses were thought to be relatively mild in humans, and incapable of causing a pandemic.  Since then, between the emergence of MERS-CoV in the Middle East, and the discovery of other virulent coronaviruses in bats, that perception has changed.
  
• Until the West African outbreak 4 years ago, Ebola was thought simply too debilitating, too lethal, and too remote to spread efficiently. Those infected were considered `too sick to travel’, and small outbreaks would inevitably `burn themselves out’ in relatively short order.
  
• Until a couple of years ago, many scientists were still questioning the role of migratory birds in the spread of Highly Pathogenic Avian Influenza (HPAI) viruses.  After the 2016/2017 European epizootic and H5N8's spread into the Middle East & Africa, that debate has about ended (see
  
• Migratory Birds & The Spread Of Highly Pathogenic Avian Flu).
  
• The 2016 Zika epidemic in the Americas taught us that mosquito borne viruses - like Zika - can not only cause birth defects (see NEJM: CDC Concludes Zika Causes Microcephaly & Other Birth Defects, they can be sexually transmitted as well.  Neither of which were considered serious threats before.
  
• Despite years of assurances that `Legionellosis does not spread person to person', in 2016 in NEJM: Probable Person-to-Person Transmission Of Legionnaires’ Disease, we saw an epidemiological investigation following the 2014 outbreak in Portugal that strongly suggests that - while very rare - it is possible.
  

TRex2 wrote:

(I am still learning how to format on this forum,
so forgive the roughness)

Three months ago, in CDC: The 8 Zoonotic Diseases Of Most Concern In The United States, we looked at a joint CDC, USDA, DOI report on the top (n=56) zoonotic diseases of national concern for the United States. Of these 56 diseases examined, 8 were selected as being of particular concern in the United States.

The zoonotic diseases of most concern in the U.S. are:
Zoonotic influenza
Salmonellosis
West Nile virus
Plague
Emerging coronaviruses (e.g., severe acute respiratory syndrome and Middle East respiratory syndrome)
Rabies
Brucellosis
Lyme disease

While zoonotic (i.e., swine, avian, etc.) influenza tops the list - due to its potential impact - coming in second place is Salmonellosis, which the CDC estimates causes about 1.2 million illnesses, 23,000 hospitalizations, and 450 deaths in the United States every year.

The largest of the outbreaks involves backyard poultry, and was updated on Jul 19th.
Outbreaks of Salmonella Infections Linked to Backyard Poultry

Since the last update on June 13, 2019, illnesses in an additional 489 people and eight states have been added to this investigation. Five additional Salmonella serotypes have also been added.
A total of 768 people infected with the outbreak strains of Salmonella have been reported from 48 states.
122 (29%) people have been hospitalized and two deaths have been reported, one from Texas and one from Ohio.
156 (24%) illnesses occurred among children younger than 5 years.
Epidemiologic and laboratory evidence indicate that contact with backyard poultry, such as chicks and ducklings, from multiple hatcheries are the likely source of these outbreaks.

Ten years ago this week (Aug. 11th, 2009), a woman in Rochester, New York - who had recently returned from the Florida Keys - visited her doctor complaining of headache, malaise, and chills.  
Although initially diagnosed and treated for a presumptive urinary tract infection, after her symptoms worsened an infectious disease specialist decided to test her for a disease not seen in the state of Florida in nearly 70 years; Dengue Fever.
She became the first (of more than 2 dozen) Dengue patients identified in and around Key West in the fall of 2009 (see 2010 MMWR report Locally Acquired Dengue --- Key West, Florida, 2009--2010).

A year later, the CDC would issue a report indicating far more people were exposed in Key West, although most developed only mild symptoms (see CDC Press Release Report Suggests Nearly 5 Percent Exposed to Dengue Virus in Key West).

Fifteen years ago, when I began writing about pandemic influenza, H5N1 avian flu was at the top of our worry list - hence the title of this blog. But since then, we've learned a great deal more about the prevalence of - and potential risks from - other zoonotic influenzas.
Over the past 14,000+ blogs, we've looked at novel flu viruses in pigs, dogs, cats, horses, seals, camels, mink, and even bats (to name but a few).
While all of these species - in theory - could host the next pandemic virus, the reality is that not all zoonotic flu threats are created equal.  

