Saturday, May 4, 2013

Recombinomics: Beta2c Coronavirus Familial Cluster In Al-Ahsa

Recombinomics Commentary 21:30
May 4, 2013
Enter Virus «Corona», Hesham Mohamed Al Bin Sheikh and his family, in the event of «sorrow», since lost their father, while lying two members of the family on the family white, in two hospitals for treatment after injuries

They are lying in intensive care since 8 days. And each one of them in the hospital.

The above translation describes an nCoV familial cluster involving a father, who has died, and two sons who are at the Al Ahsa hospital in Al Hofuf, Saudi Arabia (see map).  Initial reports described 7 confirmed novel beta2c coronavirus cases including five who have died.  A follow-up report cited three more confirmed cases, including one case (33M), who was a relative of the a confirmed fatal case. 

It is likely that the father in above cluster was one of the two most recent deaths in confirmed cases (each was 56M who developed symptoms on April 22 and died April 29 or 30) and one of the brothers was the case (33M) who was a relative of a confirmed fatal case.  The son developed symptoms on April 28 which was at least 6 days after a confirmed fatal case.  This gap in disease onset dates supports H2H transmission of H7N9 (me:  typo: should be Coronavirus)....., from father to son.

The detail associated with the prior report suggests that the second son had not been confirmed, even though he has been in the ICU for eight days, raising concerns that the number of unconfirmed / unreported cases is high.  Multiple media reports have also cited the deaths of two children (10 and 11 years old) at the hospital over a week ago, and they have also not been reported.  The absence of these three critical and fatal cases who were hospitalized over a week ago suggests that the number of unreported cases is significant.

Detail on the number of fatal, hospitalized, and symptomatic suspect SARS-like cases (see map) would be useful.


AVIAN INFLUENZA (51): H5N1/H1N1 HYBRIDS, TRANSMISSIBILITY IN GUINEA PIGS

A ProMED Mail Post:
Published Date: 2013-05-04 15:29:56
PRO/AH/EDR> Avian influenza (51): H5N1/H1N1 hybrids, transmissibility 
Date: Thu 2 May 2013
Source: CIDRAP News [abridged and edited]
http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/may0213h5n1.html


Chinese scientists report that lab-generated hybrid viruses combining genes from avian H5N1 and pandemic 2009 H1N1 (pH1N1) influenza viruses can achieve airborne spread between guinea pigs, a finding that seems likely to renew the debate about the risks of creating novel viruses that might be able to spark a human pandemic. Writing in Science, the researchers say that 5 of 127 hybrids they generated by shuffling genes [that is, genome subunits] from the 2 subtypes showed "highly efficient" transmission in guinea pigs. None of the guinea pigs died, but some mice that were infected with the reassortant strains did succumb.

Guinea pigs are not regarded as the best experimental model for human flu, a distinction that belongs to ferrets [that is, the most susceptible mammal]. The Chinese team did not test any of the hybrid viruses in ferrets, because a voluntary moratorium on "gain of function" research on H5N1 virus -- studies involving the creation of potentially dangerous new strains -- intervened in January 2012 and lasted a year. The moratorium was prompted by the controversy that erupted in late 2011 over 2 earlier studies in which researchers generated novel H5N1 strains that spread among ferrets via respiratory droplets. One of the studies involved an H5N1-H1N1 reassortant, while the other involved an H5N1 virus in which specific mutations were induced. The US National Science Advisory Board for Biosecurity (NSABB) sought to prevent publication of full details of the 2 studies but eventually reversed itself, and the studies were published in May and June of 2012. In a statement to reporters, the editors of Science said the new Chinese study "provides evidence that H5N1 viruses spread by air between mammals can be generated by reassortment. Reassortment, as it occurs in nature, however, is much slower."

In another study on H5N1 transmissibility, also published today [2 May 2013] in Science, another team of Chinese researchers examined how hemagglutinin (HA) from H5N1 attaches to human cell receptors. They identified a mutation, Q226L, that enables a mutant form of H5N1 HA to bind to both avian and human receptors.

