MERS-CoV vigilance rises in US

[dothedd]

Monday May 5, 2014

Saudi Arabia MERS cases surpass 400, more than 100 dead, 4 pm today
Some 414 people in Saudi Arabia have fallen victim to the deadly Middle East Respiratory Syndrome (MERS) virus after a further 18 were diagnosed on Monday. One hundred and fifteen people have died so far as a result of the disease.

All of the new cases diagnosed in the past 48 hours were concentrated around the country’s capital, Riyadh, along with Jeddah – the main gateway to the Islamic holy city of Mecca, in the country’s west – and both holy cities of Mecca and Medina, according to the Saudi Health Ministry, which reported the cases on its website.

The disease is beginning to pose a severe concern to Saudi Arabia, which will host millions of foreign Muslim pilgrims during Ramadan in July. Millions more are expected in October for the Hajj pigrimage to Mecca. The journey must be completed at least once in every Muslim's lifetime, and is one of the 'Five Pillars' of the faith.

“From mid-March 2014, 111 people have tested positive in the Jeddah area; the biggest single surge in the MERS-CoV outbreak since the new virus was detected in April 2012. Thirty-one persons have died,” the World Health Organization (WHO) said in a statement released Friday.

Some 115 people have now died from the SARS-like virus, according to the health ministry. A large proportion of the deaths have been foreign health workers.

A further case was reported on Monday in Jordan. The man in question is reportedly related to someone previously diagnosed with MERS, according to Reuters.

Qatar, Kuwait, the United Arab Emirates, and Tunisia have been among other countries which have documented cases within their borders. Greece has also reported that one of its citizens – a permanent resident of Saudi Arabia – contracted the virus, and last week the US confirmed the case of a man who had recently been to Saudi Arabia.

On Monday, Egypt said it was looking into the possibility of whether a 60-year-old woman had died of MERS.

MERS has spread since it was initially discovered in Saudi Arabia two years ago; incidences have doubled since the beginning of April alone.

MERS has frequently been compared to the Severe Acute Respiratory Syndrome (SARS) virus which swept through Asia in 2003, infecting over 8,000 people and causing some 800 deaths worldwide. MERS is thought to be deadlier but more difficult to transmit. There is no vaccine or treatment for MERS at present.

[dothedd]

Monday May, 5 2014

Saudi Arabia MERS cases surpass 400, more than 100 dead, 4 pm today

Some 414 people in Saudi Arabia have fallen victim to the deadly Middle East Respiratory Syndrome (MERS) virus after a further 18 were diagnosed on Monday. One hundred and fifteen people have died so far as a result of the disease.

All of the new cases diagnosed in the past 48 hours were concentrated around the country’s capital, Riyadh, along with Jeddah – the main gateway to the Islamic holy city of Mecca, in the country’s west – and both holy cities of Mecca and Medina, according to the Saudi Health Ministry, which reported the cases on its website.

The disease is beginning to pose a severe concern to Saudi Arabia, which will host millions of foreign Muslim pilgrims during Ramadan in July. Millions more are expected in October for the Hajj pigrimage to Mecca. The journey must be completed at least once in every Muslim's lifetime, and is one of the 'Five Pillars' of the faith.

“From mid-March 2014, 111 people have tested positive in the Jeddah area; the biggest single surge in the MERS-CoV outbreak since the new virus was detected in April 2012. Thirty-one persons have died,” the World Health Organization (WHO) said in a statement released Friday.

Some 115 people have now died from the SARS-like virus, according to the health ministry. A large proportion of the deaths have been foreign health workers.

A further case was reported on Monday in Jordan. The man in question is reportedly related to someone previously diagnosed with MERS, according to Reuters.

Qatar, Kuwait, the United Arab Emirates, and Tunisia have been among other countries which have documented cases within their borders. Greece has also reported that one of its citizens – a permanent resident of Saudi Arabia – contracted the virus, and last week the US confirmed the case of a man who had recently been to Saudi Arabia.

On Monday, Egypt said it was looking into the possibility of whether a 60-year-old woman had died of MERS.

MERS has spread since it was initially discovered in Saudi Arabia two years ago; incidences have doubled since the beginning of April alone.

MERS has frequently been compared to the Severe Acute Respiratory Syndrome (SARS) virus which swept through Asia in 2003, infecting over 8,000 people and causing some 800 deaths worldwide. MERS is thought to be deadlier but more difficult to transmit. There is no vaccine or treatment for MERS at present.

[dothedd]

AHAM ... 

"MERS has frequently been compared to the Severe Acute Respiratory Syndrome (SARS) virus which swept through Asia in 2003, infecting over 8,000 people and causing some 800 deaths worldwide. MERS is thought to be deadlier but more difficult to transmit. There is no vaccine or treatment for MERS at present."



NOVAVAX TO THE RESCUE:

New Experimental Vaccine Produces Immune Response Against Middle East
Respiratory Syndrome Coronavirus (MERS-CoV)

University of Maryland School of Medicine Study Published in Vaccine Highlights First
Potential Effective Means for Preventing MERS Coronavirus Outbreak
Baltimore and Gaithersburg, MD – April 30, 2014 – The University of Maryland School of Medicine (UM SOM) and Novavax, Inc. (NASDAQ: NVAX) today announced that an
investigational vaccine candidate developed by Novavax against the recently emerged Middle East Respiratory Syndrome Coronavirus (MERS-CoV) blocked infection in laboratory studies.

UM SOM and Novavax also reported that a vaccine candidate against Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) developed by Novavax on a similar platform also inhibited virus infection. Researchers reported these findings in an article published in the April 13, 2014 issue of Vaccine1.

Historically, vaccine strategies for emerging pathogens have been limited due to the sudden nature in which the virus first appears and delayed by the protracted traditional vaccine development process. This peer-reviewed manuscript describes a novel method to rapidly develop vaccines against previously unknown viruses, such as MERS-CoV, which appear suddenly and cause severe illnesses in humans. The experimental vaccines, which were tested in conjunction with Novavax’ proprietary adjuvant Matrix-M™, induced neutralizing antibodies, or immune responses, that prevent viruses from infecting cells.

“Our protein nanoparticle vaccine technology is proving to have the potential to respond rapidly to emerging viruses such as MERS-CoV and certain potential pandemic influenza strains, addressing what are clearly urgent public health needs,” said Gale Smith, Ph.D., Vice President of Vaccine Development at Novavax. “Novavax will continue to evaluate this technology to produce highly immunogenic nanoparticles for coronavirus, influenza, and other human disease pathogens with the potential for pandemic and sustained human to human transmission.”

“The emergence of SARS-CoV and MERS-CoV demonstrates how coronaviruses can spillover from animals into humans at any time, causing lethal disease,” said Matthew B. Frieman, Ph.D., Assistant Professor of Microbiology and Immunology at the University of Maryland School of Medicine and corresponding author on the publication. “Despite efforts to create a vaccine against SARS-CoV, no vaccine candidate has, to date, been successfully licensed for use. We have demonstrated that this novel method rapidly creates SARS-CoV and MERS-CoV vaccines that induce neutralizing antibodies in mice.”


CONTINUED:

[dothedd]

CONTINUED - PAGE 2

“The University of Maryland School of Medicine investigators are continually working toward a
better understanding of the interactions between the human immune system and a variety of
known and novel harmful microbes,” said E. Albert Reece, Vice President of Medical Affairs,
the University of Maryland and the John Z. and Akiko Bowers Distinguished Professor and
Dean, University of Maryland School of Medicine. “This makes our faculty poised to respond to
emerging infectious diseases, such as MERS-CoV, which threaten the health and wellbeing of
the global population.”


The vaccine candidates were made using Novavax’ recombinant nanoparticle vaccine technology
and based on the major surface spike (S) protein, a SARS-CoV and MERS-CoV surface protein
responsible for attaching the virus to cells. Novavax previously demonstrated that spike protein
nanoparticles could protect animals against lethal live challenge using the SARS-CoV virus2.

About MERS-CoV
MERS-CoV, first identified in 2012, is one of a family of viruses with the potential to rapidly
spread from a benign infection of animals to cause severe disease in humans. In 2003, a
previously unknown coronavirus called SARS-CoV caused an outbreak that raised health alarms
by infecting over 8,000 individuals and killing 775. According to the World Health Organization,
the novel MERS-CoV thus far has resulted in 107 deaths out of 345 infections, the majority of
which are characterized by severe illness and hospitalizations. Both diseases were marked by a
jump from animals to people and while SARS-CoV spread more quickly in humans, MERS-CoV
is proving to be more deadly.

