Influenza Virus Mashup

(Wed, 31 Aug 2011 15:21:00 +0000)

Photo Credit CDC PHIL 

# 5798

HAIs, or Hospital Acquired Infections, take an incredible toll on patient’s health and our health care system every year. 

According to the HHS, they rank among the top ten leading causes of death in the United States, and accounted for an estimated 1.7 million infections and 99,000 associated deaths in 2002.

While hospitals are constantly working to reduce the incidence of HAIs, it is a daunting task.  We live in a  germy world, and the opportunities to spread bacteria in a healthcare setting are abundant.

Studies have shown that while compliance rates are improving, up to 50% of health care workers in the United States may fail to consistently wash their hands between patients (cite).

This year, the World Health Organization designated May 5th as global  CLEAN YOUR HANDS DAY - to encourage HCWs (Healthcare workers) to improve and sustain hand hygiene practices around the world (see A Movement With Five Moments).

 

One of the ongoing concerns regarding nosocomial transmission of pathogens has been that lab coats, neckties, and long sleeves might help to spread harmful bacteria from patient to patient in a healthcare facility.

In response, in 2007 the NHS banned the wearing of long-sleeved white coats, wristwatches, and neckties by HCWs in hospital wards, and in 2009 the AMA (American Medical Assoc.) considered a “bare below the elbows” dress code during their annual meeting, but decided the issue needed more study (see Lab Coat Legislation).

The rap against lab coats and neckties has primarily been that they are not usually freshly laundered every day.

One recent study showed that 62% of doctors surveyed waited 2-weeks or longer to launder their coats. 

 

While that sounds like a bit of a red flag, earlier this year we saw a study (see The Long And The Short Of It) that found no statistical difference between the amount of bacteria of freshly laundered short sleeve uniforms versus infrequently laundered white coats after only 8 hours wear.

What isn’t known is how well pathogens transfer from uniforms to the surrounding environment, or to patients.

Today, another study appears in APIC’s American Journal of Infection Control, that looks at the prevalence of harmful bacteria on uniforms worn in a university-affiliated hospital in Israel.

The areas of each uniform tested were the abdominal zone, sleeves’ ends and pockets.

 

Potentially pathogenic bacteria were isolated from the uniforms of 85 participants (63%) and were detected in half the samples taken.

They found 21 cultures from the nurses uniforms and 6 from physician uniforms grew multi-drug resistant pathogens, including 8 that grew MRSA.

While a bit disconcerting, given the environment in which these uniforms are worn, and previous studies we’ve seen, these results are not all that surprising.

The abstract can be read at:

AJIC: American Journal of Infection Control
Volume 39, Issue 7 , Pages 555-559, September 2011

Nursing and physician attire as possible source of nosocomial infections

Conclusion

Up to 60% of hospital staff’s uniforms are colonized with potentially pathogenic bacteria, including drug-resistant organisms. It remains to be determined whether these bacteria can be transferred to patients and cause clinically relevant infection.

In an Elsevier Health Services Press Release (Doctors’ and nurses’ hospital uniforms contain dangerous bacteria majority of the time, study shows), APIC President Russell Olmsted, MPH, CIC is quoted as saying:

"It is important to put these study results into perspective. Any clothing that is worn by humans will become contaminated with microorganisms. The cornerstone of infection prevention remains the use of hand hygiene to prevent the movement of microbes from these surfaces to patients.

 

New evidence such as this study by Dr. Wiener-Well is helpful to improve the understanding of potential sources of contamination but, as is true for many studies, it raises additional questions that need to be investigated."

Last year, according to Infection Control Today, the American Medical Association (AMA)  announced plans to begin formal research on "textile transmission of infections" singling out the "physician’s white lab coat as a primary concern associated with textile transmission of infections."

Promising new technologies, including bacteria-resistant fabrics, are being developed in hopes that they will reduce HAIs.

But for now, more research is needed to determine just how much of a role contaminated uniforms really play in the spread of harmful pathogens to patients in the hospital.

Via Daily News & Analysis.com: India prepared to deal with bird flu: Government. Excerpt:

In the wake of the international agriculture monitoring and research body Food and Agriculture Organisation (FAO) issuing an alert for bird flu, the Indian government on Wednesday said it is prepared to handle any situation. 

"A few reports have come out in the press mentioning an FAO alert against a new and deadly mutant strain of avian influenza, popularly known as bird flu. The government has taken note of the FAO’s alert and is prepared for any eventuality," an agriculture ministry statement said. 

FAO, in a statement issued on August 29, has "urged heightened readiness and surveillance against a possible major resurgence of the H5N1 Highly Pathogenic Avian Influenza amid signs that a mutant strain of the deadly Bird Flu virus is spreading in Asia and beyond, with unpredictable risks to human health". 

