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Inside this issue
Membership News
Dues reminders will be mailed in November 2006. Please make the necessary corrections and return to the Treasurer. The mailing labels on announcements, etc. will reflect all updates. Also please include your e-mail address. Please notify Irene H. George, Secretary, of any changes at (617) 983-6371. Membership in the national branch automatically makes you a member of the local branch in some organizations, but this is NOT the case in the ASM. You may be both a National Member and a NEB member, but you have to join each individually. The Northeast Branch membership currently has 257 paid members, which includes: 22 Emeritus members, 2 Honorary members and 2 student members. Council Meeting Schedule, 2006-2007
Council Meetings this year will be held at the State Laboratory Institute in Jamaica Plain. Members and all interested microbiologists and scientists are welcome to attend. Please notify Irene H. George at (617) 983-6371 in advance. The next Council Meetings are scheduled for November 16, 2006, December 12, 2006, and January 23, 2007. Additional meetings will be announced. Visit Our Web Site!!
The NEB has established a home page on the World Wide Web where all current events and the Newsletter are available. ASM has also established a Branch Meetings page. Visit us via the ASM Home Page or directly at: http:/www.asm.org/branch/brNoE/index.shtml. Council Elections, 2006
Congratulations to the following newly elected officers: President, Jeffrey Klinger from Genzyme Corporation and Local Councilor, Patricia Overdeep, from Johnson & Wales University, who is serving her second term. We look forward to working with you in the coming year! Science Fair Winners
The NEB annually donates an award of $100 to each of five MA Regional Science Fairs and the VT science fair, while the MA Science Fair receives $200. Congratulations again to the students for their outstanding work! We would like to thank Council members Greg Reppucci, Paulette Howarth, and other NEB members for volunteering to judge at these fairs. Recipients of this year's science fair awards whose names we were able to obtain and their projects were: Region 2: Worcester Regional Science and Engineering Fair: It's in the Genes, by Joshua Grolman, Wachusett Regional High School. Region 3: Bristol Community College-Rensselaer Polytechnic Institute Regional Science Fair: Lymphocytic Chroriomeningitis Virus and Vesicular Stomatitis Virus: Models for Significant NS Viral Pathogens, by Anupama Q. Khan and Thomas P. Howard, both 10th grade and sixteen years old, of Attleboro High School. Region 5: Two second place $50 awards were given at the South Shore Regional Science Fair for: Epigallocatechin gallate: Curative Applications, Pronunciation Optional! by Harvey Sham, a senior at North Quincy High School; and for Barnacle Metamorphosis, by Talia Singer-Clark & Cecelia Pineda from Falmouth High School. Region 6: Boston Regional Science Fair: the winner was Katie Harrison, grade 11, age seventeen, of Boston Latin School, with The Effect of Mucus on Bacterial Growth. NEB Orono Student Chapter
The ASM currently has 62 student chapters; one of which, the University of Maine Microbiology, at Orono, ME, is affiliated with the Northeast Branch. The NEB supports Student Chapter activities, and has annually funded undergraduate and graduate student travel to ASM General Meetings. The ASM Student Chapter Support Program provides additional funding for various chapter activities. This year, five students and advisor Anne Hanson attended the 2006 General Meeting in Orlando, FL. Students attending ASM Meetings in the past have described the experience as "overwhelming and intimidating, an eye-opener in every aspect, with so much to see and do; we could have never imagined how much is available to microbiologists". Several students enjoyed the opportunity to meet employers and to make connections. This year ASM has developed a Student Chapter Lending Library, giving students access to audio and power point presentations of career and history sessions from the 2005 ASM General Meeting in Atlanta, GA. Future additions to the library will include sessions from the 2006 Meeting in Orlando, FL. Requests for the CD-ROM's can be completed online through the ASM website. 
Anne Hanson (L), Faculty Advisor to the ME Society for Microbiology and Students at General Meeting
Field Trip to Woods Hole
Taunton High School Applied Biology & Chemistry students and Science Curriculum Supervisor Rosemary Rak made a field trip to the Woods Hole Marine Biologics Laboratory on April 27, 2006. They were accompanied by Garry Greer, Massachusetts State Laboratory Training Coordinator, Irene George, Northeast Branch Secretary, and Dr. Harvey George, past president of the Northeast Branch. The group of twenty-five visited the Marine Resources Center where they learned the history of how marine biology developed in Woods Hole and of work done at the Center. They also saw and handled living marine animals used in MBL research that has led to a greater understanding of human diseases such as cancer, arthritis and birth defects.
