We have only known about Lyme disease since 1975, but now the discovery of an amber-encased 15-million-year-old tick has revealed that the bacteria that causes the disease has been around much, much longer than the human race. The discovery was made by George Poinar, Jr. from Oregon State University, and the findings were published in Historical Biology.
Lyme disease is caused by the bacteria in the genus Borrelia, which uses ticks as vectors to infect a variety of organisms. Upon infection, the disease produces flu-like symptoms, including fatigue, fever and headache. It can be easily treated with antibiotics in the earliest stages, and it is very important to seek treatment as soon as possible. Without treatment, the infection can progress and it could affect the nervous system, heart, and joints.
“Ticks and the bacteria they carry are very opportunistic,” Poinar said in a press release. “They are very efficient at maintaining populations of microbes in their tissues, and can infect mammals, birds, reptiles and other animals.
“In the United States, Europe and Asia, ticks are a more important insect vector of disease than mosquitos,” he continued. “They can carry bacteria that cause a wide range of diseases, affect many different animal species, and often are not even understood or recognized by doctors. It’s likely that many ailments in human history for which doctors had no explanation have been caused by tick-borne disease.”
The study utilized four ticks that had been preserved in amber. Bacteria typically doesn’t fossilize well, but amber protects it from conditions that would otherwise destroy the colony. Poinar discovered that the ticks had large amounts of bacteria that look very much like species of Borrelia.
Throughout his career, Poinar has found evidence of disease like malaria and leishmania in the fossil record, and thinks it is likely that dinosaurs were infected by bacteria similar to what we see today. He also states that for as long as there have been humans, there have been ticks that were likely passing along disease.
In 1991, researchers discovered Ötzi the Iceman, a naturally mummified human who was encased in ice in the mountains between Austria and Italy about 5,300 years ago. DNA evidence revealed that Ötzi was in poor health prior to his death and was infected with Lyme disease. This is the oldest known evidence of a human to have the disease.
In this same research, Poinar also discovered ticks that had bacterial cells which resemble the Rickettsia bacteria, which causes Rocky Mountain spotted fever. Those results were published in the journal Cretaceous Research.
After leveling off over the past few weeks, Ebola virus activity in West Africa sparked up again on two fronts, in a newly affected area of Guinea and in Sierra Leone, which had not had a previous outbreak case, the World Health Organization (WHO) said in its latest updates.
In Guinea, eight new cases and three more deaths were reported from three districts. Three of the infections were reported from Telimele prefecture, its first infections to be reported in the country’s outbreak, the WHO said. The area is just east of the country’s capital of Conakry, which has been one of the disease hot spots.
The other new cases are from two prefectures in the southeastern forested region of the country that have already reported cases. Two are from Gueckedou, and three fatal cases are from Macenta.
The developments lift Guinea’s Ebola virus disease (EVD) total to 258 infections, 174 of them fatal. So far 146 of the illness and 95 of the deaths have been confirmed by lab tests.
Nine patients are still hospitalized, including six in Gueckedou and three in Telimele. Public health workers are following several patient contacts—132 in Gueckedou and 41 in Telimele.
First cases in Sierra Leone
In a separate update posted yesterday, the WHO said Sierra Leone has reported an EVD outbreak, with one lab-confirmed case and four deaths. The illnesses and deaths all occurred in patients from the Koindu chiefdom, which shares a border with Guinea’s Gueckedou prefecture, an area that has reported several cases.
While waiting for epidemiologic details, health officials in Sierra Leone and their partners from the WHO took several measures, including convening a national Ebola emergency task force and deploying a field team to investigate the outbreak and start preliminary response steps.
The EVD cases are Sierra Leone’s first in the outbreak. Earlier in the event there were several suspected cases, but all tested negative.
The country’s chief medical officer, Brima Kargbo, said Sierra Leone’s first Ebola patient is a female traditional healer who had attended a funeral in Guinea, Agence France-Presse (AFP) reported today.
Editor’s note: W. Ian Lipkin is John Snow professor of epidemiology and director of the Center for Infection and Immunity at Columbia University. The opinions expressed in this commentary are solely those of the author.
