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Evidence that Reston ebolavirus resides in live bats in the Philippines...

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Update #1 18JUN2015
Jayme and colleagues find some
"smoking bats"-possible bat reservoir
species for Reston ebolavirus
in the Philippines.
In what I think is only the second example of this, a new collaborative study from Jayme and a team of eminent researchers in the Philippines, Australia, Vietnam and the United States, have reported the finding of Reston ebolavirus (RESTV) viral RNA and antibodies to viral infection in a range of different bat species....some more "smoking bats" - bats with more than just past evidence, sometimes considered vague and unreliable, of an ebolavirus being hosted by the animal.

The finding of RNA is not the same as actual infectious virus, but RNA is a very specific marker for the virus nonetheless. And the authors note that they didn't want to kill the bats so only a small volume of sample was available-not enough for culture.

Leroy and colleagues had previously reported finding Zaire ebolavirus RNA and antibodies against this species of virus in Hypsignathus monstrosus, Epomops franqueti and Myonycteris torquatebats, all fruit-eating megabats of the family Pteropodidae. These are considered to be important reservoir hosts, yet they do not show signs of disease.[2] 

According to one of the authors on the latest study, bats in the Philippines also seemed clinically well...

Locating the Philippine RESTV sequences
on the ebolavirus phylogenetic tree.
Jayme et al. Virology J. (2105) 12:107.[1]
Jayme's findings are important to the story of RESTV importations to animal facilities in the United States from the Philippines which occurred multiple times between 1989 to 1996. These fed into the dramatized retelling we know of as The Hot Zone. There were also signs of antibodies to the virus in humans working with infected non human primates in the Philippines in 1994, 1996 and 2008.

The amount of viral RNA in most of the bats was quite low - but was usually repeatably detectable. I'm a firm believer in PCR giving a specific signal when there is something specific present to detect (assuming it was done in a professional laboratory setting that reduces the risk of false positives-which it was in this instance). So low viral loads are not no viral loads.

RESTV RNA was repeatably found in oropharyngeal swabs taken from bats assigned to the following species:

...and in one sample from:
  • Chaerephon plicata (Wrinkle-lipped Free-tailed Bat; range; insectivorous bats)
What's particularly interesting to me is that some of these bat species are found in Australia. However, keep in mind that the range of some (?many) bats may be underestimated. The example here is using the IUCN Red List's described range for M. schreibersii-apparently it's a bat that inhabits an area around the Mediterranean.[4] Last I looked, the Philippines is a bit south of there. In the past, as Wikipedia lists, a much bigger range was ascribed to this bat, also including Australia,[5] Guinea, Liberia and Sierra Leone - among many others. Looks like there may be lots of work to do in the area of bat census.

Jayme and colleagues also sampled the blood of 61 flying foxes (of the fruit-eating bat family Pteropodidae) and antibodies were found by ELISA and Western blot in 3 Acerodon jubatus (giant golden crowned flying fox; range) bats and by ELISA alone in a Pteropus vampyrus (Large flying fox; range). If you trust the test, then this indicates past exposure.

Superman and the Joker know very well - Bats can be very tricky. But at least this finding helps to further address the Riddle(r) of the reservoir. Now, if only we could only nail down the specific culprit(s) in West Africa.

References...
  1. Molecular evidence of Ebola Reston virus infection in Philippine bats
  2. Fruit bats as reservoirs of Ebola virus
  3. Many details about bats to be found at the excellent IUCN Red List
    http://www.iucnredlist.org/
  4. Population Structure of a Cave-Dwelling Bat, Miniopterus schreibersii: Does It Reflect History and Social Organization?
    http://jhered.oxfordjournals.org/content/100/5/533.full
  5. Seasonal movements of the Schreibers� bat, Miniopterus schreibersii, in the northern Iberian Peninsulahttp://www.tandfonline.com/doi/abs/10.1080/11250000801927850#.Vamrtvnzp1M
Updates...
  1. Added bat specie range data (and discussion) from IUCN Red List and Wikipedia.
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Haemorrhagic fever viruses...

