EBOLA HEMORRHAGIC FEVER - UGANDA: (BUNDIBUGYO), CASE-FATALITY RATIO

Ebola as a WMD; http://www.globalsecurity.org/wmd/intro/bio_ebola.htm

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A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Thu 28 Oct 2010
Source: CIDRAP News [edited]



Ebola studies detail fatality rate
----------------------------------
A detailed report on a 2007 outbreak in Uganda's Bundibugyo district
involving a novel Ebola strain confirmed that the case-fatality rate
(CFR) was lower than seen with the 2 other strains that cause human
illness, researchers from the US Centers for Disease Control and
Prevention (CDC) and Uganda reported yesterday [27 Oct 2010] in
Emerging Infectious Diseases (EID) [Case Fatality Proportion of
Deaths for Infection with Ebola Hemorrhagic Fever, Uganda A. MacNeil et al.
].

They noted that CFRs in outbreaks of Zaire and Sudan Ebola strains
usually range from 50 percent to 90 percent, but the 2007 outbreak
involving what is now known as the Bundibugyo strain had a 40 percent
CFR (17 of 43 cases). Like the other 2 strains that are human
threats, the Bundibugyo strain was more lethal in people who were
older. Despite the lower CFR, researchers warned that the new strain
is a serious public health concern and showed sustained
person-to-person transmission.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Previous accounts of the outbreak of Ebolavirus hemorrhagic fever at
Bundibugyo in Uganda left the actual number of cases and fatalities
unresolved (see ProMED-mail archived reports below). This new report
establishes that the case-fatality ratio in the outbreak associated
with the Bundibugyo species of Ebolavirus was lower than that
observed previously in outbreaks caused by the Zaire and Sudan
species of Ebolavirus. But the number of confirmed cases in the
outbreak was less than in some previous estimates of the case number. - Mod.CP]

[see also:
2008
----
Ebola hemorrhagic fever - Uganda (06): (Bundibugyo), new species 20081121.3675
Ebola hemorrhagic fever - Uganda (05): (Bundibugyo), susp. 20080304.0883
Ebola hemorrhagic fever - Uganda (04): (Bundibugyo), WHO 20080221.0704
Ebola hemorrhagic fever - Uganda (03): Arua, susp 20080122.0275
Ebola hemorrhagic fever - Uganda (02): (Bundibugyo) 20080107.0092
Ebola hemorrhagic fever - Uganda: (Bundibugyo) 20080104.0050]
...................cp/ejp/dk

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Genetic Engineering & Biological Weapons

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1326447/

Health Institutes Worry Over Time Released Mutant Virus

Page down to bottom to see summary in red text

INFLUENZA (11): SITE 222 MUTATIONS AND OUTCOMES
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A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Thu 28 Oct 2010
Source: Eurosurveillance, Volume 15, Issue 43 [abbreviated & edited]



Molecular surveillance of pandemic influenza A(H1N1) viruses
circulating in Italy from May 2009 to February 2010: association
between haemagglutinin mutations and clinical outcome
--------------------------------
By: S Puzelli1, M Facchini1, M A De Marco1, A Palmieri1, D Spagnolo1,
S Boros1, F Corcioli2, D Trotta3, P Bagnarelli3, A Azzi2, A Cassone1,
G Rezza1, M G Pompa4, F Oleari4, I Donatelli1, the Influnet
Surveillance Group for Pandemic A(H1N1) 2009 Influenza Virus in Italy5

At:
(1) Department of Infectious, Parasitic and Immune-mediated Diseases,
National Institute of Health (Istituto Superiore di Sanita - ISS), Rome, Italy
(2) Department of Public Health, University of Florence, Italy
(3) Unit of Virology, Department of Biomedical Sciences, Universita
Politecnica delle Marche, Ancona, Italy
(4) Ministry of Health, Rome, Italy

Summary:

Haemagglutinin sequences of pandemic influenza A(H1N1) viruses
circulating in Italy were examined, focusing on amino acid changes at
position 222 because of its suggested pathogenic relevance. Among 169
patients, the D222G substitution was detected in 3 of 52 (5.8
percent) severe cases and in one of 117 (0.9 percent) mild cases,
whereas the D222E mutation was more frequent and evenly distributed
in mild (31.6 percent) and severe cases (38.4 percent). A cluster of
D222E viruses among school children confirms reported human-to-human
transmission of viruses mutated at amino acid position 222.

