Expert reaction to the first reported case of monkeypox in the UK as confirmed by Public Health England.

Prof Jimmy Whitworth, Professor of International Public Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, said:

“It is surprising to see two, apparently unrelated, cases of monkeypox reported in the UK within the space of a week.  This disease has not been reported before in the UK, both cases are recent travellers from Nigeria, so these are imported cases.

“An upsurge in cases of monkeypox has been reported from Nigeria in the past 12 months, which probably explains why we are seeing these occasional cases in the UK now.

“The disease is usually mild, sometimes resembling chickenpox, although it can be severe and has been reported to cause deaths in west Africa.  The two cases are now being cared for in specialist infectious disease units.

“Monkeypox is usually caught from small rodents and squirrels in forested areas of west Africa and does not spread easily from person to people.  In an outbreak in the USA related to imported pets from west Africa, all the cases caught the infection from their pets and there was no person to person spread.  However, it is a sensible precaution that those people who may have come into contact with these two recent cases are being traced and followed up.”

Declared interests

Prof Jimmy Whitworth: “My wife, Dilys Morgan, works on emerging infections at PHE.”

Expert reaction to the third reported case of monkeypox in the UK as confirmed by Public Health England.

Dr Jeremy Farrar, Director of Wellcome, said:

“That this third case of monkey pox has been diagnosed now in a healthcare worker in the UK is worrying and an important reminder of the threat posed by infectious diseases in our connected world.  Whilst cases of monkey pox are thankfully rare, it is an example of one of a number of diseases for which there is no approved vaccine or treatment.  With proper infection control in place the disease can be controlled and is usually self-limiting and currently poses a very low threat to the wider population.  International borders present very little barrier for disease, and we must work together and support scientists and researchers wherever they are in the world to develop vaccines and treatments for the patients who need them the most in order to protect us all.”

Prof Jonathan Ball, Professor of Molecular Virology, University of Nottingham, said:

“The fact that only one of the fifty contacts of the initial monkeypox-infected patient has been infected shows how poorly infectious the virus is.  It is wrong to think that we are on the brink of a nationwide outbreak.

“There are two main strains of virus – West African and Central African.  Given that the first infected patient had travelled from Nigeria then it would be a reasonable guess that we are dealing with a West African strain; but this needs to be confirmed.  The West African virus is associated with milder disease, fewer deaths, and limited human-to-human transmission.  Patients usually clear the infection with relative ease within a few weeks.

“Of course, today’s news is monkeypox but tomorrow it could be anything – we live in a very connected world, where people can, and do, travel from one side of the world to the other in the blink of an eye.  That’s why it is so important to build global capacity to detect and deal with emerging viruses as and when they appear.”

All our previous output on this subject can be seen at this weblink:

http://www.sciencemediacentre.org/expert-reaction-to-reported-cases-of-monkeypox/

Declared interests

Prof Jonathan Ball: “No CoIs.”

None others received.

Expert reactions to news that a British national has died after contracting rabies following a cat bite in Morocco.

Dr Michael Tildesley, Associate Professor in Mathematical Epidemiology, University of Warwick, said:

Q: How is it kept under control in some places?

“In countries where rabies has been controlled, this is typically achieved through repeated high-coverage mass vaccination campaigns of the reservoir population. This requires significant financial and logistical resources to carry out these campaigns, that must continue even after it appears that the disease has been eliminated as rabies can persist unobserved circulating at very low incidence. This is particularly challenging for low- and middle-income countries where technical limitations and repeat vaccine shortages result in less effective vaccination campaigns.”

Q: What it actually does to the body?

“The symptoms of rabies can vary depending upon the person infected, but usually include fever and headaches, confusion, irritability and abnormal behaviour. Later symptoms can include overt aggressiveness, overproduction of saliva (leading to frothing at the mouth) and in some cases lethargy and paralysis. If not treated promptly, rabies is almost 100% fatal.”

Q: How it’s contracted?

“Rabies is usually transmitted to humans through saliva from infected animals, which typically occurs through animal bites. Transmission can also occur when infected saliva gets into an open wound, for example through licks. Human to human transmission is exceedingly rare, though is possible through bites or due to organ transplantation.”

Q: Whether it’s just dogs and cats that are reservoirs?

“Rabies can affect any mammalian species. However, around 99% of human cases are a result of exposure to rabies-infected dogs. In some countries (such as the USA), rabies has been eradicated in the domestic dog population but still circulates amongst terrestrial wildlife and bats.”

Kristyna Rysava, PhD Candidate in Disease Ecology and Control, University of Warwick, said:

Q: Why is it not kept under control in others?

“In many countries around the world, rabies is extremely challenging to control. It circulates in mostly free roaming dog populations with fast demographic turnover, so infected animals have high potential to spread infection to other animals and humans and are more difficult to vaccinate. There is a lack of awareness of the risks associated with biting dogs and many people do not seek treatment in the event of an animal bite. Most importantly, in countries where the disease circulates endemically resources to vaccinate dogs in large numbers and consistently over longer periods of time are strained, which presents a significant obstacle to controlling and eliminating the disease.”

Q: How much we know about the illness?

“We know a lot about the symptoms associated with rabies, how it progresses in the body upon infection and the need for post-exposure vaccination in the event of exposure. However, rabies epidemiology at population level, including the scale of rabies transmission and persistence, remains a very active subject of scientific research. This is especially challenging for rabies compared to many other human diseases as in most endemic countries the disease is extremely under-reported, providing a sparse representation of the system.”

Q: How uncommon it is to contract nowadays?

“Rabies is extremely uncommon in the high-income countries. The disease has been eliminated in both domestic dogs and wildlife in most parts of Europe, and humans that have become infected were typically exposed to a rabid animal in other parts of the world where the disease is still present. Particularly in Sub-Saharan Africa and Southeast Asia the virus circulates endemically with around 60,000 human death from rabies worldwide every year. Unfortunately, some of the most affected places and communities are also most neglected with little or no access to post-exposure treatment, ultimately leading to preventable deaths.”

Dr Katie Hampson, Reader at Institute of Biodiversity Animal Health & Comparative Medicine, University of Glasgow, said:

Why is rabies so deadly?

“The virus infects the nervous system and before reaching the brain replicates slowly in a way that does not trigger the immune system. When the virus reaches the brain it replicates rapidly, and that’s when symptoms become evident. At that point it is too late and death is inevitable. Death involves muscle spasms, brain inflammation, and coma, although victims go in and out of lucidity, which makes it even more traumatic.

How is it kept under control in some places?

“The most common source of rabies is free roaming unvaccinated dogs. The vast majority of dogs in low- and middle-income countries where rabies is prevalent are free roaming. But rabies can be easily controlled through dog vaccination, since most dogs are owned and accessible through well-organized campaigns. Rabies has not been a problem in most high-income countries for decades as it has been eliminated entirely from dog populations through dog vaccination.

Why is it not kept under control in others?

To deliver large-scale dog vaccination requires a strong veterinary sector committed to controlling a public health problem and/or a medical sector that is willing to invest in veterinary control efforts.

That has not happened in low-income countries – where vaccinating kids has been a struggle never mind dogs. These days childhood vaccination is central to healthcare around the world – but veterinary services have much smaller budgets than Ministries of Health. They are typically required to control diseases for trade (e.g. Foot-and-Mouth-Disease) or require livestock owners to pay for disease control. But this is not the model that has successfully controlled childhood vaccine-preventable infections. When dog owners are charged for vaccination, it is very difficult to vaccinate enough dogs to have an impact.

Rabies has been largely ignored by development agencies – most deaths are not seen because they occur in rural and poor communities where people cannot afford or access lifesaving vaccines. Rabies post-exposure vaccines are some of our most effective vaccines – if delivered immediately after a bite they are 100% effective in preventing death. But bite victims need access to these vaccines, which are expensive and often out of stock.

Many in the UK and all high-income countries are now aware this disease is still such a problem in low-income countries – where one person dies every 10 minutes from an infected dog bite. It seems like such a Victorian disease and it was a major problem previously in the UK. Travellers may also have the impression that wildlife is the main risk. Any mammal can transmit rabies, so spillover into other species does occur, with cats commonly infected form dog-transmitted rabies.

WHO and partners, including the Global Alliance for Rabies Control recently launched a global strategy ‘Zero by 30’ aiming to completely end human deaths from dog-mediated rabies by the end of 2030. The main tool for this strategy to work is dog vaccination, which can eliminate the disease at source – stopping spill over into humans, cats, wildlife and livestock.

Professor Tom Solomon, Professor of Neurology at the University of Liverpool, said:

“Rabies is the most deadly of all diseases. Humans become infected following the bite or scratch of an infected animal. If they receive vaccine soon after, then the disease can be prevented. But once someone develops the clinical features of the disease, the death rate is almost 100%, despite the best efforts at treatment. It is so deadly because there is no proven antiviral drug against rabies. The virus works its way through the nervous system destroying nerve cells; once those that control breathing, and the heart rate and blood pressure are affected, death inevitably follows.

“Rabies virus is transmitted in nature among dogs, cats and other mammals. In some countries, such as the UK, this has been controlled by restricting the entry of animals from endemic areas, and by vaccinating. In parts of Asia and Africa wild dogs and other wild animals contribute to the spread of the disease. However campaigns to vaccinate such animals have proved successful to help bring the disease under control.”

Dr Jonathan Stoye FRS, Senior Group Leader, Francis Crick Institute, said:

“The most common source of rabies is ownerless, unvaccinated dogs. Thus areas with high numbers of such animals, for instance certain areas of the African continent are those where there is the greatest risk and the highest number of cases. Canine vaccination is a highly effective means of controlling rabies and the Global Alliance for Rabies Control has set a target for eliminating canine rabies in endemic areas by 2030 using vaccination.”

Dr Edward Wright, Senior Lecturer in Microbiology, University of Sussex, said:

“Rabies virus is found on every continent, with the exception of Antarctica. However, it is a real concern in Africa, Asia and the Middle-East where 95% of the annual 59,000 human deaths from rabies occurs. Infection follows transmission of the virus via the bite or scratch from an infect animal. The most commonly infected animals vary depending where you live in the world but 95% of human cases are cause by dogs. Other animals, such as foxes, skunks and bats can also spread the virus.

“Once infected the virus will replicate within the host and invade the nerve tissues. Eventually it will make its way to the brain. At this point symptoms will start which can include hallucinations, partial paralysis, and brain inflammation and dysfunction.  It is also very difficult to treat the disease once the brain is infected. Once symptoms have developed death results in over 99.9% of infections.