A viral haemorrhagic fever (VHF) is an umbrella description for severe illnesses, usually discussed in relation to human and non-human primates, which can be associated with bleeding - although not always or even most of the time. VHF diseases often have fever and can affect multiple organs and systems within the body.

Outbreaks of VHFs are zoonotic (infection of humans after contact with an infected animal) and often irregular, reflecting sporadic transmission from an infected animal or insect host, spread between humans, or from an animal reservoir to other animal hosts.

As we learn more, it seems that the majority (?all) of viral infections result in outcomes that exist in a spectrum from severe to moderate to mild and even at times and perhaps controversially, asymptomatic infections (depending on what and how you measure and whether you look deeply enough and for long enough). Yet even though overt bleeding might not be obvious, there are frequently laboratory indications of clotting abnormalities in the blood of infected people-so the naming is still functional.[4] Bear in mind however, that "VHF" may not always be used to describe severe disease, but it will always be a term that pervades the historical literature.

VHF disease results mostly from infection by a number of viruses which have RNA genomes surrounded by a lipid envelope and which belong to a wide range of distinct viral families. Below I've listed some of these family names in italics (immediately adjacent to the filled bullet point) and under each family are some specific examples of viral species, also in italics (open bullet point):[3]
  • Arenaviridae including: 
    • Lassa mammarenavirus (disease: Lassa fever) 
    • Jun�n mammarenavirus (disease: Argentine haemorrhagic fever)
    • Machupo mammarenavirus (disease: Bolivian haemorrhagic fever)
  • Bunyaviridae including:
    • Crimean-Congo haemorrhagic fever virus 
    • Rift Valley fever virus (disease: Rift Valley fever)
    • Hantaan virus (diseases: hantavirus pulmonary syndrome [HPS], hantavirus haemorrhagic fever with renal syndrome [HFRS])
  • Filoviridae including: 
    • Zaire Ebolavirus (Ebola virus disease [EVD]) 
    • Marburg marburgvirus (Marburg virus disease)
  • Flaviviridae including: 
    • Yellow fever virus 
    • Dengue virus
    • Omsk hemorrhagic fever virus 
    • Kyasanur Forest disease virus
This blog has recently acquired quite a bit of knowledge about one of these VHF viruses - a variant of Zaire ebolavirus called Makona.You may have heard about what a single "sporadic" transmission is capable of in the right setting and circumstances.

Just like those all over the world who got caught out in different ways by the scale and ferocity of the EVD epidemic in West Africa last year and early this year, VDU knew little about the virus or the disease before March 2014. It took a lot of reading to get blog posts together in the early days and weeks. Over time VDU aims to learn more about the other viruses listed above so it can more effectively communicate about them...should the need arise; and that list is not exhaustive. As VDU learns, it will share that knowledge here. VDU isn't a textbook of course or is it a peer-reviewed source - its what's may be called community grey literature,[5,6] and there already many excellent resources for this knowledge. But as ever, I do this because it teaches me some new things as well as one or two of you - that makes it well worth my spare time and basically for purely selfish reasons! 

If you simply can't wait for more detail, you're now armed with a few names...so go forth and learn more!


References...
  1. http://www.who.int/topics/haemorrhagic_fevers_viral/en/ 
  2. http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/vhf.htm
  3. http://ictvonline.org/virustaxonomy.asp
  4. http://mmbr.asm.org.ezproxy.library.uq.edu.au/content/79/3/281.full.pdf+html
  5. http://www.lib.uwo.ca/tutorials/greyliterature/ 
  6. http://eprints.rclis.org/15411/9/5%2014%20Banks.pdf
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MERS simmers down in South Korea...did we learn anything this time?

