Journalists archives
2003-2004
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The SARS episode went through the end of year
2003, and a short resurgence in 2004. Retrospective studies explaining
the reasons why the mortality due to the disease was so variable is
much wanted. It may be remarked that countries with the highest level
of medical treatments showed the highest mortality toll.
- 31 august 2004. At the International
Primatological Society, scientists from the Republic of Congo
indicated that an outbreak of Ebola haemorrhagic fever might be
killing gorillas. Two more patients (one passed away) in Vietnam
might have been infected by bird flu recently.
- 29 august 2004. Cholera remains endemic at
many places in the world, and it tends to spread as soon as the
situation deteriorates. Sierra Leone, which had been free from the
disease since 1999 is now facing an epidemic: since august 6th
Health authorities have identified 374 cases of the disease, that
caused 40 fatalities.
- 23 august 2004. China's ministry of
agriculture denies that the H5N1 virus has been found in pigs
recently. However the virus was indeed infecting pigs in 2003 and
earlier this year, and it is expected that the disease will be most
likely to spread through this indirect contamination route in the
future. Vietnam is still combatting the outbreak.
- 21 august 2004. It
seems now established that bird flu has contaminated pigs in Chinese
farms (other mammals have been contaminated several times
earlier, in particular predators and, of course humans). It is not
yet clear whether there has been pig to pig contamination. If so,
then a human epidemic becomes extremely likely.
- 19 august 2004. In an effort to ensure a quick
end to its first outbreak of bird flu, Malaysia has gassed hundreds
of birds in Kampung Baru Pekan Pasir, a village near the Thai border
and enforced a quarantine for 10 kilometres around the property
where two chickens have been found to have avian influenza.
- 17 august 2004. Bird flu is still rampant in
Vietnam. More ostrich farms are hit (by a less dangerous virus) in
South Africa. A case of dengue fever has been diagnosed in a
Japanese patient staying in Nepal. This might suggest extension of
the mosquito-borne disease.
- 12 august 2004. The
bird flu strain (H5N2) affecting South Africa is more virulent than
in the past. Vietnam faces a dengue fever outbreak more severe than
last year, with 45 fatalities 38,605 cases. Since
1969 dengue fever keeps on spreading in South East Asia. Three
imported cases have been discovered in Hong Kong. As reported by the
popular magazine Nature today blood transfusion might be a
source of Creuzfeld Jacob disease (vCJD) in a way that went
unsuspected. Most of the 142 vCJD deaths in UK are believed to have
been caused by beef products infected with the agent of bovine
spongiform encephalopathy. But two people are now known to have been
infected through blood transfusions containing the disease-causing
proteins known as prions. And there is concern that in the latest
case, revealed last week, the recipient of the transfusion carried
the prions for years without developing the disease.
- 11 august 2004. authorities in Vietnam are
testing whether four patients displaying acute respiratory symptoms
were killed by avian flu.
- 10 august
2004. The continuation of the human test of a SARS
vaccine started in may appears to be successful. A first group
of 18 volunteers were injected with a low dosage vaccine and the
second group of 18 with a high dose at the China-Japan Friendship
Hospital in Beijing. The first group have completed the test while
the second group have received the first of two inoculations. No
adverse effects have been recorded. The avian flu virus that is
killing ostriches in South African is of the H5N2 type, usually
considered a less dangerous type than the feared H5N1 type. In the
meantime Thailand banned the use of vaccine against flu in birds,
being concerned that this might accelerate the evolution of the
virus.
- 7 august 2004. It is winter time in the
Southern hemisphere and bird flu is beginning to affect South
Africa. Two ostrich farms have been contaminated, spreading fear
that the disease might extend to other places. This makes it likely
that there will be more or less continuous outbreaks of avian flu,
from now on. Vaccination measures have been implemented in Chinese
farms, but it is not yet known whether this will be a successful
approach.
- 6 august 2004. Infection by the West Nile
virus is now a well-established scourge in Northern America. The
holiday time in Europe makes that media try to find all kinds of
information to fill in their programmes: legionellosis is thus a
common theme of summer news in France, for example (see last
year at the same period of the year).
- 1 august 2004. Passive
serotherapy (using serum from recovered patients) can confer
immediate protection against microbial infection. Unfortunately,
methods to rapidly generate human neutralizing monoclonal antibodies
from such sera are not yet available. Lanzavecchia, Rappuoli and
their colleagues have found an original way to prove both that a
vaccine against SARS is possible and that the memory of the immune
repertoire of recovering patients can be used to generate a serum
that can be used against the disease. Using the serum from a patient
they isolated monoclonal antibodies specific for different viral
proteins, including 35 antibodies with strong in vitro neutralizing
activity. One such antibody confered protection in vivo in a mouse
model of SARS-CoV infection. We can therefore safely assume that
SARS will not be a significant menace in the future. The student
that died in Taiwan was affected by a still unknown virus (now
confirmed not to be SARS-CoV) with superinfection by a dangerous
bacterium that infects the lung of immunocompromized patients,
Pseudomonas aeruginosa (for information on its genome see our
database AeruList). While bird flu is
still lingering in South East Asia, the obvious but often
underestimated possible role of pigs in its transmission to humans
is fortunately resurrected by some. This involvement had been
postulated many years ago (and we summarized ten years ago the
scenario of evolution of the virus from poultry, to pig, then to
man, by recalling that, in China ducks and pigs are used to live
together, as one can see in the Chinese character for the happy
"family", which represents a pig under a roof: the
Chinese pig also sneezes!).
- 29 july 2004. Trypanosoma parasites are
infamous for their role in the sleeping sickness. They are also
involved in a very dangerous diseases that plagues South America,
Chagas disease. Its agent is Trypanosoma cruzi, but until
recently it was not at all understood how the disease could stay
dormant in patients and nevertheless induce strong autoimmune
pathologic responses. As remarked by The Scientist, a
intriguing study by Nadjar Nitz, Antonio Teixeira, and their
colleagues, from the University of Brasilia, published in the
journal Cell reports the integration of T. cruzi DNA
into the genomes of infected patients, as well as chicken and rabbit
animal models, suggesting that horizontal gene transfer may play a
role in T. cruzi host–parasite interactions. This would
indicate that aside from retroviruses such as HIV, some pathogens
could leave traces of their presence in the genome of their host, a
new path to understand diseases that escaped our understanding. Horizontal
gene transfer is widespread and has been described many years ago
as contributing to bacterial speciation. It has been known to
explain how some tumors are created in plants (and this natural
mechanism was used to create Genetically modified Organisms) but
until now we did not suspect that such mechanisms of parasitic DNA
transfer could be associated to well-known parasites. One student at
a Taiwan army college has died and 23 have fallen ill from an
unknown pathogen, but health officials said it was unlikely to be
SARS. Dengue fever and Japanese encephalitis, both mosquito-borne
diseases have been ruled out.
- 28 july 2004. Vietnamese state media say bird
flu has spread to the north despite earlier assurances outbreaks in
the south had been contained. Scientists at Yale found remarkable
properties of the RNA helicase NS3 that unwinds the virus of
hepatitis C for replication inside the cell. NS3 is a major drug
target against HCV and understanding the helicase function will aid
in the development of HCV inhibitors. NS3 moves with a discontinuous
stepping motion that alternates rapid translocation with pausing.
- 27 july 2004. At this time of the year it is
interesting to have a little reflection on important health problems
in the world. As an example, in France, media start campaigning
again about Legionellosis (this time in the region of Nancy, in the
east of France). However the number of persons involved is as yet
quite small, while the likely number of persons affected yearly in
the country must probably be in hundreds, and be significantly
underreported. This disease may be a quite old one, that has only
been recognized recently (it is frequent that aged people die of
diseases with pneumolia-like symptoms). However this disease is
important because it is associated to our way of using water, as hot
water, or in cooling systems. If unchecked it could slowly have very
adverse consequences. Another political remark comes from the near
absence of US scientists at the Bangkok meeting. Does this mean that
AIDS is no longer a priority in the US, or that the US is not
interested in diseases affecting the developing world? History will
tell, but this is an important fact to notice. On the front of avian
flu, the European Union has prolonged its ban on poultry import from
Asia. Flooding in Bangladesh, India and China will result in water
associated diseases outbreaks, but the large amount of water
involved for the moment is rather likely to wash out some of the
worse microbes (and vectors). The outbreaks will probably start when
water recedes. Two cases of West Nile Virus infection have been
confirmed in Ireland. In both instances, the patients had recently
visited the Algarve in Portugal.
- 23 july 2004. Thailand authorities in Bangkok
are testing two children as possible cases of bird's flu. The
government of Jakarta implemented measures to vaccinate poultry.
- 22 july 2004. A report published in the magazine Nature,
combining pathological, cytological and molecular investigations
identified Bacillus anthracis as the cause of death for at
least six wild chimpanzees (Pan troglodytes verus) in the Taï
National Park, Ivory Coast. Anthrax is an acute disease that mostly
infects ruminants, but other mammals, including humans, can be
infected through contacting or inhaling high doses of spores or by
consuming meat from infected animals. Respiratory and
gastrointestinal anthrax are characterized by rapid onset, fever,
septicaemia and a high fatality rate without early antibiotic
treatment. These results suggest that epidemic diseases represent
substantial threats to wild ape populations, and through bushmeat
consumption also pose a hazard to human health. Thailand confirmed
three more outbreaks of bird flu in the capital Bangkok after a
spate of deaths among ducks and chicken over the weekend. The
outbreak re-emerges in Indonesia. Fear of cholera or other
water-borne diseases spreads in India after catastrophic flooding.
