Ebola: Impact lasts in Liberia

Although the Ebola epidemic in Liberia peaked two years ago, survivors are still feeling the emotional impact of a virus that ravaged their country. More than 4,800 people died in 2014 and 2015, and in March of 2016, it was estimated that 1 in 5 Liberians suffered from some sort of mental illness. PTSD and depression are most common, although other types of illness are also present in communities. Medecins Sans Frontiers psychologist Frederic Gelly remarked “[citizens] continue to suffer from an extreme sense of guilt – for being the first in their family to catch Ebola and spread it to others, or for being the only one who survived. Two years later, they ask themselves over and over again: ‘Why did I survive and others die?” 

There are several factors that play into the psychological impact of the disease, apart from the severity of the epidemic.  One major contributor is the interruption of religious rites around death and dying. In response to the Ebola crisis, the government had to put strict regulations on death and burial or cremation rites. As a result, many people felt that they could not properly honor their loved ones. Another is the stigma of mental illness in Liberia. Until recently, mental health services were hugely under resourced in the country.  Many physicians did not know how to care for patients suffering from mental illness, and community members did not know how to support those with PTSD or depression. Finally, many people in Liberia also remember the civil war that ended in 2003, and historical trauma of poverty and violence. The Ebola outbreak brought back bad memories for many Liberians, and reminded them of harsh realities.

Although the situation in Liberia is challenging to tackle, WHO has made an effort to increase the number of mental health workers, and to train 1,300 people in a weeklong intensive course by the end of 2016. They are confident that this will begin to make an impact, especially as they work to reduce the stigma of emotional trauma in the country.

Elisa Hofmeister -18

Info at: 

http://reliefweb.int/report/liberia/liberia-psychological-scars-ebola

http://www.who.int/features/2016/mental-health-liberia/en/

Why is there so little microcephaly in Colombia?

It's welcome news, certainly, but a puzzling mystery nonetheless. Colombia's Zika outbreak has been second only to Brazil's in magnitude. Based on Brazil's 2,000 cases of microcephaly and counting, officials predicted upwards of 700 such cases in Colombia by the end of this year. Yet only 47 have so far been counted.

Experts point to a couple of different possibilities to explain this difference. One hypothesis is that pregnant women in Colombia underwent abortions at higher rates than their Brazilian counterparts. Unlike in Brazil, abortion in Colombia is legal in the case that a fetus is severely deformed, as this is viewed as a threat to the mother's mental health.

Another possibility is that many women followed the government's advice to delay pregnancy.

- Julia Daniel

Source: http://www.nytimes.com/2016/11/01/health/colombia-zika-microcephaly.html

Rift Valley fever virus infection linked to miscarriages

A study of 130 pregnant Sudanese women with Rift Valley fever suggests that the virus is linked to miscarriages in humans. Rift Valley fever is a mosquito-born infection with outbreaks in Africa and the Arabian Peninsula. Although it has been known to cause miscarriages and fatality in cattle, goats, and sheep, most human cases are characterized by flu-like symptoms. 

In this cross-sectional study, pregnant women who presented at the governmental hospital of Port Sudan with fever of unknown origin were tested for a number of viruses that cause fever, and their medical records were reviewed. 54% of these women with acute Rift Valley fever virus infection had miscarriages compare to 12% of those negative for Rift Valley fever virus. On multivariate regression, Rift Valley fever virus infection was an independent predictor of having a miscarriage. This is the first study to link Rift Valley fever infection with miscarriages.

-Sally Tran

References:

Baudin M, Jumaa AM, Jomma HJE, Karsany MS, Bucht G, Naslund J, Ahlm C, Evander M, Mohamed N. "Association of River Valley fever virus infection with miscarriage in Sudanese women: a cross-sectional study." The Lancet Global Health. 2016 Nov; 4(11):864-871. 

Umea University. "Mosquito-born Rift Valley fever virus causes miscarriage." ScienceDaily. 2016 Oct 3. www.sciencedaily.com/releases/2016/10/161003113242.html 

Heartland virus death in New Orleans

Earlier this week, a man from New Orleans died from the Heartland virus. The virus is rare and was only included in medical literature relatively recently (2012). The virus is an arbovirus (arthropod borne) and is thought to have infected the man via a tick bite. He went to the hospital when his leg started to hurt and a rash appeared. Doctors initially thought he might have a bacterial infection from the tick bite, but when treatment failed and he got worse, they treated more aggressively for a viral infection. Upon inspection of the man's tissues post mortem, CDC investigators found the presence of the virus in nearly every sample. This is a stark contrast to previous cases of Heartland virus, where the virus was only found in blood and bone marrow samples.

