That's Not the Flu –– It's Hanta!!

Even though it feels like flu season may be dying down near you, across the country it is by no means going away just yet. However, there is evidence to suggest that not all of these cases are actually being caused by the Influenza virus. In Arizona, a 27 year old woman tested negatively for flu, pneumonia, and hepatitis after coming to the doctor with symptoms such as a shortness of breath weeks after her first visit. And the illness was only progressing. Finally, a test came back positive: Hantavirus.

Hantavirus are not very common and only about 700 cases have been found in the US since 1993 but have the potential to cause a sometimes fatal infection called hantavirus pulmonary syndrome (~40% fatality rate). The virus is transmitted from rodents (through urine, feces, or nesting areas) and found primarily in the western and central areas of the United States. Doctors presumed that the woman from Arizona had the flu because the symptoms of an illness similar to a hantavirus infection resemble those of the flu (fever, body aches, nausea, fatigue, etc.). However, later the infection progresses to shortness of breath because the lungs begin to fill with fluid. It is unclear how the infected woman from Arizona acquired the virus but she is currently in intense care in New Mexico in an Extracorporeal Membrane Oxygenation machine to help pump blood through an artificial lung outside of the body and then add it back to the body. Her conditions appear to be improving. However, this story is just another reminder that it is not just the flu circulating around the country. Physicians need to be careful to not become complacent to simply diagnosing the flu upon first glance because it may be the most common and easiest diagnosis.

Source: https://www.livescience.com/61869-hantavirus-infection-arizona-woman.html 

-Alexandra

Mass Vaccination to Control Hepatitis A Outbreak has lead to a Vaccine Shortage

    The United States is in the midst of a nationwide epidemic of Hepatitis A: an acute viral disease spread through contaminated food and water.  Over the course of the last year, Hep A has spread rapidly through homeless populations in city centers across the country. 
     The outbreak began in San Diego where there were over 300 cases and the city created extensive vaccination and sanitation campaigns throughout the city.  This blog has previously covered the initial outbreak and response in more detail. 
     However the outbreak was not contained to just California or even the West Coast.   Cases have spread to Utah, Pennsylvania and many other states.
    The outbreak in Kentucky began late in 2017 but by February of this year there have been over 100 cases including 73 hospitalizations due to the disease.  In order to combat the outbreak and keep it from spreading to nearby states the Kentucky Public Health Dept. instituted a mass vaccination give away in Louisville on Tuesday, Feb 20th.
     However, due to the intense demand for the Hep. A vaccine across the country this year there is now a shortage of the immunization. Each year about 1.2 million doses of the vaccine are made, but due to this large epidemic more than that have been requested by health departments and hospitals. Since only two companies make the vaccine, they are unable to keep up with extra supply to meet the demand. The CDC has reported to CNN that they are now working with heath departments to target vaccines at most at risk populations.
    The CDC report on the shortage:  https://www.cdc.gov/vaccines/hcp/clinical-resources/shortages.html#note1

- Chris LeBoa

An Expanding Lassa Fever Outbreak in Nigeria

       Lassa fever, a violent hemmorhagic disease spread through the inhalation of rodent feces has recently been expanding throughout Nigeria.  In the last week public health officials have confirmed that there were cases in 7 different states throughout the country.
     Edo State (pictured below),  lies in the southwestern portion of the country has seen the most cases, with 35 in the last month alone.

So far in 2017 17 different states of Nigeria have reported cases of the disease, infecting a suspected 973 people and killing 73.  Health officials are worried because the number of cases have increased year over year. Some think that the higher number of cases could be attributed to climate change, as the number of cases spike in the summer months due to more human rodent contact. 
   In order to quell the outbreak of Lassa fever, the WHO has been working on an education campaign to get Nigerians to cover their grain, giving victims plenty of water and proper care and cooking all foods thoroughly. I have included one of their educational fliers below.
http://www.who.int/csr/disease/lassafever/Lassa-fever-infographic.pdf?ua=1
http://outbreaknewstoday.com/nigeria-lassa-outbreak-68-new-confirmed-cases-last-week-99646/

- Chris LeBoa

 

Hepatitis E in Shellfish

Recently, in multiple markets across Scotland, traces of Hepatitis E Virus was found in the shellfish harvested from the waters just off the coast. It is not necessarily an unusual finding for a virus to be found in shellfish as they are often considered "filters of the sea". However, this is the first time that HEV specifically has been identified in shellfish in Scotland and is causing health officials and food processing companies to further investigate. For, while HEV is not generally a deadly virus, it can be extremely dangerous for pregnant women.

