Wednesday, May 23, 2018

EID Journal: Reemergence of Reston Ebolavirus in Cynomolgus Monkeys, the Philippines, 2015


Long time readers with good memories will recall in September of 2015, in Ebola Reston Discovered In Philippine Lab Monkeys, we looked at the  announcement of the discovery of Ebola Reston among laboratory monkeys being kept at an unnamed research laboratory in the Philippines.
Ebola Reston is one of five known Ebola virus species, and the only one found to be endemic outside of Africa.
Unlike its African cousins, Ebola Reston – while capable of infecting humans – is not known to produce illness or death in man.  It can, however, produce serious illness in non-human primates, and can infect pigs (generally asymptomatically).
Ebola Reston was first discovered in crab-eating macaques - imported from the Philippines - at a research laboratory in Reston, Virginia (USA) (hence the name) in 1989. This discovery was recounted somewhat sensationally in the book, The Hot Zone, by Richard Preston.
In the October 2014 CDC Review of Human-to-Human Transmission of Ebola Virus described the 1989 Reston laboratory outbreak and subsequent infection of personnel. 
Similarly, an outbreak of Reston virus (Reston ebolavirus species, which does not cause EVD in humans) infection occurred in a quarantine facility housing non-human primates in separate cages and the transmission route could not be confirmed for all infected primates.
Multiple animal handlers developed antibody responses to Reston virus suggesting asymptomatic infection was occurring in humans with direct animal contact and implicating animal handling practices in transmission between primates
Somewhat famously, in late 2008 Ebola Reston made another high profile appearance when it was reported for the first time in pigs, again from the Philippines.  This from the FAO.
First detection of Ebola-Reston virus in pigs

FAO/OIE/WHO offer assistance to the Philippines

Manila/Roma, 23 December 2008 - Following the detection of the Ebola-Reston virus in pigs in the Philippines, FAO, the World Organization for Animal Health (OIE) and the World Health Organization (WHO) announced today that the government of the Philippines has requested the three agencies send an expert mission to work with human and animal health experts in the Philippines to further investigate the situation.
An increase in pig mortality on swine farms in the provinces of Nueva Ecija and Bulacan in 2007 and 2008 prompted the Government of the Philippines to initiate laboratory investigations. Samples taken from ill pigs in May, June and September 2008 were sent to international reference laboratories which confirmed in late October that the pigs were infected with a highly virulent strain of Porcine reproductive and respiratory syndrome (PRRS) as well as the Ebola-Reston virus.

(Continue . . .)

Roughly a month later, we learned that several farm workers in contact with infected pigs tested positive for antibodies to the Ebola-Reston virus.  None displayed any signs of illness (see Ebola Reston in pigs and humans in the Philippines).

While not currently viewed as a human health threat, the World Health Organization hedges its bets slightly with Ebola Reston by stating:
Among workers in contact with monkeys or pigs infected with Reston ebolavirus, several infections have been documented in people who were clinically asymptomatic. Thus, RESTV appears less capable of causing disease in humans than other Ebola species.
However, the only available evidence available comes from healthy adult males. It would be premature to extrapolate the health effects of the virus to all population groups, such as immuno-compromised persons, persons with underlying medical conditions, pregnant women and children. More studies of RESTV are needed before definitive conclusions can be drawn about the pathogenicity and virulence of this virus in humans.
Two years ago (March 2016) we took another look at this Ebola outlier (see I'm Not Dying, I'm Just Reston) after a study was published in Nature Scientific Reports that found relatively few differences between Ebola Reston and the deadlier strains.
By focusing on a few key areas of the virus that are believed to affect its virulence in a human host, the authors concluded that only a few changes in one Ebola virus protein (VP24) might be needed to turn Ebola Reston into a virus that can cause human disease.
Although somewhat speculative, this study does remind us that viruses can change behavior over time, and that just because Ebola Reston doesn't appear to produce disease in humans today, that doesn't guarantee how it will behave tomorrow.

