MERS-CoV vigilance rises in US

[dothedd]

MERS-CoV vigilance rises in US

Jun 13, 2013 (CIDRAP News) – The Centers for Disease Control and Prevention (CDC) said today that more than 30 US patients have been tested for MERS-CoV (Middle East respiratory syndrome coronavirus), as clinicians asked questions about the criteria for testing people who show up in emergency rooms with suspicious symptoms.

During a conference call to update clinicians on MERS-CoV, the CDC's Susan Gerber, MD, emphasized that no cases have been detected in the United States yet, but said the CDC has tested patients from various parts of the country since the virus was discovered last September.

Gerber, a medical epidemiologist, didn't specify how many patients have been tested, but Mark Pallansch, PhD, director of the CDC's Division of Viral Diseases, told CIDRAP News that the CDC has tested more than 30 suspected cases, all with negative results.

Unofficially, 58 MERS-CoV cases, 33 of them fatal, have been reported since the virus was identified last September, all of them with direct or indirect ties to the Middle East. (The official World Health Organization count is 55 cases with 32 deaths, but Saudi Arabia reported three more cases, one fatal, yesterday.)

The CDC is advising clinicians to consider MERS-CoV in patients who have an unexplained, acute respiratory illness, which may include fever or cough, with suspected pneumonia and a history of travel from the Arabian Peninsula or neighboring countries within the past 14 days. The illness also should be considered in persons who are close contacts of such patients and have a severe acute respiratory illness.

During the Clinician Outreach and Communication Activity (COCA) conference call, Gerber was asked several questions about the appropriate level of MERS-CoV vigilance in hospital emergency departments (EDs). One participant, for example, asked "whether you believe we should begin active screening at all our emergency departments?"

Gerber replied by summarizing the CDC's surveillance case definition, adding, "We do not have any case in the US as yet, but we're trying to alert clinicians and public departments to look for these features, as an astute clinician would be important in possibly identifying a first case."

Another participant asked what should trigger questions about a patient's travel history. Gerber replied that it's important to get a travel history for anyone who comes to an ED with a severe acute respiratory infection, and also to ask about the travel history of such patients' close contacts.

Another listener wondered if MERS-CoV should be considered for patients with influenza-like illness.

Gerber responded that some MERS-CoV cases have been mild, but most have been severe. "Right now our surveillance is focused on severe acute respiratory infections. However, as data or the situation changes, it could be different," she said.

She commented that CDC-developed tests for the novel virus are becoming more widely available, which will enable more laboratories, especially state health department and Laboatory Response Network facilities, to test for the virus.

For cases with a high index of suspicion for MERS-CoV, the CDC recommends testing for it without first ruling out other possible causes, Gerber said.

She reviewed what's been learned about MERS-CoV, relying mainly on published reports, but the question-and-answer period following her presentation served to illustrate how much remains unknown.

When a participant asked about the kinds of comorbidities reported in MERS-CoV patients, Gerber said, "We don't know all the comorbidity information; however, some have included renal transplantation, malignancy, steroid therapy, and renal failure."

In response to a question about surveying US military personnel who recently returned from the Middle East, Gerber said the CDC is working on a serologic test for the virus, but it has not yet been validated. "A validated serologic assay would be very useful in populations such as the one you describe," she said.

Regarding travel advisories, another CDC official on the call said the agency has a "watch" on the Middle East for MERS-CoV, the lowest of three alert levels. The agency is not recommending that anyone change their travel plans, but travelers are advised to monitor their health for 2 weeks after returning from the region.

In other comments during the question-and-answer period, Gerber said:
• There are no good data yet on how long MERS-CoV can survive in the environment.
• The animal source of the virus remains unknown, but investigations are ongoing.
• There is no evidence so far that people can transmit the virus before they have symptoms, but information is limited.
• The virus has been found in the blood of sick patients, but it is unknown whether viremia can occur before onset of symptoms.
• While one patient, the index patient in France, had diarrhea before any respiratory symptoms, the information on initial signs and symptoms remains very incomplete.

Eurosurveillance reports
In related news today, Eurosurveillance published a report providing more details about the first two cases in France, which involved a 64-year-old man who got sick after a trip to Dubai and a 51-year-old man who shared a hospital room with him.

The report says that the index patient, who died on May 28, had had a kidney transplant, and that the second patient remains isolated in an intensive care unit.

"The respiratory presentation of the index case strongly suggests an airborne transmission in the hospital room shared by both patient," the article states. "However, some questions remain about the possible infectiousness of other body fluids or clinical samples, including stools as the index case presented with diarrhoea at an early stage of his disease, and a cross transmission through contaminated surfaces, medical devices or hands of healthcare workers cannot be ruled out."

And in a Eurosurveillance commentary, a team of epidemiology experts from London's Imperial College sketched out three possible transmission scenarios for MERS-CoV, making a case that more detailed case reporting would be useful for gauging how the epidemic may unfold and how the threat might be controlled.

The group said they supported urgent appeals for more data on the MERS-CoV cases, which could shed light on the transmission situation.

"Given the current level of uncertainty around MERS-CoV, it is important that adequate data are collected on future cases to underpin rigorous assessment of the transmission characteristics and severity of MERS-CoV, and the public health threat it may pose," they wrote.

[dothedd]

New MERS virus spreads easily, deadlier than SARS
AP News | Jun 19, 2013

LONDON (AP) — A mysterious new respiratory virus that originated in the Middle East spreads easily between people and appears more deadly than SARS, doctors reported Wednesday after investigating the biggest outbreak in Saudi Arabia.

More than 60 cases of what is now called MERS, including 38 deaths, have been recorded by the World Health Organization in the past year, mostly in Saudi Arabia. So far, illnesses haven't spread as quickly as SARS did in 2003, ultimately triggering a global outbreak that killed about 800 people.

An international team of doctors who investigated nearly two dozen cases in eastern Saudi Arabia found the new coronavirus has some striking similarities to SARS. Unlike SARS, though, scientists remain baffled as to the source of MERS.

In a worrying finding, the team said MERS (Middle East respiratory syndrome) not only spreads easily between people, but within hospitals. That was also the case with SARS, a distant relative of the new virus.

"To me, this felt a lot like SARS did," said Dr. Trish Perl, a senior hospital epidemiologist at Johns Hopkins Medicine, who was part of the team. Their report was published online Wednesday in the New England Journal of Medicine.

Perl said they couldn't nail down how it was spread in every case — through droplets from sneezing or coughing, or a more indirect route. Some of the hospital patients weren't close to the infected person, but somehow picked up the virus.

"In the right circumstances, the spread could be explosive," said Perl, while emphasizing that the team only had a snapshot of one MERS cluster in Saudi Arabia.

Cases have continued to trickle in, and there appears to be an ongoing outbreak in Saudi Arabia. MERS cases have also been reported in Jordan, Qatar, the United Arab Emirates, Britain, France, Germany, Italy and Tunisia. Most have had a direct connection to the Middle East region.

In the Saudi cluster that was investigated, certain patients infected many more people than would be expected, Perl said. One patient who was receiving dialysis treatment spread MERS to seven others, including fellow dialysis patients at the same hospital. During SARS, such patients were known as "superspreaders" and effectively seeded outbreaks in numerous countries.

Perl and colleagues also concluded that symptoms of both diseases are similar, with an initial fever and cough that may last for a few days before pneumonia develops.

But MERS appears far more lethal. Compared to SARS' 8 percent death rate, the fatality rate for MERS in the Saudi outbreak was about 65 percent, though the experts could be missing mild cases that might skew the figures.

While SARS was traced to bats before jumping to humans via civet cats, the source of the MERS virus remains a mystery. It is most closely related to a bat virus though some experts suspect people may be getting sick from animals like camels or goats. Another hypothesis is that infected bats may be contaminating foods like dates, commonly harvested and eaten in Saudi Arabia.

Doctors around the world have struggled to treat patients. "We need more information from other countries to find out what the best treatment is," said Dr. Clemens Wendtner, who treated a MERS patient who later died in Munich. "Our patient got everything possible and it still didn't help him."

Other experts said there are enough worrying signs about MERS that it can't yet be written off, despite the relatively small number of cases it has caused.

"As long as it is around, it has every opportunity at the genetic roulette table to turn into something more dangerous," said Michael Osterholm, an infectious diseases expert at the University of Minnesota.

WHO Director-General Dr. Margaret Chan has previously called MERS the single biggest public health threat and acknowledged officials were "empty-handed" regarding prevention measures.