A walking tour of the campus included viewing other research laboratories in the Falmouth scientific community, and at the Exhibit Center, the group had an opportunity to sit behind the controls of a replica of the world's deepest diving research submarine Alvin. At the Woods Hole Science Aquarium, they saw displays of about 140 species of marine animals found in the Northeast and Middle-Atlantic U.S. waters, including three mutant blue lobsters. A lunchtime presentation included a discussion of careers in Microbiology by Mr. Greer, Dr. George and Mrs. George, and the students learned of other programs sponsored by the Northeast Branch. The field trip was made possible by an unrestricted educational grant from the American Society for Microbiology. Ms Rak personally thanked the ASM and the Northeast Branch at the May 16, 2006 dinner-lecture in Danvers. She emphasized how important it is for students in health-related careers to receive support from professionals outside public education and to be exposed to applied science events and applied learning.  Taunton High School Students at Woods Hole Marine Biologics Laboratory
 Students Examine Marine Specimens at Woods Hole
Programs in Review-2006
CDC's Laboratory Diagnostic Approaches in Parasitology
From Microscopy to DNA Analysis: CDC's Laboratory Diagnostic Approaches in Parasitology was presented by Alexandre J. DaSilva, Molecular Biologist from the Division of Parasitic Diseases (DPD), NCID, Centers for Disease Control and Prevention (CDC) in Atlanta, GA on Tuesday, May 16, 2006 at the Affinity Golf clubhouse in Danvers, MA. The dinner-lecture had 60 attendees, and was held in conjunction with two Parasitology workshops held at North Shore Community College. Dr. DaSilva, who is the reference person for the Molecular Biology Laboratory, described what the CDC is doing to strengthen the diagnosis and development of new tests in parasitology. Several years ago the CDC Reference Diagnosis Laboratory was divided into three sections that functioned as a single unit, i.e., the DPD Morphology Laboratory that employs microscopy, which is the backbone of all parasitology, the DPD Serology Laboratory, and the DPD Molecular Laboratory. Samples are primarily received directly from state health departments and occasionally from national and international collaborators; about 5000 samples are processed annually. Reorganization of the Division was brought about due to emerging parasitic diseases in the 1990's, when immigration and global travel by US citizens increased but US educational programs in Parasitology were not expanding. The DPDX project, based on telenet diagnosis and internet communications was born, and the DPDX Web Site (dpdx@cdc.com) went on line in March 1998. The site has information about telediagnosis assistance, CDC Products, training courses, and implementation of molecular techniques especially in Public Health Laboratories. In telediagnosis, the laboratory sends images and information needed to CDC, where it arrives at a general mailbox, and is sent to four team members. This acts as a screening tool as the CDC team sees the parasite before the specimen is even mailed out. They can thus (1) confirm/rule out a certain agent, (2) request another specimen for additional testing and (3) contact other experts if needed. If there is a consensus, the team responds to the sender and requests additional information. Telediagnosis allows for a rapid diagnosis and is an efficient teaching tool. Most of this work is done through grants to the states, which are on-line, and the cost is less than for routine methods. Dr. DaSilva showed photos of E. histolytica and Cyclospora received through the site. Among serological/immunological tests used at CDC are immunoprecipitation, ELISA, IFA, and Western Blot. Sometimes more than one technique is needed, such as serology and PCR. DNA Analysis is done on blood, tissue, CSF, stool, urine and sputum. PCR is done for amoebae, Cryptosporidium, Cyclospora, free-living amoeba, malaria, and microsporidia. For example, nested PCR with dual amplification is used for Cyclospora, and the technique can detect as few as 6 oocysts/ml of stool (sample) measured. The band isolated is sequenced, followed by RTPCR to make a dissociation curve and identification takes a few hours only. Work is currently being done on Chagas Disease and leishmaniasis. Probes for Leishmania will be designed based on differences in the species. RTPCR, employing the Taqman thermocycler instead of gels, is used for Cryptosporidium, thus amplification plots and quantitative values are obtained. Luminex technology, in which laser excitation of fluorescent microspheres in a fluid stream occurs and a sorter reads the fluorescent tags, is used for Cryptosporidium. Probes are attached to spheres and tagged with streptavidin. They are then hybridized and Luminex is run. The method can differentiate C. hominis from C. parvum, and Cryptosporidium spp.  (L to R) Garry Greer (MDPH), Alexandre J. DaSilva (CDC),Stephanie P. Johnson, (CDC), EIizabeth Szymczak (NLTN), and Henry Bishop (CDC)