- 21 july 2004. Scientists from the World Health
Organization National Influenza Center at Erasmus Medical Center,
(Rotterdam, Netherlands) and the USA Department of Energy at Los
Alamos National Laboratory with collaborators from the University of
Cambridge (UK) have developed a computer modeling method for mapping
the evolution of the influenza virus. The model (published in the
magazine Science) aims at helping medical investigators
worldwide develop a better understanding of certain mutations in
influenza and other viruses that allow diseases to escape the human
immune system.
- 16 july 2004. The bird's flu outbreaks in
Vietnam and Thailand is spreading. The AIDS conference in Bangkok
ends on mixed feelings, with much concern about the spread of the
disease in Asia.
- 11 july 2004. At a time when 17,000
participants from 170 countries are meeting in Bangkok to discuss
the situation of AIDS in the world, where Asia (including Indonesia)
is now one of the greatest concerns, dengue fever spreads in
Bangladesh. South Korea issues warnings about cholera after a
traveller from Manila entered the country with the disease. It also
steps up its surveillance of avian flu, to try to keep out contagion
from other Asian countries.
- 9 july 2004. The government of Thailand will
order the killing of open-billed storks in a
move to contain the spread of avian flu. While it is clear
that migrating birds are certainly spreading the disease, this move
might be quite inappropriate, and similar in its disastrous effect
with the killing of sparrows ordered by Chairman Mao a long time
ago. A similar unhappy situation might be faced by beavers in the
USA since they are now supposed to create appropriate conditions for
mosquitoes to breed, and bring about the West Nile fever.
- 8 july 2004. A group headed by Pr Peiris at
the University of Hong Kong has substantiated the conclusions drawn
during the last bird's flu episode, that the virus is becoming more
and more dangerous, and is now well implanted, at least in Southern
China: their "findings indicate that domestic ducks in southern
China had a central role in the generation and maintenance of this
virus, and that wild
birds may have contributed to the increasingly wide spread of the
virus in Asia." This last inference was already made as early
as 2001. The new virus strains are now established firmly as endemic
(see the conclusions already reached by other scientists on March
19th).
- 7 july 2004. Two crows found in West Elgin in
Ontario have tested positive for the West Nile virus. The outbreaks
of H5N1 avian flu are confirmed both in China and in Thailand, where
two provinces are affected. More than 300,000 Nigerians were
infected with tuberculosis last year out of which only 46,569 were
detected and placed on treatment. In Cambodia the campaign against
dengue fever has been a success this year with more that half the
number of infections and deaths in children as compared with the
situation last year.
- 6 july 2004. Two cases of Japanese
encephalitis (a mosquito vector-borne disease) have been diagnosed
in Hong Kong. A new bird flu outbreak might be underway in Thailand.
Northern China begins to be affected by an outbreak of full-blown
AIDS. This is due to the blood contamination episode of 1995, when
poor hygiene corresponded to systematic collection of blood in the
province. China reports new cases of bird flu from Anhui province.
- 3 july 2004. Active tuberculosis has been
found in two patients from Singapore, that were infected by SARS
last year. This number of cases is far too small to permit one to
draw conclusions, but it may be that the immune system of patients
has been compromised, at least for some time, by SARS.
- 2 july 2004. The "official" position of the
Chinese government on the last SARS episode is now available as
published by the China Daily. It fits with the conclusions that
could be obtained yesterday. Interestingly, according to the World
Health Organization two laboratory workers in Beijing suffered from
a SARS-like illness in February and went back to work but were not
detected until they tested positive for SARS antibodies when
hundreds of lab workers were screened following the April outbreak.
Two cases of legionellosis have been identified in Normandy
(France). The origin of the disease is unknown.
- 1 july 2004. Li Liming, director of the
Chinese Center for Disease Control and Prevention, has resigned for
"mismanagement of the Severe Acute Respiratory Syndrome (SARS)
virus." While the exact cause of the contamination is not yet public
it is likely that the outbreak occurred because the institute itself
became contaminated, which explained why two victims, both
laboratory workers, became infected even though their work did not
involve any handling of the virus.The Diarrhoea Virus Laboratory
under the Institute of Virus Diseases of the center was found to
have conducted SARS virus research adopting untested methods to kill
the virus in an ordinary lab. Also, the lab failed to report to
higher authorities the fact when unusual health conditions were
detected among some of their staff members. The bird flu outbreak in
Vietnam is extending infecting around 20,000 poultry in recent days,
now present in six southern provinces of the country.
- 30 june 2004. Avian flu is re-emerging in
South-East Asia: more than 5,000 fowls in Vietnam's southern Bac
Lieu Province have been culled to prevent spreading of bird flu type
A, sub-type H5. It is not yet known whether this is the H5N1 letal
type, but this seems likely because of the apparent virulence of the
outbreak. China, with officially reported about 840,000 HIV carriers
(likely to be more than one million) and 80,000 AIDS patients, plans
to increase the number of national AIDS/HIV surveillance outlets
from the current 194 to 300 next year to perfect the existing
surveillance network. Fifthy million euros will be allocated to
strengthen AIDS/HIV control this year, a sharp increase over the
effort supported in the past years. Presence of West Nile virus in
dead birds in the USA is beginning to be recorded this year. Figures
for 2003 show that almost every state in the USA has been
affected last year. On the front of dengue fever more than 17,700
people have contracted the disease in Vietnam this year, and 33 have
died. 114 cases have been reported in Bangladesh this season so far.
- 29 june 2004. According to a report published
by the Proceedings of the National Academy of Sciences in
the USA, the newer forms of the H5N1 flu virus kill more rapidly
than their predecessors. This shows that the virus is still mutating
to better adapt to its host, and raises concern about possible
adaptation to human hosts.
- 26 june 2004. Scientists at the National
Institute of Allergy and Infectious Diseases in Bethesda, USA,
reported that four African green monkeys given a single dose of a
vaccine made of a protein of the SARS coronavirus and then infected
four weeks later with the virus developed neutralizing antibodies
and showed no sign of the disease in their respiratory tracts.
Several other attempts by other scientists in the world also
suggested that it was likely that a synthetic vaccine would be
efficient to protect against the disease. It is therefore likely
that SARS will no longer be a major problem, especially with the
type of measures that have already been implemented in Asian
countries to restrict and control travel when any hint of an
outbreak happens. This is in sharp contrast with flu, for which we
know that we will be able to create a vaccine once a letal strain is
idenfied, but for which we unfortunately we already know that
several months will be necessary to produce enough doses of the
vaccine.
- 23 june 2004. "It has been a year since
Hong Kong emerged slowly but surely from the shadow of one of the
greatest threats to public health in living memory." Thus
begins an article
in the China Daily by the Hong Kong's secretary for health,
welfare and food to celebrate the end of the SARS outbreak last
year. Data have accumulated since then and the hypothesis that the
virus is lingering in the environment has been substantiated during
the last episode in december in Guangzhou, China. This accounts for
the likely protection of some people who could have been in contact
with an innocuous form of the virus and be protected by it (the double
epidemic hypothesis). This would also be good news since this
would indicate that vaccination will be possible. A recent
study substantiates this straightforward hypothesis, and
suggests that vaccines using proteins of the virus will probably be
easy to construct. Another study from Singapore shows that the virus
can be present in body fluids, in particular in
tears, early in the course of the development of the disease.
More than 900 cholera cases have been reported from New Delhi so far
this year.
- 21 june 2004. An oubreak of legionellosis
(first case identified on june 10) in Zaragoza (Spain), has
triggered investigation of the possible cause of contamination:
bacteria have already been detected in 2 refrigeration towers of the
Hospital Clinico de Zaragoza. This, once again, demonstrates that
the cooling systems now employed everywhere can propagate dangerous
diseases.
- 17 june 2004. As reported in The
Scientist at least seven people in an Oakland research
laboratory have been inadvertently exposed to live anthrax bacteria
that had twice been tested to be dead, when it was found that mice
inoculated with the "dead" spores died from the disease. While the
scientists involved could be treated in time this demonstrates, once
again, that laboratories may be dangerous sources of letal diseases,
if appropriate precautions are not taken. Several regions in Hong
Kong have been found to be plagued by the Aedes albopictus
mosquito, which may carry the disease of dengue fever. According to
the Hong Kong Special Administrative Government, four areas in Hong
Kong were particularly affected. The Vietnamese government has asked
localities nationwide to keep on preventing the reoccurrence of bird
flu, following the deaths of fowls in several areas, including some
testing positive to avian influenza viruses.
- 14 june 2004. Because of global warming, in
Central America dengue fever is spreading above its former limit of
1,000 m. Some of its mosquito vector Aedes aegypti have been
found up to 2,200 m. The number of cases in the world is estimated
to be already of the order of 50 million cases a year. It is endemic
in more than 100 countries in South-East Asia, the western Pacific,
Africa, the Americas and the eastern Mediterranean.
