Wednesday, June 19, 2013

Comments on the NEJM Study published today #MERS #Coronavirus

an excerpt from a Reuters article dated today:
Initially, 23 people in Saudi Arabia were infected with MERS at the time of the investigation, and 11 died. Saudi health officials now put the death toll at 32, with another 49 infected.
Among the 23 infected initially, five were family members and two were health care workers, the researchers said.
As well as the nine infected patients on dialysis, another dialysis patient had been transferred between units at different hospitals, where others became infected.

Eight other infected patients were transferred between facilities or hospitals - a factor the researchers said probably led to more patients becoming exposed.
So the initial 23 people were:

Saudi Arabia Cluster*
Case Number—Name—From--Onset—Condition—DOD
#1--59M—al Hofuf--4/14—Died--4/19*
#2--24M—al Hofuf--4/17—Died 5/29*
#3--87M—al Hofuf--4/17—Died--4/28*
#4--58M—al Hofuf--4/22—Died--5/29*
#5--94M—al Hofuf--4/22--Died--4/26*
#6--56M—al Hofuf--4/22—Died--4/30*
#7--56M—al Hofuf--4/22—Died--4/29*
#8--53F—al Hofuf--4/27--ICU Critical/Stable*--Recovered
#9--50M —al Hofuf--4/30—ICU Critical**--Recovered
#10-- Hussein al-Sheikh 33M—al Hofuf--4/28—Recovered, discharged.
#11—62F—al Hofuf--4/19—Died—5/3*
#12—71M—al Hofuf--4/15—Died—5/3*
#13—58F—al Hofuf--5/1—ICU Critical/Stable*--Recovered
#14—48M—al Hofuf—4/29—Died—6/9
#15—58M—al Hofuf—4/6—Recovered, discharged 5/3
#16—69F—al Hofuf—4/25—Died 5/8
#17—48M—al-Hofuf—4/24—Critical--Recovered
#18—81M—al-Hofuf—4/26—Critical--Recovered
#19—56M—al-Hofuf—5/7—Recovered, discharged
#20—45M HCW—al Hofuf—5/2—Critical—Recovered
#21—43F HCW—al Hofuf—5/8—Stable**--Recovered
#22—81F—HCF patient—4/28—Died 5/26


I have 22, not 23, but that's close enough.  The article says that 11 died. I have 12.  So, out of the 23, 5 were family members. Now, that is the FIRST TIME I have heard this. AND, 2 were Healthcare workers. Another enlightening moment.  But, don't forget that this is separate from the "Family Cluster" list that I have, but was never "documented" by those in the know.  That list goes like this:


Saudi Arabia Family Cluster:
Article 5/12:
Name:  Mohammed al-Sheikh (56)**Index Case Father
From:  Ahsa
Adm:  Dhahran Hospital.  ICU.
sym’s on Adm: high fever, low blood sugar. (diabetic).  First 2 days were find.
DOD:  4/15
Note:  Coma last 2 days alive.  Former Employee at National Oil Co. Saudi Aramco.
Son:  Hussein al-Sheikh, Abdulla al-Sheikh, Hanan daughter
Confirmation: Sample still being tested.

Article 5/12:
Name:  Hussein al-Sheikh (33), son of Mohammed al-Sheikh
Onset:  4/18 (3 days after Fathers death)
Adm:  Dhahran ICU
Note:  Still being tested.  Most likely positive.  When sick, temp was high, blod oxygen levels were low.  So tired could walk for days.  Any activity made him cough.  PhD student who studies in Canada.
Confirmed:  No.  Still being tested.  Discharged 5/8

Article 5/12:
Name:  Abdullah al-Sheikh (27), son of Mohammed al-Sheikh
Onset:  4/29
Adm:  5/1  Hospital in district al-Ahsa
Confirmation:  Positive
Note:  Father Died 2 weeks before his onset.
Recovered.  Released 5/15.


Article 5/12
Name:  Hanan, daugher of Mohammed al-Sheikh
From:   Ahsa
Adm:  5/6 Hospital in district al-Ahsa ICU
Not confirmed yet.

