Who should pay for Hendra virus research?
A proposed levy on horse owners to fund Hendra virus research has been met with opposition in Queensland. It has been suggested that a $25/horse levy in Queensland would provide needed funding for research into this rare but deadly disease, but this has been opposed by some vets and horse owners. One comment in response to the suggestion of a Hendra virus research levy is that the disease kills humans, so it should be publicly funded. However, Hendra only affects humans who have very close contact with horses, so that's a questionable argument. Also, medical research funding is certainly not overflowing, and the odds of a study such as this getting funded this way may be limited because it is so horse-oriented. I run into the same problem all the time with zoonotic disease research grants. Medical agencies don't want to fund it because it's too animal related, while animal agencies don't want to fund it because it deals more with human health.
Who should fund equine research? Should the government (i.e. all taxpayers) be solely responsible, or should some of the responsibility fall on horse owners, who stand to benefit the most from equine research? This is particularly true for a disease like Hendra that is very rare, currently restricted to one region, and only affects horses and people associated with horses. The rarity of the disease means that industry (e.g. vaccine companies) is probably not eager to fund research (because it would not be profitable). The focal nature of the problem geographically may limit interest from national or international groups. These factors could result in failure to do the necessary research to try to control this deadly disease.
This raises broader questions about funding for equine research. Many people and governments make lots of money from horses, directly or indirectly. You'd like to think that since so much money is made off the backs of horses (both figuratively and in some cases literally), that some of the profits would be put back into helping ensure the health and welfare of these animals. A fraction of a percent of the money generated by horses would be a tremendous asset for equine research, and help make great strides in improving the health and welfare of horses. Unfortunately, such funding is rarely available, and equine researchers are often very limited in terms of the research that can be done with the available dollars. As a researcher, I know the difficulties of finding enough research funding to pay laboratory personnel and grad students, plus perform high quality research. The limited funding that is available is one reason that equine research is now only a fraction of my overall research program. The equine industry as a whole needs to think about its role in research, even if it's from a self-serving standpoint whereby research is funded to help boost performance and profits.
This Worms & Germs blog entry was originally posted on equIDblog on 14-Oct-09.
Hendra virus vaccine: For horses or people?
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In the wake of the death of Dr. Alister Rodgers from Hendra virus, there have been increasing calls for the Australian government to put significant resources into Hendra virus research. Various areas need to be investigated, including how this virus is maintained in the bat population, how it is transmitted from bats to horses, ways to treat infection and ways to prevent infection. Vaccination is an obvious topic, and creation of a vaccine appears to be possible. However, as I wrote the other day, there's a question about whether a company would put millions of dollars into development of a Hendra virus vaccine for people, given that the disease is very rare, is currently limited to one region, and only appears to be a risk for people in close contact with sick horses.
One thing that needs to be considered is whether it may be better to develop a vaccine for horses rather than people. Think about it:
- All reported human Hendra virus infections have come from people in close contact with sick horses.
- Human vaccines are very expensive to develop, test, get approved and market.
- Vaccines for animals are much cheaper to make because testing and regulatory requirements are not as strict. (This can lead to marketing of vaccines for animals with limited evidence of effectiveness, but the upside is that vaccines can get to market quicker and with less expense.)
- People are often more willing to get their horses vaccinated than to get vaccinated themselves.
So, even though it might sound strange, development of a Hendra virus vaccine for horses may be a more effective way to protect people.
If this approach is taken, a key step would be continued research into the epidemiology of Hendra virus infection to investigate other routes of human exposure. If people can get infected by other routes, vaccination of horses obviously wouldn't address the entire problem. However, based on what we know currently, vaccination of horses might be the most effective, timely and economic response to this pressing problem.
This Worms & Germs blog entry was originally posted on equIDblog on 04-Sep-09.
Hendra virus claims life of veterinarian
Unfortunately, Dr. Alister Rodgers, who had been hospitalized with Hendra virus infection acquired from a sick horse, died yesterday in a hospital in Brisbane, Australia. He was infected last month while treating an infected horse on a farm that was subsequently identified as having multiple horses infected with the virus. Despite experimental ribavirin treatment, he developed the infection three weeks later. He is the second veterinarian from Queensland to die from Hendra virus infection in a little over a year. Four of the seven people known to have been infected by this virus since it first emerged in 1994 have died.
Veterinarian diagnosed with Hendra virus infection
A veterinarian, one of four people in Australia that were under close observation due to exposure to a horse with Hendra virus infection, has developed signs of infection. Dr. Alister Rodgers is now in hospital in critical condition. He had close contact with a sick infected horse three weeks ago - Hendra virus was not considered initially, it was thought that the dying horse had been bitten by a venomous snake. Dr. Rogers didn't wear gloves or a mask when examining the horse because he had left them in his car.