All of which serves as prelude to a new study, published this week in the CDC's EID Journal, which provides us with details on the 2015 Ebola Reston outbreak and subsequent investigation at the Primate lab in the Philippines.

Volume 24, Number 7—July 2018

Reemergence of Reston ebolavirus in Cynomolgus Monkeys, the Philippines, 2015
Catalino Demetria, Ina Smith, Titus Tan, Daniel Villarico, Edson Michael Simon, Rex Centeno, Mary Tachedjian, Satoshi Taniguchi, Masayuki Shimojima, Noel Lee J. Miranda, Mary Elizabeth Miranda, Melissa Marie R. Rondina, Rowena Capistrano, Amado Tandoc, Glenn Marsh, Debbie Eagles, Ramses Cruz, and Shuetsu Fukushi

In August 2015, a nonhuman primate facility south of Manila, the Philippines, noted unusual deaths of 6 cynomolgus monkeys (Macaca fascicularis), characterized by generalized rashes, inappetence, or sudden death. We identified Reston ebolavirus* (RESTV) infection in monkeys by using serologic and molecular assays.
We isolated viruses in tissues from infected monkeys and determined viral genome sequences. RESTV found in the 2015 outbreak is genetically closer to 1 of the 4 RESTVs that caused the 2008 outbreak among swine. Eight macaques, including 2 also infected with RESTV, tested positive for measles. Concurrently, the measles virus was circulating throughout the Philippines, indicating that the infection of the macaques may be a reverse zoonosis. Improved biosecurity measures will minimize the public health risk, as well as limit the introduction of disease and vectors.


In 2015, 19 years after the last known epizootic occurrence of RESTV in macaques in the Philippines, we detected and confirmed the incidence of RESTV in macaques in a primate facility south of Manila, by serologic and molecular testing. In spite of the long hiatus, RESTV was found in a controlled environment in which monkeys are systematically housed to avoid spread of diseases and to which no wild monkeys have been introduced. Personnel in the facility had no evidence of infection because no RESTV antibodies were detected.

We observed rats in cages in the primate facility that housed the primates being tested, indicating the potential for small animals to gain access to the facility. A recent study identified the microbat Miniopterus schreibersii as a possible reservoir of RESTV (6); therefore, this bat species and similar ones of this size may be the source of infection in the quarantine facility. If this is the case, improved biosecurity measures are warranted to limit the introduction of disease. However, we do not claim the bat species as the direct source of infection in 2015 outbreak. Because the facility building has its own anteroom with welded wire window screens, there is little likelihood that bats entered the facility.

Dual infections of RESTV and simian hemorrhagic fever virus (SHFV) in cynomologus monkeys has been reported in a facility in Reston, Virginia, and SHFV is the suspected causal agent for mortality in monkeys (17). Dual infections of RESTV and PRRSV in swine have been identified in the Philippines (5) and in Shanghai, China (18). In these cases, all of the RESTV-positive swine were coinfected with PRRSV. In contrast, we found in this study that 1 (ID: DrpZ1–26D-B) of the 10 macaques positive for RESTV antibody was also positive for MV antibody. Furthermore, another macaque (ID: DrpZ2–10B-G) was confirmed to have dual infection of RESTV and MV by using PCR. The results show similarities with dual infections such as SHFV and RESTV in macaques (17), or RESTV and PRRSV infections in swine (5). However, MV was not detected among most macaques positive for RESTV that died from the disease. Also, it remains unclear whether the MV infection supports an increase in RESTV replication in macaques. We found that 8 macaques had antibodies against MV, and 1 was MV PCR positive. Considering the risk for human-to-primate transmission (19,20), there is a possibility that MV infection in macaques is associated with human MV outbreak in the Philippines, although further studies are required to identify the mode of transmission of MV infection in macaques.

The RESTV sequences obtained were most similar to Reston-08-E from the Philippines 2008 outbreak in swine (5) (Figure 1). There were 3 nucleotide variations between the viral isolates that were sequenced, 2 of which in isolate DrpZ5–2B-F resulted in nonconservative changes in the NP and VP24 proteins that were unique when compared to all of the RESTV isolates sequenced. 

