tag:theconversation.com,2011:/us/topics/nipah-virus-1694/articlesNipah virus – The Conversation2023-09-19T13:40:30Ztag:theconversation.com,2011:article/2136922023-09-19T13:40:30Z2023-09-19T13:40:30ZNipah virus outbreak in India – what you need to know<p>There has been an outbreak of the deadly Nipah virus in Kerala, India. Five people have caught the virus, <a href="https://indianexpress.com/article/india/nipah-virus-outbreak-kerala-dead-treatment-kozhikode-offices-schools-shut-8938498/">two of whom have died</a>. </p>
<p>The authorities in the Kozhikode district, where the outbreak occurred, have instituted “containment zones” in the area and schools have been closed. Seventy-six people who came into contact with the infected are being <a href="https://promedmail.org/promed-post/?id=20230913.8712097">closely monitored</a> for signs of the disease.</p>
<p>This is the fourth Nipah virus outbreak in Kerala. The most deadly was in 2018, with 18 laboratory-confirmed cases and five suspected cases, <a href="https://www.who.int/southeastasia/outbreaks-and-emergencies/health-emergency-information-risk-assessment/surveillance-and-risk-assessment/nipah-virus-outbreak-in-kerala">17 of whom died</a>. </p>
<p>Nipah virus is an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169151/">RNA virus</a> of the <em>Paramyxoviridae</em> family. The first detected human outbreak occurred in Malaysia in 1998 and caused 265 cases and 105 deaths. Since then, one or two outbreaks occur each year. More than half the people who are infected <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169151/">die</a>. </p>
<p>Outbreaks have most commonly been reported from Bangladesh, but also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169151/">India, Malaysia, Singapore and the Philippines</a>. </p>
<p>The proportion of Nipah virus infections that are asymptomatic varies from one outbreak to another and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169151/">ranges from 17% to 45%</a>. When the virus does cause disease, the main effect is encephalitis (brain swelling). Patients develop a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169151/">fever and complain of an intense headache</a>, and many will experience disorientation, drowsiness and confusion. Some patients also develop a chest infection. </p>
<p>There are no specific drugs to treat Nipah virus, so medical care is merely “supportive”, that is, treating individual symptoms and keeping the patient comfortable until they hopefully recover.</p>
<p>Some treatments look as though they have potential, at least in animal studies, but few studies have been conducted in humans. One small trial of a drug called ribavirin suggested <a href="https://pubmed.ncbi.nlm.nih.gov/11409437/">it could reduce deaths</a>, but more studies need to be done. </p>
<p>A targeted therapy called monoclonal antibodies have been shown to be effective at reducing death in <a href="https://www.science.org/doi/abs/10.1126/scitranslmed.3008929">green monkeys</a> if given early enough in the course of a Nipah virus infection. But no studies have yet shown how effective these drugs are in humans with Nipah virus.</p>
<p>Nevertheless, the Indian authorities are buying monoclonal antibodies <a href="https://www.wionews.com/india-news/india-procures-monoclonal-antibodies-from-australia-to-battle-deadly-nipah-virus-636379">from Australia</a> to use in the current outbreak. </p>
<p>There are no vaccines against Nipah virus although an mRNA vaccine against the virus is being <a href="https://www.nih.gov/news-events/news-releases/nih-launches-clinical-trial-mrna-nipah-virus-vaccine">tested in humans</a>.</p>
<h2>How do people get infected?</h2>
<p>In the original outbreak in Malaysia, the main risk factor was <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/00057012.htm">contact with pigs or being a pig farmer</a>, but there was no evidence of person-to-person transmission. At the time it was not clear why pigs had started transmitting the infection. </p>
<p>Since the initial outbreak, we have learned more about the virus and the risk factors associated with transmission to humans. It is now accepted that the primary host for Nipah virus is <a href="https://www.who.int/news-room/fact-sheets/detail/nipah-virus">fruit bats</a>, specifically the Indian flying fox. Nipah virus has been previously detected in <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-05865-7">bats in Kerala</a>. </p>
<p>Most infections are thought to come from contact with an infected animal, either the fruit bats themselves or from intermediate animals such as pigs, as in the first <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/00057012.htm">detected outbreak in Malaysia</a>. But there are interesting differences between outbreaks. In Bangladesh, there is an association with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169151/">drinking date palm sap</a>, either raw or fermented. </p>
<p>In one Bangladeshi study, the researchers used <a href="https://www.ncbi.nlm.nih.gov/books/NBK114490/">motion-sensor-infrared cameras</a> to show that fruit bats often visited those date palms where villages collected date palm sap for consumption. </p>
<p>Initially, it was thought that person-to-person transmission did not occur for Nipah virus as <a href="https://pubmed.ncbi.nlm.nih.gov/11181159/">no healthcare workers were infected</a> during the large outbreak in Malaysia. Since then, healthcare workers have been reported as having caught the infection, as in this most recent outbreak, where one of the deaths was in a healthcare worker who treated a person infected with the virus. </p>
<h2>Deadly, but doesn’t transmit easily</h2>
<p>A study of some 248 Nipah virus infections in Bangladesh conducted over several years concluded that about a third had been <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1805376">caught from another human</a>. The researchers estimated that the R value – the number of people an infected person is likely to pass the disease to – is about 0.33, meaning the infection would be unlikely to spread far from its animal source.</p>
<p>Although the Nipah virus causes a deadly infection there is no evidence that it is likely to spread widely outside of areas where people or their livestock come into contact with infected bats. However, outbreaks of Nipah virus may be another indication that habitat loss as a result of human incursion forces greater contact between humans and animals increasing the risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041730/">animal-to-human transmission</a>.</p>
<p>Even though the R value is low, should infected animals be transported into large cities the increased population density would <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7087654/">increase the risk of person-to-person transmission</a> that could enable the evolution of the virus to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7095141/">become more human transmissible</a> and trigger a new pandemic. </p>
<p><em>Correction: The original article incorrectly stated that the first detected human outbreak of Nipah occurred in Malaysia in 1978. The year was actually 1998.</em></p><img src="https://counter.theconversation.com/content/213692/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Hunter consults for the World Health Organization. He receives funding from National Institute for Health Research, the World Health Organization and the European Regional Development Fund.</span></em></p>More than half the people who become infected with the Nipah virus die.Paul Hunter, Professor of Medicine, University of East AngliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1896222022-09-05T20:04:33Z2022-09-05T20:04:33Z5 virus families that could cause the next pandemic, according to the experts<p>The CSIRO has delivered a comprehensive <a href="https://www.csiro.au/pandemic">report</a> on how we should prepare for future pandemics. </p>
<p>The report identifies six key science and technology areas such as faster development of vaccines and onshore vaccine manufacturing to ensure supply, new antivirals and ways of using the medicines we already have, better ways of diagnosing cases early, genome analysis, and data sharing. </p>
<p>It also recommends we learn more about viruses and their hosts across the five most concerning virus families. These causes of disease could fuel the next pandemic. </p>
<p>We asked leading experts about the diseases they can cause and why authorities should prepare well:</p>
<h2>1. Coronaviridae</h2>
<p><strong><em>COVID-19, Middle East respiratory syndrome (MERS), severe acquired respiratory syndrome (SARS)</em></strong></p>
<p>The first human <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204879/">Coronaviruses</a> (229E and OC43) were found in 1965 and 1967 respectively. They were low-grade pathogens causing only mild cold-like symptoms and gastroenteritis. Initial understanding of this family came from study of related strains that commonly infect livestock or laboratory mice that also caused non-fatal disease. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358201/">HKU-1 strain in 1995</a> again did not demonstrate an ability to generate high levels of disease. As such, coronaviridae were not considered a major concern until severe acquired respiratory syndrome (<a href="https://www.who.int/health-topics/severe-acute-respiratory-syndrome#tab=tab_1">SARS-1</a>) first appeared in 2002 in China.</p>
<p>Coronaviridae have a <a href="https://www.nature.com/articles/s41467-021-22785-x">very long RNA genome</a>, coding up to 30 viral proteins. Only four or five genes make infectious virus particles, but many others support diseases from this family by modifying immune responses. The viruses in this family mutate at a steady low rate, selecting changes in the outer spike to allow virus entry into new host cells.</p>
<p>Coronaviridae viruses are widespread in many ecological niches and common in bat species that make up <a href="https://www.si.edu/spotlight/bats/batfacts">20% of all mammals</a>. Mutations spread in their roosts can spillover into other mammals, such as the <a href="https://link.springer.com/article/10.1007/s11259-020-09781-0">civet cat</a>, then into humans. </p>
<p>Coronaviridae <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/genomic-surveillance.html">genome surveillance</a> shows an array of previously unknown virus strains circulating in different ecological niches. Climate change threatens intersections of these viral transmission networks. Furthermore, pandemic human spread of SARS-CoV-2 (the virus that causes COVID) has now seeded new transmissions back into other species, such as mink, cats, dogs and white-tailed deer. </p>
<p>Ongoing viral evolution in new animal hosts and also in immune-compromised <a href="https://www.bmj.com/content/376/bmj-2021-069807">HIV patients in under-resourced settings</a>, presents an ongoing source of new variants of concern.</p>
<p><strong>– Damian Purcell</strong></p>
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Read more:
<a href="https://theconversation.com/long-covid-how-researchers-are-zeroing-in-on-the-self-targeted-immune-attacks-that-may-lurk-behind-it-169911">Long COVID: How researchers are zeroing in on the self-targeted immune attacks that may lurk behind it</a>
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<h2>2. Flaviviridae</h2>
<p><strong><em>Dengue fever, Japanese encephalitis, Zika, West Nile fever</em></strong></p>
<p>The flaviviridae family causes several diseases, including dengue, Japanese encephalitis, Zika, West Nile disease and others. These diseases are often not life-threatening, causing fever, sometimes with rash or painful joints. A small proportion of those infected get severe or complicated infection. Japanese encephalitis can cause inflammation of the brain, and Zika virus can cause birth defects.</p>
<p>While all these viruses may be spread by mosquito bites, when it comes to each individual virus, not all mosquitoes bring equal risk. There are <a href="https://www.cdc.gov/zika/prevention/transmission-methods.html#:%7E:text=Zika%20virus%20is%20transmitted%20to,spread%20dengue%20and%20chikungunya%20viruses.">key mosquito species</a> involved in transmission cycles of dengue and Zika virus, such as <em>Aedes aegypti</em> and <em>Aedes albopictus</em>, that may be found in close to where people live. These mosquitoes are found in water-holding containers (such as potted plant saucers, rainwater tanks), water-filled plants, and tree holes. They also like to bite people.</p>
<p>The mosquitoes that spread these viruses are not currently widespread in Australia; they’re generally limited to central and far north Queensland. They are routinely detected through biosecurity surveillance at Australia’s major <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005993/">airports and seaports</a>. With a rapid return to international travel, movement of people and their belongings may become an ever-increasing pathway of introduction of the diseases and mosquitoes back into Australia.</p>
<p>Different mosquitoes are involved in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000427/">transmission</a> of West Nile virus and Japanese encephalitis. These mosquitoes are more likely to be found in wetlands and bushland areas than backyards. They bite people but they also like to <a href="https://theconversation.com/how-australian-wildlife-spread-and-suppress-ross-river-virus-107267">bite the animals</a> most likely to be carrying these viruses. </p>
<p>The <a href="https://theconversation.com/japanese-encephalitis-virus-has-been-detected-in-australian-pigs-can-mozzies-now-spread-it-to-humans-178017">emergence of Japanese encephalitis</a>, a virus spread by mosquitoes between waterbirds, pigs, and people, is a perfect example. Extensive rains and flooding that provide idea conditions for mosquitoes and these animals create a “perfect storm” for disease emergence. </p>
