Karori Cemetery, Wellington – One of many graves on those who died of the flu in 1918 Photo: RNZ/Philippa Tolley
Karori Cemetery, Wellington – One of many graves on those who died of the flu in 1918 Photo: RNZ/Philippa Tolley

ScienceNovember 4, 2018

100 years ago, NZ was in the depths of deadly pandemic. Are we ready for the next one?

Karori Cemetery, Wellington – One of many graves on those who died of the flu in 1918 Photo: RNZ/Philippa Tolley
Karori Cemetery, Wellington – One of many graves on those who died of the flu in 1918 Photo: RNZ/Philippa Tolley

November was the peak month of the 1918 pandemic that killed 9,000 New Zealanders. A century, will we be able to deal with another outbreak? Philippa Tolley reports for RNZ’s Insight

The memories captured from the days and weeks the pandemic took hold in 1918 are tragic. Decades later, in a 1967 interview, a Wellington shop assistant recalled how a little boy came in one morning with the paper, as she went into work at a pharmacy.

“He told me the children next door were crying. I asked him why and sent him off to find out.”

The answer the boy came back with was chilling.

“The mother and father looked awfully funny, the mother was black and the father was turning black and there was a baby in the cot and there was a little toddler running round and there was no-one to do anything for them.”

Photo: The Press Collection Alexander Turnull Library – Ref 11-008542-G

Nationwide, it is thought 135 children lost both parents. While the virus itself was bad, it was the pneumonia, a secondary infection, which proved to be the real killer. The skin of some people who develop pneumonia darkened due to burst blood vessels.

People were dropping on the streets, hospitals, doctors and pharmacists were over-run. Lawyers were hurriedly brought into wards to draw up wills before people died.

In lieu of undertakers funeral carriages, trucks were used to transport coffins to local cemeteries as the number of deaths rose rapidly. At the Waikumete Cemetery in Auckland, hundreds of victims were buried in one mass grave.

On the 19 November there were 63 burials at Wellington’s Karori Cemetery in one day.

In total 9,000 New Zealanders lost their lives to the virus.

Even though medical science has made huge leaps forward, Professor Michael Baker, who specialises in public health at Otago University in Wellington, believes the threat remains high.

“There are literally tens of thousands of microbes in the animal world that have the potential to infect us … even pathogens we think are now eradicated like small pox could be re-introduced.

“There’s no guarantee it’s contained in the two sites we know about. It’s maybe elsewhere or it could be re-created.”

Despite being eradicated, the small pox virus is still held in two locations for research. It is officially stored and handled under WHO supervision at the Centers for Disease Control in Atlanta in the United States and at the State Research Center of Virology and Biotechnology in Koltsovo, Russia.

H1N1 Flu virus commonly known as Swine Flu Photo: SUPPLIED

Any release of the small pox virus would be absolutely devastating, according to Professor Baker, as the world’s populations has very little natural immunity, supplies of vaccine are quite small and it would take some time to build up stocks.

“In that time it could kill hundreds of millions of people potentially.”

The most likely cause of the next pandemic is thought to be a new strain of flu.

In Wallaceville, north of Wellington, you have to be expected and buzz-in at the gate before you’re allowed to visit the World Health Organisation’s National Influenza Centre. It is part of the WHO worldwide network keeping tabs on strains that are already circulating and any possible new ones.

Its director, Dr Sue Huang, speaks of the virus almost as if it is an animal siting in front of us, one she describes as “very cunning”.

“They have this ability to jump into humans. The animal virus and the human virus can mingle together and…they are actually able to transmit into a population that has no immunity.”

This is what creates a new pandemic strain, the mixing together of animal and human flu that has been seen with bird flu and swine flu. Seasonal flu comes from the virus’s ability to mutate frequently to “outsmart” antibodies, but does not have the animal-human interchange of a pandemic strain.

Dr Sue Huang at the World Health Organisation’s National Influenza Centre in Wellington Photo: RNZ/Philippa Tolley

“This is really the biggest worry because it cause a pandemic … no other virus is able to do,” Dr Huang said.

The response to a pandemic is planned for and coordinated through an Emergency Management team based at the Ministry of Health.

Director Charles Blanch explained there are national pandemic reserve supplies including anitvirals, masks and syringes to deliver vaccinations once they are developed. Pharmac requires medical wholesalers to hold higher than minimum stocks of drugs in the country, so Mr Blanch says New Zealand does have a reasonable level of resilience.

But not everyone is happy with the way the response system is set up.

Otago University Public Health professor Michael Baker is worried about the public health infrastructure is broken into smaller parts and talks about an erosion, especially in staff and fragmentations of services.

“If the future was predictable that may work, but the things I’m talking about are highly unpredictable and when they come, they’ll come in a way no-one expects in many cases and you need to assemble an almost military style operation to manage that.”