"We understand too little about this virus when viewed against the magnitude of its potential threat," she said last month in Geneva.

At a meeting this weekend in Cairo, WHO will meet with other experts to discuss MERS and to possibly develop guidelines for next month's Ramadan, when millions of Muslim pilgrims will be visiting
Saudi Arabia.


Journal: www.nejm.org

WHO: www.who.int

CDC: www.cdc.gov/coronavirus/mers/overview.html

[Virgil Showlion]

Soooo... they don't know what causes it, where it comes from, what exactly the symptoms are, whether it can be transmitted by non-symptomatic patients, how long it can survive, whether it's reached the US, or how to treat it.

We just know that it has a brutally high mortality rate and that it "feels like" a more lethal version of SARS.

That's... pleasant.

[dothedd]

Bloomberg News

Coronavirus Mystifies Scientists Seeing SARS-Like Spread
 Jun 19, 2013 7:02 PM ET

Hofuf, a run-down desert oasis town in eastern Saudi Arabia, is home to some of the world’s richest oil fields. It’s also the source of a more worrisome export: a deadly coronavirus.

The city is at the epicenter of an outbreak of a previously unknown virus that has killed 38 people in the Middle East and Europe, recently prompting Margaret Chan, the World Health Organization’s director general, to call it her “greatest concern.”

Now more voices are chiming in. The European Centre for Disease Prevention and Control said yesterday that a dearth of information about the outbreak from Saudi Arabia means it could evolve into a crisis similar to the SARS epidemic in China a decade ago. And researchers in the New England Journal of Medicine said in a study released yesterday that the infection is easily transmitted in hospitals, posing a “serious risk.”

“There’s ongoing transmission,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy in Minneapolis. “That’s what really poses the ongoing threat to the world.”

The virus, dubbed Middle East respiratory syndrome coronavirus, or MERS-CoV, has spread to the U.K., Germany, France and Italy, stoking concern it may spark a pandemic. And like SARS, it’s striking first in a nation unaccustomed to being at the forefront of a global health emergency.

Missing Information
Worldwide, 64 people have been confirmed with the virus since September, according to the WHO. Forty-nine of the cases and 32 of the deaths have been in Saudi Arabia. Other cases have been identified in Jordan, Qatar, the United Arab Emirates and Tunisia.

Basic information about the disease, such as how patients are exposed to it, is still missing for most cases, despite Saudi Arabia’s obligations to share such details under international health regulations, the ECDC said in a report yesterday. That’s making it impossible to estimate accurately the threat posed by the bug, the Stockholm-based agency said.

“At this stage, it is not possible to exclude a future SARS-like scenario,” the agency said. “It is unusual to have such a degree of uncertainty at this stage in an outbreak.”

There haven’t been any reported cases in the U.S. or among Americans traveling abroad, according to the Centers for Disease Control and Prevention, which hasn’t recommended any health warnings or precautions for those going to the Arabian Peninsula or elsewhere.

Vaccine Development
The deputy director of the U.S. CDC’s influenza division, Dan Jernigan, who joined a WHO trip to Saudi Arabia this month, was “not at liberty” to discuss it, according to Jason McDonald, a CDC spokesman.

Discussions are under way about developing an inoculation, the CDC has said. Novavax Inc. (NVAX), a Rockville, Maryland-based vaccine developer, said June 6 that it has produced a vaccine candidate against the virus.

Still, it will probably take at least a year to produce a vaccine, said Albert Osterhaus, the virologist at Erasmus Medical Center in the Netherlands whose team first identified the new virus in a sample it received from a doctor in Saudi Arabia.

Global health officials and scientists, including some from Saudi Arabia, are meeting in Cairo this week in an effort to get to the bottom of the outbreak and devise a plan for tackling it.

At King Fahd Hospital, where most of Saudi Arabia’s cases have been treated, officials including spokesman Ibrahim al-Hajji declined to provide information during a June 16 visit to the hospital, referring questions to the country’s health ministry.

Journal Study
Though Ziad Memish, the Saudi deputy minister of public health, didn’t respond to an e-mail seeking comment, he led the study released yesterday by the the New England Journal of Medicine on the risk of hospital transmission.

No one knows where the virus came from or how it’s spreading, though theories abound. While MERS-CoV belongs to the same family of viruses as the one responsible for SARS, it appears far less transmissible than the earlier pathogen, the WHO has said. Most cases so far have occurred in men with underlying medical conditions, and many family members who’ve had close contact with the sick haven’t been infected, according to statements from the Saudi health ministry.

Bat Origins
Still, the statements don’t specify what those conditions are or how the patients may have been exposed to the virus, information that global health officials need as they try to pinpoint the bug’s origin.

Clues are coming from scientific reports on the handful of patients identified in Europe. A man from the U.A.E. who was flown to Munich for treatment in March owned camels and had tended to a sick animal shortly before showing symptoms of disease, researchers from the University of Bonn Medical Center in Germany wrote in The Lancet Infectious Diseases journal on June 17, citing the dead man’s relatives. No animal samples could be retrieved, they said.

The virus most likely has its origin in bats, which are known carriers of coronaviruses, said Erasmus’s Osterhaus.

Contact between people and bats in the Middle East is uncommon, making it likely the virus has an intermediate host. Camels, goats and domestic animals are being investigated as potential sources of infection, said Gregory Hartl, a WHO spokesman. Another theory is that dates may be to blame. Bats live in date palm trees, which are plentiful in Hofuf, and may contaminate the fruit by defecating or urinating on it. No samples from animals or dates have yet tested positive, Hartl said.

Containing Outbreak
The Geneva-based WHO has said Saudi Arabia is doing an “excellent job” investigating and controlling the outbreak after about 15 international researchers traveled to Saudi Arabia this month to meet with local health officials and assess the situation.

Still, WHO’s Chan, who fought Severe Acute Respiratory Syndrome as director of health in Hong Kong a decade ago, has expressed frustration that her agency isn’t getting all the information it needs to assess the threat. She repeatedly reminded countries of their obligations under international health regulations at the World Health Assembly last month.

‘World Threat’
“The novel coronavirus is not a problem that any single affected country can keep to itself or manage all by itself,” Chan said in a speech last month at the annual meeting of the WHO’s 194 member states. “The novel coronavirus is a threat to the entire world. Any new disease that is emerging faster than our understanding is never under control.”

That level of consternation isn’t evident in Hofuf, a way station for travelers moving between Saudi Arabia and neighbors Qatar and the United Arab Emirates. The area is near Ghawar, the oil field owned by Saudi Arabian Oil Co. that produces an average of 5 million barrels a day, making it the world’s largest.

After learning of the virus, Ahmed al-Hamada, a Saudi mechanical engineering student in Kansas, returned home from the U.S. as planned for his summer break.

“I got back eight days ago,” Hamada, 25, said June 16 at the largest shopping center in Hofuf. “I don’t know much about the virus, but I haven’t changed my behavior. I still go out and still walk around.”

Little Concern
Bader Abdullah, a 26-year-old electrician from the town of Qatif, north along the Persian Gulf, also said there was little concern among his friends and family.

“In the beginning, people were nervous,” he said. “They aren’t anymore. The people getting the virus are coming from villages, where there are no sewer systems.”

While most cases have been reported in Saudi Arabia’s eastern region, the nation’s health ministry last week reported two cases in Taif, a city about 90 kilometers (56 miles) from Mecca, and another in a 2-year-old in Jeddah, about the same distance west of Mecca. Millions of visitors are expected in Mecca for the annual Hajj pilgrimage in October. The Saudi government this week asked visitors to postpone traveling to the country for Hajj, citing construction at the city’s Grand Mosque, according to Arab News.

The Hajj is one of the five pillars of Islam and every able-bodied practicing Muslim is obliged to make the journey at least once in their lives, performing rituals such as circling the cube-shaped Kaaba, one of the religion’s most sacred sites. A record 3.16 million pilgrims traveled to Mecca to perform the Hajj in 2012, according to the Saudi Arabian government.

“Anytime you have massive numbers of people coming together in a crowded way, there’s always a risk,” said Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases. “The lesson from SARS is that awareness and good infection control methods essentially put a stop to SARS, even prior to having any vaccine or having any drugs.”

[dothedd]

Jun 19, 2013 16:47:36 GMT -5 Virgil Showlion said:

Soooo... they don't know what causes it, where it comes from, what exactly the symptoms are, whether it can be transmitted by non-symptomatic patients, how long it can survive, whether it's reached the US, or how to treat it.