- 13 june 2004. The number of dengue fever
cases in Vietnam is soaring. Up to 15,000 people have been detected
to suffer from the disease there so far this year, a year-on-year
rise of 80 percent. While 45 cases have been detected in Jeddah
(Saudi Arabia), one patient died of the disease. The Center for
Disease Control in Taipeh (Taiwan) reported that a second person had
contracted dengue fever in a laboratory, after the first case of
dengue fever in Taiwan this year had been declared the result of
laboratory mismanagement. This is a further indication of problems
caused by diseases manipulated in laboratories as examplified by the
SARS last outbreak in Mainland China (still not understood). The
World Health Organisation has reported that the death toll from the
Ebola outbreak in southern Sudan has held at seven this week, with a
number of infected people besides the dead of 23.
- 7 june 2004. Thirty cases of dengue fever
have been confirmed in Jeddah and the holy city of Mecca in Saudi
Arabia.
- 6 june 2004. Afghanistan recorded its first
AIDS casualties. The country is the world’s top producer of opium.
The United Nations says drug abuse is becoming a serious problem in
many parts of the country. Officials estimate that about 200 to 300
Afghans are infected with HIV. The real number could be higher,
however, because the social stigma associated with the disease keeps
many sufferers from seeking help. Intravenous drug use, shared
needles, and contaminated blood transfusions are believed to be the
primary modes of transmission in Afghanistan.
- 5 june 2004. While there had been seven
confirmed cases of the mosquito-borne yellow fever and one death
from yellow fever since the outbreak in Bobo Dioulasso was first
reported in early May, the WHO urges the government of Burkina Faso
to vaccinate one million persons since there is a high risk of a
major outbreak developping as the rainy season gets under way this
month. However, WHO officials are concerned by the fact that the
government has been playing down the seriousness of the outbreak.
This is hampering efforts to raise 500 million CFA francs (US$1
million) from donors for an immediate vaccination campaign against
the disease. In a move to better understand the spread of AIDS in
China, a nationwide data bank on all known HIV carriers and AIDS
patients is expected to be established by the end of this year, with
each HIV/AIDS patient having an individual file. This is similar to
what was done in Europe when it was understood that tuberculosis has
to be controlled. It has been a curiosity that this type of
information is not collected in Western countries in the case of a
disease that may spread fast for purely socio-economical reasons,
and that is mostly a matter of serious concern for the poorest
people. A reflection on this issue is the more important as the
likeliness of finding a vaccine against AIDS is less probable than
ever.
- 4 june 2004. The natural host(s) of Ebola
virus are unknown. Until recently it was assumed that Ebola spread
from a single outbreak across the Congo basin. A recent study
demonstrates that Ebola outbreaks in the Gabon and the Republic of
Congo are preceeded by virus infection of large apes and deer, and
that multiple strains of virus cause simultaneous epidemics in the
human population. Scientists at the Genome Institute of Singapore
developed a faster method for detecting strains of the SARS virus. A
DNA chip containing a "fingerprint" of the virus genome reduces the
length of molecular testing of the disease to three days from about
one week. Speed is a critical step in bringing outbreaks under
control.
- 1 june 2004. The Dutch biotechnology firm
Crucell reported that a single dose of its Ebola vaccine has
successfully protected monkeys from the deadly disease in trial
tests. While Ebola has only a marginal role among human diseases,
its spectacular symptoms and deadly outcome has made the virus a
popular model for new plague types (which is however fortunately
quite unlikely because the mode of contagion requires direct
contact).
- 30 may 2004. A second bird flu outbreak
affects fowl in Texas. This is a further warning that we shall
probably witness in the next years a dangerous flu outbreak. The
H1N1 epidemic, that killed millions in 1919 is still not completely
understood. It is however likely that it was caused by an avian
virus that passed through an intermediate animal, probably pig,
where it adapted to mammals. It is therefore extremely important to
monitor, in addition to bird to human contamination, any other type
of contamination of mammals by avian flu viruses. On the front of
dengue fever, Vietnam is dramatically affected this year, with more
than 35,000 patients affected, and increase of some 50% as compared
to last year. Transmitted by mosquitoes, dengue fever is not very
dangerous the first time a person is infected, but the disease is
often letal on a second infection.
- 25 may 2004. The first preliminary results
about the response and possible unwanted side effects of a first SARS
vaccine are published today. Lin Jiangtao, head of the Respiratory
Medical Department at the China-Japan Friendship Hospital, where the
experiment is conducted, stated that all four volunteers are in
excellent condition with no adverse effects of the vaccine. The
number of cholera cases in the capital of India, New Delhi is
already 635, higher than last year at the same period. Every year
witnesses around 1,500 cases in New Delhi. Five people have died of
Ebola haemorrhagic fever in southern Sudan. A Russian investigator
has died after sticking herself with a needle containing the Ebola
virus. This event stresses again the danger inherent to research on
deadly viruses in laboratories.
- 23 may 2004. Four students volunteered in the
clinical testing of a vaccine against severe acute respiratory
syndrome (SARS). The volunteers, students from Beijing-based
universities, were injected a SARS vaccine or a SARS-virus free
placebo Saturday afternoon. No adverse reaction was found and the
volunteers will be followed for a period of 210 days, with
monitoring of their immune response. Further volunteers will be
inoculated later on, if no sign of adverse reaction is seen in this
first team.
- 14 may 2004. The strain of bird flu found in
British Columbia is likely to be of still another type, the H6
subtype (causing a mild form of the disease). This demonstrates in a
vivid manner how variable is flu. The government of Burkina Faso
announced that 25 suspected cases of yellow fever had been reported
in the city of Bobo-Dioulasso and the nearby town of Gaoua (close to
the border with Cote d'Ivoire and Ghana). Four cases have been
confirmed.
- 12 may 2004. A new strain of avian flu is
just spreading in British Columbia (Canada). Interestingly this
strain does not appear to be of the H7 subtype, but may be of the H5
subtype. Exploration of last year's SARS outbreak gives new clues
about its propagation, but its origin is still not clear, despite
indications that it is derived from an animal virus.
- 9 may 2004. Scientists in Guangzhou found that
the SARS coronavirus could be transmitted through sweat, urine and
feces in addition to the postulated route of infected droplets from
the patients' respiratory tracts. This
was suspected early on, but not confirmed. The oro-faecal
route had already been suspected as a cause in the Amoy Gardens
estate outbreak in Hong Kong in 2003.
- 7 may 2004. Malaria
kills more than 1 million people a year, 90% in Africa, at a
time when resistance of the parasite to the most common drugs is
exploding.
- 6 may 2004. While the SARS outbreak seems
over in China (159 persons have been released from quarantine
in Beijing), a new local outbreak of H5 (H5N1 not yet confirmed, but
likely) bird flu has been detected in Vietnam.
- 5 may 2004. The avian flu virus strain that
infected poultry in West Canada recently is of the H7N3 type (The H
and N symbols represent different proteins of the virus). There are
fifteen varieties of the H protein and nine of the N protein.
Variants of the proteins combine in different ways to make up
specific viruses, some of them more dangerous than others. In
contrast to the H5N1 type, the H7N3 type is usually innocuous for
humans, and not very dangerous to birds, but a recent mutation has
made it extremely virulent, explaining the outbreak in Canada.
Reassortment of genes from various strains, when co-infection occurs
in a host, can produce deadly variants. On the front of SARS, while
no new case is emerging, internet forums in China discuss the
apparent efficiency of some treatments involving Traditional Chinese
Medicine to make the disease milder and improve patients' recovery.
- 4 may 2004. The number of SARS cases in China
has now been confirmed to nine, with no further identified case. The
origin of the outbreak is not yet fully understood. In Taiwan, a
recently developed SARS vaccine will undergo animal testing as soon
as high-security laboratories re-open for SARS research. We remember
that the P3/P4 facility laboratory where these experiments have to
be performed (for security reasons) was the source of an
accident.
- 1 may 2004. An outbreak of cholera has
triggered some panic reactions in the North West province of South
Africa. Cholera remains endemic in the world, particularly in Africa
and India because of poor hygiene. No new SARS case in the world.
The second student who was showing symptoms
of atypical pneumonia has been confirmed with the disease.
- 30 april 2004. In a recent study from
scientists in Toronto and at
the Prince of Wales hospital in Hong Kong it has been
demonstarted that last year SARS patients had a very high level of
the Th1 chemokine IFN-gamma-inducible protein-10 (IP-10) as soon as
they showed symptoms of the disease. Healthy people never have a
high level of the molecule. This finding is important because this
protein in the blood may be detected by diagnostic kit, and it may
help discriminate between SARS and other fever causing pulmonary
diseases such as flu. Further study is however needed to know the
actual significance of the observation.
- 29 april 2004. Monitoring possible outbreaks
of dangerous diseases is a difficult task. In addition to yearly
epidemics of cholera or meningitis, as well as the ubiquitous AIDS,
with its associated diseases such as tuberculosis, old diseases such
as plague are still lingering in the environment. Interestingly
Russia recently reviewed possible local foci in the southern Asia
regions of the country. This may suggest that there are already
indication that suspect cases have been observed. Fortunately,
bubonic plague mostly propagates through flea bites so that it is
relatively easy to stop an outbreak when it has been identified. On
the SARS front, the Chinese government is trying to curb down the
number of its laboratories working on SARS-CoV to diminish the
number of possible contamination sources. Governments of the many
countries which had sent scientists to the Virology Laboratory that
was at the origin of the outbreak have been warned by China to test
for suspect cases. Until now nothing of the kind has, fortunately,
been reported.