About University of Maryland School of Medicine
Established in 1807, the University of Maryland School of Medicine was the first public medical
school in the United States, and the first to institute a residency-training program. The School of
Medicine was the founding school of the University of Maryland and today is an integral part of
the 11-campus University System of Maryland. On the University of Maryland's Baltimore
campus, the School of Medicine serves as the anchor for a large academic health center which aims to provide the best medical education, conduct the most innovative biomedical research and provide the best patient care and community service to Maryland and beyond.
www.medschool.umaryland.edu.

[dothedd]

CONTINUED - PAGE 3

About Novavax
Novavax, Inc. (Nasdaq: NVAX) is a clinical-stage biopharmaceutical company creating novel
vaccines and vaccine adjuvants to address a broad range of infectious diseases worldwide. Using
innovative proprietary recombinant protein nanoparticle vaccine technology, the company
produces vaccine candidates to efficiently and effectively respond to both known and newly
emergent diseases. Novavax is involved in several international partnerships, including
collaborations with Cadila Pharmaceuticals of India, LG Life Sciences of Korea, PATH and
recently acquired Isconova AB, a leading vaccine adjuvant company located in Sweden.
Together, Novavax’ network supports its global commercialization strategy to create real and
lasting change in the biopharmaceutical and vaccinology fields. Additional information about
Novavax is available on the company’s website, novavax.com.

About Vaccine
Vaccine is the pre-eminent journal for those interested in vaccines and vaccination. It is the
official journal of The Edward Jenner Society, The International Society for Vaccines and The
Japanese Society for Vaccinology. www.elsevier.com/locate/vaccine

[Aman A.K.A. Ahamburger]

May 5, 2014 11:04:09 GMT -5 dothedd said:

May 5, 2014 0:28:02 GMT -5 Aman A.K.A. Ahamburger said:

B,

Looks like we are about 100 confirmed cases from have some travel restricted. Per the way it went with SARS.. NA FTW!!!

 

  THANKS FOR YOUR INPUT ... Always happy to see/know that someone is reading my efforts!  

I always do! I just forget to hit the like button. Thanks for that, BTW!

Sure seems like the Saudis are in deep doo-doo here. Mix it with the polio outbreak in Syria and Iraq, and of course the bird flu coming from the east....

Well I don't have to tell you. Thanks for keeping us up to date!!

God bless!

[dothedd]

Indiana MERS patient improving, hospital workers isolated

10:02 p.m. CDT, May 5, 2014

The man authorities cite as the nation’s first confirmed case of Middle East Respiratory Syndrome and dozens of hospital workers who first came into contact with him are being isolated from the general public, an effort by officials and public health experts to contain the potential spread of a deadly new pathogen.

Medical workers at an Indiana hospital who now have contact with the man are required to wear gloves, masks, gowns and eye protection. He’s being held in a room designed especially for patients with respiratory infections, segregated from the hospital’s air circulation system.

The patient needed oxygen during the first part of his stay, officials at Community Hospital said Monday, but was never admitted to intensive care. Doctors said he’s now breathing regular air, is in good spirits and has a good appetite.

As the man’s condition appears to improve and nobody else has shown evidence of infection, officials provided the most detailed account to date of the seriousness of care with which public health and Centers for Disease Control and Prevention have taken to investigate and contain the potential spread of MERS in the United States.

Roughly 50 hospital nurses, clerks, aides, dietary experts and other workers who came into contact with the patient before his infection was confirmed are on paid leave — isolated inside their homes as experts watch for signs of symptoms and test for infection during the virus’ known incubation period.

The patient’s family members are in the same predicament. Those isolated at home have been asked to wear face masks if they leave the building, officials said.

At a briefing with Indiana and federal officials Monday, officials said the Saudi Arabian health care worker, who has not been identified but whom experts refer to as the “index patient,” is expected to return to home isolation with his family “very soon.”

But it’s unclear when the man, who officials said crossed the U.S. border through O’Hare International Airport while en route to a planned visit with Indiana relatives, will be able to travel or leave the country.

No one who has been isolated because of their contact with the patient has tested positive for the virus, officials said. Its incubation period lasts an estimated two to 14 days, and the patient first reported his illness at an Indiana hospital on April 28.

“We think this is well-contained, but we are exercising an abundance of caution,” said Dr. Daniel Feikin, a CDC epidemiologist and head of an agency response and investigation team sent to Indiana.

“I think it is promising that the staff that have had contact with him have already tested negative,” he said.

Feikin said the patient lives in Saudi Arabia and was working in a Riyadh hospital that housed MERS patients, though Feikin said the patient did not recall working directly with infected persons.

The patient has family in the United States and came for a planned visit, officials said, but cited confidentiality rules when they declined to provide additional details about him. A Monday update on the case from the World Health Organization, however, described the patient as a U.S. citizen in his 60s.

“This is still a fluid situation,” said Dr. William VanNess II, Indiana’s state health commissioner.

MERS is a new type of what scientists call “coronaviruses,” a widespread group of diseases that includes the common cold and pneumonia. The highly contagious SARS virus, which killed hundreds in Asia and North America in the early 2000s, is another kind of coronavirus.

First discovered in a Saudi Arabian patient in summer 2012, some experts believe MERS originated from an animal source because it's been detected in camels and bats in the Middle East.

MERS symptoms — fever, cough and respiratory problems — resemble those of influenza. Unlike the flu, however, there is no available vaccine or specific treatment recommended for the virus.

Health officials around the world have been particularly concerned about MERS because it is a new virus that scientists still have much to learn about, but has already proven to be quite lethal, with a recent CDC estimate showing it has killed nearly one quarter of the people who contracted it.

U.S. health experts aren't certain where MERS originated, but say they’ve long expected the virus’ arrival to the country. Still, they say it currently poses low risk to the general public.

CDC officials said the patient flew from Riyadh to London, then onto Chicago before boarding a bus to Indiana on April 24. Roughly 100 people were on the patient’s flight to Chicago, officials said. Another 10 were on the bus.

The CDC has quarantine stations located at ports of entry across the country, including one inside the international wing of O’Hare airport. But the patient did not identify himself as being ill when he cleared customs, Feikin said. His symptoms did not develop until after his arrival, Feikin said.

There is no active screening for passengers arriving from the Arabian Peninsula, Feikin said, nor are there currently any travel restrictions to countries in the region.

Nearly three-quarters of the patient’s fellow air travelers had been contacted, Feikin said, and none had exhibited any symptoms. State officials were working to identify bus passengers and officials in London are probing the Riyadh to Heathrow leg of the journey, Feikin said.

“We do know that he had limited exposure to the community once he arrived. He went directly to his family’s house,” Feikin said.

The patient arrived with family members at the hospital on the evening of April 28, said Dr. Alan Kumar, Community Hospital’s chief medical information officer. He was admitted to a private triage room, practitioner’s room and bed within three hours of his arrival.

But after confirming the man had contracted MERS, and considering the virus’ mysterious nature, officials pulled hospital workers from duty, Kumar said.

Officials used a variety of surveillance and recordkeeping tools to locate hospital workers who might have been exposed. They reviewed security camera footage to track the patient’s movements through the building and examined medical records to determine who was near him and when. The hospital’s health care workers are also tracked by a radio-frequency identification system, a hospital official said, which tells officials exactly where workers are at during a given time.

“If you think about it, you would think ‘Wow, that’s a ton of people,’ but we actually have 3,500 people who work on this campus on a daily basis,” Kumar said. Other workers have been called in to fill vacant shifts, Kumar said, and the hospital has been running its normal operations.

[dothedd]

MERS Shows That The Next Pandemic Is Only a Plane Flight Away
May 5, 2014

On Feb. 21, 2003, a 64-year-old Chinese physician named Dr. Liu Jianlun traveled to Hong Kong to attend a wedding. He stayed in room 911 on the ninth floor of the Metropole Hotel. Liu, who had been treating cases of a mysterious respiratory disease in the neighboring Chinese province of Guangdong, was already sick when he arrived in Hong Kong, and the next day he checked into the city’s Kwong Wah hospital. Liu died on Mar. 4 of the disease doctors soon named Severe Acute Respiratory Syndrome, or SARS. But before he died, he inadvertently infected at least 16 people who spent time on the ninth floor of that Hotel.

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Some of those people boarded international flights before they knew they were sick, seeding new outbreaks in places like Vietnam, Taiwan and Singapore. SARS had been confined to southern China for months, but once Liu checked into the Metropole Hotel, it was only a matter of time before the first new infectious disease of the 21st century went global. Before it was stamped out months later, SARS had infected 8,273 people, killing 775 people in 37 countries.