“This is the most tragic statistic of rabies disease.  There are vaccines and post-exposure drugs that targeted the virus.  These have been shown to be highly effective in protecting humans and animals against rabies virus. They’ve even been used to eliminate rabies from some communities. However, the cost of these treatments can be several time higher than the average monthly income in the areas where the virus is endemic.  Therefore, they are underused.

“The UK is considered rabies free, with sporadic case imported in unvaccinated travellers who have become infected following contact with infected animals in countries where the virus is known to circulate.  If travelling to any areas where rabies is present it is essential to receive the vaccine prior to travel.  This normally requires 3 jabs so must be started at least 4 weeks ahead of the trip. Vaccination is also recommended for bat handlers in the UK. While we have a rabies free status, a rabies-related virus capable of causing the same fatal disease as rabies, has been repeatedly found in UK bats. However, the rabies vaccines provide protection against this virus too.”

Prof Geoffrey Smith, Wellcome Trust Principal Research Fellow, Head of Department of Pathology, University of Cambridge, said:

Q: How much do we know about the illness?

“We know a lot about the illness caused by infection by rabies virus. After the infection is started, usually by being bitten by a rabies-infected animal, the virus travels up the nerves to the central nervous system where it infects the Perkinji cells of the cerebellum. The infection of these cells causes the aggressive behaviour associated with hydrophobia. The final place where the virus replicates is in the salivary glands and it is from here that the virus in spread to new hosts by biting.”

Q: Which animals are reservoirs?

“It is not just dogs and cats that are reservoirs for rabies virus. Virtually all mammals can be infected by rabies virus and a large reservoir is in bats. Indeed, the last person to die of rabies in UK was a bat handler who was bitten by a bat and then refused to be vaccinated. In US skunks and raccoons are a source of the virus, and vampire bats are reported to have spread the infection to cattle.”

Q: How uncommon is it to contract rabies nowadays?

“In the UK it is extremely uncommon. Cases in UK citizens are usually associated with travel to an endemic country and then being bitten by a rabies infected animal there. It is common to be vaccinated against rabies before travelling to an endemic country.”

Q: What is the treatment?

“Vaccination against rabies is safe and effective, and rabies is one of the few diseases in which vaccination after infection can be effective. But this depends on how soon this is done and also where the patient is bitten. After a bite on the foot, there is more time to vaccinate before the virus reaches the brain by travelling along nerve cells, than if one was bitten on the back if the neck.”

Dr Daniel Horton, Senior Lecturer in Veterinary Virology and Research Director, Department of Pathology and Infectious Diseases, University of Surrey, said:

Q: How much do we know about the illness?

“Rabies is one of the oldest recognised zoonotic diseases (diseases transmitted from animals to people) but still causes tens of thousands of deaths every year, in 150 countries across the world. Although knowledge of the virus and illness have improved, the actual number of animal rabies cases is poorly understood in many areas- which means predicting the chance of getting the disease if bitten is very difficult.”

Q: What does it actually do the body?

“Rabies is caused by a virus which travels up the nerves from a bite or scratch, to the brain. Changes in the brain then cause the symptoms of rabies, which include anxiety, headaches, fever and famously a fear of water (hydrophobia) and difficulty swallowing. The virus then spreads back down the nerves to many organs, including the salivary glands. Unfortunately once symptoms have developed, rabies is almost always fatal.”

Q: How is it contracted?

“Rabies in humans is contracted when the virus, usually from the saliva of an infected animal, enters a wound. The majority of cases are caused by bites or scratches from dogs and cats.”

Q: Which animals are reservoirs?

“Although the majority of human cases are caused by dog bites, in many parts of the world wildlife also get rabies and can act as a reservoir- for example, fox rabies in Europe and racoon rabies in North America. Bats also carry similar viruses capable of causing rabies.”

Q: How uncommon is it to contract rabies nowadays?

“Rabies remains a globally important problem, with tens of thousands of human cases every year. Unfortunately many of these cases are in children. The UK and Western Europe is currently free from dog rabies, and all five human cases in the UK since 2000 have been acquired abroad.”

Q: What is the treatment?

“Once clinical signs develop the disease is almost always fatal. To prevent the disease developing any bite or scratch should be cleaned thoroughly with soap and water and medical attention sought immediately. Post exposure treatment may be given, which can consist of vaccine and passive immunisation according to international standard protocols.”

Dr Pierre Nouvellet, Reader in Evolution, Behaviour and Ecology, University of Sussex, said:

“A great deal is actually known about the virus, its pathology, its transmission cycle… a vaccine has been available since the 1880’s! However, the majority of cases occur in place where surveillance is very poor.

“Rabies develops and multiplies in the muscle, then migrates to the brain via the nervous system. It then causes encephalitis (inflammation of the brain). After first symptoms occur, death happens within days (2-10).

“All mammals can be infected but dogs are the main problem in term of transmission to humans and typical exposure is from infected dogs – >90% of human cases.

“Despite the vaccine, it’s not that uncommon to contract rabies nowadays. Credible estimates from 2015 put the burden at around 60,000 human deaths. Also it’s estimated that almost half of cases are in children less than 15!

“Treatment is in the form of preventive or post-exposure vaccination – recommendations from WHO:”

Prof Jonathan Ball, Professor of Molecular Virology, University of Nottingham, said:

Q: How much do we know about the illness?

“We know lots about it. Much pioneering work was done by Louis Pasteur who developed and used the first rabies vaccine (even though he didn’t know he was working with a virus back then).”

Q: What does it actually do the body?

“It affects the nervous system, particularly the brain and eventually causes total paralysis and therefore death. It is nearly always fatal in humans.”

Q: How is it contracted?

“Through the bite of scratch of an infected (rabid) mammal, such as dog, fox, wolf, cat etc.”

Q: Which animals are reservoirs?

“A variety of mammals can be infected but it is usually contact with a rabid dog that results in human infections.”

Q: How uncommon is it to contract rabies nowadays?

“It isn’t uncommon in places around the world where rabies is endemic, but in the UK and Europe it is pretty rare.”

Q: What is the treatment?

“We have very effective vaccines that can be used post-exposure, but have to be used before a person starts to develop symptoms. You can also be given antibody therapy post exposure.”

Q: How is rabies kept under control?

“Vaccination of pets (eg. Dogs and in some places (e.g. North Europe) by wildlife vaccination programmes (which was how they controlled rabies in wild mammal populations in parts of northern Europe)”

Q: Why is it not kept under control in some places?

“Because vaccination programmes aren’t adequately deployed. It is on the list of WHO’s priorities (http://www.who.int/neglected_diseases/news/WRD_2017_Press_release/en/)”

Declared interests

None received

Research, published in The Lancet Infectious Diseases, reports the discovery of a new strain of bacteria linked to scarlet fever.

Prof Jimmy Whitworth, Professor of International Public Health, London School of Hygiene and Tropical Medicine, said:

“This important study gives us a plausible clue to the worrying recent increase in cases of scarlet fever in children in England. The investigators have found that a new virulent strain of streptococcal bacteria has emerged producing nine times the amount of toxin found in other strains.

“The researchers rightly call for more surveillance to confirm these findings, as these streptococcal infections are highly sensitive to antibiotics, unlike most other types of sore throat in children. The researchers also call for development of a vaccine, but perhaps more achievable in the short-term would be to re-evaluate and refine existing desk-top diagnostic tests which could greatly help GPs to accurately and rapidly identify streptococcal sore throats in the future.”

‘Emergence of dominant toxigenic M1T1 Streptococcus pyogenes clone during increased scarlet fever activity in England: a population-based molecular epidemiological study’ by Lynskey et al. was published in The Lancet Infectious Diseases at 23:30 UK time on Tuesday 10 September. 

DOI: 10.1016/S1473-3099(19)30446-3

Declared interests

Prof Jimmy Whitworth: No COIs

Research, published in JAMA Network Open, reports on an association between exposure to disinfectants and cleaning products at work and risk of new cases of chronic obstructive pulmonary disease (COPD) among a large group of female nurses.

Prof Martie van Tongeren, Professor of Occupational & Environmental Health, University of Manchester, said:

“Respiratory health effects due to exposure to cleaning agents and disinfectants is a persistent and known problem, in particular in the health care sector, where there is a strong focus on prevention of hospital acquired infection.  Previous data from The Health and Occupational Research network (THOR), which is study carried out by the University of Manchester in the UK, suggest that respiratory disease due to cleaning agents in the UK is a persistent problem, and that there is no evidence of any reduction in incidence of respiratory disease such as asthma in the UK.

“This new study is based on a large longitudinal cohort of US female nurses and provides further evidence that cleaning agents in health care workers are associated with increased risk of respiratory disease, in this case chronic obstructive pulmonary disease (COPD).  Using questionnaires linked with a Job Task Exposure Matrix the researchers were able to identify various common components of the disinfection products, such as glutaraldhyde, bleach, hydrogen peroxide, alcohol and quaternary ammonium compounds, that were associated with an increased risk of COPD, although the authors observed that many of these agents often occurred concurrently, so it was difficult to determine which the agents were associated with the COPD risk.  This study had a number of limitations in terms of the assessment of exposure and the use of self-reported COPD, and as with any observational study, it is difficult to prove causality.  However, the study was large and results appeared to be robust following a range of sensitivity analyses that the authors carried out.  In addition, results are similar to those that have been observed by others.

“There is a need to develop effective intervention in health care workers and cleaning staff in health care settings that will reduce and prevent respiratory health problems in staff that use cleaning agents and disinfection products, whilst maintaining effective control / prevention of infectious disease in patients and staff.”

‘Association of occupational exposure to disinfectants with incidence of chronic obstructive pulmonary disease among US female nurses’ by Orianne Dumas et al. was published in JAMA Network Open at 16:00 UK time on Friday 18 October 2019.  

DOI: 10.1001/jamanetworkopen.2019.13563

Declared interests

Prof Martie van Tongeren: “No conflict of interest, although I am the PI of the THOR study that I mention.”

There has been a confirmed case of the rare disease Monkey Pox in the UK, it was reportedly contracted in Nigeria.

Prof Geoffrey Smith FRS, Professor of Pathology, University of Cambridge, Wellcome Trust Principal Research Fellow, and Chairman of the WHO Advisory Committee for Variola Virus Research, said:

“Monkeypox is a disease caused by infection with monkeypox virus.  Monkeypox virus is a poxvirus and a member of the same genus of poxviruses as vaccinia virus (the vaccine used to eradicate smallpox), cowpox virus and variola virus (the cause of smallpox).