<p><strong>– Cameron Webb & Andrew van den Hurk</strong></p>
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Read more:
<a href="https://theconversation.com/japanese-encephalitis-virus-has-been-detected-in-australian-pigs-can-mozzies-now-spread-it-to-humans-178017">Japanese encephalitis virus has been detected in Australian pigs. Can mozzies now spread it to humans?</a>
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<h2>3. Orthomyxoviridae</h2>
<p><strong><em>Influenza</em></strong></p>
<p>Before COVID-19, influenza was the infection most <a href="https://www.health.gov.au/resources/publications/australian-health-management-plan-for-pandemic-influenza-ahmppi">well-known</a> for causing pandemics.</p>
<p>Influenza virus is subdivided into types (A, B, and rarely C and D). Influenza A is further classified into subtypes based on haemagglutinin (H) and neuraminidase (N) protein variants on the surface of the virus. Currently, the most common influenza strains in humans are A/H1N1 and A/H3N2.</p>
<p><a href="https://www.who.int/news-room/spotlight/influenza-are-we-ready/zoonotic-influenza">Zoonotic infection</a> occurs when influenza strains that primarily affect animals “spill over” to humans. </p>
<p>Major changes in the influenza virus usually result from <a href="https://www.nejm.org/doi/full/10.1056/NEJMp0904572">new combinations</a> of influenza viruses that affect birds, pigs and humans. New strains have the potential to cause pandemics as there is little pre-existing immunity.</p>
<p>Since the beginning of the 20th century, there have been four influenza <a href="https://www.cdc.gov/flu/pandemic-resources/basics/past-pandemics.html">pandemics</a>, in 1918, 1957, 1968, and 2009. In between pandemics, seasonal influenza circulates throughout the world. </p>
<p>Although influenza is not as infectious as many other respiratory infections, the very short incubation period of around 1.4 days means outbreaks can spread quickly.</p>
<p>Vaccines are available to prevent influenza, but are only <a href="https://pubmed.ncbi.nlm.nih.gov/31903487/">partially</a> protective. Antiviral treatments are available, including oseltamivir, zanamivir, peramivir and baloxavir. Oseltamivir <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62449-1/fulltext">decreases</a> the duration of illness by around 24 hours if started early, but whether it reduces the risk of severe influenza and its complications is <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600%2814%2970041-4/fulltext">controversial</a>.</p>
<p><strong>– Allen Cheng</strong> </p>
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Read more:
<a href="https://theconversation.com/my-year-as-victorias-deputy-chief-health-officer-on-the-pandemic-press-conferences-and-our-covid-future-166164">My year as Victoria's deputy chief health officer: on the pandemic, press conferences and our COVID future</a>
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<h2>4. Paramyxoviridae</h2>
<p><strong><em>Nipah virus, Hendra virus</em></strong></p>
<p>Paramyxoviridae are a large group of viruses that affect humans and animals. The most well known are measles and mumps, as well as parainfluenza virus (a common cause of <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Croup/">croup</a> in children). </p>
<p>Globally, <a href="https://www.who.int/news-room/fact-sheets/detail/measles">measles</a> is a dangerous disease for young children, particularly those who are malnourished. Vaccines are highly effective with the measles vaccine alone <a href="https://www.who.int/news/item/12-11-2015-measles-vaccination-has-saved-an-estimated-17-1-million-lives-since-2000">estimated</a> to have saved 17 million lives between 2000 and 2014.</p>
<p>One group of paramyxoviruses is of particular importance for pandemic planning – henipaviruses. This includes Hendra virus, Nipah virus and the new <a href="https://theconversation.com/what-is-this-new-langya-virus-do-we-need-to-be-worried-188577">Langya virus</a> (as well as the fictional MEV-1 in the film <a href="https://www.reuters.com/article/idUS57323549020110913">Contagion</a>). These are all zoonoses (diseases that spill over from animals to humans)</p>
<p>Hendra virus was first <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/j.1326-5377.1995.tb126050.x">discovered</a> in Queensland in 1994, when it caused the deaths of 14 horses and their horse trainer. Infected flying foxes have since spread the virus to horses in Queensland and northern New South Wales. There have been seven <a href="https://www.outbreak.gov.au/for-vets-and-scientists/hendra-virus">reported</a> human cases of Hendra virus in Australia, including four deaths.</p>
<p>Nipah virus is more <a href="https://www.who.int/news-room/fact-sheets/detail/nipah-virus">significant</a> globally. Infection may be mild, but some people develop encephalitis (inflammation of the brain). Outbreaks frequently occur in Bangladesh, where the first <a href="https://pubmed.ncbi.nlm.nih.gov/10781618/">outbreak</a> was reported in 1998. Significantly, Nipah virus appears to be able to be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547369/">transmitted</a> from person-to-person though close contact.</p>
<p><strong>– Allen Cheng</strong></p>
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Read more:
<a href="https://theconversation.com/what-is-this-new-langya-virus-do-we-need-to-be-worried-188577">What is this new Langya virus? Do we need to be worried?</a>
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<h2>5. Togaviridae (alphaviruses)</h2>
<p><strong><em>Chikungunya fever, Ross River fever, Eastern equine encephalitis, Western equine encephalitis, Venezuelan equine encephalitis</em></strong></p>
<p>The most common disease symptoms caused by infection with alphaviruses like chikungunya and Ross River viruses are fever, rash and painful joints.</p>
<p>Like some flaviviruses, <a href="https://www.who.int/news-room/fact-sheets/detail/chikungunya">chikungunya virus</a> is thought to be only spread by <em>Aedes aegypti</em> mosquitoes in Australia. This limits risks, for now, to central and far north Queensland. </p>
<p>Many different mosquitoes play a role in transmission of alphaviruses, including dozens of mosquito species suspected as playing a role in the spread of <a href="http://conditions.health.qld.gov.au/HealthCondition/condition/14/217/120/ross-river-virus">Ross River fever</a>. Many of these mosquitoes <a href="https://theconversation.com/how-can-the-bite-of-a-backyard-mozzie-in-australia-make-you-sick-171601">are commonly found across Australia</a>. </p>
<p>But what role may these local mosquitoes play should diseases such as eastern equine encephalitis or western equine encephalitis make their way to Australia? Given the capacity of our home-grown mosquitoes to spread other alphaviruses, it is reasonable to assume they would be effective at transmitting these as well. That’s why the CSIRO report <a href="https://www.csiro.au/pandemic">notes</a> future pandemic preparation should work alongside Australia’s established biosecurity measures. </p>
<p><strong>– Cameron Webb & Andrew van den Hurk</strong></p>
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Read more:
<a href="https://theconversation.com/how-can-the-bite-of-a-backyard-mozzie-in-australia-make-you-sick-171601">How can the bite of a backyard mozzie in Australia make you sick?</a>
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<p class="fine-print"><em><span>Allen Cheng receives funding from the Australian National Health and Medical Research Council and the Australian government for research, including in influenza. He is Chair of the Advisory Committee for Vaccines and a member of the Australian Technical Advisory Group on Immunisation. </span></em></p><p class="fine-print"><em><span>Andrew van den Hurk has received funding from local, state and federal agencies to study the ecology of mosquito-borne pathogens, and their surveillance and control. He is an employee of the Department of Health, Queensland Government.</span></em></p><p class="fine-print"><em><span>Cameron Webb and the Department of Medical Entomology, NSW Health Pathology, have been engaged by a wide range of insect repellent and insecticide manufacturers to provide testing of products and provide expert advice on mosquito biology. Cameron has also received funding from local, state and federal agencies to undertake research into mosquito-borne disease surveillance and management.</span></em></p><p class="fine-print"><em><span>Damian Purcell consults for Moderna on mRNA vaccine education and receives funding from the National Health and Medical Research Council, and the Victorian Government grants. He is Past Presidents' advisor for the Australasian Virology Society, and Committee member of the RNA Network of Australia.</span></em></p>Authorities have been warned about five virus families that could cause future pandemics. Here are snapshots of the diseases each can cause and why we should be worried.Allen Cheng, Professor in Infectious Diseases Epidemiology, Monash UniversityAndrew van den Hurk, Medical Entomologist, The University of QueenslandCameron Webb, Clinical Associate Professor and Principal Hospital Scientist, University of SydneyDamian Purcell, Professor of virology and theme leader for viral infectious diseases, The Peter Doherty Institute for Infection and ImmunityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1702432021-10-28T10:24:25Z2021-10-28T10:24:25ZNipah virus: could it cause the next pandemic?<figure><img src="https://images.theconversation.com/files/427769/original/file-20211021-25-6u33j0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fruit bats are the main animal host of the nipah virus</span> <span class="attribution"><a class="source" href="https://pixabay.com/photos/fruit-bats-bats-megabats-chiroptera-5586143/">BTS-BotrosTravelSolutions / Pixabay</a></span></figcaption></figure><p>The severe and devastating consequences of the coronavirus pandemic were undoubtedly made worse by a substantial lack of pandemic preparedness, with the exception of East and South East Asia, which had built up defences after their experience with SARS in 2003. So it is crucial that governments begin to develop strategies to protect us if other deadly viruses emerge. </p>
<p>A recent outbreak of Nipah virus in India has raised the question of whether we should start to consider it as a future threat, and look to build up our arsenal of defences now.</p>
<p>The rapid development of vaccines against the novel coronavirus, SARS-CoV-2, have provided a pathway out of this pandemic. So, if vaccines for other potentially dangerous viruses could be developed and stockpiled, they could be rolled out as soon as any new outbreak is detected. We would then be ahead of the curve and a pandemic could be avoided. </p>
<p>This approach is laudable - but it assumes that viruses with pandemic potential can be identified in advance, which is not easy to do. And it also runs the risk that a “don’t worry, there’s a vaccine” mindset might cause simpler preventative methods to be overlooked.</p>
<p>Nipah virus was first identified in Malaysia in 1998. Cases such as the <a href="https://www.cbsnews.com/news/nipah-virus-outbreak-india-kerala/">recent death of a boy</a> in Kerala, India have raised <a href="https://www.who.int/activities/prioritizing-diseases-for-research-and-development-in-emergency-contexts">concerns</a> that it could mutate and increase its efficiency of transmission, leading <a href="https://www.thesun.co.uk/health/16394382/nipah-virus-kills-half-victims-next-pandemic-threat-gilbert/">to widespread circulation.</a></p>
<p>That scenario is frightening as the virus currently has a case fatality rate of over 50% and there is no vaccine or tried-and-tested treatment. </p>
<p>But before we can invest resources into vaccine development against Nipah we need to assess whether it is a realistic pandemic threat. And even if it is, there are other viruses out there, so we must understand where it should rank on the list of priorities.</p>
<h2>Assessing the pandemic risk of Nipah</h2>
<p>To assess the risk we need to look at how the virus transmits and replicates. </p>
<p>Nipah is a paramyxovirus. It is related to a human virus, human parainfluenza virus, one of the handful of viruses that cause the common cold. Its natural host is the fruit bat, the large and small flying foxes which are distributed across South and Southeast Asia. All cases of human infection with the Nipah virus to date have been due to direct or indirect contact with infected bats. </p>
<p>The infection in bats is sub-clinical, so goes largely unnoticed. Virus is excreted in the urine which, via grooming and crowding, ensures transfer within and between colonies. </p>
<p>Fruit or fruit juice contaminated by bat urine is the principal route of virus transmission to people. </p>
<p>A <a href="https://www.pnas.org/content/117/46/29190">long-term study in Bangladesh</a>, where regular Nipah virus outbreaks occur among its people, suggests that bat population density, virus prevalence and people drinking raw date palm sap are the main factors explaining the pattern of transmission. The bats contaminate the sap while it is being tapped from the date palm tree, and it is then consumed locally. </p>
<p>That is an important finding. As we have seen with SARS-CoV-2, better transmitting viruses evolve while the virus is circulating among its human, not animal, hosts. So, keeping the number of infections in people to a minimum not only minimises the death rate from Nipah itself but also reduces the chance of virus adaptation. Stop the transmission and you stop the pandemic threat. </p>