The agriculture ministry statement sought to allay the fears, saying a standard procedure was followed when ever any case was reported and this has so far kept the situation in control. 

"Outbreaks of avian influenza have occurred in several countries in Asia for some time now. India has successfully handled all outbreaks in the country ever since the first outbreak of avian influenza in February 2006." 

According to the government, the last outbreak of bird flu which hit the northeastern India in February this year was controlled effectively. 

"The last outbreak took place during February-March, 2011, in Tripura. After following prescribed control and containment procedures the country was declared free from the disease with effect from July 4, 2011”.

WHO has published a statement: Evolution of H5N1 avian influenza virus does not increase risk to public health.

WHO closely monitors the evolution of influenza viruses and is aware of recent reports of an H5N1 virus (described as H5N1 clade 2.3.2.1) circulating in poultry in parts of Asia. 

Based on available information, this evolution of the H5N1 virus poses no increased risk to public health. It is not considered unusual because influenza viruses are constantly evolving, especially in areas where they circulate regularly in poultry. 

The WHO Global Influenza Surveillance and Response System, the group of experts that studies animal and human influenza viruses that may impact human health, recognized this new clade in February 2011. 

WHO also routinely assesses the public health risk from all animal influenza viruses. Based on available information, the identification of this newly-reported H5N1 virus clade does not change the current public health implications of the H5N1 avian influenza viruses for humans. 

Human cases of H5N1 infection remain rare and sporadic events, occurring mostly in areas where H5N1 viruses circulate regularly in poultry. Human cases could occur wherever the viruses are present in poultry and when humans might be exposed to infected birds or contaminated environments.

(Wed, 31 Aug 2011 11:24:00 +0000)

# 5797

The World Health Organization has posted a brief statement regarding the FAO’s warning earlier this week (see FAO Warns On Bird Flu) of a mutated strain of the H5N1 virus circulating in China and Vietnam.

This FAO announcement has been widely reported by the press, and over the past 48 hours has elicited some criticism (see Australian CMO Calls Bird Flu Warning `Overstated’) for stating that this emerging strain poses `unpredictable risks to human health.”

Given the amount of press coverage this statement has received, the WHO has sought to clarify matters with the following statement.

 

Evolution of H5N1 avian influenza virus does not increase risk to public health

30 August 2011 — WHO closely monitors the evolution of influenza viruses and is aware of recent reports of an H5N1 virus (described as H5N1 clade 2.3.2.1) circulating in poultry in parts of Asia. Based on available information, this evolution of the H5N1 virus poses no increased risk to public health. It is not considered unusual because influenza viruses are constantly evolving, especially in areas where they circulate regularly in poultry.

 

The WHO Global Influenza Surveillance and Response System, the group of experts that studies animal and human influenza viruses that may impact human health, recognized this new clade in February 2011.

 

WHO also routinely assesses the public health risk from all animal influenza viruses. Based on available information, the identification of this newly-reported H5N1 virus clade does not change the current public health implications of the H5N1 avian influenza viruses for humans. Human cases of H5N1 infection remain rare and sporadic events, occurring mostly in areas where H5N1 viruses circulate regularly in poultry. Human cases could occur wherever the viruses are present in poultry and when humans might be exposed to infected birds or contaminated environments.

As I wrote yesterday, we’ve no indications that this new strain of H5N1 is any more likely to be transmitted to, or among, humans than the earlier strains.

What we are seeing is viral evolution in action.  And for influenza viruses, the only constant is change.

For now, this new clade presents the biggest challenge to poultry farmers in countries where it is now endemic. Current vaccines do not protect livestock against it, and so the fear is it will spread further across Asia.

And that could not only result in substantial losses in countries already dealing with low food security, it could potentially expose more people (along with a variety of non-human hosts) to the virus.

 

Providing the H5N1 virus with more opportunities to evolve and adapt.

Hence the calls for increased surveillance and vigilance.

Not so much for what the public health threat of the H5N1 virus is today, but for what it might become in the future.

The United Nations warned Monday of a possible resurgence of the deadly bird flu virus, saying wild bird migrations had brought it back to previously virus-free countries and that a mutant strain was spreading in Asia.
A mutant strain of H5N1, which can apparently sidestep defences of existing vaccines, is spreading in China and Vietnam, Tthe U.N. Food and Agriculture Organization said in a statement Monday. It urged greater surveillance to ensure that any outbreaks are contained.

continued

http://www.thespec.com/news/world/article/585758–un-warns-of-new-bird-flu-outbreak

Australia
• Bird flu no threat to Australia: chief medic

Bangladesh
• 21,500 chickens culled in Chuadanga

India
• Research on HINI deaths
• Kanpur: Three cases of swine flu detected
• Lucknow: Swine flu alert in state; 13 cases in 10 days
• FAO alerts India of possible bird flu resurgence
• Bangalore: Man succumbs to H1N1

