A new and aggressive strain of HIV, which can develop into AIDS within three years of infection, has been discovered in Cuba . Researchers raise concerns that the strain’s accelerated progression...
Two types of malaria-transmitting mosquitoes in Mali -- Anopheles gambiae and Anopheles coluzzii -- have interbred to create a new hybrid “super” mosquito resistant to insecticide treated bed nets [1...
Since mid-December 2014, several cases of highly pathogenic avian influenza (HPAI) have been reported in birds in the Pacific Northwest United States, including Washington, Oregon, Idaho...
H5N1 has resurfaced in Africa’s most populous country, Nigeria. As of January 30, 2015, 11 out of 36 states across the nation have reported cases of avian influenza in poultry . The outbreak seems...
As the festivities at Times Square ushered in the new year, for young children in New York City, it also signified the start of a new mandate. For the first time in the city’s history, children under...
In the grand scheme of things, antibiotics are fairly new additions to our medical repertoire. Germ theory achieved general scientific acceptance around the 1860s . It is logical that in order to...
A new and aggressive strain of HIV, which can develop into AIDS within three years of infection, has been discovered in Cuba . Researchers raise concerns that the strain’s accelerated progression is so rapid, that antiretroviral treatment may come too late . The study came in response to Cuban clinicians reporting an ‘increasing trend’ of rapid progression AIDS cases in Cuba and results were recently published in EBioMedicine on January 28, 2015 [1,2].
About HIV and AIDS
As the world’s leading infectious killer, ‘HIV’ stands for Human Immunodeficiency Virus. HIV attacks a person’s immune system, destroying what the body needs to fight off disease and infection [4,6]. The virus is transmitted through bodily fluids such as blood, semen, and breast milk and these fluids must come into contact with the mucous membrane, damaged tissue, or injected directly into a person’s bloodstream, in order for transmission to occur . Some of the earliest symptoms of HIV infection include: fever, swollen glands, sore throat, fatigue, and rash . However, many who are HIV positive may not immediately look or feel sick. During this stage -- clinical latency -- HIV reproduces at low levels, though remains very active within a person’s body . Treatments such as antiretroviral therapy (ART) have successfully helped manage HIV symptoms and has prolonged lives .
Over time, HIV can develop into AIDS -- Acquired Immunodeficiency Syndrome -- which is considered to be the final stage of HIV infection . While not everyone reaches the AIDS stage, those who do often have a certain number of opportunistic infections, cancer, or a low CD-4 cell count. It is the onset of these symptoms that indicates that the infected person has transitioned from the clinical latency stage to AIDS .
The Cuban Strain - CRF19
Typically, it takes HIV infection without treatment approximately five to ten years to advance to AIDS. Among patients included in the study in Cuba, the strain advanced significantly faster. According to the study, it was found that patients with the mutated strain developed AIDS within three years [1,2]. It is important to note that rapid progression of HIV to AIDS does happen -- individuals who contract HIV with an already suppressed immune system can have faster advancement to AIDS . That said, it is often a patient’s pre-existing immune system differences and not the HIV-subtype that contributes to AIDS development. However, in this study, the HIV variant seemed to play an imperative role in the rapid advancement .
Upon closer inspection, researchers found that the rapidly-advancing HIV patients were linked by their variant type of HIV. The new, variant-HIV was found to be a new recombinant subtype consisting of sub-types A, D, and G . This new combination has been named CRF19 .
A researcher on the study, Prof. Anne-Mieke Vandamme of Belgium University-Leuven, further explains how this particular variant accelerates the AIDS process:
“There are two types of co-receptors that HIV can use: CCR5 or CXCR4. And in the normal progression of the HIV to AIDS it often happens that the virus switches co-receptor. It almost always starts with using CCR5 and then it switches to CXCR4 after many years. And once it switches the progression to AIDS goes very fast” .
Researchers also suspect that the inclusion of sub-type D may also be the key in the aggressiveness of the CRF19 strain. HIV sub-type D “contains an enzyme that enables HIV to reproduce in greater numbers – and it takes proteins from other subtypes and uses them in new virus particles” .
