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Nipah Virus, MERS-Cov and the Blueprint List of the World Health Organization

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Nipah Virus, MERS-Cov and the Blueprint List of the World Health Organization Le Infezioni in Medicina, n. 3, 195-198, 2018 EDITORIAL 195 What’s new in infectious diseases: Nipah virus, MERS-CoV and the Blueprint List of the World Health Organization Giuliano Rizzardini1, Tommaso Saporito2, Alessandro Visconti2 1Dipartimento di Malattie Infettive, ASST Fatebenefratelli Sacco, Milano, Italy School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; 2Direzione Strategica ASST Fatebenefratelli Sacco, Milano, Italy ometimes, late in the ‘60s, an authoritative SAmerican politician declared ‘It’s time to close the books on infectious diseases, declare the war against pes- tilence won, and shift national resources to such chronic problems as cancer and heart disease’ (Figure 1). How wrong it was! As shown in Figure 2, in 2010 of the estimated 52.8 million deaths that occur throughout the world yearly, almost 10 million are directly caused by infectious diseases. Millions more deaths are a secondary effects of infections [1]. Infectious dis- eases cause 63% of all childhood deaths and 48% of premature deaths [2]. Moreover, today, on one hand, we observe the so-called antibiotic paradox (How the Misuse of Figure 1 - William H. Stewart, the Surgeon General. Antibiotics Destroys Their Curative Powers), with the increase in multidrug resistant bacteria and the epidemics of preventable infections favored by the no vax campaigns, on the other the emer- gence and re-emergence of new and old infectious diseases; some of them, reported, in the Table 1 below represent examples of emerging infectious diseases. The 2014-2016 West Africa Ebola epidemic (the largest since the virus was first discovered in Zaire in 1976, with a total of 28,616 confirmed, probable and suspected cases and 11,310 deaths) saw a large mobilization to find new technologies to address the disease and save lives. The Blueprint was a successor project to the work Corresponding author From Lonzano et al. Lancet, 2012 (modified) Giuliano Rizzardini Figure 2 - Infectious diseases cause ~19% of all deaths E-mail: [email protected] worldwide. 196 G. Rizzardini, T. Saporito, A. Visconti Table 1 - Examples of emerging infectious diseases. priority diseases. The blueprint outlines glob- Legionella pneumophila (first outbreak in 1976 as Legionnaire al strategies to reduce the time lag between the disease and since associated with similar outbreaks linked identification of an outbreak and the approval of to poorly maintained air conditioning systems) diagnostics, vaccines, and drugs needed to save Ebola virus (first outbreaks in 1976 and the discovery lives and thwart disease spread. For each disease of the virus in 1977) an R&D roadmap is created, followed by target E. coli 0157:H7 (first detected in 1982, often transmitted product profiles [3]. through contaminated food, has caused outbreaks The first list of prioritized diseases was released of hemolytic uremic syndrome) in December 2015 (4). The second list was pub- Borrelia burgdorferi (first detected in 1982 lished this year (see Table 2) [5]. and identified as the cause of Lyme disease) Several other diseases that could have major pub- HIV/AIDS (virus first isolated in 1983) lic health risks, (arenaviral hemorrhagic fevers Hepatitis C (first identified in 1989, now known other than Lassa fever, and emergent nonpolio to be the most common cause of post-transfusion enteroviruses - including EV71, D68-, chikungun- hepatitis worldwide) ya), were also discussed, but not included in the Influenza A(HSN1) virus(well known pathogen in birds priority list. Monkeypox and leptospirosis were but first isolated from humans in 1997) also recognized and discussed at the meeting as Severe Acute Respiratory Syndrome (SARS) public health risks to watch. (first detected in 2003 in Asia; the first emerging infectious In this article we would shortly emphasizes some disease of the 21st century) of the diseases included in 2018 list. Swine Flu Influenza A (H1N1) n NIPAH AND HENIPAVIRAL DISEASES that World Health Organization (WHO) did dur- ing this recent Ebola outbreak in West Africa and Nipah virus (NiV) is an emerging zoonotic virus was initiated at the WHO Ebola Research and [6]. NiV is an RNA virus, part of the Paramyxovidae Development (R&D) Summit held in May 2015. family that was first identified as a zoonotic patho- The Ebola epidemic demonstrated the inadequa- gen after an outbreak involving severe respiratory cy of current approaches to vaccine, drug, and di- illness in pigs and encephalitic disease in humans agnostics development. Learning from mistakes, in Malaysia and Singapore in 1998 and 1999. Lim- for the purposes of the R&D Blueprint, WHO has ited human to human transmission of NiV has also developed a special tool for determining which been reported among family and care givers of in- diseases and pathogens pose a public health fected NiV patients. During the later outbreaks in risk because of their epidemic potential and for Bangladesh and India, Nipah virus spread directly