In the reassortant study, the team focused on H5N1 and pH1N1 because both viruses can infect pigs, suggesting the possibility that reassortants could arise naturally. The researchers, led by Ying Zhang of the Harbin Veterinary Research Institute, conducted their experiments in enhanced animal biosafety level 3 (ABSL-3) conditions at that institute. They say all the experiments were done before the moratorium began. The scientists used an H5N1 virus isolated from a duck in China in 2001 and the 1st pH1N1 strain that was identified in China during the 2009 pandemic. Using reverse genetics, they generated 127 reassortants that combined the H5N1 virus's HA gene with all possible combinations of the other 7 genes from the pH1N1 isolate. The reassortants were easily generated, and all grew efficiently in chicken eggs, the report says. The authors used genetically modified mice to test the virulence of the hybrid viruses. They found that 54 of the reassortants had about the same virulence as the original H5N1 duck virus, killing some of the mice; 38 viruses were less pathogenic than the H5N1 strain; and 35 viruses were more virulent, killing all the mice.

The researchers say guinea pigs are comparable with ferrets as models of human flu transmission. Although guinea pigs have both avian and mammalian types of airway receptors, flu viruses that bind only to avian receptors (alpha2,3-linked sialic acids) don't spread by respiratory droplets in the animals, they report. The team used the original H5N1 and pH1N1 viruses and 19 of their reassortants to test for airborne transmission in guinea pigs. For each strain, 3 guinea pigs were dosed with the virus, and 3 other guinea pigs were placed in cages near them but not close enough for direct contact. The scientists found "highly efficient" airborne transmission of the pH1N1 virus in 5 of the 19 reassortants. The results indicated that the PA (acidic polymerase) and NS (nonstructural protein) genes of the pH1N1 virus can make H5N1 highly transmissible by respiratory droplets in guinea pigs and that the NA (neuraminidase) and M (matrix) genes from the pH1N1 also promote such transmission of H5N1. "These transmission studies indicate that many of the H5N1 hybrid viruses bearing one or more of the PA, NA, M, or NS genes of 2009/H1N1 were transmissible in guinea pigs," the report states.

The scientists say they previously showed that a mutant strain of a duck H5N1 isolate, with changes at HA positions 226 and 228, bound exclusively to human receptors (alpha2,6-linked sialic acids). They found that this mutant, which contains the same combination of mutations as reported in the ferret-transmissible H5N1 virus reported by Ron Fouchier, PhD and colleagues in 2012, did not transmit in guinea pigs. "Our studies provide evidence that H5N1 viruses that are capable of respiratory droplet transmission between mammals can be generated by reassortment between mammalian 2009/H1N1 and avian H5N1 viruses," the report concludes. "Since the internal genes of these reassortants can already replicate efficiently in mammalian hosts, we predict that similar reassortants could infect humans and subsequently acquire mutations that improve binding efficacy for alpha2,6-linked sialic acids," it states.

The Science statement says that studies in a more human-like animal model, such as ferrets, were halted by the research moratorium, "but these are the potential next steps if the influenza research community decides it is important to quantify the degree of threat from avian influenza viruses."

[These experiments are described in the following publications:

Zhang Y, Zhang Q, Kong H, et al. H5N1 hybrid viruses bearing 2009/H1N1 virus genes transmit in guinea pigs by respiratory droplet. Science 2013 May 2 (Early online publication) [abstract http://www.sciencemag.org/content/early/2013/05/01/science.1229455]

Zhang W, Shi R, Lu X, et al. An airborne transmissible avian influenza H5 hemagglutinin seen at the atomic level. Science 2013 May 2 (Early online publication) [abstract http://www.sciencemag.org/content/early/2013/05/01/science.1236787]

The reactions
-------------
The report drew varied reactions from other experts consulted by CIDRAP News, with one hailing it as a useful contribution and others questioning whether the findings were worth the risks involved in the experiments.

Andrew Pekosz, PhD, a virologist at Johns Hopkins Bloomberg School of Public Health in Baltimore, said the study provides new information about the kinds of genetic combinations that can lead to flu transmission, which is useful for flu surveillance. "The more we understand how wide-ranging those combinations of genetic changes are that can lead to this kind of transmission, the better off we'll be," he said. "That knowledge helps inform us what we should be looking for regarding viruses that are potential human pathogens." He commented that the study doesn't provide "any kind of lightning-strike or light-bulb observations, but it helps tell us what to be looking for in terms of viruses acquiring transmissibility."

