Preparing for the next pandemic

by admin on 25/01/2013

Professor Lightfoot In the BMJ talking about zoonoses, the next pandemic, One Health and disease surveillance and CORDS..

logo1-199x40

 

 

What does CORDS stand for?

CORDS stands for ‘Connecting Organizations for Regional Disease Surveillance’.

The organization was established as an ‘Association’ in Lyon, east-central France in 2012. It has a small headquarters and will have four members of staff.

Professor Nigel Lightfoot was appointed as Executive Director designate of CORDS in April 2012 and took up his appointment on 1 September 2012. Here he answers some questions about the work he is doing.

What does CORDS do?

“CORDS is a unique international not-for-profit partnership. It was first set up in 2009 to provide a framework for networks between countries around the world to improve their capacity to detect, identify and respond to the threat of diseases within countries and across borders, to establish exchange of information between networks and to stimulate a culture of early communication about potential events.”

“The international community has recognized the crucial need to be able to identify and respond rapidly to disease outbreaks -

- In this, the age of global air travel, viruses like SARS and the influenza A (H1N1) 2009 pandemic virus can be given a free ride anywhere in the world and have the potential to have a rapid and devastating impact on people, industries and economies.”

What is the aim of CORDS?

“The aim of CORDS is to promote the exchange of information among different disease surveillance networks around the world and to share best practices, surveillance tools, strategies, training courses, innovations, successful operating procedures, case studies and other technical data.”

Who is in CORDS?

“As at January 2013 CORDS has six founding members – with plans to expand. The founding members are:

 

CORDS is also welcomed by the World Health Organization (WHO), the World Organization for Animal Health (OIE) and the Food and Animal Organization (FAO) of the United Nations.”

 

CORDS in the developing world

 

“In developing countries a lot of the surveillance infrastructure required for the early detection and identification of diseases is simply missing. Even in the developed world public health surveillance systems are quite compartmentalized.

 

CORDS believes the key to limiting – or perhaps even preventing – the next pandemic is the early suspicion about – or recognition of – any new emerging disease, whether it be flu or something else, with the potential to become a pandemic.”

 

CORDS and communication

 

“There’s a willingness to develop capacity in the developing countries and, with the in-country training that CORDS will provide under the global One Health initiative, health practitioners and veterinarians will be able to work and communicate their thoughts and findings on potential emerging public health threats internationally via the CORDS website.”

 

CORDS online

 

“The development of the CORDS website aims to facilitate and promote a culture of collaboration and communication. The website will have three key elements:

 

1. A public facing element to provide information via the Internet

2. A knowledge management element to provide a virtual library of best practices and information for CORDS networks and other networks

3. A web portal or ‘chat room’ for health practitioners and veterinarians in countries around the world to promote the early discussion of unusual cases

 

Working in this way CORDS will be ‘on the ground’ and close to the emerging action, complementing the work done by the WHO, OIE and FAO.

 

And finally, CORDS will provide daily news alerts on potential public health threats to all its members.”

 

CORDS and collaboration – a recent example

 

“The work that CORDS will do will be about collaboration on all levels and between countries across the globe. One recent example of this is the discovery of a novel coronavirus (which, of course, has the potential to become a pandemic but which does not appear to transmit readily between humans at the present time).

 

Since June 2012 we have seen nine cases of novel coronavirus infection, including a possible cluster, which was associated with the emergency department of a hospital in Jordan.

 

The recognition that something was ‘not right’ when the cases of illness in Jordan first appeared in the news streams that we scan over at NL Intelligence was immediate. Something didn’t ring true. I spoke to the Jordanians and advised them to get the patient samples tested outside the country after the tests conducted in Jordan had found nothing unusual.

 

The samples were taken to Egypt and tested again and, again, nothing was found. But when the novel coronavirus appeared again later in the year and was identified, the Jordanian samples were tested again and three cases of infection were found.

 

And it’s this suspicion, this recognition that something is out of the ordinary and doesn’t quite ‘fit’, combined with the knowledge of what to do about it when it happens that is the key.

 

It’s the early suspicion and early discussion amongst peers that something is not quite right that is so vital in successful early detection.”

 

CORDS and surveillance

 

“CORDS will be implementing innovative surveillance solutions such as using mobile phone technology to report field test results to a central surveillance database within the network.