The Burden of HIV/AIDS
On a global scale, 35 million people worldwide are currently living with HIV/AIDS . The greatest burden of the disease lies within low and middle income countries, specifically within sub-Saharan Africa . According to UNAIDS, there is approximately 16,000 people in Cuba currently living with HIV/AIDS . Of those infected, about 15,000 are adults aged 15 years and older .
More than 1.2 million people are currently living with HIV in the United States and 1 in 7 people do not know that they are infected . Approximately 25% of those who are acquiring new infections in the United States are between the ages of 13 and 24 years old -- those in this demographic also are usually unaware that they are infected and may pass on the virus to others unknowingly, perpetuating the transmission cycle .
A recent outbreak of the “superbug”, carbapenem-resistant Enterobacteriaceae (CRE) bacteria, at the Ronald Reagan UCLA Medical Center has resulted in seven confirmed infections and two deaths . The source of the outbreak was found to be two of the hospital’s seven Olympus Corp. duodenoscopes that were used between October 3 and January 28 . A total of 179 patients have been exposed [1,2]. The UCLA Medical Center is providing these individuals with free, at-home screening tests to determine if they are infected with the CRE bacteria as a result of their exposure .
What is CRE?
Carbapenem-resistant Enterobacteriaceae bacteria are part of a family of bacteria commonly found in the colon. Over time, some of these gut-dwelling pathogens have developed high-resistance against many widely used antibiotics. These bacteria contain an enzyme that breaks down carbapenem antibiotics, rendering them useless, and making it very difficult to treat patients with CRE infections. Antibiotic-resistance has become an increasing public health problem across the globe. CRE is particularly dangerous because the bacteria are able to resist “last defense” antibiotics.
Healthy individuals are generally not at risk for CRE. Infections are most common in nursing homes and hospitals, where invasive devices such as ventilators, urinary catheters, and intravenous catheters, result in exposure to CRE.
How Did This Outbreak Happen?
Duodenoscopes are a type of endoscope used to obtain material for a biopsy, treat gallstones and cancers, as well as other digestive disorders . The scope consists of flexible tubes, which are inserted into the mouth, threaded through the throat, stomach and into the small intestine . Although fairly non-invasive compared to surgery, this procedure allows for easy contamination of the devices with pathogens, such as CRE. Contaminated scopes are then able to transmit the pathogen from patient to patient [4,5]
The UCLA Medical Center duodenoscopes were cleaned according to both FDA and manufacturer guidelines, therefore the outbreak has not been traced to a break in protocol . Due to their structure and mechanics, these devices are difficult to clean. Duodenoscopes cannot be autoclaved, like a scalpel would be, because their lenses and electronics make them sensitive to high temperatures . Instead, the scopes are cleaned by hand with liquid disinfectants . These procedures are not sufficient to completely remove CRE bacteria, which can then colonize on the device .
What's Being Done?
Following this outbreak, the UCLA Medical Center has removed the two contaminated duodenoscopes and implemented a more stringent decontamination process for the remaining devices . In addition to the FDA and manufacturer cleaning guidelines, automated machines are now used for disinfection, and the devices will now be receiving off-site sterilization using ethylene oxide gas .
This outbreak is not unprecedented. Since 2012 there have been CRE outbreaks in Illinois, Pennsylvania and Washington . Furthermore, duodenoscopes are often the source of disease transmission . Thus hospitals are encouraged to re-evaluate their sterilization procedures, and consumer advocates are calling for greater disclosure to patients undergoing procedures that put them at risk for infection .
Two types of malaria-transmitting mosquitoes in Mali -- Anopheles gambiae and Anopheles coluzzii -- have interbred to create a new hybrid “super” mosquito resistant to insecticide treated bed nets . A recent publication in the Proceedings of the National Academy of Sciences, provides convincing evidence that man-made changes in the environment -- in particular, the introduction of insecticides -- have impacted the mosquito’s evolutionary relationship and has removed the “reproductive isolation that separates them” . Prof. Gregory Lanzaro -- a medical entomologist and professor at the University of California, Davis -- the leader of the study’s research group, states that the results of the study is “an example of one unusual mechanism that has promoted the rapid evolution of insecticide resistance in one of the major malaria mosquito species” . Given the recent findings, there may be a few implications regarding its impact on malaria, particularly in endemic areas.
What are the Implications?
