History of Whooping Cough: Outbreaks and Vaccine Timeline

Mpox And H5N1 Bird Flu Viruses Continue On The March

Amidst a lackadaisical public health response, two viruses with pandemic potential continue to spread in the United States. The California Department of Health reported the first case of mpox in the United States caused by the clade I mpox virus. Concurrently, the Centers for Disease Control and Prevention (CDC) confirmed five new human cases of H5N1 (bird flu) in the state of Washington.

A colorized transmission electron micrograph of mpox particles (red) found within an infected cell (blue), cultured in the laboratory [AP Photo/NIAID]

The mpox case is concerning because the clade I mpox virus causes more severe illness and death than the clade II virus and thus is considered "more aggressive." The case fatality rate in clade I mpox outbreaks has ranged from three percent to 11 percent. 

The patient in California had recently traveled from East Africa and is assumed to have contracted the infection there, where an outbreak of clade I virus is ongoing. Based on symptoms and travel history, the patient was tested for mpox, which confirmed infection. The patient had mild symptoms and was permitted to return home and self-isolate there.

In August, the World Health Organization declared the ongoing global clade I mpox infections in Africa a public health emergency of international concern (PHEIC). As reported by the WSWS at the time, the response of politicians and public health officials was largely silence with minimal follow-through to combat it.

That lack of urgency has now resulted in the confirmed appearance of the virus in the United States. The failure of the global capitalist system to eradicate the virus has enabled the outbreaks in East and Central Africa to fester, which in turn enabled the virus to travel to the United States.

At present, authorities believe that the mpox virus is spread only through close personal contact including sexual activity. Although they do not believe that casual contact poses a significant risk of transmission, they are nevertheless investigating travelers who shared the airplane with the patient in California.

Previously, the rapid spread around the world of the clade II mpox virus raised the specter of respiratory transmission. A detailed review of the evidence in a Lancet Microbe article assessed the risk of respiratory transmission of clade II to be low, but could not rule it out and called for further studies and vigilance.

Multiple outbreaks of clade II are still ongoing and were the subject of a WHO declaration of a PHEIC in 2022, which is still active. The WHO is holding an emergency meeting next week to determine whether PHEIC status still applies to these outbreaks of clade II. 

While clade I mpox virus appeared in North America for the first time, the CDC announced five new human cases of H5N1 avian influenza in the state of Washington. A sixth presumptive positive case there is under investigation. All five infected individuals are farmworkers who had mild symptoms and did not require hospitalization. They are assumed to have contracted the virus from infected dairy cattle on farms where they work.

Wastewater monitoring in California has detected H5N1 virus in 21 of 28 monitoring sites statewide, including Los Angeles, San Francisco, Palo Alto, San Diego, and San Jose. Authorities do not know for certain how the H5N1 is getting into wastewater, but current hypotheses include unpasteurized milk, wild bird droppings, and discarded animal products.

A recent case of H5N1 in a young man in British Columbia, who is critically ill, has undergone further study. Scientists isolated and sequenced the virus from the patient. They found that this H5N1 variant is different from the one circulating in birds and cattle in the US and Canada

They also found that the virus has undergone several "unsettling" mutations. Specifically one mutation, known as PB2 E627X, makes it easier for the H5N1 virus to infect humans. This increases the potential for human-to-human transmission, which would very likely trigger a new pandemic. The mutation also makes the virus more lethal, helping to explain the patient's critical illness.

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In the meantime, a study published in Nature Communications last week showed that H5N1 virus circulated among southern elephant seals in Argentina, Uruguay, and Brazil in 2023. This means that the H5N1 virus has shown the capability for transnational mammal-to-mammal transmission for the first time. 

The study notes that: "From a public health perspective, mammal-to-mammal transmission could be a stepping-stone in the evolutionary pathway for these viruses to become capable of human-to-human transmission."

The elephant seal populations were devastated by the outbreak, with a case fatality rate of 95 percent among pups of one group of seals.

Valeria Falabella, co-author of the study and Wildlife Conservation Society in Argentina director of coastal and marine conservation said: "We were totally appalled by the dramatic impact of the epidemic of avian influenza on this population. It will take decades before the numbers are back to the 2022 population size."

