The Intersection of Human and Animal Disease
Happy New Year
Governor Newsom of California declared a state of emergency recently after H5N1 Avian Influenza has been found to be infecting at least 70% of the state’s dairy herds. That’s something like activating an air-raid siren at Pearl Harbor on December 8th 1941, and then holding a press conference to tell everyone what a good job you did. In my latest post, “Science Whispers the Truth Again”, I was complaining that the Canadian Department of Health was refusing to provide information on the outcome of the case of the teenager with severe H5N1 infection. This week the NEJM published details of the case of this 14 year old infected with the clade of the virus which is associated with wild birds, (as distinct from that which has infected our dairy herds). Aside from a history of asthma and being overweight, she had no prior history of serious medical illness or immunocompromise. Her course was severe with shock, respiratory failure and ARDS, requiring prolonged intubation and ECMO (extra corporeal membrane oxygenation), acute kidney failure requiring dialysis, and various blood cell depletions. She was treated with the three available drugs with activity against Influenza viruses, plus plasma exchange; she survived, but was still hospitalized at the time of the case report. This is certainly more in keeping with the kind of critical and frequently fatal H5N1 disease reported over recent years from Asia, and not the milder illness seen so far in the US folks infected with the cow version of the virus. So far 65 human cases of Avian Influenza have been reported in the US this year—but we know the actual number is much larger. The cow associated virus has so far been relatively mild, and it is certain that many other animal workers have been infected; a recent CDC survey of currently asymptomatic dairy hands at farms with documented cow infections showed specific antibodies to this virus in 7%.
Now it is flu season, and national levels of influenza disease are ramping up. The peak this year looks to be later than the trend of recent years, and more typical of the per-pandemic 2019-2020 season. CDC is now reporting national flu levels as high, with some western states the highest right now. (Oregon last week reported 9% of ER visits are due to flu). As I have discussed previously, people co-infected with the usual, seasonal Influenza viruses and with H5N1 will offer the avian virus the opportunity to exchange genetic material with the perfectly human adapted viruses that cause outbreaks every year, and pandemics every so often. Those pandemics have been quite notably severe in some cases, and the result of relatively minor changes in the human virus. When these viruses go swapping large territories of genetic material the outcome is unpredictable— unfortunately evolutionary selection and the law of large numbers don’t particularly bode well for us. Fortunately our government has had lots of time to prepare a well worked out plan, but more importantly, both sides of the political spectrum know exactly who to blame when things go south.
Should there be a pandemic of H5N1, or a closely related virulent variant of Avian Influenza, the only thing that will make a difference in the human death toll is an effective vaccine—and there is some good news on that front. Right now our government has stock-piled about 5 million doses of traditionally prepared vaccines, which were developed against an earlier version of the H5N1 virus, but they have not asked the FDA to approve them for use in case of emergency. If there was a pandemic with a highly contagious virus, one with a significant mortality rate for both adults and children, 5 million doses should be about the right amount to see riots at pharmacies and people storming the locations where their elected representatives are lining up to get vaccinated as “essential individuals” (notice I don’t use the word workers) The good news is that Moderna just published results of a new mRNA vaccine directed against the currently circulating H5N1, which was 100% effective in protecting ferrets (a common stand in for humans in respiratory vaccine trials) from a lethal dose of the virus. The advantages of an mRNA vaccine of course being that it can be rapidly adjusted to changes in the virus, and mass produced in record time with no dependence on the availability of eggs.
An influenza mRNA vaccine protects ferrets from lethal infection with highly pathogenic avian influenza A(H5N1) virus | Science Translational Medicine https://www.science.org/doi/10.1126/scitranslmed.ads1273
I have detailed H5N1’s spread through numerous mammalian species over the last two years, with devastating effects on various sea mammals—particularly those that live in close proximity to wild birds, such as seals, sea lions and walruses. Now apparently it’s the kitties turn. Cats are vulnerable to severe disease from a number of respiratory viruses, and earlier in the COVID-19 Pandemic, domestic cats were found to be susceptible to infection with SARS2. Cats mostly didn’t get significant illness from our human corona virus, but in 2023 a new virus appeared on the island of Cypress killing many tens of thousands of cats. That virus was found to be a recombinant of a canine corona virus and a feline corona virus, which caused a rapidly spreading epidemic of lethal feline infectious peritonitis. Now we are seeing cats in the US infected with Avian Influenza H5N1, and it is highly lethal. The initial reports here were from dairy farm cats, but now small numbers of household cats have died from the infection as well. Several cases have been linked to consumption of raw cat food products found to be contaminated with the virus, triggering recalls. The disease progresses very rapidly, with cats developing neurologic signs and often dying within a few days of first symptoms—one can assume that many infections go undiagnosed. The big predatory cats are equally susceptible to mortality from this virus, and a big cat sanctuary in Oregon just reported the deaths of 20 out of their 37 tigers, cougars, leopards, and bobcats over a period of only several days. Cats, of course won’t be a major or even a minor vector for introduction of H5N1 to humans. The real danger will be from the thousands of dairy and poultry workers exposed on the job to H5N1 (thanks at least in part to the inept initial response of our government agencies), and simultaneously in the community to seasonal Influenza A. The other major avenue of risk will come from infection of immunocompromised persons, who become chronically infected for prolonged periods of time, allowing the virus extraordinary opportunity to fine tune its adaptation to the human host. Now where have we seen that before?
