10

Is thIs how

the next vIrus

pandemIc starts?

world events

NO prOtectiONNo gloves or face mask offers this butcher no protection from a hen that could be infected with a bird-flu strain.

virus hOtspOtAlmost all outbreaks of influenza-related viruses such as avian flu (a.k.a. bird flu) can be traced back to poultry markets such as this one in Shanghai, China, which brings people and potentially infected birds into close proximity. Despite widespread bans and the slaughter of hundreds of millions of birds, deadly avian flu has been found in 60 countries in all corners of the globe.

LeakiNg fLuidsBlood from slaughtered birds openly spills onto the floor, where it could come into contact with shoppers’ shoes or be touched by children.

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in the kitchen of an upmarket restaurant in Macao, China, a chef is preparing a small pig for his customers, stuffing the animal’s innards with his bare hands. He’s not suspicious of the swine; he doesn’t need

to be. He bought the pig from a reliable supplier, his usual man. He performs the same ritual night in, night out, before serving his pork dish to the restaurant’s well-healed patrons.

But the pig has a secret. It’s carrying a deadly disease; a disease it caught when an infected bat defecated on the animal earlier in the supply chain. No one could have known it had happened, least of all the pig farmer; it’s not uncommon for bats to fly into the pig sheds. He sold the pig to the meat suppliers in good faith, who in turn then sold it onto the restaurant owner.

Now the chef is interrupted. There’s a customer who wants to say hello. He removes his hands from inside the pig and wipes them on his apron, leaving

minute traces of infected fluid on his fingers. He enters the restaurant floor and shakes the lady’s hand. The fluids, and the disease, are transferred to another host. A few minutes later, the woman touches her mouth. She does this repeatedly over the next few hours. Over the next couple of days, she also touches a multitude of surfaces and door handles. Not just during her remaining days in China, but on her flight back home to the United States, and when she lands in Chicago. Of course, she’s already come into physical contact with hundreds of people since that fateful moment when she shook the chef’s hand: hotel staff, air hostesses, taxi drivers, her own family. And so the cycle of infection is continued.

Anyone who’s seen the 2011 movie Contagion will recognise the events just described. It’s a dramatisation of the film’s final scene, when

peruswiNe fLu (h1N1)760 cases, 44 deathsIn response to the latest outbreak, in the midst of the harshest Peruvian winter in 30 years, the Health Ministry has distributed 1.7 million vaccines around the country. Seventeen of the deaths occurred in the capital, Lima; the latest victim was a pregnant woman from the northern coastal region.

recorded vIrus outbreaks In 2013

ugaNdaebOLauNkNOwN cases, three deathsA male farmer in the country’s northern district is still being treated for the lethal tick-borne virus; six others who’ve come into contact with him are also being investigated. In 2012, ebola claimed 32 lives in Africa.

austraLiaheNdra viruseight cases (aLL hOrses, NO humaN)In response, Racing Queensland has introduced a new Hendra vaccination program for racehorses in the state. In Queensland alone, more than 30,000 people work in the racehorse business and associated industries.

iNdiaswiNe fLu (h1N1)4848 cases, 610 deathsThe state of Gujarat has been most affected by the latest outbreak of the influenza sub-type, with 196 deaths. Experts are concerned it could mutate into a more virulent strain at any time.

chiNaaviaN fLu (h7N9)133 cases, 43 deathsMost cases involve people who have visited live poultry markets in the seven days before falling ill. The strain has proved resistant to influenza drug Tamiflu. Various markets across the country have been closed, and in May a mass bird cull was ordered at a major wholesale poultry market in Dongguan.

one bIllIonNumber of people who are seasonally infected with

influenza around the world.

middLe east (variOus)mers108 cases, 44 deathsThe majority of infections have been recorded in Saudi Arabia, but in February an elderly man in Manchester, UK, died after visiting Pakistan. Other cases have been reported in France and Italy.

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SICK BEDA patient is treated for bird flu in China’s Zhejiang Province in April 2013

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the events behind the fatal infection of Gwyneth Paltrow’s character, Beth, are finally revealed to the audience.

