Wednesday, April 23, 2014

Saudi MOH: 2nd Update Today – 13 New MERS Cases

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# 8519

 

My thanks to Helen Branswell, @FluTrackers and @Ironorehopper for tweeting this latest update from the Saudi Ministry of Health where – for the second time today – they’ve released a double-digit update.  This time, they have 13 new cases on the list, bringing the day’s total to 24.

 

While the number of cases is concerning, one very good sign is the increase in the amount of information this update is providing on each case.  A nice summary at the top, and individual case details (including dates of hospital admission), are welcome additions to this latest release.

 

Hopefully this will be a sign of continued better organization, and more openness, from the Saudi Ministry of Health.

 

Of particular note with this release, the MOH is acknowledging 4 more cases in the Holy City (Mecca), which  must be a concern for those planning on making the pilgrimage this year (Umrah or Hajj) and for its organizers.  Also, only one HCW case (fatal) was reported, as well as only 1 asymptomatic case, bucking recent trends that have seen a large surge in both types of cases.

 

(Health) record (13) case infected with Corona

The total number of confirmed cases recently: 13

Distribution of cases, cities of the Kingdom:

 5 cases in Riyadh city

 2 two in Jeddah

 4 cases in the Holy City

 If one in Madinah

 one case reported by the who representative in Jordan for hypnotic Saudi citizen

• Distribution of cases at hospitals in Saudi Arabia

 5 cases in the military hospital in Riyadh.

 If one at King Faisal specialist hospital in Jeddah

 If one in a hospital in Medina

 If one in the security forces hospital in the Holy City

 3 cases in Al Noor hospital in Makkah

• Health status of cases:

 one case without symptoms

 3 stable situations and hypnotic in suites

 If one stable Jordan

 6 cases in intensive care

 2 deaths

• Details of cases

1/80-year citizen, has diabetes and high blood pressure and chronic renal failure and cancer in the blood, entered the military hospital in Riyadh on 28/3/2014, died in date 22 April 2014.

2/def 69 years, has diabetes and high blood pressure, entered a military hospital in Riyadh on 18 April 2014 complaining of symptoms of diabetic foot, then was hit by pneumonia, hypnotic in hospital on artificial respiratory.

3/a 70 years old, has a heart disease and chronic lung disease entered a military hospital in Riyadh on 4 April 2014 with pneumonia, hypnotic in hospital on artificial respiratory.

4/citizen 72 years, has diabetes and high blood pressure, entered a military hospital in Riyadh on 5 April 2014 and then was hit by pneumonia hypnotic in hospital on artificial respiratory.

5/an 88 years has diabetes, hypertension and stroke, the military hospital in Riyadh on 27/3/2014 and then was hit by pneumonia and his condition is stable.

6/41-year citizen contacts of the confirmed case in Jeddah and there are no symptoms.

7/def 74 years, entered King Faisal Hospital in Jeddah on 14 April 2014 suffer symptoms of anemia, symptoms of pneumonia on 20 April 2014 hypnotic in intensive care.

8/46-year citizen entered the security forces hospital in the Holy City on 21 April 2014 with respiratory symptoms sedation in intensive care.

9/68 citizen entered the Al Noor hospital in Makkah on 12 April 2014, a sample negative on 14 April 2014, became positive on 22 April 2014 hypnotized in intensive care.

10/moatamer Turkish nationality, 65, entered the hospital in the Holy City with respiratory symptoms, his health stable.

11/sexuality Klaus's 52-year resident income of Al Noor hospital in Makkah on 18/4/2014 died on 22 April 2014.

12/13 year old citizen who has asthma, he developed respiratory symptoms on 9/4/2014, entered a hospital in Medina on 21st April 2014 stable condition.

13/the case reported by the who representative in Jordan for a 25 years in Burwood, the Ministry was informed of the positive test result, still in Jordan and stable condition.

• Two deaths of two patients were suspected and confirmed and condition is as follows:

  • resident working in the health field in Al-kharj, 45, and suffering from chronic illness and sadly passed away on 21st April 2014
  • a 29-year-old was infection and died in King Fahd Hospital in Jeddah on 22 April 2014

WHO EMRO Statement On MERS-CoV

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Coronavirus – Credit CDC PHIL

 

 

# 8518

 

Via an emailed press statement from the WHO’s Eastern Mediterranean Regional Office, we get the following statement on the MERS outbreak, taking particular note that  roughly 75% of recent cases are attributed to human-to-human transmission, that healthcare facilities are the site of two major clusters, and  the victims are mainly healthcare workers.


Acknowledging that `some critical information gaps remain to better understand the transmission of the virus as well as the route of infection’, the WHO has offered `its assistance to mobilize international expertise to Saudi Arabia and UAE’.