Overall, there has been an increase in HEV cases across Scotland. In 2011, just 13 cases were reported whereas in just 5 years there were over 260 cases by 2016. It is currently unclear why there has been an increase in HEV spread throughout the area but further research is being conducted. Health officials are particularly worried about this shellfish case as often some shellfish, such as oysters, are consumed raw and therefore it is more likely for any form of virus to be transmitted. The levels of HEV in the shellfish were low, about 2.9%, but still call for more investigation into how the contamination occurred and how to prevent further contamination in the future.

Source: http://www.bbc.com/news/uk-scotland-43154981

-Alexandra

The Chicken Pox Vaccine has Been Linked to Shingles in Healthy Patients

     Seven cases of pediatric shingles in healthy children at the site of chickenpox vaccination have been reported in the Journal of Pediatric Dermatological Reports. Chickenpox is caused by the varicella-zoster virus which, after primarily affecting the host, can lay dormant for long periods of time, before reemerging as an acute infection known as shingles. Since the primary vaccine for chickenpox is a live-attenuated varicella-zoster virus, it was known to be theoretically possible that some who received the vaccine would develop shingles, but the recent research is first case of this phenomena being concretely reported in pediatric patients.
    Though most of the patients were initially misdiagnosed as having some other form of viral exanthem, they all were eventually correctly diagnosed with shingles, and most where given acyclovir for treatment. All seven made a full recovery.
    This study demonstrates the importance of recognizing the trademark signs of shingles outbreaks, even in patients who do not seem to fit the supposed shingles demographic. Quick recognition of shingles can save patients time and anguish, while leading to cheaper and more effective care.
-J. Cole Holderman
The Article
The Paper

Federal Funding Ban on Lethal Virus Manipulation Is Lifted

            Three years ago, federal officials at the National Institute of Health (NIH) placed a funding moratorium on lethal pathogen creation in the response to “gain of function studies” involving MERS, SARS, and Avian Influenza. These studies investigated the behavior of viruses that had been manipulated to become more virulent in the laboratory environment, something that many researchers say is necessary to preparing for deadly pandemics and bioterrorism. It seems that this December, after an unusually long review period, NIH officials headed by Dr. Francis Collins are agreeing with these researchers and lifting the ban in favor of a stringent review process.

            At the time of its imposition, the moratorium halted 21 studies in progress across the US. Eventually 10 of those studies were granted exemptions. The remaining 11 studies will now be eligible for funding, once accepted by new review panels, run by the NIH. These panels, which will also accept new research proposals, will review candidate studies on a variety of criteria. Applicants for gain of function studies must show that their research is scientifically sound, conducted in a high-security laboratory, directly beneficial to mankind, and impossible to complete in a safer way.

            Though many disease researchers are heartened by the news, others aren’t nearly as optimistic. Marc Lipsitch, an epidemiologist who directs the Center for Communicable Disease Dynamics at the Harvard School of Public Health, said that gain of function studies “have given us some modest scientific knowledge and done almost nothing to improve our preparedness for pandemics, and yet risked creating an accidental pandemic.” Additionally, some researchers have criticized the policy for extending only to publicly funded experimentation.

            Time will only tell whether the new policy will widen our virological knowledge or bring the next superbug down on our heads. Perhaps it will do neither.

-J. Cole Holderman

The Article
Another Article

New Serochip Blood-Test Promises to be the First Multiplex Test for Tick-Borne Diseases

            Scientists at the Center for Infection and Immunity at Columbia University’s Mailman School of Public health have released a research report in the Journal Nature, detailing their development of a new multiplex blood-test for tick-borne diseases (TBD). Dubbed the TBD Serochip the new test can simultaneously identify exposure to any of eight tick-borne pathogens, including 3 viral pathogens: Heartland virus, Powassan virus, and the newly discovered Long Island tick rhabdovirus. The diagnostic is also designed to be easily upgradable. Researchers say they can modify the TBD Serochip to include new tick-borne agents in as little as four weeks.