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It’s that chain of events that must have been on American officials’ minds last week when news broke that the U.S. had its first case of Middle East Respiratory Syndrome (MERS). A male health care provider had been in Saudi Arabia, the epicenter for the ongoing MERS outbreaks, before flying to Chicago via London on Apr. 24. After arriving in Chicago, he took a bus to the Indiana town of Munster, where on Apr. 28 he was admitted to the hospital and was eventually diagnosed with MERS. A deadly respiratory disease that has already infected hundreds, almost all in Saudi Arabia, and killed over 100 people had come to the U.S.

CDC officials played down the larger threat of the first U.S. MERS case. “In this interconnected world we live in, we expected MERS to make its way to the U.S.,” Dr. Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters on May 2. “We have been preparing for this.” CDC officials will contact and track individuals who might have been close to the patient — including health workers who treated him and fellow travelers on his international flights and his bus ride to Munster — just in case any developed MERS symptoms. That’s not likely. So far MERS hasn’t shown much ability to spread easily from person to person, so the threat to the larger U.S. public is probably very small.

But if that Indiana case remains isolated — and MERS itself never becomes the global health threat that SARS was — it only means we were lucky.

As Schuchat put it, exotic, emerging diseases are now “just a plane’s ride away.” In the past, before international air travel became common, emerging pathogens could begin infecting people but remain geographically isolated for decades. Scientists now think that HIV was active among people in Central Africa for decades before it really began spreading globally in the 1970s, again thanks largely to international air travel. Today there’s almost no spot on the planet — from the rainforests of Cameroon to the hinterland of China — so remote that someone couldn’t make it to a heavily populated city like New York or Hong Kong in less than 24 hours, potentially carrying a new infectious disease with them.

The surest way to prevent the spread of new infectious disease would be to shut down international travel and trade, which is obviously not going to happen. The occasional pandemic might simply be one of the prices we pay for a globalized world. But we can do much more to try to detect and snuff out new pathogens before they endanger the health of the planet.

Because most new diseases emerge in animals before jumping to human beings (the virus that causes MERS seems to infect humans mostly via camel, though bats may be the original source), we need to police the porous boundary between animal health and human health. That work is being done by groups like Global Viral (whose founder I profiled in November 2011) is creating an early warning system capable of forecasting and containing new pathogens before they fuel pandemics. But as the stubborn spread of MERS shows, that’s easier said than done — especially if diseases emerge in countries that have less than open political systems.

Because as it turns out, the driving factor behind the spread of new diseases isn’t just globalization. It’s also political denial. SARS was able to spread beyond China’s borders in part because the Chinese government initially covered up the outbreaks — at one point even driving SARS patients around Beijing in ambulances to hide them from an international health team. Meanwhile, the autocratic Saudi government has made life difficult for researchers studying MERS. Much the same thing happened when the avian flu virus H5N1 began spreading in Southeast Asia in 2004. In every case, a rapid and public response might have contained those viruses before they threatened the rest of the world.

Eleven years later Hong Kong’s Metropole Hotel is now called the Metropark, and Liu Jianlun’s infamous room 911 doesn’t exist any more. After SARS, hotel management changed the number to 913 in an attempt to scrub out the past. Denial is always so tempting. But in an interconnected world, where the travel plans of a single person can seed deadly outbreaks a continent away, it’s no longer an option.

[Deleted]

"Plane flight away."

During my last plane ride, some guy seated behind me spent the trip sniffling, blowing his nose and hacking up a lung toward the back of my head and it didn't sound like he was covering his mouth, either. If you're sick, stay off the plane. 

[dothedd]

That is why I have not been on a plane in YEARS! It is definitely RV TIME!  

[dothedd]

(TODAY) Conference Call 

Novavax management will host its quarterly conference call today at 4:30 p.m. EDT. The dial-in number for the conference call is 1 [phone] (U.S. or Canada) or 1 [phone] (international). A webcast of the conference call can also be accessed via a link on the home page of the Novavax website (novavax.com) or through the "Investor Info"/"Events" tab on the Novavax website.

A replay of the conference call will be available starting at 7:30 p.m. on May 7, 2014 until midnight June 7, 2014. To access the replay by telephone, dial 1 [phone] (domestic) or 1 [phone] (international) and use passcode 34845350. The replay will also be available as a webcast and can be found on the "Investor Info"/"Events" on the Novavax website.

GAITHERSBURG, Md., May 7, 2014 (GLOBE NEWSWIRE) -- Novavax, Inc. (NVAX), a clinical-stage biopharmaceutical company focused on the discovery, development and commercialization of recombinant nanoparticle vaccines and adjuvants, today reported its financial results for the first quarter ended March 31, 2014.

Novavax Corporate Highlights

Year-to-date 2014 Achievements:

Delivered positive top-line data from a dose-confirmatory Phase 2 clinical trial of its RSV F-protein vaccine candidate in 720 women of childbearing age, showing:
Vaccine candidate was well-tolerated with no vaccine-related serious adverse events
Highest immune responses observed with a single dose of vaccine combined with aluminum phosphate adjuvant Palivizumab-like antibodies exceeded levels observed in previous trials, and High levels of antibodies developed within 14 days after immunization and persisted over 91-day observation period; 
Initiated a U.S. Phase 1/2 clinical trial of H7N9 avian influenza VLP vaccine candidate with Matrix-M(TM), targeted to enroll 610 healthy adult subjects between 18 and 64 years old, under the company's HHS BARDA contract;
Published data in Vaccine demonstrating that an investigational vaccine candidate developed by Novavax against recently emerged Middle East Respiratory Syndrome Coronavirus (MERS-CoV) blocked infection in laboratory studies, adding further evidence of the power and potential of Novavax' recombinant nanoparticle vaccine technology; Demonstrated commitment to alliance management through extension of HHS BARDA contract for development of seasonal and pandemic influenza vaccines and continuation of RSV vaccine partnership on maternal immunization with PATH -- both collaborations bring valuable development resources, insight and experience, along with non-dilutive sources of capital funding; and Expanded Management team with appointment of John Trizzino, Senior Vice President, Commercial Operations, Cindy Oliver as Senior Vice President, Process Development, and Sven Andreasson as Senior Vice President, Corporate Development.

2014 Anticipated Events:

Release of top-line data from recently initiated Phase 1/2 clinical trial of H7N9 avian influenza VLP vaccine candidate with Matrix-M in the second half of 2014;
Initiate Phase 2 clinical trial of its RSV F-protein vaccine candidate for protection of infants via maternal immunization in pregnant women in fourth quarter of 2014;
Initiate Phase 2 clinical trial of its quadrivalent VLP seasonal influenza vaccine in the fourth quarter of 2014; and Initiate Phase 1 combination RSV/seasonal influenza clinical trial and Phase 1 pediatric RSV clinical trial, both in late 2014 or early 2015.

"Following the substantial progress in our RSV and influenza vaccine development programs in 2013, I am delighted with our accomplishments in the first quarter of 2014. Based on this first quarter activity, I continue to believe that 2014 represents greater potential accomplishments across our entire pipeline than we have ever had in our company's history," said Stan Erck, president and CEO of Novavax. "Our recently announced top-line data from the Phase 2 clinical trial in women of child bearing age gives us flexibility in the development of our RSV F vaccine candidate, not just for a maternal immunization strategy, but across all potential populations impacted by RSV."

Financial Results for the First Quarter March 31, 2014

In connection with its acquisition on July 31, 2013, Novavax AB's operations have been included in the company's consolidated results of operations and financial position as of the acquisition date. Novavax reported a net loss of $13.8 million, or $0.07 per share, for the first quarter of 2014, compared to a net loss of $10.0 million, or $0.07 per share, for the first quarter of 2013.

Novavax revenue in the first quarter of 2014 increased 95% to $7.5 million as compared to $3.8 million for the same period in 2013. The increase in revenue was primarily due to the higher level of activity in the first quarter of 2014 associated with the company's Phase 1/2 clinical trial using its H7N9 candidate and Matrix-M adjuvant and preliminary manufacturing work for its Phase 2 seasonal clinical trial under the HHS BARDA contract and the PATH amendment to support the company's Phase 2 clinical trial in women of childbearing age.

Research and development expenses increased 57% to $14.5 million in the first quarter of 2014, compared to $9.3 million for the same period in 2013, primarily as a result of higher employee-related costs tied to continued growth in support of the Company's RSV and influenza vaccine programs, as well as Novavax AB research and development expenses. General and administrative expenses increased 50% to $4.3 million in the first quarter of 2014 as compared to $2.9 million for the same period in 2013, resulting from higher professional fees and employee-related costs, as well as Novavax AB general and administrative expenses.

