Peter Sandman: Outrage On Both Sides

 

 

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Dr. Peter Sandman is a world renown expert on crisis communications, and along with his wife and colleague Dr. Jody Lanard, provide consulting services to individuals, organizations, and companies – often during their worst public relations nightmares.

Together they also produce a wealth of invaluable risk management advice on their website, which quite frankly should be second home for anyone involved in public relations or risk communications.

 

 

I’ve highlighted Peter and Jody’s work often in the past, including:

 

Peter Sandman: Swine Flu For Grownups

Experts: `Mild’ Is A Misleading Term For This Pandemic

Peter Sandman On Pandemic Risk Communication

 

 

When you think about `risk communications’ and `flu’, very little comes close to the often unseemly debate of the past few months over the publication of the Kawaoka and Fouchier H5N1 transmissibility papers.

 

 

For those that need a refresher:

 

Last September, Ron Fouchier from the Netherlands (and almost simultaneously Professor Yoshihiro Kawaoka from Wisconsin) announced success in creating enhanced strains of the H5N1 avian flu virus in the laboratory that can transmit efficiently among ferrets, which quickly sparked biosecurity concerns.

 

For some background, see Katherine Harmon’s Sci-Am article , New Scientist: Five Easy Mutations, & NPR: Bio-Terrorism Concerns Over Bird Flu Research.

 

 

The fate of these two papers has now been decided; Kawaoka’s was published earlier this month (see Nature Publishes The Kawaoka H5N1 Study), and a revised version of Fouchier’s paper is due out anytime.

 

While the original focus of this debate has been settled, we are left with nagging questions regarding the way this debate was handled, and concerns over what happens when this sort of situation inevitably occurs again.

 

Which brings us to a long, detailed, and very informative analysis of the risk communication missteps made by both sides of this debate, posted by Dr. Sandman on his website in response to a reader’s comment.

 

It is called:

 

Risk communication aspects of the debate over H5N1 transmission studies

 

 

I’ll not try to summarize this well reasoned and detailed examination of the events of the past few months, as to do so would be a disservice.

 

This article deserves to be read in its entirety. 

 

Highly recommended.

»» Read More

Renewed Respect For Wild H5N1

 

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Part of the fallout from the publication of Yoshiro Kawaoka’s research paper (see Nature Publishes The Kawaoka H5N1 Study) has been renewed concerns over the progress the avian flu virus is making in the wild and its potential for sparking a pandemic.

 

A few headlines from the past 24 hours include:

 

Once-Banned Bird Flu Study Suggests Pandemic Threat Is Real Newsday.com

 

Bird flu viruses have potential to cause a ‘human pandemic' The Hindu

 

Study Shows How Bird Flu Could Jump to Humans - MedPage Today

 

Pandemic Potential? Bird Flu Becomes Airborne With Just 4 Mutations LiveScience.com

 

 

Kawaoka showed that it would take perhaps only 3 or 4 mutations to turn the H5N1 virus into a mammalian transmissible influenza, and noted that similar genetic changes have already been observed in virus samples collected from the middle east.

 

The `money quote’ from his paper was:

 

Therefore, these viruses may be several steps closer to those capable of efficient transmission in humans and are of concern.

 

 

Kawaoka references a 2011 study that found that several new H5 sublineages have emerged in Egypt with an increased affinity for (human) α2,6 SA receptor cells while still retaining their binding ability to (avian) α2,3 SA receptor cells.

 

We looked at this paper roughly a year ago in PLoS: Human-Type H5N1 Receptor Binding In Egypt.

 

Of note, in 2011 the authors found `increased attachment and infectivity in the human lower respiratory tract, but not in the larynx.’

 

Many scientists believe the virus must learn to bind to, and replicate in, the upper airway (nose, larynx, pharynx, trachea)  of humans in order to transmit efficiently from human to human. 

 

And that hasn’t happened in the wild yet.

 

Of concern, one of Kawaoka’s discoveries is a single mutation that `stabilizes’ the virus so that it can replicate within the pH range normally found in the trachea.

 

Some scientists worry that this pH stabilization might be one of the last big hurdles the virus must clear before becoming more of a human threat.

 

Whether the `right’ mutations will occur in nature, and at a time and place conducive for sparking a pandemic, is subject to debate. 

 

Some scientists argue that if it hasn’t happened by now, it isn’t likely to.

 

But it now appears that the number changes needed for the H5N1 virus to make a leap from being an avian-specific virus to a human-adapted one may be fewer than previously suspected.

»» Read More

More Reaction To The Kawaoka Paper

 

 

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As promised, some additional reports on the publication in Nature today of Yoshiro Kawaoka’s H5N1 study (see Nature Publishes The Kawaoka H5N1 Study).

 

First from Carl Zimmer, an in-depth (and extremely well done) explainer of the issues surrounding the publication of this study.

 

Behold The Forbidden Flu: A Loom Explainer

 

 

Ed Yong for Discover Magazine writes:

 

Mutant flu paper is finally published, reveals pandemic potential of wild viruses

 

 

And the journal Nature runs an editorial:

 

Nature | Editorial

Publishing risky research

Nature 485,5 (03 May 2012)

doi:10.1038/485005a

Imperfect global biosafety standards and a threat to researchers' motivations from biosecurity concerns are among the significant risks in current flu research.

 

 

Via The Scientist we get the following.