New Zealand
• Big chill brings flu crisis

Thailand
• Thailand alerted to bird flu after patients reported in neighbouring countries

United States
• MA: State will cut free flu shots by over half
• OH: Flu vaccinations now mandatory for Children’s Medical Center workers

General
• UN warns of new bird flu outbreak
• Bird Flu in China and Vietnam

Commentary
• Recombinomics: Indiana trH3N2 Case With Pandemic H1N1 MP
• Recombinomics: trH3N2 Sequence Cluster Raises Pandemic Concerns
• Australia: Bird-swine flu hybrid could be a killer combo

Research

• Sweden: Positive avian flu trial data using Isconova’s Matrix M published
• Elderly more susceptible to seasonal flu but better protected against H1N1, researchers say
• Australia: Treat all household contacts of flu patients “Intrahousehold Transmission of Pandemic (H1N1) 2009 Virus, Victoria, Australia”:

(Tue, 30 Aug 2011 16:31:00 +0000)

# 5796

Tomorrow, August 31st from 1:00 PM to 2:00 PM EDT, the CDC will present a webinar on the role of social media in disaster preparedness.

Details on how to attend online can be found at the web page below.

 

Leveraging Social Media for Disaster Preparedness

Join us on Wednesday, August 31st, 2011 1:00 PM (ET) for a special webinar presentation "Leveraging Social Media for Disaster Preparedness."

 

This presentation will begin by laying out the major areas where social media is being used in emergency preparedness, response, and recovery. The presenter will discuss the ways that social media can be leveraged to enhance situational awareness, strengthen operational aspects of response, support recovery efforts, and build community resilience.

(Continue . . . )

Mike Coston at Avian Flu Diary has the story: Australian CMO Calls Bird Flu Warning `Overstated’. Excerpt:

With many newspaper headlines screaming the words `Mutant Bird Flu’ in their headlines these past 24 hours, not everyone is happy with the wording of the FAO’s recent announcement.   

Australia’s new CMO (Chief Medical Officer) Professor Chris Baggoley, who took office this week, has called the warning `overstated’.

(Tue, 30 Aug 2011 13:46:00 +0000)

# 5795

With many newspaper headlines screaming the words `Mutant Bird Flu’ in their headlines these past 24 hours, not everyone is happy with the wording of the FAO’s recent announcement.

Australia’s new CMO (Chief Medical Officer) Professor Chris Baggoley, who took office this week, has called the warning `overstated’.

To read his comments, and concerns, you can visit Radio Australia’s article called:

Australian medical chief talks down Asian bird flu fears

While the media has, a bit predictably, latched onto the more sensationalized human implications of this mutation, the primary threat at this time is to poultry.

So far, the H5N1 virus remains poorly adapted to human physiology.

The FAO announcement (see FAO Warns On Bird Flu) simply stated that this new strain “is spreading in Asia and beyond, with unpredictable risks to human health.”

While perhaps not the most reassuring statement in the world, it happens to be true.

To be clear, we’ve no indications that this new strain of H5N1 is any more likely to be transmitted to, or among, humans than the earlier strains. And human infections from the bird flu virus, thus far, have been mercifully few in number.

No one knows if the H5N1 virus will ever develop the ability to transmit efficiently among humans.

 

And there are other influenza viruses out there with perhaps even a greater chance of sparking the next pandemic.

While one can argue that the threat of a bird flu pandemic remains remote, the FAO has a responsibility to alert us whenever they have knowledge of an emerging zoonotic health concern.

One can only imagine the howls of protest should H5N1 suddenly emerge as an imminent threat and the appropriate agencies had failed to warn us.

Given the circumstances, simply stating the truth  . . .  that this new strain poses `unpredictable risks to human health’, hardly seems alarmist. 

(Tue, 30 Aug 2011 12:04:00 +0000)

# 5794

With yesterday’s FAO announcement (see FAO Warns On Bird Flu), the H5N1 virus is suddenly back in the news cycle again.

Today, the Australian Life Scientist Magazine carries an interview with world renown, 1996 Nobel Prize winning scientist Professor Peter Doherty, who discusses the pandemic potential of this avian virus.

Although his comments range from research on GM (genetically modified) flu-resistant chickens to universal flu vaccines, the main thrust of the today’s article centers around the possibility that the H5N1 virus might one day swap genes (reassort) with the H1N1 virus and produce an easily transmitted, highly virulent flu strain.

First a link to the article, which is very much worth reading, then I’ll return with more.

Bird-swine flu hybrid could be a killer combo

The appearance of a new mutant of bird flu in Asia raises the concern that it might hybridise with swine flu creating a new pandemic threat.