- 28 april 2004. China reported one new
suspected SARS case for the past 24 hours. This patient, who worked
at the same hospital as the nurse who attended the index patient is
in critical condition. None of the quarantined people with close
contact with the index case have shown abnormal symptoms so far and
38 among them have been removed from observation. All suspected SARS
cases are connected together: Chinese authorities say a 26-year-old
lab worker named Song, in Beijing, passed SARS to a 31-year-old
nurse named Li, whose father, mother, aunt and roommate also are ill
and are suspected SARS cases. Song returned to Anhui and her mother
died shortly thereafter, and experts suspect SARS. The newest
suspected case is a 49-year-old woman surnamed Zhang who was being
treated in the same hospital room as Li. More than 700 persons have
now been quarantined. Teams of the WHO have arrived in Beijing and
are investigating the origin of the first cases, as well as
implementing tight measures to prevent possible spread of the
disease during the May festival. To replace this event in
perspective it is interesting to note that during the last couple of
weeks more than 1,500 patients have been admitted with cholera at
the Infectious Diseases Hospital in Calcutta, India.
- 27 april 2004. The authorities of China Anhui
province reported that 143 persons have been identified after having
contacts with the SARS index patient. Several are already discharged
from quarantine. The present absence of new putative SARS cases
suggests that the fear of an outbreak may hopefully soon be over.
- 26 april 2004. China has quarantined more
than 500 people in an attempt to control the SARS outbreak triggered
by a laboratory contamination. In a fast reaction move triggered by
the proximity of the 1st of May holiday, the government has
publicised details of trains and buses used by the student at the
origin of the outbreak and by her mother, who died after caring for
her. Both travelled to Anhui province. The student contracted SARS
while working in a national laboratory specialized on dangerous
diseases. It is important to remember that in all high technology
processes the human factor is important. While the laboratory itself
might be of the best standard, human errors are always possible.
Fortunately the incubation time of SARS is short (normally less than
10 days) so that absence of new cases within a few days would
suggest that the outbreak will soon be over. It
now appears that another student, working at the same lab as the
index patient also fell ill on April 17th. The fact that the
original patient caught the disease a month ago and that no case of
atypical pneumonia has yet been observed on her travel path is in
favor of the idea that she did only contaminate people with close
contact with her. This is why the World Heath Organisation, which
sent experts to analyse the situation in the original laboratory,
indicated that it could hope that the consequences of this
unfortunate event will soon be over, provided no other person
working at the incriminated laboratory shows signs of the disease.
- 24 april 2004. The cause of the recent
outbreak of SARS in China is not yet completely identified. The WHO
is investigating whether it is a laboratory accident, and if so,
what is the source of the virus. Indeed, SARS is caused by a virus
that is continuously evolving: probably starting as
a rather innocuous virus (as demonstrated by a recent study
from Guangdong and Shanghai), it evolves after a region of its
genome is deleted into a rather mild SARS form. Subsequently, the
region of the genome that codes for the "spike" protein, which
allows to enter the host cells, mutates and creates a highly
infectious and pathogenic "super spreader" form. If this were the
form at the origin of the outbreak, many persons might have been
contaminated during the travel of the student who caused the
contamination... Avian flu is still spreading in West Canada.
- 23 april 2004. A possible second case of SARS
has been diagnosed in China's eastern Anhui Province. This patient,
the mother of whom passed away from unknown causes (possibly SARS),
worked at the Center for Disease Control in Beijing, probably on
SARS-CoV. Both cases appear in fact to have been connected, as the
first case is a nurse at the hospital where this patient was briefly
hospitalized before going back to Anhui province. All persons who
have been in contact with these patients have been placed in
observation and quarantined. Among those, six persons showing fever
may also be infected, rising the number of cases to nine.
Unfortunately, during her travel back to the Anhui Province this
patient might have contaminated others. Hospitals along the train
line have been placed on high alert for patients with pneumonia
symptoms. This would be the third instance of laboratory
contamination, showing that confinement of viruses under
strict laboratory rules must absolutely be enforced.
- 22 april
2004. A new suspected SARS case has been identified
in Beijing in a nurse working at the Beijing Jiangong Hospital. Two
relatives also showed symptoms of the disease. These cases are under
investigation.
- 20 april
2004. The New York Times reports that a patient was
infected during last fall by the H7N2 bird flu virus (much less
letal than H5N1), and that this had escaped attention. This further
demonstrates (after H7N7 last year in Europe and H5N1 in Asia) that
avian flu is able to be transmitted from birds to humans. The signal
of danger will appear when this will have triggered a
person-to-person contamination. Cambodia is hit by two new avian flu
outbreaks, while others are spreading in Canada's British Columbia
(different viruses).
- 17 april 2004. According to Xinhua news
agency, Chinese scientists tested thousands of people carrying SARS
antibodies in 16 cities in Guangdong and found that among 994 people
working in animal markets, 10.6 percent carried positive antibodies.
In contrast, among 123 civet cat
husbandry staff, only 3.25 percent tested positive. Moreover many
other animals, including foxes and cats also carried the virus. The
origin of SARS-CoV is therefore not yet understood. A man from Ohio
tested positive for the West Nile virus, making this cases the
earliest case since the arrival of the disease in America.
- 15 april 2004. The government of China takes
the question of AIDS seriously, now that some 1 million persons in
China are probably infected by HIV. Because the disease may become
out of control and threat the growth of the economy, the health
ministry promised to fully cover the treatment costs of poor
patients, while offering free testing to the whole population of the
country.
- 13 april 2004. Japan declares the H5N1 bird
flu outbreak over, while the number of British Columbia (Canada)
farms infected by a H7 strain reaches 25. Tuberculosis is not only
affecting poor countries: the number of tuberculosis patients in
Japan is the highest among rich, industrialized countries, with
32,828 people contracting the disease in 2002.
- 7 april 2004. Several rooks that migrated
recently to Russia's Far East from southeast Asia were found dead of
suspected avian flu creating a risk of spreading the disease in
Northern parts of Asia and Europe.
- 6 april 2004. Scientists at the NIAID
demonstrated in mice that a DNA vaccine could induce neutralizing
antibodies against SARS-CoV. This is the demonstration that
vaccination will be possible in case of resurgence of the disease.
However it is certainly unlikely that DNA vaccines will be used,
because they are still unwieldy. Canada
is plagued again by outbreaks of bird flu, probably originated with
wild ducks. This is the 18th oubreak of the H7N3 virus since
february. Fortunately this brand of virus is less dangerous for
humans than the Asian H5N1 type. China orders quarantine for persons
coming from Burkina Faso (West Africa) for fear of contamination by
bacteria causing meningitis.
- 2 april 2004. Human diseases are not the only
causes of concern triggered by viruses and microbes: China is about
to announce publicly that foot-and-mouth disease is an endemic virus
that is presently causing havock in livestock.
- 27 march 2004. While avian flu is abating,
dengue fever is on the rise in Vietnam, having killed twice as many
people in Vietnam compared to the same time last year, with 5,371
persons having contracted the disease so far. In Indonesia the death
toll due to the disease climbs to 534, with 44,027 cases recorded so
far this year.
- 25 march 2004. AIDS remains the major source
of concern for health in the world. As an illustration Mozambican
Prime Minister Luisa Diogo said in Maputo that thee country reached
the figure of 13.6 per cent prevalence of HIV/AIDS among Mozambican
adults. In South Africa nearly half of state hospital patients in
the country are HIV-positive, and 15% of the health workers who look
after them also have the virus.
- 24 march 2004. Several cases of a highly
pathogenic strain of H7N3 avian flu have been discovered in Western
Canada. The UN Food and Agriculture Organization warned that the
deadly H5N1 virus has extended its range in Indonesia. The first
test at the University of Rochester and Baylor College of Medicine
of a vaccine designed to protect people against one form of bird flu
is under way, tested in about 200 people. While that precise brand
of vaccine (acting against a form of the virus, H9,
which infected several people in Hong Kong in 1999) is not designed
to protect against the precise bird-flu virus causing the current
outbreak in poultry and in people, scientists will learn whether it
protects against another strain of the virus that infects birds and
people. Other investigators are now developing vaccines that could
protect against the H5 form, which is responsible for most of the
recent deaths in Asia. The main difficulty with producing vaccine
too early is that it is known to lead to selection of new virus
strains.
- 22 march 2004. A team from the University of
Amsterdam uncovered a new coronavirus that could be highly related
to SARS-CoV, the agent that caused SARS last year. This virus,
HCoV-NL63, causes respiratory diseases such as bronchiolitis in
children. While a related common cold virus has been known for a
very long time, it is surprising that this new isolate took so long
to be identified. All this points to the idea that a virus related
to SARS-CoV is widely spread in the environment. This could explain
the unusual
pattern of the epidemic, that appeared to cause the disease in
some regions, while neighbour regions were apparently immune.