Because of the similarity with other Ebola viruses and the virus’ ability to infect humans, there is a concern that RESTV could mutate during passage through animals like macaques and cause an epidemic of disease in humans. Because it could mutate to pose health consequences for humans, continued surveillance is required to reduce the risk of transmitting Reston Ebola virus. 

Dr. Demetria is the head of the Rabies and Special Pathogens Laboratory at the Research Institute for Tropical Medicine in The Philippines. He has a strong interest in emerging zoonotic infectious diseases.
Ebola viruses, the Marburg Virus, Nipah, MERS, and a long list of other pathogens are carried by bats, making their study increasingly important in the world of virology and epidemiology.

A list of some recent bat-related blogs include:

Indian Government Responds To Reported Nipah Outbreak In Kerala

Back To The Bat Cave: More Influenza In Bats

EID Journal: A New Bat-HKU2–like Coronavirus in Swine, China, 2017

Emerg. Microbes & Infect.: Novel Coronaviruses In Least Horseshoe Bats In Southwestern China

SARS-like WIV1-CoV poised for human emergence

WHO DRC Ebola Update - May 23rd


We are just a few weeks into the DRC's 9th Ebola outbreak of the past 40 years, and already there are (as of May 21st) 58 confirmed or suspected Ebola virus disease (EVD) cases, including 27 deaths reported from 3 separate regions of Equateur Province.
Last week (see WHO Statement On 1st Urban Ebola Case Reported in DRC) we learned the virus has been detected in Wangata, part of the heavily populated city of Mbandaka (pop. 1.2 million), some 150 km from the initial outbreak in the Bikoro health zone.
Today's report indicates that the number of cases in Wangata has now increased to 7 (4 confirmed and 3 suspected cases), raising concerns over futher transmission in this heavily populated region.  

Details, however, remain scant and multiple epidemiological investigations are ongoing.  We know that 3 of the 58 cases are health care workers, and about 600 potentially exposed people are being monitored.

The full update follows:

Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news
23 May 2018 

On 8 May 2018, the Ministry of Health (MoH) of the Democratic Republic of the Congo declared an outbreak of Ebola virus disease (EVD). This is the ninth outbreak of Ebola virus disease over the last four decades in the country, with the most recent outbreak occurring in May 2017 (Figure 1). Additional information on this outbreak is available from situation reports in the links below. 

Since the last Disease Outbreak News on 17 May 2018, an additional fourteen cases with four deaths have been reported. On 21 May 2018, eight new suspected cases were reported, including six cases in Iboko Health Zone and two cases in Wangata Health Zone. On 20 May, seven cases (reported previously) in Iboko Health Zone have been confirmed. Recently available information has enabled the classification of some cases to be updated1.

As of 21 May 2018, a cumulative total of 58 Ebola virus disease (EVD) cases, including 27 deaths (case fatality rate = 47%), have been reported from three health zones in Equateur Province. The total includes 28 confirmed, 21 probable and 9 suspected cases from the three health zones: Bikoro (n=29; ten confirmed and 19 probable), Iboko (n=22; fourteen confirmed, two probable and six suspected cases) and Wangata (n=7; four confirmed and three suspected case). 

Of the four confirmed cases in Wangata, two have an epidemiological link with a probable case in Bikoro from April 2018. As of 21 May, over 600 contacts have been identified and are being followed-up and monitored field investigations are ongoing to determine the index case. Three health care workers were among the 58 cases reported.