Pekosz said he thinks the findings justify any risks involved in the experiments: "As far as I could tell from reading this and being familiar with the group and how they do their research, everything falls under the guidelines that apply to labs in the US regarding biocontainment, respiratory protection, and monitoring. ... I think the safety concerns are well taken care of." He also commented that it's difficult to make "direct leaps" from the guinea pig findings to what would happen in the human population, but the results suggest the possibility that the reassortants could spread in humans. He noted that guinea pigs are not as widely used as ferrets in flu transmission experiments because they've only been rediscovered in that regard in the past decade or so. "I think another important thing about this paper is this is a directed or systematic creation of reassortant viruses, which makes it hard to say if these would occur in natural infection," Pekosz said. "You're not allowing for the natural competition that would take place in an infected animal."

David Relman, MD, a microbiologist and infectious disease expert at Stanford University, expressed concern over the biosecurity implications of the study. "It clearly has biosecurity concerns," he said in an interview. "I would have liked to see these experiments discussed by a wider community of scientists and nonscientists before they were undertaken. ... I would have some grave questions about doing these without having a clearer idea of how exactly the results would lead to tangible real-time benefits. Having a BSL-3 lab and not working during the moratorium does not address the issue," he said.

Simon Wain-Hobson, PhD, a veteran HIV researcher and an opponent of gain-of-function experiments, was more sharply critical of the study. He is a professor at the Pasteur Institute in Paris and chairs the board of the Foundation for Vaccine Research, a privately funded group that recently asked President Obama's Commission for the Study of Bioethical Issues to review the ethics of experiments designed to increase the transmissibility of H5N1 viruses. In a written statement, Wain-Hobson said this study, along with the earlier ones by Fouchier and Yoshihiro Kawaoka, DVM, PhD, show that many different starting points and different experimental protocols can lead to a flu virus capable of airborne transmission. He said it's impossible to predict the pathway that might lead to a pandemic flu virus in nature. "Which evolutionary trajectory will nature take?" he said. "We don't know because there are simply too many. So what is the use [of the findings] for surveillance? What we learn [from the H5N1 transmissibility studies in general] is that, qualitatively, flu can exploit a huge fraction of sequence space and can adapt to almost anything given time," Wain-Hobson said. "But this we knew, not only from flu work, but also from RNA virology in general. ... The benefits are general knowledge which we basically knew, while the risks are increased by this work."

Wain-Hobson said the authors did "a super piece of work" from the science standpoint and undoubtedly meant well. But he labeled the study "very dangerous work disguised as big science. Given this, one wonders why it is published in Science."

[byline: Robert Roos]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[These experiments provide evidence that H5N1 viruses that are capable of respiratory droplet transmission between mammals can be generated by reassortment between mammalian 2009/H1N1 and avian H5N1 viruses. The authors conclude since the internal genes of these reassortants facilitate efficient replication in mammalian hosts, it is likely that similar reassortants could promote infection of humans and subsequently acquire mutations that improve binding efficacy to the alpha2,6-linked sialic acids receptors.

These are remarkable experiments in molecular genetics that provide better understanding of the determinants of host range of influenza viruses. Whether such experiments should have been carried out at all, even under BSL-3 conditions, is another matter. - Mod.CP]

http://www.promedmail.org/direct.php?id=20130504.1691399

#Coronavirus: Details on 7 Cases - 2 Separate Areas: Al-Ahsa and Dhahran

[This article brings a few more details, in bold below.  The two locations are depicted on the map below and appear to be a good 70 miles apart.]

Translation
May 4, 2013

Ministry of Health decided to form a committee «to follow-up and finding the spread of virus 'Corona' in Al-Ahsa province, which recorded a 7 injuries this virus, of whom 5 people died, while lying in two rooms intensive care بمستشفيين, in Al-Ahsa and Dhahran. And decides to turn off satisfactory cases to civil hospitals have seen the emergence of this virus temporarily until the completion of the results of the investigation into the causes of the spread between the intensive care rooms in some hospitals, and make sure eliminate it. (More)

One owner refused to comment on the civil hospitals spread of this virus in Ospat, said in a telephone interview with Al-Hayat yesterday: «This is the prerogative of the Ministry of Health, as the disease is present in a number of hospitals Kingdom».