Deadly new coronavirus a "serious risk" in hospitals - Saudi study #MERS #Coronavirus

June 19, 2013



In a study published in the New England Journal of Medicine, the researchers said the Middle East respiratory syndrome (MERS)was not only easily transmitted from patient to patient, but also from the transfer of sick patients to other hospitals.
Nine infected patients in Saudi Arabia had received dialysis treatment at the same hospital, some at the same time.
-snip-

Beijing takes precautions against MERS coronavirus #MERS #Coronavirus

2013-06-19
Excerpt:
Health care providers are being advised to be vigilant and have been advised to test travelers returning from the Middle East for MERS if they show signs of developing severe acute respiratory infections, experts said. Specimens from patients' lower respiratory tracts should be obtained for diagnosis where possible. Meanwhile, medical staff in China have also been informed that immuno-compromised patients exhibiting atypical signs and symptoms such as diarrhea should be tested for the virus.
 -snip-
Healthcare facilities are have been reminded of the importance of infection prevention and control, while samples from suspected cases should be sent immediately to the Beijing Center for Disease Control and Prevention for examination, the paper said.

Beijing authorities have convened 110 medical experts from major hospitals to be on standby 24 hours a day, the Beijing Times said. But Pang Xinghuo, deputy director of Beijing's disease control center, said that the measures are all precautionary as MERS has a limited capacity for transmission, with only 64 confirmed cases reported worldwide since last year.

Complete article:  http://www.wantchinatimes.com/news-subclass-cnt.aspx?cid=1103&MainCatID=11&id=20130619000070

New Coronavirus 'Eerily' Like SARS #Coronavirus #MERS

By Michael Smith, North American Correspondent, MedPage Today
Published: June 19, 2013
 
The novel coronavirus outbreak in the Middle East is eerily similar to SARS, according to an expert who was part of a team studying a cluster of cases in hospitals in Saudi Arabia.

"This feels like SARS, it really does," said Trish Perl, MD, of the Johns Hopkins University School of Medicine.
"The illness pattern, the incubation period -- there are a lot of eerie similarities," Perl told MedPage Today.

-snip-
Continued:  http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/39972
 

Virologic Features in a Case of MERS-CoV Infection

June 19, 2013
Urine and stool, as well as respiratory tract samples, tested positive for the Middle East respiratory syndrome coronavirus. 

Researchers recently reported details of a fatal case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. The patient — a 73-year-old man — had multiple myeloma and was on treatment that included steroids. He reportedly had contact with a sick camel before illness onset. After being hospitalized in Abu Dhabi with progressive respiratory failure, he was transferred to a hospital in Munich (day 11 of illness); he died on day 18 of illness. At the time of the present report, no infection had been observed in healthcare workers who had contact with the patient.

In Munich, sequential clinical samples were collected from the patient and tested for MERS-CoV by reverse-transcription polymerase chain reaction and indirect immunofluorescence. Concentrations of the virus were highest in bronchoalveolar fluid samples. Urine (collected on days 12 and 13 of illness) and stool samples (collected on days 12 and 16) and one of two oronasal samples also tested positive for the virus at low levels. No virus was detected in blood. Suction catheters that had been refrigerated as long as 5 days also tested positive.

The investigators sequenced the MERS-CoV genome from respiratory samples and conducted phylogenetic analysis using four other available MERS-CoV genome sequences. The estimated time of a common ancestor was mid-2011. The virus clustered with a virus from a patient from Qatar treated in the U.K.