It will promote the joining up of networks to enable the sharing of cutting-edge technology such as molecular identification and fingerprinting of pathogens.”

 

A new phase begins…

 

“Although CORDS has been developing under the stewardship of the Nuclear Threat Initiative and The Rockefeller Foundation since 2009, a new phase for the organization begins now.

 

CORDS was created as a legal entity in France in 2012 and will officially be launched at the Prince Mahidol Awards Conference in Bangkok, Thailand at the end of January 2013.

 

CORDS is in receipt of funding from the Rockefeller Foundation, the Bill and Melinda Gates Foundation and Skoll Global Threats Fund.”

 

Moving forwards

 

Professor Lightfoot already has plans to carry out a mapping of all networks and stakeholders globally to provide a future context for the development of CORDS and, importantly, has planned a network workshop at Les Pensières – the Fondation Mérieux conference centre in Annecy, France – in April 2013.

 

At this workshop he will galvanize ‘the excellent work already achieved’ by the founding networks of CORDS into a mission to ‘create the eyes and ears of the WHO, OIE and FAO’..

You may have heard of the influenza viruses found in pigs, commonly known as ‘swine flu’. You will very likely have heard of the influenza viruses found in birds known as ‘bird flu’. But how about ‘seal flu’? Or ‘bat flu’?

At NL Associates we keep a close eye on the influenza viruses found in animals and birds in the natural world and an even closer eye on what is called the ‘animal/human interface.’  This is where influenza viruses are transmitted from animals to humans.

A Bit of Background Information – the 2009 H1N1 Influenza Pandemic

Pandemic: ‘an epidemic of infectious disease that has spread through human populations across a large region; for instance multiple continents, or even worldwide.’

In 2009 a new strain of influenza H1N1 virus was detected in humans.  This strain emerged after a series of co-infections and mutations at the animal/human interface and it began with an infected pig.

Pigs are susceptible to avian, human and swine influenza viruses. If a pig is infected with influenza viruses from different species at the same time, the creation of a new virus is possible. This process, in which genes from different viruses mix to create a new virus, is called an ‘antigenic shift’.

How it happened:

Studies of the genetic make up of the pandemic H1N1 virus have shown that it is a completely new virus, quite unlike the previous H1N1 viruses that affected humans in the 1918 pandemic and the 1977 pandemic. These genes have been found before in North American H1N2 swine influenza viruses, Eurasian H1N1 swine influenza viruses and human H3N2 seasonal influenza virus. It has appeared after a so- called “triple re-assortment in pigs”.

It seems that the virus first appeared some years ago and has been circulating in pigs in North America.

It then infected humans in Mexico in about February 2009 and was mistakenly considered to be seasonal flu.

The new virus was confirmed in US citizens on 24 April 2009 and subsequently confirmed as the cause of the influenza in Mexico.

Influenza viruses are continually evolving and mixing and the exact chain of events leading to the new pandemic strain appearing cannot be determined. Conspiracy theories abound on the internet but it is highly likely that this is a “Mother Nature” determined event. There is no evidence to suggest that this new virus was created in a laboratory; it does not like growing in eggs.

Since April 2009 the pandemic caused a reported 18,500 laboratory confirmed deaths worldwide and may, according to The Lancet, have killed many thousands more.

Flu vaccines now protect against the H1N1 virus.

Avian Influenza H5N1

Close attention is paid to the influenza H5N1 virus throughout the world. To date the virus has infected 607 people worldwide and killed 358. (Source: WHO)

Earlier this year new research was published into a strain of the H5N1 virus that had been mutated under laboratory conditions into an airborne strain. Scientists were worried that the results of the research were ‘too dangerous’ to publish for fear it might get into the wrong hands and because a bioterrorist threat. In an article about the research, published by The Guardian, John Oxford, professor of virology at Barts and the London School of Medicine and Dentistry said:

“Forget all the nonsense about bioterrorism. These papers tell us that nature is where we should focus our concern … The mutant strains that (the researchers) described are probably already out there. They must be out there. Fortunately for us, it is probably in some duck in Siberia, but were it to move close to hand by the vagaries and chances of nature, we’d be for it.