Emergence and spread of feline infection peritonitis due to a highly pathogenic canine/feline recombinant coronavirus | bioRxiv https://www.biorxiv.org/content/10.1101/2023.11.08.566182v1
If you are completely bored with the same old viruses (and who could blame you), I thought I’d relate the story of a relative new comer on the scene illustrating the intersection of humans, animals and their viruses. Severe Fever and Thrombocytopenia Virus (SFTV) is a tick born Bunyavirus first recognized China in 2009. It causes pretty severe human illness with mortality around 12% with advanced medical care, but as high as 30% in some series. Since its initial description in China the disease has been seen in Japan, Korea, Taipei, Vietnam and Thailand. Cattle and other ruminant animals are a natural reservoir of disease as reported from China, but the magnitude of their infection has been confirmed by a paper this month in Vector Born and Zoonotic Diseases. Investigators in Korea (South, not the Northern Peoples Paradise) found that samples from over 800 randomly selected cattle over a two year period showed 4% had active infection, and 21% had specific antibodies indicating prior infection. That is a pretty impressive burden of a nasty virus cohabiting with a lot of people and a lot of ticks.
Prevalence, Isolation, and Molecular Characterization of Severe Fever with Thrombocytopenia Syndrome Virus in Cattle from the Republic of Korea | Vector-Borne and Zoonotic Diseases
Here is a map showing the concentration of the disease in eastern China and Japan, but also its anticipated spread to surrounding regions, based on the current distribution of the tick species which carry the virus. The graphic is a few years old so doesn’t show that cases have more recently been observed in Thailand, Laos and Vietnam. US doctors will need to be prepared to add this virus to the differential in travelers.
Mapping the global potential transmission hotspots for severe fever with thrombocytopenia syndrome by machine learning methods - PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC7241453/
Declining vaccination rates are the topic of endless articles, arguments, accusations and appeals. The slippage in US (and world) measles vaccination rates has been particularly concerning given the extraordinary infectivity and severity of this virus. There is an information war going on between the proponents of Public Health, and the medical profession, and a wide variety of anti-vaccine voices. Criticism of vaccines roughly falls into two categories. First, and generating almost all the attention, is the mountain of nonsensical disinformation which permeates social media, and is generally along the lines of: “All vaccines are evil, they are not natural, they exist just to make money for big Pharma and the scientists who have been bought off, plus vaccines create autism”. Then there are truly informed, thoughtful critiques of particular vaccines, the quality of their testing, safety and effectiveness, and the rational of the recommendations for their administration in certain demographics. Similarly, questions regarding the childhood vaccination schedule, co-administration of multiple vaccines, and ad hoc decisions about re-administration of multiple doses of vaccines to people who have been naturally infected (without adequate study) need to be admitted as legitimate concerns. If you fall into the camp of all, or most, vaccines are dangerous and unnecessary; then you are miserably wrong, and risking yours and potentially other people’s children. If you fall into the camp of all vaccines are just great, “sign me up to take whatever the government is recommending”, then you are gullible, poorly informed and at their mercy. Severe vaccine side effects are generally very rare, and when the the benefit outweighs the minimal risk it is an example of the dictum that no medication is without side effects, even tragic ones. But when a vaccine is recommended and given to a person whose risk from disease is so low that they never should have been advised to take the shot, then tragic side effects are malfeasance.
The “collective intelligence” of a society forms quickly these days, with the barrage of news and opinions constantly saturating every aspect of life. Let’s look at how that “collective intelligence” in America has come down on the issue of giving healthy children repeated yearly doses of the COVID vaccine. The CDC and ACIP both recommend this, and the government spends lots of money supporting the yearly procurement of the vaccine—while European nations do not. The uptake of this year’s COVID booster in children is around 10% of those recommended by the CDC. This includes all the children with significant medical issues that actually place them at some risk, so we can assume the vaccination rate among healthy children (the vast majority of whom have already had repeated COVID infections) is even a bit lower. The second graph shows exactly the same result in the previous 2023 year. Looks like Americans, both Democrats and Republicans, have made up their minds on this issue, siding with the European medical and Public Health officials. When it comes to the critically important vaccines for the highly morbid and lethal childhood diseases, I agree pretty closely with Donald MacNeil Jr.’s assessment, even if it is rather dark. If there are even small epidemics of measles, diphtheria, whooping cough etc., the majority of anti-vax parents will start vaccinating their kids, when they see other children dying and horribly suffering. (See MacNeil’s article in Medium on this, Vaccines Will Have to Prove Themselves Again. The Hard Way, and also his excellent book The Wisdom of Plagues)
This year’s winter COVID surge is starting later than usual and as I intimated in the last post here, perhaps will be more of a splash. So it’s time for the editorial department. We are all sickened by the vicious terror attack in New Orleans this week—a city that has known its share of misery from natural disaster, and now pure human evil. The FBI has been warning the administration and Congress for three years that the “no actual” border approach has allowed infiltration of the country by very dangerous individuals, and created the highest national security threat situation in many years. This was Christopher Wray’s (no friend of Donald Trump) repeated warning. While the lunatic in New Orleans was homegrown, he was inspired by, and perhaps encouraged by these terrorists. Kamala Harris stated during her campaign, and previously, that we should not use the term Islamic Terrorism. So in the spirit of, let’s all go along to get along, I propose calling events like New Orleans and the repeated German Christmas Market Massacres: Automotive Outings. Take your kids out to see the sights in the big city at holiday time, but don’t forget your running shoes. We will now spend enormous amounts of resources and money tracking down and removing highly dangerous terror elements from the country—but unfortunately there will be more events like this to come.
It being the Holiday season there was unprecedented dispensing of gifts in Washington, in the form of pardons, clemency, and glittery medals. Congratulations to all the recipients—except George Soros. His financial support for radical progressive DAs around the country, greatly contributed to a violent crime wave in many cities, which disproportionately led to the deaths and maiming of countless Black Americans, and the hollowing out of the business community in their inner city neighborhoods. George will die soon but his misguided legacy will likely survive him. Now is the time to make a resolution to hit the like button.