Anticipating The Flu Season Down Under

 

The red band signifies the tropics, which has no distinct flu season.  Viruses circulate there, at a low level, year round. – Credit Wikipedia

 

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Although flu season south of the equator won’t begin for several more months, health authorities in Australia and New Zealand are watching our busy flu season closely, and are warning the public to get vaccinated in advance of what could be a difficult flu season.

 

Watching what happens during the flu season in the opposite hemisphere can sometimes provide clues as to what the next flu season will bring.

 

Of course, it doesn’t always prove predictive. 

 

Last year, Australia and New Zealand saw a moderately active flu season, despite North America’s unusually quiet 2011-12 flu season (see The 2012 Flu Season Down Under).

 

While the media coverage is a bit hyperbolic (the flu season here is being described as moderately-severe), I’ve linked to a few recent news stories from down under to provide the `flavor’ of the coverage.

 

 

Warning over killer flu

Karen O'Sullivan, Yahoo!7 January 15, 2013, 3:46 pm

Health experts are warning a deadly flu that has spread across the United States will inevitably hit our shores.

Doctors want Australians to be prepared and to make sure they are vaccinated.

 

 

The devastating flu outbreak in the US could be on its way here

• Tory Shepherd From: news.com.au
• January 15, 2013 12:00AM

• 20 children have died from flu in the US
• Influenza strains travel the globe
• Australia should consider US season a "forewarning"

 

 

NZ preparing for deadly flu

Tuesday, 15 January 2013 10:50

Medical experts in New Zealand are bracing themselves for the arrival of a deadly flu that is sweeping the US which has already killed 20 children.

 

The southern hemisphere flu season doesn’t usually begin in earnest until May or June, but the flu vaccine will be available starting in March. Public health officials are urging early vaccination in order blunt the flu’s impact.

 

Since it takes roughly six months to produce enough flu vaccine for the next flu season, twice each year (February & September) experts gather to decide on the strains to include in the next vaccine.

 

Last September participants from divisions of the World Health Organization’s GISRS (Global Influenza Surveillance and Response System), along with members of OFFLU (the OIE/FAO Network on Animal Influenza), and other experts met in Beijing, China.

 

After group consultation, the experts opted for the same vaccine formulation that is currently being used in the northern hemisphere (see WHO: Southern Hemisphere 2013 Flu Vaccine Composition).

 

They recommended that trivalent vaccines for use in the 2013 influenza season (southern hemisphere winter) contain the following:

• an A/California/7/2009 (H1N1)pdm09-like virus;
• an A/Victoria/361/2011 (H3N2)-like virus;
• a B/Wisconsin/1/2010-like virus
  

They also recommended that quadrivalent vaccines containing two influenza B viruses contain the above three viruses and a B/Brisbane/60/2008-like virus.

 

 
Recent studies (see (A Comprehensive Flu Vaccine Effectiveness Meta-Analysis) have shown the flu shot to be moderately effective in preventing influenza – at least among healthy adults under the age of 65.

 

Similarly, last Friday in FluView Week 1 & MMWR Vaccine Effectiveness Report, we saw the first estimate of this year’s flu vaccine’s effectiveness, and early numbers suggest it to be around 62%.

 

For the elderly and for those with immune problems the flu vaccine’s effectiveness is often lower (see Study: Flu Vaccines And The Elderly).

 

In 2011, NFID - the National Foundation for Infectious Diseases - convened a group of experts to address the issues of influenza and the elderly. From that panel a 5-page brief has emerged, called: Understanding the Challenges and Opportunities in Protecting Older Adults from Influenza.

 

While the elderly generally see less protection from the flu vaccine, they state that older individuals may still mount a robust immune response. Even if the vaccine doesn’t always prevent infection in the elderly, studies suggest that the vaccine may blunt the seriousness of the illness in those over 65.

 

Although there is a pressing need for better flu vaccines (see CIDRAP: The Need For `Game Changing’ Flu Vaccines), flu shots are still considered the best preventative action you can take against influenza, and serious side effects are extremely rare.

 

So while not a guarantee against getting influenza, they do provide a moderate degree of protection.

 

Beyond the vaccine, the CDC also reminds us:

 

Take everyday preventive actions to stop the spread of germs.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.*
• Avoid touching your eyes, nose and mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with flu–like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)
• While sick, limit contact with others as much as possible to keep from infecting them.

»» Read More

Dr. Alan Hampson Interview On Indonesia’s New Bird Flu Clade

Photo Credit – FAO

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On Monday we began to see reports that a previously unseen clade of the H5N1 virus had recently turned up in Indonesia, causing the deaths of tens of thousands of ducks (see Report: Clade 2.3.2 H5N1 Detected In Indonesia) in and around central Java.

 

Today, Radio Australia has an excellent interview (audio & transcript available) with Dr. Alan Hampson about this recent news.

 

Dr. Hampson, who is chair of Australia’s Influenza Specialist Group (ISG), is the former Deputy Director of the Australian World Health Organization Collaborating Centre for Reference and Research on Influenza.

 

Dr. Hampson assesses the risks, discusses how the virus may have arrived in Indonesia,  and defines the difficulties in controlling H5N1 in that country.  

 

He also warns that the H5N1 strains currently circulating in the Middle East appear to be the ones moving quickest towards `being able to become a human influenza virus.’

 

Follow the link to read/listen to this five-minute, highly informative interview.

 

 

Indonesia identifies new strain of bird flu: report

Updated 12 December 2012, 17:36 AEST

The Indonesian Agriculture Ministry has reportedly identified a new, more virulent type of bird flu that's killed hundreds of thousands of ducks in recent weeks.

 

There are suspicions the virus entered Indonesia from other countries - like Vietnam or Thailand.

 

To determine this, the agriculture ministry's veterinary chief has reportedly written a letter to local government offices and the World Health Organisation calling for further research into the origins of the virus.

 

(Continue . . . )

»» Read More

NSW: Hen Facility Quarantined Under Suspicion Of Avian Influenza

Photo Credit – FAO

UPDATED: I see Crof has picked up a story indicating Australia: Bird flu at chicken farm is H7 strain

 

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While H5N1 gets most of our attention, there are many varieties of avian influenza including H7s and H9s. Some are highly pathogenic (HPAI)  and produce high rates of morbidity and mortality in flocks – while others are of lower pathogenicity (LPAI).