Malaria, a mosquito-borne disease caused by a parasite, impacts mostly developing tropical and subtropical areas of the world . According to the Center for Disease Control (CDC), approximately 627,000 people died from malaria in 2012, with the majority being young children in sub-Saharan Africa . Young children are the most vulnerable to malaria, because they have yet to develop immunity to the disease . Additionally, pregnant women are also vulnerable, because their immunity decreases as a result of their pregnancy .
Malaria-control efforts have curbed the disease’s impact, cutting mortality by 45% and saving 3.3 million lives globally . The most common preventive measures include indoor residual spraying (IRS), vector control, anti-malarials, and insecticide-treated bed nets (ITNs) . It has been shown in community-wide trials across Africa that ITNs can reduce child mortality from all diseases by 20% . An estimated 214 million long-lasting ITNs were distributed to malaria countries across Africa in 2014 -- this has brought the distributed regional total to 427 million long-lasting ITNs since 2012 .
With the introduction of a new hybrid species of mosquito that is resistant to ITNs, the impact that ITNs have had in the battle against malaria may truly be a figment of the past. This issue will only get worse if left unaddressed. Mosquito insecticide resistance isn’t novel. According to the WHO, 49 countries reported mosquito resistance to at least one insecticide between 2010 and 2013, and the number seems to be growing . Prof. Lanzaro reports that, "it has reached a level at some localities in Africa where it is resulting in the failure of the nets to provide meaningful control, and it is my opinion that this will increase" . Without new means to combat insecticide resistance, a rise in mosquito-borne diseases such as malaria, is imminent.
Since mid-December 2014, several cases of highly pathogenic avian influenza (HPAI) have been reported in birds in the Pacific Northwest United States, including Washington, Oregon, Idaho, Utah and California (1). The avian influenza (AI) strains detected, include: H5N2, H5N8 and even one case of H5N1. The H and N refer to hemagluttin and neuraminidase, respectively, and are proteins expressed by the virus that are used to identify different strains of influenza (2). Afflicted birds include captive wild birds, wild aquatic birds, and backyard poultry (1). All birds in the backyard flocks with reported infections were culled (3). Most AI strains are not known to infect humans, but some that do (including H5N1) can be very serious and potentially life-threatening.
What It Means for US Poultry
Large outbreaks of AI do not often occur in the United States. Although there is a fear of potential spillover of AI strains from birds to humans, there is a more imminent risk of economic loss due to AI infections. Although there has been only one report of AI infection in a U.S. commercial flock, the entire industry suffers (4). As of January 7th, 2015, at least 30 countries have implemented restrictions on the importation of US poultry, including a ban on poultry from Oregon and Washington (3). Thailand, South Korea, and Sri Lanka, have gone as far to ban all US poultry and poultry products (3).
AI Clinical Signs
Avian influenza can sometimes have no clinical signs in poultry. In low pathogenic avian influenza (LPAI), some clinical signs include coughing, sneezing and nasal discharge. Morbidity and mortality are usually low in LPAI strains. Some clinical signs that can manifest in HPAI include: cyanosis (blue coloration of skin and membranes due to low oxygen) and edema (swelling from fluid build-up) of head, comb, waddle and other exterior body parts, greenish diarrhea, and bloody ocular or nasal discharge (5).
Although there has not yet been a human case of H5N8 or H5N2, it is important to take precautions when in close contact with backyard birds. Currently, H5N8 and H5N2 are not known to infect humans. Given the ever-changing nature of influenza viruses, it is possible that someday H5N8 and H5N2 can jump to humans, just as H5N1 did. If you are an owner of backyard poultry, it is important to keep your birds vaccinated to prevent infection of avian influenza and to report any clinical signs to your state’s Department of Agriculture.
The 2015 Disneyland measles outbreak in the United States, which started in late December and spread to more than 100 people in just 6 weeks, has recently become the subject of substantial media scrutiny. Measles is extremely infectious, exhibiting a basic reproductive number between 12 and 18 - one of the highest recorded in history. This means that for every 1 case who gets sick in a totally susceptible population, 12 to 18 other folks get sick, too. Thankfully, when uptake of the measles vaccine is high enough in a given community, it's almost impossible for the disease to spread - thus halting a potential outbreak in its tracks.