“Monkeypox virus infection is rare and cases in UK have originated from those who contracted the disease in Nigeria and travelled back to UK.  About a year ago there were 3 cases of monkeypox virus in UK: two cases where infection was acquired in Nigeria, and one case of a health care worker who was infected within UK from one of the imported cases.

“Monkeypox virus comes in two types that originate from either central Africa (Democratic Republic of Congo) or West Africa.  Monkeypox virus strains that originate from West Africa are less dangerous than those present in Central Africa and are usually not associated with fatalities.  Over the last two years there have been more than 300 cases of monkeypox in humans in Nigeria and these have all been of the West Africa type.

“The disease in humans can be serious and looks like smallpox, but unlike smallpox, does not transmit efficiently from human to human.  So usually there are isolated sporadic cases.

“The reservoir of monkeypox virus in West Africa is in rodents with transmission to man and other primates are relatively rare zoonoses.

“Monkeypox can be prevented by vaccination with the smallpox vaccine (vaccinia virus).  In July 2018, a drug called TPOXX or ST-246 was licensed by the US Federal Drug Administration against smallpox.  This drug was also shown to be effective against other orthopoxviruses, such as cowpox, vaccinia and monkeypox virus.  The target of this drug is a protein called F13 that is highly conserved in all these viruses.

“Now that this case has been diagnosed and the patient quarantined, the chance of transmission to others is extremely low.  The public should not be concerned by this imported case of monkeypox and should continue with life as normal.”

Prof Jimmy Whitworth, Professor of International Public Health, London School of Hygiene and Tropical Medicine, said:

“Monkeypox is a viral infection that causes flu-like symptoms and a blistering rash.  Most infections are mild and patients recover fully although severe infections and even deaths have been known.  I understand the patient had recently been in Nigeria where there has been a widespread outbreak of monkeypox in progress since 2017.  There were two cases in the UK last year also associated with travel to Nigeria.  The infection is not easily transmitted between people, although there was a health worker in close contact with one of the cases who became infected last year.  The key public health measures are to isolate the patient and to identify and follow up any close contacts.  These are being done by the NHS and Public Health England so the risk to the general public is extremely low.  It is possible that additional cases will be identified from amongst the contacts of this case, or in other travellers returning from countries in Africa where the infection occurs.”

https://www.gov.uk/government/news/monkeypox-case-confirmed-in-england

Declared interests

Prof Geoffrey Smith: “I have no conflicts of interest in making this statement.”

Prof Jimmy Whitworth: “No conflicts of interest.”

A new study has identified seven routes by which deadly human pandemics could occur and 161 options for reducing the risk. Dealing with such a complicated mix of potential sources of infection requires widespread changes to the ways humans and animals interact.

Compiled by a team of 25 international experts, the study considered all major ways that diseases with high potential for human to human transmission can jump from animals to humans.

It concludes that simplistic solutions such as complete bans on ‘wet markets’ or consumption of wild animals may be unachievable and are not enough to prevent another pandemic.

The findings have been submitted to a journal, but publication is likely to take several months. Given current debate and recent campaigning, the authors were keen to discuss their findings with science and environment journalists now.

Speakers included:

Dr Silviu Petrovan, Research Associate in Zoology, University of Cambridge

Dr Amy Hinsley, Senior Research Fellow, University of Oxford

Dr Alice Hughes, Associate Professor, Centre for Integrative Conservation, Xishuangbanna Tropical Botanical Garden, Chinese Academy of Sciences

Prof Andrew Cunningham, Deputy Director of Science, Institute of Zoology

Prof James Wood, Head of Department of Veterinary Medicine, University of Cambridge

A study, published in PNAS, reports the identification of an influenza virus in pigs in China with the potential for pandemic spread in humans.

Prof Diana Bell, University of East Anglia’s School of Biological Sciences, said:

“These are very important findings published by Chinese scientists and highlight the need for continued horizon scanning for other zoonotic pathogens during a global pandemic caused by another.

“Pig rearing occurs on a massive scale in China, as does poultry farming which resulted in H5N1 immediately after SARS.

“This paper indicates that close monitoring of both pigs and farm workers in close contact with them is in place which is essential to containment of risks associated with this novel flu virus.”

Prof James Wood, Head of Department of Veterinary Medicine, University of Cambridge, said:

“Pig farming is a massive industry in China and pigs can be important hosts from which novel influenza viruses may emerge. The authors have conducted a thorough investigation into the risks of newly emerging swine flu viruses in China and show that there is evidence that these may pose a risk to human health, in particular that they can replicate in human cells and may already be infecting some pig farmers in China. Current vaccines may not protect adequately against them.

“The work comes as a salutary reminder that we are constantly at risk of new emergence of zoonotic pathogens and that farmed animals, with which humans have greater contact than with wildlife, may act as the source for important pandemic viruses.”

Dr Alice Hughes, Associate Professor, Centre for Integrative Conservation, Xishuangbanna Tropical Botanical Garden, Chinese Academy of Sciences, said:

“Swine and avian flus are not uncommon in Asia, and we hear periodic reports of them (thankfully largely limited to livestock – in China there is sensitivity on this, so there is screening).

“Hygiene standards, and feeds including hormones and steroids across Asia are likely to be contributory factors to compromised immune systems and the potential of viruses to spread. Pork and poultry are also very popular across Asia, so there are huge numbers of the animals in the region – in fact, current statistics show over half the world’s pig population is in China”

‘Prevalent Eurasian avian-like H1N1 swine influenza virus with 2009 pandemic viral genes facilitating human infection’ by Honglei Sun et al. was published in Proceedings of the National Academy of Sciences (PNAS) at 20:00 UK time on Monday 29^th June 2020.

https://www.pnas.org/cgi/doi/10.1073/pnas.1921186117

DOI: 10.1073/pnas.1921186117

Declared interests

None received.

There have been reports of a case of bubonic plague in Inner Mongolia.

Prof Jimmy Whitworth, Professor of International Public Health, London School of Hygiene & Tropical Medicine (LSHTM), said:

“Bubonic plague regularly occurs in Mongolia. It normally affects wild rodents and is spread by infected fleas. Humans occasionally get infected if they come into contact with the rodents – in this case marmots- or fleas. While plague causes severe illness, if it is recognised promptly then it can be easily treated with antibiotics and patients will make a full recovery. The press reports indicate that this is the case in Inner Mongolia now, suggesting that there is no risk to public health. Two cases of plague were identified in Beijing last year in travellers from Mongolia and were quickly treated with no further spread of infection.

“As well as Mongolia, this disease occurs in other parts of the world, including the USA. Because plague is a disease of wildlife, it is very difficult to eliminate it completely. With the pneumonic form of plague, there is a risk of direct transmission from human to human, as was seen in the large outbreak in Madagascar in 2017.”    

Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said:

“Bubonic plague is a thoroughly unpleasant disease and this case will be of concern locally within Inner Mongolia. However, it is not going to become a global threat like we have seen with COVID-19. Bubonic plague is transmitted via the bite of infected fleas, and human to human transmission is very rare.”

Prof David Mabey, Professor of Communicable Diseases, London School of Hygiene & Tropical Medicine (LSHTM), said:

“This is not worrying at all. We know there are rodent reservoirs of Yersinia pestis, the cause of plague, in Mongolia and a number of other countries, including the USA, and occasional human cases are reported in those areas where there are infected rodents. It is transmitted from rodents to human by flea bites.  There were a number of cases recently in Madagascar where it was suspected there might have been human to human transmission due to so called pneumonic plague, when the infection spreads via the blood stream to the lungs, but this was never proven.  Y. pestis remains fully susceptible to a number of antibiotics.”

Dr Matthew Dryden, Consultant microbiologist, Hampshire Hospital NHS Trust, University of Southampton & Rare and Imported Pathogens Department, PHE said:

“The report seems to be of a suspected case in Mongolia. It is good that this has been picked up and reported at an early stage because it can be isolated,  treated and spread prevented. Bubonic plague is caused by a bacterium and so unlike covid-19 is readily treated with antibiotics. So although this might appear alarming, being another major infectious disease emerging from the east, it appears to be a single suspected case which can be readily treated.

“I was involved in a localised outbreak in Gujarat, India in the 1990s. There was concern in the UK at the time that cotton waste from that area imported for the paper trade arrived in the UK infested with fleas which may have transmitted the illness. The cotton waste was contained and there were no human cases.

“There are seasonal cases in Madagascar most years.

“The last outbreak (about 8 people) in the UK was close to the port in the river Orwell in Suffolk in 1907.

“The plague bacillus is still present in many parts of the world including the USA usually amongst rodents such as prairie dogs and marmots in grassland habitats. It occasionally spreads to humans when there is direct contact between infected animals or their fleas and man. The risk of transmission to and explosive outbreaks amongst humans, as happened in the middle ages and up to the antibiotic era, is very unlikely at present as the bacterium causing plague remains sensitive to antibiotic treatments. It is important that we use antibiotics appropriately and sparingly to retain the activity of these important drugs.

“What kills patients quickly is the septicaemic illness (the bugs in the bloodstream). The bubos, as in bubonic, are the swollen lymph glands in the groin and armpits that may suppurate and release pus.”

Prof Malcolm Bennett, Professor of Zoonotic and Emerging Diseases, School of Veterinary Medicine and Science, University of Nottingham, said:

“Bubonic plague is caused by the bacterium Yersinia pestis, which circulates naturally in various wild rodents, transmitted by fleas, in particular in central Asia, parts of Africa and Madagasar and N. America.  Where these wild rodents live in relatively unpopulated (by people) areas, the infection rarely spills over into people.  However, the epidemiology of infection in these rodents often involves cycles of rodent population size and of  infection, and it is these cycles plus contact with humans  – direct or via other animals with closer contact with humans, such as pets in N America or peri-domestic rodents such as brown rats – that can lead to larger outbreaks in people. Particularly large outbreaks, or even epidemics, in humans can occur either when lots of peri-domestic rodents (such as brown rats) are infected, so lots of animal-human transmission can occur, or when people develop the respiratory form of the disease – pneumonic plague – which enables human-to-human transmission (so it stops being a zoonotic infection, and becomes a human one).  