 

The OIE requires their notification whenever an avian influenza of the H5 or H7 strains are identified, because these strains have a history of evolving from LPAI into HPAI strains.

 

We’ve seen many non-H5N1 outbreaks in local poultry operations in places like the UK, Mexico, and Canada. And while exceeding rare, we’ve seen sporadic human infection from these strains as well (see MMWR: Mild H7N3 Infections In Two Poultry Workers - Jalisco, Mexico).

 

If not quickly contained, these outbreaks can force the culling of tens of millions of bird and can inflict devastating economic losses.

 

Today authorities in Australia’s state of New South Wales are reporting a suspected outbreak of an as-yet unidentified avian influenza (not suspected to be H5N1) at a hen facility in the Lower Hunter region.

 

Details are a bit scant, but here is the official release  from the  NSW Department of Primary Industries.

 

Authorities respond to suspect NSW Avian Influenza case

15 Nov 2012

The Department of Primary Industries (DPI) has quarantined a layer hen facility in the Lower Hunter region following a suspect case of Avian Influenza.

 

"The suspected virus is definitely not the highly pathogenic H5N1 strain that has gained worldwide attention — nor is it closely related to that strain," NSW Chief Veterinary Officer Ian Roth said.

 

"Australia has previously had a small number of outbreaks of Avian Influenza viruses which were all quickly and successfully eradicated.

 

"The property has been placed under quarantine and initial tracing and surveillance is being undertaken to confirm that the virus hasn’t spread. We currently have no evidence to suggest it has.

 

"DPI’s First Response Team has been dispatched to monitor the locked-down property."

 

Dr Roth said the peak egg industry body Australian Egg Corporation has been advised and the property owners are co-operating with authorities.

 

"We are still waiting on final confirmation from CSIRO’s Australian Animal Health Laboratory which is expected later this afternoon," Dr Roth said.

 

Dr Roth said people who notice sick or dead birds should contact their local veterinarian or call the Emergency Animal Disease Watch Hotline 1800 675 888.

 

For further information on avian influenza is available.

 

 

Beyond the question of the type of avian influenza at work here will come questions on how this virus was introduced into this flock.  

 

Although Australia has been largely spared from avian influenza outbreaks over the past decade, this is not the first incident reported in 2012.

 

In Janaury a duck farm in Victoria was depopulated due to a LPAI outbreak. Although the strain is not identified in the government press release below, according to the OIE REPORT it was an LPAI H5 strain.

 

Low Pathogenic Outbreak January 2012

6 June 2012

In January 2012 The Department of Primary Industries (DPI) quarantined a commercial duck farm in two locations north-west of Melbourne after birds there tested positive to Low Pathogenicity Avian Influenza (LPAI).

 

To prevent spread of the disease, and in accordance with the Livestock Disease Control Act 1994, the Minister of Agriculture declared Restricted and Control areas around the infected properties in which movement of birds and eggs was restricted.

 

Subsequently, the infected properties were depopulated and decontaminated and the results of surveillance have shown that LPAI is no longer present. On 5th June 2012 the Minister revoked the movement restrictions around the infected properties.

 

 

I’ll post an update to this blog when CSIRO releases their analysis of the strain.

»» Read More

Queensland: A Hendra Watch & A New Vaccine

Nipah/Hendra Virus & Fruit Bat Home Range – WHO

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Although long known to carry rabies, over the past two decades bats have increasingly been linked to emerging infectious diseases.

 

The SARS-CoV (coronavirus) outbreak of 2002-2003 – which infected roughly 8,000 people and killed nearly 800 – is undoubtedly the best known of these diseases, but is by no means the only one to emerge.

 

Genetic analysis of two recent novel coronavirus infections in the Middle East suggest (but fall short of proving) that bats may be the primary host for this virus as well (see Coronavirus `Closely Related’ To HK Bat Strains).

 

And the natural reservoir for the Ebola viruses (including Marburg) are believed to be fruit bats of the Pteropodidae family.

 

Prior to the SARS outbreak - during the 1990s – two new bat-borne viruses made headlines; Nipah and Hendra, both henipaviruses of the family Paramyxoviridae.

 

Of the two, Nipah has been the deadliest, causing outbreaks primarily in India and Bangladesh. But the virus was first discovered in April of 1999 when an outbreak occurred at a pig farm in Malaysia. 

 

During this initial outbreak, the virus jumped to local swine herds from bats, and infected more than 250 people, killing more than 100. The virus was then exported via live pigs to Singapore, where 11 more people died (see MMWR Update: Outbreak of Nipah Virus -- Malaysia and Singapore, 1999)

 

Over the past decade, Nipah has sparked a hand full of smaller outbreaks across Southern Asia with the greatest activity centered around Northern India and Bangladesh. Fruit bats (Pteropodidae) are considered the natural host of Nipah virus.

 

Perhaps most concerning has been evidence of limited nosocomial, or human-to-human transmission, of the Nipah virus (see Bangladesh: Updating The Nipah Outbreak).

 

The Nipah virus, like it’s close cousin the Hendra virus, is classified as a biosecurity level 4 (BSL-4) agent.

 

While not associated with as many human fatalities, the Hendra virus was first identified after the deaths of 13 horses and a trainer in Hendra, a suburb of Brisbane, Australia in 1994. A stable hand, who also cared for the horses, was hospitalized, but survived.

 

Another outbreak was later identified as having taken place in MacKay, 1000 km to the north of Brisbane, the previous month. Two horses died, and the owner was hospitalized several weeks later with meningitis. He recovered, but developed neurological symptoms and died 14 months later.

 

Over the past 18 years 40 outbreaks of Hendra virus – all involving horses – have been reported in Australia. Four human fatalities have been linked to the virus as well.

 

Subsequent studies have showed a high prevalence of the newly identified Hendra virus in Pteropid fruit bats (flying foxes) in the region.

 

Unlike Nipah, to date no human-to-human transmission of Hendra has been documented.

All of which brings us to the latest outbreak news, and hope for a new vaccine for horses that just became available. First stop, an update from the QLD Department of Agriculture, Fisheries, and Forestry.

 

November 2012

---

Hendra virus communique no.10-5 November 2012

Hendra virus incident Ingham

Biosecurity Queensland is managing a Hendra virus incident in Ingham after a positive test result was received on Friday 2 November 2012.