which countermeasures are insufficient. The R&D from human-to-human through close contact with Blueprint works on the basis of a list of identified people’s secretions and excretions. In Siliguri, In- dia, transmission of the virus was also reported within a health-care setting: 75% of cases occurred Table 2 - Diseases posing significant risk of an interna- among hospital staff or visitors. From 2001 to 2008, tional public health emergency for which there is no, or insufficient, countermeasures. Source: WHO, 2018. around half of reported cases in Bangladesh were due to human-to-human transmission through Crimean-Congo haemorrhagic fever (CCHF) providing care to infected patients. Other regions Ebola virus disease and Marburg virus disease may be at risk for NiV infection, as serologic evi- Lassa fever dence for NiV has been found in the known nat- Middle East respiratory syndrome coronavirus (MERS-CoV) ural reservoir (Pteropus fruit bat species): the ev- and Severe Acute Respiratory Syndrome (SARS) idence of Henipavirus infection in Pteropus bats Nipah and henipaviral diseases from Australia, Bangladesh, Cambodia, China, In- Rift Valley fever (RVF) dia, Indonesia, Madagascar, Malaysia, Papua New Guinea, Thailand and Timor-Leste. Nipah virus Zika can be transmitted to humans from animals (bats, Disease X pigs), and can also be transmitted directly from What’s new in infectious diseases 197 human-to-human [7]. The incubation period is be- identified in dromedaries in the Middle East, Af- tween 4 and 14 days. However an incubation pe- rica and South Asia. However, the exact role of riod as long as 45 days has been reported. Human dromedaries in transmission of the virus and the infections range from asymptomatic infection, exact route of transmission are unknown. The ma- acute respiratory infection (mild, severe), and fatal jority of human cases of MERS have been attrib- encephalitis. Infected people initially develop in- uted to human-to-human infections in health care fluenza-like symptoms as fever, headaches, myal- settings. The incubation time is 2-14 days and the gia, vomiting and sore throat. This can be followed infectious period 1-11 day from illness onset. The by dizziness, drowsiness, altered consciousness, clinical manifestations range from no symptoms or and neurological signs. Some people can also ex- mild respiratory symptoms to severe acute respira- perience atypical pneumonia and severe respirato- tory disease and death. A typical presentation of ry problems, including acute respiratory distress. MERS-CoV disease is fever, cough and shortness Encephalitis and seizures occur in severe cases, of breath. Pneumonia is a common finding, but progressing to coma within 24 to 48 hours. Most not always present. Gastrointestinal symptoms, in- people who survive acute encephalitis make a full cluding diarrhoea, have also been reported. Severe recovery, but long term neurologic conditions have illness can cause respiratory failure that requires been reported in survivors. Approximately 20% of mechanical ventilation and support in an intensive patients are left with residual neurological conse- care unit. The virus appears to cause more severe quences such as seizure disorder and personality disease in older people, people with weakened changes. The case fatality rate is estimated at 40% immune systems, and those with chronic diseas- to 75%; however, this rate can vary by outbreak es (i.e., diabetes, cancer, chronic renal impairment, depending on local capabilities for epidemiolog- BPCO) [11]. Fatality rate of the disease is approx- ical surveillance and clinical management. NiV imately 35%; this percentage may be an overes- infection can be diagnosed together with clinical timate as mild cases of MERS may be missed by history during the acute and convalescent phase of existing surveillance systems (until more is known the disease. Different tests include: enzyme-linked about the disease, the case fatality rates are count- immunosorbent assay (ELISA), polymerase chain ed only amongst the laboratory-confirmed cases). reaction (PCR) assay, virus isolation by cell culture Real-time reverse-transcription-polymerase-chain [8]. There is no treatment or vaccine available for -reaction (RT-PCR) of respiratory secretions is either people or animals. Intensive supportive care the mainstay for diagnosis, and samples from is recommended to treat severe respiratory and the lower respiratory tract have the greatest yield neurologic complications. among seriously ill patients. To date, there is no antiviral therapy of proven efficacy and, even in this case, treatment remains n MIDDLE EAST RESPIRATORY SYNDROME largely supportive. Potential vaccines are at an CORONAVIRUS (MERS-COV) early development phases. Middle East respiratory syndrome is a viral res- piratory disease caused by a novel coronavirus n DISEASE X (MERS-CoV) that was first identified in Sau- di Arabia in 2012 [9]. Since then, as of 31 May The WHO included “Disease X” in its 2018 global 2018, the World Health Organization (WHO) has plan for accelerating research and development been notified of 2,220 laboratory-confirmed cas- during health emergencies.
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