“In other words, the drivers of plague emergence and re-emergence are similar to the drivers of other emerging diseases (such as Covid-19) – the infection is already there, mainly causing little problem to humans, but changes in its epidemiology and, in particular, changes in how we interact with it either directly or through other animals, can lead to more ‘spill over’ to people and possibly even human-to-human transmission. Although some areas have, in the past, undertaken lots of surveillance of plague in wildlife in order to identify when the risk to human health might increase, the expense of this means that in many places nowadays the focus is on identifying  human cases as soon as possible, both so that those individuals can be treated and their sources of infection can be investigated and control measures put in place – which the reports so far suggest to have been the case here.

“So individual human infections occur fairly frequently in central Asia and N America, and there are ongoing epidemics in parts of Africa and Madagascar, but these haven’t spread further in recent years.  The last pandemic was in the 19^th Century, and the most recent outbreaks of plague in Britain were in the early 1900s, when there were outbreaks in Glasgow which appear to have been driven largely by human-to-human transmission, and in East Anglia, when people got infected from local wildlife.”  

Prof Christl Donnelly, Professor of Applied Statistics, University of Oxford and Professor of Statistical Epidemiology, Imperial College London, said:

“Commonly available antibiotics are effective at treating plague.  Sometimes antibiotics are given preventatively to close contacts of cases.  Most cases of plague in the last 30 years have been recorded in Africa. However, small numbers of plague cases occur annually in the United States, usually in rural areas of western states. “

Dr Alexander Edwards, Associate Professor in Biomedical Technology, Reading School of Pharmacy, University of Reading, said:

“The immediate level of concern should not be high for this specific case of plague bacteria, as we still have effective antibiotics for many of the most threatening bacterial infections including Yersinia pestis which causes bubonic plague. Public health measures such as hygiene and safe drinking water are also still very effective for some many important ‘outbreak bacteria’ such as cholera and typhoid.

“However, there remains the looming threat of antimicrobial resistance (AMR) i.e. resistance to antibiotic drugs. AMR could reverse the last ~80 years progress in preventing deadly bacterial pathogens, if we lose our precious antibiotic drugs and these pathogens become drug-resistant.

“We’ve heard a lot about AMR over the past 5-10 years, if you remember superbugs (MRSA) in hospitals as well as more recent campaigns, and the UK has significant investment into research and innovation to combat AMR. But the current COVID-19 pandemic should really put this into sharp focus, as we still have time to prepare and put in place a wide range of measures to prevent antibiotic resistance and to be able to minimise the health and economic impact of drug-resistant bacteria.

“But new antibiotic resistance ‘tricks’ are constantly evolving in bacteria, and these can spread surprisingly rapidly across the world. Some of these make it much harder to treat bacterial infection. Often the resistance can spread between bacteria. We have learned recently quite how fast an emerging threat can spread globally- before we forget this lesson, we must apply what we have learned to antibiotic resistance.

“We must act now and follow the range of strategies the UK government and global health networks have identified, and make sure we aren’t underprepared for emergence of new resistance and/or spread of known resistance.”

Declared interests

Prof Jimmy Whitworth: No conflicts of interest.

Dr Alexander Edwards: Al Edwards is co-founder and director of a business developing rapid antibiotic resistance testing technology, and holds a current Innovate UK grant to develop this technology to detect AMR.

None others received.

A study, published in Nature Microbiology, looked at he evolutionary origins of the SARS-CoV-2 virus lineage responsible for the COVID-19 pandemic.

Prof Mark Pagel, Professor of Evolutionary Biology, University of Reading, said:

Has this study been done well; is it robust?

“Yes.

Does the press release accurately reflect the paper?

“Yes.

Is this a surprise / is it a significant finding?

“Less a surprise than a careful analysis of a lingering question.

Is this the first study to put a specific data on the evolution of Sars-Cov-2 and the divergence from bat viruses?

“No, but it is probably the best estimate yet.

“The new Nature Microbiology paper is important for providing evidence that the SARS-CoV-2 (hereafter covid-19) jumped directly into humans from the horseshoe bats rather than via an intermediate host, suspected by many to be the pangolins.  The authors’ analyses, if correct, suggest that coronaviruses capable of infecting humans have been present in bats for perhaps 40 to 70 years but have gone undetected.  This is significant in pointing to the scale and nature of the problems that zoonotic transmission presents to humans — there may be numerous and as yet undetected viruses capable of infecting humans that reside in animal hosts.

“Pangolins have been suspected as the possible source of covid-19 because of their prevalence in live animal markets and their use in traditional medicines, but also because a key part of the pangolin coronavirus that is implicated in human infectivity – the variable loop region of the important spike protein – is more closely related to covid-19 than is the variable loop region of the most closely related horseshoe bat coronavirus, known as RaTG13.

“The spike protein is the region of the covid-19 virus that allows it to gain access to human cells, and is the part of the virus that vaccine developers are targeting.  Superficially this new result might suggest that the pangolin is the intermediate host from which the virus jumped to humans.  But the authors’ analysis shows that the difference between RaTG13 and covid-19 in the critical variable loop region probably arose in RaTG13 after it separated from the common ancestor it shares with covid-19.  This then points to the conclusion that there are as yet undetected horseshoe bat viruses that are the likely source of covid-19 — ones that have not been altered like RaTG13 has.

“To achieve these new results the authors removed regions of the bat, human and pangolin coronavirus sequences that are thought to exchange information with each other when they are found in the same host, a phenomenon known as recombination.  Previous studies have not done this.  Removing these regions leaves a clearer signal of ancestry and improves dating.  The authors’ work is robust, but unlikely to be the final word.  If they are correct, there will be coronaviruses circulating in horseshoe or other closely related bats that will prove to be closer to covid-19 than is RaTG13.  In an earlier epidemic – that of the original SARS – researchers searched for over 14 years before finding the probable source, also in horseshoe bats.”

‘Evolutionary origins of the SARS-CoV-2 sarbecovirus lineage responsible for the COVID-19 pandemic’ by Maciej F. Boni et al. was published in Nature Microbiology on Tuesday 28 July 2020.

DOI: 10.1038/s41564-020-0771-4

https://www.nature.com/articles/s41564-020-0771-4

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

None received.

A study, published in the Virology Journal, looked at how long the SARS-CoV-2 virus can last on surfaces in the dark and at different temperatures.

Dr Julian Tang, Honorary Associate Professor in Respiratory Sciences and Clinical Virologist, University of Leicester, said:

“This is yet another study of SARS-COV-2 survival on various surfaces – following on from these earlier studies: https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30003-3/fulltext and https://www.nejm.org/doi/full/10.1056/nejmc2004973.

“Unfortunately, there are no standard, consensus ways of performing such studies – which have been performed for influenza as far back as the 1980s: https://pubmed.ncbi.nlm.nih.gov/6282993/; and more recently for 2009 pandemic flu: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0027932; and for the SARS 2003 and other common cold coronaviruses: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7107832/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4659470/pdf/mBio.01697-15.pdf

“This recent Australian study:

– contaminated various surfaces with cell-cultured SARS-COV-2 in African green monkey kidney-derived Vero E6 cell – so not using virus obtained directly from human patient clinical samples;

– mixed the cultured SARS-COV-2 virus with a ‘matrix’ solution containing bovine (derived from cows) proteins to mimic human saliva/mucous;

– at viral loads for SARS-COV-2 essentially similar to those found in human saliva/spit.

“This is a fairly typical lab-based approach, but both the virus (passaged through non-human Vero E6 cell lines) and the ‘matrix’ may not be truly representative of typical human SARS-COV-2 shedding – which is subject to rapid human innate/specific immune responses and clearance in saliva/mucous.

“Also, if the initial SARS-COV-2 surface contamination is via smaller exhaled droplet aerosols landing on surfaces (much more common) than from just a saliva/mucous-contaminated fingers, the viral loads in aerosols are usually lower – perhaps about 1000-10,000 times lower, based on similar studies on influenza.  Although these lower aerosol viral loads may be enough to cause transmission via inhalation (i.e. directly to cells in the respiratory tract bearing ACE2 SARS-COV-2 receptors), this same viral load on surfaces from aerosol deposition is likely not enough to transmit via hand-to-surface-to-mouth/nose route, as human sweat, saliva, mucous all have natural antiviral properties which are not present in the virus ‘matrix’ in this study.

“In fact the whole approach/optimisation of such lab-based viral culture studies/experiments deliberately try to enhance virus survival – whereas our bodies’ natural immune defences do the opposite.

“So whilst such survival may be possible to demonstrate in the lab, in real-life everyday situations, such long survival periods may not be realistic.

“Also, if people are wearing masks – they cannot self-inoculate to their nose/mouth easily (touching eyes is less common and eye fluids also have antiviral properties) – and people should be washing/alcohol gelling their hands more frequently now, anyway.”

Prof Paul Digard, Chair of Virology, and Head of the Division of Infection & Immunity, The Roslin Institute, University of Edinburgh, said:

“This is a good quality study that measured infectious virus, not just detectable bits of virus.  It makes an important point that the virus CAN survive in an infectious form for quite long periods of time on commonly-handled objects – what’s important to remember however, which hasn’t featured in the media coverage I’ve seen so far, is that the infectivity decays over time.  So the amount of virus surviving at 28 days is very low and is therefore likely to be much less likely to infect someone than the higher amounts present when the virus is freshly deposited.”

‘The effect of temperature on persistence of SARS‑CoV‑2 on common surfaces’ by Shane Riddell was published in the Virology Journal.

DOI: 10.1186/s12985-020-01418-7

https://link.springer.com/epdf/10.1186/s12985-020-01418-7

Declared interests

None received.

A preprint, an unpublished non peer reviewed study posted on Research Square, has looked at the course of SARS-CoV-2 infection in a COVID-19 human challenge study.

This Roundup accompanied an SMC Briefing.

Prof Lawrence Young, Virologist and Professor of Molecular Oncology, Warwick Medical School, University of Warwick, said:

“Human challenge trials have a long history having been used to study infections, treatments and vaccines for many different pathogens ranging from common cold viruses to malaria. These trials provide vital information about the course and dynamics of infection providing insights into virus replication and spread as well as more detailed studies of the body’s immune response to infection and vaccination.

“This is a world first – the first time naïve uninfected individuals have been exposed to SARS-CoV-2 under controlled conditions where the timing of initial infection is known. The study reinforces observations from previous studies of natural infection confirming rapid onset of upper respiratory tract infection after 2 days but shows that high levels of virus are produced in the throat before being detected in the nose. While symptoms were predominantly mild to moderate, peak symptoms correlated with peak virus loads in the nose where high levels of virus shedding were detected compared to the throat. But there was no correlation between the levels of virus shedding and symptom severity. These observations confirm that virus transmission can occur in the absence of significant symptoms emphasising the importance of wearing face coverings over both the nose and mouth. The study also confirms the value of lateral flow testing in identifying those who are likely to be infectious and supports the isolation period of 10 days symptom onset.