 

A mare was first noticed unwell on Wednesday 31 October 2012 by her owner. She was not interested in food, had a slight nasal discharge, rapid, laboured breathing, elevated heart rate, lowered head and was unsteady on her feet.

 

A private veterinarian visited the horse and collected samples for Hendra virus testing. The horse deteriorated and went down and was euthanased on Thursday 1 November 2012.

Movement restrictions

Biosecurity Queensland has quarantined the property and undertaken tracing and risk assessments to determine susceptible animals that may have had exposure to the virus.

 

There are eight horses remaining on the property as well as dogs and cats. Several rounds of testing will be conducted on animals assessed to be at risk of being exposed to Hendra virus before the quarantine can be lifted.

 

Restrictions will apply to moving horses and horse materials on and off the infected property, and the property will be quarantined for at least one month. There are no other movement restrictions for the general Queensland horse population because of Hendra virus.

Hendra virus vaccine

A commercial pharmaceutical company has released a Hendra virus vaccine for use in horses under a Minor Use Permit. Under permit conditions, only accredited veterinarians can administer the vaccine.

 

The vaccine provides another option for the horse industry to reduce the risk of Hendra virus infection; however it is important to remember no vaccine is 100% effective and people in contact with horses need to continue to practice good biosecurity and hygiene measures even if horses are vaccinated.

 

Horse owners should discuss with their veterinarian whether vaccinating their horse is appropriate.

 

From CSIRO (Commonwealth Scientific and Industrial Research Organisation) we get more details on this newly available vaccine, via a 9 minute audio podcast & transcript.

 

Vaccine for killer Hendra virus launched

Australian horse owners and the equine industry have received an important boost in their fight against the deadly Hendra virus with the introduction of Equivac® HeV vaccine. (9:02)

• 1 November 2012

 

 

A final note, in the QLD notice above, it mentions that dogs and cats are quarantined, as well as horses. This comes about primarily because in 2011, we saw the first evidence of canine infection with the virus (see Australia: Dog Tests Positive For Hendra Virus).

 

The Queensland DAFF maintains a FAQ file on Hendra and dogs, where they write:

 

What animals have been shown to get Hendra virus?

Naturally occurring infection is limited to horses, flying foxes, humans and dogs. In animals, naturally occurring clinical disease is limited to horses.

 

Hendra virus is present in wild flying fox populations but does not appear to cause disease in them.

Laboratory studies have shown that other species including cats, guinea pigs, ferrets and pigs can develop disease when inoculated with Hendra virus in an experimental setting. Other species, including rabbits and dogs, have developed antibodies to Hendra virus in an experimental setting, but did not develop any signs of illness.

 

Although transmission from animals other than horses to humans has not been demonstrated, it is always a concern whenever a virus adapts to or jumps to a new host.

 

It not only gives the pathogen fresh opportunities to mutate and evolve, it provides another potential vector to spread the disease.

 

And when that host is a dog or a cat – animals with whom humans closely interact – it naturally serves to increases those concerns.

»» Read More

CSIRO: The Quest For Flu Resistant Poultry

 

 

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The idea of creating genetically modified chickens with a built-in resistance to the H5N1 virus has been around for some time, and given the threat posed by an avian flu pandemic, and the costs of the virus to the world’s poultry industry, I can understand the allure.

 

At the forefront of research in this field has been Australia's national science agency called CSIRO (Commonwealth Scientific and Industrial Research Organisation).

 

Below is a snapshot of a 2005 cover of CSIRO’s Livestock Research Magazine, where Cambridge University virologist Laurence Tiley stated, “The tools to make poultry resistant to flu infection already exist”. His bigger concern was whether they could persuade the public of the benefits of Genetically Modified (GM) poultry.

 
Since 2005, research on how best to make resistant poultry has been conducted at the Australian Animal Health Laboratory (AAHL), a BSL-4 facility located in Geelong, Victoria.

Earlier this summer, CSIRO released a 7-minute audio podcast where one of their researchers – Dr Tim Doran – is interviewed about the research.

 

The audio and transcript are available at this link.

 

Overnight,  The Conversation – which is a combined journalistic effort by a number of Australian Universities – published details of a presentation by Dr. Doran at CSIRO’s Emerging Infectious Diseases Symposium, where he announced that the first `challenge study’ will be conducted on transgenic chickens later this year.

 

23 October 2012, 3.39pm AEST

 

Silencing the bird flu gene: scientists prep live hen trials

Researchers hoping to produce modified chickens hatched with in-built resistance to bird flu will conduct trials on live hens later this year, an Australian scientist said on Tuesday.

 

CSIRO research scientist, Dr Tim Doran, has been using a technique called gene silencing to “switch off” virus genes that make chickens susceptible to H5N1, the bird flu that has devastated livestock and killed 359 people worldwide since 2003.

(Continue . . .)

 

This experiment is being billed as a `proof of concept’, and given the regulatory hurdles that lie ahead, we are still quite some time away from seeing GM flu resistant chickens entering the food chain.

 

Assuming this challenge study works, the biggest barrier will be getting the public to willingly accept the idea of eating transgenic chicken & dumplings for Sunday dinner.

 

Although I’m not a part of the `anything genetically modified must be bad’ camp, I’m always mindful of the law of unintended consequences. History is filled with examples of experiments that `seemed like a good idea’ at the time, but turned out to be less so in the long run.

 

Two particularly famous examples of this law in action come from Australia. The introduction of rabbits for food stock in the 18th century, and the importation of the Cane toad (Bufo marinus) to control the cane beetle in 1935.

 

Both spread quickly as invasive and environmentally damaging species, and both continue to require expensive control programs to this day.

 

The rabbit overpopulation became such a problem in the 1950s, scientists deliberately released the Myxoma virus into the rabbit population. While that virus quickly decreased the rabbit population, the resistant survivors quickly re-gained lost ground.

 

Another attempt was made with the release  of RHD(Rabbit Hemorrhagic Disease) in the 1990s, and while initially effective, its efficacy appears to be waning (cite).

  

 

Given the furor we’ve seen over the release of GM mosquitoes (see Key West: Public Debate Over GM Mosquitoes), and some high profile miscalculations in the past, getting the public to accept transgenic chickens at this point may prove a hard sell.

 

Of course, one severe flu pandemic springing out of poultry, and public sentiment might change in a hurry.

