MERS misses Mumbai man

Hat tip to @makoto_au_japon

According to a DNA report (a Mumbai-based, English broadsheet daily owned by Diligent media Corp in case you were wondering), the 40-year man from Mumbai is not positive for the MERS-CoV. He is also negative for "swine flu" (pick one)...what he is positive for is unclear but he is recovering.

Just another insight into how often we don't know what causes an acute respiratory infection ...and this is the case worldwide, not just in India.

Oh for a Tricorder.

Read More

Health infrastructure at the site of the suspect MERS case in Mumbai, India

Hat tip to @makoto_au_japon for bringing this article to the fore

Facilities for patient isolation at the Kasturba hospital, Mumbai, where the 40M undergoing testing for (hopefully) a range of respiratory viruses including MERS-CoV, are less than ideal.

A report on The Times of India notes poor bed separation, concern for healthcare workers (HCWs) dealing with the case (whatever respiratory virus they have) and whether World Health Organisation minimum requirements of management of patients with airborne infections can be met. N95 particulate respirators are considered very important for protection of HCWs and caregivers.

If the case is MERS-CoV negative, this may be something of a wake-up call to the regional health authorities.

Read More

H5N1 did not transmit easily between humans in the wild...

Hat tip to @Laurie_Garrett and CIDRAP

Despite wearing next to no personal protective equipment (5% of 419 contacts used a mask, face shield, gown or gloves) and coming into contact with sick or dead poultry (12% of contacts), 85/87 household members and 332 "less close" contacts of 23 influenza A(H5N1) virus cases did not show any significant sign of antibodies to the virus, a study published in PLOS|ONE by Bai and colleagues noted.

Only 2 (0.4% of all contacts tested) were defined as infected by H5N1  during the study period of 2005-2008, on mainland China. 

The study used both haemagglutination test (antibodies in the patients sera bind horse red blood cells together giving a distinctive pattern) and micro-neutralization (presence of specific antibodies in a sample prevents a lab stock of virus from infecting a cell line-amount of virus can be determine by making dilutions of  the sample and comparing to a sample with no antibodies to the virus). When they had a single serum, the authors used:

• A neutralizing antibody cut-off titre of =40 children (<14-years of age)  with a haemagglutination titre =40.
• A neutralizing antibody cut-off titre =80 for those aged 15-59-years with a haemagglutination titre =40.

For acute and convalescent sera pairs positivity to H5N1 was defined as:

• A =4-fold rise in neutralizing antibody titre between acute and convalescent sera
• Convalescent sera needed a neutralizing titre of =40 for children and =80 for adults, or a haemagglutination titre =40

There were a few more positives below these cut-offs.

While genetically altered H5N1 can be made to spread among ferrets in the lab, it seems that some years ago in the wild, H5N1 had a ways to go before it could spread efficiently between humans. That's a good thing.

Read More

Suspected case of MERS-CoV in India...

A story at The Times of India describes a 40-year old male with fever and pneumonia who has been quarantined after returning to India from 35-days in the Kingdom of Saudi Arabia.

The patient is responding well to oseltamivir medication which does not support a MERS-CoV infection, rather an influenza infection. 40M has already tested negative for influenza A(H1N1) and MERS-CoV was suspected based on his travel history.

Testing at the National Institute of Virology in Pune, is ongoing.

FluTrackers has a thread on this story too.

Read More

Its probably not a MERS-CoV!

I commented on a news article from tweeted by @pandemic_News yesterday....

@pandemic_news Woah!! There is a known FELINE coronavirus...that is not at all #MERS-CoV. See pink filled circles at http://t.co/vUEyD2FoaO
� Ian M Mackay, PhD (@MackayIM) August 14, 2013

The article's headline had read MERS corona kills cat in the East. It seems to have been picked up some others overnight. 

I notice the headline has been changed today. [UPDATE 160813-the concept of a "feline reservoir has not been picked up by ProMED and a new version can be found at the Saudi Gazette.]