As of March 31, 2014, the company had $112.8 million in cash and cash equivalents and investments compared to $133.1 million as of December 31, 2013. Net cash used in operating activities for the first quarter of 2014 was $20.4 million compared to $10.6 million for the same period in 2013. The increase in cash usage from the prior year was primarily due to higher research and development spending, including the company's RSV clinical trial and higher employee-related costs, as well as timing of customer and vendor payments.

Conference Call

Novavax management will host its quarterly conference call today at 4:30 p.m. EDT. The dial-in number for the conference call is 1 [phone] (U.S. or Canada) or 1 [phone] (international). A webcast of the conference call can also be accessed via a link on the home page of the Novavax website (novavax.com) or through the "Investor Info"/"Events" tab on the Novavax website.

A replay of the conference call will be available starting at 7:30 p.m. on May 7, 2014 until midnight June 7, 2014. To access the replay by telephone, dial 1 [phone] (domestic) or 1 [phone] (international) and use passcode 34845350. The replay will also be available as a webcast and can be found on the "Investor Info"/"Events" on the Novavax website.

About Novavax

Novavax, Inc. (NVAX) is a clinical-stage biopharmaceutical company creating novel vaccines and vaccine adjuvants to address a broad range of infectious diseases worldwide. Using innovative proprietary recombinant nanoparticle vaccine technology, the company produces vaccine candidates to efficiently and effectively respond to both known and newly emergent diseases. Additional information about Novavax is available on the company's website, novavax.com

[dothedd]

Saudi Arabia reports 5 more deaths from MERS

Associated Press By ADAM SCHRECK

2 hours ago (5/8/14)  12:35 pm

DUBAI, United Arab Emirates (AP) — Five more people have died in Saudi Arabia after contracting an often fatal Middle East respiratory virus as the number of new infections in the kingdom climbs higher, health officials confirmed Thursday.

The Saudi health ministry said in a statement posted online that the dead included two men previously confirmed to be suffering from the Middle East Respiratory Syndrome in the Islamic holy city of Mecca and another two in the holy city of Medina.

A 62-year-old woman who suffered from diabetes, high blood pressure and asthma also died, in Riyadh. She was one of 14 newly confirmed cases of the disease reported Thursday in the Saudi capital, and in the cities of Jiddah, Taif and Medina.

Authorities late Wednesday reported an additional 18 confirmed cases and four fatalities.

MERS belongs to a family of viruses known as coronaviruses that include both the common cold and SARS, or severe acute respiratory syndrome, which killed some 800 people in a global outbreak in 2003. MERS can cause symptoms including fever, breathing problems, pneumonia and kidney failure.

Not everyone who contracts the virus that causes MERS gets sick, while others show only mild symptoms. There is no cure or vaccine.

The latest figures bring to 463 the number of confirmed cases in Saudi Arabia, the site of most MERS infections. A total of 126 people in the kingdom have died from the virus since it was first identified in 2012.

The virus has since spread to other parts of the world, including the United States, which recently confirmed its first case in a health care worker returning from Saudi Arabia.

Scientists believe camels may play a role in primary infections. The disease can then spread between people, but typically only if they are in close contact with one another. Many of those infected have been health-care workers.

Among those who died this week after contracting the virus was a Filipino nurse working in Riyadh, Carmelita Dimzon, head of the Philippines' Overseas Workers Welfare Administration, said Thursday.

In Lebanon, Health Minister Wael Abu Faour ordered that thermal cameras be set up at Beirut's international airport to check arriving passengers for possible signs of fever, indicating a possible MERS infection, the official National News Agency reported. Lebanon has no recorded cases of the MERS virus so far.

A team of experts from the World Health Organization has completed a five-day mission to Saud Arabia to help health authorities there assess a recent rise in cases.

Their mission included meetings with health officials in the capital and visits to two major hospitals in Jiddah, which has been the site of a number of recent infections. The WHO noted that most human-to-human infections have occurred in health-care facilities.

Evidence so far suggests that a possible seasonal rise in incoming cases combined with insufficient infection prevention and control measures could be to blame for the rise in infections there, according to the WHO.

"Current evidence does not suggest that a recent increase in numbers reflects a significant change in the transmissibility of the virus," the WHO said Wednesday. "There is no evidence of sustained human-to-human transmission in the community and the transmission pattern overall remained unchanged."

It added that there is a "clear need" to improve medical workers' knowledge and attitudes about MERS.

[dothedd]

MERS: A Virologist's View From Saudi Arabia
6 May 2014 11:15 am


Growing awareness about MERS will help curb the epidemic in Saudi Arabia, says Christian Drosten.

Christian Drosten
Eyes on the virus. Growing awareness about MERS will help curb the epidemic in Saudi Arabia, says Christian Drosten.

BERLIN—Christian Drosten, a virologist at the University of Bonn in Germany, is among those leading the effort to understand Middle East respiratory syndrome (MERS) and contain the disease. He is also one of the very few Western scientists who have worked in Saudi Arabia in collaboration with local researchers.

On Friday, Drosten returned to Germany after a week in Saudi Arabia, where he investigated what's behind a sudden explosion in reported MERS cases. ScienceInsider caught up with him during a stopover in Berlin.

Q: There have been almost 400 MERS cases and more than 100 deaths in Saudi Arabia in the last 2 years. What’s the situation like at the moment?

C.D.: There’s a huge public awareness of the disease. Lots of people are wearing facemasks now. Actually, more when I left than when I arrived. In that 1 week, there was a clear increase. People know there is this virus and they are being careful, and I think that will actually help curb the number of new infections.

Q: It certainly doesn’t feel that way. Saudi Arabia has reported more infections in April than the whole world in the two previous years. The United States announced its first case on Friday, and before that there were imported cases in Greece and Malaysia. Is the disease spiraling out of control?

C.D.: There has been a lot of discussion about whether the virus has mutated to pass more easily from human to human. But we have sequenced three genomes from samples taken early in April in Jeddah, where many of the cases occurred, two more from later in the Jeddah outbreak, and another one from a patient in Mecca. They all look completely normal.

Q: But can you really tell from the genome whether the virus has adapted to humans?

C.D.: It’s almost impossible to tell from the sequence whether there has been a functional change in the virus. But we do know that certain parts of the genome are particularly important, and one of those is the receptor-binding domain of the spike protein.

Q: The part of the virus that binds to human cells.

C.D.: Exactly. And we do not see any changes there. The rest of the virus genome is also really closely related to previously sequenced MERS genomes. You really have to look quite hard to find any changes at all, and when you do find changes, there are other MERS genomes that had those changes, too. This is not like influenza viruses, which have a way higher mutation rate. Coronaviruses have correction enzymes so in general they are more stable genetically.

Q: Still, the number of infections is going up.

C.D.: You cannot compare the new numbers to those from a few months ago. Until the 26th of March, 459 tests had been done in all of Saudi Arabia this year. Then in just 1 month, just in the city of Jeddah, 4629 PCR tests were done. Something dramatic changed, and that is the case definition.

Before, tests were done on patients who had pneumonia and required [intensive care]. But now people are being tested not because they are sick, but because they had contact with a patient. Some of these tested positive, but many of them don’t really get sick.

Q: Could the test results be wrong?

C.D.: No, when I was in Jeddah I really tested the central lab where all the PCR for MERS is done. I made them run almost 200 PCRs with water, interspersed with some real samples. The tests were done on all the machines they use, with two different PCR assays and by two different technicians. To my surprise, there were no false positives at all.

We also reran samples from six health care workers who had cared for a patient in Tabuk; they seemed to be positive at a very low level. I can say unequivocally, these results are real. When you look at the PCR data on all the recent tests, they are often very weak signals. These people probably just have a very low concentration of virus in the throat. It's hard to interpret. It’s possible that these are infections that are quickly controlled by the immune system. That may happen frequently in health care workers dealing with several really sick patients.

Q: You’re saying these people should not have been tested at all?

C.D.: During the [2003] SARS [severe acute respiratory syndrome] outbreak, there was a strict case definition. People who had had contact with SARS patients but showed no symptoms were not tested with PCR. Instead they were tested for antibodies later, to see if an infection had happened. That should happen now in Saudi Arabia, too. Asymptomatic people should not be tested with PCR. At the moment, there is no antibody test available in the country. But you could list all those contacts and take a blood sample from each of them 14 to 21 days later and then have it tested outside the country. Three people from my lab are going to Riyadh to establish an ELISA test for antibodies.

Q: But isn’t it good to know all the cases, even if they are mild?

C.D.: The question of whether there is a mild, short-lived infection in some people is scientifically interesting. But in cities like Jeddah, it is bringing the health system close to collapse. That is the big problem. So many samples are being tested that the lab capacity won’t suffice for the real cases. And as more and more samples are tested, mistakes are bound to happen. On top of that, if you identify all these mild cases and put them in isolation beds, then you have no beds left for the real cases.