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No new cases reported in 8 days and the most recent known date of illness onset now 10 days ago, are good indications that the Middle East respiratory syndrome coronavirus (MERS-CoV) hospital-driven outbreak in South Korea is pretty much over. At the least, it's contained. Finally.

Roughly speaking - based on the data from the South Korean Ministry of Health and Welfare, the World Health Organization and KBS news - there were four rounds of infection. In all, 186 cases of MERS have been reported, with 36 (19.4%) resulting in death up until the 13th July AEST:
MERS case spread among hospitals in South Korea
between the 11th May and the 19th June.
Cowling et al. Eurosurveillance Vol 20,
Issue 24, 25-JUN-2-15.[4]
Click on image to enlarge.

  • the 1st round was the person who flew into South Korea after visiting all over the Arabian Peninsula - he became ill on the 11th of May.[1,2]
  • the 2nd round included approximately 45 cases.[3] This group started becoming ill on the 19th of May, continuing until the 4th of June.[5]
  • the 3rd round included approximately 108 cases.[3] These people started showing signs and symptoms of disease between the 27th of May and the 13th of June.[5] 
  • the 4th round included approximately 22 cases.[3] This group became ill between the 5th of June and the 2nd of July.[5]
We've learned a few things (perhaps "relearned"?) and had a few things reinforced (even more) during this latest successful test of our healthcare systems ability to defend against a case becoming an outbreak...successful from the coronavirus' point of view that is. 

For example we saw that..
MERS-CoV detections, deaths, sex and age distribution in
the South Korean hospital outbreak.
From my MERS-CoV in South Korea page.
Click on image to enlarge
  1. MERS-CoV doesn't spread efficiently between humans - over 16,100 contacts did not develop MERS.[6] 186 did.
    While there were probably more infections among contacts (and future studies from South Korea will hopefully investigate and answer this), disease did not develop among many of those exposed to infected people.
  2. Closing schools, wearing masks in public, putting thermal imaging cameras in office buildings and quarantining zoo camels when not a single case has been acquired without link to a hospital was an exercise in failed communication between government and public.
    There was no indication that any of these costly, high profile measures prevented any transmission. There was also no point to them, precisely because transmission outside the hospital setting did not occur.[3]
    We have to learn to talk more, more often, and more clearly to our populations about the realistic risks of a new and scary virus when it shows up on our shores. We need to build trust here. Trust and respect takes time to build. In these outbreaks, we're always forced to rush because we seem incapable of investing in this before an event. Gods forbid we'd teach these concepts at school. We need to make a bigger deal about educating and informing our public about virus transmission. That is best done if the materials and the processes to roll the messages out to the public are already in place
  3. Holding back information that you have already collected doesn't build confidence in you.
    Whether that is not releasing the name of a hospital or the detailed data about deidentified cases, or presenting a list without discussion, engagement or correction when necessary 
  4. Hospitals are great places to spread infections, if infection control is not constantly running.
    Viruses aren't big on forgiving. Neither are zombies. The undead really suck that way. But the truth may well be that hospitals need to be on guard, cleaning surfaces and in PPE 24 hours  day, 7 days a week if they are dealing with cases of infectious disease that can be expelled from a human in the form of coughing, sneezing, bleeding or vomiting. Judging whether to use "standard precautions", "droplet precautions" or "airborne precautions" at some point after a coughing and sneezing patient has been sitting in the waiting area for hours, is going to be too little too late to stop new healthcare worker infections
  5. Allowing the public - that is, the otherwise healthy - to co-care for patients within hospitals and to sleep in rooms or wards with infected people expelling virus (as per #4) - is a bad idea if trying to contain an acute viral infection
  6. People with other underlying diseases get more seriously sick after MERS-CoV infection.
    Adult health in richer nations is not in a good way. When a wimpy spreader like MERS-CoV comes to town, it may do little damage to the young and otherwise healthy population, but we are not all healthy. 
We all have a role to play in protecting those among us who will suffer more greatly from an otherwise simple acute viral infection by even a rare and obscure camel-cold virus. Whether that is getting a vaccine to prevent us from becoming a hijacked virus production facility, being mindful of others when we cough and sneeze, or seeking out information from trustworthy sources to learn about the realistic threats from a new (or old) virus when it comes to town, we can all make some difference here. 