MERS-CoV is not the only CoV on the block of course. Have a look at the phylogenetic tree I posted a few days back - there are lots of CoVs and they infest a large number of different animals. The feline coronavirus (feline infectious peritonitis virus; FIPV) is an alphacoronavirus. It's well known. [UPDATE] It's probably the cause here. There is no evidence to support MERS-CoV in these animals. None.

I think headlines like this are akin to spam email - try and find a fact in there that has, or can be, verified from a trusted source, think about whether it makes sense (is this website likely to be the first one to report on MERS-CoV in cats?) or look for a reference in the text to an entirely different source (like a lab test result for example). That approach is not foolproof - but it's better than believing something so dramatically different from what we currently know, on first read.

Read More

Prof Ziad A Memish: principal author of MERS-CoV data

Since the human cases of MERS-CoV started in 2012, the majority of publications describing signs and symptoms of disease, incubation periods, sites and routes of transmission clusters of infections have come from the Kingdom of Saudi Arabia, and most of those have involved co-authorship, usually as senior author, by Prof Memish. He also commented on the initial ProMED posting from Prof Ali Mohamed Zaki, which announced the MERS-CoV to the world. I wrote something about that back in May.

According to a WHO biography, Prof Memish is a senior infectious diseases consultant at King Fahad Medical City, Professor at Alfaisal University and King Saud University, President of the Saudi Association of Public Health, Adjunct Professor at Emory University. He is also the KSA Ministry of Health's Assistant Deputy Minister of Health for Preventative Medicine in the Kingdom of Saudi Arabia (KSA).

I've briefly compiled some (its not exhaustive) of Prof Memish's MERS-CoV-related literature,  looking at the points he has found interesting and/or lacking in data and  requiring more research. As someone at the current hotzone, these should be points worthy of addressing. I have ordered the papers in time - starting each with the number of known MERS-CoV cases listed by the paper:

1. 3 Cases. In the article in the Saudi Medical Journal, Oct 2012, AlBarrak and colleagues noted:
• The need for a validated serological test from international colleagues; 
• 1/3 cases had farm animal exposure, but all cases had been exposed to dust storms through the summer, possibly aerosolized virus also
• Investigations of potential animal reservoirs are in progress
2. 9 Cases. In an article in the International Journal of Infectious Diseases, Dec 2012, Pollack and colleagues noted:
• 5/9 cases had a history of prior animal exposure
• They asked what the animals were and whether there had been any animal, including bat, studies?
3. 9 Cases. In an article in Clinical Microbiology and Infection, Feb 2013, Gautret and colleagues noted:
• Their study was not based on case selection using symptoms, but was a (first?) prospective screening study without regard for symptoms.
• MERS-CoV was absent from departing or returning French Hajj pilgrims using a slightly adapted (different cycler, same primers) RT-PCR assay based on that of Corman et al.
• 2012 French Hajj pilgrims had a lower flu vaccination rate than did a 2009 cohort
• Limited data to support human-to-human transmission, suggesting zoonotic transmission is likely
4. 15 cases. In an article in the Lancet Infectious Diseases, May 2013, McCloskey and colleagues noted:
• The importance of rapid genetic sequencing as was shown during the SARS-CoV outbreak
• Knowledge gaps include those pertaining to the source, mode of transmission, epidemiology  geographic distribution, predisposing factors for infection and disease, incubation period, immunopathogenesis, range of clinical manifestations and epidemic potential
• Focus on the Middle East may be missing international MERS-CoV cases
• Available molecular tests are experimental and their sensitivity and specificity require definition
• Serological test are urgently needed for epidemiology and investigations of global distribution 
5. 90 cases. In the Lancet Infectious Diseases, July 2013, Assiri and colleagues describe the largest case study so far noting:
• MERS-CoV cases present with a wide range of clinical manifestations, with greatest impact in those with underlying comorbidities
• Knowledge gaps (43 key gaps and priorities listed) include those pertaining to epidemiology, community prevalence, transmission, clinical course, diagnostics, patient management and infection control
6. ? Cases. In the Eastern Mediterranean Health Journal, July 2013, Alwan and colleagues noted:
• Priority to monitor for sustained human-to-human transmission
• The global public health community must attempt to understand the public health risks posed by MERS-CoV
• Knowledge gaps include those pertaining to source, how it emerged in humans, how widespread it is
• WHO and the global community have benefited from willingness of countries in the region to share viruses and information immediately, allowing rapid development of diagnostic tests
7. ? Cases. In the Eastern Mediterranean Health Journal, July 2013, Joseph and colleagues noted:
• Knowledge gaps include those pertaining to spectrum of disease, changes in MERS incidence, case definition, source of infection.
• There are global high expectations that everything is being done to detect and control an emerging disease threat; global preparation is needed due to uncertainties
• Need to train laboratory staff for MERS-CoV testing, identify where capacity building is required and liase with animal research group to strengthen collaborative studies
8. 90 cases. In the International Journal of Infectious Diseases, Aug 2013, Omrani and colleagues noted:
• Nosocomial transmission may be occurring via undetected or asymptomatic healthcare workers
• Knowledge gaps include those pertaining to source, intermediate host, pathogenesis, infectivity and risk factors
• Diagnostic assays need optimizing
• Therapeutic options need to be identified
9. 94 cases. In the New England Journal of Medicine, Aug 2013, Memish and colleagues noted: 
• Health care workers should be reminded of infection prevention and control measures
• The KSA routinely screens all close contacts of MERS-CoV patients and this screening has identified 7 HCWs positive for MERS-CoV
• How great a risk is posed to healthcare workers by MERS-CoV patient body fluids, excreta, bodily fluids, samples and surfaces contaminated by such