But what happens when vaccine rates aren't high enough? Given the growing anti-vaccination movement in the United States, our team at HealthMap took on the task of responding to this very question by developing an interactive visualization that allows users to explore the impact of different vaccination rates on a simulated measles outbreak.
Clearly, the lower vaccination rates are among exposed populations, the larger potential outbreaks can become - and even rates as high as 80% aren't high enough to prevent sustained transmission. The bottom line? Vaccines really do matter - and it's important for those of us who are healthy enough to get vaccinated to do our part!
Smallpox and rinderpest are two infectious diseases that have been successfully eradicated. Smallpox was eradicated in 1980 and rinderpest in 2011 [1,2]. Will Guinea Worm be the next disease to be eradicated? To fully understand disease eradication, it is important to comprehend the concepts of disease control, elimination, and eradication.
Disease control is defined as the “reduction of incidence, prevalence, morbidity or mortality to a locally acceptable level as a result of deliberate efforts” . This requires the continuous use of interventions to maintain disease incidence. Disease elimination has been defined as the “reduction to zero incidence in a defined geographical area” . Disease elimination also requires the continued implementation of control measures to prevent the re-establishment of the disease. Finally, disease eradication is defined as the “permanent reduction to zero of worldwide incidence [of disease]” . The key difference between elimination and eradication is that elimination is limited to a specific geographic location, such as a country, while eradication means the disease has been eliminated throughout the entire world. Therefore elimination is required before a disease can be eradicated.
Guinea Worm Disease, also known as Dracunculiasis, is a highly debilitating, waterborne disease caused by the parasitic worm, Dracunculus medinensis . Infection occurs when an individual drinks water contaminated with Dracunculus medinensis larvae (housed within minute crustacean copepods). Following ingestion, the larvae migrate through the intestinal wall and mature. After full maturation has been reached (approximately 1 year after ingestion), the female worm migrates to the subcutaneous tissue and is slowly expelled through a blister, usually located on the lower leg . This blister is very painful, therefore infected individuals often immerse their foot in a local body of water to alleviate the burning sensation. Once immersed in water the blister ruptures and releases larvae, thus continuing the transmission cycle .
Control efforts include mapping endemic villages, establishing surveillance and case containment (to prevent individuals from contaminating local drinking water sources), implementing interventions aimed at increasing access to safe drinking water, waterborne (?) vector control through larvicides, as well as health education and community-involvement [7,8].
So how close are we to eradication? The answer is, very close. The incidence of Guinea Worm Disease has been reduced by 99.9% .
Since the launch of global eradication campaigns, lead by The Carter Center, the World Health Organization and UNICEF, the number of Guinea Worm cases and endemic villages has been decreasing steadily [4,8]. When The Carter Center began their Guinea Worm Eradication Program in 1986 there were approximately 3.5 million cases annually and 20 endemic countries, primarily in Africa and Asia [5, 6,8]. Ghana became the most recent country to have eliminated Guinea Worm, the WHO declared it Guinea Worm-free in May 2010 . Since 2012, the disease has been limited to 4 countries in Africa - South Sudan, Mali, Chad, and Ethiopia . In 2014 there were only 30 endemic villages and 126 cases, with 70 cases in South Sudan, 40 in Mali, 13 in Chad, and only 3 in Ethiopia . This means Guinea Worm has been eliminated in Asia, is being controlled in Africa, and is rapidly moving towards the universal goal of eradication. If successful, Guinea Worm would become the first human infectious disease to be eradicated without the use of a vaccine or medication .
H5N1 has resurfaced in Africa’s most populous country, Nigeria. As of January 30, 2015, 11 out of 36 states across the nation have reported cases of avian influenza in poultry . The outbreak seems to have begun in the northern states of Kano and Lagos. Kano State has been hardest hit thus far, with an estimated 136,905 infected birds and a 13% mortality rate . However, the 13% mortality rate of infected birds in this outbreak may not be entirely accurate, due to the nature of large-scale poultry cullings in outbreaks of H5N1. Other affected states include: Ogun, Delta, Rivers, Plateau, Edo, Imo, Gombe, Jigawa, and Oyo . This is not Nigeria’s first detection of this highly pathogenic strain of influenza. In fact, H5N1 was first detected in Nigerian poultry in 2006, and claimed the country’s first human death in 2007 .