Q: What should be done with mild cases then?

C.D.: There is a good option and that is isolation at home. You can have people from the public health agency call every day to make sure people are staying home. You can give them written information on what they are allowed to do, and what not. There are many examples for this. It was used very successfully in Singapore during the SARS epidemic.

Q: Clearly there are also very serious cases. At least 38 people died of MERS in Saudi Arabia in April.

C.D.: Yes, I have seen results from patients with huge virus concentrations. These patients are highly contagious. Now in some emergency rooms in some Saudi hospitals, patients are kept for a very long time because there are no beds available on the wards. If there are such highly contagious patients amongst them, then clearly you get hospital-acquired infections and that is the other thing we are seeing at the moment. You have to remember that the absolute number of cases is still low. A few hundred. So just one hospital outbreak can raise the numbers significantly and lead to the impression that the whole epidemic is changing.

Q: You’ve also looked at how easily the virus is transmitted at home?

C.D.: We will submit a paper on that soon. We looked at 26 index cases and 280 people that they had close contact with. These were almost all family members, in some cases also maids or drivers. We looked really closely with PCR and antibody tests, and in the end you can say nine of those 280 contacts were infected. And these are people who really had immense exposure. That means the reproductive rate of the virus is 0.3, not close to 1, as others have argued.

Q: So at the moment MERS's only real chance to spread is in hospitals?

C.D.: Yes, I think those hospitals where there are problems with hygiene are fuelling this small epidemic.

Q: What about the political situation? Deputy Minister of Health Ziad Memish, who you work with, has received quite a bit of criticism.

C.D.: Some people have charged that he is holding back important information to secure high-ranking publications and things like that. But that is not true. I have been working with him since October and I had a good impression of him from the start. He is a Western-educated epidemiologist who knows what he is talking about.

Q: Others have charged that he demands to be a publication’s first or last author just in return for providing samples.

C.D.: Getting really good samples under controlled conditions is not easy in a country like Saudi Arabia. I think what Memish is organizing there is a huge contribution that warrants a first or last authorship. I have no problem with that. Memish really pushes people, he is extremely busy and he has built up an incredible network in the last 2 years. It’s a big loss that his political position is weakening.

Q: You mean that the new health minister, Adel Fakieh, is sidelining him?

C.D.: He has formed a new advisory committee and Memish is not part of that. That is a big problem, I think. It means they are starting from scratch. All the knowledge and the network that Memish has established is not being used. My impression was that the committee is dominated by clinicians and clinical microbiologists. They know how to treat patients of course, but not necessarily how to deal with an epidemic. I think Memish has really developed a kind of gut feeling for MERS in the last 2 years and that is not being used any more. I think that is the biggest mistake being made in Saudi Arabia at the moment.

Q: The ministry has also announced that three hospitals in Jeddah, Riyadh, and Dammam will be dedicated to treating MERS patients. Is that a good idea?

C.D.: Of course it’s a good idea to build these facilities so patients can be treated better. But what's needed most right now is a massive campaign for hospital hygiene. Sending teams into the hospitals to retrain the health care workers, who come from all over the globe. Teach them proper infection control. That would change a lot.

Q: Even when that is done, there have been a lot of studies suggesting that camels are an important source of infections as well.

C.D.: Camels will remain a source. It is interesting by the way, when we are talking about Jeddah: Most of the camels that are imported to the Arabian Peninsula come through the port of Jeddah. So you could think about testing all the young camels that arrive and quarantining them in the harbor until the virus is gone. But that would be a huge logistical challenge. Who would do those tests? Where should the camels be locked up all that time? A vaccine is more realistic and there are some good candidates.

Q: But none of those are being tested in camels yet.

C.D.: It is really difficult to get a sufficient number of animals that have not had an infection already. Where are you going to get them? You cannot just buy a circus. And you would want them not to be adult animals, because they are really big and hardly fit into any research lab. It’s a real challenge.

[dothedd]

Fear the camel: Why a deadly new Middle East virus will be so hard to stop...  May 8 1:25 PM ET

MERS has already killed more than 100 

Infectious disease experts have been worriedly watching a new disease for more than a year and a half now, but it’s a fair bet that most people still haven’t twigged to the existence of the world’s latest infectious threat: MERS. 

That may be changing, with new infections popping up recently in Malaysia, Greece, the Philippines, and Egypt. And late last week, the United States became the 16th country to detect a case of MERS, in an American health care worker who has been living and working in Riyadh, Saudi Arabia. 

The acronym is short for Middle East respiratory syndrome. The disease is caused by a cousin of SARS, the coronavirus that killed roughly 900 people and crippled hospital systems in China, Hong Kong, Vietnam, and Canada in 2003, knocking billions of dollars out of the world’s economy in the process. Canada’s outbreak occurred in Toronto, where I live; I covered SARS from its alarming beginning through its exhausting end. The information coming out of Saudi Arabia is limited, and it’s hard to be sure from a distance, but there appear to be many similarities between how the MERS outbreak is playing out in Saudi hospitals and what happened in Toronto during SARS. We are lucky that to this point MERS doesn’t seem to spread as easily as SARS did, though SARS didn’t spread particularly well either, and it still caused major trouble. 

As the name suggests, this new disease has been mostly found in the Middle East, in countries such as Qatar, the United Arab Emirates, Jordan, and most especially Saudi Arabia, which has reported 431 cases and 117 deaths, about 80 percent of known infections. All cases to date link back to seven countries in the Middle East. 

But one of the curious things about this new disease is that although cases appear to be concentrated in mainly a handful of countries, the virus itself is much more widespread. Evidence of the MERS coronavirus has been found over a wide swath of territory in dromedary camels, the beasts strongly suspected of passing this virus to people. Camels showing signs of previous infection with the virus have been found as far afield as Spain’s Canary Islands, off the northeastern coast of Africa; Tunisia; Ethiopia; Nigeria; and Kenya. 

SARS exploded into the human population, seeding itself in hospitals in several parts of the world before it even had a name. But MERS has been doing a slow burn. The new virus was first identified in June 2012 by an Egyptian doctor working in Saudi Arabia and scientists in a Dutch laboratory he turned to for help. But it was only brought to the world’s attention a few months later, in September 2012, when a gravely ill man from Qatar checked into a London hospital. The virus had ravaged the Qatari man’s lungs; he never recovered, dying after nine months in the hospital. 

Related 

Sharp rise in MERS cases, many human spread, has world health experts concerned 

Daniel Pipes: The sick Middle East 

The early deaths—following devastating illness—spooked public health officials and scientists observing the evolving situation. “Don’t become infected with this virus,” a public health officer familiar with one of the first cases told me more than a year ago. “It is not kind to humans.” 

Most of the earliest patients succumbed to their infections, but in the past year some mild and even symptom-free cases have been detected. Still, at this point nearly 30 percent of people who have been diagnosed with MERS did not survive. That’s a staggering percentage for any disease, especially a respiratory one that seems to spread via the mechanisms colds and flu viruses use—though fortunately not as efficiently as those human-adapted viruses spread. SARS, by comparison, killed about 11 percent of those infected. 

The recent milder cases support the hunch experts have long held—that the true ratio of fatal cases is lower because until now doctors in the main have only ordered MERS testing on people seriously ill with pneumonia. In fact the ratio has been dropping, from more than 50 percent early on to 28.5 percent, an estimate issued this week by the European Centre for Disease Prevention and Control. Epidemiologically, MERS is probably like an iceberg, with the severe cases making up the visible tip. But as none of the affected countries have been testing broadly to see how many people have been infected, it’s impossible at this point to even guess at how much lower the real death rate might be. 

It’s one of many unanswered questions about MERS. Another—and currently more pressing—is what is behind the extraordinary surge of cases over the past five weeks? The cumulative global case count more than doubled last month. Saudi Arabia alone has reported upward of 250 cases since the beginning of April; prior to that, only 207 cases had ever been reported globally. 

Some potential explanations for the sharp rise are a seasonal upswing, some outbreaks in Saudi and UAE hospitals where human-to-human spread has been taking place, and an increase in the number of people coming forward for testing. There has also been a spate of exported cases. A Malaysian man in Saudi Arabia on a religious pilgrimage contracted the virus and died after returning home. A man from Greece who lives in Jeddah, Saudi Arabia, flew to Athens after getting sick and was diagnosed there. Jordan and Egypt have recently detected cases in people from Saudi Arabia who sought care in their countries. And a health care professional who works in a Riyadh hospital flew to Chicago via London with the virus in his lungs. From Chicago he boarded a bus for Indiana, where he eventually sought medical treatment. 