Al «life» that there are a number of infected Balvyrus, one of them in the third decade of age, lying in a hospital in Dhahran. And another in the intensive care unit at a hospital in Al-Ahsa. According to information obtained by the «life» of the relatives of the injured and dead, and those working in hospitals condition of determining their identities, the beginning in all cases was «a rise in temperature, exceeded the one patient who died two days before the 39th grade, and his patient in a coma, and suffered from difficulty breathing, and the inability to move. Most of the injured and deceased retirees from a major company in the eastern region, and over the age of 50 years, as well as some of their relatives.

Saudi Arabia locations mentioned above

 http://www.hassacom.com/news.php?action=show&id=31517



#Coronavirus: Doctor Speculates on Family Transmission To Eachother

Translation
Doctor: Corona virus belongs to the 'big family' ...Attacking humans and animals
May 4, 2013

Medical source said, that the virus 'Corona', or 'coronary', which hit a 
number of the sons of Al-Ahsa, and led to the death of 5 of them, «a new strain of the virus 'coronary', has not been identified by humans. He stated that 'Corona', from a large family of viruses that may cause disease in humans and animals, and between the symptoms of the common cold, to the Severe Acute Respiratory Syndrome (SARS).
He said: «The symptoms of this virus in confirmed cases of the disease in humans, the respiratory system, with fever, cough, and shortness of breath. This has caused kidney failure, and death in some cases, pointing out that the current understanding of the disease caused by this disease 'is based on a limited number of cases.

 On the possibility of transmission from one person to another, he said that «it is not known with certainty, currently. And situations that occur in the same family increases the likelihood of transmission of the disease from one human to another, which is limited. It is possible that the affected family members were exposed to the same source of infection, for example, in the home or workplace.

He added that «ways of transmission between humans infected with the virus are unknown. And investigations are underway to determine the source, and modes of transmission, to avoid exposure, and mode of transmission, clinical pattern and course of the disease, pointing out that «there is no vaccine for virus 'Corona' now. There is also no specific treatment for the disease. However; the number of symptoms caused by this virus can be treated, and therefore treatment should be based on the patient's symptoms. Furthermore, it can be supportive care for people living to be very effective, such as respiratory support, fluid and nutrition.
To protect oneself from the disease, he said: «Some general measures that would be wise to work, and help prevent the acquisition of any of the respiratory disease is to avoid contact patients with common cold, such as: coughing, sneezing, or heat, or pneumonia, when it is possible, as well as maintaining the cleanliness of hands.

http://alhayat.com/Details/509872 

#Coronavirus: Original Article Re: Mohamed Al Bin Sheikh and his family

[Here is the source of the article that mz-mz.net reported from.  I can not find any other articles right now that corroborate this story.  Posted here for documentation purposes.]

Saturday, May 4, 2013

Brothers Abdullah and Hussein Al bin lying Sheikh, in intensive care after they got sick.

Enter Virus «Corona», Hesham Mohamed Al Bin Sheikh and his family, in the event of «sorrow», since lost their father, while lying two members of the family on the family white, in two hospitals for treatment after injuries Balvyrus, who scored 7 injuries in Al-Ahsa, 5 of whom died. The remaining (Hisham BROTHERS) being treated. Said Hisham Al Bin Sheikh, told «life»: «wounded شقيقاي Abdullah Hussein, this virus. They are lying in intensive care since 8 days. And each one of them in the hospital. We ask God's healing for them, and go home at the earliest ', adding' I hope from the bottom of my heart, there is a cure for this virus, or the transfer of my brothers for treatment in specialized hospitals. Hisham stopped talking, after remembering his father, who left the world a week ago, wounds sustained Pfyrus the 'Corona'. The «live our family psychological conditions extremely difficult, because of the injury 3 of our family with this virus. But we say thank God if at all. And asked everyone to pray for his brothers, 'until you get back a smile to the lips of our family. We ask God to have mercy on my father's mercy and eternal peace. Furthermore, live-Ahsa hospitals, public and private, case of severe Sentry, since the announcement of the Ministry of Health, two days before the discovery of the seven cases, and the death of 5 of those infected. And subject to all the conditions that come to the emergency departments, to the tests «very accurate», while the observed «serious concern» among workers in these hospitals, which is monitored by the «life» during her round on Friday, in the emergency department in a hospital birth and children. Al «life», the death of a baby 10 days ago, at the age of 11 years, having arrived at the emergency department, an 'excellent health'. It was only suffering from a high temperature. It was only after an hour of arrival to the emergency department, was transferred to the intensive care room. And died two hours later, amid distraught all members of the medical staff at the hospital. He also received the emergency department was a kid, at the age of 10 years. And died hours after his arrival. The ambulance upon arrival children 'in good health'. Medical sources did not reveal that the children were infected Pfyrus 'Corona'. As I tried «life», to obtain clarification from a spokesman for the Directorate of Health Affairs in Al-Ahsa province, Ibrahim al-Hajji, who could only say: «The entity authorized to respond with respect to this virus, the agency is the Ministry of Public Health.