Comment: Many features resemble those already reported. Virus was found in low concentrations in stool and urine — in contrast to the prominent fecal shedding previously documented in SARS patients. Whether the presence of virus in urine reflects primary kidney infection or systemic infection is unclear. The positive test results for refrigerated suction catheters suggest that the virus may survive outside the body under appropriate environmental conditions. Editorialists urge the development of an international therapeutic protocol to help identify effective intervention strategies.
Mary E. Wilson, MD

Citation(s):

Drosten C et al. Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection. Lancet Infect Dis 2013 Jun 17; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S1473-3099(13)70154-3)
Guery B and van der Werf S. Coronavirus: Need for a therapeutic approach. Lancet Infect Dis 2013 Jun 17; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S1473-3099(13)70153-1)

Sequencing the MERS coronavirus outbreak in Saudi Arabia #MERS #Coronavirus

June 19, 2013
Excerpt - editing is mine

Genetic tools and clinical techniques combine to characterise novel virus

Using deep sequencing technologies, researchers from the Kingdom of Saudi Arabia, US, Canada and the UK have shown that the novel Middle East Respiratory Syndrome (MERS) coronavirus can spread between people in healthcare settings.

By combining clinical monitoring techniques with state-of-the-art sequencing technology to study an outbreak of MERS coronavirus, the scientists discovered that transmission occurs within hospitals and can be rapidly fatal.

Of the 23 people diagnosed with the coronavirus infection in this outbreak, 65 per cent of patients have died. Until now little has been known about the origin and characteristics of this deadly new virus. By studying an outbreak in the eastern Saudi Arabian province of Al-Hasa, the teams are starting to understand the transmission dynamics, and clinical and genetic characteristics of this often fatal virus.
"We developed our rapid, deep, and whole-genome sequencing of MERS coronavirus to understand more about the genetics of this virus, and for the method to be used in any new outbreaks. This is exactly what we have been able to achieve," says Professor Paul Kellam from the Wellcome Trust Sanger Institute.
Sanger Institute researchers developed a deep sequencing technique that can rapidly sequence MERS coronavirus genomes. This technique uses the miniscule levels of viral genetic material present in patients’ clinical samples taken to diagnose the infection. Coupled to bespoke computer programs this process reduces the time of genome analysis from weeks to days.
 -snip-
"By analysing the complete genomes of four MERS-coronavirus-positive samples, we found that the viruses were closely related to one another genetically - indicating that they are part of the same infection outbreak," said Dr Abdullah Al-Rabeeah, Minister of Health, Kingdom of Saudi Arabia. "The low level of sequence divergence of the virus within the Al-Hasa cluster is in concordance with the hospital epidemiological investigation, suggesting that transmission took place within this group of patients and healthcare workers."
 
Using this knowledge, clinicians have been able to minimise the spread of the infection and provide vital new information for helping to contain future outbreaks.

"The fact that the hospital outbreak was contained effectively and there were no more new cases reported, shows that preventive infection control measures are crucial to prevent spread of the virus," said Professor Alimuddin Zumla of University College London. "The rapid pace with which the cluster outbreak at Al-Hasa was initiated by the Saudi Arabian Ministry of Health, which enabled rapid definition of the epidemiology, identification of viral genome sequences and release of them for open use in the GenBank database, and bringing the outbreak under control, reflects the true collaborative spirit and value of effective international collaborations, which are essential to containing this virus."

Continued:  http://www.sanger.ac.uk/about/press/2013/130619.html

 


Deadly Coronavirus Spreads Easily in Hospitals: Study #MERS #Coronavirus

June 19, 2013
Bloomberg
Excerpt - editing is mine:
The new coronavirus that’s killed almost two-thirds of the people it’s infected, mostly in Saudi Arabia, spreads easily in hospitals, according to the first detailed description of the outbreak since it started in September.
-snip-
“This is the kind of information that we need to have on a real-time basis,” Osterholm said by phone. “If this information was being held for the purposes of publication, that is unfortunate.”

Globally, MERS-CoV has sickened 64 people and killed 38 since September, 32 of which have been in Saudi Arabia, according to the World Health Organization. The source of the outbreak hasn’t been identified, and infections in other parts of Saudi Arabia since since today’s study was concluded show that transmission is continuing, Osterholm said.

“It’s a dot, and it takes two dots to make a line,” Osterholm said. “If we keep getting more information, more dots, we can talk about a trend.” 

