A New "Polio" Emerges

Link found between children with paralysis and ‘more polio-like’ strain of enterovirus D68, study says

Genetic sequencing of a virus found in respiratory secretions of children in California and Colorado who suffered from paralysis or muscle weakness last fall reveals that they were infected with a mutated strain of enterovirus D68 that is closer to polio than other strains common in previous years.

The study, published Monday in Lancet Infectious Diseases, sheds new light on one of the most troubling medical mysteries of recent years. Amid a nationwide outbreak of severe respiratory illness, doctors at hospitals nationwide began to report that they were seeing an alarming number of children with unexplained weakness in an arm or a leg to complete paralysis that required them to be put on ventilators. Treating physicians noted that many of the children appeared to be infected with enterovirus D68, but researchers were cautious about drawing a causal link because virus had been bouncing around the world since the 1960s and had typically only caused breathing issues such as coughing and wheezing.

While the research does not provide a definitive link -- that would only be established if the virus were found in the spinal fluid and it was not -- it provides the strongest evidence to date of the link between enterovirus D68 and paralysis. The researchers theorize that the reason the virus was not found in the spinal fluid could be because the samples were taken too late. Scientists also tested the children for the presence of other pathogens capable of causing the symptoms but didn't find other viruses, bacteria, fungi or parasites.

Much like the polio virus, EV-D68 (or whatever acronym is being used) does not affect all people the same way. Most people who got polio (and it is very rare now globally, and eliminated in the US) did not show symptoms beyond short term cold/flu. Only a minority suffered the devastating paralysis which was the reason the vaccines were such breakthroughs at the time. For polio, people were more likely to suffer the paralysis if they had escaped the disease while young, and protected by maternal antibodies. Thus, the poor, living with less sanitation suffered from it less than the wealthy, who were less likely to be exposed while young.  My guess is that it will turn out to be true for EV-D68 as well.

The new research reveals that the children had a novel strain of the virus, called B1, which emerged about four years ago. That strain has only five to six coding differences from previous strains that were commonly found in the United States but each of those are mutated in the direction of polio or another nerve-damaging virus known as EV-D70.

"These are changes that may have made the virus more polio-like," said Charles Chiu, an associate professor at the University of California-San Francisco who worked on the study.

Now that a more dangerous strain has arrived (and the question of whether it originated in the US or was imported from Latin America is still of interest, but hardly germane to the treatment), perhaps the CDC and USDA should be thinking about funding vaccine development for this bug. Or now that we have so much more genetic knowledge than we did in the 1950s, maybe we could work out a vaccine for enteroviruses in general, or at least major groups of them.

Life In the Times of Ebola - II

Well there's no Obamacare Schadenfreude I care to report, so instead, on this blustery first day of Daylight Standard Time, let us review to status of war on Ebola instead:

We all know Kaci Hickox, the CDC nurse who is refusing to live by the state of New Jersey's and then the state of Maine's proposed 21 day quarantine, and expressed her disdain for our concerns by having a friendly judge overturn the Maine quarantine, and going biking in public?  News by way of the Daily Caller that her roommate in Africa is showing symptoms of Ebola:

Sheila Pinette of the Maine CDC has released information that the roommate of Kaci Hickox, while in West Africa has displayed signs of ebola. Pinette says “The respondents roommate in Africa became infected without knowing how she became infected with Ebola. (Any potential risk to respondent from that incident has passed).” This is one of 35 points Pinette made while filing a verified petition for public health order yesterday with the state. Kaci Hickox was issued temporary court order. The document says Hickox must submit to active monitoring, coordinate her travel with public health authorities, not use commercial or public transportation, not go to any public places or workplaces unless to receive necessary health care, and she must maintain a 3-foot distance from other people and not leave Fort Kent without consulting public health authorities.

I'm comforted, how about you? Meanwhile, the ability of Ebola to be transmitted by a sneeze or a cough (wet transmission) seems to be an issue with the CDC, who first posted a warning that it could be transmitted that way, and then quietly deleted it:

The Centers for Disease Control and Prevention has removed a warning from its website that Ebola can, in rare cases, spread from person through coughing and sneezing.

It has replaced the old language with new guidance that says there's 'no evidence' Ebola is spread through either.

According to the New York Post, the CDC also took down on Thursday a poster that said that Ebola can be transferred through 'droplets' from coughing or sneezing that land on hard surfaces, like doorknobs.

As they say, "absence of evidence is not evidence of absence."

Could it be that we don't really fully understand all the ways in which Ebola is passed from person to person? Since a majority of health professionals infected by it have no idea how they became infected despite their best efforts, that's a very safe bet.  Did someone from the upper echelon of the Obama administration lean on the CDC to remove this? Probably.