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<img alt="A tree with many branches with green leaves and hanging date palm fruit" src="https://images.theconversation.com/files/427766/original/file-20211021-16-1bmb8qn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427766/original/file-20211021-16-1bmb8qn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427766/original/file-20211021-16-1bmb8qn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427766/original/file-20211021-16-1bmb8qn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427766/original/file-20211021-16-1bmb8qn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427766/original/file-20211021-16-1bmb8qn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427766/original/file-20211021-16-1bmb8qn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The fruit of the date palm tree is a key source of transmission from bat to human.</span>
<span class="attribution"><a class="source" href="https://pixabay.com/photos/date-palm-palm-tree-dates-223250/">Simon/Pixabay</a></span>
</figcaption>
</figure>
<p>In the cases of human infection, so far, there has been limited spread to only close contacts of the primary infected individual, such as family members or, if the person is hospitalised, hospital staff. </p>
<p>General transmission does not occur, mainly because the proteins the Nipah virus uses to enter cells, the receptors, are concentrated in brain and central nervous tissues. </p>
<p>Nipah infection leads to death by acute encephalitis in most cases as the virus replicates best in the tissues where it is easy for the virus to enter the cells.</p>
<p>The virus does replicate to a small degree in the vasculature, the blood vessels which provide a route for the virus to travel from consumed foodstuffs to the nervous system. But the central nervous system preference also suggests why onward transmission is limited. The virus cannot easily transmit from there. </p>
<p>Of course a very sick individual will have virus everywhere, but as with Ebola, the virus is not efficiently transmitted by the respiratory route and requires touch or transfer of body fluids. Very close contact is required to infect someone else.</p>
<p>The chance of the virus changing to replicate in the upper respiratory tract, from where it certainly would be more transmissible, is small, and while this does not rule out pandemic potential it significantly lessens its probability. Like other regular zoonotic infections, the spillover event itself from bat to human, and the immediate people affected is more the issue than the potential for epidemic spread. </p>
<p>There is a case for a Nipah vaccine, but more for emergency use in those in contact with a primary case than for a vaccination campaign in general. </p>
<p>The case against it rests on the fact that absolute numbers are low, costs high and outbreaks so sporadic that a clinical trial would be very difficult to organise. Research has shown that therapeutic antibody is effective and that would make a far more practical treatment option in the short term. </p>
<p>In my view, Nipah does not pose a high risk of causing a pandemic. Its current pattern of outbreak is likely to remain the norm. Instead, as has been discussed elsewhere, we need to ensure that surveillance, improved awareness and effective <a href="https://pubmed.ncbi.nlm.nih.gov/34389832/">public health measures</a> are in place and adhered to. They will have a much bigger impact on the control of Nipah virus cases in the immediate future. </p>
<p>As for pandemic preparedness in the medium and long term, we need to turn our attention to identifying which other viruses pose a threat and work to develop vaccines and other defensive measures against those.</p><img src="https://counter.theconversation.com/content/170243/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Jones receives funding from BBSRC, Wellcome Trust and the Bill and Melinda Gates Foundation. </span></em></p>Virologists are beginning to assess which other viruses could have pandemic potentialIan Jones, Professor of Virology, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1342262020-05-12T15:29:36Z2020-05-12T15:29:36ZHuman activities are responsible for viruses crossing over from bats and causing pandemics like coronavirus<figure><img src="https://images.theconversation.com/files/332082/original/file-20200502-42923-1jb2q4v.jpg?ixlib=rb-1.1.0&rect=16%2C0%2C5542%2C3700&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Egyptian pipistrelle bat is one of seven bat species associated with spreading the coronavirus Middle East Respiratory Syndrome.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Viruses are naturally occurring entities. <a href="http://doi.org/10.1126/sciadv.1500527">Viruses have existed on Earth long before humans</a> and <a href="https://doi.org/10.1038/nrmicro2644">vastly outnumber humans</a>. There are <a href="https://doi.org/10.1038/nature19094">more viruses on Earth</a> than there are <a href="https://doi.org/10.1139/gen-2013-0152">stars in the universe</a> or <a href="https://www.tandfonline.com/doi/abs/10.3109/03014460.2013.807878">cells in the human body</a>. </p>
<p>As a cellular microbiologist who has studied <a href="http://dx.doi.org/10.1128/jmbe.v15i1.707">the origin and development of infectious diseases and their prevention</a>, understanding where infectious agents come from is as important, if not more important, to understanding how to combat the rampant spread of diseases within the human population. </p>
<p>Fortunately, only a small fraction — <a href="http://doi.org/10.1098/rstb.2011.0354">about 200</a> — of this vast array of viruses can infect humans. Some of the better-known human viral infections include measles, varicella, polio, human papilloma virus, influenza and rhinoviruses, which are typically responsible for the common cold. </p>
<p>An even smaller number of viruses are responsible for the deadliest human infections that we have experienced. In recent decades these include rabies virus, human immunodeficiency virus (HIV), Ebola virus and now, infamously, coronaviruses. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/327416/original/file-20200413-174608-omeq7p.jpg?ixlib=rb-1.1.0&rect=9%2C0%2C2035%2C2026&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/327416/original/file-20200413-174608-omeq7p.jpg?ixlib=rb-1.1.0&rect=9%2C0%2C2035%2C2026&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/327416/original/file-20200413-174608-omeq7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/327416/original/file-20200413-174608-omeq7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/327416/original/file-20200413-174608-omeq7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/327416/original/file-20200413-174608-omeq7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/327416/original/file-20200413-174608-omeq7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/327416/original/file-20200413-174608-omeq7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A colour-enhanced image of SARS-CoV-2 virus particles, isolated from a patient.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/niaid/49597020648/in/album-72157712914621487/">(National Institute of Allergy and Infectious Diseases Integrated Research Facility)</a></span>
</figcaption>
</figure>
<p>Viruses that circulate in other animals can enter a human population when <a href="https://dx.doi.org/10.1086%2F652860">a variety of human activities</a> allow for consistent and regular interaction with naturally occurring reservoirs. These events involve repeated and routine <a href="http://doi.org/10.1056/NEJMra1108296">interaction of humans with these animal hosts</a>. </p>
<p>Some of these interactions take place through the following <a href="https://www.unenvironment.org/news-and-stories/story/six-nature-facts-related-coronaviruses">human activities</a>: hunting, butchering and farming (husbandry), as well as the global trade of animals and domestication of exotic animals as pets. Population growth, global travel and <a href="https://www.who.int/globalchange/summary/en/index5.html">climate change</a> that cause the disruption of habitats further provide opportunities for cross-species transfer.</p>
<h2>Cross-species transfer</h2>
<p>Many of the viruses that have affected us over the past 20 years have emerged from non-human reservoirs. Reservoirs are the source of viruses and other pathogens and can be located in animal populations or the natural environment. What is of note is that <a href="https://doi.org/10.1038/cddiscovery.2016.48">the original reservoir for many of these viruses are bats</a>. </p>
<p>Bats have been shown to be the <a href="https://dx.doi.org/10.1128%2FCMR.00017-06">natural reservoir</a> of numerous deadly human viruses. The specialized immune systems of bats allow multiple different types of viruses to persist within these hosts. The coexistence of these <a href="https://dx.doi.org/10.1098%2Frspb.2012.2753">viruses within the same host</a> in combination with the molecular makeup of viruses further allows for the emergence of deadly human diseases. Bats aren’t all bad though; they have an <a href="https://theconversation.com/its-wrong-to-blame-bats-for-the-coronavirus-epidemic-134300">important role in our ecosystem</a>. </p>
<h2>Current COVID-19 pandemic</h2>
<p>The current <a href="https://doi.org/10.1016/S0140-6736(03)15329-9">coronavirus pandemic has been traced to a wet market, called the Huanan Seafood Wholesale Market, in Wuhan, China</a>. Within these wet markets, numerous animals are held together in confined spaces and small cages. This setting is inherently stressful and can allow for the exchange and mixing of multiple different bodily fluids. Human handling of these animals allows for <a href="http://doi.org/10.1097/01.qco.0000244043.08264.fc">the viruses contained within these reservoirs to spill over into the human population</a>. This is further facilitated by the long working hours and stress of the handlers themselves, as well as cuts, scratches, bites or other wounds inflicted by the animals on their handlers. </p>
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Read more:
<a href="https://theconversation.com/coronavirus-live-animals-are-stressed-in-wet-markets-and-stressed-animals-are-more-likely-to-carry-diseases-135479">Coronavirus: live animals are stressed in wet markets, and stressed animals are more likely to carry diseases</a>
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<p>A similar confluence of factors was attributed to the 2002 outbreak of SARS, <a href="https://doi.org/10.1007/978-3-540-70962-6_13">which has been attributed to the virus crossing over from bats to civets</a>. The related MERS-CoV was <a href="http://dx.doi.org/10.3201/eid1911.131172">attributed to a bat reservoir in Saudi Arabia</a>.</p>
<h2>Ebola outbreaks</h2>
<p>Outbreaks of Ebola in West Africa (2014-16 and 2018-present) have been attributed <a href="https://dx.doi.org/10.1007%2F82_2017_11">to human interaction with bats</a>. Three subfamilies of fruit bats — <em>Hypsignathus monstrosus</em>, <em>Epomops franqueti</em> and <em>Myonycteris torquata</em> — <a href="https://doi.org/10.1038/438575a">have been identified as natural reservoirs for the Ebola virus</a>. </p>
<p>These bats <a href="https://www.sciencemag.org/news/2017/06/hunting-ebola-among-bats-congo">inhabit caves deep within the Ebola River Valley</a>. Cross-species transmission of the Ebola virus from bats to humans can occur either directly or via intermediary hosts such as non-human primates, horses or pigs. </p>
<p>Global travel allowed for the virus to <a href="https://www.who.int/csr/disease/ebola/en/">spread from Central Africa to West Africa, and subsequently Europe and North America</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/332081/original/file-20200502-42908-1oteam2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/332081/original/file-20200502-42908-1oteam2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/332081/original/file-20200502-42908-1oteam2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=339&fit=crop&dpr=1 600w, https://images.theconversation.com/files/332081/original/file-20200502-42908-1oteam2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=339&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/332081/original/file-20200502-42908-1oteam2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=339&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/332081/original/file-20200502-42908-1oteam2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=427&fit=crop&dpr=1 754w, https://images.theconversation.com/files/332081/original/file-20200502-42908-1oteam2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=427&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/332081/original/file-20200502-42908-1oteam2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=427&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A sign in Makoua, Congo, warns visitors that Ebola is present in the area, and to avoid handling any animals found dead.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>The Hendra virus</h2>
<p>The Hendra virus (HeV) has been a persistent infection of <a href="https://doi.org/10.5694/j.1326-5377.1995.tb126050.x">horses and humans in Australia since 1994</a>. Transmission into the equine population has been attributed to <a href="https://doi.org/10.1016/S1473-3099(12)70158-5">food or water contaminated with bat feces, urine or saliva</a>. HeV originated in black flying foxes, and its transmission to horses and humans results in a severe respiratory disease. </p>