To contact the reporter on this story: Simeon Bennett in Geneva at sbennett9@bloomberg.net

Complete article:  http://www.bloomberg.com/news/2013-06-19/deadly-coronavirus-spreads-easily-in-hospitals-study.html 

U.S. funding anti-bird flu in Vietnam #H5N1 #H7N9

[The Case Fatality Rate of 50% quoted below is for the H5N1 Human Cases in 2012.  According to my list , I have 5 confirmed cases with 3 death.]

U.S. funding for prevention of avian influenza in Vietnam.  Department of Veterinary Medicine, Department of Animal Husbandry, Veterinary Diagnostic Center for Central and regional centers, and laboratories involved are the beneficiaries of funding 1 million 700 thousand U.S. dollars by the Development Authority International, USAID awarded many more.
Announcement of the U.S. Embassy reported this today, which is a new project with funding by USAID and the Food and Agriculture Organization, FAO, done.
Mr. Van register, Chief Veterinary Epidemiology, Department of Animal Health of Vietnam said information related to activities that can be provided more funding from USAID mentioned features of the United States: To be agreed, we I have extensive monitoring program, which focuses primarily on waterfowl Forum Mekong Delta, and the North we do in some northern provinces border-related issues for the early detection of smuggled .
At the center, we are building a national program. That program is the Ministry of Planning and Investment and the Ministry of Finance to approve the long-term program from 2013 to 2017. That's one of the things that we are doing in the prevention of disease.
According to Dr. Scott Newman, technical coordinator of FAO Senior, an important current in Vietnam is ready to improve prevention and monitoring risk to the recent H5N1 flu kills a 4-year-old boy in Dong Thap. Besides monitoring the appearance of H7N9 virus. This strain has not appeared in Vietnam raging, but last February death in China kills 40 people.
In southern Vietnam last 4 deaths due to H1N1 influenza, commonly called swine flu. 
Particularly avian influenza H5N1 in Vietnam in the first case appeared in 2003. As of the 2012 influenza virus has infected 122 people this, and the mortality rate is 50%.

Vietnam: Not detected #H7N9 flu samples from more than 1,000 Poultry

June 19, 2013
Translation

More than 1,000 samples from poultry smuggled chickens discarded in the wholesale market of poultry trade are negative for H7N9 virus.

At the Steering Committee meeting national flu avian pm on 18.6, Pham Van Dong, Director of Animal Health, Ministry of Agriculture and Rural Development said: More than 1,000 samples from poultry smuggled chickens discarded in the wholesale market of poultry trade are negative for H7N9 virus. Until now, the country is no longer the blue ear disease, foot and mouth disease in cattle and avian flu

Regarding the A/H7N9 influenza virus surveillance, from May 6/2012 - 2/2013, Department of Animal Health has more than 1,200 samples taken from poultry smuggled chickens discarded for analysis and testing. Number of samples positive for influenza A, but all were negative for influenza A/H5N1 and influenza A/H7N9. 
Under the sponsorship of the Food and Agriculture Organization of the United Nations (FAO), virus monitoring program is carried out in five provinces and cities including Hanoi, Bac Ninh, Bac Giang, Ninh Binh and Nam Dinh and sampling in 25 markets for poultry diagnostic tests for A/H7N9 flu virus.

Saudi Arabia: Clarification on the press reported injuries "Corona" in Jeddah

June 18, 2013
Daily care (special): reference to the press reported on the conflict in 
the statements of Health Affairs in Jeddah and the Ministry of Health regarding infection "Corona" in Jeddah, and then see what is published wishes of Health Affairs in Jeddah to clarify the following:

First: there are no cases infected with "Corona" in hospitals affiliated to the Ministry of Health and private sector hospitals in Jeddah which follow administratively for Health Affairs in Jeddah. Secondly: the case of infected announced by the Ministry of Health is for a child aged two years hypnotic King Fahd Hospital of the Armed Forces in Jeddah, where suffering from kidney failure and disease Legacy of the lung, and proved examinations and laboratory results of her Pfyrus "Corona", and assess the patient's southern Kingdom fell hospital for treatment. Third: The supervision and press release from King Fahd Hospital of the Armed Forces does not fall within the purview of Health Affairs in Jeddah. Fourth: The stresses of Health Affairs in Jeddah that all hospitals maintain there are sections of isolating infectious diseases and Mobile and will be placed with them, if any, God forbid, and the terms of the private sector will be converted infected with the virus, if any, to government hospitals for readiness rooms and sections for insulation. conclusion:We pray to God to bless a speedy recovery for the infected and all patients.

http://enayh.com/news/general/13649-13649.html

Saudi Arabia: Jeddah's health: the case of 'Corona' registered in the Armed Forces Hospital #MERS #Coronavirus

June 19, 2013
Renewed health affairs in Jeddah position there is no case for a child infected with Corona in Jeddah. 
She explained Health Affairs that the situation announced by the Ministry of Health, three days ago, »is a child at the age of two years, which is found at King Fahad Armed Forces in Jeddah,» she said, adding that the child «suffer failure كلويا and hereditary disease in the lung, and proved examinations and laboratory results of her Pfyrus 'Corona', and assess the patient's southern Kingdom and declining hospital for treatment. The health affairs to the report published by the «Middle» yesterday on the lips of its director, Dr. Sami Badawod and the statement of the Ministry of Health which aired on the ministry yesterday, saying: »There are no cases infected with« Corona »in hospitals affiliated to the Ministry of Health and private sector hospitals in Jeddah that follow administrative affairs Health in Jeddah, adding that supervision and press release from King Fahd Hospital of the Armed Forces does not fall within the purview of Health Affairs in Jeddah. It also confirmed that «all hospitals maintain there are sections of isolating infectious diseases and Mobile and will be placed with them, if any, God forbid, and the terms of the private sector will be converted infected with the virus, if any, to government hospitals for readiness rooms and sections for insulation».
http://www.alsharq.net.sa/2013/06/19/871696

Saudi Arabia: #Coronavirus infects a child in the Armed Forces Hospital #MERS


Abdullah Al Rajhi - already - Jeddah:
 announced the Health Affairs in Jeddah, that the state of infection with HIV , "Corona", which revealed the Ministry of Health to have occurred in Jeddah, not in a hospital in the ministry, but it is for a child two years old, sleeping at King Fahd forces Armed Jeddah. 


said in a statement released a short while ago: "Todd Health Affairs in Jeddah to clarify that there are no cases infected with "Corona" in hospitals affiliated to the Ministry of Health, and private hospitals in Jeddah, which administratively tracking of Health Affairs in

Saudi Arabia: Tabuk confirm hospitals free of the virus .. The injury health nurses in Taif #MERS #Coronavirus

[There were 2 deaths from Taif, reported out of the Ministry of Health Saudi Arabia website, so I don't know what this article is talking about]

June 19, 2013
Denied the Ministry of Health on the tongue Spokesman Dr. Khalid Marghalani rumors about rising infections Coruna in hospitals in Taif, stressing that announced earlier this week two cases only, a lady in the fifty-eighth is still under treatment and follow-up, and citizen of the fifty-sixth died later. 
said Mirghalani The ministry is updating all injuries confirmed viruses Coruna in hospitals Kingdom via the website and transparently to inform citizens on the numbers of infected without reservation it. 
, and the means of reaching social picked up during the past two days suffered two nurses at King Abdul Aziz Specialist Hospital in Taif to HIV infection, and after that Bacherta cases infected. 
For her part, the General Directorate of Health Affairs in Tabuk to hospitals in the region has not recorded any cases of illness «Corona», and that the region completely free of the disease. 
revealed Assistant Director-General of Health Affairs in Tabuk of Public Health, Dr. Mustafa Al Faraj that all suspected cases and which has been taking a sample of them in the region, results were negative, and did not record any cases so far, stressing the readiness centers health monitoring ports border, particularly with the entry of the Umrah season, pointing out that the plan of the Directorate to investigate this disease and other infectious diseases continues, by taking samples of suspected cases and analyzed in the laboratories of the region and the Central Laboratories. 
For his part, the spokesman explained Media Tabuk health Back Atwi that what is traded through the means of social communication for injured persons in Tabuk infected Coruna false news does not unfounded.