The Steven Soderbergh-directed film was inspired by recent (and fatal) viral pandemics such as the 2003 SARS epidemic and the 2009 swine flu outbreak. Unusually for a Hollywood blockbuster, where facts are often glossed over at the expense of entertainment, the movie was universally applauded for its scientific accuracy, in particular the way it identified easy global travel, the migration of human and animal traffic and an interconnected global food chain as the main causes of any new pandemic.

“An epidemic like the one described in the film will almost certainly occur, though we can’t predict the details,” observed epidemiologist Larry Madoff in The Atlantic. “The notion that an agent like Nipah virus – a pathogen shared by bats, pigs, and humans and presumably the model for the virus in the movie – will break out of its niche and cause widespread disease, is very believable.”

hOw did paNdemicsfirst start?A pandemic – the word derived from the Greek words ‘pan’ (all) and ‘demos’ (people) – is the outbreak of an infectious disease affecting people across large regions of the globe, often spreading out over continents. Historically, pandemics are interlinked with both war and exploration. It was mankind’s wandering instinct that drove him behind his native borders and into contact with foreign people and their alien germs; a smallpox outbreak, for example, wiped out around 50% of indigenous Australians, and many New Zealand Maori, during the early period of British colonisation. And it was the mass migration of troops into the battlefield that brought soldiers from different nations into close contact; the first recorded cholera pandemic (there have been seven in all to date) that started around 1816 and lingered until 1870 is estimated to have killed 15 million, helped largely by the movements of British soldiers around India and Asia.

Other viral diseases such as malaria, measles, TB and the granddaddy of them all – influenza – are so intertwined with human history, they’ve become household names. They roll so comfortably off the tongue, it’s easy to forget just how devastating they can be. The ‘1918 Flu Pandemic’, a sub-type of influenza virtually identical to the one that caused

2009’s swine flu outbreak, infected 500 million people worldwide and killed between 50 and 100 million – that’s around 5% of the world’s population at the time. It did its’ dirty work in less than two years.

John Lowenthal is a scientist at the Australian-government-funded Commonwealth Scientific and Industrial Research Organisation (CSIRO), specialising in viral research. He talks about viruses with the passion of a man singing the praises of his football team. “If the 1918 flu epidemic happened today, with more global travel and denser populations, there would have been an even more serious outcome than the 50 million that died,” he says with conviction. “We’re much better prepared than we were in 1918, but this shows the scale and what could happen if we weren’t ready. Sure, we’re prepared for flu these days, but what about the next bad virus? There’s plenty out there that we don’t know anything about.”

which New viruses arespreadiNgright NOw?“The world is not ready for a large, severe outbreak.” It’s May 2013 in a conference hall in Geneva, Switzerland, and Keiji Fukuda, deputy chief of the World Health Organisation (WHO), is addressing delegates from the international body with a concerned look tightening his face. “When people get hit with an emerging disease, you can’t just go to a book and know what to do.”

These are perilous times to be presiding over an organisation in charge, among other things, of preventing virus outbreaks around the world, while >

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[1] swiNe fLu (h1N1)10% fatality rateA strain of the influenza family found in pigs, which swept largely through the US and Mexico in 2009. Spreads in a similar way to the common cold, via coughing and sneezing. Most deaths are from respiratory problems, with the elderly and children being most at risk.vaccine status: Approved anti-viral drugs protect against the virus within 10 days of taking.

[2] sars10% fatality rateSevere Acute Respiratory Virus killed 775 people in six months between 2002-2003, mainly in Hong Kong, before going global. Early symptoms are similar to the flu, making initial diagnoses tricky. Transmission between people is fast; there is still no vaccine to date.vaccine status: Could be produced within 3-5 years of future outbreak.

[3] aviaN fLu (h7N9)30% fatality rateA never-before-seen strain of bird-flu that when World of Knowledge went to press had already killed 43 people, all of them in China. Experts’ worst fears that the virus could mutate have been confirmed: a 32-year-old woman has already caught it directly from her father, not an infected bird.vaccine status: No vaccine, but other flu drugs may help if the virus is caught early.