But Mr Blanch is satisfied the system is robust. Through contracts, collaboration and co-ordination, he is confident of the high quality surveillance and response system being provided.

“We are always looking at how other countries and states organise themselves and continually review systems,” he said.

Prof Baker would like this country to mark the 100 year anniversary of the great pandemic by setting up a specialised public health agency, similar to those established in England and Wales in recent years.

This article, and its accompanying audio, originally appeared at RNZ

 

Keep going!
pooooo

ScienceNovember 1, 2018

Your poo is alive (mostly). Here is what’s in it

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Human excrement is not just a bunch of dead cells. Most of it is alive, teeming with billions of microbes, explains Vincent Ho of Western Sydney University.

What makes up poo? Here’s what studies in healthy adults tell us.

Water

Our faeces is largely (75%) made up of water, although this differs from person to person.

Vegetarians have a higher water content in their stools. Those who consume less fibre and more protein have a lower water content. Fibre has a high water-carrying ability and makes our stools more bulky, increases the frequency of bowel movements and makes the process of passing bowel motions easier.

The other 25% of faeces is made up of solids, which are mainly organic (relating to living matter) materials. A small proportion of solids is made up of inorganic material such as calcium and iron phosphate as well as dried constituents of digestive juices.

Around 25-54% of the organic material is made up of microbes (dead and living), such as bacteria and viruses.

Bacteria in faeces have been extensively studied. It’s estimated there are nearly 100 billion bacteria per gram of wet stool.

Microbes

One study that looked at a collection of fresh stools in oxygen-free conditions (as oxygen can damage certain types of bacteria) found almost 50% of the bacteria were alive.

The different types of bacteria present in faeces can influence how hard or loose stool samples can be. For example, Prevotella bacteria, which can be found in the mouth, vagina and gut, are more commonly seen in those with soft stools. In fact, a high-fibre diet is strongly associated with these bacteria.

Ruminococcaceae bacteria, which are common gut microbes that break down complex carbohydrates, favour harder stools.

Viruses have been less studied than bacteria as components of the gut microbiota – the population of bacteria and viruses that live in our gut. It is estimated there are 100 million to 1 billion viruses per gram of wet faeces in most of us.

This number can change considerably when people become sick with viral gastroenteritis, such as in norovirus infections, where levels of more than a trillion viruses per gram of stool can be found.

Certain types of viruses that infect bacteria, called bacteriophages, have been linked to diseases of the gut like Crohn’s disease and ulcerative colitis.

Archaea are bacteria-like microbes that can inhabit some of the most extreme environments on Earth such as hot springs, deep sea vents or extremely acidic waters. Archaea that produce methane are known to live in the human gut and account for around 10% of non-oxygen-dependent microbes.

Such methane-producing archaea like Methanobrevibacter are associated with harder stools and constipation as methane can slow down intestinal movement. It is believed there are around 100 million archaea per gram of wet faeces.

Single-celled fungi (yeasts) are present in the gut of about 70% of healthy adults. They occur in estimated concentrations of up to a million microorganisms per gram of wet faeces but comprise only a small proportion (0.03%) of all microbes.

Other organic material

Some of the organic material includes carbohydrates or any other undigested plant matter, protein and undigested fats. Faeces does not contain large quantities of carbohydrates as the majority of what we eat is absorbed. However, undigested amounts remain as dietary fibre.

Our faeces don’t contain a large proportion of carbohydrates as most are absorbed in the body. shutterstock.com

Some 2-25% of organic matter in faeces is due to nitrogen-containing substances such as undigested dietary protein, and protein from bacteria and cells lining the colon that have been shed.

Fats contribute 2-15% of the organic material in our faeces. The amount of fat excreted into our stools is highly dependent on dietary intake. Even with no fat intake, though, we do get some excretion of fat into our faeces. Fat in faeces can come from bacteria in the form of short-chain fatty acids when they ferment foods, in addition to undigested dietary fat.

Plastic particles

A recent study has found that microscopic plastic particles can appear in our faeces when we drink from plastic bottles or eat foods that have been wrapped in plastic.

This small study of eight participants who were exposed to plastics in their food and drink identified up to nine different types of plastics in their stools. But we need larger studies and additional analytical research to understand the clinical significance of this.

Poo is different in disease

Not everyone’s poo is going to be the same. Diseases such as inflammatory bowel disease can lead to changes in the type of bacteria in our gut and result in raised inflammatory proteins that can be detected in our stool.

The presence of blood in the stool could signal bowel cancer, though this isn’t always the case. Fortunately there is a good screening test that can pick up the presence of trace blood in the stools and lead to further investigations such as a colonoscopy.

Vincent Ho is a senior lecturer and clinical academic gastroenterologist at Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.