To date it seems the man, who is recovering, did not infect anyone on his travels or while being treated at Community Hospital in Munster, Indiana. But state public health officials with help from the Centers for Disease Control and Prevention in Atlanta faced the substantial task of tracing people who were in contact with the unidentified man during his travels, checking to see if they are experiencing symptoms. Meanwhile, around 50 hospital workers who had dealings with the man were placed in home isolation, to make sure that if they are coming down with MERS, they don’t infect anyone else. This response will have cost serious money—and all because one man picked up a virus in Saudi Arabia. 

More of these kinds of situations are going to happen, the World Health Organization warned recently in a revised risk assessment of MERS. Dr. Kamran Khan, an infectious disease specialist at the University of Toronto who studies global spread of disease through airplane travel, worries about the possibilities, given the legions of foreign workers in the region and the millions of Muslim pilgrims from around the world who flock to the holy cities of Mecca and Medina every year. The numbers of the latter, by the way, will be increasing in coming weeks as Ramadan, the Muslim month of fasting, approaches. Ramadan begins this year at the end of June. 

“Just from the standpoint of probabilities, the longer this persists, the likelihood of it showing up in other regions of the globe and causing some of that disruption—that health, that economic disruption—is going to increase,” says Khan. 

Experts would dearly like to see the virus contained, driven out of the human population and back into nature. But doing that isn’t going to be easy. For one thing, while camels are clearly a major part of the MERS story, no one is yet certain they are the only source of the virus for humans. Nor does anyone know how camels are infecting people. Is transmission occurring through the drinking of unpasteurized camel milk or consumption of cheese made from it? Or is it the drinking of camel urine, a practice some in the Middle East exercise because they believe the fluid has medicinal qualities? The eating of camel meat? And how about all the people diagnosed with MERS who say they had no contact with camels—how did they become infected? 

Culling camels will not solve the problem... 

Camels are enormously important and beloved in the Middle East, where they are beasts of burden, sources of sustenance, and even pets. And that means options used in the past to contain the spillover of animal viruses into people could not be considered here. Starting in 1997, Hong Kong slaughtered all chickens in the city to stop the first human outbreak of H5N1 bird flu. During the SARS outbreak, China culled civet cats, the raccoon-like creatures implicated in the spread to humans of SARS. But no one would countenance the mass killing of camels—and nor should they, says Peter Ben Embarek, a WHO food safety scientist working on the MERS file. 

“Culling camels will not solve the problem,” Ben Embarek says, noting replacements brought from Africa would probably carry or catch the virus, too. “That will not make such a solution either practical or feasible or wise, or make sense in any way. So no, that would not be an option.” 

Getting people of the region to put some distance between themselves and their camels won’t be an easy sell, either. “Changing behaviors is always extremely difficult,” Ben Embarek says. “It’s really critical that we understand and identify the exact set of conditions that are exposing people to the virus, so we target the most critical behavior or practices to change them.” 

In the meantime, with no drug therapy for MERS and no vaccine—and don’t expect one any time soon—MERS is a situation health authorities are watching closely. The hope is new infections will start to drop off after the spring, which may be MERS high season. The fear is the virus will get better at spreading person to person and take its nasty act on the road. The reality is there is no way to predict what MERS has in store. Stay tuned.

news.nationalpost.com/2014/05/08/fear-the-camel-why-a-deadly-new-middle-east-virus-will-be-so-hard-to-stop/

[dothedd]

WHO to hold emergency talks on deadly MERS virus Tuesday...

GENEVA: The World Health Organization said Friday it would hold an emergency meeting next week on the deadly MERS virus, amid concern over the rising number of cases in several countries.
The UN health agency will host the emergency meeting on Tuesday to discuss the worrying spread of the virus, which in less than two years has killed 126 people in Saudi Arabia alone, spokesman Tarik Jasarevic told reporters in Geneva.

The WHO’s emergency committee has already met four times to discuss the mysterious corona virus, which surfaced in mid-2012.

“The increase in the number of cases in different countries raises a number of questions,” Jasarevic said, without giving further details of the aim of the new talks.

The WHO experts will brief reporters at the end of the teleconferenced meeting on Tuesday evening, he said.

The Middle East Respiratory Syndrome coronavirus (MERS-CoV) is considered a deadlier but less-transmissible cousin of the SARS virus that broke out in Asia in 2003, infecting 8,273 people and killing nearly 800 of them.

Like SARS, it appears to cause a lung infection, with patients suffering from a temperature, coughing and breathing difficulties.

But it differs in that it also causes rapid kidney failure.

There are no vaccines or antiviral treatments for MERS, a disease that kills more than 40 percent of those infected and that experts are still struggling to understand.

According to the most recent WHO figures, 496 MERS cases have been detected since September 2012.

Source: New Straits Times

[dothedd]

Suspected MERS Case Reported in India 

The district authorities have sounded an alert following a suspected case of MERS (Middle East Respiratory Syndrome) disease being reported in Kozhikode.

Officials say that they have already opened an isolated ward at the Government Beach Hospital to meet any emergency.

Earlier, a woman who arrived from Saudi Arabia with symptoms of MERS, had been admitted to a private hospital in the city. Medical officials said that the woman, aged 57, who arrived at the Karipur airport with symptoms of the disease was taken directly to the hospital and her blood samples were sent to the Manipal Medical College lab for examination.

Dr Sabu, Additional District Medical Officer, says that there is no need to panic. “At present no confirmed case of MERS has been reported from anywhere in the district. However, as a precautionary measure, we have opened an isolated ward at the Beach Hospital,” he says.

Officials also say that they are contemplating putting in place an observation system at the Karipur airport. This will help the medical officials screen the passengers who come from Gulf countries.

"Every time tested, airport screenings have proved highly ineffective. A test in New Zealand for airport screening for influenza showed that only about 6% of incoming cases were detected. This was in part due to passenger attempts to avoid detection by taking drugs to suppress temperature to get around the remote temperature monitors.

The big problem with airport screening is that most pandemics start in less developed countries (because the substandard conditions make it easier both for them to emerge and spread) and infected persons who can afford it and have passports or access to visas want to travel abroad for better medical care. They are very well aware of the risk of their spreading the disease and just don't care (and it's been that way in every epidemic throughout human history. #$%$ sapiens is what he is and not all of it is good.)

Just another example of the many ways in which huge disparities in wealth damage not just individual countries (especially the USA) but the entire world."

[dothedd]

Widespread Human MERS Transmission In Saudi Arabia
Recombinomics Commentary 19:30
May 8, 2014

The release of the three MERS sequences from recent cases in Jeddah and Mecca match the three earlier sequences from Jeddah.

All six human sequences have nine markers not present in any prior human sequence. Two of the nine have not been reported in any other MERS sequences including recently released camel sequences from Taif.

The six human sequences are from four hospitals in two cited (Jeddah and Mecca) indicating MERS is now transmitting human to human in western Saudi Arabia.

The clonal expansion is similar to the clonal expansion of SARS in 2003, when virtually all human cases after the spread at the Metrolpole Hotel had the same marker (a 29 nt deletion not found in any prior sequence, including civets).

The match between the six humans sequences indicates human to human MERS transmission is widespread in western Saudi Arabia, which raises serious pandemic concerns.

[dothedd]

Spike Q833R and ORF8b L6Q Define MERS Transmission
Recombinomics Commentary 21:00
May 8, 2014

The recently released sequences from the MERS cases in Jeddah and Mecca match the three earlier sequences from cases in Jeddah. Nine genetic changes define the novel sub-clade. Included in the polymorphisms is a change in the Spike protein, Q833R, which has not been reported in any prior MERS sequence. Similarly, another non-synonymous change, L6Q in open reading frame, ORF8b, is in all six human sequences, but not in any previously described MERS sequence.

The presence of both of these polymorphisms in all six human cases from four hospitals in two cities (Jeddah and Mecca) signal clonal expansion due to widespread MERS human transmission.

Although clonal expansion has been seen in cases linked to a nosocomial outbreak, such as the Al Hasa outbreak a year ago in eastern Saudi Arabia, the presence of the same sequence in multiple cases in multiple hospitals in two different cities raises serious pandemic concerns.

Moreover, these 9 markers are in six of six sequences from these two cities, strongly suggesting the 25 partial S gene sequences from 25 other Jeddah patients will also match these six cases, further supporting widespread human transmission.