At some point, one of these viruses may well be better at hopping between us and may cause severe disease not just in those who have an existing ailment. If that day comes, we have proven yet again, that no facet of our response will be up to the task of halting its spread. 

We're not ready.  

But hey - that virus' arrival is probably many, many cycles of leadership change, war, and petty bickering away yet. We'll be ready by then. Right?

References..
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California Has Finally Stopped Denying Organ Transplants to Medical Marijuana Users

Nearly 19 years after her liver transplant, Yamileth Bolanos is no longer afraid of taking the medical marijuana that helps her get through the day.
Bolanos said her transplant doctors originally told her that if she used marijuana, she would be ineligible for an organ transplant if her liver failed again.
"I could be at the end of my warranty and what if they reject [me?]" she told VICE News.
This week, after California Governor Jerry Brown signed the Medical Cannabis Organ Transplant Act into state law, Bolanos was able to breathe a little easier.
The law bars medical officials from denying a patient a spot on a transplant list "solely upon a positive test for the use of medical marijuana," unless the drug use is clinically significant.
Bolanos' use of marijuana to cope with a major illness is becoming more common as 23 states have now legalized some form of medicinal marijuana. However, the drug can create problems at transplant centers since it is still illegal on the federal level, forcing medical staff and surgeons to consider if it should be considered an "illicit drug" that would make a patient ineligible for a transplant.
California is just the seventh state to pass a law protecting marijuana users from being removed from organ transplant lists, according to Americans for Safe Access, a pro-medical marijuana group.
As more states legalize medical marijuana, there are no guidelines or resolutions from the American Medical Association or the American Society of Transplant Surgeons regarding the issue as it relates to organ donation.
The United Network for Organ Sharing (UNOS), which administers the Organ Procurement and Transplantation Network, declined to speak directly on the issue but pointed out that transplant centers consider "all medical and social factors taken as a whole for any given patient."
While national medical associations have yet to comment, the California Medical Association passed a resolution in 2014 opposing "blanket restrictions of potential organ transplant donors and recipients based solely on reported or detected marijuana uses."
'Patients are often denied a life-saving organ transplant solely because they are prescribed medical cannabis.'
Bolanos started using medical marijuana four years after undergoing a liver transplant. The operation saved her life at age 41, but subsequent complications and medications left her with gastrointestinal problems that made her afraid to leave the house.
"There were days where I felt like it wasn't worth it," she said. Bolanos said it was life changing when she first tried taking a few puffs from a friend's joint.
"It was the first time I felt any relief after my transplant," the now outgoing 59-year-old medical marijuana advocate said. "Marijuana was what had given back to me my life and the quality of life."
While Bolanos said her doctors at UCLA initially said her marijuana use would disqualify her from getting a second organ, she felt she couldn't give up the drug. Years later, Bolanos said her physicians changed their minds, but she still feared that she could be barred from the transplant list due to her marijuana use.
California State Representative Marc Levine introduced the Medical Cannabis Organ Transplant Bill after hearing about patients similar to Bolanos being taken off transplant lists in the state.
"Arcane public health policies treat medical cannabis patients as drug abusers," Levine said in a statement. "As a result patients are often denied a life-saving organ transplant solely because they are prescribed medical cannabis. Many of these patients have died after being denied an organ transplant."
Bolanos herself was frightened into helping lobby for the bill after hearing about the death of Norman Smith, a 63-year-old cancer patient.
In a video made by Americans for Safe Access, Smith said he was taken off the organ transplant list at Cedars-Sinai Hospital after using medical marijuana that was prescribed to him by an oncologist at the same center.
Bolanos said after hearing Smith's story, she didn't really believe that he would remain off the organ transplant list as he got sicker.
"My thing has always been, 'What are they going to do, let him die?'" Bolanos recalled thinking at the time.
Smith did die in 2012 from complications of liver cancer, according to Americans for Safe Access.
A Cedars-Sinai spokeswoman declined to comment on Smith's case, citing federal patient privacy laws, but said at their "transplant program physicians take many complex factors into account in assessing every patient's viability for transplantation, ensuring the best chance for each patient's post-transplant health."
Dr. Christopher Wigfield, surgical director of the lung transplant program at the University of Chicago, said that transplant centers already consider multiple factors to determine a patient's transplant viability, including overall health, alcohol use, weight, and other chronic conditions.
"That's why transplant [surgery] is so complicated, we don't impose an abstinence policy just because," Wigfield said. "We need to be sure that we give the recipient [the] best chance of an outcome that matches their expectations."
Transplant patients who smoke marijuana have been found to have a higher risk of developing aspergillosis, a potentially fatal infection caused by a fungus that can grow on cannabis.
Wigfield said doctors also have to factor in how medical marijuana could interact with the delicately balanced regimen of drugs given post-surgery to keep patients alive.
Currently, 122,860 people are in need of an organ transplant in the US, according to UNOS.
Bolanos said she is now reveling in being able to use medical marijuana without the fear that she may be disqualified from getting a second transplant in the future. She uses the drug around three times a day just so she can bring herself to eat, but she isn't complaining about her daily regimen.
"I'm alive, honey, that's nothing — compared to being dead," she said.