»» Read More

The 2012 Flu Season Down Under

The red band signifies the tropics, which has no distinct flu season.  Viruses circulate there, at a low level, year round. – Credit Wikipedia

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While most of the Northern Hemisphere is basking in summer warmth and seeing very little flu activity (Hong Kong being an exception), it is winter south of the equator and flu season is well underway in Australia, New Zealand, and parts of South America and Africa.

 

Watching what happens during the flu season in the opposite hemisphere can sometimes give us clues as to what we might expect in the fall.

 

Of course, it doesn’t always prove predictive. 

 

After the mildest flu season in memory in the Northern Hemisphere, it appears that Australia and New Zealand are getting hit harder, and earlier than usual.

 

First stop, a media report from the West Australian, then we’ll take a look at the latest surveillance data.

 

 

Pressure mounts with different flu virus

Peta Rasdien, The West Australian July 19, 2012, 7:39 am

The earliest start to the flu season in 10 years and the rise of a strain known to cause more severe illness is putting pressure on WA's already stretched health resources.

(Continue . . . )

 

The `different’ flu virus is the seasonal H3N2 virus – which has antigenically drifted slightly away from the vaccine strain currently in use (see WHO: Southern Hemisphere 2012 Flu Vaccine Composition).

 

The existing vaccine contains the A/Perth/16/2009 (H3N2)-like virus, which is hoped to be at least somewhat effective against the evolving virus.

 

This fall, a new vaccine will be introduced that contains the updated A/Victoria/361/2011 (H3N2)-like virus (see WHO: Northern Hemisphere 2012-2013 Flu Vaccine Composition).

 

 

Historically, years where the H3N2 virus has been the dominant strain tend to produce worse flu seasons.  The virus often hits harder than H1N1, and is more likely to target the elderly.

 

From New Zealand’s ESR Public Health Surveillance, we get these latest numbers in their Influenza Weekly Report 2012/28.

 

As you can see, the weekly consultations for ILI’s (Influenza-like Illness) are climbing like a homesick angel, and are running well ahead of the reports from the past 2 years. 

 

While ILI activity in NZ is heavy, it does not reach the epidemic threshold (400 per 100K).

 

The week 28 report summary reads:

 

ILI through sentinel surveillance was reported from 19 out of 20 District Health Boards (DHB) with a national consultation rate of 102.8 per 100 000 (399 ILI consultations). A total of 905 swabs were received from sentinel (79) and non-sentinel (826) surveillance.

 

331 viruses were identified: A(H3N2) (232), A (Not subtyped) (35), A(H1N1)pdm09 (31), B (Lineage not determined) (26), A/Perth/16/2009 (H3N2)-like (5) and B/Wisconsin/1/2010-
like (2)

 

 

About 70% of the viruses identified were H3N2, while only 10% were the 2009 H1N1 strain.

 

The situation in Australia appears similar, although the latest surveillance numbers are not quite as current as what we have from New Zealand.

 

This from Australia’s Department of Health and Ageing.

 

Australian influenza report 2012 - Current report: No 2 - 9 June to 22 June 2012

Summary

• Across all surveillance systems, influenza activity has continued to increase this fortnight.
• All jurisdictions have reported increases in influenza detections above background levels, with South Australia, Victoria, New South Wales, the Australian Capital Territory and the centre of the Northern Territory reporting significant recent increases in activity.
• Influenza-like illness (ILI) activity has continued to increase, with the seasonal increase occurring slightly earlier than in previous years (excluding 2009).
• During this fortnight there were 2,233 laboratory confirmed notifications of influenza, almost double the number of notifications from the previous fortnight. New South Wales, Queensland and South Australia continue to report the highest number of notifications.
• Nationally, influenza A(H3N2) is the predominant circulating strain with some co-circulation of influenza B. Influenza A(H3N2) is predominant across most states and territories, however influenza B represents around 75% and 40% of all notifications in the Northern Territory and Western Australia, respectively. So far in 2012 there have been very few notifications of pandemic (H1N1) 2009.
• As at 22 June 2012, there have been 6,027 confirmed cases of influenza reported. Excluding 2009, notifications of influenza in 2012 have started their seasonal increase slightly earlier in comparison with previous years.
• Influenza associated hospitalisations have continued to increase this fortnight, particularly at the South Australian and Northern Territory sites. Overall, 40% of hospitalisations have been associated with influenza B infections, mostly reported from the Northern Territory. Amongst other jurisdictional sites, influenza A is more common.
• The WHO has reported that the influenza season has not yet started in the temperate countries of the southern hemisphere, although several countries, including Australia, Chile, Paraguay and South Africa have reported small but sustained increases of influenza virus detections. Influenza A(H3N2) viruses have been the most commonly detected in recent weeks in the southern hemisphere temperate region.
• 

Based on this chart, this year’s ILI activity is off to the fastest start in Australia since the H1N1 pandemic of 2009.

As far as what the southern hemisphere’s flu season tells us about the fall flu season ahead?

 

Well, the old adage is that if you’ve seen one flu season, you’ve seen one flu season.

 

Influenza viruses are notoriously unpredictable, and flu seasons that span the globe, even more so.  We won’t know what kind of flu season we are going to have until we’ve had it.

 

We will continue to watch the flu season evolve to our south, however, looking for any clues that might arise.

 

But whatever comes, we do have one advantage over our friends south of the border this year; the new flu shot with antigens expected to be more protective against the drifted H3N2 virus that will be available this fall.

 

Making getting the seasonal flu shot this fall all the more important this year.

 

Add in the routine practicing of good `flu hygiene’ (covering coughs, washing hands, staying home when sick), and you can substantially decrease you odds of getting the flu this coming winter.

»» Read More

CSL: Report On Febrile Reactions To FluVax

Photo Credit PHIL

 

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A year after the 2009 pandemic started, vaccine manufacturers began delivering a seasonal trivalent influenza vaccine (TIV) with this newly emergent H1N1 strain included.

 

Australia was among the first to receive this new formulation in the spring of 2010.

 

Within weeks it became apparent that a significant number of young Australian children receiving a specific brand of flu shot - FluVax or FluVax Junior (CSL) - developed adverse reactions. Most of the side effects were mild and related to fever, but some children experienced potentially serious febrile convulsions.

 

Other symptoms included nausea and vomiting, or injection site inflammation (see Australia Investigating Adverse Vaccine Reactions).