 

While there have been media reports indicating that Saudi Arabia was `inviting’ international experts in to discuss the MERS situation, there is no mention in this press release as to whether either country has taken the WHO up on this offer. 


For now, I can’t find this press release on the WHO EMRO website.  When it appears, I’ll post a link (posted).

 

 

WHO vigilant on new Middle East Respiratory Syndrome developments


Cairo, 23 April, 2014 – The World Health Organization (WHO) is concerned about the rising number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) in recent weeks, especially in the Kingdom of Saudi Arabia and the United Arab Emirates (UAE) and in particular that two significant outbreaks occurred in health facilities.


“Approximately 75 percent of the recently reported cases are secondary cases, meaning that they are considered to have acquired the infection from another case through human-to-human transmission,” Regional Director of WHO for Eastern Mediterranean Dr. Ala Alwan said. “The majority of these secondary cases have been infected within the healthcare setting and are mainly healthcare workers, although several patients are also considered to have been infected with MERS-CoV while in hospital for other reasons.”


Although the majority of the cases had either no or only minor symptoms, and most do not continue to spread the virus, WHO acknowledges that some critical information gaps remain to better understand the transmission of the virus as well as the route of infection. WHO is unaware at this point in time of the specific types of exposure in the health care facilities that have resulted in transmission of these infections, but this remains a concern.


Therefore, WHO has offered its assistance to mobilize international expertise to Saudi Arabia and UAE to investigate the current outbreaks in order to determine the transmission chain of this recent cluster and whether there is any evolving risk that may be associated with the current transmissibility pattern of the virus.


Since the emergence of MERS in April 2012, a total of 253 laboratory-confirmed cases of human infections with MERS have been reported to WHO, including 93 deaths. These cases have been reported in the Middle East (including Jordan, Kuwait, Oman, Qatar, Saudi Arabia and UAE); in Europe ( France, Germany, Greece, Italy and the United Kingdom of Great Britain and Northern Ireland); in North Africa (Tunisia); and in Asia (Malaysia and the Philippines). The source and mode of infection for the virus remain undetermined.


Several recent cases of people becoming infected in either Saudi Arabia or UAE and traveling to a third country have also been reported.  Greece, Jordan, Malaysia, and Philippines each reported one such case. So far no further spread of the virus in those countries has been detected. Imported cases already occurred in the past that resulted in limited further human-to-human transmission in France and United Kingdom.


WHO urges all Member States to remain vigilant and enhance surveillance to detect any early sign that the virus has changed and has attained the possibilities of causing sustained person-to-person transmission. WHO expects that it is only through an enhanced coordinated effort the mystery and the risk to global health associated with the emergence of this virus can be unraveled. 
Media contacts:
WHO Regional Office in  Cairo -- Bahaaeldin Elkoussy:   (mobile) +201006019316

The Fog Of MERS

surveillance

Credit CDC

 

# 8517

 

We are now two years into the MERS outbreak on the Arabian Peninsula, with roughly 350 human infections announced to date. Of those, nearly 30%  have been reported over the past month.  A spike in case reports that has many scientists wondering if the virus is better adapting to human hosts (see Osterholm On NPR Shots).

 

Given limited (and sometimes, totally absent) surveillance for the virus in the Middle East and the wide variability of illness it produces in humans (from asymptomatic to severe, or even fatal), the actual number of infections is undoubtedly much higher.

 

As with any disease, we usually only see the tip of the pyramid, and must rely on various tools (like seroprevalence studies) to estimate the true burden.   Tools that have yet to be well utilized in this MERS outbreak.


Although no surveillance system can expect to capture all of the cases, keeping epidemiological line listings remains an important tool.  It can show trends, geospatial clustering, epidemiological links between cases, and can suggest the rate at which an infection is spreading. 

 

Even under the best of conditions maintaining a line listing is a difficult job, but in the case of MERS, far too often the case data announced by the Ministries of Health in the region have either been delayed or have not contained the kind of information (onset dates, previous contacts, date of lab confirmation, etc.) that would be particularly useful.

 

Compared to the H7N9 information we’ve seen coming from the Chinese Authorities, the quality of data on MERS cases has been very uneven and disappointing.

 

Despite the difficulties involved, Sharon Sanders and the newshounds on FluTrackers have been maintaining an extensive 2012-2014 Case List of MoH/WHO Novel Coronavirus nCoV Announced Cases for the past 15 months. Case are linked to the MOH or WHO announcements, and are updated (when possible) with outcomes.  Cases are also grouped by `cluster’ and by country.

 

Almost from the beginning, however, it was apparent that there were `gaps’ in the reporting of cases out of the Middle East, and so Sharon posted the following announcement at the top of the list nearly a year ago.