We are just over two weeks away from the start of National Preparedness Month - and as I do every year - I'll be posting new, and updated, blogs on how you, your family, and your community can become better prepared to deal with a disaster.  
While FEMA, Ready.gov, and every state and local Emergency Management office across the country wants you to be prepared, regrettably `prepping' has gotten a bad rap over the past few years.

According to the FAO (cite), China is both the world’s number one producer and consumer of pork (USDA, Foreign Agriculture Services Forecast, 2017). Roughly half of the pork raised in the world comes from China.

We have often talked about the importance of NPIs (Nonpharmaceutical Interventions) like flu hygiene, school closures, and social distancing in the opening months of any pandemic because the creation, mass production, and distribution of an emergency  vaccine is a difficult, uncertain, and time consuming endeavor.
We were lucky in 2009, in that the pandemic virus required a relatively simple `strain change', and it did not require - as first feared - two shots spaced a month apart to produce immunity.
Even so, the first batches of the emergency vaccine arrived after the peak of the pandemic, and in much smaller quantities than predicted.  Fortunately, the novel H1N1 virus proved to be relatively mild compared to past pandemics.

This new class of antiviral is particularly welcome as the two existing neuraminidase inhibitors - zanamivir and oseltamivir (Tamiflu ) - have been in use now for 20 years, and there are always concerns over creeping resistance.
In early March of this year, however, we saw several reports - and a Eurosurveillance Rapid Communications - on the detection of a small number of Baloxavir resistant flu viruses among patients in Japan

Yesterday's MMWR carried a detailed investigation report into an antibiotic- resistant Salmonella enterica Newport outbreak - linked to U.S. Beef and soft cheeses from Mexico - which began in June of 2018 and continued until March of this year.
While this particular outbreak appears to be over,
...
In 2002, CIDRAP carried a report called Drug-resistant Salmonella Newport in dairy cattle is growing threat, CDC expert says, detailing its dramatic rise.
Four months ago, in The 8 Zoonotic Diseases Of Most Concern In The United States, in a joint CDC, USDA, DOI report listing the top (n=56) zoonotic diseases of national concern for the United States, Salmonellosis came in 2nd only to Avian flu.

For the past three years we've been following the emergence and spread of a recently identified fungal pathogen - Candida auris - which appeared nearly simultaneously around the globe (see Candida Auris: CDC July Update).

The number of identified infections remains small, but the rise of C. auris is of particular concern because:
C. auris infections have a high fatality rate
The strain appears to be resistant to multiple classes of anti-fungals
This strain is unusually persistent on fomites in healthcare environments.
And it can be difficult for labs to differentiate it from other Candida strains

This isn't the first time we've seen the limitations of these alcohol-based hand sanitizers, particularly when dealing with norovirus and C.diff (see CDC C. Diff FAQ & CMAJ: Hand Sanitizers May Be `Suboptimal’ For Preventing Norovirus).
Today's study investigates the effect of mucus in protecting the virus from ethanol based disinfectants (EBDs). While 30 seconds of rubbing hand sanitizer kills dried flu germs on the hands, it takes between 2 and 4 minutes of EBD rubbing to kill wet `protected' flu viruses.
Thirty seconds of soap and water handwashing, however, killed both wet and dried flu viruses.

by 2012 avian influenza activity appeared to be in decline, with only 32 human (H5N1) cases reported around the globe.
Bird flu activity in past hot spots like Vietnam and Indonesia had fallen dramatically, while some signs of increased activity were being reported from Egypt and Cambodia.
...
Timing, as they say, is everything:
Less than 3 weeks later, China announced the emergence of the biggest avian flu threat seen to date - H7N9 - which first appeared (as predicted) in the central coastal provinces of China (Anhui, Shanghai).
Before the end of 2013, two more novel viruses would spring forth from China, a clade 2.3.4.4. H5N8 that would spread globally sparking large avian epizootics, and the brief appearance of H10N8.
...
Fast forward more than six years, and once again we appear to be in an avian flu drought, brought on in large part by an aggressive nationwide poultry vaccination program in China, which has greatly dampened down avian flu transmission.
But, with the possible exception of avian flu in China, the conditions remain ripe for these same regions to produce newly reassorted (avian or swine) flu viruses.  And no one can say how long China's poultry vaccination program will keep the lid on their bird flu.

