The Dr. Niman Show 11172024

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You
Good evening and welcome to the doctor Niman show today is Sunday, November 17, 2 024. I think we're gonna start doing these a lot more often and Dr. Niman will give a daily update so would today's update Dr. Niman you have the floor 

Dr. Niman
OK, thanks Ryan. Yeah today I'd focus a little bit more on the teenager. That's in the hospital now still in British Columbia and secrets came out a couple days ago. Just to give some background on on the human cases the outbreak they are going the existing outbreak really started a couple of years ago and and in 2022, but there was a prior outbreak this in the United States. There's another prior outbreak in 20 14 and all of these were the same played, which is 2.3. 4 B And that is in reference to what the H5 was this is H5 with a poly basic TV beside which is kind of the Define high that all the viruses that have this type of this number of basis at the site in H5 or 8 7 end up being high Pat is the high pass virus, but Initially, it seemed to be pretty Specific for the Birds and so like I say it started in 20 14 Back then, there were even three different stereotypes there was HI than one and two and an eight at the end all came from North America and zero down and two which created most of the damage of the damage was significant there were over 50 million birds that ended up being infected or called and dumb, and that particular outbreak went away and then it came back in 202 4 and the end of the earlier ones there were actually zero human cases and then the ones that began in 202 2 there was again 50 million birds that got killed either by infection or euthanized and And that year there was actually only one human case and then there were no human cases in 202 3 and 202 4 things changed fairly dramatically and they began with the viruses is given different genotypes and the genotypes are Based on what the eight segments look like and like I said the last podcast influencers Gino is split up in the eight segments in those segment can shuffle around if one host Factor by two different viruses, they cannot mix and Matt and the virus that end up emerging has usually some of the sickness from one of the viruses and some of the segments from the other since it's called reassortment, but the the genotype really is based upon what the constellation is of these eight different segments And that can have a significant difference and they can have a different certainly in the sequence, but what what does the biological affect that has is not that clear and it turns out the The virus ended up, probably with wild bird that it really wasn't that widespread in wild birds, but infected the cattle and in the panhandle of Texas and it was designated B3. 13 and it had actually evolve from another similar virus, which is B 3– 7 and the difference was the 13 had picked up a M P, I'm sorry An NP segment in the NP was one North American sequence segment exchange with another and emerge A particular change at position 52 and it changed the Y to H and that particular mutation had been associated her has been associated with The alien virus evading the human and human response to that virus and so this was a bit of like an escape mutant Was as affected by the human response and that may have something to do with disability to get the catalog there was a significant delay in identifying the H5 and one in the cattle because they've never been seen before and frankly it hasn't been seen anywhere outside of the United States, but they started out in the panhandle and then it spread to Adjacent states, and so it was in the north east of New Mexico and the southwest of Kansas and it Finally got identified in March of this year and Then it's spread out further through the sale of the cattle of the cattle and not going to other states and that's why all of the dairy actually has the same that they're all B3. 13 and they're all fairly close to be related to each other and And in addition, you know they call dairy, but In the spread, they ended up spread spreading to poultry farms, and and that was where a couple of the larger clusters were so the first cluster actually did happen in Texas That did have one of the changes the mail changes which is in the PB 2 segment and it's called E627 K and that's kind of a temperature sensitive mutant that allows the virus to grow more efficiently at 33° C was a lack of human body temperature than 4 1 for the birds, and if it had to eat that position, it was most efficient at the bird temperature, but but that was a keychain, and that was tested And various to see if it was More easily spread through the air the way those experiments or they affect ferrets and they have them in one cage and they have uninfected ferret and a second cage, and They don't they don't have direct contact with each other and they see whether the second cage, parents end up getting infected by air from the Infected ferret, which she with cough or sneezing, aerosolized the virus and frankly they did get positive of the viral. The Ferris did show some ability transfer from one mammal to the other mammal and what was unusual is all of the fairies that were initially inoculated ended up dying, and that that usually doesn't happen, the ferrets are used all the time in this animal bottle. They were used some of the gain of function studies where they deliberately made some changes in the virus. Affected the ferritin, then saw whether they could transferred it and they were able to do that and under those circumstances also and I'll probably get that another session. I wanna kind of stay at what's going on this year and that's all that was a little bit concerning, but then there they've been quite a few that have been identified in humans with this b3. 