Dr. DaSilva also described a Diphyllobothrium outbreak that occurred in 2005 in Brazil, where the organism essentially does not exist (2 cases/year occur). CDC was asked to provide support in this case, and through molecular analysis of the worm, traced the outbreak to salmon imported from Chile. The Division of Parasitic Diseases (DPD), a CDC core facility, is also involved in diagnostics and epidemiological projects and has a DPD Water and Environmental Laboratory. The Division frequently collaborates with other agencies, such as the FDA, and international agencies to solve cases. Parasitology Workshops
Two "wet" parasitology workshops were held on May 16, 17 & 18, and were co-sponsored with the National Laboratory Training Network, North Shore Community College, Northeast Association for Clinical Microbiology and Infectious Diseases, the Massachusetts Department of Public Health, Centers for Disease Control and Prevention, Division of Parasitic Diseases (DPDx), NCID, Atlanta, GA, and the Northeast Branch-ASM. These intermediate level programs were held at North Shore Community College and featured internationally renowned faculty from CDC's DPDx team. Both workshops were filled to capacity. Course instructors included Alexandre J. DaSilva, PhD, Molecular Biologist, Stephanie P. Johnston, MS, microbiologist, Henry S. Bishop, microbiologist, and Melanie Moser, health communications specialist. Food & Waterborne Intestinal Parasites was held on May 16, 2006 and included the study of undetected food and waterborne parasites such as Cryptosporidium, Giardia, that can threaten the safety of our food chain and water supply. Bloodborne Pathogens: Plasmodium & Babesia was held on May 17, 18, 2006, and covered the identification of these organisms based on their diagnostic morphologic features; serologic and molecular techniques available for confirming the diseases were discussed.  Parasitology Workshop Participants at North Shore Community College
Mold and Indoor Environmental Quality
ASM Foundation Speaker Linda Stetzenbach, PhD, spoke to an audience of over seventy people on Mold and Indoor Environmental Quality-What Is the Real Story Behind the Headlines? at a dinner-meeting held at Vinny Testa's in Dedham on April 10, 2006. Dr. Stetzenbach is an environmental microbiologist and Professor, Department of Environmental and Occupational Health, School of Public Health. University of Las Vegas, NV. Her research focuses on enhanced methods for the detection, identification and enumeration of airborne and surface-associated microorganisms, including studies for the Department of Defense with bacterial and viral surrogates for bioweapon agents. Molds are part of both indoor and outdoor environments said Dr. Stetzenbach. However when environmental conditions favor growth, molds and bacteria grow on indoor surfaces and become implicated in indoor air quality problems. Agents such as radon, asbestos, chlorine, microorganisms, and tobacco smoke impact productivity and health of occupants. Many of these are bioaerosols, i.e. a collection of airborne biological particles 0.5-30µm in diameter that are transported by air, the concentrations and populations of which shift over time. Molds have been a problem historically, i.e. the 5th Egyptian plague was possibly anthrax, in 1346 AD the Tartans catapulted plague-infested diseases bodies into Kaffa, and in the modern era we now worry about biological warfare. Dr. Stetzenbach defined mold as a variety of filamentous fungi (Alternaria, Trichophyton etc.). Many fungi (such as mushrooms, which are basidiomycetes) are not mold even though they grow on rugs and their spores are allergenic. Fungi are not plants as they have no chlorophyll, and like many other saprophytes, they use dead organic material. Beneficial fungi are used in food, beverages and pharmaceuticals. Although the press uses the words mold and mildews interchangeably, mildews are agricultural pathogens. Molds on sheetrock etc. are not mildew. Fungi can cause adverse reactions. Old spores about 2-10µm in size, when released from a colony are easily transported thru air, the numbers fluctuating constantly. Some are allergenic even if dead and many may contain mycotoxins, of which there are over 300 that occur naturally. Traditionally linked to ingestion and having different chemical properties, mycotoxins have only been recently associated with inhalation and dermal contact. Salem "witches" may have had a psychogenic reaction to fungi when they inhaled fungal spores while cooking. The issue is controversial and much research is needed to determine how bad an indoor problem they are. One group of mycotoxins, Trichothecenes, is a small molecule protein inhibitor and may affect macrophages and phagocytosis.  ASM Foundation Speaker Dr. Linda Stetzenbach