[Readers should access the original text to view the data, figures
and literature references. What follows are extracts from the
authors' discussion of their conclusions. - Mod.CP]

Discussion and conclusions:

We have previously described the only documented transmission event
of a D222G mutant pandemic influenza A(H1N1) virus; to the best of
our knowledge, this mutation appears to be hardly ever transmitted.
Less is known about the human-to-human transmissibility of D222E
virus mutants. In the present study, we found that this mutation is
much more frequent than the D222G mutation and equally distributed
between severe and mild cases. In particular, we describe a cluster
of close contacts carrying the D222E substitution in a group of high
school students with mild disease returning from England, suggesting
inter-human transmission of D222E pandemic influenza A(H1N1) mutant
viruses. However, the clinical significance of the D222E substitution
remains uncertain.

It is of note that the D222G mutation was detected more commonly
among viruses isolated from severe cases, which were about 7 times
more likely to have this genetic change than those isolated from mild
cases; however, the difference did not reach statistical
significance, probably due to limited study power.

The D222G variants were detected among adults (18-64 age group).
Whether this was due to the fact that this age group had the highest
number of cases (including severe ones) or to unidentified biological
factors remains undefined. In particular, due to the relatively
limited number of cases with the D222G variant, definitive
conclusions about possible age differences cannot be drawn.

Studies conducted in other countries, e.g. Norway and Scotland, also
found D222G to be more common among severe than mild cases. Although
these results indicate that the 222G variant may be more virulent,
this association must be interpreted with caution as the same
mutation was detected in mild cases, and mixed D222D and D222G virus
populations were found in original samples and isolates from patients
with severe disease.

In vitro studies show conflicting results. Studies conducted in the
United States found the 222G mutation only in isolated viruses but
not in the original clinical samples. On the other hand, preliminary
results from in vitro studies suggest that D222G substitution might
enhance binding of HA to alpha2-3 sialic acid (avian-like) cell
receptors, thus increasing virus ability to infect human lung cells.
Moreover, studies from Liu et al. [9] and Chutinimitkul et al. [See
ProMED-mail report: Influenza (10): D222G & severity 20101026.3881.]
suggest an increased receptor affinity of the 222G variant for
ciliated bronchial epithelial cells, which may explain enhanced
disease in humans. Increased binding to macrophages and pneumocytes
of the respiratory tract may indeed have an impact on disease
severity, since those cells are major producers of inflammatory
cytokines upon viral antigen stimulation.

Finally, our data suggest that the D222G substitution is overall
rather infrequent, even among severe cases. However, we confirm that
it occurs with a higher frequency in severe cases. Whether this
association is indicative of higher virulence or is the consequence
of receptor-specific adaptive mutation needs to be further investigated.

--
Communicated by;
ProMED-mail

[These data further document the mutability of the 222 site in the
influenza virus haemagglutinin and demonstrate an association of the
D222G substitution with a severe disease outcome in a subset of
Italian patients, in addition to those previously reported in
patients in Norway, Scotland and elsewhere. However, evidence for
transmissibility of the D222G mutation is lacking. In contrast, a
cluster of isolates from school children with D222E substitutions
confirms human-to-human transmission of viruses mutated at amino acid
position 222. Whether this association of the D222G substitution with
severe disease outcomes is indicative of higher virulence or is the
consequence of receptor-specific adaptive mutation is an open question.


It should be remembered, in addition, that a study carried out at the
WHO Collaborating Centre for Reference and Research on Influenza in
Atlanta found the D222G substitution in 14 virus isolates, but not in
viruses in the original clinical specimens, indicating the D222G
substitution in these 14 virus isolates occurred after growth in the
laboratory

[see also:
Influenza (10): D222G & severity 20101026.3881
Influenza pandemic (H1N1) (31): UK (Scotland) D222G mut'n 20100422.1310
Influenza pandemic (H1N1) (28): Hong Kong SAR, Norway, D222G mutation
20100409.1147
Influenza pandemic (H1N1) (21): Norway, D222G mutation 20100305.0729]
..........................................................cp/msp/dk

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ProMED-mail makes every effort to verify the reports that
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using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
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or archived material.
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Cholera Outbreak Threatens Hatians Existance / Notes From Penn

Cholera as a Biological Weapon; http://www.topix.com/forum/afam/T7C5CSLRAH2MQ4AU7/p15#lastPost

Dear Friend,

Haiti is now facing its worst health crisis since the earthquake -- the cholera epidemic that has already claimed over 250 lives, with another 3,000 cases confirmed by the Ministry of Health (MOH).