(CNN) — A third case of Middle East Respiratory Syndrome in the United States has been reported. An unidentified Illinois man was infected after having “extended face-to-face contact” with an Indiana man who was diagnosed with the MERS virus. Fortunately, he is no longer ill.
The rise in the reported number of MERS cases in the United States, Asia and Europe has fueled concern that this may be the big one: the 21st century equivalent of the 1918 influenza pandemic that killed 3% to 5% of the world population.
Concern is appropriate, because the coronavirus responsible for MERS can evolve to become more potent public health threats. However, I don’t yet see evidence that will happen.
For one thing, an increase in the number of reported cases is not equivalent to an increase in the number of actual cases. As MERS testing is expanded from people with severe disease to include those with mild disease or only a history of potential exposure, we will detect more cases of infection. The mortality rate associated with infection will decrease from the current estimate of 30%. In short, we don’t yet know the extent to which an increase in the reported number of cases only reflects better case ascertainment.
MERS, like 70% of all emerging infectious diseases, including influenza, SARS, HIV/AIDS and ebola, originates in wildlife. With MERS, both bats and camels may be implicated. Studies of camels in Saudi Arabia indicate that the majority have a history of MERS coronavirus infection. Infection appears to occur in early life and then clears. Up to a third of young camels carry this infectious virus. Because camels are born in the spring, there may be an increased amount of virus circulating in camels in spring and summer months. This may contribute to a seasonal spike in the reported number of MERS cases.
Humans may become infected through contact with infected animals, meat or other animal products such as milk. However, pandemic spread cannot occur without efficient human-to-human transmission. The MERS coronavirus grows deep in the human respiratory tract, so it is less likely to be transmitted than viruses that grow in teh nose, mouth or upper airways where a sneeze or a cough is sufficient to create an infectious aerosol.
Hospitalized patients with pneumonia-like MERS receive vigorous respiratory interventions such as intubation, assisted ventilation, drugs that dilate airways and chest percussion. These interventions may bring virus into the environment in aerosols and on the surfaces of medical equipment, resulting in infection of hospital personnel and other patients. Since the MERS coronavirus has been shown to be stable for up to 48 hours, it may be difficult to determine the source of infection as people and equipment circulate in the health care environment.
To date, cases of human-to-human transmission have only been reported in hospitals and in families where there is intimate contact with an infected person. If we notice a change in this pattern such that clusters of infections begin to appear in communities with more casual contact, that would be a strong sign that the virus is evolving to become a pandemic threat.
The MERS cases in new countries are disturbing but not surprising given how globally connected we are. International travel and foot traffic make it easier to spread a virus.
The first two cases reported in the United States, in Indiana and Florida, were health care workers returning from Saudi Arabia. Although a third case has been linked to contact with the Indiana case, I am cautiously optimistic that a cluster of cases will not be triggered.
Nonetheless, vigilance is essential. Saudi Arabia has more than 7 million foreign workers and hosts more than 3 million religious pilgrims annually. If new cases arise they will almost certainly be imported.
The key to an effective pandemic response is to acknowledge that infectious disease challenges are global rather than national. Information and biological samples must be shared freely to facilitate surveillance and the development of diagnostics, drugs and vaccines.
In this spirit, the government of Saudi Arabia has recently invited teams of international experts to join forces in addressing the global challenge of MERS. Although we are focusing on MERS now, the reality is that viruses and antibiotic resistant bacteria with pandemic potential are continuously emerging and re-emerging worldwide.
The recent MERS cases should not trigger an alarm. But if a pandemic happens, it is important we are prepared to combat it.
Only one prefecture in Guinea—Gueckedou—has reported continued community transmission and deaths in the Ebola virus disease (EVD) outbreak there as of May 18, says an update from the World Health Organization (WHO) Regional Office for Africa.
Gueckedou is the prefecture that has seen the most clinical cases (168, with 123 deaths) during the outbreak, which began earlier this spring. The cumulative total for clinical cases stands at 253, with 176 deaths. Confirmed cases number 144 with 97 deaths—6 and 5 more, respectively, than reported in the last WHO update May 12.