Ticks are a frequent vector for many nasty disease, both bacterial and viral

          The device promises to both quicken medical diagnostics and accelerate scientific research into TBDs. It replaces a slew of devices and diagnostic tests with limited diagnostic accuracy, subjective criteria, and prolonged wait time. Lyme disease, the most common TBD in the US and a major pathogen detected by the TBD Serochip, previously required two separate tests to diagnose, and these only accurately identified 40% of patients with early disease. For Powassan and Heartland virus, this will be the first diagnostic test available outside of specialized laboratories.

           

          The research group has filed preliminary patents of the device, but there is no word yet as to how soon the diagnostic will be ready for the market.

-J. Cole Holderman

The Paper

The Article

Poultry Production Shut Down in Cambodia Due to H5N1

         Avian influenza H5N1 which is also known as Highly Pathogenic Avian Influenza is a type of influenza A virus that has spread through much of Asia and Europe. While there are many strains of avian influenza, scientists and health departments are especially worried about H5N1 because of its high rates of mortality among humans (between 30-60% of cases are fatal).  While the disease does not spread well between people it can zoonosis from chickens or other poultry into people at markets. 
     Cambodia, a small country in Southern Asia has struggled with controlling H5N1 since 2005. In that year there were 4 human cases in which all four people died.  Since then there have been 57 cases of humans getting H5N1 in Cambodia and 37 of those people have died.
     The government had tried to control the disease by stepping up surveillance of poultry facilities, culling infected flocks and decreasing transport of possibly infected birds between farms.  It was during one of these now common surveillance initiatives that one bird from the Prey Phdao village dested positive for the disease. The health department immediately ordered for disinfectant to be sprayed around the village and for all transport of birds to and from the area to cease until the outbreak was quelled.  Just last month the health department had culled 135 birds from near the same area because they were in a flock that had H5N1.  

- Chris Leboa 
http://www.phnompenhpost.com/national/bird-flu-detected-prey-veng

Influenza D in Horses

       This year a lot of media coverage has focused on influenza. The flu, which sickens more than 1 billion people annually comes in four distinct strains, influenza A, B, C and D. Within each strain of the flu there are different variants of the Haemaglutanin and Neuraminidase envalope proteins that envoke novel immune system detection to the disease each year. 
   In humans the most common strains of influenza are influenza A and B.  Influenza D actually was discovered fairly recently, in pig populations in 2011.  The big worry with animal influenza is that it will cross over into human populations so a lot of work is done to survey flu in animal hosts.  By conducting in depth animal surveillance we know which populations of humans are most vulnerable to also getting the disease.   When it comes to influenza D, researchers found that the main animal host of the disease is not actually pigs, but cows.
     Last week, a report coming out of South Dakota State expanded the scientific community's knowledge on influenza D even more. This study reported that the the disease is actually found in horses as well.  The study tested 364 horses for influenza D and found that 12% of them had symptoms of the disease.  Since humans ride horses this means that there be an even greater increased risk of spillover from horse populations to humans than cow populations. 

- Chris LeBoa
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5766371/>

   

Incidence of Merkel Cell Carcinoma is Increasing

According to research recently presented at the American Academy of Dermatology’s 2018 annual meeting in San Diego, California, Merkel cell carcinoma (MCC), a rare form of skin cancer caused by the Merkel cell polyomavirus, is becoming less rare in the US. From 2000-2013, the number of cases of the disease swelled by 95%, a rate of growth that’s outpaced every other kind of skin cancer, and most other malignancies. By 2025 its expected that the incidence will have grown another 25%.
            It’s not just the US either. Research has showed that rates of MCC are on the rise in Sweden as well, and studies are investigating the rise in incidence of the cancer in other similar populations.

MCC usually appears as a bluish-red or fleshy nodule on the head, neck, or face region, though it can appear elsewhere. Its incidence is correlated with age, immunodeficiency, light skin, and sun exposure, but the proximal cause in most cases seems to be the Merkel cell polyomavirus, a common infection with no known signs or symptoms. It is currently unknown exactly how the virus induces MCC. This cancer is a serious concern, because it is much deadlier that the more common melanoma.  