“One interesting observation is that only 53% of infected individuals developed PCR-confirmed infection with no obvious differences between the groups. What factors are responsible for this difference are unknown but are likely due to immune factors that will be examined in on-going studies.

“This first report of a human challenge trial with the original SARS-CoV-2 virus paves the way for future studies examining the effect of different vaccines and treatments as well as the behaviour of virus variants.”

Dr Doug Brown, Chief Executive of the British Society for Immunology, said:

“It is exciting to see the results of this study published. This important pre-print provides significant in-depth insights into how SARS-CoV-2 infects the human body and how that infection progresses. This type of study, called a Human Challenge Trial, is where volunteers are exposed to the virus and the course of their infection then monitored in detail. These studies are not easy to carry out and require a lot of resources. However, they provide us with hugely valuable insights into minutiae of disease progression that cannot be obtained through other types of research. 

“This is the first step in developing human challenge studies on COVID-19. While the main aim of this study was to establish a safe and successful protocol to build on in the future, the significance of it should not be underestimated. This study has already generated intriguing insights into the timeline of infection, particularly in the early phase. In the longer-term, the hope is that these findings will now open up a new research avenue to develop a platform that will allow us to speed up the development of new vaccines, antivirals and diagnostics against COVID-19. The UK is a world leader in this type of research that, with the right ongoing investment, will play a significant role in helping us live alongside this virus.”

Preprint title: Safety, tolerability and viral kinetics during SARS-CoV-2 human challenge by Christopher Chiu et al. This work is not peer-reviewed.

https://www.researchsquare.com/article/rs-1121993/v1

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

Dr Doug Brown: “A Trustee of the Association of Medical Research Charities.”

None others received.

The UK Health Security Agency (UKHSA) have confirmed 3 cases Lassa fever following travel to West Africa, one of whom has died.

Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said:

 “Lassa fever is a serious infection, but is nothing like as infectious as COVID-19.  Previous studies have estimated the R number of Lassa to be roughly between 1.0 and 1.6.

“The original wildtype coronavirus at the start of this pandemic had an R number of about 3, and the variants have become increasingly infectious. With the reported death, of course any Lassa cases within the UK are of concern. However, we won’t be seeing transmission anything like the scale we have with the COVID-19 pandemic, and the risks to the wider public are very low.

“The reporting has so far suggested the cases have a recent travel history from West Africa. There is an ongoing outbreak in Nigeria at the moment, with 911 suspected cases, 211 confirmed cases, and 40 deaths.”

Reproduction number of Lassa – https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC7019145/

Nigeria outbreak – https://promedmail.org/promed-post/?id=8701326

Dr Melanie Saville, CEPI’s Director of Vaccine R&D, said:

“The three confirmed cases of the potentially deadly Lassa fever in the UK, now very sadly including one death, are a stark reminder of our interconnected world and the need to continue invest in outbreak preparedness and response efforts. Emerging infectious diseases are increasing in prevalence, severity, and spread as a result of climate change, global transportation, and human encroachment into previously isolated areas.

“Given the urgent need for vaccines, Lassa fever has remained one of our priority targets since CEPI first launched in 2017. With our partners in West Africa and across the world, we are advancing the development of six Lassa fever vaccines. Three of these—developed by Inovio Pharmaceuticals, IAVI, and Themis Bioscience—are the first in the world to enter clinical trials. CEPI’s ultimate goal, as part of our $3.5bn pandemic preparedness plan, is to produce a licensed Lassa vaccine for routine immunisation.

“To support the development of these vaccines, CEPI has created and funded the largest ever Lassa fever study, named Enable, to provide a more accurate assessment of the incidence of Lassa fever infections in the West African region. Over 20,000 participants are being recruited to take part in the study. The research will provide key information to help guide future late-stage Lassa vaccine clinical trials and potential vaccination strategies following licensure of a product.

“Finally, it is important to remember that Lassa virus is just one of a number of viruses within the Arenaviridae viral family. Recognising that other novel viruses within this family could emerge in the future with greater transmissibility and/or fatality rates, CEPI is using its Lassa vaccine work to guide the creation of a prototypic vaccine for use against the Arenaviridae family. The idea here is that this prototype vaccine could be ready to be pulled off the shelf and swiftly adapted next time a novel Arenaviridae virus emerges. That way, we don’t lose valuable time creating a new vaccine from scratch, helping to reach CEPI’s ambitious goal to develop future vaccines within 100 days.”

https://www.gov.uk/government/news/lassa-fever-cases-identified-in-england-following-travel-to-west-africa-1

Declared interests

None received.

A study, published in The Lancet Infectious Diseases, looked at 54 patients with monkeypox in London, describing demographic and clinical characteristics.

Dr Jake Dunning, Senior Researcher in Emerging and High Consequence Infectious Diseases, Pandemic Sciences Institute, University of Oxford, said:

“This is an important, rapid clinical case series describing mostly patients with monkeypox who did not require admission to hospital, from one of the UK’s busiest providers of sexual health services. Sharing this information will help raise awareness amongst health professionals and the public, and adds to information being shared by other countries with outbreaks.

“Monkeypox transmits through close contact, and although monkeypox is not a classical ‘sexually transmitted infection’, sex typically involves close contact, so it appears to be an effective route for transmission. The role of transmission during sex or intimate contact in outbreaks in African countries is less clear, and an important area for future research. Globally, we see that some individuals have more lesions or worse lesions on their genitals and/or anus and rectum than on other parts of their body; this supports the idea that worse disease may occur in parts of the body exposed to a lot of virus during contact, in this case, a lesion on someone’s genitals could shed a lot of virus onto someone else’s genitals, anus or mouth during sex, and this then leads to a lot of infection in those heavily exposed areas. Exposure to respiratory droplets or seminal fluid containing virus could also play a part in transmission during sex, as well as exposure to a contaminated environment, such as the linen on the bed of someone with monkeypox. More research is needed to understand transmission routes, and routes may differ according to different contexts of interactions, and possibly different countries and populations. It is vital that we link data from studies describing the clinical disease with information about the type of sex or close contact people have had.

“It’s good that we are not hearing of deaths occurring during the outbreaks occurring outside Africa, but we know that monkeypox can and does cause serious disease and deaths in endemic countries in Africa. This is a global health problem. Although people often describe the majority of cases of monkeypox being reported in the UK as ‘mild’, it is still an unpleasant infection for many people, even if they are not admitted to hospital. The lesions can be incredibly painful, wherever they occur on the body. Some patients need pain killers that have to be given in hospital, and some require antibiotics for secondary bacterial skin infections.

“It’s important that we use tools already available to us to prevent and treat monkeypox infections: recognition of signs and symptoms to obtain appropriate medical care and prevent transmission to others; use of preventative vaccines in some people; and antiviral treatments like tecovirimat, which is already being given to some people with severe monkeypox being cared for in specialist hospitals in England. Clinical trials will hopefully commence soon in Europe, to look at who is most likely to benefit from tecovirimat treatment, and whether it may also be useful in treating patients who do not require admission to hospital. Studies of tecovirimat are also underway and others are being planned in affected countries in Africa. In England, individuals identified as being at significantly greater risk of exposure to monkeypox will soon be offered vaccination; hopefully people who live in endemic countries in Africa and are at increased risk of exposure to monkeypox will also be offered effective vaccines, as that is where the greatest burden of severe disease is seen and healthcare resources are often more limited.”

Dr Boghuma Kabisen Titanji, Assistant Professor of Medicine, Emory University, Atlanta, said:

“This is an interesting and comprehensive retrospective cohort reporting on 54 cases on Monkeypox in the UK. It provides useful insights on the demographic characteristics and clinical presentations in the ongoing outbreak. The findings are similar to those reported in cohorts from EU countries and the USA i.e. cases are among MSM, atypical presentations are common (anogenital lesions, clinical course is mild to moderate). One in four individuals in this cohort had a concurrent STI which may reflect the study being conducted in sexual health clinics but could also reflect the overlap between how monkeypox is presenting in the ongoing outbreak and common STIs. It highlights the need to clarify the mechanisms of transmission in the current outbreak to better inform policies and approaches to contain the outbreak.”

Dr Hugh Adler, Department of Clinical Sciences, Liverpool School of Tropical Medicine, said:

“This paper corroborates previous, smaller reports from other countries affected by the current monkeypox outbreak: the initial presentation can be subtle and can mimic many sexually transmitted infections. Co-infection with monkeypox and more “traditional” STIs is another important diagnostic consideration.  The current UK case definitions are broader than they were when the data was collected for this paper, and do allow for clinician discretion in patients who are at high risk of infection.  Any new skin rash in a man who has sex with men should prompt consideration for monkeypox testing in the current climate, even if they have no other symptoms.”

Prof Paul Hunter, Professor in Medicine, UEA, said:

“This is effectively an observational study that described what we call a case series. So it is sound as far as it goes and that is describing peoples’ symptoms. These types of studies are used a lot in medicine and whilst very valuable in helping other doctors understand the range of presentations they may see, such studies do not provide conclusion evidence on issues like risk factors. These types of study are valuable educational sources for doctors.

“The most useful thing is the description of the anal and genital lesions which would help a doctor better know where to look and what to look for. The other important finding is that ¼ are HIV positive (a possible risk factor for severe diseases) and ¼ had another sexually transmitted disease.

“I don’t think there is a need to change the UK’s case definitions as these are actually very broad (https://www.gov.uk/guidance/monkeypox-case-definitions) and I think cover the presentations reported here.

“The evidence on anal genital lesions is important. This has been described already but such lesions can be missed. Not a problem if there are rashes elsewhere but if the only lesions than could be missed if not looked for. These haven’t really been reported in cases in African reports but I am not sure you would have really looked before.”

‘Demographic and clinical characteristics of confirmed human monkeypox virus cases in individuals attending a sexual health centre in London, UK: an observational analysis’ by Nicolò Girometti et al. was published in The Lancet Infectious Diseases at 23:30 UK time on Friday 1 July.

DOI: https://doi.org/10.1016/S1473-3099(22)00411-X

Declared interests

Dr Hugh Adler: No COI

None others received

The University of Oxford’s Pandemic Sciences Institute (PSI) will formally launch this week.

It will draw together academics and experts from across the University to build a multi-disciplinary institute focused on reducing the risk from infectious threats through science, innovation and building global preparedness.