We just know that it has a brutally high mortality rate and that it "feels like" a more lethal version of SARS.

That's... pleasant.

[dothedd]

Morning Virgil,

Through “my” grapevine, it’s just a matter of time until world population control is implemented.

Could be this one?

LOTS OF MONEY MOVING INTO FEW HANDS.

[Virgil Showlion]

I highly doubt it.

There's always a theoretical possibility they created the strain and the vaccine has deleterious side effects in the very long term, but if there's a major outbreak in North America it won't stop me from getting vaccinated.

With the 2009 fail flu, I wasn't going to waste my money getting vaccinated against the sniffles. This MERS kills two out of every three people it touches. That kind of forces the issue.

[dothedd]

Jun 20, 2013 14:31:04 GMT -5 Virgil Showlion said:

I highly doubt it.

There's always a theoretical possibility they created the strain and the vaccine has deleterious side effects in the very long term, but if there's a major outbreak in North America it won't stop me from getting vaccinated.

With the 2009 fail flu, I wasn't going to waste my money getting vaccinated against the sniffles. This MERS kills two out of every three people it touches. That kind of forces the issue.

[dothedd]

I hit the wrong button and lost my research ...

Long story short ... I don't take vaccines. However, depending on how Novavax's "creations turn out" I might reconsider.  I'm prepared to isolate for up to 6 months.

Later,


   God bless America

[dothedd]

MERS: Deadly Virus from the Middle East Spreading Quickly


JUNE 24, 2013 BY JAMES PENDLETON, NMD

The MERS Middle East Respiratory Syndrome virus has an extremely high fatality rate.
The lethal virus has emerged from the Arabian Peninsula and it’s striking fear in the hearts of public health officials throughout the world.

Middle East Respiratory Syndrome (MERS) virus materialized out of nowhere last summer, and has since infected at least 60 individuals -mostly in the Middle East. Though this sounds like a relatively small number, apparently 65% of those infected die, and the virus appears to rapidly spread from person to person with minimal contact. World Health Organization Director-General Dr. Margareth Chan recently stated this is an immediate threat to the entire world.

Middle East Respiratory Syndrome (MERS) virus materialized out of nowhere last summer, and has since infected at least 60 individuals -mostly in the Middle East. Though this sounds like a relatively small number, apparently 65% of those infected die, and the virus appears to rapidly spread from person to person with minimal contact. World Health Organization Director-General Dr. Margareth Chan recently stated this is an immediate threat to the entire world.

Another Coronavirus

Like severe acute respiratory syndrome (SARS), MERS is novel member of the coronavirus family. These are large RNA viruses consisting of a spike-lined outer membrane (envelope) and an inner armored shell (protein capsid) that houses instructions for the virus. The name comes from the spiked, crown-like appearance of these virions under the electron microscope. We find corona viruses throughout all mammals; they generally impact the upper respiratory tract. Besides SARS and MERS, several tamer members of this group are known to cause flu-like symptoms in humans.


Signs of MERS Infection

MERS has a long incubation period – it may simmer up to 2 weeks, with symptoms usually occurring within 10 days of transmission. Signs and symptoms start out mild (cough, fever, and malaise) then progress over days to renal disease and pneumonia. So far more men have been infected, but all age groups are susceptible. Those with underlying medical conditions are at even more risk for severe illness.

MERS vs. SARS

Both SARS and MERS are novel emerging coronaviruses with high rates of person-to-person transmission. SARS emerged from Southern China in November of 2002, and became a global threat by March 2003. Of the 8,100 that became sick, 8% progressed to pneumonia and died. By 2004 the outbreak was over and no new cases were reported. The source of SARS appears to be the consumption of wild civet cats in China.

Of those with a diagnosis of MERS, thus far, 60% have progressed to pneumonia and renal problems before death. Researchers still do not know the source of MERS, but this novel coronavirus appears to be related to virus species that infect bats.

 Why is MERS So Deadly and Contagious?

Could Rousettus aegyptiacus, the Egyptian fruit bat, be the source of MERS? Photo by Dawson
Why is MERS so Deadly and Contagious?

The ideal virus is usually well-behaved and tailored to a specific species. These virions tend to lurk quietly in cells and are kept in check by the host’s immune system. They silently evade with minimal negative impact to their host. Their survival and spread depends on the host living a long and productive life, which allows frequent opportunity for interaction with others.

Sometimes an event occurs in the environment that brings two species in contact that normally don’t interact. These accidental encounters allow for the opportunity to exchange novel microbes like bacteria and virions between the species.

Since the newly infected hosts has never encountered these microbes, it may have no immune defense against them. In this case, expect devastating illness. Eventually the virus may evolve in those that survive to get along with the host -achieving a homeostatic equilibrium-with mild or complete absence of symptoms.

MERS is Probably of Bat Origin

Another consideration is that virions are prone to mutations that might make it easier to take the leap between species. This is probably the scenario with MERS. The MERS coronavirus appears to be quite similar to those that infect bats in regions of Africa and the Middle East. Researchers hypothesize that bats harboring a new version of coronavirus are contaminating dates, which people produce and consume heavily throughout the Middle East. Bats may also transmit the virus to goats or camels, which then pass the virus to humans.

Middle East Respiratory Syndrome: Treatment Options

At this time there are few conventional options in the management of MERS beyond supportive measures and quarantine. No antiviral medications or vaccines have been developed. Emphasis is on prophylactic strategies like hand washing.

Resources

Assiri, A., A. McGeer, et al. Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus. (2013). N Engl J Med. Accessed June 24, 2013.
Centers for Disease Control and Prevention USA. Middle East Respiratory Syndrome. (2013).
de Groot, R. J., S. C. Baker, et al. Middle East Respiratory Syndrome Coronavirus (MERS-CoV); Announcement of the Coronavirus Study Group. (2013). J Virol.
Drosten, C., M. Seilmaier, et al. Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection. (2013).Lancet Infect Dis.
Memish, Z. A., A. I. Zumla, et al. Family Cluster of Middle East Respiratory Syndrome Coronavirus Infections. (2013). N Engl J Med.
Mou, H., V. S. Raj, et al. The receptor binding domain of the new MERS coronavirus maps to a 231-residue region in the spike protein that efficiently elicits neutralizing antibodies. (2013). J Virol.
Petherick, A. MERS-CoV: in search of answers. (2013). Lancet 381(9883): 2069.
World Health Organization: Global Alert and Response: Coronavirus Infections. (2013).

www.decodedscience.com/mers-deadly-virus-from-the-middle-east-spreading-quickly/31430


 Novavax, has the one & only vaccine candidate according to the CDC

[dothedd]

Wednesday, 26 June 2013




Possible Pandemic:  Is MERS the New Sars VIDEO

article.wn.com/view/2013/05/30/Possible_Pandemic_Is_MERS_the_New_SARS/#/video

[dothedd]

Saudi Arabia reported nine new MERS-CoV (Middle East respiratory syndrome coronavirus) cases in the past 3 days, including six cases that were asymptomatic.

In addition, the World Health Organization (WHO) reported on Jun 22 that two Saudi MERS cases that had been announced earlier were also asymptomatic. The Saudi and WHO reports offered the clearest evidence yet of such cases, which suggest the possibility that people can unknowingly carry and spread the virus.

Also over the weekend, the WHO's Eastern Mediterranean Regional Office (EMRO) appealed for fast, complete reporting of MERS-CoV cases, in the wake of a meeting in Cairo of public health experts from all countries that have had cases.

New Saudi cases

The Saudi Ministry of Health (MOH) announced the latest cases and deaths in statements on Jun 21 and 23.

The Jun 21 announcement reported the illness in a 41-year-old woman in Riyadh and a 32-year-old Saudi citizen in the country's Eastern region. The woman is a contact of a previous case-patient and was in stable condition, while the 32-year-old had cancer and was in an intensive care unit. The statement also noted the death of a previously reported patient but gave no details.

The MOH's Jun 23 statement announced the six asymptomatic cases and one symptomatic one. Four of the silent cases were in children between the ages of 7 and 15, all of whom had contact with other cases in Riyadh and the Eastern region.

The other two symptom-free cases involved female healthcare workers (HCWs in the Eastern region and Al-Ahsa. The MOH did not specify if the two HCWs were exposed to MERS patients, but it seemed likely, since Al-Ahsa was the site of recent hospital outbreaks.

The Jun 23 statement also cited a case in a 50-year-old woman in the Eastern region who was hospitalized with "pulmonary disease" and was listed in stable condition. In addition, the statement reported the death of the 32-year-old cancer patient whose case was announced on Jun 21.