What About H5N1?
According to the CDC, H5N1 -- a highly pathogenic subtype of the influenza virus -- “occurs mainly in birds, is highly contagious among birds, and can be deadly to them, especially domestic poultry” . While rare, human cases have been reported worldwide, with some leading to death . As of January 30th, Egypt’s Ministry of Health has reported at least 31 human cases and 10 deaths from H5N1 so far this year . Generally, H5N1’s most common symptoms include fever and cough, with possible complications including respiratory failure and acute respiratory distress syndrome . Research shows that those who work directly with poultry and birds are at higher risk of becoming infected. The mortality rate for H5N1 in humans hovers around approximately 60% .
What’s Nigeria Doing?
Lagos, the state with Nigeria’s largest commercial city and a population boasting 15 million, has provided prevention measures to the public to further prevent the spread of H5N1 . Lagos State’s Commissioner for Health, Dr. Jide Idris, “advised members of the public to avoid contact with chickens, ducks or other birds, including their feathers, faeces and other wastes in areas where the disease is known to exist” . Additionally, proper hand hygiene was emphasized to aid in halting the spread of H5N1 . Dr. Idris also reiterated that sick and dead poultry be kept away from children and that all poultry should be cooked thoroughly . In regards to surveillance, Dr. Idris “pleaded with the general public to be watchful and report any casualty with a history of having been in direct or indirect contact with dead poultry or confirmed case of the disease to the health and agricultural departments of the nearest Local Government Area office, or to the Directorate of Disease Control in the State Ministry of Health” .
In the middle of December 2014, the CDC announced an outbreak of Listeria linked to commercially produced caramel apples. The outbreak resulted in 32 individuals being hospitalized (FSN, CNN). One-third of those hospitalized were pregnant women, who are one of the high-risk groups of listeriosis (CNN). While seven deaths have been reported, the CDC has linked listeriosis to contributing to at least three of the deaths (CNN). The first illnesses were reported in mid-October -- the peak of caramel apple season -- and the outbreak has spread to 11 states (AZ, CA, MN, MO, NM, NC, NV, TX, UT, WA, WI) (FSN). Two cases of listeriosis have been reported in Canada, with the same PFGE (“DNA Fingerprint”) as the US strains. The majority of the ill people interviewed (89%) reported eating commercially produced and prepackaged caramel apples prior to their illness onset (CDC).
Listeria: The Bug
Listeria monocytogenes is a bacterium that can cause serious illness: Listeriosis. Listeriosis generally results from eating food contaminated with the bacterium. Symptoms include fever, muscle aches, severe headache, stiffness, diarrhea, and chills, beginning a few days to a few weeks after the consumption of contaminated food (FDA). Listeriosis can be fatal in high-risk groups including the elderly, immunosuppressed patients, and pregnant women - which may result in stillbirths or miscarriages (FDA). Approximately 1,600-2,500 cases of listeriosis are reported in the US every year, and the infection causes approximately 260 deaths annually according to the CDC (CNN, CDC). Unlike some other foodborne pathogens, the Listeria bacterium can grow in refrigeration temperatures, so the longer foods are stored, the more opportunity the bacterium has to grow.
As a result of the outbreak,three companies have voluntarily recalled their caramel apple products,, including: Merb’s Candies, California Snack Foods Inc., and Happy Apple (FSN). These companies used apples from the same grower, Bidart Bros, who recalled their Granny Smith and Gala apples on December 22 (CNN). Environmental testing at Bidart Bros revealed Listeria contamination at the firms apple-packaging facility (CDC).
A California man has filed a wrongful death lawsuit against the grocery chain Safeway, claiming that the contaminated caramel apples sold in the store contributed to the death of his wife.
Further Questions & Concerns
Consumers with questions about the Bidart Bros. recall may contact the company at 661-399-0978.
Consumers with questions about the California Snack Foods recall may contact the company at 800-966-5501 Monday through Friday during normal business hours or via email at email@example.com.
Consumers with questions about the Happy Apple recall may contact the company at 800-527-7532 Monday through Friday during normal business hours or via email at firstname.lastname@example.org.