Stachybotrys chartarum, called the "black mold", is often in the news and implicated in indoor problems. However, it is not the only black mold. A gelatinous mass holds the spores together; when dry they become airborne, such as when sheetrock etc. is ripped out. Only an experienced mycologist can distinguish this organism from other black molds. A close relative of Stachybotrysis the mycotoxin producer, Memnoniella, in which chains of long spores are seen. Exposure to the spores of S. chartarum and absorption of its non-volatile toxin can produce dermatitis, daily flu-like symptoms, headaches, excessive fatigue, diarrhea, respiratory and CNS disorders. Molds are nature's recyclers outdoors but are brought indoors through air handling systems, open doors, etc. HVAC filters and plena can have a collection of debris and moisture condensation on them, enabling molds that pass through filters to thrive there and in air ducts. Condensation and leaking often occurs in ceiling tiles above our heads, where fire control and sprinkler systems are located. Molds grow on building materials and furnishings such as wood, fiberglass, plastics, metal, paint, fabric, and cement/concrete. They can thrive on wallboard, the back of wallpaper (utilizing the paste), mastic on ceiling tiles, fabrics, and on food, waste and debris in rooms at home and offices by people. Roof, plumbing and icemaker feed line leaks, or condensation on walls and ceilings in bathrooms without a fan cause mold to thrive. Problems occur with non-waterproofed foundations and sunken living rooms, flooring materials (rugs and pads that hold moisture), damp crawlspaces, and defective window flashing. Factors affecting growth of mold are nutrients, temperature and water. Nutrient sources for fungi indoors include dust, dirt, food, water (as in floods and sewage backups), indoor plants, and detritus. Low temperatures slow its growth but don't stop it, while higher temperatures select for certain genera/species. Of the three factors, only water can be controlled. Many times buildings can be remediated or repaired; rarely do they have to be torn down. Requests to monitor the number of fungal spores in a building may occur due to employee complaints (daily headaches etc. at work), a physician being concerned over a patient having mold exposure-like symptoms, or suspected water damage in a building. Monitoring is also done to verify that once a problem was cleaned up, the area is actually free of contamination. Air sampling is done for a short discrete period of time, but this fluctuates, while surface sampling identifies sources going into the air. One analytical method used is culture, which is limited to those organisms we can culture and to the expertise of the analyst in identification. Some molds won't grow with other species present on a plate or if stressed. Both viable and nonviable organisms are seen in microscopy and some can be speciated by a good microscopist. A biochemistry assay can detect cellular components and molecular biology (QPCR) is rapid, sensitive and amplifies the target. How well culture-based air samplers work is a concern (overload, underload, etc). Dr. Stetzenbach the described the various types of air samplers used to identify and quantitate organisms in the air. Probably most widely used is the Anderson Single Stage Impactor Sampler (developed in 1958) in which particles are drawn in thru the top by a vacuum pump, passing through a series of 400 precision holes, and landing on a Petri dish placed inside. This however depends on electricity and can be a problem in buildings where electricity is shut off. An ergonomically designed battery operated device, the Surface Air System (SAS) Sampler, is popular in the pharmaceutical industry and can be taken into a clean room. The RCS/RCS Plus Sampler was used in space shuttle and employed centrifugal collection in cupules. The Slit to Agar (STA) Biological Air Sampler holds 150 plate samples and can run continuously. There are also a variety of microscopy-based air samplers, each with its own issues. Surface Sampling, in which many samples of rug, sheetrock, etc. are taken at once is less expensive to perform and locates and identifies the source of mold. Dr. Stetzenbach named many airborne fungi of historical interest, such as Aspergillus fumigatus, Blastomyces dermatidis, Penicillium sp., and the list is growing. Health effects of these fungi and their mycotoxins include allergic reactions and hypersensitivity. She again emphasized that much research into mycotoxins is needed as there is little information on the subject, and that interpretation of indoor air sampling results is problematic because there are no established exposure values. Indoor samples/organisms