Heartland virus is a phlebovirus in the family Bunyaviridae. Heartland viruses spread by insect bites and there is no vaccine, so the best way to prevent infection is by wearing insect repellent, protective clothing, and routinely inspecting your body for ticks if you spend time in forests.

-Katy Graham

Sources:
http://www.livescience.com/56674-death-from-heartland-virus.html

http://www.cdc.gov/ncezid/dvbd/heartland/

Rhinovirus vaccine development

If you've ever had a cold, you know that medical appointments end with the same treatment advice: get rest and drink lots of fluids. Essentially, wait out the virus and its symptoms.

Why spend the time and effort to develop a vaccine for a virus that is not super threatening? In 2003, the economic losses due to the common cold were estimated to be $40 billion. Between the cost of staying home to take care of children, the cost of medicine to relieve symptoms, and other expenses, the cold is really expensive for Americans. And because colds are so ubiquitous, the total cost balloons beyond that of more serious illnesses, like emphysema.

Fortunately, virologists are working on a vaccine to prevent the common cold. Most colds are caused by rhinovirus- which currently doesn't have a treatment or a vaccine. Rhinoviruses have many different serotypes and have rapidly evolved, making vaccine development difficult. However, a vaccine currently being tested in macaques is showing promise. The scientists combined 50 different types of rhinoviruses to create the vaccine- hoping to protect humans from as many different serotypes of the virus as possible. They hope to include serotypes that are most hazardous to immunocompromised patients, including those with COPD.

-Katy Graham

Sources:

https://www.scientificamerican.com/article/scientists-wonder-if-the-common-cold-may-at-last-be-beatable/

http://www.ur.umich.edu/0203/Mar10_03/15.shtml

Ocular Herpes Transmitted Via VR Headsets?

The PlayStation VR console has had a whirlwind journey in the news recently. Released 2 weeks ago, sales soared and exceeded all other VR consoles, exciting VR fans and Sony stockholders. However, a thread on social media has been suggesting that ocular herpes, caused by a Herpes Simplex virus, is being passed from headset user to headset user at trade shows and demo booths.

Though unconfirmed by authorities, an outbreak would be serious because oral herpes is not necessarily a benign disease. Though oral herpes generally only affects the epithelium of the eye and heals without scarring, a rarer trajectory of the disease can lead to deeper corneal damage and blindness.

Regardless of whether an outbreak is occurring, this report highlights the importance of sterilizing shared equipment before use, especially at conventions where hundreds of users are trying new technologies.


News Article:
https://gamerant.com/vr-headset-herpes/ 
More on Ocular Herpes:
http://www.allaboutvision.com/conditions/ocular-herpes.htm
ProMed Analysis of Situation:
http://www.promedmail.org/post/4592839

-- Sharon Kam

More Accessible Hepatitis C Medicines Impact Lives of Millions Worldwide

The World Health Organization released an article on October 27th, 2016 stating that over one millions people who are diagnosed with Hepatitis C in under-developed or developing nations have received effective medicines that possess a cure rate of ~95%. There was initially a fear of the medicine being too expensive for patients in developing/under-developed nations; however, with the partnership of global organizations and the World Health Organizations nations such as Nigeria, Pakistan, Philippines (and many others) were able to afford the medicine. Other methods of reducing the cost of medicine include provisions in licensing agreements and local production.

According to Dr. Gotfried Hirnschall, the Director of the WHO HIV and Global Hepatitis Programme, reducing the costs of these medicines is crucial in addressing the health needs of patients living in low and middle-income nations who are impacted by Hepatitis C, a disease that leads to more than 700,000 fatalities as year. Although developing nations may be paying less for the medications, middle-income countries are paying an enormous price for the medications, leading to a great cost disparity (e.g. $9,400 in Brazil vs. $79,900 in Romania).

Dr. Hirschall states that another effort to decrease the number of Hepatitis C patients is the Global Health Sector Strategy on Viral Hepatitis, which aims to eliminate Hepatitis C as a public health threat in 194 countries by 2030. One step in reaching this goal will be more affordable costs for Hepatitis C medicines and effective distribution of medications to infected patients. Through this new initiative, more than 80% of Hepatitis C patients are predicted to be treated.