A patient with an unusually large MCC tumor

Experts at the American Academy of Dermatology say that the primary driving force behind this increase has to do with the changing demographics of western industrialized nations. “We believe the aging of the U.S. population is likely driving the increase in MCC, as this cancer is much more prevalent in older individuals” stated the head of dermatology at the University of Washington in Seattle, Dr. Paul Nghiem. “If you notice a new, unusual growth, especially one that looks different from the other spots on your skin, or one that is growing quickly, see a board-certified dermatologist for diagnosis.”

-J. Cole Holderman

The Article

The Paper

Mumps in Alaska: The final frontier of disease

    

    Mumps, an infection caused by a paramyxovirus, causes muscle ache, fever, swollen salivary glands and painful fluid buildup in the face and neck. Mumps was once a common disease in the United States until an effective vaccine was created to treat it in 1967.   After the vaccine was licensed the prevalence of this painful disease dropped dramatically as seen in the image to the right.       However due to low rates of vaccination among certain populations in the United States, mumps has been recently making an unnecessary resurgence. 
    Most recently there is an ongoing epidemic of Mumps in Alaska. In the last 5 yeas Alaska has seen a 98% increase in mumps cases. There are 248 cases of the disease in this most recent outbreak, centered in Anchorage. The outbreak has recently spread to the city of Juno, where there are now 3 cases of the disease. This this the 1st time mumps has been in Juno, Alaska since 1997.
   In order to quell the outbreak Alaska's health department is recommending that everyone get a thrid booster of the MMR vaccine to confer a high amount of antibodies to the disease in case they are exposed. 

- Chris LeBoa
http://promedmail.org/post/20171230.5528344 
https://www.cdc.gov/mumps/hcp.html#virus

New Legislation: Hearing Screening for CMV

Congenital CMV infections infects 1 in 200 newborns.   Of these babies most cases of CMV are asymptomatic but in the cases that do have symptoms, hearing loss is the most common risk. 
   When babies exhibit hearing loss due to CMV infection the effects can hinder development and learning.  Some studies have shown that giving infants gancyclovir to treat CMV infections can limit or even reverse the hearing loss that they endure.   
   Now some states are trying to implement legislation to reduce the rates of CMV caused hearing loss in children.  Starting in 2013 Utah implemented a law that tasked all hospitals to test all babies for hearing loss as soon as they are born (many states have a similar new baby hearing test). The law then institutes a CMV test for all infants who fail their hearing test.  Iowa in 2017 passed a similar bill, making CMV tests an option for all babies that fail the hearing test. 
   In the first two years that the Utah law was passed it caught 6 children with CMV and tested 234 for the disease.  This catch of 6 children is being lauded in a study in Pediatrics magazine but some are wondering about the economic viability of the law since the catchment rate of finding a baby is just over 2% of those with hearing loss.

- Chris LeBoa
https://unews.utah.edu/hearing-loss/

Worst Flu Season of Decade according to CDC

According to an MMWR report released on February 16^th by the CDC, this is the worst flu season in over a decade, where the percentage of influenza like illness in emergency departments and doctor’s offices were reported to rise to 7.7% from late 2017 to February. This percentage has not been as high since the 2009 H1N1 pandemic. Overall, the majority of hospitalizations attributed to influenza infection are in the elderly (59% of cases) although there still is an unnatural percentage of individuals from other adult age groups such as 18-49 that have been hospitalized. Overall as of February 3^rd , there have been a total of 63-pediatric flu associated deaths. The CDC also predicts that there are still several more weeks of elevated influenza activity to go before the flu season quiets down. As such, the CDC has continued to push the population to continue vaccination for flu if individuals have not done so. Preventative measures to combat the spread of flu include washing your hands with soap thoroughly, avoiding being in public spaces if one has contracted the flu and is sneezing or coughing, and taking certain neuraminidase inhibitors that have been shown to reduce the duration of the illness.

-Daniel Gutierrez

Sources:

http://www.eyeonannapolis.net/2018/02/flu-deaths-spike-in-children-75-didnt-get-flu-shot/

https://www.cdc.gov/mmwr/volumes/67/wr/mm6706a1.htm?s_cid=mm6706a1_w

CRISPR Back at it Again with Another Breakthrough!