Several researchers on the study are part of Argentina's Institute of Virology and Technological Innovations. This agency is in turn part of Argentina's National Council of Scientific and Technical Investigations, Spanish acronym CONICET.

This fact is significant because Argentina's fascist president Javier Milei has cut the budget of CONICET by over 30 percent since 2023. It is also telling that Milei was the first foreign leader hosted by US President-elect Donald Trump after the election. 

Trump's hosting of Milei and his nomination of anti-science hucksters to key roles in his administration signals that he will similarly gut research and public health measures aimed at preventing the next pandemic. Future studies of H5N1 transmission and evolution would be eliminated, leaving workers in the dark about the growing threat and practically ensuring the emergence of future pandemics.

The ongoing march around the world of two highly dangerous viruses, enabled by the ruling class policy of profit over lives which in turn dictates the gutting of public health science and practice, is a warning to the working class. The working class can only re-organize society to prevent future pandemics by organizing its own, independent political struggle against capitalism through the International Committee of the Fourth International.

Avian Flu Virus Sparks Mammal Mutation Concerns In Quebec

The infection of mammalian species by avian flu viruses is causing concern, with cell replication in mammals making the virus more pathogenic to humans.

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A recent investigation into the increase in deaths among seal populations in the St. Lawrence River in 2022 shed light on this risk.

Between April 1 and Sept. 30, 2022, 209 dead or sick seals were reported in the Estuary and Gulf of St. Lawrence. The increase in summer deaths among harbour and grey seals was almost four times greater than historical data. For several specimens, the H5N1 strain of avian flu was identified as the cause of death.

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The results of a survey published in the Centers for Disease Control and Prevention (CDC) suggest the presence of large numbers of H5N1-infected bird carcasses at seal landing sites most likely contributed to the spread of infection to pinnipeds. But current data is insufficient to determine whether seal-to-seal transmission has occurred.

"In the epidemic we saw in 2022 in harbour seals, especially, there doesn't seem to be any evidence that the virus was transmitted from one seal to another," explained survey co-author Stéphane Lair. "What we can assume is that the disease was so acute, the death was so rapid, that the animals didn't have time to excrete the virus for very long."

However, the current H5N1 strain has caused "very significant" deaths in pinnipeds, especially sea lions in South America.

"We're talking about several thousand animals that have died, which suggests that in these cases, there have been transmissions from one sea lion to another. And in these herds of sea lions, they have a lot more close contact with each other, which may have favoured this kind of direct transmission between sea lions," Lair said.

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His work highlights the fact marine mammals could act as reservoirs for the H5N1 avian flu virus, which could increase the risk of mutations leading to infection of new mammalian hosts. Consequently, surveillance of this virus in wild marine mammal populations is essential to assess the public health risk associated with this emerging pathogen-host dynamic, the CDC report said.

In Quebec, the Canadian Food Inspection Agency recently conducted two investigations relating to avian influenza in domestic birds. The infection was detected on Nov. 17 and 18 on two poultry breeding sites in Montérégie.

A first case of H5N1 avian flu in humans in Canada was confirmed last week in British Columbia.

No need to panic, experts say

According to two experts, we should not panic at ​​the virus being transmitted to humans because cases are so few.

"There have already been reported cases in humans," said Lair, who is also a professor at the Faculty of Veterinary Medicine at the Université de Montréal. "These are fairly limited cases in terms of number, which suggests that this virus is not very well adapted to humans.

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"What we need to understand with influenza viruses is that they make recombinations between viruses, mutations. And so, they can change over time. The one currently circulating in North America is a Eurasian strain, which is different from the Asian one that has caused several human cases. This strain seems much less likely to be transmitted among humans than the Asian strain," he explained.

According to Lair, more worrying is the fact this virus can mutate and do not know what future generations of the virus will have as an adaptation.

"Public health is always a little more concerned when this avian virus starts infecting mammals such as seals, because it shows that there is a certain adaptation to mammalian cells, and since we are mammals, we can ask ourselves: are we next on the list?"