Check out the article here: http://who.int/mediacentre/news/releases/2016/hepatitis-c-medicines/en/

~Michelle Bach (Humans and Viruses 2016-2017)

First Zika Case in Myanmar

MyanmarTV recently reported the first Zika case in the country. The patient is a pregnant woman who has been identified as an international resident currently receiving treatment in Yangon, one of Myanmar's largest cities. Since September, there have been two other Myanmar patients infected with Zika; however, both patients are living abroad in Singapore and Thailand, which are two countries in the Southeast Asia that have been significantly impacted by Zika with ~800 cases.

As preventative measures, Myanmar has attempted to increase education and enforce further anti-mosquito measures. According to Dr. Nyan Win Myint, an representative from the Myanmar Ministry of Health, these public health measures are also predicted to aid with Dengue outbreaks as well. Dr. Myint has also stated that screening measures at airports have become more cautious in order to allow for early detection of patients infected with Zika.

In cooperation with the World Health Organization, the Myanmar Ministry of Health has enforced close monitoring of birth defects in Myanmar's seventeen largest hospitals. As of now, no birth defects in Myanmar have been correlated to Zika. Although no vaccine exists in Zika, it is predicted that a new vaccine may be available within five years; therefore, current measures will heavily rely on changes in behavior by the general public to take extra precautions in preventing mosquito bites.

Check out the article here: http://www.foxnews.com/health/2016/10/28/myanmar-confirms-first-case-zika-virus-infection-state-tv.html

~Michelle Bach (Humans and Viruses 2016-2017)

Preventing the Spread of Respiratory Pathogens on Airplanes

 A recent technological development in the recycling of cabin air in airplanes could significantly impact the spread of respiratory pathogens.  A Canadian teenager, Raymond Wang, has developed what he calls a “personalized breathing-zone” through the implementation of directional fan technology that has been proven to effectively limit particle spread.  In terms of pathogen transmission, specifically viral, respiratory routes are the most contagious and effective, thus when combined with the closed and close quarters of an airplane cabin, the instance of infection rises exponentially.  History reminds us of this fact by presenting countless instances when a single infectious passenger, making the ignorant decision to travel, has transmitted a viral infection to nearly one-third of the passengers on-board the plane.  Some of the viruses that are transmitted by a respiratory route are especially virulent, including: measles, Ebola, SARS, and various strains of influenza.  In a rapidly globalizing world, this tech could provide a significant decrease in massive transmission of pathogens that could result in a potential pandemic.

-Ethan Wentworth

Article:

http://nextshark.com/raymond-wang-global-inlet-director/

Mumps in Vacinnated University Students (San Diego, California)

Two San Diego State University students have been diagnosed with mumps, despite both being up-to-date with mumps vaccinations. The two have recovered without needing hospitalization and are housemates living off-campus-- suggesting there is less chance the disease was spread to other classmates. 

An increased number of mumps cases has been reported in San Diego this year: 19 so far, in comparison to the yearly average of 3 cases. Health officials are advising people to stay up-to-date with the recommended measles, mumps, and rubella vaccine schedule as the increased number highlights the disease being in the community. 

However, as these students have followed the recommended vaccination guidelines, three questions remain outstanding: 1) which strain of mumps did the students fall ill to; 2) does this strain have increased virulence and is the vaccine unable to protect against it; and 3) where did the first student pick up the disease?

News Report:
http://outbreaknewstoday.com/mumps-cases-up-in-san-diego-this-year-11000/

-- Sharon Kam 

Measles on a Plane

An individual contagious with measles flew on Singapore Airlines, instigating an alert to be made in Western Australia.  The patient flew from Tokyo, Japan to Perth, Australia via Singapore while contagious.  In addition to the airports and planes involved, the patient had stopped at a fitness center, café, and the hospital, so people in those places could have also been exposed.  The Western Australian health officials were working to track down those people, but they further detailed the difficulty of finding all of who could have been involved, especially at common spaces such as a café (Outbreak News Today).  The reason for such concern, especially on airplanes, is that measles is extraordinarily contagious and, so much so, in fact, “that if one person has it, 90% of the people close to that person who are not immune will also become infected” (CDC - Transmission).