CRISPR is certainly taking the scientific community by storm, rightfully so as this genome-editing technique has proven time and time again to be very versatile. This time, CRISPR has been found to be a very effective tool to accurately identify HPV, Zika, or dengue infections from human samples. A researcher Jennifer Doudna, states that a new DETECTR system can achieve the feat of distinguishing even differing HPV strains without the need to isolate them. The accuracy in which DETECTR could detect HPV-16 and HPV-18 in human samples were 100% and 92% respectively. The cost of a DETECTR test is around one dollar and the time for the test is approximately one hour. Wow. Additionally, improvements were made to the existing SHERLOCK system, a more versatile system that can detect Zika and dengue.

As a professor from Mitchell O’Connor simply put it “It enables a new generation of diagnostics that may be more cost-effective than current technologies” I wonder what CRISPR will be up to next?

-Daniel Gutierrez

Sources:

https://www.theverge.com/2018/2/15/17012866/crispr-detectr-sherlock-zika-dengue-hpv-diagnostic-tools

Vireale? Viruses may be linked to diabetes?

There was a time when we didn’t know what viruses where, there was a time when we didn’t know that viruses cause some types of cancer, there was a time that we did not know that viruses caused disease. Today, we know so much, but with all of our knowledge, we have barely scratched the surface of how these microorganisms work and function. Very recently, we have learned of a possible association of viruses with diabetes.

Scientists at Joslin Diabetes Center PhD Emrah Altindis and MD Ronald Khan have recently discovered that some particular viruses may play a role in diabetes since these viruses have been found to have the ability to produce their own insulin-like hormones that can affect human cells. These viruses come from a family of viruses that mainly infect fish and amphibians and are not known to infect humans even if humans ingest the fish. However, new data and research may change our perception. To test the hypotheses on whether these viruses that have insulin like sequences in their genome could effectively act as hormones in mice, the scientists conducted an experiment using a mouse model.  In the ensuing experiment, it was found that these viruses could in fact produce viral insulin like peptides that could bind to insulin receptors in mice, specifically IGF-1.

Such a discovery is exciting in the amount of doors that it may possibly open if the data support the hypothesis down the road. For instance, Dr. Khan has coined the possibility that such a discovery might lead to the synthesis of novel insulin that may not need to be refrigerated or that can be absorbed more quickly.

-Daniel Gutierrez

Sources:

https://medicalxpress.com/news/2018-02-viruses-insulin-like-hormones-human-cellsand.html

Why there is still a high rate of HPV associated cervical cancer in the US?

Based on data from 2009 to 2013 from the CDC, there are 23,300 cases of HPV associated cancers in women, and around 16, 500 cases in men, adding up to a total of 39,800 cases of HPV associated cancers in the US annually.  If there is a vaccine available for HPV like Gardisil that protects against the key HPV strains 16 and 18 associated with cervical cancers among women, why is the incidence of HPV associated cervical cancer cases so high? Well the vaccine is certainly not the problem, it is highly efficacious, the problem lies in factors that we may not initially see or think about.

For instance, some individuals just can’t afford to even get the vaccine, or they don’t have easy access to having the option to decide to get an HPV vaccine. Another important factor apart from economical and geographic factors includes a behavioral one. In South Carolina for instance, there are extremely low rates of vaccination with HPV vaccine in children, where only 29% are vaccinated with a first dose and an even lower 13% get vaccinated with the second dose. Why? Many parents have misconceptions about the HPV vaccine, where some see it as enabling sexual activity in their children, although this is not the case at all. Quadrivalent Gardasil vaccine protects against the development of cancer, and thus both boys and girls should get the vaccine to reduce the incidence of infection with these particular HPV strains.

It is now 2018, so such a high incidence of HPV associated cancer cases in the US is unacceptable. There needs to be a continual push to educate parents about the importance of vaccinating their children with HPV vaccine, and there also needs to be measures taken to ensure everyone has access and the opportunity to take the HPV vaccine if they deem it so.

Maybe in the hypothetical future, where the incidence for HPV associated cancer cases in the US is close to zero, we can move on to push towards taking the nonavelent Gardasil 9 vaccine, because I’m not going to lie, that is the superior HPV vaccine that covers so much more than the regular quadrivalent Gardasil vaccine.