[4] aviaN fLu (h5N1)60% fatality rateCommonly dubbed ‘bird flu’, the strain is responsible for four major pandemics in the last decade: most recently in 2007. It’s usually passed from infected poultry to humans, but human-to-human transmission is possible. Around 375 people have died from the virus since 2003.vaccine status: Several exist, but constant H5N1 mutations limit their effectiveness.

[5] mers60% fatality rateShort for Middle Eastern Respiratory Syndrome, this coronavirus (meaning it infects humans as easily as animals) is a close relative of SARS. Although most people catch coronaviruses during their lives, a contagious strain is currently ripping through the Arab world, killing 44 people to date.vaccine status: Not available. Currently being tested on animals.

[6] heNdra virus60% fatality rateFirst discovered in Australia in 1994, the virus – closely related to rabies – is carried by flying foxes, and passed onto horses – then, in rare cases, onto humans. Out of seven reported cases, four people have died. The last big equine outbreak was in 2011.vaccine status: Available for horses only. Gives six-months immunity.

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the deadliest viruses

WARNING SIGNA health official in Shanghai takes precautions against a swine flu outbreak

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simultaneously devising strategies to contain the ones that do inevitably explode.

As World of Knowledge went to press, WHO had recorded 133 confirmed cases of a new form of avian influenza in China, including 43 deaths. Like other influenza variants before it, and ‘zoonotic’ diseases such as swine flu and the Australian-specific Hendra virus, the H7N9 strain is passed from animals to humans. Human-to-human transfer is unlikely, but not impossible.

It’s no surprise, then, that most bird flu outbreaks can be traced back to Asian food markets, where poultry is bought alive and then slaughtered fresh at the buyer’s home, thus potentially exposing that person to the animal’s blood and other fluids. Without good hygiene, viruses can be spread by simply touching the mouth, eyes or nose with tainted fingers, or transferred on clothes or shoes.

Meanwhile in the Arab world, a brand new virus called Middle East Respiratory Syndrome (MERS) has claimed 44 lives, mostly in Saudi Arabia. Lab tests carried out by the National Institute for Public Health and Environment suggest camels are carrying the disease. As yet there are no vaccines for MERS or any of the new strains of bird flu; by their own admission, scientists concede that they’re fighting a battle where they’re always two steps behind the opposition.

“The biggest problem is you don’t know where viruses are coming from, you don’t know when they’re coming and often you don’t know what you’re looking at because you’ve never seen that kind of virus before,” says the CSIRO’s John Lowenthal. “With pandemics, it’s all about speed, a race against the viruses. But the problem is viruses can mutate very quickly. The very real risk is you get a virus that efficiently transmits from human to human that also has a high mortality rate.”

Is he worried about the sudden emergence of MERS in the Middle East? “At the moment, it doesn’t transmit easily between humans,” says Lowenthal. “It’s lethal once you get it, you have a 60 per cent chance of dying. But it doesn’t have that explosive effect yet. But if the virus mutates, and it can do that without warning, MERS could explode.”

cOuLd viruses be used by biOterrOrists?Towards the end of 2011, in a lab in Wisconsin, Dutchman Ron Fouchier and Yoshihiro Kawaoka

discovered the secret formula to producing a form of the H5N1 bird-flu – in effect, a man-made virus with the potential to spread between mammals. If the variant had have been strategically unleashed into the general population, the consequences could have been catastrophic.

Fortunately, Fouchier and Kawaoka are not bioterrorists or madmen; they’re respected, if somewhat controversial, virologists, who two years ago created the mutant strain of bird flu so that they could study it and gauge the risk of it evolving into a deadly pandemic. By testing the virus on ferrets in close proximity to each other, they also showed the virus could become airborne.

Even though they’d conducted their work in good faith, the US National Science Advisory Board for Biosecurity (NSABB) was so concerned the research could fall into the hands of terrorists, they tried to ban the study from being made public.

Microbial geneticist and NSABB chair Paul Keim said: “I can’t think of another pathogenic organism that is as scary as this one. I don’t think anthrax is scary at all compared to this.”