The update notes that the number of cases is subject to change because of reclassification, retrospective investigation, consolidation of cases and lab data, enhanced surveillance, and contact tracing.
Liberia and Sierra Leone reported no new EVD cases. In Liberia, which has not seen a case since Apr 9, the EVD outbreak may be declared over tomorrow (May 22), says the WHO.
The US, Canadian, and Mexican governments formally agreed yesterday that during health emergencies they will share communications plans and statements with one another before releasing them to the public.
The three countries signed a declaration of intent on the subject at the 67th World Health Assembly in Geneva, according to an announcement from the Canadian government.
“Infectious diseases are not limited by countries’ borders, and neither are the ways through which we receive the news,” Canadian Minister of Health Rona Ambrose stated in the announcement. “This Declaration will help our countries work together on the essential task of communicating more effectively on public health issues, which will protect the health of all of our citizens.”
The declaration of intent calls on the three countries to “share public communications plans, statements and other communications products related to health emergencies with each other prior to their public release.” In addition, the agreement calls for conducting annual joint communications exercises to improve coordination.
The agreement aligns with the requirements of the International Health Regulations, which call for neighboring countries to cooperate on shared public health issues, the Canadian statement said. In addition, it supports the “underlying principles of the 2012 North American Plan for Animal and Pandemic Influenza (NAPAPI).”
Building on the experiences of the H1N1 influenza pandemic, the NAPAPI outlines how the three countries intend to strengthen and coordinate their emergency response capacities, including public communications, in preparation for a pandemic virus arising in or spreading to North America, the statement said.
Saudi Arabia today reported seven new Middle East respiratory syndrome coronavirus (MERS-CoV) cases, one of them fatal, as details emerged that Filipinos are among the recent deaths.
Six of the new Saudi cases are from areas that have reported several recent infections, such as Jeddah (4), Medina (1), and Riyadh (1). But one of the patients is from Gonfothah, on the southwestern coast of the country, according to a statement from Saudi Arabia’s health ministry (MOH).
One of the patients is in critical condition, three are listed as stable, and two are asymptomatic. The patient who died is a 74-year-old man who had lymphoma and started having respiratory symptoms on May 18. He was hospitalized the next day and died on May 20.
All of the patients are adults and range in age from 33 to 75. Four are men. Aside from the man who died, only one other patient has an underlying medical condition, a 75-year-old man who has hypertension.
Only one patient—a 65-year-old man from Gonfothah who is asymptomatic and visited a government hospital for health reasons—was reported to have contact with a confirmed case. Otherwise, no healthcare, camel, or animal environment exposure was listed for the other patients.
Illness onsets range from May 10 to May 20, and hospital admission dates range from May 12 to May 22.
The new cases boost Saudi Arabia’s MERS total to 551, including 177 deaths.
Filipinos among recent MERS deaths
In a related development, government officials from the Philippines said they have been notified that two of Saudi Arabia’s recent MERS deaths involved Filipinos, ABS-CBNnews.com reported today. The officials did not specify the genders or occupations of the two people, but did say that the patients died on May 12 and May 18.
On May 19, Saudi Arabia’s health ministry listed a May 18th death of a 28-year-old woman in Jeddah and on May 13 listed four May 12th deaths from Jeddah, but it’s unclear if any of them involve the patients from the Philippines, because the MOH hasn’t been listing nationalities in any of its recent updates.
They are the fifth Filipinos to die from MERS in the Middle East, according to the report. At least two of the earlier deaths were in health workers, a paramedic working in the United Arab Emirates and a nurse working at a Riyadh hospital.
Drug-resistant bacteria annually sicken 2 million Americans and kill at least 23,000. A driving force behind this growing public health threat is the ability of bacteria to share genes that provide antibiotic resistance.
Bacteria that naturally live in the soil have a vast collection of genes to fight off antibiotics, but they are much less likely to share these genes, a new study by researchers at Washington University School of Medicine in St. Louis has revealed. The findings suggest that most genes from soil bacteria are not poised to contribute to antibiotic resistance in infectious bacteria.