This post’s title is ‘Three Reasons Why H5N1 is Not the Only Influenza Virus to Watch’ because in recent months we have seen reports, not only of avian influenza H5N1 in the world, but of a number other types of influenza. And they are doing very interesting things:

Reason 1: Pigs

In the US this month there has been activity at the animal/human interface with a large outbreak of variant influenza H3N2v virus. This virus usually infects pigs but it can be directly transmitted to humans, as the health officials who have reported over 144 cases of human infection with the virus in the states of Indiana, Ohio and Hawaii in the last few weeks will attest.

So far there have been no cases of human-to-human transmission of this variant virus but health officials in the US are continuing to investigate the possibility that this might happen.

Reason 2: Seals

Elsewhere in the US, an influenza virus similar to one seen in waterfowl since 2002 has been detected in the bodies of 162 dead New England Harbor Seals. The seals died between September and December 2011 in an outbreak of pneumonia and the postmortem research found that the avian influenza or bird flu H3N8 virus had mutated to adapt to a mammalian host.

Calling the virus ‘bird flu’ is slightly misleading because it is not the highly pathogenic H5N1 virus prevalent in Asia that people normally think of when they read bird flu. Instead, this variant of influenza virus, H3N8v, travels in between species.

Reason 3: Bats

In February 2012 we saw a story about the discovery of influenza A virus in fruit bats in Guatemala. This is the first time that a flu virus has been identified in bats and means that the species may act as a source of flu viruses. The CDC reported on the story that the virus ‘should be studied as a potential source for human influenza.’ This virus is not believed to pose a threat to human health.

In Conclusion

So, pig flu, bird flu, seal flu and bat flu are out there. The recent human infections with variant influenza virus, seen in Indiana, Ohio and Hawaii, are a reminder that influenza viruses from pigs could potentially produce the next pandemic strain. The significance, in the case of the dead seals, is that the virus mutated while in the waterfowl and created a new variant virus capable of transmission from birds to mammals and in Guatemala, influenza has been identified in a new species this year.

The ever-changing nature of influenza viruses mean that it is vital to keep a close eye on stories like these as they emerge across the world. Avian influenza H5N1 is not the only virus that is out there and that has the potential to change and mutate.

And Finally: H2N2

In 1957 “Asian” flu appeared, caused a pandemic, went on to be seasonal flu and then disappeared in 1968 when the current H3N2 strain caused a new pandemic. The virus therefore disappeared from the wild but is kept in some laboratories; it was mistakenly sent out as a quality control strain to influenza laboratories in 2005. Anyone under 44 years old is susceptible to this previous pandemic strain.

When it comes to influenza:

It is important to be prepared.

It is vital to identify changes early.

It is important to respond appropriately.

NL Associates can provide expertise to help you in all three of these key components of emergency preparedness and response in the context of infectious disease generally and influenza specifically..

Risk Assessment – Enterovirus 71

by admin on 18/07/2012

We have been closely monitoring outbreaks of Hand, Foot and Mouth Disease across Asia for a number of months and have recently observed an increase in the number of reported cases.

Last week an unknown illness was reported in Cambodia which had killed more than 50 children since April 2012. Within days the WHO issued a statement citing the probable cause as Enterovirus 71 which can cause Hand Food and Mouth Disease.

We have therefore created a Risk Assessment and will be monitoring the situation in South East Asia closely:

Level 2 Risk Assessment EV71.

Public Health News in Brief

by admin on 18/06/2012

PLAGUE IN US

Another case of plague has been reported in the United States (June 14th Oregon, St Charles Medical Centre) and the international media have made their concern clear. The facts are, however, entirely reassuring. Although the plague Bacillus which caused medieval pandemics continues to exist in low levels in rodents in the south west of America, the conditions for it to go on to cause a pandemic through rats and fleas simply do not exist in the modern world.

The local American public are well aware that cases of plague will be contracted from wild animals from time to time – and they attend their doctor accordingly to receive antibiotic treatment. Due to an incorrect understanding of the mechanisms of disease, there has been an overreaction in the media – which is understandable, but unfounded – and may be causing undue worry to some people.

 

FOOD SAFETY IN CHINA

Yet another food contamination incident in China has occurred, with mercury being detected in infant milk powder from a major dairy firm in the Inner Mongolian city of Hohhot. This is likely to have happened during preparation and serves to illustrate just how widespread a food hazard can become in todays mass-market food distribution networks.