On Jun 22 the WHO weighed in by recognizing four cases that Saudi Arabia had announced 2 days earlier. These involved a 43-year-old woman in the Eastern region who had already recovered, plus three female HCWs, ages 29, 39, and 45, from Taif governorate, near Mecca.

The three HCWs had cared for two previously confirmed MERS case-patients, and their infections were detected in the course of contact tracing, the WHO said, adding, "Two of these three cases were asymptomatic and all three tested weakly positive by PCR [polymerase chain reaction]."

Only one asymptomatic MERS case has been reported previously, and only unofficially. Recently Jordanian and US health officials reported via the media that eight Jordanians had positive serologic (antibody) tests indicating past MERS-CoV infections, and one of the individuals had not had any symptoms.

They were among 124 people who were tested recently in a retrospective investigation of a hospital outbreak of MERS in Jordan in April 2012, the officials said.

The WHO issued another statement on Jun 23, which noted the two cases reported by the Saudi MOH 2 days earlier, in the 41-year-old woman and 32-year-old man, along with the death of a previous patient.

The WHO statement put the global MERS-CoV count at 70 confirmed cases with 39 deaths. The latest cases and additional death reported in Saudi Arabia appear to raise the global numbers to 77 cases and 40 deaths. Saudi Arabia's tally is 62 cases and 34 deaths.

Cairo meeting

At the Cairo meeting, which ran from Jun 20 to 22, more than 100 public health experts agreed on the need for rapid, detailed reporting of MERS-CoV cases, using consistent methods, according to a WHO EMRO press release.

"At an international level, fast and complete reporting of cases, with contact histories, clinical care and treatment outcomes in as much detail as possible, and collected in a uniform manner across countries, is necessary for the international public health community to be able to build up a picture of what works and what doesn't in combatting this virus," the statement said.

Ala Alwan, MD, EMRO director, said that using the same tools and protocols will facilitate the most effective pooling of information and resources. "This meeting has taken us an important step in that direction," he added.

Keiji Fukuda, MD, the WHO's assistant director-general for health security and the environment, called for urgent action: "At the moment we have an important window where cases have still been relatively few and human transmission is relatively limited. We need to exploit this chance to agree and implement the best public health measures possible across the board for, in so doing, we stand the best chance of controlling this virus before it spreads further."

Officials at the meeting agreed that every country should enhance surveillance for severe acute respiratory illness and "urgently investigate any cluster of pneumonia with unusual clinical presentations, or any immune-compromised patient or healthcare worker with any unusual sign of acute respiratory infection," the release said. Also, countries "should share data with the WHO and report any confirmed and probable cases of MERS-CoV within 24 hours of classification."

Countries represented at the meeting included all those that have had MERS cases and all nations in the WHO's Eastern Mediterranean Region.

[dothedd]

Saudis, WHO report 8 silent MERS cases - Jun 24, 2013

Saudi Arabia reported nine new MERS-CoV (Middle East respiratory syndrome coronavirus) cases in the past 3 days, including six cases that were asymptomatic.

In addition, the World Health Organization (WHO) reported on Jun 22 that two Saudi MERS cases that had been announced earlier were also asymptomatic. The Saudi and WHO reports offered the clearest evidence yet of such cases, which suggest the possibility that people can unknowingly carry and spread the virus.

Also over the weekend, the WHO's Eastern Mediterranean Regional Office (EMRO) appealed for fast, complete reporting of MERS-CoV cases, in the wake of a meeting in Cairo of public health experts from all countries that have had cases.

New Saudi cases
The Saudi Ministry of Health (MOH) announced the latest cases and deaths in statements on Jun 21 and 23.
The Jun 21 announcement reported the illness in a 41-year-old woman in Riyadh and a 32-year-old Saudi citizen in the country's Eastern region. The woman is a contact of a previous case-patient and was in stable condition, while the 32-year-old had cancer and was in an intensive care unit. The statement also noted the death of a previously reported patient but gave no details.

The MOH's Jun 23 statement announced the six asymptomatic cases and one symptomatic one. Four of the silent cases were in children between the ages of 7 and 15, all of whom had contact with other cases in Riyadh and the Eastern region.

The other two symptom-free cases involved female healthcare workers (HCWs in the Eastern region and Al-Ahsa. The MOH did not specify if the two HCWs were exposed to MERS patients, but it seemed likely, since Al-Ahsa was the site of recent hospital outbreaks.

The Jun 23 statement also cited a case in a 50-year-old woman in the Eastern region who was hospitalized with "pulmonary disease" and was listed in stable condition. In addition, the statement reported the death of the 32-year-old cancer patient whose case was announced on Jun 21.

On Jun 22 the WHO weighed in by recognizing four cases that Saudi Arabia had announced 2 days earlier. These involved a 43-year-old woman in the Eastern region who had already recovered, plus three female HCWs, ages 29, 39, and 45, from Taif governorate, near Mecca.

The three HCWs had cared for two previously confirmed MERS case-patients, and their infections were detected in the course of contact tracing, the WHO said, adding, "Two of these three cases were asymptomatic and all three tested weakly positive by PCR [polymerase chain reaction]."

Only one asymptomatic MERS case has been reported previously, and only unofficially. Recently Jordanian and US health officials reported via the media that eight Jordanians had positive serologic (antibody) tests indicating past MERS-CoV infections, and one of the individuals had not had any symptoms.

They were among 124 people who were tested recently in a retrospective investigation of a hospital outbreak of MERS in Jordan in April 2012, the officials said.

The WHO issued another statement on Jun 23, which noted the two cases reported by the Saudi MOH 2 days earlier, in the 41-year-old woman and 32-year-old man, along with the death of a previous patient.

The WHO statement put the global MERS-CoV count at 70 confirmed cases with 39 deaths. The latest cases and additional death reported in Saudi Arabia appear to raise the global numbers to 77 cases and 40 deaths. Saudi Arabia's tally is 62 cases and 34 deaths.

Cairo meeting
At the Cairo meeting, which ran from Jun 20 to 22, more than 100 public health experts agreed on the need for rapid, detailed reporting of MERS-CoV cases, using consistent methods, according to a WHO EMRO press release.

"At an international level, fast and complete reporting of cases, with contact histories, clinical care and treatment outcomes in as much detail as possible, and collected in a uniform manner across countries, is necessary for the international public health community to be able to build up a picture of what works and what doesn't in combatting this virus," the statement said.

Ala Alwan, MD, EMRO director, said that using the same tools and protocols will facilitate the most effective pooling of information and resources. "This meeting has taken us an important step in that direction," he added.

Keiji Fukuda, MD, the WHO's assistant director-general for health security and the environment, called for urgent action: "At the moment we have an important window where cases have still been relatively few and human transmission is relatively limited. We need to exploit this chance to agree and implement the best public health measures possible across the board for, in so doing, we stand the best chance of controlling this virus before it spreads further."

Officials at the meeting agreed that every country should enhance surveillance for severe acute respiratory illness and "urgently investigate any cluster of pneumonia with unusual clinical presentations, or any immune-compromised patient or healthcare worker with any unusual sign of acute respiratory infection," the release said. Also, countries "should share data with the WHO and report any confirmed and probable cases of MERS-CoV within 24 hours of classification."

Countries represented at the meeting included all those that have had MERS cases and all nations in the WHO's Eastern Mediterranean Region.

[dothedd]

Jun 25, 2013

WHO notes latest MERS-CoV cases, raises global count to 77 cases

The World Health Organization (WHO) today used Twitter to acknowledge the seven latest MERS-CoV (Middle East respiratory syndrome coronavirus) cases in Saudi Arabia.

The agency said it had received Saudi Arabia's report of the seven new cases and the death of a previously announced patient.

The cases increased the global MERS count to 77 cases and 40 deaths, the WHO said.

Saudi Arabia's Ministry of Health had announced the seven cases and the death on its Web site on Jun 23.
Six of the cases, involving four children and two female healthcare workers, were described as asymptomatic. The seventh case was in a 50-year-old woman who was reported to be hospitalized and in stable condition.

[dothedd]

MERS-CoV Essen Sequence Matches England1
Recombinomics Commentary 01:15
June 29, 2013

University of Bonn Medical Center researchers release a partial sequence from the Qatari resident who traveled to Essen, Germany for medical treatment. The sequences, designated Essen, was used to develop PCR primers and tests and the sequences for the RdRp and N gene had been made public at the researchers website.