[Original Article]

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Recovering female stroke victims may benefit from uric acid

A stroke is a life-changing event, impacting on an individual's psychological and physical well-being. Rehabilitation for recovering stroke victims is a crucial step for which many recovering patients struggle.
In the study - published in the journal, Stroke, for the American Heart Association (AHA) - Angel Chamorro, PhD, lead author and director of Barcelona's Comprehensive Stroke Center, Hospital Clinic Chamorro, Spain, sheds further light on what is the most effective treatment.
Dr. Chamorro and her colleagues re-analyzed 2014 data based on URIC-ICTUS, a randomized double-blind trial of patients admitted to stroke centers in Spain. The participants in the study were 206 women and 205 men who were all were given treatment to remove clots. Half of each gender group were randomly given either 1,000 mg of uric acid therapy or a placebo administered through intravenous infusion.
At the time, the results of the study interpreted the addition of uric acid therapy to neither increase the well-being of recovering stroke patients or lead to any safety concerns.
However, upon re-analyzing the data, researchers found 42% of women treated with uric acid reported less disability 3 months after a stroke compared with 29% of women treated with a placebo.
In addition, women had less dead tissue resulting from a lack of blood supply after receiving uric acid, but among men, there was essentially no difference between the uric acid treatment and the placebo.

Protect tissue from free radicals

In an ischemic stroke, the most common form of stroke, a clot lodges in an artery supplying oxygen to the brain. Once doctors remove the clot, oxygen is free to re-enter the brain but it also releases harmful monocles, known as free radicals, which can damage surrounding tissue.
Although high levels of uric acid can lead to health problems such as kidney stones and gout, results show it can be used to counteract the dangers of free radicals. According to Dr. Chamorro, women fared better because they traditionally possess less uric acid in their bodies.
In the study, women were, on average, 7 years older than men and they were more likely to have an irregular heartbeat, high pressure and other conditions. Dr. Chamorro believes results of uric acid therapy would be even more impressive when tested on young and healthier stroke victims. The findings echo a study last year that discovered uric acid to be a major intracellular antioxidant.
Last year, the AHA reported 795,000 Americans suffer from a new or recurrent stroke every year. About 55,000 more women suffer strokes than men in the US, with 60% of stroke deaths occurring in women. In response, guidelines for the prevention of stroke in women were created for the first time.

[Original Article]

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