<p>Subsequent transmission from horses to humans involves the close contact of humans with the <a href="https://www.cdc.gov/vhf/hendra/transmission/index.html">bodily fluids of infected horses</a>. Fortunately, <a href="http://doi.org/10.1016/j.coviro.2016.02.004">horse-to-horse, human-to-horse and bat-to-human transmission of hendra virus (HeV) is currently limited</a>. As a result, <a href="https://www.who.int/health-topics/hendra-virus-disease">this viral infection has not lead to widespread infections or fatalities</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/327418/original/file-20200413-109081-fryzhj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/327418/original/file-20200413-109081-fryzhj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/327418/original/file-20200413-109081-fryzhj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=447&fit=crop&dpr=1 600w, https://images.theconversation.com/files/327418/original/file-20200413-109081-fryzhj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=447&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/327418/original/file-20200413-109081-fryzhj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=447&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/327418/original/file-20200413-109081-fryzhj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=562&fit=crop&dpr=1 754w, https://images.theconversation.com/files/327418/original/file-20200413-109081-fryzhj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=562&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/327418/original/file-20200413-109081-fryzhj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=562&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Black flying foxes (<em>Pteropus alecto</em>) roosting in the Redcliffe Botanical Garden in Brisbane, Australia.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/niaid/49597020648/in/album-72157712914621487/">(gailhampshire/flickr)</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>The Nipah virus</h2>
<p>Nipah virus (NiV) infections have been occurring <a href="https://doi.org/10.1007/s00281-002-0106-y">in Bangladesh and Malaysia since 1998</a>. This virus causes respiratory disease and swelling of the brain — encephalitis — in pigs. Human contact with infected pigs results in severe encephalitis, fever and eventually death. This virus also emerged from fruit bats through a spill-over event with the <a href="https://doi.org/10.1007/s11908-006-0036-2">close proximity of living conditions</a> between humans, domesticated animals and the natural reservoir. </p>
<p>Altogether, it is clear that human activities play a role in the emergence or re-emergence of infectious diseases. The role of <a href="http://dx.doi.org/10.1038/cddiscovery.2016.48">bats as natural reservoirs</a> to numerous deadly human diseases is also very clear.</p>
<p>The uncertainty of subsequent outbreaks or pandemics is not related to how or why but rather a question of when.</p><img src="https://counter.theconversation.com/content/134226/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Narveen Jandu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Bats have been the reservoir for recent disease outbreaks, including SARS and the current COVID-19 pandemic. But it’s human activity that allows the virus to cross over.Narveen Jandu, School of Public Health & Health Studies, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1069842018-12-12T22:18:20Z2018-12-12T22:18:20Z‘One Health’ keeps humans one step ahead of the microbes<figure><img src="https://images.theconversation.com/files/250101/original/file-20181211-76986-1kmbgd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Paramedics bury a man who died of the Nipah virus in Kozhikode, southern India, in May 2018. There is no vaccine for the virus, which can cause raging fevers, convulsions and vomiting, and kills up to 75 per cent of people infected. </span> <span class="attribution"><span class="source">(AP Photo/K.Shijith)</span></span></figcaption></figure><p>For a healthy planet, the health of all living creatures is equally important. <a href="https://www.cdc.gov/onehealth/index.html">One Health</a> is a fairly new concept that prioritizes an interdisciplinary approach in science — to preserve the health of animals, humans and the environment. It is an approach that can be extended to any problem. </p>
<p>The <a href="https://www.cdc.gov/onehealth/basics/history/index.html">history of One Health</a> can be traced to the term “One Medicine,” coined by veterinary epidemiologist <a href="https://senate.universityofcalifornia.edu/_files/inmemoriam/html/calvinwschwabe.htm">Calvin Schwabe</a> and the later <a href="http://www.oneworldonehealth.org/sept2004/owoh_sept04.html">12 Manhattan Principles</a>, published by the Wildlife Conservation Society in 2004. The United States Centers for Disease Control and Prevention (CDC) has a <a href="https://www.cdc.gov/onehealth/in-action/index.html">website listing several One Health projects</a> and several other organisations now operate on similar principles — such as the <a href="https://www.onehealthcommission.org">One Health Commission</a>, <a href="http://www.onehealthinitiative.com">One Health initiative</a> and <a href="https://www.onehealthplatform.com">One Health platform</a>. </p>
<p>This approach is important now because <a href="https://wwwnc.cdc.gov/eid/page/zoonoses-2018">75 per cent of emerging infectious diseases in humans have an animal origin</a>. As our human population expands, <a href="https://doi.org/10.1073/pnas.1208059110">deforestation and climate change</a> will increase the potential for transfer of microorganisms from wildlife to humans and vice versa.</p>
<p>In this article, we have used two examples to explain the principles of One Health. We highlight how they enable us to tackle emerging problems that require solutions at the human-animal-environment interface. </p>
<h2>Identifying a new deadly virus</h2>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pubmed/19108397">1999 Nipah virus encephalitis</a> outbreak in Malaysia is a classic example of a high-impact disease that was contained with the help of One Health principles. </p>
<p>Nipah virus infected more than <a href="https://jcm.asm.org/content/56/6/e01875-17">265 people and killed 40 per cent</a> of them. This virus also caused significant disease in pigs in Malaysia, which led to the <a href="https://doi.org/10.1016/S0140-6736(05)74483-4">culling of domestic pig herds</a>. </p>
<p>When the outbreak was first reported, the Malaysian government hastily responded by <a href="https://doi.org/10.1086/338818">vaccinating against Japanese encephalitis virus (JEV)</a>. Since JEV is endemic in that region, this seemed like a logical decision. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/250104/original/file-20181211-76980-1ow96uo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/250104/original/file-20181211-76980-1ow96uo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=905&fit=crop&dpr=1 600w, https://images.theconversation.com/files/250104/original/file-20181211-76980-1ow96uo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=905&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/250104/original/file-20181211-76980-1ow96uo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=905&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/250104/original/file-20181211-76980-1ow96uo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1138&fit=crop&dpr=1 754w, https://images.theconversation.com/files/250104/original/file-20181211-76980-1ow96uo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1138&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/250104/original/file-20181211-76980-1ow96uo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1138&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pig farm workers kick live pigs into a large grave in Sungai Nipah, Malaysia, 1999.</span>
<span class="attribution"><span class="source">(AP Photo/Andy Wong)</span></span>
</figcaption>
</figure>
<p>However, it soon became apparent that the outbreak was not caused by JEV. It took a tremendous amount of <a href="https://www.ncbi.nlm.nih.gov/pubmed/19108397">effort and international collaboration</a> to bring together a team of veterinarians, clinicians, epidemiologists, environmental scientists, anthropologists and wildlife specialists to tackle this outbreak. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/19108397">To contain the contagion,</a> this team had to identify a novel infectious agent (Nipah virus), identify a potential reservoir host (bats) and then modify the natural setting (farming practices) by separating fruit trees and pig farms. </p>
<p>Subsequently, <a href="http://www.searo.who.int/entity/emerging_diseases/links/CDS_Nipah_Virus.pdf?ua=1">Malaysia developed policies</a> to minimize contact between wildlife (bats) and domestic animals (pigs). This approach reduced the possibility of Nipah virus transmission from wildlife to other animals and humans. </p>
<p>Although the term One Health had not been coined yet, these experts used similar principles — to form interdisciplinary teams to contain an infectious disease at the human-animal-environment interface. </p>
<h2>Tackling antibiotic resistance</h2>
<p>The growing problem of <a href="https://theconversation.com/canada-could-lead-the-fight-for-life-in-a-post-antibiotic-world-80864">antimicrobial resistance</a> (AMR) is known to most. As bacteria around us become resistant to the full spectrum of antibiotics, we are struggling to discover newer replacement drugs. The problem of AMR is multifaceted. It involves an intricate network between humans, animals and the environment. </p>
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Read more:
<a href="https://theconversation.com/humanity-under-threat-from-antibiotic-resistant-infections-106682">Humanity under threat from antibiotic-resistant infections</a>
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<p>As humans, we need to regulate the use of antibiotics. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3203003/pdf/mayoclinproc_86_11_012.pdf">Antibiotic stewardship</a> is critical to prevent the over, and often unnecessary, use of these drugs. The rise of AMR is increasing the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644569/">burden on our public health infrastructures globally</a>. </p>
<p>In order to limit this problem, the involvement of multiple governmental agencies, non-profits, research institutions and, more importantly, the dedication and determination of the public, is required. </p>
<p>In certain countries, antibiotics are <a href="https://www.telegraph.co.uk/news/2018/07/10/antibiotics-frequently-supplied-without-prescription-global/">freely available without a prescription</a>. How do we change this practice? What role does the government play in setting out policies restricting the distribution of over-the-counter antibiotics? Are big pharmaceutical companies lobbying governments and providing physicians and pharmacists with incentives to “sell” more antibiotics? </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/250113/original/file-20181211-76980-15h1vaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/250113/original/file-20181211-76980-15h1vaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/250113/original/file-20181211-76980-15h1vaj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/250113/original/file-20181211-76980-15h1vaj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/250113/original/file-20181211-76980-15h1vaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/250113/original/file-20181211-76980-15h1vaj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/250113/original/file-20181211-76980-15h1vaj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Antibiotics are commonly used to fatten the animals that supply the chicken, turkey, beef and pork we eat every day. Here, turkeys raised without the use of antibiotics are seen at David Martin’s farm, in Lebanon, Pa.</span>
<span class="attribution"><span class="source">(AP Photo/Matt Rourke)</span></span>
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</figure>
<p>In certain regions of the planet, antibiotics are <a href="https://www.nejm.org/doi/full/10.1056/NEJM200110183451610?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed">used in agricultural animals such as cattle to boost their growth</a>. These antibiotics can <a href="http://jfoodprotection.org/doi/pdf/10.4315/0362-028X-47.8.647">enter our food chain through milk</a> and other dairy and <a href="https://doi.org/10.1016/S0924-8579(00)00144-8">animal products</a> or give rise to <a href="https://doi.org/10.1098/rspb.2018.0332">resistant bacteria</a>. </p>
<p>In <a href="https://albertamilk.com/ask-dairy-farmer/ive-started-buying-organic-milk-based-on-the-assum/">Canada, there are policies preventing a farmer from milking a cow while it is taking antibiotics</a>. However, such policies are relaxed or even absent in some countries. How do we regulate adherence to these policies? Why should a farmer refrain from milking a cow that is being treated with antibiotics? </p>
<p>These are complicated questions. In certain situations, dairy produced from cattle enables a farmer to put food on the table for his or her family. There needs to be a principle of compensation, rather than penalties, for more compliance from the farming community. But again, where does a government in a resource-starved situation find the money for compensation? </p>
<p>Thus, antibiotic resistance is not just a biological problem, it is indeed <a href="https://doi.org/10.1093/trstmh/trw048">a true One Health problem</a>, which will require a tremendous team effort at the global level.</p>
<h2>Generating holistic approaches</h2>
<p>One Health does not solely depend on creating a vaccine or a therapeutic to tackle novel pathogens, which is often difficult and time-consuming. Instead, it aligns different disciplines to develop holistic and effective approaches to limit the transmission of disease. </p>
<p>This effort includes changing agricultural practices, traditional practices and superstitious beliefs — all of which come with a lot of challenge. </p>