- 21 march 2004. A new outbreak of avian flu is
affecting South Korea. Chicken, as well as a magpie have died of the
H5N1 disease. This indicates, once again, that the virus has spread
in wild, casting doubt on the possibility to control the disease in
the future.
- 20 march 2004. The number of cases of dengue
fever is on the rise in nine Indonesian provinces. A twelve years
old child dies of H5N1 bird flu in Vietnam, bringing the present
identified toll of the disease to 24 (16 in Vietnam). An epidemic of
meningitis had killed dozens of people and infected hundreds more in
northern Nigeria.
- 19 march 2004. The genome sequence of the H5
avian flu virus found in Japan was not the same as that of the virus
found in Vietnam, which has been blamed for the deaths of at least
15 humans there since the disease struck in January. The gene
sequence does not match that of the bird flu virus that caused human
deaths in Hong Kong in 1997. In contrast the sequence of the genome
virus found in Japan is almost identical to that found in South
Korea. This suggests that the disease has been endemic in Eastern
Asia for many years, and that the virus is still evolving as several
more or less independent isolates. Because of possible reassortment
of pieces of this fragmented genome it may suddenly appear as a
highly virulent strain that might extend its host recipients.
- 18 march 2004. The annual outbreak of
meningitis is developing in Sahelian West Africa. More than 400
people died in Burkina Faso where a vaccination programme has been
implemented. The dengue fever epidemic has claimed more lives in
several parts of Indonesia, despite reports that the number of cases
was declining. A vaccine against bird flu would be available in one
week according to the UK's National Institute for Biological
Standards and Control (NIBSC). Preparation of a large number of
doses would however require much longer, since the vaccine is
developed on fertilized eggs.
- 17 march 2004. Two new cases of brid flu have
been reported from Cambodia, while the disease appears to ebb down
elsewhere. Preliminary data with mice indicate that these animals
can be vaccinated
against SARS-CoV.
- 14 march 2004. Dengue fever is now affecting
Australia's Northern Territories. 3,300 persons have been infected
in Vietnam, where 5 passed away.
- 12 march 2004. Several South Asian countries
are hoping to been soon free of the recent bird flu outbreak. Japan
is still investigating the source of its outbreak, monitoring
scavenging birds as well as pigeons, which tend to have frequent
contacts with poultry. New reflections will be needed about the
spread of West Nile virus in the USA after it has been discovered
that a hybrid Culexmosquitoe species might have been the
main source of contamination in the USA. Dengue fever, another
mosquito spread disease is still spreading in Indonesia, where the
death toll passed 427. This should be an incentive to develop more
research on insects and on insect pathogens, such as Photorhabdus
luminescens. An outbreak of still another mosquito
vector borne deadly disease, yellow fever, is affecting the coast of
West Africa.
- 8 march 2004. Thailand has probably stopped
the spread of avian flu and will resume production of poultry early
net month. The chairman of a poultry company in Japan that failed to
report bird flu on one of its farms has hanged himself with his wife
near the city of Kyoto. The farm sold about 15,000 live chickens and
also shipped some 900,000 eggs even after chickens started dying en
masse. The dead crows found in Kyoto had been infected by a H5 flu
virus, spreading concern that contamination might extend out of
contaminated farms.
- 7 march 2004. Two crows found dead in Kyoto
Prefecture, which has been hit by outbreaks of a highly pathogenic
strain of avian influenza, have tested positive for bird flu. It is
not yet known whether they died from H5N1 avian flu. In China,
thirty volunteers will be selected for phase 1 clinical tests for a
SARS vaccine, in a WHO accepted test. The volunteers will be
vaccinated only after signing a consent form. A second phase will
have more participants from a wider age bracket. The final phase
will only be carried out if there is a new outbreak of SARS.
- 5 march 2004. More than 200,000 people have
been recently infected by dengue fever in Indonesia and the death
toll reaches 389.
- 4 march 2004. Japanese authorities have
called the army in to help disinfect an area of the Kyoto prefecture
hit by a new outbreak of bird's flu.
- 2 march 2004. 53 out of the 57 infected
provinces and cities in Vietnam have recorded no new outbreaks of
the H5N1 virus in the past six to 26 days, raising hope that the
outbreak will be out by the end of this month. As reported by the
official Xinhua Agency, the China-ASEAN Special Meeting on Highly
Pathogenic Avian Influenza (HPAI) Control was held today in Beijing.
The Deputy Prime Minister of Thailand, the Minister of Animal
Husbandry and Fisheries of Myanmar, Vice-Ministers and senior
officials for agriculture and health, and experts from China and 10
ASEAN countries, as well as officials from ASEAN Secretariat, UN
Food and Agriculture Organization, World Health Organization and
World Organization forAnimal Health participated in the Meeting.
Representatives from Hong Kong and Macao Special Administrative
Regions of China attended the meeting as members of the Chinese
delegation. The participants recognized the trans-boundary nature of
the disease, its threat to public health, and the need for China and
ASEAN to cooperate on HPAI prevention and control so as to minimize
economic losses, while preventing the occurrence of birds to humans,
followed by person-to-person contagion. In a common declaration they
stated that they will: "provide access to and exchange of
information and experience on HPAI status, prevention and control
between China and ASEAN through the ASEAN disease surveillance
network, the ASEAN plus three SARS focal point network and the
proposed regional veterinary network to work towards creating an
early warning system for epidemic recognition and control; enhance
cooperation among inspection and quarantine agencies for border
management in China and ASEAN countries to prevent the spread of the
disease and minimize its impact on health and trade; propose the
establishment of a China-ASEAN cooperation mechanism for public
health, through regular meetings of agriculture or health ministers
and their senior officials, and the convening of joint meetings of
the health and agriculture ministers as appropriate; operationalize
the "China-ASEAN Fund for Public Health" to finance relevant
cooperation between China and ASEAN in addressing regional public
health crisis; strengthen extensive cooperation and exchanges with
other countries, regional and international organizations, such as
WHO, FAO, OIE on HPAI prevention and control; exchange HPAI expert
teams and organize joint technical training courses on HPAI-related
technologies and methodologies to include among others laboratory
management, diagnosis and testing, emergency response measures and
quality of vaccines in compliance with OIE international standards;
finally, China and ASEAN will mutually provide, within their
respective capacity, bilateral financial, material and technical
assistance to countries in the region hit and at risk to be infected
by HPAI. In this regard, the National Reference Laboratory of China
will share experience and offer technical cooperation with
diagnostic laboratories of ASEAN countries in terms of diagnostic
technology."
- 29 february 2004. Avian flu remains a major
concern for the World Health Organization. However this should not
make us forget that several other viral diseases are of great
concern: AIDS is on the rise in Asia, with its terrible consequences
in terms of propagation of other diseases, such as tuberculosis.
While hepatitis B vaccination has been successful in China in
restricting the propagation of the virus, some 100 million people
still live with the virus. Hepatitis C is on the rise. Furthermore,
with global warming pending,
diseases propagated by mosquito vectors are now infecting people in
more northern areas, and regions such as Indonesia have underwent
this year an epidemic of dengue
fever twice as severe as one year ago.
- 24 february 2004. For the first time since
1983-84 a highly pathogenic and contagious avian flu has been found
in the United States. This triggered a ban by the South Korea and
the European Union governments of poultry import from the USA,
despite the fact that the strain (H5N2) is not the feared H5N1
strain. The Chinese government officially declares that there are at
present no known SARS case in the country. Dr. Albert Osterhaus and
coworkers show that early treatment with a long-acting form of
interferon (pegylated interferon-alpha), reduces lung damage caused
by the SARS-CoV in macaque monkeys. This may lower fatalities if it
works in Man in the case of a new outbreak.
- 23 february 2004. While bird's flu no longer
makes the headlines of media, the outbreak of H5N1 bird flu in Asia
is not under control yet. Fortunately no person-to-person cases have
been reported. The actual number of persons infected by direct
contact with birds is not know, while the number of fatalities,
which is registered as 22 is certainly an underestimate (many
diseases have flu symptoms). About 50 outbreaks have been identified
in China and 2 in Japan. Another family of bird flu (of the H7 type)
is developping in North East USA and Canada. More than 80 million
birds had to be put to death world-wide and this causes an economic
problem in poultry industry. In the case of legionellosis several
water cooling towers have been found infected at a level higher than
acceptable in France. It will be interesting to increase monitoring
in all types of cooling and air-conditioning systems world-wide.
- 17 february
2004. Some 500 open-billed storks were found dead in
Ladkrabang district and 300 birds had died at the Bueng Borapet
wetland since Jan. 27, Prapat Panyachatraksa, the Thai minister of
natural resources and environment, told reporters. Laboratory tests
found 30 percent to 40 percent of the dead storks, which are
migratory birds, were infected with bird flu virus. After Tibet, the
outbreak hits Shandong in China, while the disease spread to the
island of Kyushu in Japan. The
legionellosis outbreak in the North of France is considered over.
- 14 february 2004.