http://alhayat.com/Details/509867

#Coronavirus: MOH Commission Continues to Check Hospitals in Al-Ahsa

5/4/13
Translation: 

The Commission continues to set up by the Ministry of Health tours to hospitals in Al-Ahsa, confirmed spokesman ministry Khaled Marghalani that the Committee in the process of scanning for hospitals to maintain to make sure they are free of the disease.

Died five people sick and wounded two others are still in intensive care at a hospital. And discovered the first cases over a week ago, and recorded as a case suspicion and after a thorough examination make sure her virus was then discovered other cases in the same hospital, prompting the Ministry of Health, Directorate of Health Affairs preservation to take many precautionary measures and detection on the contacts, where he was commissioned a committee to determine the Pan maintaining hospitals to make sure they are free of the disease.

Dr. Marghalani pointed out that the ministry is necessary precautionary measures, noting that the information is still a few about the virus and its modes of transmission and its source, where the injuries recorded in the world so far only 17 cases. He demanded Marghalani both feel symptoms of the disease even if the simple lack of negligence and speed of the hospital to check on his health., The Ministry of Health announced yesterday on the monitoring of 7 cases of infection Corona new during the past few days in the province of Al-Ahsa, died, including five people and two in intensive care, where the health of all the precautionary measures for Mkhaltin infected by routers scientific local and global sampling of them to see if there are cases among them, indicating recording 17 confirmed cases of the disease in the world so far.

They pointed out that the virus Corona is one of the viruses that infect the respiratory tract , representing 15% of the influenza viruses that affect humans, while This is a new style does not yet exist at the level of the world accurate information about the source of the virus and its modes of transmission, as there is no vaccine or preventive antibiotic treatment for him.

http://www.inewsarabia.com/516/%D9%81%D8%AD%D8%B5-%D9%85%D8%B3%D8%AA%D8%B4%D9%81%D9%8A%D8%A7%D8%AA-%D8%A7%D9%84%D8%A3%D8%AD%D8%B3%D8%A7%D8%A1-%D8%A8%D8%AD%D8%AB%D8%A7%D9%8B-%D8%B9%D9%86-%D9%83%D9%88%D8%B1%D9%88%D9%86%D8%A7-%D8%A7%D9%84%D8%BA%D8%A7%D9%85%D8%B6.htm

Corona kidnaps Mohammed Al Bin Sheikh and two of his sons in intensive care

[Translated from Arabic.]


130503082410911 Coruna snatched Mohammed Al Bin Sheikh and two of his sons in intensive care

Enter the virus «Corona», Hesham Mohamed Al Bin Sheikh and his family, in the event of «sorrow», since lost their father, while lying two members of the family on the family white, in two hospitals for treatment after injuries Balvyrus, who scored 7 injuries in Al-Ahsa, 5 of whom died. The remaining (Hisham BROTHERS) being treated.


said Hisham Al Bencheikh: wounded شقيقاي the Abdullah and Hussein, this virus. They are lying in intensive care since 8 days. And each one of them in the hospital. We ask God to them, healing, and to return home as soon », adding that« I wish from the bottom of my heart, there is a cure for this virus, or transfer my brothers for treatment in specialized hospitals ». 
stopped Hisham, talking, having to remember his father, who left the world a week ago , wounds sustained Pfyrus the 'Corona'. The «live our family psychological conditions extremely difficult, because of the injury 3 of our family with this virus. But we say thank God if at all. And asked everyone to pray for his brothers, 'until you get back a smile to the lips of our family. We ask God to have mercy on my father's mercy and eternal peace. 
, live-Ahsa hospitals, public and private, case of severe Sentry, since the announcement of the Ministry of Health, two days before the discovery of the seven cases, and the death of 5 of those infected. And subject to all the conditions that come to the emergency departments, to the tests «very accurate», while the observed «serious concern» among workers in these hospitals, which is monitored by the «life» during her round on Friday, in the emergency department in a hospital birth and children. 
indicated Press sources to the death of a child 10 days ago, at the age of 11 years, having arrived at the emergency department, an 'excellent health'. It was only suffering from a high temperature. It was only after an hour of arrival to the emergency department, was transferred to the intensive care room. And died two hours later, amid distraught all members of the medical staff at the hospital. He also received the emergency department was a kid, at the age of 10 years. And died hours after his arrival. The ambulance upon arrival children 'in good health'. Medical sources did not reveal that the children were infected Pfyrus 'Corona'.
Source: Al-Hayat newspaper