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As the number of cases has grown rapidly over the past month, we’ve seen some `blind’ announcements coming from various MOH’s, where batches of  `new cases’ are announced without any identifying details (age, gender, location, etc.).

 

When cases are eventually reported to the World Health Organization and posted on their Global Alert & Response webpage, there is no way to link those cases with earlier `blind’ reports.

 

Although the number of these `unable to match’ cases is small right now, keeping any sort of `count’ of cases grows more difficult with each passing day.  `Creeping errors’ are inevitable, and so today Sharon Sanders (who deserves the `Dogged Determination Award’ for curating this list for well over a year) made the following announcement on her list.

 

PLEASE NOTE: Due to apparent redundant case reporting, we are no longer tracking case totals. April 23, 2014

 

FluTrackers will continue to accrue and post cases, and that information will continue to be incredibly useful to bloggers, journalists, and researchers.  But there are limits as to what can be done when data is released haphazardly, or without adequate detail, by health ministries.

 

As to whether this signals a new, more serious `phase’ in the MERS outbreak  . . .  well, it is possible.

 

Unfortunately, the outside world isn’t being given enough information to make that determination.

WHO MERS-CoV Update – UAE

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Photo Credit WHO

 


# 8516

 

 

This morning the World Health Organization has released an update detailing an additional 9 MERS cases from the UAE, adding to the 16 cases previously announced by WHO over the past 2 weeks. 

 

As to the total case count with this cluster, the numbers are murky at best (more on that in a later post), given the `blind’ announcements from the HAAD (Abu Dhabi Health Authority) providing numbers, but no details, making it impossible to match their announcements up with the WHO’s.

 

That said, here is the latest GAR (Global Alert & Response) DON.

 

Middle East respiratory syndrome coronavirus (MERS-CoV) – update

Disease Outbreak News

23 April 2014 - On 21 April 2014, 18 April 2014 and 16 April 2014, the Ministry of Health of the United Arab Emirates (UAE) reported an additional 9 laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV).

The following details were provided to WHO on 21 April 2014 by the Ministry of Health UAE:

  • A 52 year-old woman from Abu Dhabi. She became ill and was admitted to a hospital on 16 April. She has underlying medical conditions and is currently in a stable condition. The patient travelled to Jeddah, Saudi Arabia from 5-16 April, where she visited the hospital 3 times. She has no history of contact with animals. All her contacts are being investigated.

The following details were provided to WHO on 18 April by the Ministry of Health UAE:

  • A 63 year-old woman from Abu Dhabi who had close contact with a previously laboratory-confirmed case reported on 14 April. She was screened on 13 April and became ill on 15 April. She is reported to have an underlying medical condition. She is reported to have no exposure to animals or a recent travel history.
  • A 73 year-old woman from Abu Dhabi who has been an in-patient at the hospital since 26 February due to other illnesses. She has underlying medical conditions. The patient was admitted to the intensive care unit (ICU) on 14 April. She is reported to have no exposure to animals or a recent travel history.

Globally, from September 2012 to date, WHO has been informed of a total of 253 laboratory-confirmed cases of infection with MERS-CoV, including 93 deaths.

Case totals published in the Disease Outbreak News on MERS-CoV on 20 April 2014, already included the 6 laboratory-confirmed cases reported from the UAE on 16 April, 2014 below.

The following details were provided to WHO on 16 April 2014 by the Ministry of Health UAE:

All the cases are from Abu Dhabi and have had close contact with a laboratory-confirmed case reported on 10 April. To date, the cases are kept in isolation in a hospital and are well. Screening of other health care contacts and family members are ongoing.

  • A 52 year-old woman who had mild illness on 9 April and was screened on 10 April. She is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
  • A 28 year-old who was screened on 10 April. He has no illness and is reported not to have any underling medical condition and does not have exposure to animals or a recent travel history.
  • A 59 year-old man who was screened on 12 April. He has no illness. He is reported to have an underlying medical condition. He is reported not to have exposure to animals or a recent travel history.
  • A 28 year-old man who was screened on 10 April. He developed mild illness on 11 April. He is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
  • A 55 year-old woman who was screened on 12 April. She developed mild illness on 8 April. She is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
  • A 28 year-old woman who was screened on 10 April. She developed mild illness on 8 April. She is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.

(Continue . . .)

 

CIDRAP News: Antibody study hints at MERS-CoV in African camels

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Photo Credit Wikipedia

 

 

# 8515

 

While the debate over the role of camels in the carriage, and potential spread of the MERS coronavirus rages in Saudi Arabia (see Saudi MOA Spokesman: Camel Link Unproven, MERS-CoV Is MOH Problem) the scientific evidence continues to accumulate that camels are a large part of the MERS equation.