So, there is a consistent thread among these expert publications highlighting a need to find the animal host and requests for improved diagnostic tests, although I'm not sure what is wrong with the WHO-recommended assays. 

There is a similar need for antibody-detection (serological) tests. I believe these already exist, but are lacking in validation (proof they are as good at detecting negatives as positives, and not picking up too many false negatives or false positives). This will need a suitably large panel of known positive sera, best obtained from the most numerous source of cases, the KSA. Hopefully that is being assembled now, even if it requires contacting former patients, symptomatic or asymptomatic, to retrospectively ask for a blood sample. This is a one-off validation that would be invaluable to the world since there are multiple sources of MERS-CoV or virus proteins to make the assay, but sources of known positive sera are limited. 

As noted by Prof Memish, an antibody test would allow each country to see if MERS-CoV was was/had been active there and could be used to determine what level of mild or asymptomatic illness there is, if any, worldwide.

What Prof Memish and his co-authors and the world's scientist want to know seems to have been largely made clear back in 2012 when MERS emerged. What's unclear is what is being done to address the list (Ref 7 has a good example) and who is doing what?

Read More

4.8-million Umrah pilgrims free of MERS-CoV...?

According to an Arab News report, the Kingdom of Saudi Arabia's (KSA) Health Minister Abdullah Al-Rabeeah, has said that 4,800,000 pilgrims visited  to perform Umrah this year, and not one left having had a Middle East respiratory syndrome coronavirus (MERS-CoV) infection. 

That certainly suggests that the virus is hard to catch and that its not transmitting stealthily.

Wait...it doesn't mean either of those things. 

What it means, in case you were to misinterpret the headline, is that the disease, MERS (as opposed to the virus, MERS-CoV), was not diagnosed in those people. 