The PSI’s underlying mission will be to create collaborative solutions to infectious disease threats, bringing together fundamental and translational research to improve global health and enhance real-world capabilities to respond to future outbreaks.

Journalists came to this briefing to put their questions to some of the key scientists.

Speakers will include:

Prof Sir Peter Horby, Moh Family Foundation Professor of Emerging Infections and Director of the Pandemic Sciences Institute

Prof Dame Sarah Gilbert, Saïd Professor of Vaccinology at the University of Oxford

There have been several media reports of an undiagnosed pneumonia outbreak in Argentina.

Dr Jake Dunning, Senior Research Fellow in Emerging and High Consequence Infections, Pandemic Sciences Institute, University of Oxford, said:

“The reported, currently small cluster of cases of unexplained acute severe respiratory illness in Tucuman, Argentina is a live event and investigations are ongoing; understandably there will be interest and speculation as to the cause, especially after everyone is twitchy after the pandemic events of the last two years, but we really need to await the outcome of the public health and clinical investigations, which are ongoing.  It is possible that further cases may be identified and reported going forward, as that often occurs with these sorts of events, but that does not mean this event is the start of a new pandemic.

“Some disconcerting features have been reported, however, which will cause concern to public health agencies in Argentina and to agencies in other countries, as well as the World Health Organization.  These include the reported severity of illness in many of the known cases, sadly including some fatalities, the common epidemiological link of a single health centre, and the fact that healthcare workers make up a large proportion of the recently reported cases.  This suggests, but in no way proves a common exposure source, and possibilities include exposure to a patient with an infection of unknown cause that was being cared for at a health facility, either with common exposure of multiple individuals to the same source, or initial exposure of one or two individuals and then secondary transmission between individuals.  Of course, this is purely speculative on many levels and also assumes the severe lung disease described is actually caused by an infection and, if it is an infection, seemingly it is one that may be easily transmitted to several people within the same location.  Other potential explanations include exposure to environmental agents and toxins, and the reports state this possibility is also being investigated, as one would expect.

“Although lists of all the pathogens tested for have not been made public (which is not unusual, as it’s a complicated, specialist process), available reports suggest that the clinicians have looked for and excluded many common respiratory pathogens that occur globally and are capable of causing severe acute respiratory infections, as well as some more unusual infections that occur in some parts of Argentina, including hantavirus infections and leptospirosis.  It is reassuring to hear that rapid actions are being taken by the Argentinian Ministry of Health and provincial health authorities; I expect this includes using a range of diagnostic technologies to look for alternative, specific pathogens or families of pathogens when the ‘usual suspects’ are excluded through appropriate sampling and testing.  This is in addition to detailed outbreak investigations and contact tracing by public health teams.  Reports state that control measures are also being applied, despite the cause of the outbreak being unclear; this is sensible and typical for such an event, assuming it may be a transmissible infection and applying precautionary control measures on that basis.

“Argentina has lots of experience in investigating and managing outbreaks of severe acute respiratory illness, particularly those caused by infections (e.g. pandemic H1N1 influenza, COVID-19, Andes hantavirus infection), so hopefully this cluster will remain relatively small and the underlying cause will be identified quickly.  Sharing information with WHO and with other countries, as Argentina is doing, shows commitment to Global Health Security and should be commended and supported.  In England, the experts working in UKHSA’s Epidemic Intelligence team will be monitoring this event closely, as it does for multiple events occurring globally year-round, informing and updating relevant stakeholders and performing formal risk assessments if and when they are needed.”

Dr Lance Turtle, Reader and Honorary Consultant in Infectious Diseases, University of Liverpool, and NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, said:

“Pneumonia is very rarely actually diagnosed down to which specific microbe is causing it.  Not all patients with pneumonia have the same clinical features, these can vary.  If a pneumonia case looked a bit different to usual, and if there are fatalities, which seems to be the case here, then you might expect to find the cause.  But unexplained pneumonia cases probably happen frequently and are not reported, meaning it is hard to know how common things like this really are.

“At this stage it is impossible to know what the likely cause of these cases are, without more information.  It may be a viral cause, but we don’t know that yet.

“We shouldn’t be very worried at this stage.”

Dr Louise Sigfrid, Public Health Specialist and Clinical Research Fellow, ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, said:

“It is a tragedy for those involved, and a concern for the affected hospital unit.

“From the information available, it is too early to say what this may be caused by until we have further information from the ongoing investigations by the Minister of Health in Argentina.

“If it is not detected by standard hospital tests available at the site, standard procedures are to send samples to specialist laboratories that have capacity to do further tests, which will take some time.  This may involve testing of samples from those affected as well as environmental sampling in the healthcare centre.

“The early notification of the cases and the information provided in the PAHO briefing indicates that the authorities in Argentina are dealing with the situations using standard recognised health protection methods to identify and contain the source.”

Prof Paul Hunter, Professor in Medicine, UEA, said:

“Yesterday the Pan American Health Organization reported an outbreak of undiagnosed pneumonia in Argentina.  At present there is very little information available.  As of the 1^st September there were six infections reported of whom two had already died.  The first case was a patient in a private sanatorium who started having symptoms between 18 and 22 Aug 2022.  The remaining cases were all health care workers.  Initial analyses suggests all six affected people had pneumonia.  In yesterday’s report there had been no new cases since the 22^nd August.  Media reports have suggested that three more cases including an additional death have been identified but the dates of onset have not been given.  As yet initial analyses have not identified covid, or influenza or indeed any other virus or bacterial cause of the outbreak.

“Even before covid outbreaks undiagnosed respiratory infections were reported three or four times a year on promed mail, the global infectious disease early warning system.  In the three years 2017 to 2019 I counted 12 reports of undiagnosed respiratory infections reported by promed mail https://promedmail.org/.  Most, but not all, of these outbreaks are eventually identified as being due to a known cause and most usually fizzle out or are controlled.

“At this stage it is not possible to know whether this outbreak has been already controlled or whether it will cause further cases locally or further afield.  Most such outbreaks do not ultimately spread internationally but it is too early to judge how concerned we should be about this.  Further work should be being done to try and identify a microbial cause and also whether the likely infection may still be spreading.  Hopefully additional information should be available within coming days to enable us to better understand what if any greater risk may be involved.”

Prof Beate Kampmann, Professor of Paediatric Infection & Immunity, and Director of The Vaccine Centre, London School of Hygiene and Tropical Medicine, said:

“This limited initial report appears to refer to cases of severe pneumonia that occurred at a single health centre, and some form of nosocomial transmission (within a hospital or healthcare setting) is therefore likely – even though it is not yet clear what organism has been causing the pathology.

“In addition to running further tests for bacteria, viruses, fungi and toxicology, it is also important to understand where the patients and healthcare workers interacted to limit spread within the institution and put infection control measures in place.

“Underlying illnesses also appear to influence severity of disease.

“This is not unusual, although more detailed information is required and ongoing surveillance remains crucial to protect population and healthcare workers alike.

“It is too early to comment on whether this represents a threat to a wider population or remains restricted to the institution, or whether it might be caused by a new pathogen or one we already know about.”

https://www.paho.org/en/documents/informative-note-cases-pneumonia-due-unknown-cause-tucuman-argentina

Declared interests

Dr Jake Dunning: “I was previously Head of Emerging Infections and Zoonoses (which includes the Epidemic Intelligence service) at Public Health England and I currently hold an honorary consultant contract with UK Health Security Agency, for the purposes of doing research.  I am a practising NHS Consultant in Infectious Diseases and HCIDs, at the Royal Free Hospital, and Director of the NHS England High Consequence Infectious Diseases (Contact) Network.  Views expressed are my own and do not represent those of UKHSA, NHS England and NHS Improvement, the Royal Free London NHS Foundation Trust, or the UK Department of Health and Social Care.”

Dr Lance Turtle: “None.”

Dr Louise Sigfrid: “No conflicts of interest to declare.”

Prof Beate Kampmann: “No COI.”

A study published in eClinicalMedicine looks at long term symptoms associated with respiratory infections such as the common cold versus COVID-19. 

Prof Peter Openshaw, Professor of Experimental Medicine, Imperial College London, said:

“This study of over 10,000 adult (>15y, mostly older white female) community participants identified cases of acute respiratory infection (ARI) known due to SARS-CoV-2 (n=1,311), and ARI cases in which testing for SARS-CoV-2 infection was negative (n=472).  The study ran from May 2020 to Oct 2021, during which time pre-Alpha, Alpha and Delta variants of SARS-CoV-2 were circulating and highly prevalent.  Influenza was rare in this period due to lockdown, but some circulation of human rhinovirus/enterovirus continued.

“The study confirms that many people who had not yet been vaccinated against COVID-19 and developed symptomatic ARI during the pandemic were not fully recovered at the time of final follow up.  As severity increased, participants were more likely to report having long COVID, ranging from 5.9% in the mild class to nearly half of participants in the severe class.  In either group, symptoms were often present at follow up for at least 4 weeks, but up to 12 weeks.  This was the case especially if symptoms were severe (which they were in 21%), but the symptom profile was largely similar in both ARI study groups.  An exception to this was memory problems and loss of taste or smell, which was more frequent in those identified as SARS-CoV-2 infected.  The study relies on diagnostic tests to exclude SARS-CoV-2 infection, which are known not to be perfect.

“The study is important in showing that recovery from ARI may be slow regardless of cause, that people should expect a slow return to normality and not expect to immediately return to full activities immediately after an ARI from whatever cause.  The study does not show how many of those suffering from ARI go on to develop longer term debility.

“The term ‘long cold’ used in the press release should not belittle the very significant disability that some with Long COVID suffer.”

Dr David Strain, Clinical Senior Lecturer and Honorary Consultant, University of Exeter, said:

“Vivaldi et al have presented a very well conducted prospective review of residual symptoms after Covid 19, and after other non-Covid respiratory infections.  They demonstrated, at least in the short term, persistence of symptoms can be troubling not just after COVID-19 but after many other infections.

“Whilst in the first to explore this prospectively, this is not a new phenomenon.  Indeed, the Spanish flu epidemic in 1918-20 left many individuals with Encephalitis Lethargica that took decades to resolve (This was the subject matter for the Oliver Sachs book “The Awakenings” or depending on the audience the Robert DeNiro and Robin Williams film).  The concept of post viral illness is also well established.  Today in the UK, approximately 280,000 people are living with Myalgic Encephalomyelitis (ME, otherwise known as Chronic Fatigue Syndrome) many of whom report a rather benign initial viral illness as the trigger.