More cheery news: Experts: Worst-case U.S. Ebola scenario 130 cases by end of 2014

Infectious disease experts predict anywhere from a mere one or two additional cases of Ebola to a worst-case scenario of 130, according to simulations conducted for the Associated Press.

Almost all of the predicted cases will be healthcare workers returning from West Africa.
"I don't think there's going to be a huge outbreak here, no," Dr. David Relman, a professor of infectious disease, microbiology and immunology at Stanford University's medical school, told the AP. "However, as best we can tell right now, it is quite possible that every major city will see at least a handful of cases."

A total of eight patients have currently been treated for Ebola in the U.S.

Of course, this is the result of computer simulations of disease whose mechanism of transmission is not yet clear. As they say, all models are wrong; some models are useful. I would also remind you of my three laws for interpreting science:

1. Half of all the science in the mass media is wrong, and the other half is exaggerated:
2. All models are wrong; the only question is by how much and in which direction.
3. It is highly probable that a model is biased in the direction its author believes is correct.

Another expert, Northeastern University professor Alessandro Vespignani, is more worried about the disease making its way to Asia.

"My worry is that the epidemic might spill into other countries in Africa or the Middle East, and then India or China. That could be a totally different story for everybody," he said.

Certainly, Ebola loos in the Far East would be a tragedy of almost unimaginable dimensions; imagine the Black Death on steroids; however, as far as a threat to the US, I'm more afraid of the disease becoming established in Latin America, given our long, empty and unprotected border.

News that the CDC may not be as optimistic: CDC to purchase body bags in anticipation of more ebola deaths.

The Centers for Disease Control is looking to purchase body bags and a host of other personal protective equipment in response to the Ebola outbreak as concerns continue to linger about the spread of the virus.

A “sources sought” notice posted on FedBizOpps reveals that, “The Centers for Disease Control and Prevention (CDC), Procurement and Grants Office (PGO) is seeking multiple sources of supply for personal protective equipment (PPE) for potential use in the current Ebola Virus Disease outbreak response.”

According to an attachment entitled “List of Personal Protective Equipment for Sources Sought Notice,” the federal agency is looking to source suppliers of body bags that can hold 200-250 lbs of weight. The bags must also include, “At least 6 handholds included in the body bag to allow burial team to hand carry it safely.”

The advisory states that the body bags and other equipment are intended to be used both in West Africa and in response to other Ebola outbreaks worldwide.

The CDC is also looking to source surgical face masks, sterile gowns, infectious waste containers, and tarps amongst other PPE supplies. The notice does not specify the quantity of body bags that the CDC is looking to obtain.

And: FEMA conducts pandemic training in NY, NJ

Talk about timing. The Federal Emergency Management Agency, or FEMA, is currently in the middle of a two-year pandemic training exercise with New York City and northern New Jersey. Titled “2013-14 Pandemic Influenza Continuity Exercise Strategy,” the FEMA training simulates a global pandemic of influenza that spreads from person to person, including in the U.S.

The Obama administration, meanwhile, is under fire for its mishandling of the Ebola crisis, allowing infected people to enter the country and cause widespread panic and political turmoil as officials make claims and promises that turn out to be false.

The FEMA training began last year, before the current Ebola outbreak in West Africa, which has killed nearly 5,000 people.

An overview of the training includes a list of assumptions such as that the “clinical disease attack rate will likely be 30 percent or higher in the overall population,” utilizing a prediction from the Centers for Disease Control and Prevention.

We know the military plans for everything imaginable including the conquest of Canada (why bother), so this is fully consistent with a war on disease.

And finally, a little off the topic of Ebola, but right on in reference to plagues, the Daily Caller is still pursuing the possibility that the enterovirus EV-D68 that has been causing paralysis and at least 9 deaths around the country was introduced by the flood of juvenile immigrants across the border earlier this year: Obama’s Border Policy Fueled Epidemic, Evidence Shows

The deadly EV-D68 enterovirus epidemic, which struck thousands of kids this fall, was likely propelled through America by President Barack Obama’s decision to allow tens of thousands of Central Americans across the Texas border, according to a growing body of genetic and statistical evidence.

The evidence includes admissions from top health officials that the epidemic included multiple strains of the virus, and that it appeared simultaneously in multiple independent locations.

The question can be settled if federal researchers study the genetic fingerprint of the EV-D68 viruses that first hit kids in Colorado, Missouri and Illinois to see if they are close relatives to the EV-D68 viruses found in Central America.

Officials ”have to do the genetic analysis” to disprove or prove the link, Nora Chapman, an enterovirus scientist at the University of Nebraska, told The Daily Caller.

I suspect this hypothesis has grains of truth. Expect the Administration/CDC to slow roll the genetic analysis of the virus that would prove it true, resist releasing the results if they go the wrong way, and make endless excuses and prevarications about why it was necessary to put the kids where they were.