Travel notice issued for Middle East

By Alison Hsiao
Sat, May 04, 2013 
As the H7N9 avian influenza outbreak in China seems to show signs of slowing down and the first confirmed patient in Taiwan is recovering, the Centers for Disease Control (CDC) issued a Level 1 (“Watch”) travel notice for 14 Middle Eastern countries, as seven novel coronavirus infections have been recently reported in the area.
On the developments surrounding the H7N9 virus, CDC deputy director Chou Jih-haw (周志浩) told a press conference yesterday that he agrees with the comment made by an expert earlier this week saying that the activity of H7N9 virus might be contained in the summer due to high temperatures, as occured with many other avian influenza viruses.
“Also, China has closed down a lot of live poultry markets. This probably also helped to contain the spread a great deal,” Chou said.
However, he said that the research work on the vaccine development will continue as scheduled.
The patient with the first imported case of H7N9 flu is said to be recovering.
National Taiwan University Hospital deputy superintendent Chang Shan-chwen (張上淳) said earlier yesterday that the patient infected with the H7N9 bird flu virus “is getting better,” adding that the ECMO (extracorporeal membrane oxygenation) support system has been removed from the patient.
Meanwhile, the CDC reported that it had been notified by the WHO that Saudi Arabia’s health ministry has reported seven confirmed cases of novel coronavirus infection, five of which were fatal and two in critical condition.
The new cases raise the global count of novel coronavirus infections to 24, with 16 deaths.
In the wake of the outbreak, the CDC issued a Level 1 travel notice, which advises travelers to follow usual precautions, for 14 countries in the Middle East — Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestine, Qatar, Saudi Arabia, Syria, Yemen and the United Arab Emirates.

http://www.taipeitimes.com/News/taiwan/archives/2013/05/04/2003561423
 

CDC: Watch: Level 1, Practice Usual Precautions

Novel (New) Coronavirus in the Arabian Peninsula and United Kingdom

This information is current as of today, May 03, 2013 at 17:06 EDT
UpdatedMay 02, 2013

What Is the Current Situation?

As of May 2013, a total of 27 people in Saudi Arabia, Qatar, Jordan, the United Kingdom (UK), and the United Arab Emirates were confirmed to have respiratory illness caused by a novel (new) coronavirus. Sixteen of these 27 people died.
In the UK, an infected man likely spread the virus to two family members. He had recently traveled to Pakistan and Saudi Arabia and got sick before returning to the UK. This cluster of cases provides the first evidence of person-to-person transmission. The UK’s Health Protection Agency is continuing to investigate this. Also, clusters of cases in Saudi Arabia and Jordan are being investigated. For more information, see CDC’s novel coronavirus update.
CDC does not recommend that anyone change their travel plans because of these cases of the novel coronavirus. CDC recommends that US travelers to countries in or near the Arabian Peninsula* monitor their health and see a doctor right away if they develop fever and symptoms of lower respiratory illness, such as cough or shortness of breath. They should tell the doctor about their recent travel.

What Is a Coronavirus?

Coronaviruses are a cause of the common cold. A coronavirus also was the cause of the severe respiratory illness called SARS (severe acute respiratory syndrome). SARS caused a global epidemic in 2003, but there have not been any known cases of SARS since 2004. This novel coronavirus is not the same coronavirus that caused SARS.

What Is Known About Novel Coronavirus?

The novel coronavirus is different from any other coronavirus that has been previously found in people. In the UK, the virus likely spread from an infected person to two family members. Symptoms of novel coronavirus infection have included fever, cough, and shortness of breath. CDC is working with WHO and other partners to understand the public health risks from this virus.

How Can Travelers Protect Themselves?