However, the sequence at Genbank covered multiple regions and provided sufficient information to classify the sequence as a close relative of the England1 sequence. That designation had been suggest from the partial N gene sequence which included A29719T, which was exclusively shared with the England1 sequence which was from the other Qatari resident.

Prior to the release of this longer sequence, full sequences had been generated for nine patients. The first four divided the MERS-CoV sequences into two sub-clades. One was composed of the two earliest sequences, Jordan-N3 (ICU nurse, 40F, in Jordan) and EMC (first confirmed case, 60M, from Jeddah), while the other was composed of England1 (Qatari, 49M, air ambulance to England) and England2 (England resident, 60M, Urah pilgrim to KSA). These two sub-clades were largely defined by clustered polymorphisms in the OFR 1ab gene. All subsequent isolates mapped to the England1/2 branch, which was then divided into England1 and England2.

The recently released Dubai sequence (73M traveled to Germany for treatment) mapped to the England1 branch, while the four sequences from the Al Hasa nosocomial outbreak mapped to England2.
The Essen sequence had two additional polymorphisms (C25597T and C27229T) which were also exclusively shared with England1, as well as two unique polymorphisms (C680T and G12116A). the clustering of the polymorphisms shared with England1 also supports evolution via homologous recombination, which was also seen for the earlier polymorphisms that defined the two major sub-clades.

The shared polymorphisms between England1 and the Essen sequences suggests the Qatari who developed mild symptoms in KSA while performing Umrah, recovered after he returned to Qatar and then was MERS-CoV infected in Qatar, since the patient generating the Essen sequence had not traveled outside of Qatar prior to symptoms.

Thus, England1, Essen, and the Dubai sequences define MERS-CoV in Qatar and UAE, while the Al Hasa and England2 sequences define the other branch of the England1/2 subclade.

[dothedd]

WHO Forms MERS Emergency Committee
Recombinomics Commentary 17:45
July 8, 2013

Fukuda: Okay, good question. So in terms of how often, just to remind you, the Emergency Committee is convened under the International Health Regulations so basically what that means is that the International Health Regulations envisioned the need for emergency committees to be stood up every once in a while. And so the International Health Regulations themselves were adopted in 2005 after SARS occurred but really came into force in 2007, that’s when they were actuallyimplemented.

The first time we used the emergency committee was during the 2009 H1N1 pandemic. That’s when we called it so this will be the second time that we will have convened an emergency committee. Anyway, it’s the second time.

So in terms of the control room we have something called – it’s basically an emergency operating centre – we call it the SHOC room – I think, Strategic Health…

Hartl: Operations Centre.

The above comments are from the transcript of the WHO June 5 press release on the emergency panel which is meeting tomorrow to assess the needs for additional actions regarding the MERS-CoV outbreak, which is largely limited to countries in the Middle East (the need for emergency committees was inspired by the 2003 SARS outbreak)..

The press release offered few clues on the timing of the meeting since the number of reported cases has been approximately 20 for each of the past three months. However, the lack of information on mild or asymptomatic cases was cited and there have been a number of developments in this area in the past several weeks. WHO also released new guidelines on case definitions (on July 3) which addressed issues associated with recent reports, which have raised questions about reporting of mild and asymptomatic cases, including possible gaming of the IHR reporting rules through the use of false negatives.

The reporting concerns began to increase in the spring when Kingdom of Saudi Arabia (KSA) officials noted that MERS-CoV cases where much like flu cases in that most cases survive without hospitalization or treatment and most of these mild cases were in Jeddah. However, at the time there were no mild Jeddah cases reported. The only reported case linked to Jeddah was the first confirmed case (60M) who lived in Bisha, but was treated and died in a hospital in Jeddah. Moreover, the only reported Jeddah case since the comments in the spring was a child (2M), who recently also died. Thus, to date there have been no mild cases reported from Jeddah, although milder cases have recently been reported in Taif (see map).

The comments on mild cases in Jeddah raised concerns that there cases were testing positive, but were not being reported because they were weak positives and a higher cut-off was being used to define a positive case, or samples were degrading between collection and confirmatory testing, so patients were not being confirmed because the second test was (falsely) negative.

Testing issues became more obvious due to recent developments. Symptomatic Health care workers and cases in France were said to be negative, but the home quarantine or immediate hospital discharge suggested that these symptomatic contacts had recovered prior to sample collection, and the negative data was false.

This possibility was increased by subsequent results from Italy. Two confirmed contacts tested positive prior to hospitalization, but were discharged a few days later when they tested negative. These two cases indicated the window of opportunity for detection of MERS-CoV in mild cases was small and samples collected several days after disease onset would be negative for mild infections.

Testing issues were also raised when contacts in Italy, including five health care workers produced weak positives. Although the weak positives were not confirmed by a second lab, different PCR primers were used raising concerns that the use of tests with a lower sensitivity would produce false negatives for samples that produced weak positives with more sensitive tests.

In addition to the suspect negatives in France and Italy, results from serum antibody testing of ICU contacts from the 2012 outbreak in Jordan confirmed MERS-CoV in an asymptomatic and mild case (both recovered without treatment or hospitalization). Moreover, positive results with one of the two antibody tests suggested additional mild or asymptomatic cases would be confirmed with a more optimized antibody test, indicating additional spread to ICU contacts (as well as additional mild and asymptomatic cases).

Moreover, KSA then reported PCR confirmation of MERS-CoV in mild and asymptomatic contacts, which WHO described as “weak positives”, which once again raised concerns that cut-off changes or improved sample handling led to confirmation of cases similar to the earlier Jeddah ‘mild” cases which were not reported.

The testing concerns have been addressed in the WHO case definition update, which classifies these cases as probable. These mild or asymptomatic cases are important for determination of transmission chains and the conversion of “seemingly sporadic” cases into clusters and the limited human to human transmission into sustained transmission.

[dothedd]

More MERS cases reported; WHO names emergency panel
July 8 2013

News over the weekend of another MERS-CoV (Middle East respiratory syndrome coronavirus) case and two deaths in Saudi Arabia was followed today by the naming of 15 experts from nearly as many countries to serve on the World Health Organization's (WHO's) MERS-CoV emergency committee.

The WHO said yesterday that the latest Saudi case involves a 56-year-old female healthcare worker in Hafr Al-Batin, in the Northeastern region. She had contact with another MERS-CoV case-patient, who recovered.

The two patients who died were a 53-year-old "citizen" from the Eastern region and a 2-year-old boy, the WHO said.

The Saudi Ministry of Health (MOH) noted the two deaths in a typically brief statement a day earlier, on Jul 6. That statement reported the case in the 56-year-old woman and two other cases that had been announced first by the WHO on Jul 5. Those involved two men, aged 66 and 69, from Riyadh.

The additional illness and deaths raised the WHO's MERS-CoV count to 80 cases and 44 deaths. Of those, 65 cases and 38 deaths have occurred in Saudi Arabia, according to the MOH.

Committee members named

In naming the members of the new MERS-CoV emergency committee, the WHO followed up its Jul 5 announcement of the panel's formation. The group, officially called the International Health Regulations (2005) Emergency Committee concerning Middle East Respiratory Syndrome Coronavirus (MERS-CoV), will advise the WHO on how to respond if the virus starts spreading more widely.

The committee is scheduled to hold its first teleconference tomorrow and a second one 2 days later, the WHO said last week. These first sessions will mainly involving backgrounding the members about MERS-CoV developments to date.

The committee includes Ziad Memish, MD, Saudi Arabia's deputy minister for public health. The United Kingdom, another country that has had MERS cases, is represented by Maria Zambon, PhD, director of reference microbiology services for Public Health England. No other countries that have reported MERS cases have members on the panel.

Other members are:
•Tjandra Aditama, MD, of Indonesia's Ministry of Health in Jakarta
•Dr Salah T. Al Awaidy of the Oman Ministry of Health in Muscat
•Chris Baggoley, MD, of Australia's Department of Health and Ageing in Canberra
•Martin Cetron, MD, director of the Division of Global Migration and Quarantine at the US Centers for Disease Control and Prevention in Atlanta
•Claudia Gonzalez, psychologist and researcher at Universidad del Desarrollo in Santiago, Chile
•Paata Imnadze, MD, PhD, of the National Center for Disease Control and Public Health in Tibilisi, Georgia
•Fadzilah Kamaludin, MBBS, of Malaysia's Ministry of Health in Putrajaya
•Bjorn-Inge Larsen, MD, of the Ministry of Health and Care Services in Oslo, Norway
•Babacar Ndoye, MD, PhD, an infection control expert from Dakar, Senegal
•Mahmudur Rahman of the Ministry of Health and Family Welfare in Dhaka, Bangladesh
•Maha Talaat, MD, MPH, DPH, of US Naval Medical Research Unit No.3 in Cairo
•Theresa Tam, MBBS, of the Public Health Agency of Canada in Ottawa
•Oyewale Tomori, DVM, PhD, of Redeemer's University in Lagos, Nigeria

Animal samples to be tested

In other developments, US scientists may begin testing animal samples from Saudi Arabia this week, after succeeding in a difficult effort to get the samples into the United States, the Canadian Press reported today. The testing is part of ongoing effort to figure out the virus's animal origin.