Current WHO global phase of pandemic alert: Avian Influenza A(H5N1)

Current phase of global alert according to criteria described in the WHO Pandemic Influenza Risk Management Interim Guidance

The pandemic influenza phases reflect WHO’s risk assessment of the global situation regarding each influenza virus with pandemic potential that is infecting humans. These assessments are made initially when such viruses are identified and are updated based on evolving virological, epidemiological and clinical data. The phases provide a high-level, global view of the evolving picture.
As pandemic viruses emerge, countries and regions face different risks at different times. For that reason, countries are strongly advised to develop their own national risk assessments based on local circumstances, taking into consideration the information provided by the global assessments produced by WHO. Risk management decisions by countries are therefore expected to be informed by global risk assessments, but based on local risk assessments.
The current WHO phase of pandemic alert for avian influenza A(H5N1) is: ALERT 

Alert phase: This is the phase when influenza caused by a new subtype1 has been identified in humans. Increased vigilance and careful risk assessment, at local, national and global levels, are characteristic of this phase. If the risk assessments indicate that the new virus is not developing into a pandemic strain, a de-escalation of activities towards those in the interpandemic phase may occur.
Please consult the interim guidance document for complete information on pandemic phases:
More information on avian influenza H5N1 in humans can be found at the:


1 The IHR (2005) Annex 2 includes “human influenza caused by a new subtype” among the four specified diseases for which a case is necessarily considered “unusual or unexpected and may have serious public health impact, and thus shall be notified” in all circumstances to WHO.

Tuesday, June 18, 2013

CDC: Update: Severe Respiratory Illness Associated with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) — Worldwide, 2012–2013

Weekly

June 14, 2013 / 62(23);480-483

  • Page last reviewed: June 14, 2013
  • Page last updated: June 14, 2013

On June 7, 2013, this report was posted as an MMWR Early Release on the MMWR website (http://www.cdc.gov/mmwr).
CDC continues to work in consultation with the World Health Organization (WHO) and other partners to better understand the public health risk posed by the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), formerly known as novel coronavirus, which was first reported to cause human infection in September 2012 (1–4). The continued reporting of new cases indicates that there is an ongoing risk for transmission to humans in the area of the Arabian Peninsula. New reports of cases outside the region raise concerns about importation to other geographic areas. Nosocomial outbreaks with transmission to health-care personnel highlight the importance of infection control procedures. Recent data suggest that mild respiratory illness might be part of the clinical spectrum of MERS-CoV infection, and presentations might not initially include respiratory symptoms. In addition, patients with comorbidities or immunosuppression might be at increased risk for infection, severe disease, or both. Importantly, the incubation period might be longer than previously estimated. Finally, lower respiratory tract specimens (e.g., sputum, bronchoalveolar lavage, bronchial wash, or tracheal aspirate) should be collected in addition to nasopharyngeal sampling for evaluation of patients under investigation. An Emergency Use Authorization (EUA) was recently issued by the Food and Drug Administration (FDA) to allow for expanded availability of diagnostic testing in the United States.
As of June 7, 2013, a total of 55 laboratory-confirmed cases have been reported to WHO. Illness onsets have occurred during April 2012 through May 29, 2013 (Figure 1). All reported cases were directly or indirectly linked to one of four countries: Saudi Arabia, Qatar, Jordan, and the United Arab Emirates (Figure 2). Most cases (40) were reported by Saudi Arabia. Four countries, the United Kingdom (UK), Italy, France, and Tunisia, have reported cases in returning travelers and their close contacts (5–8). Ill patients from Qatar and the United Arab Emirates have been transferred to hospitals in the UK and Germany. To date, no cases have been reported in the United States. WHO and CDC have not issued any travel advisories at this time; updated information for travelers to the Arabian Peninsula is available athttp://wwwnc.cdc.gov/travel/notices/watch/coronavirus-arabian-peninsula.