13 and. This first case out of Texas is the only one with 67K so The largest cluster is really came out of spill true a couple layer farms in Wells County Colorado, and that resulted in one cluster of six and one cluster of three. These layer fires were relatively close to each other and. The affections were only a couple. I didn't know those couple is probably about a one week apart, but those were the two biggest clusters that had been reported to date and that got a lot of attention and a lot of the sequences that are that are still being positive really hard these very sequences whether they came from. Dairy cattle humans Layer farms or Actually gotten into the milk supply so I knew that's where the milk supply the milk pasteurized. The virus is still detected and those are the key areas but then there was a new outbreak fairly recently and that was in Franklin County Washington, and that had a different constellation that those had it was designated the one that one. And that cluster, which was Definitely the largest actually nine and they take two more so it's really up to 11 now and other than it's three more that were initially PCR confirmed and so they're just suspect because they didn't get confirmed by the CDC so there's been 14 people that they came out of the same fire and That had created some concern, and then the concern increased when this teenager and British Columbia ended up getting a serious case of the virus. These other cases were mostly conjunctivitis some hits of mild conditions. They were pretty much all farmers on the farm or colors and in general. Especially the colors got treated relatively quickly with Tamiflu and they all recovered and didn't really end up in the hospital. This teenager though. Didn't do that well The teenager initially went to the emergency room and And probably being tested for seasonal flu when he was they were negative and then They were actually sent home and then they ended up coming back at least one more time and Possibly too, but even if it was only one, they came back a second time and then they got admitted and they did more sophisticated testing, and they found out that the teenager had been affected with with H5 and then they were subsequently confirmed that it was five and one and the sequence was just released A couple of days ago, Friday night actually, and the sequence ended up being quite concerning that there are specific positions that have been monitored Because that is kind of a model on the 1957 pandemic and in that case H2 and two ended up replacing seasonal fluid with his H one and what add the What the sequences were were compared to what they found is that the that they were really three different positions that were changed that whoever were in the H 5 and they were at position to 26 to 28 20 16 with a Q changing to 28 was a G S and then there was this the same chain that I've mentioned in the PB 2 DE on 62 7 Main to K And it turns out that H 5 has the Has the bird version for all three of those and so when there would be an outbreak in China for instance, and that they were to be an outbreak it could just be people that were very, very sick or actually might've been fatal and they would sequence that individual to see if they had One or more of these changes and they would always come back and say they looked at it, and it doesn't have any changes that worked out for more efficient transmission from human to human and the sequence came back from this teenager and Teenager actually had Change that to out of these three positions and then there was a there was a fourth position which was a position 1 90 on the eighth on the eighth and that was E changed the D and the teenager had that The EEE 1 90 D and they also had to change out the 22 6 but the queue at that position didn't change the Allen started to change the H and they had E 67 And so it really they really had three changes that were gonna make the virus infect other mammals more easily. Now the sequence that came out I really did. These weren't that clean they had mixed signal and which meant they had. This mutation, I said plus they had the original secret they had wow type so they were about 50-50 for each of these three, but those were the only three positions that actually showed dis mixed signals and kinda indicated that they had a virus that didn't have these changes that Was mixed with a virus that had all three of them and and the teenager kinda had this mixed version and in all likelihood the sample that will get clones so they can get a clean version that has all three of these without the wild type Signals in the background and and they might even get more of that by just taking out a new sample from the teenagers, it's lungs, which is where the virus seems to be causing the pneumonia and the recent day the patient is now critical condition with heart, which is acute Respiratory disease syndrome and that's when the lungs and pneumonia is bad enough that is very hard for the patient to oxygen their blood and they may actually be on a ventilator to help do that So the question is, where did he get