Public health response

The Ministry of Health is leading the response in affected health zones with the support of WHO and partners. Priorities include the strengthening of surveillance and contract tracing, laboratory capacity, infection prevention and control, case management, community engagement, safe and dignified burials, response coordination, and vaccination.
  • WHO is working with the Ministry of Health, Gavi, the Vaccine Alliance, Médecins Sans Frontières (MSF), UNICEF and other partners, including the Ministry of Health of Guinea, to conduct vaccination against Ebola for people at high risk of infection in affected health zones.
  • On 21 May 2018, ring vaccination started along with vaccination of health workers in Mbandaka (WHO) and Bikoro (MSF). Merck has provided WHO with 8 640 doses of the rVSVΔG-ZEBOV vaccine of which 7 540 doses are available in the Democratic Republic of the Congo (approximately enough for 50 rings of 150 people). An additional 8 000 doses will be available in the coming days.
  • WHO continues to strengthen surveillance and contract tracing activities. The Early Warning Alert and Response (EWAR) System was deployed to Wangata to improve the collection and management of information cases and contacts.
  • Staff in health facilities in Wangata and Bikoro continue to be trained to use EWARS and enhance surveillance activities. A hotline was re-established to assist the detection of new cases, and an alert system was setup with MSF in Wangata. Rapid Response Teams (RRT) and “relais communautaires” have been trained and activated to investigate new cases and conduct contract tracing.
  • WHO continues to coordinate with the UN Humanitarian Air Service (UNHAS) for daily air transport between Mbandaka and Bikoro. In Iboko, an airstrip has been cleared for helicopters to land.
  • Case management and infection, prevention and control activities continue to be scaled up with the establishment, stocking and staffing of Ebola Treatment Units (ETUs) within affected areas. MSF-Belgium continues support case management within the Bikoro Reference Hospital. WHO is coordinating with clinical teams (EMTs) to be on standby should further ETUs be required, and to mobilize four teams to support triage, IPC and maintenance of essential health services for the population at the major health facilities in Mbandaka, as well as a team to support a safe ambulance referral system for patients.
  • WHO, UNICEF and partners are supporting the Ministry of Health to raise awareness and engage affected communities to promote the early identification of signs and symptoms of EVD, seek prompt treatment, and practice safe and dignified burials. Risk communication activities are continuing in the affected areas and Kinshasa.
  • As of 21 May, WHO has deploymed 123 personnel. WHO is working with the Global Outbreak Alert and Response Network (GOARN) partners and technical networks, including the Emerging Diseases Clinical Assessment and Response Network (EDCARN) and the WHO Emerging and Dangerous Pathogen Laboratory Network (EDPLN) to coordinate response planning and technical support, and to deploy additional technical support. As of 21 May, 15 exerts from GOARN partners are being deployments to strengthen field teams.
  • Preparation Support Teams (PST) missions are underway in several priority countries in the region to enhance preparedness and readiness in the event of further spread.

WHO risk assessment

Information about the extent of the outbreak is still limited and investigations are ongoing. The confirmed case in Mbandaka, a large urban centre located on major national and international rivers, roads and domestic air routes, increases the risk of spread within the Democratic Republic of the Congo and to neighbouring countries. WHO has, therefore, revised the assessment of public health risk to very high at the national level and high at the regional level. Nine neighbouring countries, including Congo-Brazzaville and Central African Republic, have been advised that they are at high risk of spread, and preparedness activities are being undertaken. At the global level the risk currently remains low. This risk assessment is continuously being review as further information becomes available.

Based on the current situation and information available, the WHO Director-General convened an Emergency Committee under the International Health Regulations (IHR) (2005) on Friday 18 May to provide advice on whether the current outbreak constitutes a public heath event of international concern2. It was the view of the Committee that the conditions for a Public Health Emergency of International Concern have not currently been met.

WHO advice

In light of the advice of the Emergency Committee, WHO continues to advise against the application of any travel or trade restrictions. WHO continues to monitor travel and trade measures in relation to this event, and currently there are no restrictions on international traffic in place. 