The median age of patients is 56 years (range: 2–94 years), with a male-to-female ratio of 2.6 to 1.0. All patients were aged ≥24 years, except for two children, one aged 2 years and one aged 14 years. All patients had respiratory symptoms during their illness, with the majority experiencing severe acute respiratory disease requiring hospitalization. Thirty-one of the 55 patients are reported to have died (case-fatality rate: 56%) (5–8). Two cases in Tunisia, in siblings whose father's illness was a probable case, and a case from the UK, were in persons with mild respiratory illnesses who were not hospitalized (5,9). Information was not available for all cases; however, several patients had accompanying gastrointestinal symptoms, including abdominal pain and diarrhea, and many cases occurred among persons with chronic underlying medical conditions or immunosuppression, as reported to WHO (5,9).
The original source(s), route(s) of transmission to humans, and the mode(s) of human-to-human transmission have not been determined. Eight clusters (42 cases) have been reported by six countries (France, Italy, Jordan, Saudi Arabia, Tunisia, and the UK) (5) among close contacts or in health-care settings and provide clear evidence of human-to-human transmission of MERS-CoV. The first documented patient-to-patient nosocomial transmission in Europe was confirmed recently in France (10). The first French patient, a man aged 64 years with a history of renal transplantation, became ill on April 22, 2013, within 1 week after returning from Dubai. He presented with fever and diarrhea. Pneumonia was diagnosed incidentally on radiographic imaging, and he subsequently died with severe respiratory disease. The secondary case is in a man aged 51 years on long-term corticosteroids who shared a room with the index patient during April 26–29 and who remains hospitalized on life support. The incubation period for the secondary case was estimated to be 9–12 days; this is longer than the previously estimated 1–9 days (10). A larger cluster, consisting of 25 cases including 14 deaths, ongoing since April 2013 in the region of Al-Ahsa in eastern Saudi Arabia, also has included cases linked to a health-care facility (5). Cases have included health-care personnel and family contacts. An additional five cases, not linked to the cluster in Al-Ahsa, were reported recently in another region of eastern Saudi Arabia (5). Thus far, no evidence of sustained community transmission beyond the clusters has been reported in any country.
In some instances, sampling with nasopharyngeal swabs did not detect MERS-CoV by polymerase chain reaction (PCR); however, MERS-CoV was detected by PCR in lower respiratory tract specimens from these same patients. In the two patients reported by France, nasopharyngeal specimens were weakly positive or inconclusive, whereas bronchoalveolar lavage and induced sputum were positive (10).