 

For a while, Australia placed a moratorium on dispensing flu shots to children under the age of 5, but that was lifted after investigations found the problem was only linked to one manufacturer (see Australia Lifts Ban On Flu Vax For Under Five’s).

 

Since then, Australia, the United States, and Great Britain have recommended that CSL’s vaccine not be used in children under the age of 5 (see FDA Approves 2010-2011 Flu Vaccines) and cautioned for those aged 5 to 9, and investigations into the cause of these adverse reactions have continued.

 

Fast forward two years, and today we have a report from CSL Biotherapies that describes, at least in general terms, what appears to have gone wrong.

 

The details are presented in a press release and a series of supporting documents, including an Investigation summary.  Some excerpts (in blue) from that summary follow:

 

After ruling out bacterial or chemical contamination as the cause, the focus moved to CSL’s manufacturing process, and there they found (in animal models and in vitro systems):

 

• CSL’s influenza vaccines, as a class, trigger a greater immune gene response and induce higher levels of immune-stimulating hormones (cytokines) compared to other manufacturer’s influenza vaccines
• Fluvax^® 2010 induces higher levels of immune-stimulating hormones (cytokines) compared to previous season’s formulations of CSL’s influenza vaccine
• The B strain followed by the H1N1 strain used in Fluvax^® 2010 induces the strongest activity in the paediatric blood samples.

 

 

The reasons for these differences, CSL believes, include but may not be limited to:

 

CSL’s method of manufacture preserves more short gene fragments and lipids from the virus than other manufacturers.

 

The particular characteristics of the gene fragments and/or lipids from the swine flu strain and the B strain used in Fluvax^® 2010 may have led it to being more reactive in some young children in 2010 compared to CSL’s vaccines in previous seasons.

The gene fragments and lipids appear to be from split virus, but residual whole virus or clusters of both may have also contributed, and are under further investigation.

 

Increasing the amount of splitting agent (TDOC) reduces the amount of short gene fragments and lipids in the CSL vaccine, and also reduces the reactivity of the CSL vaccine (in vitro).

 

The scientific studies indicate that the root cause of the severe febrile response seen in some young children after vaccination with Fluvax^® in 2010 is complex and multi-factorial.

 

CSL continues their investigation, and is looking at ways to remedy the problem. Until they do, they plan no immediate changes to their manufacturing process, and recommend their vaccines for children over the age of nine.

 

While there are a number of news stories on the wires this morning, the always excellent Jason Gale, writing for Bloomberg News has some of the most complete coverage that I’ve seen.

 

Convulsion Risk From CSL Flu Vaccine Linked to Components

By Jason Gale on June 20, 2012

Convulsions in children immunized with a CSL Ltd. (CSL) flu shot probably were caused by an excessive immune response to viral components in the vaccine, according to preliminary findings of a two-year study.

 

(Continue . . . )

 

It is worth noting that In the summer of 2011, the Medical Journal of Australia (MJA) published a letter that looked at early flu-season testing of several non-CSL TIVs (Trivalent Influenza Vaccines) given to thousands of children under the age of 5. 

 

Ensuring safety of the 2011 trivalent influenza vaccine in young children

Christopher C Blyth, Tracy Y Markus, Paul V Effler and Peter C Richmond

 

 

As expected, a small number of febrile reactions were observed, but none proved serious, and none required professional medical attention.

 

Their reassuring finding was that the pediatric flu shots manufactured by both Sanofi Pasteur and Solvay proved to be very safe when administered to young children, with no repeat of the significant number of adverse reactions reported in 2010.

 

While no vaccine (or drug) can be said to be 100% safe – and rare but sometimes serious adverse effects have been reported - the preponderance of evidence continues to support the scientific consensus that flu vaccines are very safe and most years, reasonably effective.

 

Given that influenza-related illnesses claims thousands of lives each year in the United States (cite Estimating Seasonal Influenza-Associated Deaths in the United States), the smart money is on getting the vaccine every year.

 

For more on flu shot safety and benefits, you may wish to revisit:

 

BMJ: H1N1 Vaccination & Fetal Death Rates

Harvard Study Reaffirms Safety Of Flu Vaccine

»» Read More

Australia Finds LPAI H5 On Two Duck Farms

 

 

Victoria, Australia – Credit Wikipedia

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Overnight the wire services have been abuzz with news of the discovery of a low pathogenic form of of avian influenza (LPAI) on a couple of duck farms in Victoria, Australia.  

 

A few samples of the media coverage include:

 

Chicken safe to eat, despite Victorian bird flu

 

Bird flu detected in ducks near Melbourne

 

Bird flu outbreak sparks duck cull

 

While all of the stories (rightfully) point out that this is a low-path strain - and not considered to be a serious health hazard to humans – noticeably absent from any of the above reports is any identification of the strain of avian flu detected.

 

There are, of course, a great many LPAI strains out there, but only the H5s and H7s are required to be reported to the OIE because of their potential to evolve into a more pathogenic strain.

 

For a good background on avian influenza in agriculture I would invite you to visit CIDRAP’s  Avian Influenza (Bird Flu): Agricultural and Wildlife Considerations - Last updated January 21, 2012

 

 

A visit to Victoria’s Department of Primary Industries website solves the subtype mystery (stated to be H5), which is included in the following statement by Victoria’s Chief Veterinary Officer, Dr Andrew Cameron.

 

 

Chief Veterinary Officer’s Avian Influenza Update

27 January 2012

The Department of Primary Industries (DPI) has quarantined a commercial duck farm in two locations north-west of Melbourne after birds there tested positive to Low Pathogenic Avian Influenza (LPAI).

 

DPI Chief Veterinary Officer, Dr Andrew Cameron said analytical tests carried out at the Australian Animal Health Laboratory at Geelong, Victoria, had given a positive response to low pathogenic H5 subtype avian influenza virus, prompting authorities to act immediately.

 

This low pathogenic subtype of avian influenza is not the highly pathogenic H5N1 virus affecting poultry and humans throughout much of Asia. The wider community is not at risk from this incident.”

 

Dr Cameron has said, “The virus is relatively harmless now, but we do not want to take the risk it could linger in bird populations and mutate to a more virulent strain.”

 

The farm has been placed under strict quarantine and no birds, eggs, meat or associated equipment can be taken off the property.

 

The Consultative Committee for Emergency Animal Diseases (CCEAD) will meet on Friday 27 January, to discuss containment, surveillance and next steps.