The Emergency Committee while noting that the conditions for a PHEIC are not currently met, issued the following Public Health Advice:
  • Government of the Democratic Republic of the Congo, WHO, and partners remain engaged in a vigorous response – without this, the situation is likely to deteriorate significantly. This response should be supported by the entire international community.
  • Global solidarity among the scientific community is critical and international data should be shared freely and regularly.
  • It is particularly important there should be no international travel or trade restrictions.
  • Neighbouring countries should strengthen preparedness and surveillance.
  • During the response, safety and security of staff should be ensured, and protection of responders and national and international staff should prioritised.
  • Exit screening, including at airports and ports on the Congo river, is considered to be of great importance; however entry screening, particularly in distant airports, is not considered to be of any public health or cost-benefit value.
  • Robust risk communication (with real-time data), social mobilisation, and community engagement are needed for a well-coordinated response and so that those affected understand what protection measures are being recommended.
  • If the outbreak expands significantly, or if there is international spread, the Emergency Committee will be reconvened.
For more information on Ebola virus disease, please see the link below:

EMRO MERS-CoV Summary - April


We are now just over a week into the Holy Month of Ramadan, which is second only to the Hajj in seeing religious pilgrims visiting the Holy sites of Saudi Arabia, and daily reporting from the Saudi MOH - which has been increasingly erratic the past few months - hasn't been updated since May 15th (see below).

Screen shot taken today

Missing also this month are reports for the 8th, 9th & 10th. The confirmed number of cases at the top of the page (1622+64 cases) are more than 6 months out of date (WHO reported 1831 cases as of end of April).

The World Health Organization hasn't posted a Saudi MERS-CoV DON Report (with case line listing) since January 26th (current through Jan 17th). This is (by far) the longest gap between MERS WHO DON reports since the virus was first announced in September of 2012.

Over the past week the Saudi MOH had appeared to be in the process ofredesigning their website, and until this morning, all data since the last week of January has been missing. 
They seem to have - at least temporarily - restored the old format.  Or at least some of it, as only the most recent page of daily reports appears to be accessible. 
Aside from the increasingly erratic postings by the Saudis, the only other MERS data we've seen has come from the WHO EMRO (Eastern Mediterranean Regional Office) monthly summary, which is based on reporting by the the Saudi MOH. 
As noted previously (see A Curious EMRO MERS-CoV Update - March), the numbers reported by EMRO don't necessarily match those posted by the Saudi MOH.
In any event, we have the EMRO report for the month of April (see below), which reports a total of 7 cases reported by the Saudis during that time period.

MERS situation update, April 2018
 Highlights, April 2018
  • At the end of April 2018, a total of 2206 laboratory-confirmed cases of Middle East respiratory syndrome (MERS), including 787 associated deaths (case–fatality rate: 35.7%) were reported globally; the majority of these cases were reported from Saudi Arabia (1831 cases, including 713 related deaths with a case–fatality rate of 39%).
  • During the month of April, a total of 7 laboratory-confirmed cases of MERS were reported in Saudi Arabia including 2 associated deaths (case-fatality rate: 28.6%). No healthcare associated transmission or hospital outbreak was reported during this month.
  • The demographic and epidemiological characteristics of cases do not show any significant difference when compared to cases reported during the same corresponding period of 2013 to 2018. Owing to improved infection prevention and control practices in hospitals, the number of hospital-acquired cases of MERS has dropped significantly since 2015.
  • The age group 50–59 years continues to be at the highest risk for acquiring infection as primary cases. The age group 30–39 years is most at risk for secondary cases. The number of deaths is higher in the age group 50–59 years for primary cases and 70–79 years for secondary cases.
Meanwhile - despite the ongoing frustration over the lack of current and accurate numbers - the good news is we've seen no signs of any sustained or efficient transmission of the MERS virus outside of health care facilities.