This fast spreading cholera outbreak—the first to hit Haiti in 50 years – has reached Port-Au-Prince, and J/P has already stepped to the forefront of the action. We are currently fighting a two front battle of treatment and prevention. We've deployed teams and medical supplies to the worst hit areas in the North, while also taking extensive precautions in Petionville camp, which we manage.
Petionville is still initially cholera free. J/P HRO's proactive measures include building an isolation ward separate from our hospital with a capacity for 100 patients and stocking it with the fluids and medical supplies needed for treatment. We’ve also installed additional handwashing stations in camp, and mounted massive education campaigns about hygiene & sanitation not only in the camp but also the surrounding communities.





This outbreak has the potential to wreck this already devastated country, but if we act quickly, we can make a tremendous difference. That's why I'm writing to you to request your immediate help.

Here's what you can do:

Make a contribution to J/P HRO. No matter how much you can afford to give, every dollar of your contribution goes directly to helping the people of Haiti.
Start fundraising for J/P HRO. Help bring your friends and family into the fight against the cholera outbreak in Haiti by setting up your personal fundraising page and asking them to contribute.



In addition, if you work in the medical community, you can help by:
Donating Supplies: Click here for a list of medical supplies we urgently need to fight the cholera outbreak.

Becoming a Medical Volunteer: All sorts of licensed medical personnel are needed in Haiti, including pharmacists. Unfortunately we cannot take EMT's, medical students or under 3rd year resident MD's. This work is first and foremost about saving lives, not a learning experience, so we are looking for people who can manage these roles well in a high stress emergency environment.

Please also be sure to forward this email on to friends, family members or colleagues who may be able to help financially or by volunteering.
We are dependent upon our incredible supporters to achieve what we do. Now, we face our greatest crisis since the earthquake. Please, do what you can today to help us fight this dangerous outbreak of cholera in Haiti.

Thank you for everything you do.
Sean Penn
CEO, J/P HRO

ANTHRAX, HUMAN, BOVINE - BANGLADESH (23)

****************************************

A ProMED-mail post



ProMED-mail is a program of the

International Society for Infectious Diseases





In this update:

[1] Human: IEDCR update

[2] News report



******

[1] Human: IEDCR update

Date: Thu 14 Oct 2010

Source: Bangladesh Institute of Epidemiology, Disease Control and

Research (IEDCR) [edited]







Government of the People's Republic of Bangladesh, Institute of

Epidemiology, Disease Control and Research (IEDCR) Mohakhali, Dhaka-1212



Number of cutaneous anthrax cases from 18 Aug to 25 Oct 2010

------------------------------------------------------------

District / Total / Change since last posting 14 Oct 2010 / In last 24

hours (25 Oct 2010) / Upazilla [subdistrict] (cases)

1. Pabna / 69 / 0 / 0 / Bera (11), Santhia (35), Faridpur (23)

2. Sirajganj / 219 / 0 / 0 / Shadjadpur (56), Belkuchi (54),

Kamarkhanda (99), Ullapara (10)

3. Kushtia / 49 / 0 / 0 / Daulotpur (46), Bheramara (3)

4. Tangail / 26 / 0 / 0 / Ghatail (14), Gopalpur (12)

5. Meherpur / 82 / 0 / 0 / Ganghi (81), Mujibnagar (1)

6. Manikganj / 8 / 0 / 0 / Shaturia (8)

7. Shatkhira / 1 / 0 / 0 / Sadar (1)

8. Lalmonirhat / 107 / 0 / 0 / Sadar (78), Aditmari (29)

9. Rajshahi / 8 / 0 / 0 / Chaghat (7), Tanore (1**)

10. Narayangonj / 12 / 0 / 0 / Araihajar (12)

11. Laxmipur / 25 / 0 / 0 / Kamalnagar (25)

12. Chittagong / 1 / 0 / 0 / City (1)

Total: 607 (0*)



*No new cases reported since 8 Oct 2010

** Imported from Sirajganj



--

Communicated by:

ProMED-mail





[It would appear that this epidemic may be over. - Mod.MHJ]



******

[2] News report

Date: Sun 24 Oct 2010

Source: The New Nation [edited]







Anthrax red alert goes

----------------------

The government the other day lifted the 'red alert' on anthrax it had

issued a month back in the backdrop of an outbreak infecting cattle

and human beings. The prompt government action is aimed at 'removing

unnecessary fear of anthrax disease' from the people as explained by

the fisheries and livestock minister through the press as meat-sale

came almost to a halt throughout the country causing a serious threat

to all the related industries. In fact, the red alert resulted in a

drastic fall in the consumption of beef, mutton, milk, and virtually

halting cattle trade and drying up supply of hides and skin to the

leather industry, as reported.