Brian Ward, professor in the Department of Medicine at McGill University and co-director of the Vaccine Centre of the MUHC, is also moderately concerned.

"It's worrying, but at a low level," he said.

"In recent years, there have been cases in elephant seals, farm animals and domestic birds. But in wild birds, especially seabirds, geese and ducks, these viruses have been circulating actively for decades. We now have histories of multiple clades, and there are mutations that make transmission to mammals easier," Ward said.

So far there have been no cases of human-to-human transmission.

"There's not a huge signal that this is going to change quickly," Ward said.

"Transmission in birds is mainly via the faecal oral route, so faeces contain the virus. There are birds around seals. Aerosols are formed in these environments. It's possible that even without a receptor, which is appropriate in an infection, the seal could fall ill because of the intensity of the aerosols," Ward said.

Lair and Ward agree the next pandemic could be avian influenza. But they don't think we need to worry too much.

"No panic at the moment, but we need to use this moment, while these viruses have our attention. We need to use this motivation to be better prepared when one of these viruses comes out, or another virus like SARS-CoV-2. We need to be prepared for the next pandemics, because they're inevitable," Ward said.

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A Wastewater Surveillance Program Sounds The Alarm On Avian Influenza

As the popularity of wastewater surveillance programs soared during the COVID-19 pandemic, microbiologist Anthony Maresso and microbial geneticist Michael Tisza from Baylor College of Medicine broadened their horizons. Through the wastewater detection initiative of the Texas Epidemic Public Health Institute (TEPHI), Tisza, Maresso, and their team detected over 400 different human and animal viruses through hybrid capture-based sequencing, testing samples predominantly from urban areas throughout Texas. Their goal was to detect infectious disease outbreaks early, and recent upticks in avian influenza (H5N1) cases beyond bird species caught their attention. 

In their latest correspondence published in the New England Journal of Medicine, the researchers sounded the alarm on H5N1 present in the wastewater across 10 Texas cities, and championed agnostic viral monitoring as a sentinel surveillance tool in infectious disease preparedness.1

Anthony Maresso turned his expertise in wastewater microbial surveillance toward COVID-19 and beyond, helping to establish viral wastewater monitoring in Texas.

Baylor College of Medicine

Searching for Viruses in Wastewater

Maresso and his team had been examining wastewater for about a decade prior to the COVID-19 pandemic, looking for microbes. They had built protocols around going to wastewater plants, getting material, and isolating viruses. "We had the idea that maybe SARS-CoV-2 was in the wastewater, and if we were able to detect it, we might be able to tell an entire community what the levels were, rather than relying on individual tests," said Maresso. That led to a program at Baylor College of Medicine, developed in conjunction with the Houston Health Department, where the researchers were testing for SARS-CoV-2 on a weekly basis and reporting where outbreaks were occurring. As the pandemic went on and the vaccine came into play, wastewater testing started to grow. Maresso and his team then asked themselves, "What is the next big breakthrough in this? Can we look for not just one virus, but all viruses?" And that is where Tisza and his team came in.

Tisza joined Baylor College of Medicine just as the TEPHI wastewater sequencing initiative, Texas Wastewater and Environmental Biomonitoring (TexWEB), was being conceived. "We were figuring out how we could enrich for these viruses in the lab and then sequence them. That has been a big technical undertaking, and it has been a big technical triumph that people in our organization have pioneered," Tisza said.

Together, the Baylor College of Medicine team built a program where they now detect and report on as many human viruses as possible in wastewater using sequencing technology. One of the features of the program is that they can detect things people are not thinking about, and one of the things they detected was avian flu, which they started to see a signal for in early March 2024.

With a background in bacterial and viral genomics, Michael Tisza applies bioinformatics and sequencing expertise to track viral signatures as they arise in Texas wastewater.

Baylor College of Medicine

Detecting H5N1 in Texas Wastewater

When Tisza first detected a signal for H5N1 in Texas wastewater, he was very surprised. There had been early reports that the virus was circulating in cattle, and at the end of March 2024, there was one case in west Texas of a human who presumably was infected from a dairy cow. Still, the researchers did not expect to see a signal across so many urban areas. "At that point, I thought, 'Well, that is probably just an isolated situation.' I did not expect that this would be in our urban areas in Texas," said Tisza. 