Wait, no, it means that a disease severe enough to be put on the radar for MERS testing, did not occur among the 4,800,000 pilgrims. Just a reminder from the World Health Organisation of what their interim definition of a probable MERS-CoV case looks like: 
excerpted form the 3rd July 2013 version

1. A person with a febrile acute respiratory illness with clinical, radiological, or histopathological evidence of pulmonary parenchymal disease (e.g. pneumonia or Acute Respiratory Distress Syndrome)
   AND
   Testing for MERS-CoV is unavailable or negative on a single inadequate specimen
   AND
   The patient has a direct epidemiologic-link with a confirmed MERS-CoV case
2. A person with a febrile acute respiratory illness with clinical, radiological, or histopathological evidence of pulmonary parenchymal disease (e.g. pneumonia or Acute Respiratory Distress Syndrome)
   AND
   An inconclusive MERS-CoV laboratory test (that is, a positive screening test without confirmation)
   AND
   A resident of or traveler to Middle Eastern countries where MERS-CoV virus is believed to be circulating in the 14 days before onset of illness.
3. A person with an acute febrile respiratory illness of any severity
   AND
   An inconclusive MERS-CoV laboratory test (that is, a positive screening test without confirmation)
   AND
   The patient has a direct epidemiologic-link with a confirmed MERS-CoV case.

So really, only #3 would account for any MERS-CoV infection that wasn't at the severe end of the clinical scale (the tip of the iceberg as we all like to refer to it). But even then, a case has to be linked to another MERS-CoV case. 

In other words, less obvious cases - those infections that may look like a standard influenza-like illness (ILI), or be asymptomatic (both have occurred win MERS-CoV positive people) - would not get tested and we have no way of saying that these people were MERS-CoV free.

I'm sure that many of those 4,800,000 pilgrims had some respiratory symptoms during their time in the KSA - we know from research papers that the 200 or so endemic respiratory viruses continue to circulate among pilgrims in the KSA during large gatherings.

It would be very reassuring to know how many cases of mild or moderate ILI respiratory infections were seen by a Doctor in the KSA and how many were tested for MERS-CoV by RT-PCR. A prospective study like that by Gautret et al which did not sample on the basis of signs and symptoms, augmented with some serology testing to show recent or past MERS-CoV infection but conducted by/at/for the KSA, would be a great example. It would even pick up asymptomatic cases. Even without the serology component that would be a valuable good study.

I guess we'll just have to wait for the research paper. 

Read More

Australia's NHMRC briefing to Grant Review Panellists...

The Australian government's peak medical research funding body, the National Health and Medical Research Council (NHMRC) has a webcast (like podcast but for all platforms and devices) of the briefing given to the multidisciplinary Grant Review Panellists (GRPs; 516 members this year) as they meet in Canberra this week to award this year's pot of money (Project grants were awarded $458 million in 2012) to the best of the 3,912 Project Grant applications.

If you'd like a peek behind the scenes, this is a great way to demystify some of the process behind the decision that gives many Australian researchers their future research funding for 1 to 5 years.

A couple of overview points from Prof Roy Goldie and Prof Warwick Anderson:

1. Assessments have been made prior to this meeting but panellists can still "rescue" those identified as "Not For Further Consideration" (NFFC; ist issues earlier this year to allow more focus on thise Apps that remain viable)
2. Project Grants are approximately 50% of NHMRC funding
3. 54/299 New Investigator grants were funded last year. 297 NI Apps this year
4. Mean requested budget in 2012 was $626,345 ($48k-$3,422k)
5. Project grants trending toward more multi-disciplinary teams and application content
>7,800 external assessments were received (14,300 requests sent out), 97.3% have 3 external assessments
6. Most panels have <100 Apps to consider before NFFC

The link to the full 1-hour long webcast is at http://webcast.gigtv.com.au/Mediasite/Play/ac7f74b9e0164561b15c914f07e108861d

Read More

3 in 50 mostly asymptomatic workers handling live poultry have H7N9 antibodies...

Earlier in the week Yang and colleagues, publishing in the Journal of Infectious Diseases, found that among 1570 people from Zhejiang province tested for antibodies towards influenza A(H7N9) virus, 25 of 396 (6.3%) poultry handlers from live poultry markets had antibodies detected. Only 9 (0.8%; statistically significantly fewer) of the 1129 community members showed signs of an immune response to H7N9 infection while 33 of 45 (73%) laboratory confirmed H7N9 cases had significant levels of antibody.