 

Victoria’s Acting Chief Health Officer Dr Rosemary Lester reinforced the assurances that the public is not at risk. “Our poultry meat and eggs continue to be safe under normal food handling and cooking arrangements” she said.

 

For further information about Avian Influenza review the links below or call 1300 135559.

 

In Victoria, strict biosecurity guidelines apply to all poultry farms to prevent poultry, feed and water from mixing with wild birds. This minimises the risk of disease. It is a good practice to protect the food and water used for your pet birds and to ensure wild birds cannot come into contact with them. Finally, it is important for all of us to follow good hygiene practices to minimise the risk of any disease, such as washing hands after contact with animals and birds and, in particular, not handling sick or dead birds. These are sensible precautions that will prevent many diseases, not just AI.

Dr Andrew Cameron
Chief Veterinary Officer, Victoria

 

You’ll find another press release on this site, providing greater detail on the steps that are being taken to eradicate this virus.

 

Media release: Swift Action to Contain Avian Influenza

27 January 12

»» Read More

Prof. Peter Doherty On Influenza’s Threat

 

 

 

# 5953

 

 

Last August in Professor Peter Doherty On Bird Flu I wrote about an Australian Life Scientist Magazine  interview with world renown 1996 Nobel Prize winning scientist Professor Peter Doherty, who discussed the pandemic potential of the H5N1 avian virus.

 

Today, The Conversation – which is a combined journalistic effort by a number of Australian Universities – has the first of a two-part article by Professor Doherty on influenza.

 

Rather than try to excerpt or summarize his views, I’ll simply provide a link so you can read the entire article.

 

 

Author

Peter C. Doherty
Laureate Professor at University of Melbourne

10 November 2011, 2.36pm AEST

Global efforts against flu evolving in the face of continuing threat

Influenza is never off the news agenda for long. If it’s not the flu season (and it always is in one hemisphere) and the attendant calls for vaccinations, it’s news about vaccines causing problems or new ones that will imbue immunity to all variants and mutations of the virus.

 

In this first of a two-part series on influenza and the future of vaccines for it, Peter Doherty discusses how these viruses mutate and how we monitor them to create effective vaccines.

(Continue . . . )

Tomorrow’s article will look at the feasibility of developing a “universal” flu vaccine.

»» Read More

Another Yank From Oxford

 

 

 

 

# 5863

 

 

The 2010-2011 flu season across much of the northern hemisphere was unremarkable, but there were a few notable exceptions. The UK saw a dramatic resurgence of the 2009 H1N1 virus in December of 2010, stressing hospital ICUs across Britain.

 

According to the HPA’s figures . . . with the exception of the swine flu pandemic of 2009 . . .  last year’s flu epidemic in Great Britain was the worst in nearly a decade.

 

These, and many other flu graphics, are available from HPA Weekly National Influenza Graphs (PDF, 687 KB).

 

North America in contrast, which was dominated by the H3N2 virus, saw a relatively mild flu epidemic last year.  Despite that, flu claimed thousands of American lives last year.

 

Giving further evidence that influenza is notoriously unpredictable. Even during the same year, the strains and severity can vary widely across the globe.

 

Still, this time of year many scientists look towards the slowly waning flu season south of the equator for clues as to how the northern hemisphere will fare this year.

 

As you might expect, the picture is mixed.  The following graphic comes from the World Health Organization’s  latest influenza surveillance report.

 

 

Influenza activity in South Africa and much of South America peaked early in their season and is on the decline (influenza B, however, is still circulating in parts of Africa at significant levels).

 

Australia and New Zealand are reporting continued, and relatively heavy, influenza activity.

 

The following graph comes from the latest Australian Influenza Surveillance report, and the pattern is similar to the one we saw in the first graphic from the HPA. 

Influenza activity this year (with the exception of the 2009 pandemic) is the highest they’ve recorded in recent years.  According to this report, so far:

 

. . .  in 2011, 14,222 (71%) cases were reported as influenza A (35% influenza A (untyped), 31%
pandemic (H1N1) 2009 and 5% A/H3N2) and 5,620 (28%) were influenza B.

 

All of which serves as prelude to a report today in the UK Express Newspaper, featuring interviews with several noted virologists including John Oxford - Scientific Director of Retroscreen Virology Ltd. and a Professor of Virology at St Bartholomew’s and the Royal London Hospital.

 

In the UK, when the press wants a quote or opinion on influenza or pandemic issues, you’ll find it often comes from Professor Oxford. 

 

At the start of the influenza pandemic of 2009 Oxford was publicly insisting that the real number of infected from the H1N1 virus in the UK was many times greater than the British government was saying (see A Yank From Oxford).

 

As it turned out, he was right. 

 

Today we have:

 

KILLER FLU TO GRIP BRITAIN

Many Britons have little immunity after two years of relatively limited outbreaks

Monday September 26,2011

 

Hyperbolic headlines aside (a `killer flu’ hits Britain every year. It’s really just a matter of degree), Professor Oxford is quoted as saying:

 

“No one is sure why our patterns of flu tend to follow what happens in the southern hemisphere during the summer but it does.

 

Unfortunately in Australia there has been a sharp outbreak with higher than normal numbers of flu strains A and B.

 

The chances are the same will happen here.”

 

He qualifies his statement later by saying that they really won’t know how the UK will fare until later in the year.

 

But even without the elevated flu levels reported in Australia, Oxford is concerned over a resurgence of Influenza B which as been overshadowed the past couple of years by the A/H1N1 strain.  

 

Community immunity to the B strain may be declining, and the virus can cause serious illness, particularly in the very young and very old.

 

 

Other scientists interviewed in this article are less willing to predict how the upcoming flu season will evolve, although all admit a heavy flu season is possible.

 

All of this comes amid controversy over the UK government’s decision not to publicly push their “Catch it. Kill it. Bin it” flu hygiene advertising campaign, or run PSAs encouraging vaccination.

 

Instead, the NHS is relying on a targeted flu vaccination plan for `at-risk’ populations through their network of GPs.

 

Another controversy is that only about a third of Health Care Workers (HCWs) in Britain voluntarily accepted the flu vaccine last year.

 

Professor Lindsey Davies, president of the UK Faculty of Public Health, calls that a “complete dereliction of duty” and warns that it could endanger the lives of `at-risk patients such as babies, the elderly, pregnant women and those with breathing trouble.’

