Human MERS-CoV cases are falling but pose an ongoing pandemic threat

Anthrax knowledge, attitudes and practice survey - Lao PDR, 2010

BackgroundIn view of ongoing pandemic threats such as the recent human cases of novel avian influenza A(H7N9) in China, it is important that all countries continue their preparedness efforts. Since 2006, Central American countries have received donor funding and technical assistance from the U.S. Centers for Disease Control and Prevention (CDC) to build and improve their capacity for influenza surveillance and pandemic preparedness. Our objective was to measure changes in pandemic preparedness in this region, and explore factors associated with these changes, using evaluations conducted between 2008 and 2012.MethodsEight Central American countries scored their pandemic preparedness across 12 capabilities in 2008, 2010 and 2012, using a standardized tool developed by CDC. Scores were calculated by country and capability and compared between evaluation years using the Student’s t-test and Wilcoxon Rank Sum test, respectively. Virological data reported to WHO were used to assess changes in testing capacity between evaluation years. Linear regression was used to examine associations between scores, donor funding, technical assistance and WHO reporting.ResultsAll countries improved their pandemic preparedness between 2008 and 2012 and seven made statistically significant gains (p < 0.05). Increases in median scores were observed for all 12 capabilities over the same period and were statistically significant for eight of these (p < 0.05): country planning, communications, routine influenza surveillance, national respiratory disease surveillance, outbreak response, resources for containment, community interventions and health sector response. We found a positive association between preparedness scores and cumulative funding between 2006 and 2011 (R2 = 0.5, p < 0.01). The number of specimens reported to WHO from participating countries increased significantly from 5,551 (2008) to 18,172 (2012) (p < 0.01).ConclusionsCentral America has made significant improvements in influenza pandemic preparedness between 2008 and 2012. U.S. donor funding and technical assistance provided to the region is likely to have contributed to the improvements we observed, although information on other sources of funding and support was unavailable to study. Gains are also likely the result of countries’ response to the 2009 influenza pandemic. Further research is required to determine the degree to which pandemic improvements are sustainable.

With an estimated three to five million human cases annually and the potential to infect domestic and wild animal populations, influenza viruses are one of the greatest health and economic burdens to our society, and pose an ongoing threat of large-scale pandemics. Despite our knowledge of many important aspects of influenza virus biology, there is still much to learn about how influenza viruses replicate in infected cells, for instance, how they use entry receptors or exploit host cell trafficking pathways. These gaps in our knowledge are due, in part, to the difficulty of directly observing viruses in living cells. In recent years, advances in light microscopy, including super-resolution microscopy and single-molecule imaging, have enabled many viral replication steps to be visualised dynamically in living cells. In particular, the ability to track single virions and their components, in real time, now allows specific pathways to be interrogated, providing new insights to various aspects of the virus-host cell interaction. In this review, we discuss how state-of-the-art imaging technologies, notably quantitative live-cell and super-resolution microscopy, are providing new nanoscale and molecular insights into influenza virus replication and revealing new opportunities for developing antiviral strategies.

During the past few months we witnessed two phases in the reaction of the public in Greece to the threat of an influenza pandemic. Initially, during October 2005, practically all mass media in the country devoted extensive time to the coverage of various aspects of the outbreak of avian influenza. An overflow of information from the media targeted the general public who did not have prior knowledge of this type of influenza and who were not aware of the possibility of such a pandemic. The psychological impact to the public that was caused by the media was intense. The reaction of the public for self-preservation under this psychological condition was to rely on the immediate use of influenza vaccine. As a result, more than one million influenza vaccine doses were sold, mainly over the counter; people were vaccinated without risk assessment or without priority being given to those more vulnerable to influenza. This led to a situation where a considerable number of people who are in need of the influenza vaccine, including the elderly and immuno-compromised patients, are deprived of the availability of the vaccine. Surprisingly, after the overwhelming coverage of the possibility of an influenza pandemic from the media during October 2005, the follow-up on the issue was almost complete silence during November and December 2005 (this manuscript was written prior to the occurrence of human cases of avian influenza in Turkey in January 2006). The alarmed state was replaced by a silence of equivalent intensity and the public was left with the impression that the possibility of influenza pandemic crisis was over. This phenomenon, namely the initial over-reaction and subsequently the under-reaction of the public, was probably not unique to Greece; instead, we believe that a similar sequence of events related to the threat of influenza pandemic occurred in many other countries. Important conclusions may be derived from this experience that may become a classic example for the mass media to avoid in the coverage of public health risks [1,2]. We believe that public health agencies should have operational plans towards the delivery of information to the public that are promptly implemented. They should make use of all types of mass media in a timely manner, before the media presents potentially unfiltered information to the public regarding a health-related risk such as the influenza pandemic. Effective risk communication is a priority early in an outbreak. Both the mass media and public health authorities have the responsibility to deliver correct information to the public. The fear-based approach and over-reaction towards a potential influenza pandemic may be hazardous to the general public, because it encourages solutions that inhibit the ability to properly respond to a potential pandemic.