A team headed by Ian Lipkin, PhD, director of the Center for Infection and Immunity at Columbia University's Mailman School of Public Health, collected specimens from hoofed animals during a trip to Saudi Arabia in April, the story said.

But because Saudi Arabia has foot-and-mouth disease (FMD), a highly contagious cattle disease, the samples could not readily be brought into the United States, Lipkin said. Through deliberations that went all the way to the White House, however, he was able to circumvent the problem.

The samples will be tested at the US Department of Agriculture's (USDA's) Plum Island Animal Disease Center, off Long Island.

If the USDA lab finds the samples to be free of FMD virus, they will be released to Lipkin's lab, which will test them for evidence of MERS-CoV, similar viruses, or antibodies to the virus, according to the story.

Lipkin also reported that a bat sample that was collected in Saudi Arabia last October contained a trace of virus that looked like MERS-CoV. But the sample arrived in poor condition, leaving too little material to justify confidence in the finding, he reported. The virus is related to coronaviruses found in bats.

The story also said Lipkin's lab has been testing blood samples from more than 200 Saudi Arabians, including MERS case-patients and contacts of patients. The tests for MERS-CoV antibodies may eventually shed light on whether there have been many mild or asymptomatic cases that have remained invisible.

Cross-reactive antibodies

In other news, a research team from the University of Hong Kong said antibodies to the SARS (severe acute respiratory syndrome) coronavirus may cross-react with other betacoronaviruses, including MERS-CoV. The team said this finding could complicate efforts to identify people carrying antibodies indicating past exposure to MERS-CoV.

Writing in the Journal of Infection, the researchers said they tested archived serum samples from 94 workers at wildlife markets, 28 SARS patients, and 152 healthy blood donors. Immunofluorescence screening suggested that 17 of 28 SARS patients had significant MERS-CoV antibody titers, and 7 of 28 had low levels of neutralizing antibodies.

[dothedd]

WHO sees changing pattern in recent MERS cases
CIDRAP News|

Jul 09, 2013

Recent MERS-CoV cases have featured less severe symptoms and patients who were younger and more likely to be female, but precisely what the changing pattern means is not clear, the World Health Organization (WHO) said in a new summary today.

The report came on the heels of a Saudi Arabian Ministry of Health (MOH) report of another new case, this one in a 66-year-old man in the southwestern province of Asir, who was said to be in stable condition. His illness raises Saudi Arabia's MERS-CoV (Middle East respiratory syndrome coronavirus) count to 66 cases with 38 deaths.

The MOH also announced the recovery of another patient, a female healthcare worker in Hafr Al-Batin in the northeastern part of the country. She apparently is the same patient whose case was noted by the WHO 2 days ago. The WHO listed her age as 56.

In still another development, the WHO's new emergency committee on MERS-CoV held its first teleconference today and scheduled a second session for Jul 17, the WHO said. Today's inaugural session focused on background briefings.

The global MERS-CoV tally, according to today's WHO summary and literature update, is now 80 cases and 45 deaths, which does not include the new Saudi case. That's one more death than was reported by the agency on Jul 7. WHO spokesman Gregory Hartl said the additional death was that of the Qatari patient who died in London last week after being hospitalized there since last September.

Asymptomatic cases

The WHO summary says that 16 new confirmed cases have been reported by Saudi Arabia since the last WHO summary on Jun 20, and 8 of those were reported to be asymptomatic. Four of the symptom-free cases were in female healthcare workers, while the other four were in children who had contact with other MERS patients.

Of the 80 total cases so far, 45 patients (56%) have died. Of 75 case-patients whose sex was known, 49 (64%) were male, and the median age is 51 years, the WHO reported.

When the WHO released its last MERS-CoV summary on Jun 20, the case-fatality rate was 59% (38 of 64 cases), slightly higher than the new number of 56%. Seventy-two percent of the case-patients were reported to be male at that time.

"With recent reports of asymptomatic and mild cases, the proportion of confirmed cases that have died of MERS-CoV infections is lower than previously reported, as is the average age, and the proportion of patients who are female has increased," the agency said. "It is noteworthy that these cases have been detected as part of contact investigations around severe cases."

Index case-patients in clusters are presumably more likely to have caught the virus from non-human sources and continue to be mostly older men, the report goes on to say. "Whether the relative mildness of illness in contact cases is an artifact of surveillance and case-finding activities or represents a difference in virulence between sporadic infections acquired from non-human exposures and those acquired from human-to-human transmission is unknown," it adds.

The WHO further observes that the recent mild and asymptomatic cases raise concerns about the possibility that many mild cases are going undetected. It's clear that human-to-human transmission occurs, but it's not clear if it is sustained in the community.

Two possible scenarios

"The currently observed pattern of disease occurrence could be consistent either with ongoing transmission in an animal reservoir with sporadic spillover into humans resulting in non-sustained clusters, or unrecognized sustained transmission among humans with occasional severe cases," the agency says.

To answer the questions, detailed case contact investigations, increased surveillance in other Middle Eastern countries, and studies of non-human exposures in index cases are urgently needed, it adds.

Although the worry about asymptomatic cases is that people can spread the virus unwittingly, the WHO says the public health importance of such cases is uncertain. The record of the SARS (severe acute respiratory syndrome) outbreak in 2003, also caused by a coronavirus, suggests that "very little if any transmission occurred from asymptomatic individuals."

Also, false-positive MERS-CoV tests in asymptomatic patients can result from laboratory contamination, the agency said. Serologic or other tests can provide additional confirmation in doubtful cases.

Some similar comments about the pattern of recent MERS cases were heard at a London conference sponsored by Public Health England (PHE) today, according to the conference's Twitter feed.

John Watson, MB MS, MSc, of PHE said secondary cases in clusters have tended to be milder than index cases, and the significance of milder and asymptomatic cases is not yet clear, according to conference tweets.

In other points in the WHO statement, the agency said it is preparing travel and health advice for travelers to upcoming mass gatherings. Saudi Arabia is expecting crowds of visitors this month for the Umrah pilgrimage and far more for the Hajj in October.

The WHO also said it is coordinating the collection of a set of clinical serum samples, including negative and positive ones, to standardize serologic assays. Other steps include a review of hospital infection prevention recommendations and development of advice on infection prevention for patients being cared for at home.

Emergency panel's first conference

The WHO's new International Health Regulations Emergency Committee on MERS-CoV had a 3-hour inaugural teleconference today, according to a statement from WHO Director-General Margaret Chan, MD.

The 15-member group of experts heard a review of the situation by the WHO Secretariat and briefings from representatives of several countries that have had MERS cases, Chan said. The panel decided it needs time for further discussion and consideration and decided to schedule its second conference for Jul 17.

The committee's task is to provide technical advice to the WHO on responding to MERS. Its establishment was announced last week.

[dothedd]

This conference, hosted by Public Health England, will provide an update on the global and UK local situation with respect to the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), including the clinical, virological and epidemiological features, investigation and research and the public health response. The conference aims to bring together local, national and international perspectives on this disease, to consider its potential future course and to agree research priorities. In addition to speakers from the UK who have been involved the UK's response to date, a number of distinguished international experts will be giving presentations.

The event has been accredited for CPD by the Royal College of Pathologists (5 credits).

Who should attend?
Clinical, public health and microbiology professionals and policy makers in the UK, and academic and international partners.

This event is free to attend but space is limited so please book early using the link on the Book to attend page.


About Public Health England

Public Health England (PHE) will work to help people live longer, healthier lives by supporting and enabling local government, the NHS and the public to protect and improve health and wellbeing and reduce inequalities. This new national body, an executive agency of the Department of Health, took up its full responsibilities on 1 April 2013.