After a leopard died from bird flu in a thailandese
zoo, probably infected by a chicken it ate, authorities begin to
isolate rare animals, such as pandas in zoos. Several regions in
Guangdong have been recently affected by bird flu, raising concern
in Macao and Hong Kong. Fortunately, until now, no person-to-person
transmission has been reported anywhere. Legionellosis begins to be
recognized as an important disease for elderly persons in France,
since, in 2002 it is likely that more than 2000 persons were
affected by the disease in France, with a death rate of 13%. It is
interesting to compare these observations with the 2003 SARS scare.
- 13 february 2004. India called an emergency
meeting of seven South Asian countries to discuss urgent measures to
combat Asia's bird flu epidemic. New Delhi says heightened vigilance
at its borders has so far prevented the H5N1 virus, which has
emerged in Cambodia, China, Indonesia, Japan, Laos, South Korea,
Thailand and Vietnam, from erupting within Indian territory. Until
now, agricultural authorities have favoured culling over
vaccination, in part because vaccinated animals can still harbour
and shed infectious virus. Until recently it had not been possible
to differentiate between infected and uninfected vaccinated animals,
so vaccinated animals were still subject to trade bans. It is not
known how much vaccination selects for virus mutants, and this is
sometimes considered as a matter of concern.
- 11 february 2004. The Standing Committee for
Food Chain and Animal Health has extended the ban on imports into
the EU from Thailand of poultry meat and meat products, wild and
farmed feathered game and eggs, for six months until 15 August 2004.
Compulsory inoculation is being carried out on poultry raised in
areas within five kilometers of regions in four cities of central
China's Hubei Province, where confirmed or suspected bird flu cases
are reported. Economic considerations prevent many farmers to cull
their poultry (to understand the cost, it should be noted that 30
million have been culled in Vietnam alone), in particular in the
poorest regions of the world. Vaccination of poultry could be
efficient, but there is a significant danger created by the
selective role of the vaccine, that might trigger a faster evolution
of the virus (those viral mutants escaping control by the vaccine).
More than 1 million homing pigeons have been confined to their pens
in Beijing as bird flu spreads across China, but their keepers seem
to be going stir crazy, doubting whether the confinement will save
them from the disease. Migrating birds could spread the virus and
China has reacted to this possibility. However this may result in a
difficult time for endangered species and precautions should be
taken not to over-react. March is usually the busiest season
for homing pigeons in China, and this practice may also propagate
the virus. A second farm has been hit with bird flu in Delaware
(USA) (a H7 type virus).
- 8 february 2004. Thirteen regions of China
are affected by the H5N1 bird flu outbreak. An outbreak of an H7
strain of bird flu affected the east of the USA (during last summer
a dangerous outbreak of a similar virus affected the Netherlands,
where millions of poultry had to be killed and a veterinarian died
of the disease, that is usually milder than that caused by the H5N1
virus).
- 7 february 2004. A large number of poultry
died in India, in the region near Bangladesh, triggering panic.
However the disease is not yet identified. The situation of bird flu
is complicated by the political implications of the fight against
the disease, that make appropriate assessment (and decisions)
awkward, if not plainly wrong. It must be understood first that the
prime victim of the disease, by far, will be China if an outbreak
starts (with person-to-person contamination). Unfortunately this
does not seem to be well understood by an underlying "antichinese"
feeling that appears to be lingering in the world. It must also be
understood that panic is one of the most efficient causes of
epidemics. It is also well reported, during the past epidemics of
Black Death, that the common reaction of panicked people is to find
a scapegoat, rather than promptly and efficiently fight the disease.
This means that conflicting interests or strategies have to be dealt
with. On the one hand it is necessary that proper information is
provided to the institutions that can help best (the WHO in
particular), but, on the other hand it is necessary to have a proper
control over rumors that trigger panic, and it is essential not to
point finger at the wrong places. In addition it is essential to
understand that it is obviously extremely difficult, if not plainly
impossible, in a 1.3 billion persons country such as China, to have
a control on all local authorities, at each and every steps in the
hierarchies (this is the price to pay for the development of
democracy: if that control existed this would, of course, mean a
terrifying dictatorship). Finally, the structure of the Chinese
economy is remarkably diverse, with extremely poor regions with
farming atomized into very small entities, and quite wealthy regions
with large poultry breeding farms. While it is relatively easy to
control the latter, and slaughter animals when a bird flu outbreak
happens, this is almost impossible in the small scattered farms,
with people certainly not willing to kill their only resources; and,
naturally, proper reporting from these regions is almost impossible
to achieve. Education is another obvious problem. Hence, rather than
attack China, it would be much more efficient and morally
appropriate to help her try to solve the problem. As a matter of
fact, in the present outbreak, smaller countries such as Indonesia
might be much more of a concern, because of almost total lack of
information about what is happening there. Finally, the present
emphasis by journalists of "eradicating" the disease is simply a
fancy. We shall indeed have to face a
H5N1 epidemics, if not this year, in one of the next coming years.
It is relatively easy to control (and eradicate) a highly pathogenic
disease, if its reservoir is known, and if an efficient vaccine
exists. This is not the case if the disease can spread unnoticed,
and if the reservoir cannot be controlled. Slaughtering all poultry
would not solve the problem. Indeed flu is a disease of Anatidae
(the family of ducks and similar animals) where it is usuallly
innocuous or causes a mild disease. It can spread to all kinds of
birds (mixed H5N1 viruses
have been indeed repeatedly identified), and one of the
problems of this widespread species affinity, is that the virus
mutates and adapts easily to its new hosts, while being reassorted
between hosts when there is co-infection with several viruses of the
same family. It can then spread to mammals, and lead to the disease
we know as human flu. During the initial passage from a species to
another species, there is usually no intraspecies contamination.
This is probably the situation we have now with H5N1 in humans.
Unfortunately, because of virus mutations and reassortments, it is
more than likely that a new form of the virus will eventually spread
from humans to humans. Two strategies have to be combined to make
this event less likely, and to control it when it happens. First,
one has to diminish as much as possible the sources of contamination
(slaughtering animals is efficient, provided precautions are taken
so as to avoid aerosol contamination during the process itself;
vaccination of animals is a second helpful action). Second,
one has to prepare for the eventuality of person-to-person
contamination when it will be needed to act fast: this will require
isolation of the specific new virus, and preparation of a vaccine
from it (while, as indicated by the WHO, reverse genetics will allow
scientists to prepare the vaccine strain in a week, this will
require several months, but the time will be shortened if
infrastructures providing facilities to prepare a large number of
fertilized eggs for preparation of the vaccine can be made readily
available), and this will require control of movements of persons
from the affected areas. The measures that have been implemented
during the SARS episode will certainly help in this domain. However,
lessons have to be taken from what happened then, in particular
about the negative role of panic (people unobtrusively moving away
from affected areas, and underreporting, to escape quarantine
measures). In the North of France, and 11th person died from
legionellosis, while the disease has been identified in several
regions of the country. It is most likely that pneumonia caused by Legionella
pneumophila were not diagnosed in the past, and that the
diagnostic tools now identified give an unusual pattern of this
disease as compared to what was known in the past.
- 3 february 2004. An 85th case of
legionellosis discovered in the region of Lens: this suggests that
the cause of contamination is not yet identified with certainty. No
further information substantiated person-to-person contamination by
the bird flu virus. Thailand has slaughtered 27 million chickens in
an attempt to slacken the pace of bird flu, while another suspected
patient dies. China has placed 3,200 farmers under observation.
Indonesia confirmed that it had infection with the H5N1 virus, but
the measures to counteract the spread of the disease are still
unclear.
- 2 february 2004. In addition to possible
person-to-person contamination of bird flu, there is concern that
this year's human flu has reached Vietnam. This would increase
enormously the likeliness of reassort between the bird flu virus and
the human virus, triggering the possibility for a pandemic similar
to that which infected humans in 1919. In Shanghai, officials at the
markets are urged to enforce a strict quarantine system to ensure
only those poultry products with a quarantine certificate are sold
in the city. 300,000 birds have been slaughtered in a three
kilometer radius of a suspected case and the area has been
disinfected. The district government has also blocked all major
intersections in the involved area to ensure that no poultry is
transported out. The fourth SARS patient in
Guangzhou was a medical doctor, apparently without contact with SARS
patients, according to the local authorities. On january 30th a 84th
case of Legionellosis has been identified in the region of Lens. The
outbreak seems however to subside.
- 1 february 2004.
Five more provinces are affected in China by the H5N1
virus. The WHO warns that one of the infected Vietnam sisters might
have got the virus from her brother. Flu is an old disease of ducks
(usually mild) and the usual transmission route is from duck to pig
to man. It is often coming from China, because of the structure of
Chinese farms (remember that the Chinese character for family is the
pig under a roof)... The disease becomes dangerous when the
transmission shifts directly from man to man. A strong outbreak
appears every couple of decades or so ("Asian flu", "Hong Kong flu"
etc...), that progressively invades the whole world and mutates to
adapt to the reaction of the human immune system on a more or less
yearly basis. After somebody has got the disease he or she usually
recovers, with a strong immune response. But this selects mutant
viruses with the following trick: the antibodies of the host adapt
closely to the shape of a protein covering the virus; but one way
for the virus to avoid being recognized is to change one motif of
that protein by a bigger motif. In this situation the antibodies are
more or less inefficient. During this adaptation time people are
however somewhat protected by the past infections and the disease is
not so dangerous. After some time, the pool of variation is
completely covered, and the only way out for the virus is to undergo
more drastic changes, such as recombination with similar viruses.