infected and is still under investigation? It seems likely that the team was probably infected by another mammal the fact that all three changes. You know these are really key changes that they're exceedingly rare in And HI don't want the E 67K it's probably the the more common one that the same but the other two the other three are pretty are pretty rare and they have two of the others 3 + this actually have three It's almost like experiments that are done in the lab where a sample is serial passage and by taking an alien sequence in putting into a mammal and then taking the virus, incubate the mammal and put it into another mammal and do that multiple times and you end up selecting for The mail Changes to make it easier and easier to to move from one man to the other and so there's a good chance that that's what's happening with this particular virus in the team picked it up from mammal that was probably infected by another mammal. It had gone through this process several times and it's a bad news part of that would mean that. There's other mammals out there that have the sequence. They just haven't been identified yet and it's it's concerning that this teenager has all three of these changes. That's where things stand right now I mean, there's there's one story that's in development. It's a little bit. Couple different stories on it that the family dog had actually Been ill and had been euthanized and there's a mixed story as to whether that dog had been sampled or another dog had been sampled it, but there was a dog sample there was it was negative, but even if it was the family dog Since the dog was euthanized, very close to when it would sample is possible that The virus had already removed to the dog salons, and then taking swab the dog's throat by Not of yield it positive because it already cleared it from his throat, but didn't really clear from the lungs. That's why it was causing all the problems so that dog apparently is under. More Investigation where they're probably gonna take Oregon from the dog and And look at The levels of virus and see if they can pick the virus up their deck that that would be a pretty Tidy kind of explanation that teenager prior expose contact with this dog as the dog was staring, and the dog could very well have Eaten some mammal that he died from eating, potentially eating, wild birds that had been infected the sequence itself. You can do these kind of searches. It's kind of like a Google search if you're well you take the sequence and you search the database so you find sequences that are closest and it turns out that the teenagers sequence in. And three of these jeans Has exact matches with with with wild ducks, cackling geese Actually, there's two of them that are exact matches for two of the gene segments the the N P and the N S and then One of those two along with a couple of snow goose And the Canadian goose are exact matches with The plume, I say the PA and the Kathleen Is after the other two it's only got one difference in the in the PA so it does you're really point a while. This is where the sequence began, and how many mammals that went through before it got to the. To the teenager in the hospital might've been one or two and that was enough to evolve this the sequence so it's adapting to the mammal and that's what the concern is in general is the virus the HI and no one will do something similar to the H2 N2 Where started out it's just being an alien sequence and it ended up making these three key changes And then it was able to officially transmitted in humans and that they got established two and two started in 195 7 and then it went through 19 68 when I got Displace by another pandemic and and Started a Hong Kong that was H3 2 and so the bottom line is that this virus is evolving quickly and the teenager has three very important Occasions, they'll probably be more sequences coming from this samples from this teenager. They will probably clean up the wild type and they'll end up getting the virus that just has these three changes without. Competing type sequences for these positions and I'm sure this virus will be studying very very extensively as to how well it works in a model like the first one out of Texas to put this virus in the ferrets and they'll see whether the ferrets in the next cage end up getting infected to see how efficiently this virus will transmit through the air And surveillance I would imagine with would pick up significantly because this particular virus the D1 that one is very widespread in the wild birds. They tested 14 wild birds in British Columbia and 13 of them had this sequence. They tested for farms and we had the sequence and the other one was actually an H5 and two, but there was a derivative of the sequence and the wild birds are coming up positive all the way down to The wild bird and the poultry is in the United States. It's all the way down to Arizona and the Pacific fly away so they're heading south they're coming in very high numbers. It is no time with a fly out of Canada. They fly through the United States and end up going to southern areas in the US are not going. Central America down into South America so that's where we are right now will be doing some additional updates probably each day and maybe get more information on the family dog and potentially has some additional sequences even as earliest tomorrow 

You
OK, thank you for the information everyone. Thank you for listening and have a great day.