• Tim Dean (Australian Life Scientist)
• 30 August, 2011 17:12

As we’ve discussed before, influenza viruses change, evolve, or mutate over time via two well established routes; Antigenic drift and Antigenic Shift.

Antigenic drift – the more common of the two - causes small, incremental changes in the virus over time.  Drift is the standard evolutionary process by which influenza viruses mutate, and often come about due to replication errors that are common with single-strand RNA viruses.

Shift occurs when one virus swap out chunks of their genetic code with gene segments from another virus.  This is known as reassortment. While far less common than drift, shift can produce abrupt, dramatic, and sometimes pandemic inducing changes to the virus.

This process has produced pandemic flu strains in the past, and while that obviously doesn’t happen often, virologists are quick to remind us:

 

Shift Happens.

While reassortment can occur in many species, pigs have long been believed to be an ideal `mixing vessel’ for influenza because they possess both avian-like (SAα2,3Gal) and human-like (SAα2,6Gal) receptor cells in their respiratory tract.

That makes pigs susceptible to human, swine, and avian strains of flu. And while it may not happen often, they are capable of being infected by more than one flu virus at a time.

This is basically how the 2009 H1N1 pandemic virus evolved, although it took multiple gene swaps over a decade or longer before it finally emerged into the human population.

We know that reassortments do happen, but only rarely do they result in a biologically fit virus capable of causing a pandemic.

 

Most hybrid viruses are evolutionary dead-ends, are unable to compete, and die out within the host.

But as global pig production grows – particularly in places where biosecurity and surveillance may be lax – it creates increasing opportunities for a new, biologically `fit’  virus to emerge.

Source: FAO

Lest anyone doubt the ability of pigs to contract the H5N1 virus, a little over a year ago (see EID Journal: Asymptomatic H5N1 In Pigs) we saw research out of Indonesia that showed 52 pigs in 4 provinces were found to be infected with H5N1 between 2005–2007. 

While there is justifiable concern over a reassorted H5N1 virus, bird flu isn’t the only pandemic player down on the farm.

 

The H9 and H7 avian viruses, along with various strains of H3 and H1 influenza (and others) are all potential candidates for reassortment.

For more on the reassortment potential of avian, swine, and human flu viruses, you can’t do better than  Helen Branswell’s excellent Scientific American article from last December called Flu Factories, or her SciAm Podcast interview.

And for good measure, a sampling of a few of my earlier blogs on reassortment:

 

Review: Evolution & Adaptation Of The 2009 pdmH1N1 Virus

You Say You Want An Evolution?

EID Journal: Co-Infection By Influenza Strains

EID Journal: Swine Flu Reassortants In Pigs

If You’ve Seen One Triple Reassortant Swine Flu Virus . . .

 

Thanks to Sari Setiogi for tweeting the link to this article in Kompas.com: Indonesia Facing Biggest Problems of Possible Bird Flu Resurgence. First an excerpt, then a comment:

The United Nations warned of a possible major resurgence of bird flu and said a mutant strain of the H5N1 virus was spreading in Asia and elsewhere. 

The UN’s Food and Agriculture Organisation (FAO) on Monday urged increased surveillance and preparation for a potential outbreak of the virus, which it says has infected 565 people since it first appeared in 2003, killing 331 of them. 

The virus was eliminated from most of the 63 countries infected at its peak in 2006 after mass poultry culling, but since 2008 it has been expanding geographically in both poultry and wild birds, partly due to migration patterns, the FAO said. 

“The general departure from the progressive decline observed in 2004-2008 could mean that there will be a flare-up of H5N1 this fall and winter,” the FAO’s chief veterinary officer, Juan Lubroth, said in a statement. He said the appearance of a variant strain of the virus in China and Vietnam was a concern, because it appeared to be able to sidestep the defences of existing vaccines. 

The circulation of the virus in Vietnam also poses a direct threat to Cambodia, Thailand and Malaysia as well as endangering the Korean peninsula and Japan, FAO said. 

The latest human death occurred earlier this month in Cambodia, which has registered eight cases of human infection this year, all of them fatal, the agency added. 

Countries that could face the biggest problems are Bangladesh, China, Egypt, Indonesia and Vietnam, where the FAO said the virus is still firmly entrenched. It said recently affected areas included Israel, the Palestinian Territories, Bulgaria, Romania, Nepal and Mongolia.

Meanwhile, a Flublogian of long standing Scott McPherson, is back blogging after too long away. He says this new mutant is actually our old pal the Fujian strain, which was thriving in China in 2008 and even earlier. (The Chinese were no more happy about the "Fujian" tag than the Indians are about New Delhi as the name for the NDM-1 superbug.)