While the 2009 H1N1 pandemic showed that a pandemic reassortment can happen anywhere - including in the Americas - with China's avian flu activity temporarily suppressed, many experts are eyeing...

Routine vaccination against smallpox - which supposedly provides about 85% protection against Monkeypox - ended in the 1970s. Today more than half of the world's population is unvaccinated, and the level of protection remaining among those vaccinated 50+ years ago is highly suspect.
The world's supply of smallpox vaccine is extremely limited, and the older replicating smallpox vaccine carried some serious health risks. Despite these shortcomings it was used last year to help contain the UK's mini-outbreak (see Report: UK PHE Imports Smallpox Vaccine For HCWs Caring For Monkeypox Cases).
Given the likelihood of additional exports of the virus, and the potential for the virus to evolve into something more easily transmissible, yesterday's announcement from the FDA that they've approved a new non-replicating Smallpox/Monkeypox vaccine is a welcome development.

And absent a vaccine, most of us are probably going to be exposed, and likely infected, by a novel flu. The goal is not so much to prevent infection, but to slow the spread through non-pharmaceutical interventions (see Community Pandemic Mitigation's Primary Goal : Flattening The Curve).

This morning the ECDC's Communicable Disease Threats Report (CDTR) describes a new CRE outbreak - this time in Germany - of an extensively drug-resistant (XDR) K. pneumoniae, affecting four hospitals in the northeast of the state of Mecklenburg-West Pomerania.

TRex2 wrote:Is the United States prepared for a massive pandemic?
Is anyone?
WHO did a survey to determine level of preparedness.
...

If you grade on the curve, a handful of countries get a `passing grade', but no country (including the United States) is truly prepared.

Judging by the sudden (and much appreciated) jump in the number of visitors to this humble blog over the past few days, it's a pretty good bet that many of my readers are new to `Flublogia'; this little corner of the internet - staffed by volunteers - who are devoted to tracking and reporting on infectious disease outbreaks.

Our roots go back to early in the last decade, and while we've seen some changing of the guard over the years (see Effect Measure’s Farewell Blog and Farewell To The Flu Wiki) , our mission remains the same; creating a collegial, cooperative, and hyperbole free source of good information of emerging infectious diseases.

There is no charter or dues, just a shared sense of civic responsibility to seek out reliable news from around the world, and to relay that information free of charge.
We are an eclectic bunch, with a variety of skills and life experiences, running the gamut from a retired paramedic (me), to an English Professor & Sci Fi author (Crof), a former real estate agent (Sharon Sanders) who runs FluTrackers, to a working virologist (Dr. Ian Mackay), who runs the Virology Down Under Blog.

Of course, we aren't alone in this endeavor. There's ProMed Mail, Outbreak News Today, and of course, the always terrific gang at CIDRAP, led by Michael T. Osterholm.

There are also solid science reporters (an increasingly rare breed) like Helen Branswell at STAT, Lisa Schnirring (and others) at CIDRAP, Maryn McKenna, Jason Gale at Bloomberg, Mike Stobbe, and Maggie Fox who can always be counted on to report accurately, and rationally on outbreaks.

Although we all attack this task in different ways, we freely share information, are often in contact with one another, which (I'm happy to say) results in an astonishing lack of ego or competition in Flublogia.

So, for new readers looking to find the best sources for reliable infectious disease information on the web, a brief tour of FluBlogia.

oldasrocks wrote:RM, I am reading that India is shutting schools etc but they are only reporting very few cases. Is there something they are not telling us?