Measles virus is a human virus that is a member of the Paramyxoviridae family (Enders).  It is transmitted respiratorily and “can live for up to two hours in an airspace where the infected person coughed or sneezed” (CDC - Transmission), but can also be transmitted via an infected fomite.  Its symptoms typically begin with a fever, cough, runny nose, and watery eyes.  In a couple of days, the well-known measles rash develops and the fever peaks, both of which disappear in a matter of days (CDC - Signs & Symptoms).  During this time, an individual is contagious for around 4 days before and after the rash appears.  In addition to being very contagious, measles is a concern due to its complications, which could involve pneumonia and encephalitis (Outbreak News Today).  

- Devon Z.

CDC - Transmission:  https://www.cdc.gov/measles/about/transmission.html

CDC - Signs & Symptoms:  https://www.cdc.gov/measles/about/signs-symptoms.html

Enders:  https://www.ncbi.nlm.nih.gov/books/NBK8461/

Outbreak News Today:  http://outbreaknewstoday.com/perth-measles-alert-for-singapore-airlines-passengers-67320/

Australia Announces 2017 Flu Vaccine Strains

Australia has been very proactive in the development of the seasonal influenza vaccine. In 2015, a highly infectious influenza outbreak occurred in Brisbane, leading to an earlier implementation of the 2016 flu vaccine for free to at-risk populations to build immunity before the beginning of the flu season, which begins August 2016 (Australia has an earlier flu season than the United States, most likely due to seasonal difference). According to Sussan Ley, the Minister of Health in Australia, the Brisbane outbreak was particularly unusual because a record number of patients (20%) were hospitalized.

In order to prepare for the 2017 flu seasons, Ley encourages at-risk populations including the Aborigines, pregnant women with previous health complications including asthma or heart disease, people over the age of 65, and Toret Straight Islanders to be vaccinated sooner. Ley has stated that the previous 2016 trivalent flu vaccine was ineffective in protecting against the major flu strains; therefore, both trivalent and quadrivalent vaccines are being considered, and a novel strain called H1N1(pdm)09 will be included as well for the 2017 flu vaccine.

The trivalent vaccine will include strains of A(H1N1), A(H3N2), and B (Brisbane virus). The quadrivalent vaccine will include another strain of B. These strains were recommended by the World Health Organization, and the Australian Influenza Vaccine Committee (AIVC) was quick in accepting these recommendations for the 2017 influenza flu vaccine protocols.

Check out the articles here:
http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2016-ley029.htm

https://ajp.com.au/news/2017-flu-vaccine-strains-announced/

~Michelle Bach (Humans and Viruses 2016-2017)

Hand, foot, mouth disease at University of Illinois

Health officials have reported over 60 cases of hand, foot, and mouth disease in college students attending University of Illinois. A significant outbreak like this is unusual in this population, as the Coxsakie A16 virus normally causes this illness in children younger than 5 years old.

Transmisison routes for this virus are: direct contact, respiratory (including oral secretions spread by kissing), fecal-oral, and fomites. Although adults can still contract the virus, disease symptoms are typically more apparent in children.

Classic symptoms of the disease include: fever, rash, and mouth ulcers. The illness is usually resolved after 7 to 10 days.

The University of Illinois hasn't seen the only outbreak of hand, foot, and mouth disease. Earlier this fall, Florida State University saw a HFMD outbreak in about 15 students. Colorado University Boulder and high schools in Burlington, Vermont; La Porte, Indiana; and Pequannock and Kinnelon, New Jersey have seen smaller outbreaks of the disease.

Read more here: http://dailyillini.com/news/2016/10/24/60-cases-hand-foot-mouth-disease-reported-university/

http://kron4.com/2016/10/26/video-hand-foot-and-mouth-disease-popping-up-at-college-campuses-nationwide/

https://pjmedia.com/parenting/2016/09/15/hand-foot-and-mouth-disease-outbreaks-forcing-schools-across-the-country-to-cancel-events/?singlepage=true#

http://www.forbes.com/sites/judystone/2016/09/16/hand-foot-and-mouth-disease-strikes-florida-state-and-other-schools/#7586de1d7c3f

~jazzmin

Wolbachia Bacteria Used to Prevent Spread of Zika and Dengue

As the number of patients infected with Zika and Dengue continue to rise, more nations are seeking methods of controlling the main vector of transmission: Aedes aegypti mosquitoes. Both Dengue and Zika require the virus to reside within the mosquito for a long period of time before being successfully transmitted to humans. The Wolbachia bacteria was seen to shorten the length of the Aedes aegypti lifespan by half and, therefore, reduce the probability of transmission. Specific countries that are taking active measures to introduce the Wolbachia bacteria are Columbia and Brazil, two nations that have been most significantly impacted by the Zika outbreak. The introduction of the Wolbachia virus is only one component of a larger mosquito campaign. With the World Health Organization's declaration of Zika as a global health emergency, the United States, Great Britain, the Wellcome Trust, and the Bill and Melinda Gates Foundation have partnered to provide approximately $18 million to control the mosquito population in an attempt to control the spread of these viruses. Priti Patel, secretary of Britain International Development, supports the use of Wolbachia as a more cost-effective measure for controlling Zika and Dengue outbreaks, especially for developing countries.