Thus, in general, one finds a moderately severe disease every
quarter of a century, followed by "ordinary" outbreaks every year as
the rule. Now, there are sometimes new trends, corresponding to the
spreading of a form that is severe in birds (bird flu) rather than
mild. This severe disease can directly infect man: this is the case
of H5N1, and recently of H7N7. Now, if that disease can adapt to
transmit from man to man, then this will create an extremely
dangerous outbreak, because no preexisting immunity is present in
the human population. This is why the WHO is concerned at present,
because this event will most probably happen in a not remote future.
The reason is the following: the flu virus is made of a collection
of independent fragments. Each one can mutate, producing a form that
may escape the immune system of the host. But the most dangerous
thing is when two different flu viruses infect a given animal
(man included). Indeed, in this situation the fragment may
reassort and produce all kinds of viruses, some adapted to
multiplication in the human host, with a disguise allowing it to
escape its immune system. It is most likely that this will happen
sooner or later. The only way out is to try to guess what will
happen, and prepare a vaccine (ie preset the immune system by
vaccination) against the new virus... This is today's challenge.
- 31 january 2004. China's
Health Ministry announced a new confirmed case of SARS in Guangzhou,
but said the patient - the country's fourth case this season - had
already been discharged from hospital. This patient did not have
contact with wild animals.
- 30 january 2004. Progresses in the
preparation of a bird flu vaccine are being made. As for most such
vaccines they require infection of fertilized eggs, which is not
without causing practical problems. The SARS consortium has
published its work on the origin of the virus. The double epidemic
model, that accounts for this scenario might also give ideas about
the spread of the H5N1 flu [PDF].
- 29 january 2004. H5N1 flu is probably
much more widespread than previously thought. Since it last
record in february 2003 (where it sent a confusing message at
the onset of the SARS epidemic) it has certainly lingered in
China, and it was present last august in Indonesia. Millions of
chickens have been killed by the virus or slaughtered, but it is
unlikely that this will stop the disease, which is now most
certainly endemic throughout Asia. In the ten countries affected by
bird flu, it is not certain that all are due to the H5N1 virus: in
Pakistan it may be the N7 virus, a similar strain that killed
millions of chicken (and one veterinarian) in Netherlands last
summer. Mass culling is however underway. In Hong Kong a woman
returning from Vietnam is showing signs of the disease. Two further
cases of legionellosis have been diagnosed in northern
France, putting the sickness toll to 83.
- 28 january 2004. Bird flu has crossed
into China (in three provinces at least: ducks that contaminated one
man in Guangxi and chicken in Hunan and Hubei), raising to 10 the
number of Asian countries affected by the dangerous virus as
regional officials prepare for crisis talks today in Bangkok. We
advocated to monitor the health status of migrating scavengers such
as Milvus migrans
as early as 2001 as possible sentries indicating the existence
of bird's flu in remote areas. This black kite ("milan noir" in
French, and "old eagle" in Chinese) is travelling for very long
distances while eating mostly dead animals. It is therefore expected
to be highly sensitive to contamination (and this is why it is among
the species that are on the way to extinction), and the monitoring
of their populations might be a good indicator of existing epidemics
that are otherwise difficult to monitor. A SARS
epidemiological study about to be published in Science
demonstrates that several viruses derive from a
common ancestor. This indicates that the reservoir may still
be present, in agreement with the scenario of the
double epidemic. A memorandum of understanding is signed
between the Chinese Academy of Sciences and the Institut Pasteur,
under the sponsorship of the President of China, Hu Jintao, and the
President of France, Jacques Chirac, for the creation of an Institut
Pasteur in China.
- 27 january 2004. Another ExxonMobil factory
is stopped because one of its refrigerating towers is shedding high
concentrations of Legionella pneumophila, near Le Havre in
France. Malaysia is implementing anti-SARS measures to combat
the possible spreading of the bird's flu H5N1 virus.
- 26 january 2004. Eighty one persons have been
infected by legionellosis near Lens,
among which 10 passed away and 5 remain in intensive care. The
source of the contamination is still obscure, because the pattern of
infection does not match with what is known about the disease.
- 24 january 2004. Thailand informed the WHO of
several laboratory confirmed cases of H5N1 avian influenza
in humans. Earlier an outbreak of an epidemic that was interpreted
as chicken cholera (caused by the bacteria Pasteurella
multocida and can be cured by antibiotics) had surprizing
features that led to fears that, as other countries in South East
Asia, Thailand was contaminated by bird's flu. This information
prompted the European Union authorities to ban poultry import from
Thailand to Europe. The now widespread bird's flu is almost certain
not only to contaminate more humans, but to lead to person-to-person
contamination. This would trigger a flu outbreak that might have
disastrous consequences. The flu virus is made of different segments
that can exchange in an individual contaminated by another strain of
the virus. The usual route is from birds to pigs, then to humans.
Simultaneity of infection by a virus adapted to humans (such as H3N2
a family of viruses that spread in Europe this autumn) and by the
bird's flu virus would yield a recombinant both well adapted to
multiplication in Man and escape from its immune response. Several
cases of dengue were diagnosed in Hong Kong, indicating that
the disease is endemic, and may trigger an outbreak in the future.
- 22 january 2004. Legionellosis is
still there in the North of France, four more patients have been
identified, raising their number to 80. A dead peregrine falcon was
found near 2 chicken farms in Hong Kong, and it was shown to be
infected by bird's flu. This is in line with the
suggestion we made in may 2001 that wild birds, in particular
migrating birds, might be involved in the spread of the virus.
- 21 january 2004. On the front of SARS
fighting, the investigation of the WHO continues. The reservoir of
the virus is still unknown. Thirty healthy volunteers in China
accepted to be enrolled in a SARS vaccine test. The H5N1 flu virus
appears to be present in 17 localities in Vietnam, but, as yet, no
person-to-person contamination has been discovered. However, as a
precautionary measure, the WHO is stepping up the procedures needed
to rapidly produce a new influenza vaccine capable of protecting
humans against the H5N1 strain of avian influenza recently detected.
A new case of legionellosis was diagnosed in the North of France,
making the total number of persons infected to 76.
- 19 january 2004. Bird's flu has been found in
17 localities in the north and the south of Vietnam, infecting some
2 million poultry. So far, the WHO has not seen any sign of
transmission of the virus between humans. Unfortunately, as the
number of infected patients increase, the likeliness of
person-to-person transmission becomes more and more possible.
- 18 january 2004. At the turning year from the
Goat to the Monkey year, China has upgraded its control on patients
travelling, monitoring cases of fever. Hundreds of millions of
Chinese are travelling during this period of the year. SARS does not
seem to have expanded. However there is much concern about bird's
flu, since the province of Guangdong, for example, breeds some 1.36
billion poultry birds, while 5 more cases have been reported in
Vietnam, making it a true outbreak... As in the epidemic of 1919
young adults seemed to be particularly at risk.
- 17 january 2004. Again two more cases of
legionellosis in the region of Lens, France: 75 persons infected, 10
deaths. All the outbreaks of avian flu in Vietnam, South Korea and
Japan are now confirmed to have been caused by a H5N1 type of flu
virus. This virus caused the beginning of an outbreak in Hong Kong
in 1997, stopped by radical measures of killing all live poultry in
the region. The virus then subsequently came back at several times
in the region, in particular masking
the beginning of the outbreak of SARS in february 2003. It is
of extreme concern that the area now affected is so large, because
there can be recombination in and transmission by most types of
birds, leading to a potential letal disease in humans. In addition
the virus is prone to mutation that allows it to adapt fast to a new
host. A flu disease would be much more dangerous than SARS.
- 16 january 2004. Two more cases of
legionellosis in the North of France: 73 persons infected, 10
deaths. However the curve describing the time of onset of symptoms
for the first 69 cases may be consistent with a decline in the
outbreak. A case of H5N2 bird's flu, less dangerous than H5N1 has
been diagnosed in Taiwan. The recent SARS-CoV virus might be caused
by infection coming from civet cats, because the virus appears to
have been found in the restaurant where the last case (a waitress
there) was diagnosed. However this is just indicative of a possible
animal source.
- 15
january 2004. H5N1 bird's flu, the very dangerous
virus of the family that infected patients in Hong Kong in 1997 is
now out of China. Several cases have been diagnosed in Viet Nam and
diagnosis of avian influenza virus subtype H5N1 was made at the
National Institute of Animal Health, Ibaraki Prefecture, in Japan.
This is very disturbing because Japan apparently has been immune
from bird's flu since 1925, while Vietnam has never reported the
disease previously. If the disease spreads to humans, and then from
humans to humans this will be a major emergency. Vietnam said
yesterday it had detected 18 suspected cases of bird flu in humans,
and that 13 victims had died. And the World Health Organisation has
warned it could be much worse than SARS. Vietnam News Agency
reported that eighteen people have been found to have contracted
influenza A, of whom 13 died, including 11 children and two adults.