<p>One Health is allowing health scientists, physicians, veterinarians, social scientists, economists and more importantly, local communities, to connect and communicate to solve the emerging problems of tomorrow.</p><img src="https://counter.theconversation.com/content/106984/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arinjay Banerjee is affiliated with (V.A.S.T.) Veterinarians Abroad Supporting and Teaching as a volunteer virology advisor. AB is funded by a Michael G. DeGroote postdoctoral fellowship at McMaster University. AB has previously served as the Secretary General of Students for One Health, the student chapter of the One Health Commission. </span></em></p><p class="fine-print"><em><span>Karen Mossman receives funding from the Natural Sciences and Engineering Research Council and the Canadian Institutes for Health Research. </span></em></p><p class="fine-print"><em><span>Kaushal Baid does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As new viruses “jump” from wildlife to humans and we struggle with antimicrobial resistance and even climate change, a new interdisciplinary approach to human health might just save the day.Arinjay Banerjee, Postdoctoral Research Fellow, McMaster UniversityKaren Mossman, Professor of Pathology and Molecular Medicine and Acting Vice President, Research, McMaster UniversityKaushal Baid, PhD Student in Biochemistry and Biomedical Sciences, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/947472018-07-03T01:45:46Z2018-07-03T01:45:46ZHumans are to blame for the rise in dangerous viral infections<p>Today, we hear about dangerous viral infections around the world on a regular basis. Social media and internet access may be an obvious explanation for their seeming increase.</p>
<p>But it doesn’t just seem this way. The number of viruses and the infections they cause are truly increasing. Scientific advances, the way humans live today and virus biology all contribute to the rise of viruses.</p>
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Read more:
<a href="https://theconversation.com/health-check-when-are-we-most-likely-to-catch-viral-diseases-36555">Health Check: when are we most likely to catch viral diseases?</a>
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<h2>New viruses, all the time</h2>
<p>It seems viral infections are everywhere these days. Starting from January 2018, Nigeria has been experiencing an unusually large outbreak of haemorrhagic fever caused by <a href="http://www.who.int/csr/don/20-april-2018-lassa-fever-nigeria/en/">Lassa virus</a>. There have been more than 400 confirmed infections and 100 deaths to date. </p>
<p>The southern Indian state of Kerala is battling an outbreak of the rare <a href="http://www.who.int/news-room/fact-sheets/detail/nipah-virus">Nipah virus</a>, which causes severe inflammation of the brain and claimed the <a href="https://indianexpress.com/article/india/nipah-death-toll-rises-to-14-in-kerala-two-more-cases-confirmed-5193201/">lives of 14 people</a> in May. </p>
<p>The Brazilian outbreak of viral <a href="http://www.who.int/csr/don/09-march-2018-yellow-fever-brazil/en/">yellow fever</a> that began in late 2017 has moved into highly populated areas near São Paulo and Rio de Janeiro. One-third of the 723 people with confirmed infections have so far died from the illness.</p>
<p>We’re no doubt more aware of such serious diseases after the unprecedented 2014-2016 <a href="https://www.bmj.com/content/352/bmj.i243">Ebola outbreak</a> in West Africa that claimed more than 11,000 lives. And then the 2015-2017 <a href="http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006007">Zika virus</a> outbreak that closely followed during which 3,500 babies were born with nervous system or eye damage. </p>
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Read more:
<a href="https://theconversation.com/zika-dengue-yellow-fever-what-are-flaviviruses-53969">Zika, dengue, yellow fever: what are flaviviruses?</a>
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<p>The <a href="http://rstb.royalsocietypublishing.org/content/367/1604/2864">first report</a> of human virus infection was <a href="https://www.wiki.sanitarc.si/1901-walter-reed-proved-finlay-s-theory-yellow-fever-transmitted-aedes-aegypti-mosquito/">yellow fever</a> in the US army at the turn of the 20th century. And now, estimates suggest three to four new species of human viruses are <a href="http://rspb.royalsocietypublishing.org/content/275/1647/2111">found each year</a> and around 250 human virus species are yet to be discovered.</p>
<p>Discovery of a new virus today is complex and requires many steps. Typically, it involves describing its complete genetic code with a combination of intensive molecular sequencing work in the laboratory and computational analyses using enormous reference databases. </p>
<p>Medical epidemiological studies (that look at the distribution of disease) and biological experiments are then needed to understand any virus as a dangerous human pathogen. It may then take some time to link a virus with a particular human disease. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/225269/original/file-20180628-112611-10ee357.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/225269/original/file-20180628-112611-10ee357.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/225269/original/file-20180628-112611-10ee357.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/225269/original/file-20180628-112611-10ee357.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/225269/original/file-20180628-112611-10ee357.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/225269/original/file-20180628-112611-10ee357.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/225269/original/file-20180628-112611-10ee357.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/225269/original/file-20180628-112611-10ee357.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Human parechoviruses were only discovered in the 1950s.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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</figure>
<p>For instance, <a href="http://www.health.nsw.gov.au/infectious/factsheets/pages/parechovirus.aspx">human parechoviruses</a> (which can cause severe disease in young children) were discovered in the 1950s. But they were <a href="https://www.ncbi.nlm.nih.gov/pubmed/14769896">only identified</a> as a cause of disease in young children in 2004. And relatively <a href="https://wwwnc.cdc.gov/eid/article/21/7/14-1149_article">large Australian epidemics</a> since 2013 have highlighted their link to a serious sepsis-like illness and potential for developmental complications.</p>
<h2>How humans contribute</h2>
<p>Modern humans contribute to the success of dangerous viruses. A virus replicates only when inside the cell of a living being, and spreads most efficiently when there is contact between two individuals. </p>
<p>The United Nations measures current <a href="https://esa.un.org/unpd/wpp/publications/Files/WPP2017_KeyFindings.pdf">world population growth</a> at more than 1% per year. From the virus’ perspective, potential incubators are increasing. The world’s population is also <a href="https://esa.un.org/unpd/wup/publications/Files/WUP2018-KeyFacts.pdf">urbanising</a>, which means people living in closer proximity, which is conducive to spread of a virus. </p>
<p>Domestic and international mass transport permit viruses to move between regional populations.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"997028865934442497"}"></div></p>
<p>Many dangerous virus infections are zoonoses, which are diseases transmitted to humans from other animals. Bats are a common culprit – one theory is that a <a href="https://www.ncbi.nlm.nih.gov/pubmed/29421321">unique low-grade immune system</a> allows them to carry a relatively high number of viruses without developing disease. Epidemics caused by severe acute respiratory syndrome (SARS) coronavirus probably began through bat-human contact. </p>
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Read more:
<a href="https://theconversation.com/why-bats-dont-get-get-sick-from-the-deadly-diseases-they-carry-55012">Why bats don't get get sick from the deadly diseases they carry</a>
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<p>Expanding settlement towards wilderness areas provides more opportunities for viruses to meet people. Domesticated livestock may carry viruses that infect humans, and the growing human population dictates increasing and more compact livestock production. </p>
<p>Influenza virus infects pigs, cattle and poultry as well as humans. The <a href="https://www.cdc.gov/flu/avianflu/h7n9-virus.htm">H7N9 strain</a> that has infected more than 1,500 people in China and resulted in the death of one-third since 2013, first moved to humans from diseased poultry.</p>
<p>When it comes to numbers though, the most <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61151-9/abstract">important viral transporter</a> is the mosquito. The bite of certain Aedes mosquitoes, for instance, is the primary route for infection with dengue, <a href="https://theconversation.com/explainer-where-did-zika-virus-come-from-and-why-is-it-a-problem-in-brazil-53425">Zika</a> and chikungunya viruses. Queensland is home to these mosquitoes, so outbreaks of dengue <a href="https://www.health.qld.gov.au/__data/assets/pdf_file/0022/444433/dengue-mgt-plan.pdf">occur annually</a>, usually due to an infected traveller arriving from an endemic region. </p>
<p>Research conducted in the Amazon has linked expansion of the mosquito range in endemic areas to <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61151-9/abstract">deforestation and low re-vegetation</a>. Resistance to the relatively few available insecticides may also contribute to their population growth.</p>
<h2>Why viruses are sneaky</h2>
<p>The basic biology of viruses contributes to their capacity to cause disease. Most human viruses replicate almost instantaneously and in huge numbers. As a result, mutations arise at a high rate in the genetic code of a virus. This allows the virus to adapt quickly to an adverse environment, such as the human immune system or drugs. It may also allow a virus to jump from an animal host to humans.</p>
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Read more:
<a href="https://theconversation.com/new-mosquito-threats-shift-risks-from-our-swamps-to-our-suburbs-56350">New mosquito threats shift risks from our swamps to our suburbs</a>
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<p>Some viruses establish a chronic infection, which extends the potential for transmission. After acute illness, Ebola virus hides for many months in parts of the body that generate weak inflammatory responses, such as the <a href="http://www.who.int/reproductivehealth/topics/rtis/ebola-virus-semen/en/">sexual organs</a>, the <a href="https://www.ncbi.nlm.nih.gov/pubmed/28721309">brain and/or the eye</a>.</p>
<p>And although human immunodeficiency virus (HIV) may cause an acute illness, there is usually a long delay between infection and the onset of any disease. Consequently infected people may pass on HIV for years before being aware that they carry the virus.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/225271/original/file-20180628-112604-1nqaooe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/225271/original/file-20180628-112604-1nqaooe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/225271/original/file-20180628-112604-1nqaooe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/225271/original/file-20180628-112604-1nqaooe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/225271/original/file-20180628-112604-1nqaooe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/225271/original/file-20180628-112604-1nqaooe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/225271/original/file-20180628-112604-1nqaooe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/225271/original/file-20180628-112604-1nqaooe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Mosquitoes are responsible for the most viral transmissions.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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</figure>
<p>There are no specific drugs for most dangerous human viruses. This is in part because viruses are a fast growing and diverse group, with no common drug targets to exploit, as has been possible with antibiotics for bacteria. </p>
<p>But another challenge relates to the viral life cycle, which uses the infected person’s cell machinery. Drugs that target the growth of viruses therefore have effects on the person’s cell, which may result in drug side effects. </p>
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Read more:
<a href="https://theconversation.com/hiv-latency-a-high-stakes-game-of-hide-and-seek-49665">HIV latency: a high-stakes game of hide and seek</a>
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<p>Also, the capacity of a virus to adapt implies the potential to develop resistance to a drug. Drug treatment for HIV infection involves a <a href="https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/21/56/drug-resistance#">combination of drugs</a> with different actions to address this problem.</p>
<p>Despite the many challenges associated with dangerous viruses, research continues to yield even more innovative solutions. The <a href="https://www.worldmosquitoprogram.org/">World Mosquito Program</a>, run out of Monash University, is one example. This program is based on the discovery that a safe and natural bacteria, <em>Wolbachia</em>, stops viral growth in the mosquito. Insects in regions endemic with mosquito-borne diseases are being infected with <em>Wolbachia</em> to break the transmission cycle. </p>