Hendra virus and Nipah virus animal vaccines

Influenza viruses belong to the family Orthomyxoviridae with a negative-sense, single-stranded segmented RNA genome. They infect a wide range of animals, including humans. From 1918 to 2009, there were four influenza pandemics, which caused millions of casualties. Frequent spillover of animal influenza viruses to humans with or without intermediate hosts poses a serious zoonotic and pandemic threat. The current SARS-CoV-2 pandemic overshadowed the high risk raised by animal influenza viruses, but highlighted the role of wildlife as a reservoir for pandemic viruses. In this review, we summarize the occurrence of animal influenza virus in humans and describe potential mixing vessel or intermediate hosts for zoonotic influenza viruses. While several animal influenza viruses possess a high zoonotic risk (e.g., avian and swine influenza viruses), others are of low to negligible zoonotic potential (e.g., equine, canine, bat and bovine influenza viruses). Transmission can occur directly from animals, particularly poultry and swine, to humans or through reassortant viruses in "mixing vessel" hosts. To date, there are less than 3000 confirmed human infections with avian-origin viruses and less than 7000 subclinical infections documented. Likewise, only a few hundreds of confirmed human cases caused by swine influenza viruses have been reported. Pigs are the historic mixing vessel host for the generation of zoonotic influenza viruses due to the expression of both avian-type and human-type receptors. Nevertheless, there are a number of hosts which carry both types of receptors and can act as a potential mixing vessel host. High vigilance is warranted to prevent the next pandemic caused by animal influenza viruses.

Influenza A Virus (H5N1) Infection in Cats Causes Systemic Disease with Potential Novel Routes of Virus Spread within and between Hosts

Continued evolution of H10N3 influenza virus with adaptive mutations poses an increased threat to mammals

In 2012, a novel coronavirus (CoV) associated with severe respiratory disease, Middle East respiratory syndrome (MERS-CoV; previously known as human coronavirus–Erasmus Medical Center or hCoV-EMC), emerged in the Arabian Peninsula. To date, 114 human cases of MERS-CoV have been reported, with 54 fatalities. Animal models for MERS-CoV infection of humans are needed to elucidate MERS pathogenesis and to develop vaccines and antivirals. In this study, we developed rhesus macaques as a model for MERS-CoV using intratracheal inoculation. The infected monkeys showed clinical signs of disease, virus replication, histological lesions, and neutralizing antibody production, indicating that this monkey model is suitable for studies of MERS-CoV infection.

The Middle Eastern Respiratory Syndrome Mers-Cov is a new zoonotic beta corona virus of the C lineage identified in dromedary camels in East Africa and the Arabian Peninsula that exhibits the dipeptidyl peptidase 4 (DPP4) receptor. It was first described in the Saudi Arabian kingdom of Saud in September of 2012, and worldwide in May of 2019. Camels are usually asymptomatic when afflicted. Unlike in camels, clinical signs and symptoms of MERS-CoV infection in humans range from asymptomatic or mild respiratory disease to severe respiratory illness and death. There is no pathognomonic manifestation in people or camels. Molecular and serologic tests are necessary to verify the diagnosis. There is presently no medication or vaccine available to treat or prevent MERS-CoV infection in humans. Strict restriction of camel movement, isolation of ill camels, camel handlers using personal protective equipment, and public awareness creation are all critical approaches for controlling MERS-CoV transmission, particularly among Ethiopian pastoralists who ingest unpasteurized camel milk. As a result, urgent epidemiological investigations are required, particularly in the nations&#39; impoverished camel raising areas, to better understand the transmission patterns and human cases of MERS-CoV, as well as to guarantee that the aforementioned control measures are appropriately executed. As a result, the purpose of this study was to investigate the epidemiology and public health implications of MERS-CoV in Ethiopia&#39;s highly exposed pastoralist community, which has intimate contact with camels, and to recommend the illness for further epidemiological monitoring and inquiry.