No poultry handlers (mostly exposed through slaughtering) had H7N9 in nasal swabs collected at the time of blood sampling, probably reflecting that collection had occurred after the infection that elicited antibody had resolved. Less than 4% of poultry handlers or the general community had fever or respiratory symptoms at sampling compared to 100% of the lab-confirmed group.

This partially answers one of my questions from earlier in the year - but leaves the part which asks: if the main H7N9 host is poultry (and not wild birds), why don't we see the majority of ill people coming from the poultry worker population? While aerosol transmission has been described as low among ferrets, H7N9 transmission might be effective enough to explain the other human H7N9 cases not due to slaughtering of poultry.

Now we can say that poultry handlers are getting exposed and 3 in every 50 are getting infected (or mounting an immune response, to be pedantic). Only 3% of this population and 10% of the general community had underlying diseases compared to 64% of the lab confirmed cases. Sex of the groups did not seem to play a role but those aged =60-years were over-represented among the lab-confirmed H7N9 cases (53% of them) compared to poultry handlers (1%-a much younger population) or the general community (19%).

As for MERS-CoV, underlying conditions and older age are clearly important risk factors for more severe disease.

The authors also noted that higher antibody levels were found in survivors that in fatalities, perhaps suggesting (a) the fatalities did not have time to mount a suitable response before they succumbed or (b) the antibodies protected against worse outcomes. Poultry workers do not always have serious disease, which probably means lower viral loads and thus reduced likelihood that they are major sources of human-to-human transmission.

In a previous study by Bai et al, using one of same sort of antibody detection techniques (haemagglutination inhibition), no poultry handlers from were found to be positive prior to late 2013. So this new article proves the emergence of H7N9 human infections is a recent event. And this provides Chapter 2 on that earlier post. 

Some questions still remain in my mind:

• Are these 3/50 poultry handlers also getting moderately or severely ill? 
• How often does infection in this group result in asymptomatic or mild disease?
• If disease is mild or asymptomatic in poultry handlers, is it because these workers are exposed to poultry with other influenza viruses comprised of proteins that are or are sufficiently related to H7 and so they already have some protective immunity to moderate their disease after H7N9 infection? 

Read More

H7N9 antibody study finds no sign of infection in contacts of Taiwan's only H7N9 case to date...

Hseih and colleagues describe, in the Journal of Infection, their a study to find antibodies made in response to infection by influenza A(H7N9) virus among any of the 14 close contacts  of the only H7N9 case outside of mainland China, in Taiwan.

None of the contacts had influenza-like illness (ILI) during a 28-day monitoring period and none had had significant levels of antibody.

The authors conclude that human-to-human H7N9 transmission risk is low, based on these 14 cases.  

Read More

Baboons and MERS-CoV....

This post is based on @dspalten and his interest materials and analyses

Twitter yields all sorts of things to think about. Since the Lancet article on MERS-CoV-like antibody reactivity in dromedary camel sera, one tweeter has been a strong proponent of testing baboons, an African and Arabian old world, omnivorous monkey, for MERS-CoV.

A troup of Hamadryas Baboons (Papio hamdryas) outside
of Riyadh, Saudi Arabia. Hamadryads live for 30 to 35-years
Image from Northwest Wildlife Homepage.