<p>Ultimately, the cunning strategies used by dangerous viruses are no match for the wide breadth of human ingenuity.</p><img src="https://counter.theconversation.com/content/94747/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Justine R. Smith receives funding from the National Health & Medical Research Council (NHMRC), the Australian Research Council (ARC) and the Rebecca L. Cooper Medical Research Foundation. She is a Science & Technology Australia Superstar of STEM.</span></em></p><p class="fine-print"><em><span>Jill Carr receives funding from the National Health and Medical Research Council (NHMRC). </span></em></p>It doesn’t just seem like the world is experiencing more viral infections than before – it’s a reality. And the way humans live today helps viruses thrive.Justine R. Smith, Professor of Eye & Vision Health, Flinders UniversityJill Carr, Associate Professor, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/442352015-07-03T05:45:50Z2015-07-03T05:45:50ZNorthern development plan shows Australia’s fraught vision of our tropics<figure><img src="https://images.theconversation.com/files/87268/original/image-20150703-30171-1b2zgbo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An historian reading the government White Paper on developing northern Australia will realise we’re actually heading all the way back to the 1890s.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/lawson_matthews/2415335571/">andrew matthews/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><blockquote>
<p>Australia is a big blank map, and the whole people is constantly sitting over it like a committee, trying to work out the ways to fill it in.</p>
</blockquote>
<p>Written as long ago as 1911, the <a href="http://trove.nla.gov.au/work/10819532">words of journalist C.E.W. Bean</a>, later inventor of the Anzac legend, haunted me as I read <a href="https://northernaustralia.dpmc.gov.au/sites/default/files/papers/northern_australia_white_paper.pdf">Our North, Our Future</a>, the federal government’s White Paper on developing northern Australia, released on June 17, 2015. </p>
<p>For more than 100 years, white Australians have rallied to cries of northern development, obsessively figuring out how to fill in the country north of Capricorn lest Asians should come and take it or Aborigines reclaim it. </p>
<p>Indeed, the first medical research organisation, the Australian Institute of Tropical Medicine (AITM), was set up in Townsville in the decade after federation in order to <a href="https://dukeupress.edu/The-Cultivation-of-Whiteness/index-viewby=title&sort=.html">ascertain whether a working white race</a> might be implanted across our tropical territory. Or whether moist heat would sap the vitality and mentality of whites, and tropical germs destroy them.</p>
<p>One of its later directors, Raphael Cilento, a very proud white man and anti-Semite, spent his career in “the struggle to establish a tropical consciousness in Australia” — as he put it in the Queensland school text he wrote with Clem Lack, <a href="http://www.textqueensland.com.au/item/book/1e6ed5d19fc3219033ff9a76eff6a190">Triumph in the Tropics</a>. </p>
<h2>A veritable goldmine</h2>
<p>Consistent with the barrage of tropical boosterism, the current government wants yet again to unlock the potential of the North and settle millions of productive citizens above Capricorn. Only it’s inclined now to bang on about fostering a multi-racial economic powerhouse rather than making the world safe for virile white labourers. </p>
<p>Thus the government is planning, inaptly, to use “Australia Unlimited branding to showcase investor ready projects and specific northern opportunities” — surely unaware that novelist E.J. Brady, who coined the term <a href="http://trove.nla.gov.au/work/8621138?selectedversion=NBD2972726">Australia Unlimited</a>, hoped the Australian tropics would be purely white and free of pesky Aborigines and Chinese.</p>
<p>Indeed, “unlimited for whom?” is always an apposite question in the history of Australian nationalism.</p>
<p>As an historian of medicine, I found the White Paper’s emphasis on tropical health particularly intriguing. A Tropical Health Strategy is a key part of this ambitious plan to develop what may be called <a href="http://www.harpercollins.com.au/9780730408871/capricornia">Capricornia</a> (following the lead of novelist Xavier Herbert). </p>
<p><a href="https://northernaustralia.dpmc.gov.au/sites/default/files/papers/northern_australia_white_paper.pdf">Our North, Our Future</a> suggests two compelling reasons for building expertise in tropical medicine. Investment in research into “tropical” diseases, such as dengue fever, malaria, melioidosis, Australian bat lyssavirus, Hendra virus, Nipah virus, chikungunya, Murray Valley encephalitis, multidrug-resistant tuberculosis and “other emerging pathogens” would, the report says, make Australia “a leading hub for the development of tropical medicine”. </p>
<p>The federal government has <a href="http://trademinister.gov.au/releases/Pages/2015/ar_mr_150510.aspx">allocated A$6.9 million for basic research</a> on such “priority diseases” — many of them dubiously tropical, but obviously worth treating all the same. And found a further A$8.5 million to “commercialise research in new tropical therapeutics and diagnostics”.</p>
<p>Understandably, Louis Schofield, the director of the Australian Institute of Tropical Health and Medicine, a reinvention of the AITM (but note the tactful insertion of health), has welcomed the investment. </p>
<p>“By promoting commercialisation and the creation of science/industry networks,” <a href="http://www.jcu.edu.au/research/JCU_147417.html">Professor Schofield announced</a>, “this funding initiative plays to Australia’s scientific strengths in the future economy of the Pacific Rim.”</p>
<h2>Pharmaceutical cashcow</h2>
<p>The government’s obsession with commercial opportunities in alleviating tropical disease is revealing. Certainly, it fits with technocratic, disease-centred, top-down programs of global health organisations such as the Bill and Melinda Gates Foundation. </p>
<p>“In calling the world’s researchers to develop innovative solutions to ‘the most critical challenges in global health’,” writes <a href="http://www.thelancet.com/pdfs/journals/lancet/PIIS0140673605664793.pdf">public health researcher Anne-Emanuelle Birn in The Lancet</a>, “the Gates Foundation has turned to a narrowly conceived understanding of health as product of technical interventions divorced from economic, social, and political contexts.” </p>
<p>But Australia’s Tropical Health Strategy goes further, hoping to profit from such technical fixes. This reveals a sort of cargo-cult mentality: build the laboratories and commercial medical technologies will pile up, solving the problems of global disease and making us rich as well. </p>
<p>In <a href="https://muse.jhu.edu/journals/hum/summary/v001/1.1.lakoff.html">an influential 2010 article</a>, anthropologist Andrew Lakoff describes “two regimes of global health”: what drives global health, he argues, is either concern with biosecurity, with emerging disease threats, or the humanitarian engagement of organisations like Médecins sans Frontières, which seeks to relieve suffering.</p>
<p>Naively, Lakoff failed to account for the “vision” of money-rubbing Australian politicians who imagine tropical medicine simply as a cash cow — or should that be a cash mosquito?</p>
<h2>Biosecurity fears</h2>
<p>Biosecurity is not forgotten, of course — how could it be in contemporary Australia? Apart from lucrative returns, the other main reason we should invest in tropical medicine, according to the White Paper, is to safeguard the nation from the threat of introduced diseases and pests. </p>
<p>Of course, this is an old saw, dating back to the first AITM: we must be vigilant against foreign bugs and the foreigners who spread them. We are told that “the Asia-Pacific region is a global epicentre for emerging infectious diseases and drug resistance”. </p>
<p>We are reminded that “the North’s proximity to our international neighbours, extensive coastline and sparse population makes it particularly vulnerable to biosecurity threats”. </p>
<p>Almost 100 years ago, Anton Breinl, the first director of the AITM, assured nationalist politicians that there was nothing inherently pathogenic in the tropics for whites. Rather, <a href="https://www.dukeupress.edu/The-Cultivation-of-Whiteness/index-viewby=title.html">they must protect vulnerable Europeans</a> from coloured races on the margins of Australia who had a proclivity for carrying germs especially noxious to white people. This was the medical rationale for immigration restriction.</p>
<p>The authors of this White Paper still seem to assume that disease comes from outside our borders, even if many of their “priority diseases”, such as Hendra, are in fact vernacular phenomena, genuine little Aussie battler viruses. </p>
<p>Now, I’m not denying there are frightening diseases emerging beyond our borders — just that in focusing exclusively on foreign threats we unrealistically limit the epidemiological palette. Evidently, in the biosecurity industry it’s hard to break such disabling xenophobic habits.</p>
<h2>The power of medicine</h2>
<p>If the White Paper is a reliable guide, tropical medicine is more important than ever in northern development. It has a timeworn contribution to make in securing us against disease threats, and an increasing role to play in generating pharmaceutical products and profits. </p>
<p>The authors express a touching confidence in tropical medicine, a faith in its efficacy that would have embarrassed even Breinl and Cilento. Indeed, so effective is modern tropical medicine that we can now allow those supposedly dodgy, previously disease-dealing foreigners within our borders to labour in the tropics. </p>
<p>Thus the White Paper recommends Designated Area Migration Agreements (DAMA) to permit foreign skilled and semi-skilled workers into a few northern zones. It promotes the <a href="https://employment.gov.au/seasonal-worker-programme">Seasonal Worker Programme</a> for labourers from the Pacific Islands and Timor Leste, as well as a new pilot program for workers from Kiribati, Nauru and Tuvalu. </p>
<p>A few pages earlier, these people and the places they come from were stigmatised as biosecurity risks, but presumably our tropical medicine industry can render them secure. Once used to justify keeping Asians and Pacific Islanders out of Australia, tropical medicine will now be employed to bring them in “safely”.</p>
<p>Too often, members of the infamous leftie lynch mob and other vaguely ABC-types protest that prime minister Tony Abbott is taking us back to the 1950s. But any Australian historian reading this White Paper will realise we’re actually heading all the way back to the 1890s, before federation, when unbridled capitalism and various forms of indentured labour were developing our North.</p>
<p>“Whose North?” we should ask, “whose triumph?”</p><img src="https://counter.theconversation.com/content/44235/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Warwick Anderson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The federal government’s recent White Paper on developing northern Australia has disturbing echoes of the 1890s, a time when unbridled capitalism and indentured labour developed the North.Warwick Anderson, Professorial Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/104292012-10-31T20:09:04Z2012-10-31T20:09:04ZHow we developed the Hendra virus vaccine for horses<figure><img src="https://images.theconversation.com/files/17099/original/zrzz2zzx-1351641925.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Scientists worked with Hendra virus at the highest level of biosafety within CSIRO’s Australian Animal Health Laboratory.</span> <span class="attribution"><span class="source">CSIRO</span></span></figcaption></figure><p>Today we are launching Equivac® HeV, the world’s first commercially available Hendra vaccine for horses. This breakthrough is the culmination of a scientific journey that dates back to the emergence of <a href="http://www.csiro.au/en/Outcomes/Food-and-Agriculture/Hendra-Virus.aspx">Hendra virus</a> in 1994.</p>
<p>Although the Hendra virus “disappeared” for some ten years (with only one case reported in 1999) after it was discovered in 1994, it has recently been identified every year in Queensland with serious consequences for the health of animals and people.</p>
<p>For my colleagues and I working at <a href="http://www.csiro.au/en/Organisation-Structure/National-Facilities/Australian-Animal-Health-Laboratory.aspx">CSIRO’s Australian Animal Health Laboratory</a> (AAHL), in Geelong, Victoria, and overseas, these outbreaks added urgency to our research on the Hendra virus.</p>
<p>The initial flurry of work following the emergence of the virus led to Australian mainland flying foxes being identified as the natural reservoir host of the virus.</p>
<p>Research waned somewhat towards the late 1990s, when a new virus – <a href="http://www.csiro.au/en/Outcomes/Food-and-Agriculture/Fighting-Nipah-virus.aspx">Nipah</a> – emerged in Peninsular Malaysia. Nipah virus was linked to outbreaks of fever and encephalitis in people, and with respiratory disease in farmed pigs.</p>
<p>Nipah was rapidly identified as being a close relative of the Hendra virus, and there are distinct similarities between the two. They both have the ability to lead to fatal infections in several species of animal, as well as in people. And they infect animal and human cells in a similar way.</p>
<p>Following the terrorist attacks on September 11, 2001, the US Congress dramatically increased the level of funding for research into countermeasures – including vaccines and antiviral drugs - for perceived potential bioterror threats, such as Nipah virus.</p>
<p>In collaboration with researchers of the Uniformed Services University of the Health Sciences, Maryland, we generated, in vitro, one of the Hendra and Nipah virus proteins (sG) that’s essential for infection and showed that antibodies to this protein can block virus replication.</p>
<p>These observations – that the G protein provoked a strong immune response in naturally occurring Hendra and Nipah virus infections, and that development of antibodies to the G protein was associated with virus clearance in infected people and animals – suggested a vaccine based on the G protein antigen may be a feasible scientific goal.</p>