The researchers hope that what they are learning from soil bacteria will help identify ways to reduce gene sharing among infectious bacteria, slowing the spread of drug-resistant superbugs, said senior author Gautam Dantas, PhD, assistant professor of pathology and immunology.
The results appear May 21 in Nature.
“Soil bacteria have strategies for fighting antibiotics that we’re only just starting to learn about,” Dantas said. “We need to make sure the genes that make these strategies possible aren’t shared with infectious bacteria, because they could make the problem of drug-resistant infections much worse.”
Most of the antibiotics used to fight illness today were devised by soil microbes, which employ them as weapons in the competition for resources and survival. Penicillin, the first successful antibiotic, came from the soil fungus Penicillium.
But widespread use of penicillin and other newer antibiotics has prompted bacteria to evolve strategies for blocking, evading or otherwise resisting these drugs. Antibiotic-resistant disease now adds $20 billion to annual health-care costs and leads to 8 million additional hospital treatment days in the United States.
For the new study, the scientists analyzed bacterial DNA in 18 soil samples from agricultural and grassland sites from Minnesota and Michigan.
Using a technique they helped develop, the researchers isolated small fragments of bacterial DNA from the soils and screened those pieces for genes that confer antibiotic resistance.
Other scientists have identified sections of genetic code that make it possible for bacteria to share genes. A gene must be close to these “mobility elements” to be shared. The approximately 3,000 antibiotic resistance genes the researchers identified in soil bacteria typically were not close to such elements.
The researchers also found that the antibiotic-resistance genes in soil are linked tightly to specific bacteria, suggesting little sharing between species. In infectious bacteria, though, more frequent sharing of genes creates antibiotic-resistance portfolios that differ greatly among related bacteria.
“We suspect that one of the primary factors that drives the sharing of antibiotic resistance genes is exposure to new antibiotics,” Dantas said. “Because soil bacteria need many thousands of years to develop new antibiotics, the bacteria in that community don’t encounter these threats anywhere near as often as disease-causing bacteria, which we regularly treat with different antibiotics.”
Dantas and his colleagues continue to study factors that affect the spread of drug resistance in bacterial communities in hospitals, the environment and the human digestive tract.
“We were happy to find that antibiotic resistance genes from soil bacteria generally aren’t poised to jump suddenly into pathogens,” Dantas said. “But we want to do everything we can — whether it’s changing how we treat infections in medical clinics or altering the way we manage the environments where bacteria grow — to keep the odds stacked against sharing of these genes.”
The sharp rise in Middle East respiratory syndrome coronavirus (MERS-CoV) cases and the impact of the disease are concerning, but it doesn’t meet the definition of a public health emergency of international concern (PHEIC), the World Health Organization (WHO) announced today, following its emergency committee’s deliberations yesterday.
Keiji Fukuda, MD, the WHO’s assistant director-general for health security and environment, said at a media telebriefing today that after the committee heard from outside experts and health officials in affected countries and learned the findings of a WHO group that traveled to Saudi Arabia, it saw no evidence of sustained transmission in the community.
Increased seriousness, urgency
“The consensus was that the situation has increased in seriousness and urgency, but did not constitute a public health emergency of international concern,” he said. In weighing the sharp increase in cases since March, especially in Saudi Arabia and the United Arab Emirates, the group learned that suboptimal infection control practices, made worse by severe overcrowding in emergency departments, have led to a number of secondary infections in hospitals.
The reasons for an increase in cases outside of hospitals are less clear and might reflect seasonal factors, better surveillance, or an increased ability of the virus to spread among people, Fukuda said.
“This is quite a pressing question,” he said. However, he noted that there are still very few secondary infections in case contacts, no evidence of community spread, no sustained transmission when cases are detected in other countries, and no major genetic changes in the virus that might affect its transmissibility.
Fukuda said MERS viruses sequenced from recent cases in Saudi Arabia, the United States, and Greece look very much like earlier viruses. “Right now we don’t see major changes, but a caveat is that sometimes minor changes can lead to changes in properties, such as transmission,” he said.