have to be compared with outdoor samples/organisms to be meaningful; in addition the populations (species) must be compared, not just the concentrations. The reason why is evident, as mycotoxin producers indoors may far outnumber the normal numbers of these fungi outside. The presence of such a hazard must be communicated to building occupants, and often a physician is consulted. Throughout her presentation Dr. Stetzenbach showed numerous photos of mold contamination in schools, offices and residences, and described how each problem was mitigated. She suggested visiting the following sites for additional information on indoor molds: www.cal-iaq.org, www.ci.nyc.ny.us, and calling 800-668-2462 for procedures for cleaning up mold in a house. Information regarding bioaerosols can be found at: www.ACGIH.org Zoonotic Infections: Humans and Other Animals Afflicted by the Dominant Life Forms on Earth (Microorganisms)
Dan Shapiro, MD, Director of the Lahey Clinic Clinical Microbiology Laboratory in Burlington spoke on Zoonotic Infections: Humans and Other Animals Afflicted by the Dominant Life Forms on Earth (Microorganisms) at Vinny Testas of Boston on March 13, 2006. He reminded an audience of about sixty people that we are not the dominant forms of life on earth but that we share flora with all sorts of creatures worldwide. There is an amazing of diversity of microorganisms on earth said Dr. Shapiro. There are an estimated 1031 viruses, most of which are phages and infect bacteria, and millions of different viral genotypes can be found in 1 kg of marine sediment. There are also an estimated 4-6 x 1030 bacteria on earth. In fact, the number of bacterial cells in or on our body is greater than the number of human body cells. We are a good source of nutrition to bacteria: they live on our skin surfaces, and in our mouths and intestines; all of us will die and become part of the biosphere again. An amazing amount of genetic transfer occurs between bacteria. Addressing the numbers of prokaryotes in GI tracts, Dr. Shapiro remarked that the human colon has 3.2 x 1011, bacterial cells/mL or 220 gm/mL. Looking at cattle, sheep, pigs, domestic birds, and the termite hind gut, some have more than in the human colon. In health care settings cockroaches, houseflies, ants, spiders, and mites can therefore be a source of all types of human pathogens. Humans share a genome with other primates and have similar flora; we share a host of specific viruses. HSV for example, coevolved with monkeys. If it enters our bodies through the eye or mucosa, it is neurotropic, as is the human herpes virus. We also pass pathogens to monkeys; pet macaques have been found to have measles antibodies. We introduced measles to them and the disease can destroy monkey colonies; they can also catch influenza A and parinfluenza 1 from us. In zoos, primates are immunized in the same manner as we are, for human viral diseases are more severe to them than to us. Human herpes simplex can be fatal to pet New World monkeys. Introduction of new pathogens to a species that has never been exposed to it can be fatal said Dr. Shapiro. Many exotic pathogens are introduced to human populations but burn out. HIV however, was successfully transmitted to humans from presumably nonhuman primates. Human influenza is not spread efficiently to animals yet. He defined zoonotic infections as infections humans get from nonhuman vertebrates, adding that the definition is really unclear.  Dan Shapiro, PhD and Boston Medical Center Technologists
Dr. Shapiro cited numerous instances of human to animal transmission and vice versa. There was a nosocomial spread of methicillin-resistant Staphylococcus aureus (MRSA) among 79 horses in 2000-02, during which 27 horse attendants became infected. He emphasized that MRSA infection and colonization are not identical. Community acquired MRSA has acquired the PVL (Panton-Valentin Leukocidin) gene. The infection starts out looking like a spider bite and causes half of all skin infections. The infection may not be recognized immediately and treatment may be delayed, the greatest problem being that it doesn't respond to semisynthetic penicillins. MRSA now causes about 60% of all skin and soft tissue infections and has been isolated from football teams, wrestlers, fencing teams, prison systems, as well as from companion animals. Strains of SA with this gene cause about 80% of the community acquired MRSA in Atlanta. Many of our companion animals have this strain of staphylococci and they had to have acquired it from humans, because every animal has its own strain; we must now realize that animals are a source of infection. In dogs the organism has been isolated from lipomas, wounds, sepsis and pneumonia; in parrots from chronic sinusitis; in rabbits from ear infections, and in cats from tooth abscesses. Dr. Shapiro cited a medical case in which the