Taking these everyday actions can help prevent the spread of germs and protect against colds, flu, and other illnesses:
  • Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer.
  • Avoid touching your eyes, nose, and mouth. Germs spread this way.
  • Avoid close contact with sick people.
  • Be sure you are up-to-date with all of your shots, and if possible, see your healthcare provider at least 4–6 weeks before travel to get any additional shots. Visit CDC’s Travelers' Health website for more information on healthy travel.
  • If you are sick
    • Cover your mouth with a tissue when you cough or sneeze, and throw the tissue in the trash.
    • Avoid contact with other people to keep from infecting them.

When Should Someone See a Health Care Provider?

You should see a healthcare provider if you develop a fever and symptoms of lower respiratory illness, such as cough or shortness of breath, within 10 days after traveling from countries in or near the Arabian Peninsula*. You should tell the healthcare provider about your recent travel.

Clinician Information:

Health care providers should be alert to patients who develop severe acute lower respiratory illness (e.g., requiring hospitalization) within 10 days after traveling from countries in the Arabian Peninsula* or neighboring countries, excluding those who transited at airports.
  • Consider other more common causes of respiratory illness, such as influenza.
  • Evaluate patients using the CDC’s case definitions and guidance
  • Immediately report patients with unexplained respiratory illness and who meet CDC’s criteria for “patient under investigation” to CDC through the state or local health department.
  • Consider evaluating patients for novel coronavirus infection who:
    • develop severe acute lower respiratory illness of known etiology within 10 days after traveling from the Arabian Peninsula,* but who do not respond to appropriate therapy
    • develop severe acute lower respiratory illness who are close contacts of a symptomatic traveler who developed fever and acute respiratory illness within 10 days of traveling from the Arabian Peninsula.*
  • See additional recommendations and guidance on CDC’s novel coronavirus website.
  • Contact your state or local health department if you have any questions.

Additional Information:

*Countries in and near the Arabian Peninsula: Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.

http://wwwnc.cdc.gov/travel/notices/watch/coronavirus-saudi-arabia-qatar.htm

Friday, May 3, 2013

A total of 10 H7N9 patients discharged from hospital in Hangzhou

Good News!
2013-05-04 

H7N9 bird flu patients prepare to leave the First Affiliated Hospital of the Medicine College of the Zhejiang University, in Hangzhou, capital of east China's Zhejiang Province, May 3, 2013. " A total of ten H7N9 bird flu patients in Hangzhou were discharged from the hospital on Friday following treatment.

http://news.xinhuanet.com/english/photo/2013-05/04/c_132358231.htm

#Coronavirus List of 10 Recent Cases

I've composed this list, and a couple things pop out.  Mostly all males.  Mostly all having more than one comorbidity.  A few of the cases were quite alarming in the time between onset and death. 


Case Number—Name—Onset—Condition--DOD
#1—59M—4/14—Died—4/19*
#2—24M—4/17—ICU Critical/Stable*
#3—87M—4/17—Died—4/28*
#4—58M—4/22—ICU Critical/Stable*
#5—94M—4/22—Died—4/26*
#6—56M—4/22—Died—4/30*
#7—56M—4/22—Died—4/29*
#8—53F—4/27—Critical/Stable*
#9—50M—4/30—Well inpatient ward**
#10—33M—4/28—Well, inpatient ward, family contact of deceased patient**

*multiple comorbidities
**with comorbidiity

Archive Number: 20130503.1688355
Published Date: 2013-05-03 11:27:27 

Pro-MED Update #Coronavirus Saudi Arabia: 3 new cases, 7 recent cases, WHO Update

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this report:
[1] Saudi Arabia - MOH report, 3 new cases, details
[2] Saudi Arabia - details on 7 cases reported 2 May 2013
[3] WHO update 2 May 2013

******
[1] Saudi Arabia - MOH report, 3 new cases, details
Date: May 3, 2013, 7:16:49 AM EDT
From: Ziad Memish <zmemish@yahoo.com>


Subject: Urgent update nCOV cluster KSA
------------- 
This is a preliminary update on the status as of a few minutes ago. Three further cases have been discovered from the investigation which is still ongoing:

Case 8: 53 y.o. female with comorbidities. Date of symptoms [27 Apr 2013] she is in stable but critical condition

Case 9: 50 y.o. male with comorbidity. Date of symptoms [30 Apr 2013] with pneumonia and he is well on the inpatient ward.