Tuesday, May 22, 2018

A Pre-Season Reminder To Prepare


The GFS and Euro Models have been hinting at something developing in the Western Caribbean for the past week or so, and yesterday the National Hurricane Center added it to their 5 day tropical weather outlook.
This morning, they put the chances of development at 40% over the next 5 days, and while it will probably top out as a rain-making  depression or weak tropical storm, it is a reminder that the start to the Atlantic Hurricane Season is just over a week away.
 This morning's 8am update reads:

745 AM EDT Tue May 22 2018

For the North Atlantic...Caribbean Sea and the Gulf of Mexico:

1. A broad surface low centered just east of Belize is producing a large area of cloudiness and showers extending from the northwestern Caribbean Sea across Cuba into the Florida peninsula.  While strong upper-level winds and dry air aloft are expected to limit organization during the next couple of days, some gradual subtropical or tropical development is possible late this week while the system moves slowly northward into the central or eastern Gulf of Mexico.
Regardless of development, locally heavy rainfall is possible across western Cuba, the Cayman Islands, and much of Florida during the next several days.  For more information on the heavy rain threat, please see products issued by your local weather office. The next Special Tropical Weather Outlook on this system will be issued by 800 PM EDT.
* Formation chance through 48 hours...low...near 0 percent.
* Formation chance through 5 days...medium...40 percent.

Forecaster Blake

As we discussed two weeks ago in Hurricane Preparedness Week 2018 (May 6th - May 12th), NOW is the time to make your preparations for this year's hurricane season.  Before the first storm threatens.
Last September, 5 days before Irma's landfall in Florida, there wasn't a flashlight, battery, bottle of water, or NWS weather radio to be found on any store shelves where I live
As a result, tens of thousands of people went through the storm - and days without power - unprepared.  While for most it was more a matter of discomfort than of safety, Florida got very lucky with Irma.
It could have been much, much worse. And in parts of Texas, and most of Puerto Rico, it was.
Whether you live in `Hurricane Country' or not, if a disaster struck your community today, do you already have?

  • A battery operated NWS Emergency Radio to find out what was going on, and to get vital instructions from emergency officials
  • A decent first-aid kit, so that you can treat injuries
  • Enough non-perishable food and water on hand to feed and hydrate your family (including pets) for the duration
  • A way to provide light when the grid is down.
  • A way to cook safely without electricity
  • A way to purify or filter water
  • A way to stay cool (fans) or warm when the power is out.
  • A small supply of cash to use in case credit/debit machines are not working 
  • An emergency plan, including meeting places, emergency out-of-state contact numbers, a disaster buddy,  and in case you must evacuate, a bug-out bag and a predetermined place to go. 
  • Spare supply of essential prescription medicines that you or your family may need
  • A way to entertain yourself, or your kids, during a prolonged blackout
If your answer is `no’, you have some work to do.  A good place to get started is by visiting

You may also wish to revisit some of my preparedness blogs:

When 72 Hours Isn’t Enough

In An Emergency, Who Has Your Back?

#NatlPrep: The Gift Of Preparedness 2017

ESA Epidemiological Update: HPAI Clade Viruses in Europe as of 3rd May 2018

HPAI H5N6  in Europe from 1st October 2017 to 3rd May 2018


While reports of HPAI this past winter in Europe have been subdued compared to the previous year's H5N8 record epizootic, a newly reassorted H5N6 virus did arrive last December, and a smattering of H5N8 cases have been reported.
As we've discussed previously, a major bird flu season is generally followed by one or more less severe years (see chart below), and so this recent lull is not unprecedented.

We get our most detailed updates on Europe's avian flu situation from the UK's DEFRA (see April's UK DEFRA: Update On H5N6 HPAI UK/Europe & H5N8 HPAI In Europe) and France's ESA Epidemiosurveillance Santé Animale (see ESA Epidemiological Update: Global Circulation Of Avian Flu).

Today (May 22nd) the ESA has published a new report, covering the spread of Clade viruses over this past winter (Oct 1st - May 3rd) in Europe.  I've included some translated excerpts, but you'll want to follow the link to read the full report.