Some recent examples include:

EID Journal: MERS Coronavirus In A Saudi Dromedary Herd

CIDRAP NEWS report WHO sees camels as MERS source, but route uncertain)

EID Journal: MERS Coronaviruses in Dromedary Camels, Egypt

mBio: MERS-CoV In Saudi Arabian Camels 

The Lancet: Identification Of MERS Virus In Camels


Last night Robert Roos and  Lisa Schnirring, writing for CIDRAP News, brought us details of the latest study that found evidence of MERS antibodies in camels from Nigeria, Tunisia, and Ethiopia – considerably expanding the geographic range of this virus.

 

The EID Journal study also raises the possibility that human infections in these regions may have gone undetected -  a distinct possibility in areas where medical resources are low and mortality rates are high – and suggest a retrospective study of  respiratory illnesses of unknown etiology in the region be undertaken to clarify the situation.

 

Antibody study hints at MERS-CoV in African camels

Lisa Schnirring and Robert Roos | Staff Writers | CIDRAP News

Apr 22, 2014

  •   Using serum samples collected before 2012, researchers found antibodies to MERS-CoV or a very similar virus in camels in Nigeria, Tunisia, and Ethiopia.

Dromedary camels in widely separated parts of Africa were exposed to the Middle East respiratory syndrome coronavirus (MERS-CoV) or a closely related virus well before the first human case was detected, researchers from the Netherlands and Africa reported yesterday.

The discovery of MERS-CoV–like antibodies in camels in Nigeria, Tunisia, and Ethiopia expands the geographic range of the virus beyond the Middle East and raises the possibility of unrecognized human cases in Africa, according to the findings, published in an early online report from Emerging Infectious Diseases.

(Continue . . . )

Taiwan CDC: Epidemiological Follow Up On Imported H7N9 Case

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# 8514

 

Yesterday’s announced imported H7N9 case in Taiwan remains hospitalized and in serious condition, and Taiwan’s CDC is actively involved in monitoring 96 of her contacts – including members of her family, members of her tour group, airline passengers seated near her, and medical staff who were potentially exposed before her diagnosis.

 

Of these, all remain well except one who is complaining of fatigue and fever, and who is undergoing tests.

 

Additionally – based on media reports`measures to prevent the spread of the disease have been taken to help 48 of them’It isn’t clear from that report whether this refers to PEP (post-exposure prophylaxis) antivirals, quarantine, or both.

 

The good news is, while some limited human-to-human transmission of the H7N9 virus has been documented, so far – based on the follow up of hundreds of contacts of known cases – it apparently is a rare event.

 

This from  Taiwan’s CDC .

 

 

 

Disease Control Department keeps track of mainland China imported the H7N9 flu case confirmed cases and their associated contacts (2014-04-23)

Yesterday (4/22) day recognized the Department of Disease Control, Nanjing, Jiangsu Province in mainland China imported 44 year old woman confirmed cases of H7N9 flu, is a serious illness, continued to receive treatment in hospital. Contacts currently available, including cases husband and daughter near the same plane seat passenger, tour leader / guide / driver / medical staff members and a total of 96 people, of which only one group member with fever and malaise, by local medical personnel arrange for medical treatment and specimen collection for examination, another physician evaluate the remaining 95 people who are in close contact with a total of 48 without proper protective prophylactic dosing.

During the tour of patients in Taiwan, visited the attractions, restaurants and hotels, the number of patients who may have contact with the investigation a total of 62 people, all without upper respiratory tract symptoms. Medical personnel have invited all contacts and self health management 10 days to 10 tracks expire, if contact occurs with fever, cough, influenza-like symptoms during the period, please wear a mask their doctor and take the initiative to inform the physician contact history.

The Agency for human disease avian influenza outbreaks travel recommendations, Hunan Province in China, Anhui, Jiangsu, Guangdong, Fujian Province, is the second stage: Alert (Alert), the remaining provinces (excluding Hong Kong and Macao) remains the first stage NOTE: (Watch). The department plans to once again remind people of the affected areas, it is important to implement good hygiene practices such as hand washing, avoiding contact with birds, especially not to pick up dead birds, eating chickens, ducks, geese and eggs to be cooked in order to avoid infection. When you return home if fever or flu-like symptoms, they should inform the airline personnel and airport and port of quarantine officers; such as after returning the above symptoms should wear a mask and seek medical advice and inform the physician contact history and travel history. Latest epidemic diseases and other related information can be found in the Agency website ( http://www.cdc.gov.tw ) the "H7N9 flu Corner" and "International Travel Information" area, or call the toll-free hotline and caring people informed epidemic 1922 ( or 0800-001922) contact.