Now the duo are courting controversy again, making genetic modifications to the new previously unseen strain of avian flu (H7N9) currently spreading through China. The work is being conducted under Biosafety Level 4, the highest level of biosecurity that can be achieved in academic research. Known as “gain of function” research, the aim is to assess how dangerous the virus could potentially be, which will help the development of vaccines. Their experiments took on extra poignancy after a 32-year-old woman in China appeared to catch the H7N9 virus directly from her father, rather than from an animal – the first known case of human-to-human transmission of H7N9.

“It’s clear this H7N9 virus has some hallmarks of pandemic viruses, and it’s also clear it’s missing at least one or two of the hallmarks we’ve seen in the pandemic viruses of the last century,” Fouchier recently announced. “So the most logical step forward is to put in those (missing) mutations first.”

At the time of writing, scientists were still frantically working to find out the source of the H7N9 outbreak, though the likely source is chicken, ducks or pigeons sold at poultry markets; strangely, birds infected with the virus haven’t been showing symptoms. Experts fear the cold Chinese winter is the riskiest time for a surge in infections. According to Dr Alan Hampson, chairman of the Influenza Specialist Group in Australia, “There is a feeling that this virus may, with a few changes, become a virus that transmits steadily from person to person.”

hOw dO experts stOp viruses frOm spreadiNg?

While vaccines are being researched, scientists and health organisations go “virus hunting” to locate the original source of the outbreak: all recent avian flu epidemics have been traced back to live poultry markets in China. Once the source is found, infected people can be isolated, while others can be educated about wearing face masks and the importance of good hygiene – as evidenced as this poultry processing plant in Zaozhuang. At border crossings and airports, health officials use infrared thermometers and scanners to identify any sick travellers.

is aids the fOrgOtteN paNdemic?

Amidst all the headlines about animal-hosted viruses, it’s easy to forget that the planet is still in the grip of one of the worst pandemics in history: AIDS. Infection rates are rising again in Asia and the United States; the UN estimates that by 2025, the sexually transmitted disease will have killed 18 million people in China, 31 million in India and 100 million in Africa. A 2011 study showed Australian infection rates had jumped by 8%.

142 mIllIon

‘Worst-case scenario’ deaths from a modern global pandemic,

according to a study by Australia’s Lowry Institute

for International Policy.

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Measles7th century bc-1963

200 mIllIonHighly contagious, the virus will infect 90% of people

living in close proximity to a carrier. Throughout history, populations not previously exposed to the disease have been most at risk: a 1529 outbreak in Cuba wiped out two-thirds of the nation, while in the 1850s, measles

killed 20% of Hawaii’s people. Outbreaks continue to occur around the world.

sMallPox10,000bc-1979300+ mIllIon

One of the earliest examples of small pox was found on the corpse of Egyptian Pharaoh, Ramses V, who died in 1157BC; in the 18th century,

400,000 Europeans, including five reigning monarchs, died from the virus. However, most deaths from the disease, which attacks the respiratory

system and produces fluid-filled bumps on the skin’s surface, were during the 20th century, before it was eventually

eradicated by a vaccine in 1979 – one of only two infectious diseases in history to have been successfully wiped out.

sPanish flu1918-1919

50-100 mIllIonMore than 5% of the world’s population were wiped out

by this strain of influenza, making the 1918-1919 epidemic one of the deadliest natural disasters

in history. Spanish flu’s spread was hastened by troop movements

during World War I.

BlaCK DeaTh

1340-177175 mIllIon

The most devastating of history’s bubonic plagues (i.e. a zoonotic disease carried by fleas) was carried from Asia into Europe by insects living on rats onboard ships, where it claimed up to 60% of

the continent’s population. Outbreaks were recorded in the US as

recently as 1995.

hiV/aiDs

1981-present25+ mIllIon

The (mainly) sexually transmitted disease is believed to have originally existed in West African monkeys before being passed onto

humans; the first documented case was recorded in Congo in 1959. There is

still no cure…

Plague of

JusTinian541-750

25 mIllIonAn early form of bubonic plague that swept through the Eastern Roman Empire, killing 5000 people a day at its height in the city of Constantinople alone. It was carried

by rats arriving from Egypt.

ThirD PanDeMiC

185512 mIllIon

The last major bubonic plague in history wreaked havoc in China and India before

spreading to all the world’s inhabited continents via the major coastal

shipping hubs.