Epidemiological situation of HPAI viruses from clade in Europe as of 3rd May 2018

Submitted by Alizé MERCIER on 22. May 2018 - 11:40.
For the Epidemic Intelligence team (VSI) (in alphabetical order): Anne Bronner (DGAL), Didier Calavas (Anses), Julien Cauchard (Anses), Sylvain Falala (Inra), Alizé Mercier (Cirad)

For the National Hunting and Wildlife Agency (ONCFS): Anne Van De Wiele
Corresponding author:

Sources: Data updated on 3rd May 2018 (included) ADNS/FAO/OIE, DGAL (General Directorate of Food – French Ministry of Agriculture), ProMED

Since the last situation report on 26th March 2018, the highly pathogenic avian influenza (HPAI) virus of subtype H5N6 has been reported for the first time in Slovakia on 28th March in wild birds (the virus was detected in a black-headed gull (Chroicocephalus ridibundus) among five birds found dead), and in Finland with two cases reported on 3rd and 24th April in white-tailed eagles (Haliaeetus albicilla).

The H5N6 virus was also identified in wild birds in other countries:

  • Denmark: 22 new reports involving five white-tailed eagles (four reports on 23/04 and one report on 30/04), ten common buzzards (Buteo buteo) (nine reports on 24/04 and one report on 12/04), two mute swans (Cygnus olor) (reports on 23/04 and 24/04), a great cormorant (Phalacrocorax carbo) (report on 23/04), a herring gull (Larus argentus) (report on 23/04), a black-headed gull (report on 23/04), and two hooded-crows (Larus argentus) (reports on 12/04),
  • Germany: a case in a white-tailed eagle (report on 30/04),
  • Sweden: cases in two white-tailed eagles (reports on 09/04 and 26/04), in a common buzzard (report on 26/04), and in a Northern goshawk (Accipiter gentilis) (report on 26/04),
  • United-Kingdom: a case in two common buzzards (report on 20/04), and
  • The Netherlands: a case in a common buzzard (report on 28/03).
The H5N6 virus has also been notified in captive wild birds with a case reported in Sweden on 9th April in a non-commercial holding of 105 birds (species not mentioned).

The H5N8 virus continues to circulate in poultry farms:

  • Italy: an outbreak reported in a fattening turkey farm (report on 28/03), and
  • Bulgaria: four outbreaks reported in three duck farms (reports on 05/04 and 24/04) and in a State hunting reserve (report on 18/04).
Bulgaria has also reported four outbreaks of H5Nx in duck farms on 5th and 25th April.

From 1st October 2017 to 3rd May 2018 (included), a total of 145 outbreaks of HPAI H5 (including 60 outbreaks of H5N8) were notified in twelve European countries: Bulgaria, Cyprus, Denmark, Germany, Ireland, Italy, the Netherlands, Sweden, Switzerland, the United-Kingdom, Finland and Slovakia (Table 1, Figures 1&2). Two serotypes were identified: H5N6 (Figure 1) and H5N8 (Figure 2).

An H5N2 virus detected in Russia
On 29th December 2017, Russia reported an outbreak of HPAI H5N2 in a poultry farm of more than 660 000 birds, in the region of Kostroma in the Northeast of Moscow (OIE report 29/12/2017). This outbreak was initially notified as H5N8 three days prior.

This is the first report of HPAI H5N2 virus in Russia and the last outbreak of HPAI H5N2 reported in Europe dates back to January 2017 with three outbreaks reported in poultry farms in France.

Regarding the origin of this virus, two hypotheses can be formulated:
  • the mutation of a LP H5N2 virus in domestic birds, into a HP virus (as was the case in 2015 with H7N7 in the United Kingdom and Germany, or with H5N1 and H5N2 in France),
  • a reassortment between HP H5N8 which circulated in Europe in 2016-2017 with a LP Eurasian strain, as for the H5N6 virus currently circulating in Europe. Indeed, viruses from clade have a strong mutation potential, as illustrated by the emergence of H5N6 and H5N5 viruses following the circulation of H5N8 in Europe in 2016-2017.
Whatever the case may be, further analyses are needed to identify the origin, the link and the genetic composition of these new viruses, and the evolution of the epidemiological situation in Europe should be closely monitored.
 (Continue . . . )

Monday, May 21, 2018

Indian Government Responds To Reported Nipah Outbreak In Kerala


The Nipah virus - normally carried by fruit bats common to S.E. Asia - was only first identified 20 years ago after an outbreak in Malaysia, which spread from bat to pigs - and then from pigs to humans - eventually infecting at least 265 people, killing 105 (see Lessons from the Nipah virus outbreak in Malaysia).