“A limitation of this study is that it only looks at symptoms at a single timepoints.  Whereas those involved in the COVIDENCE trial report symptoms lasting beyond 3 months and up to 2 years, many of those with ME/CFS have experienced their symptoms for decades.  In the absence of an understanding of the mechanisms or any diagnostic tests they have faced unprecedented stigma from society.  It is hoped that it will not be the legacy of today’s healthcare system, to leave these young and previously fit people behind.  This study will bring into focus the urgent need for further research into post viral syndromes, the risk factors and therefore routes to risk mitigation, diagnostic tests and potential treatments to help the quarter of a million plus in the UK and Millions worldwide who are suffering this terrible condition.”

Prof Paul Harrison, Professor of Psychiatry, University of Oxford, said:

“The study supports previous findings that long-term symptoms are common after respiratory infections in general, not just following COVID-19.  However, COVID-19 infection was associated with a higher risk of several complaints, including memory problems, suggesting that ‘brain fog’ may be particularly related to the SARS-CoV-2 virus.  A strength of the study is its prospective, UK population-based nature.  A weakness is the relatively small number of non-COVID-19 infection cases.”

‘Long-term symptom profiles after COVID-19 versus other acute respiratory infections (COVIDENCE UK): a population-based observational study’ by Giulia Vivaldi et al. was published in eClinicalMedicine at 09.00am UK time on Friday 6 October 2023. 

DOI: 10.1016/j.eclinm.2023.102251

Declared interests

Prof Peter Openshaw: “Peter Openshaw is a Co-Lead on the Coronavirus Clinical Characterisation Consortium (ISARIC-4C) and immunology lead on PHOSP-COVID (a UKRI MRC COVID-19 Rapid Response consortium studying Long COVID, led by Chris Brightling, Leicester).  He has been a member of scientific advisory committees and/or spoken at meetings organised by Janssen, Sanofi, Moderna, Seqirus, AstraZeneca and GSK.”

Dr David Strain: “Prof Strain is the Medical Advisor to Action for ME, Associate Prof of Cardiometabolic Health at the University of Exeter Medical School and Chair of the BMA Board of Science.  No Financial interests to declare.”

Prof Paul Harrison: “No conflicts (except prior work on this topic, which the authors cite).”

A study published in the Journal of Physics: Complexity looks at knowledge of social networks in epidemic modelling. 

Dr Marc Baguelin, Senior Lecturer at Imperial College London, Associate Professor at London School of Hygiene and Tropical Medicine, SPI-M member and lead of the Imperial College UK real-time modelling team during the COVID-19 pandemic, said:

“This paper discusses well-established aspects of epidemic spread on theoretical networks. The findings are common knowledge within the epidemiological modelling community and are integral to introductory modelling courses. Moreover, the methods discussed in the paper were familiar to the modellers who advised the UK government, with some actively contributing to the development of the theory surrounding epidemics on networks over the last 20 years.

“While acknowledging the inherent trade-off in models between complexity and explanatory power, it is difficult to see what this particular study brings to the understanding of the spread of SARS-Cov-2, particularly the reasons behind the occurrence of multiple transmission waves. The author’s model uses scale-free networks, which may not align well with the social interactions relevant to respiratory pathogens. It also implies a complete rewiring of the network as the catalyst for a new wave – akin to a sudden overhaul of one’s social circles (family, school, friends and work colleagues). Finally, this approach disregards crucial mechanisms such as immunity dynamics, behavioural changes resulting from factors like lifting restrictions, or the emergence of new SARS-Cov-2 variants.”

Prof Graham Smith, Lead Scientist for Wildlife, Animal and Plant Health Agency (APHA), said:

“It has long been known that disease model heterogeneity is important to the overall outcome of an epidemic. My experience is primarily within wildlife and livestock disease modelling, where heterogeneity in space and contact structure have been included in many models. Thus, the press release “Models used by scientists to predict how epidemics will spread have a major flaw” starts with a large over-statement. Indeed, other authors have already described the effect of including various types of heterogeneity in COVID models – for example this one published in 2021 https://doi.org/10.1515/cmb-2020-0115.

“The difficulty with human disease models is not only that this heterogeneity is much more complex (think about meeting people at work and leisure, as well as school contacts for children) but that this original network would be adjusted through non-pharmaceutical interventions (e.g. lockdowns) and personal choice (avoiding or reducing contacts by choosing to not going to events such as parties even when permitted, or choosing to go to large rallies protesting about the various interventions). Such changes cannot be easily or accurately predicted, so in many cases would have to be accounted for by discussing the uncertainties and known inaccuracies in any model used for policy. How much this was done during the COVID assessments I do not know.”

Prof Mike Tildesley, Professor of Infectious Disease Modelling at the University of Warwick and the Director of the Mathematics for Real World Systems Centre for Doctoral Training, said:

This paper presents a theoretical analysis that concludes with a result that epidemiologists have known for decades – that variability between contacts has an impact upon how an epidemic will spread. This is an extremely well researched area and as such the results in this paper are not novel. However, what is more concerning is the suggestion in the press release that the models used during the pandemic “have a major flaw” owing to a lack of consideration of variability in contact structure. This shows a significant lack of understanding of the models that were used to guide policy. Many of these models, whilst built upon a compartmental framework, incorporated variability in risk in several ways such as age, geographical region and in some instances contact surveys were used to parameterise these models. The models were also typically fitted and refitted to data as the pandemic progressed, to ensure that they were taking into account the most up to date information regarding the spread of disease. There have also been several papers published both during and in the aftermath of the pandemic to demonstrate how well these models performed in terms of predicting future epidemic behaviour.  Whilst it is important to recognise that there is uncertainty in any model predictions (and that this is duly communicated to decision makers), those other studies would suggest that the statement in the press release that the COVID models “have a major flaw” is extremely misleading.”

Prof Matt Keeling, Director of Zeeman Institute: SBIDER (Systems Biology & Infectious Disease Epidemiology Research), University of Warwick, said:

“This is a reasonable piece of work, that highlights a well-known issue in epidemiology and infectious disease modelling: that the number of social contacts matter. As the author states in the opening section “It has been known for decades that network topology has important effects on spreading processes”. The paper considers the impact of variation in the number of contacts per person, but ignores other network factors such as the strength and duration of contacts and the clustering of contacts (such as the interconnected network within a household). The paper also ignores the observation that those individuals with lots of social connections can only spend a short time with each contact (on average) which greatly reduces the strength of the results described.

“While there is nothing wrong with the work, to suggest that this calls for a radical rethink of all epidemiological models (including those used for COVID-19) is stretching the conclusions way too far. All the groups that worked on COVID-19 modelling in the UK, have all previously studied such network models before and are well aware of the consequences and implications.  In summary is this an interesting theoretical exercise, but it adds little to the field, and certainly does not impact on applied public health modelling.”

Prof Adam Kucharski, Professor in Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine (LSHTM), said:

“Understanding the relationship between dynamic social contacts and disease transmission is an important question. But unfortunately, this paper seems to reiterate a common misunderstanding about COVID dynamics, which has been made several times by others during the pandemic already (including by some groups who claimed in summer 2020 that there wouldn’t be a second wave).

“Specifically, the model assumes that there are a very small proportion of highly connected individuals who are responsible for superspreading events, and once these individuals are infected (and hence immune) the epidemic ends with only a small proportion of the population infected. There are two key problems with this assumption:

“1. Human social contacts vary a lot from person to person, but crucially a person with a lot of contacts today won’t necessarily be a person with a lot of contacts tomorrow. COVID superspreading events often occurred at events like weddings and social gatherings (e.g. https://wwwnc.cdc.gov/eid/article/26/9/20-1469_article) – however, there aren’t a subset of individuals who attend all the weddings, while others attend none. Analysis of real-life networks has found that ‘highly connected’ individuals on a given day are generally only highly connected for short time periods (https://www.medrxiv.org/content/10.1101/2023.11.22.23298919v2), so we can’t model the accumulation of immunity against acute respiratory infections by assuming that the network is static for prolonged periods.

“Notable exceptions to this unpredictability in contacts is among certain age groups and occupations (e.g. healthcare workers), where a subset of the population routinely make more contacts than others, and households where per-contact transmission risk is much higher (https://www.nature.com/articles/s41586-023-06952-2). This is why COVID disease models generally include variation in age-specific contacts by default, and there were also separate modelling efforts focused on settings with high transmission potential (e.g. households, certain events or workplaces).

“Variation in the number of contacts people make is also important for estimating the likely effort required for individual-targeted measures like contact tracing, and numerous models therefore accounted for this variation and implications for control (e.g. https://www.thelancet.com/article/S2214-109X(20)30074-7/fulltext & https://www.thelancet.com/article/S1473-3099(20)30457-6/fulltext & https://www.nature.com/articles/s41591-020-1036-8 & https://www.nature.com/articles/s41467-022-29522-y). There is lots more to be done on understanding the relationship between contacts and disease transmission, but to be effective, such analysis should focus make best use of available data (much of which is open acce, so free to analyse).

“2. There was evidence in 2020 that a relatively high percentage of individuals got infected with COVID in hotspots, from Austria (https://www.medrxiv.org/content/10.1101/2020.08.20.20178533v1) to New York (https://www.nytimes.com/2020/08/19/nyregion/new-york-city-antibody-test.html) to Brazil (https://www.medrxiv.org/content/10.1101/2020.08.28.20180463v1) to Peru (https://www.researchgate.net/publication/343414173_Seroprevalence_of_anti-SARS-CoV-2_antibodies_in_the_city_of_Iquitos_Loreto_Peru). Since the emergence of Omicron and lifting of control measures, we have also seen the vast majority of the population get infected in the UK (https://epiforecasts.io/inc2prev/paper). Any modelling analysis of herd immunity thresholds (i.e. the point at which the reproduction number drops below 1 under normal behaviour patterns) should therefore focus on trying to explain both these infection results as well as observed contact patterns (e.g. https://www.medrxiv.org/content/10.1101/2023.10.05.23296586v2).”

‘Epidemic modelling requires knowledge of the social network’ by Samuel Johnson was published in Journal of Physics: Complexity at 9:00 UK time on 9^th January 2024.

Declared interests

Prof Graham Smith: No conflicts of interest.

Prof Kucharski: I was a member of SPI-M-O during 2020-22.

Prof Matt Keeling is a Professor at the University of Warwick. He has no financial interests to declare, but is a member of both SPI-M and NERVTAG. 

For all other experts, no reply to our request for DOIs was received.