He organized an emergency sit down with his colleague Blake Hanson, an epidemiologist at the University of Texas Health Science Center at Houston, to figure out from a computational and mathematical perspective how they could confidently know if H5N1 avian influenza was present in their data. 

"We started to see H5N1 signal in March 2024 and we were both very shocked," Tisza said. "We went back into all of our historical data from May of 2022 until current day, and we saw that we had never seen it before March of 2024, which was even more shocking to us, because in 2022 there was a very large H5N1 avian influenza outbreak in wild birds and poultry, yet we never saw it in the wastewater." 

One of the main factors that is different in 2024 is that this virus is circulating in dairy cows and there have been more human cases reported. "Obviously, that this is now in a dairy cattle reservoir is cause for grave concern," Maresso explained. "It does mean that the virus is adapting in a way that is one step closer toward human-to-human transmission." Detectable viral sequences in wastewater are largely thought of as being from a human source, but as Maresso describes their ongoing work, it still requires a lot of detective work to determine the exact source of the viral signal in urban wastewater.

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Wastewater Surveillance Challenges

According to Tisza, one challenge of wastewater surveillance is that it is a hard sample to deal with because it has liquid and solid components that can clog filters, and it requires careful biohazard considerations. Beyond working with difficult samples, searching for viral sequences in wastewater is what the researchers describe as a needle in a haystack problem. "If you were to just extract RNA and DNA from wastewater to sequence, you would have almost no sequences from human viruses, they are about one in a million," Tisza explained. "You need to drastically enrich the viral material."

The Texas team used a technique called hybrid capture to enrich viral sequences for detection. "It is almost like we have a million little magnets, each of which is specific for a different viral sequence," Tisza said. In this analogy, the magnets are nucleic acids that anneal to each other. There are representative magnets from more than 3000 human viruses, as well as about 15,000 possible variants of these viruses. Those magnets pull down the viral sequences from the wastewater extraction and the researchers wash away the remaining RNA and DNA. They are then left with sequences highly enriched for human viruses. 

After the researchers enrich and sequence this genetic material, they are faced with the challenge of making sense of all those As, Ts, Cs, and Gs. "You have to confidently, specifically, and sensitively assign sequencing reads to the appropriate virus from which they originate, and you also have to be able to distinguish very minor variations in these reads," explained Tisza. This is particularly challenging because different influenza strains or serotypes will rearrange genetic material with each other. For example, the sequences of H5N1 are sometimes very similar to the sequences from other influenza A strains or serotypes. "It is a really big biological, mathematical, and computational problem that we have been working on for the last two and a half years," Tisza added.

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The Future of Viral Detection 

Although finding H5N1 across several cities' wastewater samples has serious implications for public health, the researchers are also encouraged that their virus-agnostic and comprehensive approach allowed them to detect these events early. "From the technological standpoint, I was pleased that we were able to meet the mark," said Maresso. "I do think that this is going to be a transformative moment in public health with respect to using sequencing rather than PCR to detect these viruses in wastewater."

The hope is that, if human transmission is beginning at some low level in the population, they will see that signal in the wastewater and be able to pinpoint how the virus has started to adapt. Unlike PCR-based tests that are currently used to detect viruses, sequence information allows the researchers to track if viral evolution is occurring, right when they detect signal in the wastewater. "We can closely match the sequence of the virus in the wastewater to the virus coming from other reservoirs, like bird, cattle, and other animals, and identify possible origins," Maresso explained. 

Looking beyond their current findings, Tisza dreams that there could one day be more of a nationwide wastewater surveillance program that uses agnostic viral sequencing, which would interface with public health and clinical interventions. For example, if sequencing detects H5N1 in wastewater elsewhere, there could then be resources provided for a targeted public health approach such as voluntary testing of anyone who is coming down with cold or flu-like symptoms. "In that way, we may be able to track down if and how this virus is spreading human-to-human, or if there are people getting it from an animal vector," Tisza said.

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