patient, spouse and dog all had the same strain of MRSA. Pigs and pig farmers are known to have a high rate of nasal SA colonization and organism exchange. Human tuberculosis (TB) can be found in parrots, elephants, and seals. TB was even reported in a turtle living in a TB sanitarium in Europe (KD Stottmeier). It exists in captive elephants to such a degree that there are now are guidelines instituted in 1997 that involve screening them for TB. From 1996-2000, 18 (3.3%) of 539 elephants screened had M. tuberculosis (MTB), not M. bovis. But currently we are also seeing M. bovis. There also has been documented spread of TB from rhinoceros and elephants to humans. In 1993-1994, three elephants died of TB and in 1996 a fourth was positive. Eleven handlers had positive PPD's and one was smear negative/culture positive. Who transmitted it to who is unknown. The first case of M. bovis spread to humans was from seals in Australia. Raccoon rabies on the East coast is out of control now and originated when hunters took raccoons from a rabid area in the south and brought them to the east. In 2003 the first human case associated with raccoon rabies was documented in VA; how the patient was infected is unknown. Veterinary and human public health are intertwined and both are important. Zoonoses can be acquired by direct contact, animal products, urine (leptospirosis), feces, bites and scratches (rabies), ectoparasites (ticks), undercooked meat (trichinella), fish (tapeworm), milk (brucella), the respiratory route, etc. Attempts to limit rodent contact with humans may fail. In the western U.S., for example, excessive rainfall meant more food (plants) and rodents thrived. Increased (environmental) human interaction with rodent habitats lead to hantavirus infection. Exposure may also be unusual, such as acquiring brucellosis from beauty products containing animal placenta extracts. Even zoonotic sexually transmitted disease is possible if a person has genitourinary brucella or leptospirosis. Ten people in Uganda died after eating the meat of hippopotamus that died from anthrax. A number of people in India contracted Salmonella and died after eating curried entrails from a dead monkey they found. Dr. Shapiro noted that Salmonella is found in all vertebrates, and that any animal can be an asymptomatic carrier. When stressed the animal sheds even more organisms. Salmonella was reported in a herd of captive elephants (1984), and could be fatal in such cases. Infection control to prevent spread within a herd can be difficult. When searching for a causative agent Dr. Shapiro said, we must look for a niche in which the organisms live or for syndromes they cause. He cited a case of infection in which a healer using traditional remedies sprayed fresh fish blood on site of an ulcer area of a patient, bandaged it and told the patient not to wash it for three days. The organism was the aggressive V. vulnificus, usually found in warm salt water, and seen in wound infections or after ingestion of infected shellfish. Sepsis can result if an underlying disease is present. New concerns he spoke of are avian influenza, in which there is currently inefficient human-human transfer; but what will happen in a number of years? MRSA dissemination broadly among companion animals is possible. Also, xenotransplantation now puts porcine endogenous retrovirus into immunosuppressed humans, but to date there is no report of virus replicating. Manangle virus, related to Nipah and Hendra virus and found in infected pigs, humans and fruit bats, was found in an Australian facility growing pigs for potential transplantation. We don't really know the flora of companion and larger animals with which we share our habitat. If they die or are killed, their flora gets into the water table. Other questions Dr. Shapiro raised were that while primates are susceptible to measles, has anyone looked at how it impacts the primate population? Ebola, for example, has a tremendous impact on gorillas. Regarding avian influenza, birds fly and migrate, transmitting virus; chickens are symptomatic while ducks are not. But free-ranging chicken eggs are used in vaccines - are they infected? We also treat dog, cat and other companion animal feces differently than those of humans, and don't process them in sewage plants. Organisms they carry can easily get into the water table. We immunize dogs for leptospirosis, but the vaccine contains only a couple of strains, and dogs can still get the disease. And pig farms dump directly into the waterways! We should check our water with molecular methods, etc. Dr. Shapiro again warned that we all live in a sea of bacteria, viruses and fungi that are transmitted to and from animals and can return to haunt us! Influenza 2006 Update