[dothedd]

Revision of WHO Definition of Primary MERS Case Overdue
Recombinomics Commentary 23:15
May 8, 2014


WHO @who · May 7
Primary #MERS case is a person who got infected with MERS from an animal source (zoonotic) goo.gl/1AcKl5
WHO @who · May 7
Secondary #MERS cases are people who got infected from another MERS-infected person goo.gl/1AcKl5

The above WHO tweets on definitions assume that spontaneous or primary MERS cases are due to an animal source. However, all six recent human sequences from cases in Jeddah and Mecca match, indicating primary infections are due to humans infecting humans. The recent sequences from pateints in four hospitals in two cities (Jeddah and Mecca) leave little doubt that the vast majority of cases in western Saudi Arabia are due to human and not animal infections.

Three of the sequences have been public since April 26 ((C7149 and C7770 from hospital A collected on April 3 and 7, respectively as well as C7569 from hospital B collected on April 5), while the other three were released today - patients in Jeddah (C8826 and C9055) collected on April 12 and April 14 from hospital A and C, respectively, as well as Mecca (C9355) collected on April 15, although they were cited in an interview yesterday. WHO issued a report on their investigation of the spike in Jeddah cases, noting "the reasons for the increase in the number of primary community cases, as well as the infection route, remain unknown".

It would be useful if WHO would read the Jeddah and Mecca sequences. The data defining the novel sub-clade which has emerged in Jeddah are quite clear, and WHO’s silence is deafening.

Time for WHO to redefine a primary MERS case.

[dothedd]

A Fabulous Website!

MERS Coronavirus Cases and Sequences
Map of MERS coronavirus (MERS-CoV) cases and sequences.

maps.google.com/maps/ms?authuser=0&vps=2&hl=en&ie=UTF8&oe=UTF8&msa=0&msid=205430200180872645589.0004dbdfc3c35db1c1518&dg=feature

[dothedd]

With No MERS Vaccine Available, Ministry Urges Flu Jabs 

 07:33 pm May 09, 2014

Jakarta. Health authorities in Indonesia have urged pilgrims to get flu vaccines amidst growing fears of the spread of the Middle East respiratory syndrome, or MERS, which originated in Saudi Arabia.

“We still don’t have a specific treatment for MERS because there is no vaccine for the infection, but we do have a flu vaccine, and it is advisable for pilgrims to be vaccinated,” Deputy Health Minister Ali Ghufron Mukti said in Jakarta on Friday. “Even though it is just an alternative, this vaccine can boost the immunity.”

Ghufron said that as of Friday there had been no confirmed MERS cases in Indonesia, even though two people in Riau and Bali who had just returned from performing the umrah, or minor hajj, in Saudi Arabia had died from MERS-like symptoms.

The Health Ministry has conducted tests on 48 people recently back from Saudi Arabia and the results all came back negative, while a further case in Medan, North Sumatra, is still being investigated.

Ghufron said he believed the tests conducted by Indonesian medical workers were accurate because they were using the latest devices and testing standards.

Ghufron said that in many of the reported cases of suspected MERS, the patients happened to have existing medical conditions in which the symptoms were similar to the flu-like MERS symptoms.

However, he emphasized that the threat from the deadly viral infection should not be taken lightly, and noted that hundreds of thousands of Indonesians were set to go to Saudi Arabia for the umrah and hajj later this year.

Ghufron said that despite growing fear of a MERS pandemic, the Health Ministry had not imposed a travel ban to Saudi Arabia. The government has not even issued a travel warning, and has limited itself to distributing notification cards to pilgrims.

“We haven’t issued a travel warning because even the World Health Organization has not issued an advisory and there has been no positive case here,” he said.

However, countries like Egypt and Palestine have issued warnings against traveling to Saudi Arabia. Egypt has gone as far as recommending its citizens put off going on the pilgrimage until next year.

Ghufron defended the government against accusations that it had been slow in reacting to the threat from the disease. He said the ministry had intensified surveillance activities by reactivating thermal body scanners at airports and seaports and sent notification letters to health clinics.

Concerns about the virus reaching Indonesia spread when a man died from high fever and difficulty breathing in Riau on Sunday, shortly after returning from Saudi Arabia. The Health Ministry could not confirm if he was infected with MERS because the family refused to have him tested.

Detik.com reported on Friday that four more people who recently returned from Saudi Arabia had been admitted to Adam Malik General Hospital in Medan for fever, coughing and respiratory problems. Doctors are still waiting for test results to see if any of them were infected with MERS.

A man died in Bali after returning from Saudi Arabia last month, but his doctors said he had long suffered from a chronic lung illness.

[dothedd]

Editorial: Action Needed to Limit MERS Impact 

By Jakarta Globe on 11:06 pm May 09, 2014 

Prevention should be the first course of action Indonesia should take to prevent the spread of the virus that causes Middle East respiratory syndrome, or MERS. 

There is no known cure of the illness, first recorded in Jordan in 2012, but Indonesian authorities are advising pilgrims to take precautions, including getting vaccinated with flu shots to boost the immune system. 

Hundreds of thousands of Indonesians visit Saudi Arabia annually for umrah and hajj, and the possibility of people contracting MERS wouldn’t seem impossible, given that Indonesians tend to make up the single-biggest group of pilgrims. 

While no known cases of MERS have been confirmed in Indonesia, the virus has already claimed the lives of two travelers. 

But beyond sending an advisory to health centers around the country, the government has done little. Meanwhile, Egypt has advised its people to delay their pilgrimage until next year. 

An Indonesian Health Ministry official, though, says the threat from the deadly viral infection shouldn’t be taken lightly, and he’s right. 

One can recall the devastating impact of fears of the spread of severe acute respiratory syndrome (SARS), which swept across Southeast Asia more than a decade ago, leading to a decline in travel. 

Indonesia and Malaysia are particularly prone to a MERS outbreak. Contagion in those two countries and, by extension, the rest of Southeast Asia, would have a severe impact on the region’s economy at a time when greater integration with the Asean Economic Community is envisaged. 

Indonesia needs to be proactive. The government needs to work closely with other countries, share knowledge and use the lessons of SARS and the bird flu virus to stop MERS in its tracks. 

[dothedd]

MERS Vaccine Developers Prepared for ...
'Pandemic of Disastrous Proportions'

It was no coincidence that Gaithersburg, Md.-based Novavax already had a Middle East Respiratory Syndrome Coronavirus (MERS-CoV) vaccine in development well before the first case arrived in the U.S. last week. Companies like Novavax are always on the lookout for the next possible pandemic disease and ways to combat it, including MERS.

"MERS is worrisome," said Gregory Glenn, senior vice president for research and development at Novavax. "Emergent diseases are worrisome because they are not predictable."

Emergent diseases like MERS can make it necessary to quickly create large amounts of vaccine for an entirely new virus, which is where Novavx's technology comes into play.

"We an eye on the world and if we see something new we cab develop vaccines for it in large quantities," Glenn said.

Glenn has been involved in vaccine development for a quarter of a century and has seen a lot of viruses come and go in that time. While there's not yet been anything even close to level of the influenza pandemic of the early 20th century in that time, it's very smart for scientists and government officials to plan ahead for seriously dangerous and contagious diseases.

"[Scientists] presume there will be another pandemic of disastrous proportions," he said.

Novavax is actually under a contract with the federal government to prepare for possible pandemics. It has a $187 million Health and Human Services deal to develop a pandemic flu vaccine, something that could be necessary at any time.

MERS isn't exactly like the seasonal flu but along with being more of an unknown since it first appeared a couple of years ago, it's also proven fairly deadly, with 30 percent of reported cases ending in death. While so far not as contagious as SARS or other viruses, the fact is that it could mutate to becoming more contagious and more deadly at any point. It was a mutation that made it possible for humans to catch it all, letting it leap from its previous common host, camels.

Novavax's MERS vaccine is showing good results in animal testing and in an emergency could get out to the general public very quickly under special FDA protocols rather than the far slower if surer method used for medicine more normally.

"It would have to come out quickly in that case," Glenn said. "Otherwise you'd just be immunizing the grandchildren of survivors."

Novavax is also taking a look at treating the camels as a way of stopping MERS from spreading to humans at all. Vaccines designed for horses will have some application there, Glenn said. Hopefully MERS will end up being just another cautionary tale of diseases to keep an eye on like so many other viruses, in which case Glenn and Novavax will start on preparing to create vaccines for whatever they think might be the next dangerous disease.

"There's always going to be another one coming," Glenn said.

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WHO to hold emergency talks on MERS virus Tuesday

Published — Friday 9 May 2014


GENEVA: The World Health Organization said it would hold an emergency meeting next week on the deadly MERS virus, amid concern over the rising number of cases in several countries.
The UN health agency will host the emergency meeting on Tuesday to discuss the worrying spread of the virus, which in less than two years has killed 126 people in Saudi Arabia alone, spokesman Tarik Jasarevic said in Geneva.