Scientists react to the detection of avian influenza in mammals in the sub-Antarctica region. 

Dr Kathleen Steinhöfel, a Reader in Computer Science at King’s College London, said:

“The press release reflects quite accurately on this case of detection of H5N1.  And while this is a natural phenomenon, more study is needed to understand how this disease first infected the elephant and fur seal population.  The samples will need further analysis to see what mutations allowed the disease to spread to other species.  The data collected so far, suggests isolated cases of infection due to contact with wild birds rather than a mammalian transmission.”

Prof Rowland Kao, Professor of Veterinary Epidemiology and Data Science, University of Edinburgh, said:

“This report follows the narrative of HPAI H5N1, spreading progressively throughout the world, often (as in this case) to previously unexposed animal populations.  The underlying causes for this are still a subject of active research, though there is evidence of some properties of the virus itself that may change transmission patterns.  Throughout, the exposure of naive bird and mammal populations has resulted in mass mortalities in many species, some at conservation risk.

“It’s important to stress that here as in most cases worldwide, transmission to mammals is likely the result of scavenging by the mammal populations on infected dead birds, and represent minimal risk of further spread (e.g. to humans) with little indication that changes making it a virus adapted to humans are likely.  Despite this, where there are infected birds and mammals there is a risk, albeit low, to humans of getting infected with H5N1, so people are advised to avoid direct contact with dead birds and mammals found in the wild, anywhere that avian influenza is a likely cause.”

Dr Sarah Pitt, Applied Microbiology International member; chief examiner in virology at the Institute of Biomedical Science; and microbiologist at the University of Brighton, said:

“It is of concern that HPAI has been detected in aquatic mammals and birds in sub-Antarctica.  The Team at APHA have conducted detailed analyses of the virus samples taken from the wildlife.  It shows that some birds in that region can be infected with avian influenza.  However it is worth noting that there no evidence for presence of the virus in some of the species of bird investigated. 

The report suggests that only dead seals were tested, so the extent of the problem in the seal population is not known (so it is a qualitative result, showing that seals can be infected and affected by the virus).

“It is good that there is no indication to risk for humans from this strain of avian influenza.  This is consistent with evidence from other outbreaks of HPAI in other parts of the world.”

Dr Alastair Ward, Associate Professor of Biodiversity and Ecosystem Management; Programme Lead for Zoology, University of Leeds, said:

Does the press release accurately reflect the science?

“Yes.  This was a simple survey of found-dead animals to detect the virus.  The same team routinely conducts this sort of surveillance throughout the UK.

Is this based on good quality research?  Are the conclusions backed up by solid data?

“Yes.

How does this work fit with the existing evidence?

“Highly pathogenic avian influenza was detected in captive European mink in northern Spain in October 2022, and in otters and foxes in southern England soon after.  During 2023 it was detected in seals and sea lions around Europe and the Americas, and most recently in an Alaskan polar bear.  Considering the breadth and geographical distribution of species affected to date, this new discovery of the same strain in seals and seabirds found dead on South Georgia is perhaps unsurprising, but it is extremely saddening.

Are there important limitations to be aware of?

“Finding highly pathogenic avian influenza in several individuals of the same species of mammal does not necessarily mean that the virus has been spreading between individuals within that species.  The number of seabirds dying with avian influenza in some colonies has been very high and deaths have been rapid.  It seems feasible that mammals, such as seals, that are known to scavenge, may become infected when they consume infected bird carcasses.

What are the implications in the real world?  Is there any overspeculation?

“Perhaps the greatest concern is for bird conservation.  South Georgia, and Bird Island in particular is renowned for being home to large colonies of southern giant petrels, several species of albatross and two species of penguin.  Declines of bird populations on these islands would constitute a great loss to local ecosystem functioning and also to the world’s biodiversity.

Is this worrying or expected?  Does this change anything about the risk to humans?

“Considering the breadth and geographical distribution of bird and mammal species affected by highly pathogenic avian influenza to date, this new discovery of the same strain in seals and seabirds found dead in Antarctica is perhaps unsurprising, but it is extremely saddening.  Very specific changes are needed within the virus’s genome that make it better adapted to a human host; these changes have not been detected in samples taken from wild birds or mammals to date, so the risk to humans likely remains low.  Nevertheless, these viruses are highly adaptable, so it would be wise to maintain surveillance programmes so that we can detect new variants as they emerge and hence respond appropriately in good time if it becomes necessary to do so.”

Dr Matthew Dryden, Consultant in Infection, UK Overseas Territories Program, said:

“The FCDO funded UK Overseas Territories Program which is part of UKHSA works closely with the Government of South Georgia and South Sandwich Islands (GSGSSI) and the British Antarctic survey (BAS) and APHA to give public health and clinical advice.  Although it is sad that HPAI has reached the south Atlantic and is affecting wildlife including some mammals, this was anticipated following the outbreaks in the northern hemisphere where mammals have also been affected.  Genomic sequencing of the virus suggests that there is no mammal to mammal transmission.  In other words, the seals are acquiring the virus from sick birds on land.  With the strong biosecurity measures in place, there is no risk to human health at present and the situation continues to be monitored closely.”

Dr Ed Hutchinson, Senior Lecturer, MRC-University of Glasgow Centre for Virus Research (MRC CVR), said:

“This report is a reminder that, as well as having a serious impact on humans, influenza viruses infect many other species of birds and mammals.  A great variety of influenza viruses infect wild animals, often without causing serious illness.  However, in recent years a highly pathogenic strain of H5N1 influenza virus has been spreading around the world, causing serious illnesses in birds and occasionally infecting mammals.  Influenza viruses are particularly common in waterfowl and shorebirds, which can carry the viruses long distances as they migrate.  Although the Antarctic is extremely remote, it was inevitable that eventually the highly pathogenic H5N1 strain of influenza would reach the region, and infected birds were first reported by the British Antarctic Survey a few months ago.

“The fact that this virus has now started infecting mammals in the region is, sadly, also not surprising – viruses are usually extremely picky about which animal they infect, but influenza viruses are unusually good at infecting new host species.

“Importantly, there is a difference between isolated infections of a new species and a virus spreading efficiently within that species.  It requires a lot of changes for a bird virus to become a mammalian virus, and at the current time there is no sign that this H5N1 virus has changed from being a dangerous virus of birds to a virus that can spread easily within any mammal species.

“However, this appearance of a dangerous virus in both the birds and mammals of such a fragile ecosystem is very concerning.  This report highlights that this dangerous strain of H5N1 influenza virus has now reached all parts of the world, and as well as monitoring its impact on wildlife, ongoing work will be needed to reduce as much as possible its impacts on farmed animals around the world, and to minimise the risk that in the future the virus could adapt to spreading in humans.”

Prof Diana Bell, Professor Conservation Biology, UEA, said:

“These important findings confirm the spread of HPAI H5N1 to sub-Antarctic locations and together with the recent report of the virus in a dead polar bear in the high Arctic highlights the widespread distribution among both mammalian species and geographically to fragile ecosystems already threatened by global warming.”

Declared interests

Dr Kathleen Steinhöfel: “No conflicts of interest to declare.”

Prof Rowland Kao: “I am funded along with the APHA in a large consortium grant funded by the BBSRC to study methods to understand and combat H5N1 in the UK; also I chair Defra’s science advisory council’s exotic and emergent diseases committee, leading an independent scientific report commissioned by Defra on the current H5N1 pandemic.”

Dr Alastair Ward: “Alastair Ward collaborates with the Animal and Plant Health Agency on the FluMAP and Flu:TrailMAP consortia, two research projects funded by UK Research and Innovation and Defra to investigate the ongoing H5N1 avian influenza panzootic.”

Dr Ed Hutchinson: “Ed Hutchinson has received honoraria for work in a steering group of the Centre for Open Science (Open Practices in Influenza Research; 2021-2022) and on an advisory board for Seqirus (2022). He has unpaid positions on the board of the European Scientific Working group on Influenza and other respiratory viruses (ESWI) and as a scientific adviser to PinPoint Medical. His research group is funded in part by the FluTrailMap consortium mentioned in the press release, but he was not involved in the work reported here.”

Prof Diana Bell: “None.”

Scientists react to a conference abstract which reports that long-COVID is indistinguishable from other respiratory post-viral syndromes.

Dr Aimee Hanson, Senior Research Associate, MRC Integrative Epidemiology Unit, University of Bristol, said:

“Inflammation, whatever its cause, can disrupt many of the body’s physiological processes. The consequences of inflammation triggered by SARS-CoV-2 infection are unlikely to be entirely unique to this specific virus. Similarly, long-term symptoms following COVID-19 are likely driven by similar processes to those at play in other post-viral syndromes. The COVID-19 pandemic has provided a rare opportunity to study SARS-CoV-2 infection and its consequences in intense detail, but this collective research may inform treatment strategies to prevent or lessen the severity of symptoms that linger for months to years following viral infection more broadly.”

Dr Janet Scott, Clinical Lecturer in Infectious Diseases, University of Glasgow, said:

“This looks like an interesting study, and I will look forward to seeing this presented in more detail at ECCMID at the end of April. Many infections cause post infection syndromes, and it may be that ‘Long COVID’ is indeed not markedly different from other post -respiratory virus syndromes. It is important however not to minimise the huge personal and economic impact the long COVID have on individuals. The big difference with Long COVID is the sheer number of people infected with the same virus in a short space of time – which has facilitated more coordinated research in the area – which I hope will benefit all sufferers of post Infection syndromes.

“It would be useful in my opinion, if we could offer rehabilitation services to all who need them, irrespective of the initial infection they contracted – for example, in my own area – the Highlands of Scotland, many people suffer from post Treatment Lyme Disease, which is clinically indistinguishable from Long COVID, and yet we are not funded to support them in the same way as we do long COVID patients.

“The title is perhaps a little off the mark – I think that Long COVID is different  from some other post infection syndromes – for example post Ebola syndrome (PES) , which is predominantly a pain syndrome (whereas long COVID is predominantly a Fatigue syndrome), PES sufferers notably also get eye conditions like white cataracts and anterior uveitis (an inflammation inside the eye), which we do not see in Long COVID. This paper has focused on respiratory viruses – and perhaps the title should better be ‘indistinguishable from common respiratory viruses in Queensland’.”

This press release is based on poster abstract P327 to be presented at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Barcelona (27-30 April). The research is being prepared for submission to a medical journal ahead of the conference in April 2024.

Declared interests

Dr Aimee Hanson: No conflicts of interest

For all experts, no reply to our request for DOIs was received.