A total of 104 cows were infected by anthrax in 3 months from 1 Jul

to 30 Sep 2010 compared to much higher figures of anthrax infection

of 449 last year [2009] and 437 in 2008 as per official records. The

livestock minister held the media responsible for 'over publicity'

given to anthrax which is like many other animal diseases. The

situation came under control following the prompt official response

since the 1st case of infection was detected on 18 Aug 2010 at

Sirajganj. The concerned departments have however been asked to

remain alert and keep watch on the situation.



The red alert was issued on 5 Sep 2010 as anthrax cases were reported

from several districts. Following this, meat sales came to a stop in

the city and elsewhere in the country. The livestock directorate,

civil surgeons were on alert. As no fresh case of anthrax was

reported since 18 Sep 2010, the government lifted the red alert on 7

Oct 2010. The government accordingly instructed to complete cattle

vaccination in the affected districts a month ahead of the holy

Eid-ul-Azha to be celebrated in the 3rd week of November [2010].



--

Communicated by:

ProMED-mail





[In an earlier posting 20101008.3655 the government stated that it

intended to lift the red alert on 7 Oct 2010. It has been done. - Mod.MHJ]



[see also:

Anthrax, human, bovine - Bangladesh (22) 20101015.3741

Anthrax, human, bovine - Bangladesh (21): 3 new cases 20101008.3655

Anthrax, human, bovine - Bangladesh (20): 6 new cases 20101001.3570

Anthrax, human, bovine - Bangladesh (19): 14 new cases 20100924.3461

Anthrax, human, bovine - Bangladesh (18): 65 new cases 20100920.3395

Anthrax, human, bovine - Bangladesh (17) 20100917.3373

Anthrax, human, bovine - Bangladesh (16) 20100915.3346

Anthrax, human, bovine - Bangladesh (15) 20100914.3323

Anthrax, human, bovine - Bangladesh (14) 20100910.3279

Anthrax, human, bovine - Bangladesh (13) 20100908.3236

Anthrax, human, bovine - Bangladesh (12): Id alert 20100907.3224

Anthrax, human, bovine - Bangladesh (11): widespread 20100905.3191

Anthrax, human, bovine - Bangladesh (10): (KU, TA) 20100902.3140

Anthrax, human, bovine - Bangladesh (09): (SR, PB) 20100831.3109

Anthrax, human, bovine - Bangladesh (08): (SR, PB) 20100828.3066

Anthrax, human, bovine - Bangladesh (07): (SR) 20100827.3044

Anthrax, human, bovine - Bangladesh (06): (SR) 20100826.3009

Anthrax, human, bovine - Bangladesh (05): (SR) conf. 20100825.2996

Anthrax, human, bovine - Bangladesh (04): (SR) susp. 20100824.2970

Anthrax, human, bovine - Bangladesh (03): (PB) susp. 20100823.2944

Anthrax, human, bovine - Bangladesh (02): (SR) 20100820.2914

Anthrax, human, bovine - Bangladesh: (TA) susp, RFI 20100421.1291]

...................................sb/lm/mhj/mj/dk



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First Cholera, Now, New ANTHRAX Outbreak in Haiti

Last week we reported on a Cholera Outbreak in Haiti; http://meatsubs.blogspot.com/2010/10/thousands-die-needlessly-in-haiti-from.html

and now, today,  this;

ANTHRAX - HAITI: (OUEST) FATAL

(Apparently, Haiti has had a problem with Anthrax since the 1990's)


******************************

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ProMED-mail is a program of the

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Date: Sat 23 Oct 2010

Source: Marie-Carmel Charles reported to HealthMap Alerts [edited]







Anthrax - Haiti report

----------------------

First human death of anthrax ("charbon" in French) is confirmed in Leogane.



Communicated by:

Dr Marie-Carmel Charles

to HealthMap Alerts





[This reflects more the invasion of health personnel lately than a

change in the anthrax status of Haiti. Anthrax is hyperendemic in

this western part of Hispaniola -- Santo Domingo manages to be

essentially free. Reports during the past decade have been sparse.

They merely informed OIE that the disease was present in livestock

and humans. However during the 1900's there were significant numbers

of human cases reported most years: 1993 (more than 180), 1994 (622),

1995 (768), 1998 (183 human cases and 220 cattle cases), 1999 (176)

-- and remember the population of Haiti is not large so these

numerator numbers are significant. - Mod.MHJ]



[Leogane, in the Ouest Department of Haiti, can be located on the

HealthMap/ProMED-mail interactive map of Haiti at

. - Sr.Tech.Ed.MJ]

...................................sb/lm/mhj/mj/dk



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Nigeria's Cholera Epidemic

http://www.dowell-netherlands.com/2010/10/nigerias-cholera-epidemic-kills-more.html