The WHO’s emergency committee has already met four times to discuss the mysterious coronavirus, which surfaced in mid-2012.

“The increase in the number of cases in different countries raises a number of questions,” Jasarevic said.

The WHO experts will brief reporters at the end of the teleconferenced meeting on Tuesday evening, he said.

The Middle East Respiratory Syndrome coronavirus (MERS-CoV) is considered a deadlier but less-transmissible cousin of the SARS virus that broke out in Asia in 2003, infecting 8,273 people and killing nearly 800 of them.

Like SARS, it appears to cause a lung infection, with patients suffering from a temperature, coughing and breathing difficulties.

But it differs in that it also causes rapid kidney failure.

There are no vaccines or antiviral treatments for MERS, a disease that kills more than 40 percent of those infected and that experts are still struggling to understand.
According to the most recent WHO figures, 496 MERS cases have been detected since September 2012.

The Saudi health ministry says 463 of them have been in the country.

MERS cases have also been reported in the United Arab Emirates, Jordan, Egypt, Lebanon and even the US, with most involving people who had traveled to Saudi Arabia or worked there, often as medical staff.

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VIDEO: www.arabnews.com/how-prevent-coronavirus

(Turn on caption for English translation)

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The Middle East respiratory syndrome (MERS) coronavirus is seen in an undated transmission electron micrograph from the National Institute for Allergy and Infectious Diseases (NIAID).


RIYADH Thu May 8, 2014 2:29am EDT

(Reuters) - Saudi Arabia has identified 18 new cases of Middle East Respiratory Syndrome (MERS), it said late on Wednesday, pushing the total number of infections in the country so far to 449.

Four people died from the disease on Wednesday, taking the total death toll in Saudi Arabia to 121 since MERS, a form of coronavirus, was identified two years ago, the Health Ministry said in a statement on its website.

The rate of infection in Saudi Arabia has surged in recent weeks after big outbreaks associated with hospitals in Jeddah and Riyadh. The total number of infections nearly doubled in April and has risen by a further 21 percent already in May.

The World Health Organisation said on Wednesday the hospital outbreaks had been partly due to "breaches" in recommended infection prevention and control measures, but added that there was no evidence of a change in the virus's ability to spread.

Scientists around the world have been searching for the animal source, or reservoir, of MERS virus infections ever since the first human cases were confirmed in September 2012.

In humans, MERS cause coughing, fever and pneumonia. Cases have so far been reported in Saudi Arabia, Qatar, Kuwait, Jordan, United Arab Emirates, Malaysia, Oman, Tunisia, France, Germany, Spain, Italy and Britain.

Eight of the new cases were in Jeddah, five in the capital Riyadh, one in Najran. There were three new cases in Medina and one in Mecca, two cities that receive large influxes of Muslim pilgrims from around the country and overseas.

Half of them were in contact with people who had previously been diagnosed as having MERS, the ministry said.

www.reuters.com/article/2014/05/08/us-saudi-mers-idUSBREA3Q02F20140508

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Second Case of MERS Discovered in U.S. - FLORIDA

Monday, May 12, 2014 | Updated 10:43 AM CDT

Officials from the CDC and the Florida Department of Health scheduled a 2 p.m. ET press conference to relay more information about the newest case...

A second case of MERS -- the Middle East Respiratory Syndrome Coronavirus -- has been confirmed in the United States, officials with the Centers for Disease Control and Prevention announced Monday.

The new case, in Florida, comes 10 days after the first case of the virus was reported in the country. That first patient, a man who lived in Saudia Arabia who traveled flew to Chicago on a planned trip to visit family, recovered from the illness and was released from the hospital over the weekend.

Officials from the CDC and the Florida Department of Health scheduled a 2 p.m. ET press conference to relay more information about the newest case.

MERS belongs to the coronavirus family that includes the common cold and SARS, or severe acute respiratory syndrome, which caused some 800 deaths globally in 2003. Saudi Arabia has been at the center of a Middle East outbreak of MERS that began two years ago. The virus has spread among health care workers, most notably at four facilities in that country last spring.

Overall, at least 400 people have had the respiratory illness, and more than 100 people have died. All had ties to the Middle East region or to people who traveled there.

Officials said the disease isn't highly contagious, but there is no cure.
The MERS virus has been found in camels, but officials don't know how it is spreading to humans. It can spread from person to person, but officials believe that happens only after close contact. Not all those exposed to the virus become ill.


Source: www.nbcchicago.com/news/health/second-mers-case-florida-258915691.html#ixzz31W9mCZk8
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FLORIDA CASE CONTINUED...

The Florida patient traveled on May 1 from Jeddah, Saudi Arabia, to London, then from London to Boston; Boston to Atlanta; and Atlanta to Orlando.


The person began feeling unwell on the flight from Jeddah, and continued feeling ill on subsequent flights, with symptoms including "fever, chills and a slight cough," Schuchat said.

On May 8, the person went to the emergency department of a Florida hospital and was admitted. The patient is isolated in the hospital and is "doing well," said Dr. Tom Frieden, CDC director.

Health officials declined to say what hospital was treating the patient, but said more information would be forthcoming from the hospital later Monday.

The patient was visiting family and did not visit any theme parks in the Orlando area, said Dr. John Armstrong, Florida's state surgeon general and secretary of health.

As in the Indiana case, officials were attempting to contact people -- in this case, more than 500 -- who may have come in contact with the person during travel, both in the United States and abroad.

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Two Orlando health workers ill after exposure to MERS patient- hospital
Tue May 13, 2014 11:47am EDT

Two health workers at a hospital in Orlando, Florida who were exposed to the second patient in the United States with a confirmed case of MERS have now begun showing symptoms, and one of the two healthcare workers has been hospitalized.

Officials at the Dr P. Phillips Hospital in Orlando said on Tuesday the two healthcare workers were exposed to the patient in the emergency department before it became clear that the patient might have the Middle East Respiratory Virus or MERS, an often deadly virus that was first discovered in the Middle East in 2012. The second healthcare worker is being isolated in his home and watched for signs of infection.

British health authorities said on Monday they had found a second case of the deadly Middle East Respiratory Syndrome (MERS) virus in a person transiting through London, who flew from Jeddah in Saudi Arabia to the United States on May 1.

www.reuters.com/article/2014/05/13/us-usa-health-mers-idUSKBN0DT1FV20140513

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2 health workers who treated MERS patient report flu-like symptoms 

MERS patient in isolation at Dr. Phillips Hospital 

UPDATED 12:31 PM EDT May 13, 2014

ORLANDO, Fla. —All health workers and family members who came into contact with a MERS patient in Orlando have been contacted and tested, doctors said in a news conference Tuesday.

Doctors said 15 team members at Dr. Phillips Hospital, including three physicians, and five team members from Orlando Regional Medical Center were tested.

Out of those, two health workers from Dr. Phillips Hospital showed flu-like symptoms and one was admitted but is "doing well."

The two patients have not yet been diagnosed with MERS, but it is too soon to know if they contracted the virus, officials said.

All 20 health care workers were told to take off work for 14 days and will be allowed to return once medically cleared.

Officials said Monday that a 44-year-old health care worker from Saudi Arabia traveled to Orlando where he started feeling symptoms of MERS, or Middle East Respiratory Syndrome, on May 8. He is in isolation at Dr. Phillips Hospital.

"The patient has been doing very well. Last night he had a low grade fever. He is in good spirits. He is cooperating with all of these processes. We continue to collect samples from the patient," said Dr. Antonio Crespo, infectious disease specialist and chief quality officer for Dr. Phillips Hospital.

Crespo said the man did not initially have a cough or any respiratory symptoms at the time of admittance, meaning the probability for transmission before he was admitted is low.

"The family is being tested, and Dr. Phillips is waiting on results. Family members were instructed to stay home as much as possible and to wear masks if they do go out," said Dr. Ken Michaels, from Orlando Health.

"I think that the risk is negligible to this community. I think the risk is negligible to those who were in the waiting room or radiology area at ORMC," said Dr. Kevin Sherin, of the Florida Department of Health in Orange County.

Sherin said he doesn't think this will be the last case, as Orlando continues to see travelers from that part of the world.

MERS is a respiratory illness that begins with flu-like fever and cough but can lead to shortness of breath, pneumonia and death. A third of those who develop symptoms die from it.

Scientists don't know exactly how MERS spreads, but they think it is through close contact, including contact with bodily fluids.

The virus first emerged in 2011. There is no vaccine or special treatment for MERS.

The Orlando case is the second confirmed case in the United States.

Read more: www.wesh.com/health/mers-case-in-orlando-2-health-workers-report-symptoms/25953610#ixzz31cAoqOL7