The WHO has confirmed three deaths from the H5N1 virus in Vietnam,
but it says it is carrying out tests to determine if the bird flu
virus killed the others. The cause of contamination is not known, it
could be directly from poultry, or, a more dangerous source, through
pigs that would have caught it from poultry, paving the way for
person-to-person contamination (pigs are very similar to humans). On
the SARS front, scientists in Hong Kong have discovered antibodies
against SARS-CoV in the sera of patients collected in 2001 for a
study of hepatitis B infection. This is consistent with the double
epidemic hypothesis that assumes the existence of a
pre-existing innocuous virus that can mutate, presumably because of
a region of mutational hot spot (deletion hot spot in particular),
to the virus causing SARS.
- 14 january 2004. More rumors about SARS: New
Zeland authorities investigate about the death of a man who died in
Russia from SARS-like pneumonia. It is important indeed to
investigate cases at places out of China, if, indeed the double
epidemic hypothesis accounts for the emergence of SARS-CoV. Two crew
members of a flight from Guangzhou are isolated with temperature in
a negative pressure room in Sydney, for fear of SARS (15th january,
Australia time). As usual in this time of the year (Northern
hemisphere) the number of pneumonia is important. This makes
extremely difficult to have an accurate and fast diagnostic of SARS.
As a case in point, the Hong Kong Department of Health has already
received 125 notifications of pneumonia of people who had travelled
in the Guangdong region recently. Legionellosis in the North of
France: 71 persons infected, 9 deaths. Reports indicate the bird's
flu (H5N1) might have infected some people in Vietnam.
- 13 january 2004. Some confusion arises about
possible SARS cases in China. A fourth possible case has been
discarded, while the second case, that of a waitress in Guangzhou
has been confirmed. In France, legionellosis makes a 9th victim
while two more patients are diagnosed with the disease. They are
late diagnosed patients, suggesting that the disease may have
stopped spreading.
- 12 january 2004. A third patient likely to be
infected by SARS-CoV, has been isolated for observation in
Guangzhou, where two other SARS cases, one of them confirmed, have
been treated. Legionellosis makes an 8th victim in France (68 cases
in the region of Lens).
- 8 january 2004. A second patient may have
caught SARS-CoV in Guangdong and is hospitalized in Guangzhou. Three
reporters coming from a possible contaminating area (wild animals
market) have been quarantined in hospital in Hong Kong. If, as
expected, a mild or innocuous form of the virus is endemic in
Guangdong it is likely that the disease will reappear after a first
round of mutations of the virus in some patients, causing SARS.
However it is somewhat unlikely that the "super-spreader" form will
appear shortly. This might happen, however. This form would be the
most dangerous one (as demonstrated last year) and this justifies
stringent quarantine measures (as already applied) as well as
measures such as temperature control as they are already implemented
in Chinese airports. 62 patients have been infected by Legionella
pneumophila in the region of Lens (France).
- 7 january 2004. The first SARS case found in
Guangzhou since last year triggers a frenzy of slaughtering of civet
cats in Guangdong. This may be an inadapted reaction because nothing
proves really that civet cats were the cause of the disease:
correlation is not cause! The animals found to carry SARS-CoV were
diverse, and this argues against the idea that they were the source
of the virus. They could have been infected by Man, and/or they
could have eaten up animals carrying the virus. Indeed SARS-CoV
seems to be related to rodent viruses or viruses present in the
domestic cat. Furthermore, the patient recently infected never
ate civet cat...
- 6 january 2004. While the SARS case in
Guangzhou is confirmed by virus neutralization antibody tests
carried out by two laboratories in Hong Kong that are part of the
WHO international laboratory reference network, as well as by a
laboratory under the Chinese Centre for Disease Control and
Prevention in Beijing, rumors spread that a traveller going from
Hong Kong to Philippines might have had the disease. The Chinese
patient is now cured and will be discharged on thursday. It will be
important to monitor further developments as we are entering the
winter time in the Northern hemisphere. In the region of Lens two
more cases of legionellosis have been diagnosed, while the present
source of contamination is still unknown. The difficulty comes from
the fact that Legionella pneumophila is a normal host of
water, and that cofactors for infection (high concentration of the
bacteria aside) are not well known.
- 5 january 2004. Despite identification of a
cooling tower from the company Exxon as a source, legionellosis is
still spreading near Lens: 57 patients and 7 deaths. The way Legionella
pneumophila infects people is not well understood. It appears
likely that a significant number of bacteria is needed to cause
infection. A possible way might be that some bacteria can enter
amoebae where they are not killed, and even multiply. In turn
aerosols containing amoebae might create a focus where bacteria
still multiply, to a level where the immune system becomes unable to
cope with further multiplication. The SARS case in Guangzhou is
confirmed.
- 31 december 2003. The legionellosis outbreak
in Northern France is still spreading, with 50 cases and 6 deaths.
In the mean time questions arise about the validity of the possible
SARS case diagnozed in Guangzhou.
- 29 december 2003. Legionellosis keeps
spreading in the North of France: 42 cases have now been identified.
- 27 december 2003. A
case of SARS seems to have appeared in the Guangdong province,
suggesting that the virus, or its parent, is still present in the
region. Data from the province suggest that the virus derives from
an ancestor after a series of mutations. This fits with the
"double epidemic" hypothesis, that suggests the presence of an
innocuous virus mutating to the dangerous SARS causing form. In
France, legionellosis reaches 38 cases, since the end of november in
the region of Lens. The cause of infection is still not identified
without ambiguity.
- 18 december 2003. The scientist working at a
military hospital in Taiwan who was probably infected by the SARS
coronavirus travelled to Singapore before showing signs of fever. As
a precautionary measure the government of Singapore decided to
quarantine 70 persons in the unlikely case they had been infected.
Because the laboratory is supposed to be submitted to the highly
secure rules of P4 containment, this accident is a matter of extreme
concern.
- 17
december 2003. An accidental case of SARS appears in
Taipeh (Taiwan) showing that conservation of pathogenic viruses is a
matter of concern.
- 16
december 2003. Legionellosis reaches 24 cases, with three
deaths, in the region of Lens (France). The source of infection is
not yet identified.
- 12 december 2003. Legionellosis is spreading
in the region of Lens (19 cases, 2 deaths). Flu (H3N2) reaches its
peak in France. It will soon have infected 3 million persons.
- 30 november 2003. A case of Legionella
infection is found in the region of Lens (north of France).
- 10 november 2003. A control test has confirmed
the 7th Czech case of a domestic cow with mad cow disease (BSE), in
a 4-year-old cow from Lomnice nad Popelkou, a town about 90 km
northeast of Prague. Flu is slowly spreading in Europe (H3N2, a
standard type of flu).
- 30 october 2003. A case of diphteria, probably
caused by an unusual form of Corynebacteria has been identified in a
Paris hospital.
- 11 october 2003. While the epidemic of
infection by West Nile virus (a deadly mosquito-borne disease)
remains a matter of concern in Northern America, and at a time when
a case has been found in France, scientists at Purdue University
have determined the structure of the West Nile virus, using
cryoelectron microscopy and advanced imaging techniques. The Purdue
team has determined the overall structure of the major surface
proteins in the virus. Because these proteins are instrumental in
allowing the virus to permeate its host cells, this could be a step
forward in combating the disease by designing molecules that would
mimick the binding properties of the virus surface and thus
interfere with host cell invasion.
- 9 october 2003. After its Hong Kong
counterpart published its conclusions on SARS, the Canadian Agency
for Public Health reviews its recommandations in the situation of
communicable diseases outbreaks.
- 2 october 2003. The Hong
Kong’s SARS Expert Committee, composed of local and
international experts from the fields of public health, health
service administrators, and communicable disease control and set up
by Hong Kong’s Chief Executive at the end of May to review the
management and control of the SARS outbreak in Hong Kong, publishes
its final report. The reports summrizes major events in the SARS
epidemic, and addresses some key issues arising from the epidemic.
- 23 september 2003. An 11 member
review panel appointed by the Singapore's Ministry of Health has
concluded that the recent SARS patient most likely acquired the
infection in the Environmental Health Institute laboratory where he
had worked. The virus has indeed a sequence similar to that of
coronaviruses manipulated in that laboratory. Inappropriate
laboratory procedures and a cross-contamination of West Nile virus
samples with SARS coronavirus in the laboratory led to the
infection. No evidence could be found of any other source of
infection. This is fortunately an isolated case of SARS, with no
associated secondary infections.
- 12 september 2003. There is a possibility that
the recent SARS case in Singapore may have resulted from a
laboratory accident. The WHO will be addressing the issue of
laboratory safety at its meeting of SARS scientific advisors in
October 2003 in Geneva.
- 9 september
2003. The government of Singapore warns that a
student that had not left the city for several months has been
diagnosed with SARS and hospitalized.
- 5
september 2003. The "double
epidemic" model of SARS, where a rather innocuous coronavirus
would spread, segregating from time to time, at independent points,
variants that are causing SARS is an important
hypothesis that should not be dismissed. If this scenario is
exact, then it is likely that SARS will appear again unless the
original source has become extinct, a quite unlikely scenario if
this corresponds to a mild or even invisible disease. This should be
made known somehow so that people are prepared.
- 4 september 2003. Eighteen persons are
infected by Legionella in the region of Poitiers (France). The
source of the bacteria is not yet identified.
The SARS 2003 outbreak
A
short description of relevant microbes