The same basic infection control measures should be applied with all patients, because, while MERS is a respiratory illness, not all patients display all symptoms, and some have diarrhea, he said. He added that health officials don’t have a good handle on the route of transmission in hospitals, though the general behavior of the virus seems consistent with droplet spread.
Better infection control needed
The committee recommended several steps for countries to take, with the most urgent one being stronger infection control practices, especially in countries where the disease is active. Fukuda said simple things like washing hands between patients, wearing gloves at the right time, and changing gloves and masks between patients can go a long way toward containing the virus.
The emergency committee also strongly urged countries to:
- start and speed up investigations to pinpoint risk factors and flesh out the epidemiology, which includes case-control, serological, environmental, and animal studies
- support vulnerable countries, especially those in sub-Saharan Africa
- strengthen case and contact identification and management
- boost awareness and risk communication about the disease among all groups
- collaborate and share information with other health ministries and global organizations, especially animal health agencies
- develop advice for people who will be attending mass gatherings, such as Umrah or the Hajj
- share information with the WHO in a timely manner, as specified in the International Health Regulations (IHR)
The WHO said in a statement today that the emergency committee will meet again in June to assess the latest developments and will meet earlier if needed.
Yesterday was the committee’s fifth meeting to discuss MERS-CoV developments and gauge whether the situation meets the WHO’s definition of a public health emergency of international concern. The last time it met was in December, before the surge of case in Saudi Arabia that started at the end of March and is spawning more exported cases in other countries. Since then, more studies have strengthened the suggestion that camels are the main reservoir for the virus.
WHO emergency committees are part of the IHR, passed by the World Health Assembly in 2005 in the wake of the SARS (severe acute respiratory syndrome) outbreak. Emergency committees have made PHEIC designations twice before: when the 2009 H1N1 virus started sweeping the globe and just last week for polio.
“We had a half-dozen dogs – Labs, pointers – die: They’d just fall over,” Berdon Lawrence said. “Nobody knew what was going on.”
Lawrence, a Houston businessman, recalled one dog in particular that made him determined to discover what was happening to the working canines housed on his South Texas ranch. On a quail hunt, a seemingly perfectly healthy pointer was zigzagging through the brush.
“The pointer was working quail and just fell over, dead,” Lawrence said. “It didn’t make any sense.”
Concerned that something associated with the kennel was causing the sudden deaths, Lawrence sent one of the deceased dogs to Texas A&M Veterinary Diagnostic Lab for a necropsy. The results stunned him.
“The diagnosis came back as a heart attack caused by Chagas disease,” he said. “I said, ‘What’s Chagas disease?’ I’d never heard of it.”
Neither have most Texans.
A growing problem
They should. And they almost certainly will. The parasite-caused disease, which in many cases causes fatal, heart-related problems, potentially is a serious threat to human health in Texas. It already is a threat to the state’s canine population.
“We know we have Chagas disease in Texas, and Texas is emerging as a hot spot,” said Dr. Sarah Hamer, assistant professor and associate wildlife biologist with Texas A&M University’s College of Veterinary Medicine and Biomedical Sciences. “There is a growing crisis of canine Chagas in Texas.”
Hamer was among speakers at a day-long “Chagas Disease in Texas” symposium held Tuesday in Kingsville and hosted by the South Texas Private Property Rights Association and Texas A&M-Kingsville’s Caesar Kleberg Wildlife Research Institute.
While there are no hard data on the number of dogs in Texas that are infected with the parasite causing Chagas disease or the number that die from its effects, anecdotal evidence indicates hundreds and probably thousands of Texas dogs die from its effects each year.
“It is a significant problem,” Dr. Glen Wilkinson, a veterinarian in Premont in Jim Wells County and one of the attendees at the Kingsville gathering, said, noting he has seen “over a hundred dogs in the past couple of years” that have tested positive for the protozoan parasite that causes Chagas disease.
Chagas disease is hardly an unknown malady. The disease long has been a major human health issue in Mexico, Central and South America, where it is estimated to infect as many as 8 million people and annually cause as many 25,000 human deaths.