TyPhus43bc-present

4 mIllIonMore of Napolean’s French soldiers were

killed by the disease than by Russians during the ill-fated 1812 campaign; it was

also rife in Nazi concentration camps. The virus was transferred to humans

by lice, fleas or mites, via rodents and cattle.

Cholera1817-present

3 mIllIonMost infections are caused by drinking water or food that’s been contaminated with human faeces, hence its continuing

prevalence in the developing world. From 2008-2009, more than

100,000 cases were recorded in Africa.

hong Kong flu

1968-19691 mIllIon

The H3N2 strain of influenza quickly mutated to form several sub-variants,

which despite the virus’s name, spread to India, the Philippines

and Australia.

deadlIest pandemIcs In hIstory

1918

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hOw wOuLd austraLia cOpewith a paNdemic?The first case of swine flu in Australia during the 2009 pandemic, was brought in by a 33-year-old woman travelling from Los Angeles to Brisbane. Six months later, Australia had counted nearly 37,000 cases of H1N1 influenza, and 186 deaths. Thermal imaging and nurses were deployed at airports. Airlines were instructed to report any passengers with flu-like symptoms. At the peak of the crisis, the government had stockpiled 8.7 million doses of vaccines, plus 40 million surgical-grade masks.

The CSIRO’s John Lowenthal says that while Australia benefits from being isolated from the rest of the world, with less population density, it’s just as susceptible to a pandemic as any other country.

“A lot of the risk is the speed in which people can travel around the world. Our strict animal quarantine measures would definitely help during a pandemic, but there’s still a lot of people traffic. Viruses can be easily ‘seeded’ on the other side of the world. That’s hard to predict, and impossible to stop because people don’t show symptoms early on.”

Stopping a proportion of air traffic would seem like a sensible answer to railroading a pandemic. But some studies, including one by Boston epidemiologist John Brownstein, claims that travel restrictions would slow the spread of disease, but not affect its ultimate death toll. Another academic study last year suggests that a 99% ban would need to be imposed to effectively delay a pandemic. Factor in the possible economic impact of a travel ban – one study estimated a 95% reduction would cost America $100 billion a year – and it’s clear that the situation would have to be almost civilisation ending for such bans to become a reality.

In response to the latest bird flu outbreak in China and the brewing MERS crisis, the CSIRO has joined forces with researchers in the US and Singapore in a $20 million venture to prepare for the next global pandemic. Says John Lowenthal: “There’s plenty of viruses out there in wildlife, the jungles of Africa, the outbacks where people rarely go. But once the human population expands and moves into areas not usually inhabited, or comes into contact with monkeys carrying ebola or bats carrying a new virus, that’s where the system falls out of balance and humans become exposed to things we’ve never seen and don’t have any treatment for. You can never be too prepared for these things.”

70%Proportion of human-

carried diseases that originate from animals.

cOuLd bats heLp us tO cure paNdemics?

Bats, or flying foxes, to be precise, are prolific carriers of zoonotic disease such as the rabies-like Australian bat lyssavirus, Nipah virus and Hendra, which they pass to horses through urine, saliva or droppings – which can then be transmitted to humans. But understanding the nature of these viruses could ultimately help us find vaccines for pandemics of the future. “That’s where the hot research is at the moment,” says CSIRO scientist John Lowenthal. “Bats can carry up to 60 different viruses. A lot of them are highly infectious and cause high mortality in humans but they don’t seem to affect the bats. The bats seem to live very happily with the virus. That’s something we’re working on.”

cOuLd a zOmbie virus Occur iN reaL-Life? Scientists universally agree that the kind of zombie virus seen in movies like World War Z – i.e. one that reanimates the dead – is impossible. But there exist so-called neurotropic viruses that attack the brain, sparking aggressive or weird behaviour – including the almost-100%-fatal rabies, and ebola. Experts continue to be baffled by a fatal and incurable African plague known as “nodding disease”, which sends those infected into a strange, trance-like state, as well as causing siezures. Sleeping sickness (pictured) passed on by the African tsetse fly, is also known to induce psychotic reactions. One third of the African continent is at risk of catching it.

48,000Number of Africans who

died during the 2008 sleeping sickness

epidemic.

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