An update on influenza was presented to a group of over 70 interested people on January 31, 2006 at Vinny Testa's in Dedham. Speakers were by Alfred DeMaria, Jr. MD, Assistant Commissioner and Director, Bureau of Communicable Disease Control and Acting Director, State Laboratory Institute, and Barbara Werner, PhD, Infectious Diseases Consultant and Former Deputy Director, both of the State Laboratory Institute, MDPH, Boston, MA. In Is There Flu in the Flight of Our Fine Feathered Friends? Dr. DeMaria. began by describing viral nomenclature, and the importance of antigenic drift (mutations leading to small changes such as in annual flu outbreaks) and antigenic shift (genetic reassortment of viral genes leading to a new virus as in pandemic influenza). The disease greatly affects the population, resulting in hospitalizations, missed work/school, deaths, and billions of dollars in cost. He described the influenza outbreaks of 1918, that resembled H5N1, the pandemics of 1957 and 1968, and the 1976 "Swine Flu", when the novel virus H1N1 was isolated in Fort Dix, NJ. The "Swine Flu" outbreak was compared to the 1918 flu and resulted in the first pandemic response plan. He remarked that there has been no pandemic since 1980. Dr. DeMaria informed us that avian influenza (fowl plague) exhibits a spectrum of disease and that wild birds are a natural reservoir of influenza A viruses; migration makes the disease a worldwide problem. The virus is highly contagious with >95% mortality within 24 hours; H5 and H7 types predominate. The symptoms in birds are usually gastrointestinal, rather than respiratory, and include egg drop, hemorrhage and diarrhea. Chickens should be penned so they won't be exposed to wild viruses, and if an infection occurs, they must be culled and replaced with new birds. Surveillance is carried out by the poultry industry in the US. In 1997 the H5N1 virus jumped to humans for the first time. In 2003 we had the highly pathogenic H7N7 virus; eighty-nine people had symptoms and one person died.  Alfred DeMaria. Jr., MD
Dr. DeMaria presented a map, showing 160 cases of H5N1 worldwide as of1/30/06. There is only a 1/15,000,000 chance of catching the virus, as although it can be spread from animals to humans, person to person transmission is very ineffective. Those contracting the disease lived in very close contact with infected animals, as in Turkey, where children played with chicken heads. Most human cases were in individuals less than 19 years of age, and 85-95% of those infected were exposed to ill poultry. There is about a 50% fatality rate with diffuse pneumonia. Ducks are developing tolerance to the virus and are appear asymptomatic; the virus is adapting and has infected wild cats in zoos, pigs, etc. It has also become resistant to such antivirals as the amantadines and one of the newer classes of neuraminidase inhibitors, oseltamavir (Tamiflu). Zanamivir (Relenza) still seems to be effective. The virus is mutating and is migrating with birds that are now just arriving in Africa and the North Pole and may come down to the US in 2006. What will be done in the US if it arrives? Since most people don't live with birds in the US, Dr. DeMaria thinks it is unlikely that many people will be infected. It will probably arrive with travelers who were exposed elsewhere. In cases of febrile respiratory illness with or without pneumonia, a person's history will be important, such as travel to Eurasia, exposure to poultry, health care/laboratory exposure, etc. Implementation of infection control (universal respiratory hygiene, droplet precautions) and sending specimens to the State Laboratory for PCR will be urgent. Dr. Werner spoke of work done on influenza at the Department of Public Health (DPH) State Laboratory Institute (SLI, that consists of the Bureaus of Laboratory and Communicable Disease Control. The Institute provides surveillance, i.e. real time monitoring for viral activity, clinical and diagnostic testing, vaccine management and continuous communicable disease control. She added that the Reference Laboratory for Viral Isolation and Viral Serology is a BSL3 laboratory, and is the only laboratory in the state using RTD-PCR to identify H5 and H7 influenza viruses. Regarding influenza reporting, laboratories should fax the Rapid Influenza Diagnostic Testing Report Form weekly to (617) 983-6220, and results of influenza viral cultures and PCR should be faxed in routine laboratory report format to (617) 983-6813. Results should also be telephoned immediately to both the local board of health and MDPH (617-983-6800). Dr. Werner referred to the DPH website, mass.gov/dph, that has links to CDC influenza information (cdc.gov), and contains valuable resources such as reporting forms, respiratory virus testing instructions, pandemic preparedness information, specimen submission forms, and instructions for packaging and shipping specimens to the SLI. Dr. Werner reviewed laboratory diagnostic methods for influenza, stating that culture, requiring 