While there is probably a very long list of animals that humans may come into contact with that could be the primary or secondary host of MERS-CoV, I've listed some of the points and references (some websites at the bottom) supporting why we should add baboons to that testing list:

• Baboons roam the horn of Africa (mid-eastern) and the southwestern Arabian peninsula including Yemen and the Kingdom of Saudi Arabia (KSA). They can climb trees.
• They are highly adaptable to environmental change and will make use of human communities for food
• They are known to acquire, harbour and suffer from, a number of bacterial and viral infectious diseases that affect humans and their fellow primates. These include tuberculosis, Salmonella , Shigella, Cryptosporidium, and viruses including HIV-2
• In Africa, humans self-report baboon exposures to include:
• Baboon to human:  eating baboon leftovers, from contact with faeces, screaming/breathing near humans, contamination of water sources, biting insects/flies
• Human to baboon: contact with sick people, bad sanitation/hygiene/human wast disposal, insect bites/flies
• Coronavirus particles were visualized in 1982 by Smith and colleagues baboon faeces from baboons and primates (some with diarrhoea/gastroenteritis, but no association). 
• Persistent excretion was noted
• The CoV-like particles did not grow on Vero cells at that time (MERS-CoV does)-because a picornavirus outgrew them (I hate it when that happens!). 
• Weaned animals had a higher prevalence of CoV particles than unweaned primates
• Other viruses found in these animals by this group of researchers include adenoviruses, herpesviruses, picornaviruses, bacteriophage and an unknown virus particle
• Signs of a spontaneous CoV outbreak in macaques and baboons was reported in a Russian (non-English) publication in 1994 by Goncharuk and colleagues. The spontaneous monkey CoV outbreak in an animal house was due by a CoV that serologically cross-reacted with the human CoV OC43. Cases were associated with pneumonia and enterocolitis.
• Another Russian article in 1986 by Shevtsov an colleagues also notes monkey involvement in an animal nursery
• Memish and colleagues noted in an article about Alkhurma haemorrhagic fever virus (AHFV) in the International Journal of Antimicrobial agents in 2010, that baboons could be found in the populous Makkah  (Mecca) region. While AHFV cases had been noted in this and other regions of the KSA, and may be occurring in baboons, no active surveillance was being carried out  for this virus.
• Drewe and colleagues described in an article in 2012 in Emerging Infectious Diseases, the infections spread between baboons and baboons and humans in Cape Town, South Africa. These baboons, Papio ursinus, are a tourist attraction, coming into frequent contact with humans. 
• The animals were seropositive for, or cross reactive to, cytomegalovirus and Epstein Barr virus (herpesviruses) and hepatitis A virus (HAV). 
• The authors noted concerns about HAV which us transmitted via the faecal-oral route and the fact that 6/7 urban were HAV seropositive while 0/8 forest baboons had antibodies.
• The data suggested a low risk, but a risk nonetheless  for zoonotic transmission of viruses

So we know that baboons are in the KSA area, they can harbour human or human-like viruses including possible coronaviruses, they adapt well to changes in their environment, they are highly mobile, they are not afraid of humans and they can be found in close contact with humans and areas of human habitation.

Definitely worth considering if anyone is getting around to some serious hunting for the source of MERS-CoV or other viral disease sources...or just for virus hunting in general. Great way to fight of the next pandemic would be to find the virus and source before we become the sentinel species of it's spread (hat tip to crof). 

This also plays into the concept of "One Health" which recognises that more than half of human infectious diseases originated in animals.

Just for the record, in case anyone interprets this or my posts on camels in such a way, I do not advocate the culling of an animal species because it is or may be a carrier of MERS-CoV. 

I do advocate quick reactions to create practices that reduce the risk of exposure to such animals. That is something that can be achieved in the interim while more scientific data are collected, even if we are not 100% certain of the transmission picture yet (if one can be 100% certain about anything in a biological system). 

I really don't think we need to go to the other extreme and decry new findings, such as those in camels, when we don't yet have enough data to prove or disprove their role in MERS. 

Education into reducing the risk of exposure may be the quickest and easiest way to minimise new MERS-CoV cases. In the meantime, expanded testing of other animals might help find the source.