 

Flu apathy, particularly in the wake of a pandemic that failed to live up to some people’s expectations, runs high in the UK and around the world.

 

Last year’s flu headlines (see The Pandemic Is Ended (But The Malady Lingers On) are all-but-forgotten, replaced by the latest crisis of the week.  It is hard for most people to worry about a flu that may come later this winter when the economy already appears to have pneumonia.

 

And so we find ourselves on the cusp of another flu season, peering ahead, but without much of a clue as to how it will pan out. 

 

The only certainty is that the flu will arrive – more or less on schedule – and even if it isn’t severe, it will sicken millions, hospitalize hundreds of thousands, and kill tens of thousands around the world.

 

Influenza can kill you, even in a `light’ flu season.

 

Reason enough to get a flu vaccine every year, and to practice good flu hygiene (covering coughs, sneezes, washing hands, staying home when sick, etc.) year round.

 

No, they are not guaranteed protection.  But they can give you a decided edge against a serious virus.

 

For more on influenza, vaccines, and prevention, I would invite you to visit:

»» Read More

ECDC: Risk Assessment On Australia’s Antiviral Resistant H1N1 Cluster

 

 

# 5815

 

 

Roughly 10 days ago, in Australia Reports Cluster Of Antiviral Resistant H1N1, I wrote of a large clustering of oseltamivir (Tamiflu) resistant H1N1 cases in New South Wales. More than 2 dozen patients – roughly 14% of the isolates tested from that region since May – have shown a genetic mutation that confers resistance.

 

Ever since the novel H1N1 swine flu virus appeared in the spring of 2009, scientists have worried that it would someday develop resistance to oseltamivir as its predecessor - seasonal H1N1 - did in 2008.

 

Overall, however, the news has been encouraging.

 

During the first two years, only 1%-2% of samples tested have shown the most common mutation known to convey oseltamivir resistance; H275Y, where a single amino acid substitution (histidine (H) to tyrosine (Y)) occurs at the neuraminidase position 275.

 

(Note: some scientists use 'N2 numbering' (H274Y) and some use 'N1 numbering' (H275Y))

 

This recent jump in resistance in Australia is concerning as these cases have not been linked to prior antiviral use or occurred in immunocompromised patients, factors commonly associated with the development of spontaneous resistance in the past.

 

Today the ECDC released a 5-page PDF risk assessment on the rise of resistant H1N1 cases in Australia.  It concludes - that at least for now - “the risk of this cluster becoming more widespread and having public health implications remains low.”

 

It goes on to warn, however, that  “only ongoing surveillance will indicate whether this occurrence remains a localised event or whether it has the potential to become widespread.”

You can read the abstract or download the entire document from the link below.

 

 

ECDC assessment on Oseltamivir-resistant influenza A(H1N1)2009 cluster reported in Australia

06 Sep 2011

Australia has reported oseltamivir resistance of A(H1N1)2009 influenza virus in the state of New South Wales, with assumed person-to-person transmission of the resistant strain. The European Centre of Disease Prevention and Control (ECDC) has produced a rapid risk assessment to assess the situation.

 

The oseltamivir-resistant cases had no known link to oseltamivir exposure and were not immunosuppressed, but were closely linked geographically. Samples from the cluster do not currently exhibit any resistance to zanamivir. Although the cluster has remained localised, it cannot be assumed that the variant virus will not spread.

 

ECDC concludes that at present, the risk of this cluster becoming more widespread and having public health implications remains low. However, if spread does occur, there will be implications for the prophylaxis and treatment of influenza patients and the consequences for public health in Europe will need to be considered.

 

Regardless of the outcome, constant antiviral resistance monitoring is vital in Europe and globally. Only ongoing surveillance will indicate whether this occurrence remains a localised event or whether it has the potential to become widespread.

 

Oseltamivir and zanamivir are active ingredients in antiviral drugs (Tamilfu, Relenza). Vaccination, supplemented by personal hygiene measures, remains the primary measure for prevention of seasonal influenza transmission. However, antiviral drugs are important countermeasures for prophylaxis and treatment, especially in vulnerable people and those with severe influenza.

 

Read the full ECDC risk assessment: Oseltamivir-resistant influenza A(H1N1)2009 cluster in Australia

»» Read More

The Flu Season Down Under

 

 

 

# 5758

 

Southern Hemisphere, Where Flu Is Active right Now – Photo Credit Wikipedia

 

Along about this time of year we watch influenza’s progress south of the equator in hopes that it will give us some clue as to how our upcoming flu season will play out.

 

In terms of flu activity, August is to the Southern Hemisphere as February usually is to the North. 

 

And so far this year we’ve seen indications that Australia is experiencing a fairly busy flu season (see Australia: Flu Season Nearing Peak – ISG). Yesterday blogger Arkanoid Legent carried a news article called Australia : Flu cases up seven-fold this year.

 

The latest official report from Australia’s Department of Health and Aging gives provides us with details on their influenza season through August 5th.  A hat tip goes to Ronan Kelly on FluTrackers for posting this link.

 

 

Influenza Report # 10 (PDF)

Summary

• Levels of influenza-like illness (ILI) in the community continued to increase through both sentinel general practitioner surveillance systems and ILI presentations to emergency departments.
• Notifications have continued to rise nationally, with notifications highest in Queensland, New South Wales and South Australia. In recent weeks, influenza notifications have started to increase in all other states and territories. Currently the weekly number of notifications in the ACT, New South Wales, Queensland and Tasmania are above the peak frequency of notifications observed in 2010.
• During this reporting period there were 3,159 laboratory confirmed notifications of influenza, with Queensland reporting the highest number of notifications, followed by New South Wales and South Australia. The majority of virus detections have been pandemic (H1N1) 2009, with co-circulation of influenza B.
• The previously high proportion of influenza B in South Australia has started to decline with increasing numbers of pandemic (H1N1) 2009 notifications. The majority of states and territories have reported mostly pandemic (H1N1) 2009, with co-circulation of influenza B, except in Tasmania where there is mostly influenza B circulating, and Western Australia where there is very little influenza B circulating and mostly pandemic (H1N1) 2009.
• As at 5 August 2011, there have been 13,521 confirmed cases of influenza reported to the National Notifiable Diseases Surveillance System (NNDSS) in 2011. Currently the weekly number of notifications being reported nationally is above the peak frequency experienced in previous years, except 2009.
• The WHO has reported that influenza activity in the temperate regions of the northern hemisphere remains at low. Influenza transmission continues to occur in a few countries of the tropical region. After peaking in early June, influenza transmission in South Africa has declined to low levels. In New Zealand, rates of national ILI consultations are currently slightly above baseline activity levels and influenza type B is currently the predominant strain circulating.