1-10 days is still the gold standard, but molecular (RTD-PCR), taking 2-4 hours, may soon replace this. Antigen detection (IF/DFA), also takes 2-4 hours, and serology takes >2 weeks and requires paired samples. Antigen detection in an EIA-like format takes 15-30 minutes, but although there are certain advantages with these tests, such as rapid turn around time, rapid outbreak identification and less expertise required, QC issues may not be in place with these tests and cost effectiveness is questionable. There are also poor test sensitivity and biosafety issues, as well as loss of isolates and surveillance data. Rapid diagnostic tests are therefore not recommended when patients are suspected of having avian influenza due to biosafety and sensitivity concerns, but are useful if there is a low suspicion of avian influenza and you need to rule in/out influenza A and B virus. Culture is still critical to obtain information about circulating viral strains and subtypes and to monitor emerging resistance and novel subtypes, as well as to identify other causes of influenza-like viruses.  Emy Thomas and Barbara Werner, PhD
Routine influenza testing at the SLI includes cell culture (RMK and shell vials), typing and subtyping using monoclonal antibodies for influenza A (H3N2, H1N1) and B. Summary results and selected specimens are sent to CDC weekly. All viral isolates in MA from 2005-06 (as of now) are H3N2, with a few instances of influenza B. Enhanced influenza surveillance is ongoing, and how a specimen is handled in the laboratory depends on a patient's illness and history. Upper respiratory specimens are preferred for RTD-PCR. If highly pathogenic avian influenza A (H5 or H7) is suspected, RTD-PCR is performed for influenza A and B typing, and H1, H3 H5 and H7 subtyping. Once H5 and H7 are ruled out, routine viral isolation and subtyping is done, as well as identification by cell culture, HI, or IFA. She added that enhanced BSL3 facilities are needed for these select agents and CDC recommends performing the testing in biological safety cabinets. Dr. Werner added that any H5, H7 or unusual influenza isolates are sent directly to CDC for further testing. In the future, all routine isolates from the Viral Isolation Laboratory will be batched and examined by RTD-PCR as part of the continuous monitoring procedure. Comparing pneumonia and influenza mortality in US cities in past years, this year, MA is running below the baseline; there is also a low hospitalization rate in children, and the number of visits for influenza-like illness reported by sentinel providers is low. CDC posts weekly influenza activity estimates reported by state epidemiologists. Dr. DeMaria explained the WHO Pandemic Phases that range from a low risk inter-pandemic phase with a low risk of human cases to pandemic phase, with efficient and sustained human-human transmission. During a possible future pandemic, there would be simultaneous outbreaks throughout the US, overwhelming the healthcare delivery system, no "outside: help would be available, there would be up to an estimated 35% absenteeism in public service, public safety and healthcare personnel, order and security would be disrupted for months and news broadcasts would occur incessantly. Elements of a pandemic plan would have to include authority and control, surveillance, vaccine management, antiviral drugs, emergency response, communications, and continuity of operations. The vaccine supply may be delayed, or supplied in allotments, with restricted availability initially. Antivirals would most likely be distributed to states pro rata, with hospitals possibly being the delivery node. There would be a need to decrease the potential for contact and infection in both healthcare and community settings while providing quality medical care. Decisions would be made as to who works, who remains at home, and who will be hospitalized. There are 3800 hospital beds in MA, which is estimated to be enough for patients needing admission said Dr. DeMaria. The 128 local health departments in MA are enhancing their communication systems. The public also needs to be educated and prepared as to cleanliness and hygiene in the spread of influenza, and the need for a home emergency plan. Dr. DeMaria added that contingency plans for 35% absenteeism at every level in every sector may occur, and people will have to be cared for at home. Annual influenza vaccination needs to be expanded and enhanced. And everyone should be vaccinated for pneumococcal disease, which is a common complication of influenza. Dr. DeMaria recommended reading John M. Barry's book The Great Influenza and Alfred W. Crosby's Americas Forgotten Pandemic for additional information on the disease. Developments on the Influenza Vaccine and Avian Influenza Fronts
Recent developments of the influenza front include:
Volume 1, Number 10, 2006/Microbe |