Benefits for the introduction of Wolbachia include the natural sustenance of the bacteria because mosquitoes are able to transfer Wolbachia to their offspring. Wolbachia is also a naturally occurring bacteria in the Aedes aegypti population. Previous studies have been conducted regarding the impacts of Wolbachia in five different nations for approximately five years, and the virus has been seen to halt the transmission of the viruses.

The use of Wolbachia demonstrates how multiple components including economics, health policy, and research have combined forces to prevent further transmission of two infectious diseases.

Check out the articles here:
http://www.eliminatedengue.com/library/publication/document/scientifix_paper/9.pdf

http://www.foxnews.com/health/2016/10/26/brazil-and-colombia-to-scale-up-bacterial-fight-against-zika-and-dengue.html

~Michelle Bach (Humans and Viruses 2016-2017)

Zika virus - a new sexually transmitted infection?

Media attention has emphasized the importance of the sexually transmittable nature of Zika, especially in the US and Europe. These countries don’t have naturally endemic areas, and thus travelers from outside areas are able to bring in Zika. By September 9, 12 countries has reported cases of non-mosquito-borne Zika virus. ‘

However, through publicly available CDC data it was reported that only 23 out of 2,381 cases were transmitted through sexual contact with a person who had traveled to an endemic area. Math models has estimated that 3% of overall R0 (reproduction number) are due to sexual transmission, with the upper limit more around 45%.  

One reason that Zika will probably not be a sustainable STI is becuase R0 for sexual transmission must be greater than one, when considering the product for infectious duration and sexual transmission rate. 

The article has a call for action for follow up studies of sexually-transmitted Zika-virus. They claim that those small groups with frequent change of sexual partners could undergo Zika infection, as well as those who don’t have endemic areas, but do have travelers. This could lead to viral persistence and reservoir potential to pass through areas with no mosquitos. However, Zika is still not a designated sexual transmitted infection - yes, sexually transmissible -  but not yet a sexually transmitted infection due to low proportion of Zika infections through this method. 

- Gianna Nino-Tapias (’18)

References: 

• Althaus CL, Low N (2016) How Relevant Is Sexual Transmission of Zika Virus? PLoS Med 13(10): e1002157. doi:10.1371/journal

Bird Flu Blues in Delhi

There is growing concern in New Delhi as more birds are found dead after an outbreak of H5N1 (avian flu) killed several birds at the local zoo in early October.   Citizens fear that the flu is spreading beyond the walls and into the rest of the city and unfortunately it seems as though these fears are well founded. Since October 21, at least 10 birds have been found dead around the city, and since the zoo closed there have been reported deaths from a local migratory bird sanctuary.

H5N1 is a zoonic subtype of Influenza A of the orthomyxoviridae family. Although humans are not the primary host of the virus, experts agree that it would only take a few mutations for a highly virulent strain to emerge. Despite inefficient transmission, tpuoltry workers are at moderate risk for contracting the illness. Beginning symptoms include high fever, diarrhea, sore throat, and abdominal pain, but these can worsen and lead to respiratory distress or pneumonia. The current Asian strain has a mortality rate of about 60%. 

In response to the outbreak, the government is advising citizens to stay away from all bird carcasses for the time being, and has provided a hotline for people to report dead birds. Additionally, there are government response teams throughout the city to keep things clean, especially near poultry farms. At this time the state has issued reassurances that there is no reason to panic, and there is no ban on cooked poultry. Nevertheless, officials say they have stocks of Tamiflu tablets should the virus begin to infect humans.

 For more information see:

http://timesofindia.indiatimes.com/city/delhi/avian-flu-scare-grows-as-more-birds-die-in-city/articleshow/54967199.cms

http://www.promedmail.org

http://news.harvard.edu/gazette/story/2012/02/fears-of-bioterrorism-or-an-accidental-release/

Elisa Hofmeister  '18