Consumers with questions about the Merb's Candies recall may contact the firm at email@example.com or during normal business hours Monday through Friday 9 a.m. to 5 p.m. CST at (314) 832-7206.
In an article published in Nature Communications in January of 2015, a connection was revealed between the presence of antibiotics in human blood and increased mosquito transmissibility of malaria. The apparent link, between the otherwise disparate concepts, lies in the effect of antibiotics on the gut flora of the Anopheles gambiae mosquito - the main vector involved in malaria transmission .
It is largely accepted that the use of antibiotics in humans can change the personal microbiome, including the makeup of gut flora. However, it has also been argued that these changes may be permanent . Long-term antibiotic use has been shown to increase susceptibility to infections, such as Clostridium difficile , by way of changes or reductions in the good bacteria in our gut flora. The effects of antibiotics on human microbiomes has been significantly studied and considered. What has not been considered are the effects of human antibiotic use on disease vectors. The Nature Communications study by Gendrin et al. highlights the effects of a mosquito’s consumption of antibiotic-laced human blood .
The effects of human use of antibiotics is passed on to the mosquitoes that feed on our blood. Gendrin et al. found that a combination of penicillin and streptomycin added to the blood ingested by mosquitoes, disrupted their natural gut microbiome, just as it does in humans. The antibiotics actually increased the mosquitoes’ susceptibility to malaria infection. With these increased rates of mosquito infection comes increased malaria parasite transmissibility to humans .
The mosquitoes fed the antibiotic-laced blood also showed advantages akin to antibiotic use in livestock growth promotion - it raised the mosquitoes’ survival and procreation rates . Altogether, areas where human antibiotic use are high (such as tuberculosis-endemic regions) may be at increasing malaria transmission risk.
In Africa, a child dies every minute from malaria and malaria-related complications . Globally, malaria infects an estimated 198 million people and leads to approximately 600,000 deaths each year . Malaria disease burden is localized to the developing tropical and subtropical climates. Although transmission used to occur in places like the southern United States and Europe, medical and public health infrastructure development has resulted in the elimination of the disease . Approximately half of the global population live in regions where malaria transmission regularly occurs .
As of January 16, 2015, Avian Influenza H5N1 has officially arrived in the United States. H5N1, a flu strain known to be highly pathogenic -- that is, known to have a superior ability to produce disease in a host -- was discovered in an American green-winged teal duck in Whatcom County, Washington [1, 2, 4].
What is H5N1?
A sub-type of influenza virus, H5N1 is known to cause exceptionally infectious and severe respiratory disease, primarily in birds . Historically, H5N1 has wreaked havoc with serious outbreaks among birds in parts of Asia and the Middle East. These outbreaks have often led to cullings of commercial flocks across the globe, with import bans and substantial economic impacts . While H5N1 does not generally infect humans, human cases do exist and there have been approximately 650 reported human cases of H5N1 across fifteen countries, since 2003 . Of those 650 reported human cases, roughly 400 have ended in death, translating to a 60% mortality rate [3, 5]. Those infected with H5N1 often work directly with poultry, which places them at higher risk of infection due to the nature of close contact and influenza transmission . However, sustained human-to-human transmission of H5N1 remains rare . Symptoms of H5N1 include: fever and cough, shortness of breath, acute respiratory distress, and abdominal pain -- complications arising from H5N1 can include pneumonia, respiratory failure, and shock .
The Silver Lining: Influenza Strain Variation
While the arrival of H5N1 in the United States may not be entirely positive news, there exists a silver lining to its discovery. The H5N1 strain detected in Washington is genetically different from the H5N1 strain circulating in Asia and the Middle East . According to the United States Geological Survey, this variation contains genes from North American waterfowl viruses and appears to be a combination of H5N1 and H5N8 . The reassortment of influenza virus was not unexpected, as influenza viruses reassort regularly in circulation and there exist hundreds of strains of influenza .
Although this particular strain of H5N1 has not infected people or domestic poultry within the United States, there are precautionary measures that can be taken to protect yourself from potential transmission and infection. These precautions include: avoiding dead or sick birds, abstaining from visiting live poultry markets, and keeping away from those who may potentially be infected with H5N1 . H5N1 cannot be transmitted through the consumption of “properly handled and cooked poultry and eggs” .