-Daniel Gutierrez

Sources:

https://www.postandcourier.com/health/this-virus-causes-cancers-annually-but-few-complete-the-vaccine/article_331cca0c-10f8-11e8-9a24-eb3cc46bd972.html 

https://www.cdc.gov/cancer/hpv/statistics/index.htm (CDC statistics of HPV)

Soil Leads to Fecal Oral Transmission in Children

Every year 500,000 children die from diarrheal diseases each year. Diarrheal diseases are causes by both viral and bacterial agents but are almost all transmitted by fecal oral transmission.  There are a variety of ways  that children get fecal matter into their mouths. Is this through food, water or soil.  There was not very much research on this before a study that came out from Laura Kwong, PhD student from Stanford University. 
   They collected 10,000 samples over the rainy and dry season for fecal contaminants and e.coli (indication that the sample was contaminated). In Bangladesh where the study was done 100% of the soil and ponds were contaminated with fecal matter.  In order to understand the relative contribution they watched children with video and structural observations.   They watched what children touched and then what they put into their mouths.  The children put less things in their mouths over time but they put their fingers in their mouths more as they grew up.  They also saw that 33% of children directly ingested soil, but no children ate fecal matter directly. 
    In order to figure out the role of ingestion they preformed a Monte-Carlo distribution to figure out a differential contribution of exposure. For children the biggest driver for the younger was the fingers in the mouth but for older children it was eating with their fingers.
     In order to decrease the risk of Carona, arena and enterovirus prevalence, it is imperative that we reduce the risk of children putting fecal covered fingers into their mouths.

- Chris

I wrote this while attending this talk: https://globalhealth.stanford.edu/research/ResearchConvening2018/abstracts.html#1oral

Chickengunya and Birth Defects in Greneda

   Chickungunya, the alphavirus transmitted by Aedes agepti mosquitos, has quickly spread around the world since 2013. The virus is characterized by fever, macupopular rash and joint pain that can las from months to years.  Although this Togavirus causes extreme amounts of pain for some individuals its spread was largely eclipsed by the Zika epidemic that spread around the world at around the same time. Zika controlled the headlines because Zika was associated with birth defects, there is some work that Chickungunya would do the same. 
    Chickungunya first entered the Americas in 2014 with an infection on the island of St Martin.  It quickly spread across the Caribbean and into some parts of Florida. An ongoing longitudinal study by Priyanka Suresh looked at if CHKV was responsible for any teratogenic effects by looking at the CHKV outbreak on the island of Grenada.
    65% of the people on the island of Grenada, with a population of 101,000 people,  have been infected with CHKV. In the study women that were infected during pregnancy (n= 156) were tracked and then their babies tested for a variety of birth defects.  The study, which is still not complete showed that while babies did not have significantly more microcephaly as did babies with Zika infection, but there was a significantly amount more neonatal complications in infected mothers  (26% complications) than those that were not infected with CHKV (7% complications).
    While the study is still not complete and has a small sample size it shows that there may be birth complications due to CHKV infection that need to be studied more.

- Chris LeBoa

I wrote this while at this talk: https://globalhealth.stanford.edu/research/ResearchConvening2018/abstracts.html#1oral

Extension of HPV Vaccination to Boys in the UK

Starting in April, men under the age of 45 will be recommended to the HPV vaccination if they have sex with men. This deliberate extension of the virus comes after a surprisingly long delay compared to the United States, where males have been given the vaccine since around 2015. The program detailed in this article specifically focuses on introducing routine vaccination consultation to men attending sexual health or HIV clinics in England. This roll-out comes in light of the general success of similar efforts in Wales, Scotland, and Northern Ireland that have already been shown to have improved vaccination coverage to protect men and women from developing symptomatic HPV infections and HPV-related cancers. In all instantiations of these initiative, vaccination has been well-received among men and even parents who chose to vaccinate their boys. Much like other gender-based vaccines, HPV should not be limited to a gender because it is so commonly transmitted through sexual contact. It’s great to see the specific targeting of certain at-risk populations, especially since vaccination of boys was met with so much resistance in the UK. Hopefully, the institution of such inclusive vaccination programs, no matter how late, will translate to observable reductions in the incidence of HPV-related cancers in the UK and the improvement of general knowledge about HPV and its vaccine.

-Andrew

Source:

http://www.bbc.com/news/health-42950608

http://www.bbc.com/news/health-40658791