• http://bwindiresearchers.wildlifedirect.org/2011/05/30/raiding-baboons-and-disease-risk/
• https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CDYQFjAC&url=http%3A%2F%2Fwww.itfc.org%2FWorkshop2011%2FPresentations%2520day%25201%2FBaboons%2520as%2520Potential%2520Reserviors%2520of%2520Pathogens%2520around%2520Bwindi%2520INP.pdf&ei=51oJUpqMEKqiiAe6ioCgCw&usg=AFQjCNE66l7isro843JpGDAJboZQm1tXRg&bvm=bv.50500085,d.aGc
• http://www.northwestwildlifeonline.com/Saudi%20Arabian%20Wildlife.htm
• 
  

Read More

Camels being tested for MERS-CoV by Saudi Arabia?

An article on arabnews.com has Prof Ziad Memish saying that the Ministry of Health has "subjected samples from camels and sheep to lab tests" (not the long-delayed batch of samples Ian Lipkin recently received?).

Hopefully that means PCR-based testing with any of the various assays publicly available. 

The article notes the results will be announced after tests are completed.

This sounds a lot like reaction to the recent Lancet paper that found antibodies in dromedary or "Arabian" camels...the article does not note whether this is an ongoing study. Notably, camels were implicated early on the in the MERS-CoV outbreak.These new data will be very important in placing the Lancet article into context.

As Professor Marion Koopmans noted to me on Saturday,

"..we tried to rule out cross reactivity, and would not have published if we were not fairly sure that this is the case, but we will know for sure if someone finds the virus that triggers these antibodies."

Perhaps these will be the findings.

Read More

Coronavirus family tree....

The phylogenetic tree below shows the relationships among the four genera of coronaviruses (CoVs); Genus Alphacoronavirus, Betacoronavirus, Deltacoronavirus, Gammacoronavirus. 

This tree is based on full length genomes (nucleotides; aligned using Geneious Pro; Neighbor-Joining tree built using Mega with 500 bootstraps). 

The MERS-CoV clade of betacoronaviruses is marked on the left and the endemic human CoVs are indicated with yellow triangles.

Read More

Editors's Note #11: A 5-min interview with me, on MERS-CoV

I was asked to chat about the MERS-CoV by FullSpectrumSurviviral, a YouTube Channel that produces the segment, News in Two Minutes.

Their newest venture is a segment called 5 Minute Interviews, interviewing researchers and individuals on current topics with a view to providing short bursts of quality background information for an interested audience. 

Because VDU was created with a view to breaking down the science of Virology and all its interconnected fields, I'm happy to do this sort of thing if I can make the time. I'm also very privileged to have been asked to be part of eh first interview in this new series. Have a look - perhaps there will be something in there that's new and interesting. 



Man, I still say "Um" a lot when I'm nervous!

Read More

Human H7N9 case in Guangdong province: Update [Updated!]

Hat tip to crofblogs for alerting me to this news article.

The Guangdong case was confirmed by Chinese CDCP.

A story on Xinhuanet describes that most (54/96) of the contacts of the 51-year old positive woman have been released - it is not clear whether they were lab tested or only under observation for signs or symptoms of respiratory disease. The patients son had a mild fever (now

resolved), but has so far tested negative for H7N9.

I wonder if the child was positive for any other virus, or if H7N9 is/was just not at sufficient viral load yet in the site of sampling (upper/lower respiratory tract).

The consulting clinician who devised the treatment plan, Prof  Zhong Nanshan noted that the current practice is to use twice the amount of Tamiflu with intravenous peramivir to be used sparingly if warranted.

Samples from 69 chickens, 8 ducks, a goose (no partridges?) and 25 environmental samples - all collected from the marketplace where the woman worked - tested negative of any H7-type influenza A viruses.

The mother remains in critical condition.

The H7N9 tally now stands at 136 cases (which includes an asymptomatic boy and Taiwan case not added to the mainland tally) with 44 (according to the Xinhuanet report) deaths. This makes the proportion of fatal case (PFC) is at 32.3%; rising by 1 from the last WHO H7N9 update here [New update just out confirms 44, will be on this list soon).

Read More