Dr. Rodgers received experimental treatment for five days to try to prevent or reduce the severity of infection. He had returned home from hospital following the treatment only one day before he became ill. It has now been confirmed that he is infected. Only six people have been previously diagnosed with this rare disease; three have died. There were hopes that all of the exposed individuals would escape unscathed given initial tests showing no sign of infection and the experimental therapy, but it's clear now that early detection of infection is not easy.
Image: Coloured electron micrograph of Hendra virus (source: www.csiro.au/science/Hendra-Virus.html)
This Worms & Germs blog entry was originally posted on equIDblog on 21-Aug-09.
Experimental treatment for Hendra virus-exposed horse personnel
Four people exposed to horses infected with Hendra virus in Australia are taking an experimental drug to try to prevent or reduce the severity of infection. All are currently healthy, but it is unknown whether the virus is incubating in them and whether disease may develop. People can be infected with this virus through close contact with infected horses, as was the case with these four individuals. While human infections are rare, 50% of infected people die. Therefore, it's understandable that they would choose to try an experimental treatment.
These people will be treated for five days with intravenous ribavirin, an antiviral drug. There is evidence that ribavirin can kill Hendra virus in the laboratory, but it's not known if it actually does anything in infected people. It has some potential adverse effects, but given the severity of disease and high risk that these people have been exposed, it's certainly a reasonable decision. This treatment was also used in the Hendra virus outbreak in 2008. One person died, one survived after a long stay in ICU, and one did not get sick. It's not known whether the drug did anything to help. The death of the treated person doesn't necessarily mean the treatment is not useful for some people or for certain stages of infection. Hopefully, ribavirin has a better chance of working when infection is only developing, before these people get sick.
This Worms & Germs blog entry was originally posted on equIDblog on 13-Aug-09.
It's back: Hendra virus in Australia
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Hendra virus, a virus that can kill horses and people, has resurfaced in Queensland, Australia. This bat-borne disease has caused periodic fatalities in horses and people that work with horses. The latest outbreak is thought to have killed up to three horses and resulted in the potential exposure of at least 30 people. The likelihood of these people getting sick depends on how close their contact was with the sick horses. Close contact with secretions from infected horses seems to be required to transmit disease. One person reported being snorted on by an infected, dying horse and being "covered" in blood, which is certainly concerning. An outbreak last year killed a veterinarian and hospitalized a veterinary nurse.
The farm in question is under quarantine and people that have been exposed are being monitored. There is no treatment for potentially exposed individuals, so they are in the unenviable position of having to wait and see if they get sick.
A virus like this is very hard to control. It's lives in fruit bats and only occasionally crosses into horses. The sporadic nature of disease makes it hard to control and predict when cases will occur. The key is early identification so that there is minimal exposure to other horses and people. People also need to take routine infection control precautions. One veterinarian handled an infected horse without using gloves or a face mask, as recommended, because he had left them in the car. Exposure to a potentially fatal infectious disease is not worth the few minutes of time saved by not following recommended precautions.
This Worms & Germs blog entry was originally posted on equIDblog on 10-Aug-09.
Deadly Hendra virus resurfaces in Australia
A small outbreak of the potentially deadly Hendra virus was identified in a group of horses near Brisbane, Australia. This virus has caused periodic cases of illness and death in horses, and can be transmitted to people working closely with infected horses. In the latest outbreak, 3 horses have died, making this the worst outbreak since 1994 when 14 horses and 2 people died. Now, a human case has been identified. This person works at a veterinary clinic that treated infected horses. This individual was admitted to hospital overnight but was discharged, so is presumably not very ill.
While Hendra virus (genus Henipavirus) is only found in Australia, it is a good reminder for everyone about the strange nature of some infectious diseases. The natural reservoir of the virus is the fruit bat. It is believed that horses become exposed when infected fruit bats give birth and contaminate horse pastures with uterine fluids. Horses develop respiratory disease ranging from mild to fatal. Human cases have been reported in people working closely with infected horses. A horse trainer and veterinarian's assistant died in the 1994 outbreak. Close contact is required for transmission to people.
Picture: Locations of previous Henipavirus outbreaks (red stars – Hendra virus; blue stars – Nipah virus) and distribution of Henipavirus flying fox reservoirs (red shading – Hendra virus; blue shading – Nipah virus)
It's very difficult to take specific measures to protect horses, people or other animals from sporadic, rare diseases such as Hendravirus infection. However, common sense infection control measures can reduce the risks associated with any animal contact.
- Wash your hands after contact with any animal.
- Avoid contact with sick animals - consider sick animals to be potentially infectious until proven otherwise.
- Remember that new animal diseases are regularly being identified, and that they might be able to infect people.
- People that work in veterinary clinics must be diligent and use good infection control practices because they are at higher risk of exposure to various diseases.