 

With the notable exception of the 2009 H1N1 pandemic, confirmed flu cases in Australia are running at the highest rate since 2007.

 

Analysis of influenza types from sentinel laboratories indicate that the 2009 H1N1 virus leads in the number detected, followed by Influenza B and then the H3N2 virus.

 

The big question we face as our flu season approaches is whether the viruses in circulation remain a good match to this year’s flu vaccine. 

 

While some `low reactor’ viruses have been reported, the latest virological summary below states that most of the viruses tested appear to be a close antigenic match to this year’s vaccine.

 

 

Antigenic characterisation has shown influenza isolates to be a close match with the composition of the 2011 southern hemisphere influenza vaccine with some viruses showing reduced reactivity, however there has been insufficient testing to date to determine any general trends.

Antiviral Resistance

The WHO Collaborating Centre in Melbourne has reported that from 1 January 2011 to 7 August 2011, one isolate (out of 1,240 tested) has shown resistance to oseltamivir by enzyme inhibition assay (EIA). A further isolate, out of a total of 7 pandemic H1N1 (2009) tested by pyrosequencing, has shown the H275Y mutation known to confer resistance to oseltamivir.

 

 

Whether Australia’s flu season will serve as a template for the upcoming northern hemisphere’s flu season is impossible to know.  Influenza viruses are constantly evolving, and so the only thing predictable about the flu is its unpredictability.

 

However this season turns out, the CDC will tell you that The single best way to protect against the flu is to get vaccinated each year.

 

Vaccine supplies are already shipping, and should be ample this year.  For more on the value (and wisdom) of getting the flu shot, you can visit the CDC’s recently updated page:

 

Key Facts About Seasonal Flu Vaccine

»» Read More

Australia: Dog Tests Positive For Hendra Virus

 

 

 

Nipah/Hendra Virus & Fruit Bat Home Range – WHO

 

 

 

# 5716

 

 

Over the past month more than a dozen horses in and around Queensland Australia have died from the Hendra Virus – a pathogen normally carried by flying foxes (bats), but that can be transmitted to horses and, on rare occasions, to humans as well.

 

The virus was first isolated in 1994 after the deaths of 13 horses and a trainer in Hendra, a suburb of Brisbane, Australia. A stable hand, who also cared for the horses, was hospitalized, but survived.

 

Another outbreak took place in MacKay, 1000 km to the north of Brisbane, the previous month. Two horses died, and the owner was hospitalized several weeks later with meningitis. 

 

He recovered, but developed neurological symptoms and died 14 months later.

Subsequent studies have showed a high prevalence of the newly identified Hendra virus in Pteropid fruit bats (flying foxes) in the region.

 

In 1999, a very similar virus emerged at a Malaysian pig farm, resulting in 105 human deaths and the culling of one million pigs.  Exported pigs caused another outbreak at an abattoir in Singapore, resulting in 11 infections and 1 additional death.

This virus was designated Nipah, named after the place where it was first isolated in humans. It too, is believed to be carried by the fruit bat.

 

 

Since then, there have been scattered outbreaks of both viruses in Australia (Hendra virus) and in Bangladesh and adjacent parts of India (Nipah).  Of the two, the Nipah virus has infected and killed the most humans.

 

For more background on these two rare viruses, the CDC’s Special Pathogens Branch maintains a fact sheet:

 

Hendra Virus Disease and Nipah Virus Encephalitis

 

The World Health Organization maintains a website on the Hendra Virus (Hendra Virus (HeV) Infection) and Nipah Virus (Nipah Virus (NiV) Infection) on their Global Alert And Response (GAR) site.

 

Today, we’ve news of an unusual discovery out of Australia.  

 

A dog on one of the quarantined ranches in Queensland has tested positive for antibodies to the Hendra Virus.  Although the dog appears healthy, this indicates a previous exposure to the virus.

 

And this marks the first known infection of a dog by the virus in the wild.

 

The following notice appears on the Queensland Government Primary Industry & Fisheries website:

 

Current situation as at 26 July 2011

The Australian Animal Health Laboratory (AAHL) in Geelong has confirmed that a dog has tested positive for Hendra virus.

 

This is an unprecedented situation, and the first time outside a laboratory that an animal other than a flying fox or horse, or a human has been confirmed with Hendra virus infection.

 

Biosecurity Queensland´s policy is to test cats and dogs on properties where there are infected horses.

 

The remaining horses and dogs on this property are still being monitored daily and show no signs of illness.

 

We recommend that people keep dogs and cats away from sick horses to reduce the risk of such an infection happening.

 

 

While it is too soon to gauge the impact of this particular discovery, anytime a virus jumps species we tend to pay close attention.

 

Many of the common illnesses we think of as `human’ diseases actually began in other species, and only later migrated to humans.

 

Tuberculosis probably jumped to humans when man began to domesticate goats and cattle. Measles appears to have evolved from canine distemper and/or the Rinderpest virus of cattle.   And Influenza, as most of you know, is native to aquatic birds.

 

The list of zoonotic diseases (those shared between humans and animals) is long and continually expanding, and includes: SARS, Babesiosis, Borrelia (Lyme), Nipah, Hendra, Malaria, Hantavirus, Ebola, Bartonella, Leptospirosis, Q-Fever, bird flu and many, many others.

 

When a virus adapts to a new host, it not only gives it fresh opportunities to mutate and evolve, it provides another potential vector to spread the pathogen.

 

And when that host is a dog or a cat – animals with whom humans closely interact – the risks of spreading to humans are even greater.

 

As the following article from the Sydney Morning Herald tells us, in light of this latest discovery scientists are now tasked with determining what – if any – changes may have occurred in the Hendra virus.

 

 

Scientists guessing over Hendra dog

Kym Agius, Jessica Marszalek and Petrina Berry

July 26, 2011 - 5:49PM

AAP

The first dog to contract the Hendra virus has scientists guessing whether the virus is being transmitted differently or if humans can now catch the disease from canines.

(Continue . . . )

 

 

For now, there are far more questions than answers.

 

 

 

»» Read More