The disease is caused by a protozoa, Trypanosoma cruzi, that, once in a mammalian host, circulates in the blood until it finds a smooth muscle tissue – usually in the heart – where it takes up residence and begins damaging that tissue. Often, the first clinical signs of the disease in dogs is sudden death from heart failure.
There are currently no vaccines that prevent the disease, treatments are invariably minimally effective and there is no cure for Chagas disease.
The protozoa are transmitted to the host by insects – specifically those of the genus Triatoma. Commonly called “kissing bugs,” the winged insects have a flat, pear-shaped body and an elongated, cone-shaped head with a prominent “beak.” That beak is used to puncture skin and gorge on blood from a mammal.
Higher risk at night
Kissing bugs invariably do their feeding at night, emerging from brush piles, cracks, crevasses, thick grasses and similar habitat. They crawl onto their victims, often drawn by the carbon dioxide the mammal exhales, and take a bite. This bite often occurs near the victim’s mouth – thus the name “kissing bug.”
The protozoan parasite carried by the insect isn’t injected during the bite but is deposited in feces typically loosed after the blood meal. The victim typically scratches the bite, smearing the feces into the wound or otherwise introducing it to the body.
If dogs are bitten by a kissing bug in Texas, odds are high that bug carries the parasite causing Chagas disease. And those bugs are found in much of Texas. Seven species of Triatoma have been identified across the state, with the largest numbers in southern and central Texas.
“In every place we have got the insects, we have found positives,” Dr. Teresa Feria, assistant professor in the biology department of University of Texas-Pan American, told symposium attendees.
The problem is not confined to South Texas. Half of the kissing bugs collected in Kerr County of Central Texas tested positive for the parasite.
With no preventative vaccine and no effective treatment for Chagas disease, the best practice for dog owners is to reduce chances their dogs will encounter a kissing bug.
Owners of dogs kept in kennels should install screening around the runs to help prevent the insects from having an unimpeded path to a sleeping dog, Dr. Greta Schuster, Texas A&M-Kingsville professor of integrated pest management, said at the Chagas symposium.
These are the tactics Berdon Lawrence pursued on his South Texas ranch. They installed screens around the chain-link fence kennels. They cleared vegetation from around the kennel and regularly applied insecticide around the peri-meter.
The result was positive. Since making those changes several years ago, the ranch has lost only one dog to Chagas disease, said Lawrence.
“Chagas disease is a problem,” Lawrence said. “The good news is, if you know about it, you can do something about it.”
NEWBURYPORT — Local veterinarians have been notified that the canine influenza has arrived in Greater Newburyport.
Dog owners who were unaware that there is even a dog flu aren’t alone.
Canine influenza was first discovered in Florida in 2005, and while the virus will have pockets of outbreaks and has made appearances in other states, this is the first time it has ever been seen in dogs in Massachusetts, said Dr. Heidi Bassler of Bassler Veterinary Hospital in Salisbury.
Since it was never a problem here before now, Bassler said, many local veterinarians, herself included, never vaccinated dogs for the virus, which leaves the dog population vulnerable right now.
“The main thing is that people know that the dogs in this area, the vast majority, have never been exposed to canine influenza,” Bassler said Friday. “We have a immunologically naïve population of dogs.”
“We are trying to notify the public that it is important they contact their veterinarian for the ‘dog flu’ vaccine,” she said.
Bassler said she ordered as many of the vaccinations as she could get; however, each dog needs to have two vaccination shots, several weeks apart. It’s not until several days after the second vaccination that the dog is considered protected, she said.
As with humans, dogs who are most susceptible to getting the flu are those who are often in social settings, such as doggie daycare, puppy groups, obedience classes, dog shows, or those who attend the groomer or dog parks, or visit a kennel to be boarded.
“Dogs that are near each other…can spread it quickly and can become easily infected,” Bassler said. “Any place where a lot of dogs congregate, there are risk factors.”
The virus can be carried on clothing or toys, according to Bassler. With summer coming, families may be planning to board their dogs while on vacation, and it’s important to get your pet vaccinated before doing so, she said.