<p>The frequency of Hendra virus incidents after 2005, particularly the Redlands outbreak of 2008 and infections at Cawarral in 2009 in which two people died following contact with infected animals, brought the desirability of a vaccine for horses more urgently into the frame.</p>
<p>All human infections with Hendra virus have occurred following exposure to infected horses and direct contact with their bodily fluids. We believed vaccinating horses would provide an opportunity to break the chain of virus transmission from flying foxes to horses, and then to people.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/17098/original/w8q44y9b-1351641920.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/17098/original/w8q44y9b-1351641920.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=426&fit=crop&dpr=1 600w, https://images.theconversation.com/files/17098/original/w8q44y9b-1351641920.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=426&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/17098/original/w8q44y9b-1351641920.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=426&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/17098/original/w8q44y9b-1351641920.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=535&fit=crop&dpr=1 754w, https://images.theconversation.com/files/17098/original/w8q44y9b-1351641920.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=535&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/17098/original/w8q44y9b-1351641920.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=535&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An artificially coloured electron micrograph of the Hendra virus.</span>
<span class="attribution"><span class="source">CSIRO/Alex Hyatt</span></span>
</figcaption>
</figure>
<p>Another benefit of a horse vaccine is that the horses themselves would be protected from a devastating infection that would otherwise most likely lead to their death.</p>
<p>As part of the ongoing research into countermeasures against biological threats, we’d developed the Hendra virus sG subunit vaccine with our US collaborators and tested it under laboratory conditions. The vaccine was formulated for use with an adjuvant (a substance that enhances the body’s immune response to an antigen) to enhance its efficacy. </p>
<p>Various forms of this preparation were evaluated in laboratory animals, where it was found to protect them from developing disease following exposure to Nipah and Hendra viruses and to prevent virus replication.</p>
<p>But a major hurdle to translation of this promising research into licensing for an equine vaccine was the lack of a commercial partner. This was a problem because the equine market is comparatively small, the infection problem largely confined to one state in Australia, and the public health impact of the disease is relatively insignificant compared to other illnesses.</p>
<p>Then, in 2010, a child received post-exposure treatment against Hendra virus infection after coming in close contact with an infected horse. This was closely followed by Queensland and Federal government funding to support the preliminary testing of the equine Hendra virus vaccine. This, in turn, acted as the catalyst for <a href="https://www.pfizeranimalhealth.com.au/home/default.aspx">Pfizer Animal Health</a> – our commercial partner - to join the research team.</p>
<p>The sG Hendra virus vaccine was soon formulated with a proprietary adjuvant suitable for use in horses. Early studies confirmed the development of immunity in vaccinated horses, prevention of disease following exposure to the virus, as well as the absence of viral shedding. This meant there was no risk of onward transmission to people or other susceptible animals.</p>
<p>In 2011, while this work was being undertaken, Australia witnessed an unprecedented spike in the number of Hendra virus cases in horses, in both Queensland and New South Wales. A total of 18 cases were identified. The first reported case of Hendra virus antibody detection in a dog outside of an experimental setting was also seen that year.</p>
<p><a href="http://www.daff.qld.gov.au/4790_20725.htm">Intergovernmental Hendra Virus Taskforce</a> was formed as a result, and additional funding was provided through the <a href="http://www.daff.qld.gov.au/4790_21026.htm">National Hendra Virus Research Program</a> to ensure that the equine Hendra virus vaccine project was able to progress as rapidly as possible.</p>
<p>Optimising the vaccine presented additional regulatory challenges, as did undertaking efficacy studies in horses at the highest level of laboratory biocontainment. At times, progress seemed frustratingly slow. But in reality, the availability of a vaccine to protect horses from Hendra virus infection and, in turn, prevent the exposure of people to this disease, has been swift. </p>
<p>The Equivac® HeV vaccine is an important step towards breaking the transmission cycle of this disease, and reducing its impact on the horse-owning community. But it’s important to ensure that we continue to protect the health of our animals and people. And to do this, we need to maintain and continue undertaking research and adding to the tools in our armoury of weapons against the deadly Hendra virus.</p><img src="https://counter.theconversation.com/content/10429/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Middleton receives funding from NIH (US) and theAustralian Biosecurity CRC. She also has grants from the Intergovernmental Hendra virus Taskforce (Commonwealth, Qld State, NSW State) and the Commonwealth/Qld State governments.</span></em></p>Today we are launching Equivac® HeV, the world’s first commercially available Hendra vaccine for horses. This breakthrough is the culmination of a scientific journey that dates back to the emergence of…Deborah Middleton, Senior Veterinary Pathologist, CSIROLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/48072011-12-21T19:44:01Z2011-12-21T19:44:01Z2011: Year of the bat-borne virus<figure><img src="https://images.theconversation.com/files/6586/original/6ydsbbdj-1324341884.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bats appear have a much better symbiotic relationship with viruses than other mammal species.</span> <span class="attribution"><span class="source">CSIRO</span></span></figcaption></figure><p>In the Chinese zodiac, 2011 is the year of the rabbit but for those of us working on viruses from wildlife animals, it was much more like the year of the bat.</p>
<p>In February, the <a href="http://www.asiaone.com/Health/News/Story/A1Story20110205-262058.html">deadly Nipah virus re-emerged in Bangladesh</a> killing at least 15 people. Nipah virus was first discovered in Malaysia during a large disease outbreak from 1998 to 1999. That outbreak resulted in around 100 human fatalities and more than one million pigs were culled in order to control the spread of the virus. </p>
<p>It’s well known that Nipah is a bat-borne virus, transmitted from bats to pigs, and then from pigs to people. Viruses that have this ability to pass from animals to people are commonly known as zoonotic viruses. </p>
<p>From June to October, Australia experienced its own zoonotic disease threat with 18 properties across <a href="http://www.dpi.qld.gov.au/4790_2900.htm">Queensland</a> and <a href="http://www.dpi.nsw.gov.au/agriculture/livestock/horses/health/general/hendra-virus">New South Wales</a> confirming cases of Hendra virus infections. This resulted in the death of 23 horses and, for the first time outside a laboratory setting, Hendra virus antibodies were identified in a dog. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/6588/original/8w2by2ps-1324342127.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/6588/original/8w2by2ps-1324342127.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/6588/original/8w2by2ps-1324342127.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/6588/original/8w2by2ps-1324342127.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/6588/original/8w2by2ps-1324342127.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/6588/original/8w2by2ps-1324342127.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/6588/original/8w2by2ps-1324342127.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bat-borne viruses spread from bats to pigs and from pigs to humans.</span>
<span class="attribution"><span class="source">Vicky Sawyer</span></span>
</figcaption>
</figure>
<p>During this worrying time, Queensland Health monitored 68 people for signs of infection due to potential exposure to the virus. Thankfully none of them showed any evidence of this.</p>
<p>In October, a <a href="http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1002304">paper published</a> in the journal <a href="http://www.plospathogens.org/home.action;jsessionid=4CF0EBE242740B4D610BDFB4DC248093">PLoS Pathogens</a> reported the discovery of a new Ebolavirus-like filovirus in Spanish bats, marking the first detection of this class of killer virus in Europe.</p>
<p>To add a dramatic finishing touch to these real-life events, the release of the <a href="https://theconversation.com/steven-soderberghs-contagion-sounding-alarm-for-the-next-pandemic-3907">Hollywood blockbuster Contagion</a> further drew the world’s attention to the potential damage a novel bat-borne virus could wreak. Although the movie is fictional, it’s a frighteningly realistic depiction of just how fast an infectious disease can take root and spread.</p>
<h2>Why bats?</h2>
<p>For the last two decades, we’ve witnessed several major disease outbreaks caused by deadly viruses, including Hendra, Nipah, Ebola, Marburg and SARS. <em>All</em> of these viruses originated from bats, yet none seem to cause any clinical disease in the bats, which are known as “reservoir hosts” as carriers of the virus. It appears that bats have a much better symbiotic relationship with viruses than other mammal species.</p>
<p><a href="http://cmr.asm.org/content/19/3/531.full">Recent research findings</a> from different international groups indicate there are numerous viruses circulating among the bat populations around the world. Work on coronavirus – the virus family to which SARS belongs – and paramyxovirus – the family to which human measles and Hendra viruses belong – suggests that all “modern” versions of human and livestock viruses may have a close relative in bats. This has led to the <a href="http://www.sciencedirect.com/science/article/pii/S1879625711001325">hypothesis</a> that bats could potentially be the “birth place” of most known viruses affecting humans. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/4644/original/COND-08358c2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/4644/original/COND-08358c2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/4644/original/COND-08358c2r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/4644/original/COND-08358c2r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/4644/original/COND-08358c2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/4644/original/COND-08358c2r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/4644/original/COND-08358c2r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Steven Soderbergh’s film Contagion drew attention to the havoc a bat-borne virus could wreak.</span>
<span class="attribution"><span class="source">Claudette Barius</span></span>
</figcaption>
</figure>
<p>Bats are very ancient mammals and have been around for at least 50 or 60 million years. They make a significant contribution to environmental health through their role as essential pollinators and seed dispersers for native forests and they’re the only mammal with true flying ability. </p>
<p>The unique virus-bat relationship is possibly the result of a long history of co-evolution. It may also be the case that the presence of low levels of different viruses in bats may actually have been, and continue to be, advantageous for the bat population.</p>
<p>Research conducted in Australia has demonstrated that although most bat populations show evidence of Hendra virus infection, the level of actively circulating virus is uniformly low. This explains why we’ve generally only experienced one or two events of host switching – from bats to horses – almost every year for the last decade. </p>
<p>But, there were at least 18 incidents of species-jumping for Hendra virus in 2011. This led to the thesis that an increase of Hendra virus in bats or a Hendra virus “spike” are the vital triggers for an outbreak. Research data obtained this year seems to support this hypothesis.</p>
<h2>Continuing research </h2>
<p>So the $12-million question is what happened in 2011 that’s different from previous years? After the dramatic increase of Hendra cases this year, the Commonwealth and state governments formed the <a href="http://www.dpi.qld.gov.au/4790_20725.htm">Intergovernmental Hendra Virus Taskforce</a> and provided A$12 million of funding for research into reducing or preventing future outbreaks by answering questions such as this. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/6589/original/9qhqx9jq-1324342435.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/6589/original/9qhqx9jq-1324342435.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=430&fit=crop&dpr=1 600w, https://images.theconversation.com/files/6589/original/9qhqx9jq-1324342435.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=430&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/6589/original/9qhqx9jq-1324342435.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=430&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/6589/original/9qhqx9jq-1324342435.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=540&fit=crop&dpr=1 754w, https://images.theconversation.com/files/6589/original/9qhqx9jq-1324342435.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=540&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/6589/original/9qhqx9jq-1324342435.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=540&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Hendra virus outbreak in Queensland and New South Wales affected 18 porperties.</span>