Using the new public health outcomes framework to measure our health for the next three years, PHE will help bring about fundamental improvements in the public's health and wellbeing, by focusing its energies on five high-level enduring priorities:

1. Helping people to live longer and more healthy lives by reducing preventable deaths and the burden of ill health associated with smoking, high blood pressure, obesity, poor diet, poor mental health, insufficient exercise, and alcohol
2. Reducing the burden of disease and disability in life by focusing on preventing and recovering from the conditions with the greatest impact, including dementia, anxiety, depression and drug dependency
3. Protecting the country from infectious diseases and environmental hazards, including the growing problem of infections that resist treatment with antibiotics
4. Supporting families to give children and young people the best start in life, through working with health visiting and school nursing, family nurse partnerships and the Troubled Families programme
5. Improving health in the workplace by encouraging employers to support their staff, and those moving into and out of the workforce, to lead healthier lives

To underpin these outcome-focused priorities we will:
6. Promote the development of place-based public health systems
7. Develop our own capacity and capability to provide professional, scientific and delivery

[dothedd]

Saturday, July 13, 2013

UAE announces first case of MERS-virus infection

Afp, Abu Dhabi

Health authorities in the UAE have announced that an 82-year-old man has been diagnosed with the MERS coronavirus infection, the first case to be recorded in the Gulf state.

The Emirati citizen who contracted the SARS-like virus suffers from cancer and is being treated in hospital in the capital, Abu Dhabi health authority said in a statement carried by WAM state news agency late Thursday.
 
The authority said that this was the first case to be diagnosed in the United Arab Emirates.

In May, France said a 65-year-old man was in hospital after being diagnosed with the coronavirus after a holiday in Dubai. But the UAE health ministry said at the time no cases of the virus had been recorded in the country.

Experts are struggling to understand MERS, or Middle East Respiratory Syndrome, which has mostly affected neighboring Saudi Arabia where 65 cases have been detected, including 38 fatalities.

The World Health Organization announced last week that it had convened emergency talks on the MERS virus.

Concerns have been expressed about the potential impact of October's hajj pilgrimage, when millions of Muslims from around the globe head to and from Saudi Arabia.

The WHO has not recommended any MERS-related travel restrictions, but says countries should monitor unusual respiratory infection patterns.

The first recorded MERS death was in June last year in Saudi Arabia.

Like SARS, MERS appears to cause a lung infection, with patients suffering from fever, coughing and breathing difficulties. But it differs in that it also causes rapid kidney failure.

[dothedd]

Government’s lax stand could allow MERS Coronavirus into Mumbai0
Jul 15, 2013 at 3:23 PM

Communciable diseases, Coronavirus, H7N9, MERS Coronavirus, Middle East, Mumbai, SARS

Our inept government is again in the dock for not being up to speed with recent developments. With Saudi Arabia and other Gulf countries witnessing an outbreak of a new SARS-like virus called MERS (Middle East Respiratory Syndrome) Coronavirus, India hasn’t taken any precautions to screen passengers arriving from the aforementioned countries.

With more cases being reported every single day, the WHO has declared the virus ‘a threat to the entire world’. With little knowledge about the virus in India and no healthcare precautions to deal with yet, airline crew are a worried lot. The crew are also angry at their airlines; reports suggest while many Air India air-hostesses travelling to the Gulf have taken ill the airline hasn’t taken any steps to conduct thorough medical checks on them.

The MERS virus is a variant of the H7N9 and has a similarity to SARS. The symptoms are similar to bird flu symptoms like nose, throat infections and fever. Those who’ve shown these symptoms should be tested and if positive then they should quarantined.

Over a thousand passengers arrive in Mumbai from the Gulf States every day and Air India alone flies 600 passengers from Jeddah and Riyadh every day. ‘Most of the poor subsidised pilgrims fly Air India as it is the official carrier,’ said an airline official who did not want to be named. ‘Since they are travelling on a subsidy their camps are not very hygienic. Air India crew, thus, are at the highest risk. But neither the airline nor the government has taken any steps to address this issue.’

‘The crew are advised to maintain hygiene and cover their mouths and noses while ensuring that they consume only clean water and cooked meat,’ said an AICCA office bearer. ‘What kind of advisory is this? It strangely does not even talk about the precautions to be adopted on board the aircraft, where crew members end up mingling with passengers who might have contracted the virus.’

Further, airlines have asked crew members to ‘keep an eye out for passengers who might be suffering from MERS.’ ‘How we are expected to do this, nobody knows,’ said the AICCA official. ‘What the airlines should do instead is to screen passengers thoroughly before they board aircrafts.’ ‘There is a scare of the virus,’ said a Saudi Airlines official. ‘We have a lot of bookings to Mumbai. But there is no active screening happening yet. The World Health Organisation sounded a general alert. But there has been no official word from the WHO on the need for ‘active’ surveillance.’

What is the MERS virus?

MERS is caused by a respiratory virus which is caused by a previously unseen variant of the coronavirus and was first detected in Saudi Arabia last year. It’s very similar to a strain of coronavirus found in bats and it’s not the same as the SARS virus that circulated in 2003.

Why we need to be worried

The problem with viruses like this is multi-fold. Vaccines and medicines are usually devised after years of planning and studying a particular pathogen so that we can contain them. Unlike seasonal influenza, healthcare professionals have no idea how to deal with unknown ailments, the way it spreads and how to contain it. The last time the world faced a situation like this was a decade ago – when the Severe Acute Respiratory Syndrome (SARS) broke out near Hong Kong where a local farmer died from the disease. In the next eight months, the disease affected over eight thousand people and caused 775 deaths in 37 different countries. The more worrying fact was that it had at its peak a fatality rate of 9.6% (almost one out of every ten people affected died) and despite the fact that the disease disappeared after early 2003, it’s not believed to have been eradicated and the virus can still be lurking in animals.

How it spreads

After much debate, the WHO conceded that the MERS virus could be transmitted form one human to another. The novel coronavirus also demonstrated a SARS-like ability to spread from one person to another through close personal contact. Transmission can occur through droplets produced by an infected person when they sneeze or cough. They can spread through the air or when a person touches a surface contaminated with the droplets. Unprotected healthcare workers were particularly vulnerable during the 2002-03 epidemic. It’s believed that the coronavirus has most likely spread to humans from another animal – most probably bats though the virus hasn’t been isolated on any particular animal species yet.

While the virus doesn’t seem to pose any particular threat to the public as of now, healthcare professionals are watching all the developments closely. Most European and American healthcare facilities have the facilities to perform a test for the new coronavirus but the problem is figuring out who to test. An even bigger problem is the virus spreads in nations with limited healthcare facilities and huge populations like India, China or even South Africa. That could really trigger a pandemic of epic proportions and ramifications.

[dothedd]

Long incubation period of Mers is good news, says leading virologist.


By Carolina D’Souza, Staff Reporter Published: 21:00 July 15, 2013Gulf News

Dubai: The long incubation period — nine to 10 days, of the Middle East Respiratory Syndrome (Mers), a viral respiratory illness, is good news according to a leading virology expert.
Previously it was thought to be about seven days.
Speaking exclusively to Gulf News from the UK, John Oxford, Professor of Virology at the University of London, said that the nine- to 10-day incubation period of Mers makes it easier for public health interventions.
He reiterated that awareness of Mers is integral and stressed the need for increased hygiene.
He spoke of two intervention methods — increasing hygiene standards and contact tracing, which is the identification and diagnosis of people who may have come into contact with an infected person.
He said that people should protect themselves by thoroughly washing hands often and disinfecting surfaces.
On the contact tracing method, he said, “The long incubation period means a person will show the symptoms after nine to 10 days. The period gives public health officials more time to find and isolate or quarantine those who have been in contact with the infected person as well as to identify the places the infected person has visited. This helps reduce the spread of the infection.”

The Flip Side of the Petri Dish... 9-10 Days = More Asymptomatic Spreaders.

[dothedd]

FDA grants Emergency Approval for test to detect MERS


July 16, 2013 - Tue Jul 16, 2013 10:35am EDT

(Reuters) - The Food and Drug Administration issued an emergency authorization on Tuesday for a diagnostic test to detect the presence of the Middle East coronavirus at the request of the Centers for Disease Control and Prevention.

The emergency approval follows the Health and Human Services secretary's determination that the virus called Middle East Respiratory Syndrome Coronavirus (MERS-CoV), which has killed at least 40 people, poses a potential public health threat.

On July 5, the World Health Organization said MERS, which can cause fever, coughing and pneumonia, had not yet reached pandemic potential and may simply die out.