CDC Guidance
In consultation with WHO, the period for considering evaluation for MERS-CoV infection in persons who develop severe acute lower respiratory illness days after traveling from the Arabian Peninsula or neighboring countries* has been extended from within 10 days to within 14 days of travel. Persons who develop severe acute lower respiratory illness within 14 days after traveling from the Arabian Peninsula or neighboring countries should be evaluated according to current guidelines (available at http://www.cdc.gov/coronavirus/mers/case-def.html). Persons whose respiratory illness remains unexplained and who meet criteria for "patient under investigation" should be reported immediately to CDC through state and local health departments. Persons who develop severe acute lower respiratory illness who are close contacts of a symptomatic traveler who developed fever and acute respiratory illness within 14 days of traveling from the Arabian Peninsula or neighboring countries may be considered for evaluation for MERS-CoV. In addition, CDC recommends that clusters of severe acute respiratory illness be investigated and, if no obvious etiology is identified, local public health officials be notified and testing for MERS-CoV conducted, if indicated.
To increase the likelihood of detecting MERS-CoV, CDC recommends collection of specimens from different sites (e.g., a nasopharyngeal swab and a lower respiratory tract specimen, such as sputum, bronchoalveolar lavage, bronchial wash, or tracheal aspirate). Specimens should be collected at different times after symptom onset, if possible. Lower respiratory tract specimens should be a priority for collection and PCR testing; stool specimens also may be collected. Specimens should be collected with appropriate infection control precautions (available athttp://www.cdc.gov/coronavirus/mers/case-def.html).
Testing of specimens for MERS-CoV currently is being conducted at CDC. FDA issued an EUA on June 5, 2013, to authorize use of CDC's novel coronavirus 2012 real-time reverse transcription–PCR assay (NCV-2-12 rRT-PCR assay) to test for MERS-CoV in clinical respiratory, blood, and stool specimens. This EUA is needed because, at this time, there are no FDA-approved tests that identify MERS-CoV in clinical specimens. This assay will be deployed to Laboratory Response Network (LRN) laboratories in all 50 states over the coming weeks. Updated information about laboratories with the capacity to conduct MERS testing with the NCV-2-12 rRT-PCR assay will be provided on CDC's MERS website (http://www.cdc.gov/coronavirus/mers/case-def.html).
In consultation with WHO, the definition of a probable case of MERS-CoV infection has been updated to also include persons with severe acute respiratory illness with no known etiology with an epidemiologic link to a confirmed case of MERS-CoV infection. Until the transmission characteristics of MERS-CoV are better understood, patients under investigation and probable and confirmed cases should be managed in health-care facilities using standard, contact, and airborne precautions. As information becomes available, these recommendations will be reevaluated and updated as needed.
Recommendations and guidance on case definitions, infection control (including use of personal protective equipment), case investigation, and specimen collection and testing, are available at the CDC MERS website (http://www.cdc.gov/coronavirus/mers/index.html). The MERS website contains the most current information and guidance, which is subject to change. State and local health departments with questions should contact the CDC Emergency Operations Center (770-488-7100).

Reported by

Div of Global Migration and Quarantine, Div of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases; Office for Emergency Preparedness and Response, National Institute of Occupational Safety and Health; Div of Global Health Protection (proposed), Center for Global Health; Div of Viral Diseases, National Center for Immunization and Respiratory Diseases; Paul A. Gastañaduy, MD, EIS Officer, CDC. Correspondence: eocreport@cdc.gov, 770-488-7100.

References & Chart

(continued)

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6223a6.htm?s_cid=mm6223a6_x&utm_source=feedly

Vietnam Refers to Poultry Purchase in A/H1N1 Flu Death

[I find it extremely odd that the authorities in Vietnam would refer to a poultry purchase, in reference to a A/H1N1 death....]
English
June 18, 2013

In the afternoon of June 17, the Ben Tre Province Health Department confirmed that a 47-year-old woman in Ben Tre City died of A/H1N1 flu virus. Phan – a rice trader – had a fever 10 days ago. On the morning of June 10, she got a mild shock and was taken to a private hospital in Ben Tre City, then transferred to the Pham Ngoc Thach Hospital in Ho Chi Minh City, suspected of lung disease.
In the afternoon of June 12, she died. Test results identified that the patient was positive to A/H1N1 virus. Another patient of Ben Tre is currently treated at the Cho Ray Hospital in Ho Chi Minh City. This patient is a nurse of the Binh Dai district hospital of Ben Tre province. The patient had a fever on May 28. Test results showed that she was positive for A/H1N1 influenza. The patient has been out of danger.
Another woman in Vinh Long province died of the flu at the provincial hospital on June 16. In the afternoon of June 17, the HCM City Pasteur Institute transferred the test results to the authorities of Vinh Long province, which identified that the patient was infected with H1N1 influenza virus.
According to the patient’s family, on June 8, the woman bought chicken at the market of Long Tan commune. On June 11, she got a fever. On June 15, she was brought to the district hospital and then transferred to the hospitals of higher levels but she did not survive.
From the beginning of the year, Ben Tre detected three cases positive for A/H1N1 virus, one died. Vinh Long has had one death of the flu. The Ministry of Health has warned of the boom of H1N1 influenza in Vietnam this year.