<span class="attribution"><span class="source">AAP</span></span>
</figcaption>
</figure>
<p>As 2011 draws to an end, the story of bat-borne viruses continues. The world continues to change and it’s certain that more and more unknown bat viruses will emerge. The challenge for us is to get ahead of the viruses before they are given the opportunity to jump from one host to another. </p>
<p>The good news is that scientists around the world have already started to work towards developing a system for predicting virus outbreaks, similar to weather and earthquake forecasts, through the <a href="http://www.gvfi.org/">Global Virus Forecasting Initiative (GVFi)</a>, which is led by Stanford University’s Professor Nathan Wolf. </p>
<p>CSIRO’s “bat pack”, a team of researchers at the <a href="http://www.csiro.au/aahl">Australian Animal Health Laboratory (AAHL)</a> in Geelong, Victoria, is a partner of the GVFi. As the name suggests, the team’s research aims to better understand bat immunology and how bats co-exist with the viruses they carry. Our goal is to identify strategies to control viruses, such as Hendra, from spreading to other animals and people.</p>
<p>Last month, Australia extended its ability to respond to a wide range of continually emerging diseases – that have the potential to harm people, animals and our environment – further with the opening of <a href="http://www.csiro.au/en/Portals/Multimedia/CSIROvod/AAHL-Tour.aspx">the world’s most biosecure laboratory</a>. </p>
<p>The new state-of the-art laboratory is located within the high containment facility of AAHL and will provide researchers, such as members of the “bat pack”, with the biosecure and safe infrastructure required to undertake vital research to effectively tackle increasing biosecurity threats, both here and around the world.</p><img src="https://counter.theconversation.com/content/4807/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Linfa Wang receives funding from ARC, NHMRC, NIH and AB-CRC</span></em></p>In the Chinese zodiac, 2011 is the year of the rabbit but for those of us working on viruses from wildlife animals, it was much more like the year of the bat. In February, the deadly Nipah virus re-emerged…Linfa Wang, Office of the Chief Executive Science Leader in Virology, CSIROLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/39072011-10-20T02:14:57Z2011-10-20T02:14:57ZSteven Soderbergh’s Contagion: sounding alarm for the next pandemic?<figure><img src="https://images.theconversation.com/files/4644/original/COND-08358c2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Jude Law as Alan Krumwiede in the thriller "Contagion".</span> <span class="attribution"><span class="source">Claudette Barius </span></span></figcaption></figure><p>One touch and you’re infected. By the next day your muscles ache, you have a fever and the beginnings of a headache. </p>
<p>You don’t know it yet, but you only have a one in three chance of survival and you’ve already infected three other people. Two weeks later, 8 million people have been infected. </p>
<p>This is the scenario presented by Steven Soderbergh’s latest film Contagion, but is it pure fantasy or an alarm bell, a warning of a devastating future?</p>
<h2>Making it real</h2>
<p>The creators of Contagion, writer Scott Z Burns (screenplay writer for The Informant and Bourne Ultimatum) and director Steven Soderbergh (director of Traffic and the Ocean’s trilogy), were determined to illuminate the potential catastrophe of a worldwide pandemic as realistically as possible.</p>
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<img alt="" src="https://images.theconversation.com/files/4642/original/COND-02469.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/4642/original/COND-02469.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/4642/original/COND-02469.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/4642/original/COND-02469.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/4642/original/COND-02469.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/4642/original/COND-02469.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/4642/original/COND-02469.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Elliott Gould as Dr Ian Sussman in Contagion.</span>
<span class="attribution"><span class="source">Claudette Barius </span></span>
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<p>To do this, they employed a number of technical consultants from the field of medical research, including Walter Ian Lipkin, a professor of epidemiology, neurology and pathology at Columbia University, whom they asked to design the virus that would cause the pandemic. </p>
<p>An expert in his field, Professor Lipkin was recruited by Chinese officials to help curb the spread of SARS during the 2003 outbreak in China in which 8000 people were infected and 750 people died.</p>
<p>Professor <a href="http://www.nytimes.com/2011/09/12/opinion/the-real-threat-of-contagion.html">Lipkin recently wrote</a> about how he had been approached by several movie-makers over time, but before the Contagion team, none had convinced him that they genuinely wanted to make a movie that “… didn’t distort reality but did convey the risks that we all face from emerging infectious diseases.” </p>
<h2>The virus</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/4649/original/Nipah.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/4649/original/Nipah.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=452&fit=crop&dpr=1 600w, https://images.theconversation.com/files/4649/original/Nipah.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=452&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/4649/original/Nipah.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=452&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/4649/original/Nipah.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=568&fit=crop&dpr=1 754w, https://images.theconversation.com/files/4649/original/Nipah.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=568&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/4649/original/Nipah.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=568&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The virus in Contagion is based on the Nipah virus.</span>
<span class="attribution"><span class="source">CDC/CS Goldsmith, PE Rollin</span></span>
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</figure>
<p>Lipkin and his research team decided to base their fictional virus, MEV-1, on the very real and deadly Nipah virus. </p>
<p>The Nipah virus infected 265 people in Malaysia between late 1998 to mid-1999, with a 40% fatality rate. Since then, it has caused 12 separate outbreaks, mainly in Bangladesh but also within Singapore and India. </p>
<p>In some of these outbreaks, every infected person died. </p>
<p>Initially transmitted from infected pigs to humans through direct contact, strains of the virus have since mutated, enabling much more dangerous human-to-human transmission. </p>
<h2>Emergence of disease</h2>
<p>Within infected humans, Nipah virus causes respiratory difficulties but can also induce an often-fatal inflammation of the brain, known as encephalitis. </p>
<p>Signs of illness begin with influenza-like symptoms of fever, sore throat, headaches and muscle pain, progressing to dizziness, altered consciousness and neurological signs that can include fits – such as those prominently depicted in the trailer.</p>
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<img alt="" src="https://images.theconversation.com/files/4646/original/COND-00398.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/4646/original/COND-00398.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/4646/original/COND-00398.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/4646/original/COND-00398.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/4646/original/COND-00398.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/4646/original/COND-00398.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/4646/original/COND-00398.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Marion Cotillard (left) as Dr Leonora Orantes and Chin Han (right) as Sun Feng.</span>
<span class="attribution"><span class="source">Claudette Barius</span></span>
</figcaption>
</figure>
<p>In Contagion, the virus originates from Hong Kong, a not unlikely scenario given the first SARS outbreak centred there.</p>
<p>Many different diseases (known as zoonotic diseases) that have similar modes of transmission – from animals to humans – have come from neighbouring South-East Asian countries. </p>
<p>Among others, they include Nipah virus and swine flu.</p>
<p>A high mortality rate is very real for these viruses, but could millions of people really become infected? And could it spread beyond Asia to wreak equivalent havoc in Western countries, such as America, where most of the film is based?</p>
<h2>Global reach</h2>
<p>Viruses spend their life replicating. Some, such as cytomegalovirus, can shed more than a million viral particles within a drop of saliva. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/4648/original/COND-04256.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/4648/original/COND-04256.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/4648/original/COND-04256.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/4648/original/COND-04256.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/4648/original/COND-04256.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/4648/original/COND-04256.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/4648/original/COND-04256.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Laurence Fishburne as Dr Ellis Cheever and Bryan Cranston as RADM Lyle Haggerty.</span>
<span class="attribution"><span class="source">Claudette Barius</span></span>
</figcaption>
</figure>
<p>Viruses such as rotavirus need as little as twenty viral particles to effectively infect a person and make them very ill. </p>
<p>According to the International Air Transport Association, there were 750 million scheduled international flights taken worldwide in 2010. </p>
<p>So it’s not beyond the realms of possibility for such a virus to spread to disparate regions of the world within weeks.</p>
<p>The 1918 Spanish influenza outbreak (mentioned in the film) is thought to have infected 30% to 40% of the world’s population at that time. </p>
<p>Conservative estimates put the death toll attributed to this strain of influenza at 50 million people. At the time of that pandemic, the aviation industry was only just beginning. </p>
<p>So a virus infecting and killing millions of people worldwide is not only feasible, it’s happened before.</p>
<h2>Elusiveness of cure</h2>
<p>But don’t the current worldwide surveillance of outbreaks, more advanced medical research capabilities and modern healthcare infrastructure, make a repeat of a pandemic like the Spanish flu, or the fictional MEV-1 of Contagion beyond the realms of possibility?</p>
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<img alt="" src="https://images.theconversation.com/files/4651/original/Spanish_flu_hospital.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/4651/original/Spanish_flu_hospital.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=445&fit=crop&dpr=1 600w, https://images.theconversation.com/files/4651/original/Spanish_flu_hospital.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=445&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/4651/original/Spanish_flu_hospital.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=445&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/4651/original/Spanish_flu_hospital.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=559&fit=crop&dpr=1 754w, https://images.theconversation.com/files/4651/original/Spanish_flu_hospital.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=559&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/4651/original/Spanish_flu_hospital.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=559&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The Spanish flu outbreak killed millions of people worldwide.</span>
<span class="attribution"><span class="source">National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington, D.C.</span></span>
</figcaption>
</figure>
<p>Unfortunately, no. The increasing encroachment of people into previously uninhabited areas, in addition to unhygienic animal husbandry practices in many South East Asian countries, means new viruses are now being introduced into the human population. </p>
<p>Early mutation of such viruses could give rise to human-to-human transmission, and it could easily spread before any surveillance organization has a chance to notice an emerging pocket of disease.</p>
<p>In fact, the detection of the MEV-1 virus in Contagion, its identification and the resulting global co-operation to curb its spread is in many respects the best-case scenario. </p>
<p>Even though the real Nipah virus had its first outbreak in 1998, a vaccine for it has not yet been developed. Nor are there any effective anti-viral drugs for treatment of symptoms in the current treatment protocol.</p>
<p>Have Steven Soderbergh and Scott Z Burns created a realistic pandemic movie? It’s the most realistic I’ve seen, and certainly not beyond the realms of possibility.</p>
<p>Can reality be scarier than fiction? Absolutely.</p>
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<p class="fine-print"><em><span>Jesse Toe receives funding from The National Heath and Medical Research Council. He is affiliated with The Walter and Eliza Hall Institute.</span></em></p>One touch and you’re infected. By the next day your muscles ache, you have a fever and the beginnings of a headache. You don’t know it yet, but you only have a one in three chance of survival and you’ve…Jesse Toe, Doctoral Student, Walter and Eliza Hall InstituteLicensed as Creative Commons – attribution, no derivatives.