WHO experts last month said countries at risk from MERS should put in place plans for handling mass gatherings but has stopped short of recommending restrictions on travel.

www.reuters.com/article/2013/07/16/us-mers-test-fda-idUSBRE96F0QP20130716

[Virgil Showlion]

If it's still sitting at a grand total of 65 infections, it wouldn't appear to be particularly virulent.

[dothedd]

Certainly got my fingers crossed it just goes away ...

[dothedd]

MERS virus causes Saudi Arabia to warn some Muslims to avoid hajj pilgrimage
TUESDAY, JULY 16, 2013, 3:46 PM

With millions of Muslims expected to travel to Mecca, Saudi Arabia for this year's hajj, the country's Ministry of Health has issued a warning over the MERS virus.

The deadly coronavirus, which has killed 38 people in Saudi Arabia, may make the annual religious journey to Mecca too risky for pregnant women, children, seniors and people with underlying health problems, Ministry of Health officials said in a statement.


This year’s hajj may not be for everyone.

Citing concerns over the deadly MERS coronavirus, the government of Saudi Arabia is urging elderly Muslims and those with underlying health problems to postpone their plans to attend this year’s religious pilgrimage in Mecca.

RELATED: DEADLY NEW CORONAVIRUS A 'SERIOUS RISK' IN HOSPITALS: STUDY
In a statement released over the weekend, the Saudi Ministry of Health warned off pregnant woman, children, the elderly and “those suffering chronic illnesses, like heart, kidney, respiratory diseases, and diabetes,” the AFP reported.
On its website, the ministry said the warning was part of “preventive measures special to the MERS coronavirus,” which has so far killed 38 people in the kingdom, the largest number reported in any country so far.

RELATED: MERS VIRUS DEATH TOLL RISES IN SAUDI ARABIA
In all, 45 of the 81 people known to have been infected with MERS have died, and the World Health Organization convened emergency talks last week on the virus.

Millions of Muslims are expected to travel to Saudi Arabia in October to participate in one of Islam’s holiest rites, and this is the first time that the country’s Ministry of Health has issued travel warnings.

It remains unclear how MERS is spread, but it is believed to be an airborne virus that causes flu-like coughing, breathing difficulties and can lead to sudden kidney failure.

In 2012, more than three million Muslim pilgrims packed Mecca’s Sacred Mosque.

www.nydailynews.com/news/world/mers-virus-muslims-hajj-article-1.1400249#ixzz2ZJLwG2Xf

[dothedd]

Scare in the air: Deadly MERS virus poses new health risk
Wednesday, Jul 17, 2013, 7:46 IST | Agency: DNA

With the Middle East Respiratory Syndrome Coronavirus (MERS - CoV) killing more than 40 people across the globe, especially in Saudi Arabia, and the threat of the swine flu-like virus spreading in the air looming large, doctors in the city have sounded alarm bells for those returning from Gulf countries.

However, doctors said it does not seem like a major health risk for Indians at the moment. “In July there are heavy rains across the country. Most air-borne viruses get washed away in the heavy rain. However, persons with travel history to Saudi Arabia and neighbouring Middle East countries should take extreme precautions,” said Dr Hemant Thacker, physician at Breach Candy Hospital.

The Union health ministry had issued a circular (received by the Directorate of Health Services in Maharashtra on July 11) stating that MERS virus has become a global threat and patients with travel history to the Middle East, China and Taiwan who show signs of respiratory discomfort should be reported and kept under surveillance. The state has further disseminated the circular to strengthen surveillance to civic bodies in every district, including Mumbai.

“We have not seen any cases of MERS in the country. In fact, the swine flu virus has also not been reported this year in Mumbai. But, any traveler who has been to Saudi Arabia and the neighbouring countries or the Far East has been experiencing prolonged periods of cough or cold needs to be reported to the civic body by the treating physician. We have been asked to isolate such patients and send their samples to National Institute of Virology in Pune for tests,” said Dr Mangala Gomara, BMC epidemiologist.

Doctors said influenza virus strains undergo deadly mutations in as less as every six months and the stronger strains do not respond to older anti-virus treatments.

“Any prolonged cough or cold that is not responding to antibiotic treatment till four days needs to be reported to a physician. There is no specific treatment. A patient may improve with supportive therapy or the health may worsen and secondary conditions like pneumonia and bacterial infections may develop. The patient may also go on ventilator support and require intensive care,” said Dr Chetan Velani, a Ghatkopar-based physician.

“We are yet to receive the circular from the BMC. If there is anything suspicious reported we will send the phlegm samples from trachea after conducting test to NIV in Pune.”

What is MERS?
Middle East Respiratory Syndrome (MERS) is a viral respiratory illness first reported in Saudi Arabia in 2012.

The illness is caused by a coronavirus called MERS-CoV.

People having MERS-CoV infection develop severe acute respiratory illness – fever, cough, and shortness of breath.

This virus spreads from infected people to others through close contact.

www.dnaindia.com/health/1861985/report-scare-in-the-air-deadly-mers-virus-poses-new-health-risk

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Six More Cases of MERS Virus Confirmed: WHO


July 18, 2013 Fox News
Six more people, most of them health care workers, have contracted the deadly MERS virus in Saudi Arabia and the United Arab Emirates, the World Health Organization said Thursday. (AFP/File)

GENEVA (AFP) – Six more people, most of them health care workers, have contracted the deadly MERS virus in Saudi Arabia and the United Arab Emirates, the World Health Organization said Thursday.
The UN's health body said that four health care workers from two hospitals in Abu Dhabi had contracted MERS, short for Middle East Respiratory Syndrome coronavirus, after caring for a patient who had fallen ill with the disease.

In two of the cases, a 28-year-old man and a 30-year-old woman had not developed symptoms of the illness, while two other women, aged 30 and 40, were in stable condition.

In Saudi Arabia, one 42-year-old female health care worker and a 26-year-old man who were in close contact with a MERS patient are both suffering from mild symptoms and have not been hospitalised, WHO said. The announcement came amid growing concern about the spread of the virus that so far has killed 45 of the total 88 people confirmed to have contracted it, especially as worst-hit Saudi Arabia braces for the Muslim hajj pilgrimage.

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UAE: 4 New Cases - all are contact cases of previous confirmed...

Published Friday, July 19, 2013

The Health Authority Abu Dhabi (Haad) has registered four new cases with coronavirus. The new registered cases are in stable conditions.

It said: "As a preventive measure, they have been isolated to prevent transmission to others."
Immediately after discovering the first case, Haad in coordination with the Ministry of Health (MoH), started investigating and examining people with direct contact with the first patient.

The Haad noted that a total of 136 individuals representing medical staff and family members of the patient were examined. As a result of the screening, four new cases with the virus were confirmed.

The Ministry of Health (MoH) stated that it is following all the latest updates regarding the new virus with the World Health Organisation (WHO). It confirmed that the virus is not a concern for public health at the moment as the detected cases globally continue to be very low.

It reiterated that the current situation does not require a travel ban to any country in the world, nor screenings at different ports, or restrictions on trade. The MoH praised the cooperation and coordination among all the health authorities in the country to follow up the health situation and safeguard public health.

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China H7N9 bird flu survivor gives birth

Published July 19, 2013

BEIJING (AFP) – A Chinese woman who spent five weeks in intensive care with H7N9 bird flu has given birth to a girl in what was described as a "miracle" first, according to state media.

Qiu Yan, 25, was five months pregnant when she was diagnosed with the virus in April, early in China's human outbreak of the disease. She was in a "very serious condition" and underwent antibiotic, antiviral and hormone treatments, along with daily X-rays, during her therapy, the Global Times cited doctors as saying.

Qiu, from Zhenjiang in the eastern province of Jiangsu, is the world's first H7N9 survivor to give birth, the paper said.

"Her lung was severely infected and she needed a respirator to breathe because she was suffering from respiratory failure," it quoted Qiu's doctor Sun Lizhou as saying.

Qiu was discharged from intensive care in May but stayed in hospital until she delivered the baby -- a 3.3-kilogram (7.3-pound), 50-centimetre (1.6-feet) girl -- on Wednesday.

"It was a miracle," Sun said according to the paper.

The first human cases of the H7N9 virus were reported in late March and it had infected 132 people in mainland China, killing 43 by the end of June, according to official data.

Experts fear the possibility of the virus mutating into a form easily transmissible between humans, with the potential to trigger a pandemic.

Both Qiu and her baby were in stable condition but the child will have to be checked regularly for any possible effects of the virus, Sun added, according to the report.