 

Bird Flu Transmission in Mammals

After much ado, Nature publishes the first report of a bird flu virus adapted for transmission in ferrets.         By Ruth Williams | May 2, 2012

And lastly, from Science Magazine:

 

One of Two Hotly Debated H5N1 Papers Finally Published

by Martin Enserink and Jon Cohen on 2 May 2012, 1:18 PM

 

»» Read More

Nature Publishes The Kawaoka H5N1 Study

 

BSL-4 Lab Worker - Photo Credit –USAMRIID

 

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Although it was Ron Fouchier’s announcement last September (see New Scientist: Five Easy Mutations) of his successful manipulation of the H5N1 virus to make it transmissible among ferrets that set off biosecurity alarm bells (see NPR: Bio-Terrorism Concerns Over Bird Flu Research) and instigated an international debate, in a laboratory halfway around the world Dr. Yoshiro Kawaoka was quietly duplicating the feat.

 

Today (the embargo having lifted at 1pm) the journal Nature publishes Kawaoka’s study, which details how he created a modified H5N1 – H1N1 hybrid that transmits via respiratory droplets among ferrets.

 

While its virulence in ferrets was reduced over that of its parental H5N1 virus (exactly why is unknown), the big news is that it only took the introduction of 4 mutations into the H5N1’s hemagglutinin (HA) to allow it to bind efficiently to the alpha (2-6) sialic acid receptors found in ferret (and human) upper respiratory tracts.

 

Three of these mutations were directly involved in the binding to the a2,6 receptor cell, while the 4th stabilized the virus to fuse with receptor cells at pH levels typically found in the upper respiratory tract. 

 

An affinity for a2,6 receptor cells has long been thought vital for the virus to adapt to humans, but this 4th mutation - that facilitates virus-cell fusion - may prove equally important.

 

Given its highly public and bumpy road to publication, Kawaoka’s study (see below) is certain to receive an inordinate amount of scrutiny and review over the next couple of days.

 

 

Experimental adaptation of an influenza H5 HA confers respiratory droplet transmission to areassortant H5 HA/H1N1 virus in ferrets

 

doi:10.1038/nature10831

Masaki Imai, Tokiko Watanabe, Masato Hatta, Subash C. Das, Makoto Ozawa, Kyoko Shinya, Gongxun Zhong, Anthony Hanson, Hiroaki Katsura, Shinji Watanabe, Chengjun Li , Eiryo Kawakami , Shinya Yamada, Maki Kiso5,Yasuo Suzuki , Eileen A. Maher, Gabriele Neumann & Yoshihiro Kawaoka

 

Kawaoka’s 11-page study is, as you might imagine, highly technical and may prove tough sledding for those without a solid background in virology.

 

Nature published a 2-page synopsis by Hui-Ling Yen & Malik Peiris that helps to explain some of the details, but this is a pay-to-view article.

 

 

Bird flu in mammals

An engineered influenza virus based on a haemagglutinin protein from H5N1 avian influenza, with just four mutations, can be transmitted between ferrets, emphasizing the potential for a human pandemic to emerge from birds. 

 

 

According to Malik Peiris, this study reaffirms the pandemic potential of the H5N1 virus, and reinforces the need for better surveillance of the virus in the wild.

 

While Kawaoka identified several mutations in the H5 HA that allowed the virus to bind to a2,6 receptors there are likely other combinations that could lead to greater transmissibility.

 

For the best all-around coverage of this story, we can always rely on Helen Branswell of The Canadian Press. Helen has just posted the following article on this research’s publication.

 

 

Bird flu study: Three mutations might give virus ability to transmit to humans

By: Helen Branswell, The Canadian Press

 

 

There will, undoubtedly, be a large number of stories and opinion pieces regarding the publication today of Kawaoka’s research.

 

Already I note  that Vincent Racaniello has blogged on this publication:

 

Kawaoka paper published on aerosol transmission of H5 influenza virus in ferrets

2 May 2012

Meanwhile Laurie Garrett  takes a more cautionary route in:

 

Manmade H5N1 Paper Finally Published, And Worrying

 

 

I’ll update this blog with more links to articles and opinion pieces on this research later today or tomorrow.

»» Read More

Nature: Yoshihiro Kawaoka Talks About His H5N1 Research

 

BSL-4 Lab Worker - Photo Credit –USAMRIID

 

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Although two scientists, working independently and a half-a-world-apart have recently created a more transmissible version of the H5N1 virus, it has been the work of Ron Fouchier at Erasmus University that has garnered the most press.

 

The reason is pretty simple.

 

Fouchier announced his findings at a scientific conference late last summer (see Katherine Harmon’s Sci-Am article and in a follow up to this story in New Scientist: Five Easy Mutations), while Yoshihiro Kawaoka has – until now - refrained from discussing his work publicly.

 

Today in a Nature commentary, flu virologist Yoshihiro Kawaoka breaks his silence and talks about his research into the H5N1 virus, and why such research should continue.

 

H5N1: Flu transmission work is urgent

• Yoshihiro Kawaoka

Nature (2012)

doi:10.1038/nature10884 Published online

25 January 2012

Yoshihiro Kawaoka explains that research on transmissible avian flu viruses needs to continue if pandemics are to be prevented.

 

Taking a different approach than that used by Fouchier, Kawaoka created a reassortant virus combining H5N1 and the 2009 H1N1 virus, which while transmissible between ferrets, was no more pathogenic than regular flu.

 

As you might expect, Helen Branswell is already all over this story, and you can find her take on it at:

 

The Canadian Press - ONLINE EDITION

Researcher at heart of bird flu studies controversy reveals details of his findings

By: Helen Branswell, The Canadian Press

»» Read More