Similar to Australia's Hendra virus - Nipah - because of its high mortality and (limited) human-to-human transmissibility - has garnered a reputation among researchers as having at least some pandemic or bio-terrorism potential.
  • In Steven Soderbergh's 2011 pandemic thriller `Contagion’, technical advisor Ian Lipkin - director of Columbia University’s Center for Infection and Immunity in New York - painstakingly created a fictional MEV-1 pandemic virus based on a mutated Nipah virus. 
  •  In 2015's Blue Ribbon Study Panel Report on Biodefense a bi-partisan panel described a fictional biological attack on Washington D.C.  using a genetically engineered Nipah virus as part of their presentation. 
  • Just last week, in the Johns Hopkins Clade X exercise, a genetically altered Nipah virus (spliced onto a parainfluenza backbone) was the cause of their fictional pandemic.  
  • And earlier this year, in WHO List Of Blueprint Priority Diseases, we saw Nipah and Henipaviral diseases listed among the 8 viral threats in need of urgent accelerated research and development.    
Overnight, India media (and now Western media) have been reporting on an outbreak of Nipah in Kozhikode, in India's southern Kerala state (see Crof's blog Kozhikode: 11 die of suspected Nipah virus infection; medical officials say no need to panic).

While the Indian media is known for its hyperbole, and the exact number of cases and/or deaths vary between accounts - other reports - such as the BBC's  Deadly Nipah virus claims victims in India at least confirm the main points of the story.

The only official statement I've found (the MOH website remains typically silent) has been the following brief press release from the Press Information bureau.
Ministry of Health and Family Welfare           21-May, 2018 13:51 IST
Shri J P Nadda assures all support to Kerala Government to manage Nipah Virus; Sends a multi-disciplinary Central team to investigate the outbreak

In view of the rising number of cases and reported deaths due to Nipah Virus in Kozhikode, Kerala, Shri J P Nadda, Union Minister of Health and Family Welfare has assured all support to the Kerala Government and has directed a multi-disciplinary Central team from National Centre for Disease Control to immediately visit the district, and assist the State and closely monitor the situation. The team will reach Kerala today.

“We are closely monitoring the situation. I have spoken to Shri Alphons and Smt K Shailaja, Health Minister, Kerala and assured them all support of the Central government. I have also dispatched a Central team to assist the State government and initiate required steps,” the Union Health Minister said in a statement from Geneva.

On the directions of the Health Minister, Smt. Preeti Sudan, Secretary (HFW) has also spoken to the Principal Health Secretary of Kerala and reviewed the situation.

The Central team includes Dr Sujeet K Singh, Director, National Centre for Disease Control, Dr S K Jain, Head Epidemiology, NCDC, Dr P Ravindran, Director, Emergency Medical Relief (EMR), Dr Naveen Gupta, Head Zoonosis, NCDC along with two clinicians and one expert from Ministry of Animal Husbandry.
Over the past decade nearly all of the reported Nipah outbreaks have come out of Bangladesh, often linked to date palm sap collection (see Bangladesh: Nipah Update).
Fruit bats of the Pteropodidae family have a preference for roosting in the tops of trees rather than caves, which allows them to contaminate date juice collection jars with their virus laden urine and feces
Once infected via a zoonotic exposure, humans can transmit the virus on to others, albeit not terribly efficiently (see EID Journal Person-to-Person Transmission of Nipah Virus in a Bangladeshi Community).

While outbreaks of Nipah have tended to be limited in size, we'll be following the events in Kozhikode (pop. 550,000) closely, as our knowledge of the virus is limited as well.

Stay tuned.