The 2008 scandal, when contamination by melamine killed six babies and made 300,000 ill, caused a heavy blow to China’s milk industry and unfortunately this current incident takes place during China’s “Food Safety Week” and a day after the cabinet introduced fresh measures to tighten food safety control.

 

LEGIONNAIRES’ IN SCOTLAND

The ongoing outbreak of Legionnaires’ disease in Scotland, which has so far caused two deaths, is of clear concern. The authorities have been unable to identify the source or perhaps unwilling to reveal their findings, which does nothing to reassure the public. It’s important to note that the Heath and Safety Executive are involved in the investigation.

Professor Lightfoot comments, ‘I’m surprised by the handling of the outbreak on two counts. Firstly, that reverse epidemiology methods as developed by the HPA modeling team at Porton Down (using case postcodes and movements) have not been called in to help identify geographic location. Great success was achieved using this method in the Hereford Legionnaires’ outbreak a few years ago. And secondly, if we clearly learnt these lessons years ago, why is this happening again? It is of vital importance that lessons are identified and learned, and if necessary, steps taken towards enforcement.’

 

ANTHRAX IN GERMANY

A new case of Anthrax has been reported in a heroin user in Germany. Similar cases occurred in the UK last year, mainly in Glasgow. Although Anthrax has not been detected in the heroin itself in Germany, Professor Lightfoot explains how the infection is likely to have begun, ‘I still believe that the contamination occurs during the collection of the Opium poppies in animal skins, which we know are often contaminated with Anthrax spores in Afghanistan. This is not surprising, because although inhalation anthrax has an infectious dose of 10,000 organisms, when injected into the skin, one single Anthrax spore is enough to cause infection.’

 

UNKNOWN INFECTIONS

There are three serious events of illness due to unknown causes still occurring worldwide; the skin disease in Vietnam, which may be due to arsenic poisoning; the nodding disease in Uganda, which still evades identification although infection with a parasitic worm called Onchocercus has been postulated; and there is an ongoing outbreak of suspected but as yet unproven Japanese Encephalitis in India, resulting in over 100 deaths so far. These deserve more attention – we must learn lessons for the benefit of future public health and we need to collaborate internationally to identify the loopholes which continue to prevent early diagnosis in developing countries.

 .

NLA News Update

June 18, 2012

CORDS in CANADA Professor Lightfoot has recently taken on the role of Executive Director Designate of a new NGO called CORDS – Connecting Organisations for Regional Disease Surveillance. This is an exciting opportunity and he spent last week in Canada, alongside TDV Global (Ottawa), preparing an implementation strategy for funding submissions to the Bill & […]

Read the full article →

Weekly Update – Interesting News Roundup

June 6, 2012

Nigel Lightfoot Associates maintains a constant global watch for emerging public health threats. Our weekly news updates, in combination with up to the minute analysis from Professor Lightfoot, are designed to keep clients and readers informed and empowered with the knowledge they need to protect their companies and staff. The earlier we know that a […]

Read the full article →

Weekly Focus – What’s going on in the World

June 1, 2012

Hand, Foot and Mouth Disease In Asia, and particularly in Vietnam, there is increasing concern about hand, foot and mouth disease, which has lead to 27 deaths in children this year. Caused by Enterovirus EV71, this is a different type of virus to the much milder hand, foot and mouth disease caused by a Coxsackie virus […]

Read the full article →

Joined Up Thinking – Part 2

May 25, 2012

With a view to the renewal of the NATO Defence Against Terrorism Programme, Professor Lightfoot was invited to speak at the NATO Anthrax Workshop, as part of the Counter Terror Expo in London this April. He presented an Anthrax Attack Scenario to set the scene for the workshop and co-chaired the meeting with Jamie Shea, […]

Read the full article →

Joined Up Thinking – Part 1

May 24, 2012

Biosafety refers to principles, technologies, practices and measures to prevent unintended exposure to biological agents and toxins. Biosecurity refers to the protection, control and accountability measures implemented to prevent the loss, theft, misuse or intentional release of biological agents and toxins. In approaching these vast issues, it is crucial that open discussion and a focus […]

Read the full article →