Case 10: 33 y.o. male with comorbidity. Family contact of a deceased patient. Date of symptoms [28 Apr 2013]. Inpatient in the medical ward and doing well.

As stated earlier our investigation of contacts and active screening of inpatients who fit case definition is ongoing.

--
Ziad A Memish,MD,FRCP(Can),FRCP(Edin),FRCP(Lond),FACP
Deputy Minister for Public Health
Director WHO Collaborating Center for Mass Gathering Medicine
Ministry of Health
Professor, College of Medicine
Alfaisal University
Riyadh 11176
Kingdom of Saudi Arabia
<zmemish@yahoo.com>

******
[2] Saudi Arabia - details on 7 cases reported 2 May 2013
Date: May 3, 2013, 5:15:28 AM EDT
From: Ziad Memish <zmemish@yahoo.com>


Subject: Urgent update on nCOV from KSA
---------------- 
The following is the summary of the 7 reported cases confirmed microbiologically as of yesterday [2 May 2013]. Prior information was based on preliminary testing both to WHO and the press; we now confirm the following results. 

Case 1: 59 y.o. male with multiple comorbidities. Date of onset of symptoms [14 Apr 2013] and passed away [19 Apr 2013].
Case2: 24 y.o. male with multiple comorbidities. Date of symptoms [17 Apr 2013] and still in ICU in critical but stable condition.
Case 3: 87 y.o. male with multiple comorbidities. Date of symptoms [17 Apr 2013] and passed away [28 Apr 2013].
Case 4: 58 y.o. male with multiple comorbidities. Date of symptoms [22 Apr 2013] still in ICU in stable but critical condition.
Case 5: 94 y.o. male with multiple comorbidities. Date of symptoms [22 Apr 2013] and passed away [26 Apr 2013].
Case 6: 56 y.o. male with multiple comorbidities. Date of Symptoms [22 Apr 2013] and passed away [30 Apr 2013].
Case 7: 56 y.o. male with multiple comorbidities. Date of symptoms [22 Apr 2013] and passed away [29 Apr 2013]. 

As the NFP for KSA you should know that the investigations are ongoing and include both testing and epidemiology investigations of family members and healthcare workers. So far we have not found symptomatic infection in any healthcare workers linked to these cases. Family investigations for 3 families are to be completed tomorrow [4 May 2013]; the others will be done as we gain access. Sensitivities around grieving are of course an issue.

--
Ziad A Memish,MD,FRCP(Can),FRCP(Edin),FRCP(Lond),FACP
Deputy Minister for Public Health
Director WHO Collaborating Center for Mass Gathering Medicine
Ministry of Health
Professor, College of Medicine
Alfaisal University
Riyadh 11176
Kingdom of Saudi Arabia
<zmemish@yahoo.com>

******
[3] WHO update 2 May 2013
Date: 2 May 2013
Source: WHO Global Alert and Response
http://www.who.int/csr/don/2013_05_02_ncov/en/index.html


Novel coronavirus infection - update, 2 May 2013
--------------------
The Ministry of Health in Saudi Arabia has informed WHO of 7 new laboratory confirmed cases of infection with the novel coronavirus (nCoV), including 5 deaths.

Two patients are currently in critical condition.

The government is conducting ongoing investigation into this outbreak.

Preliminary investigation show no indication of recent travel or animal contact of any of the confirmed cases. The confirmed cases are not from the same family.

From September 2012 to date, WHO has been informed of a global total of 24 laboratory confirmed cases of human infection with nCoV, including 16 deaths.

Based on the current situation and available information, WHO encourages all Member States (MS) to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns. WHO is currently working with international experts and countries where cases have been reported to assess the situation and review recommendations for surveillance and monitoring.

All MS are reminded to promptly assess and notify WHO of any new case of infection with nCoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course.

WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied.

WHO continues to closely monitor the situation.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[ProMED-mail would like to thank Dr. Memish for sharing details of the recent cluster of severe illnesses associated with infection with the novel coronavirus (nCoV) in Saudi Arabia. From the dates of onset of some of the earlier cases, it seems to suggest there may have been a common exposure(s) and possibly followed by some person-to-person spread -- the 1st case had onset on 14 Apr 2017; the next 2 additional cases had onset 3 days later on 17 Apr 2013, followed by 4 additional cases with date of onset 5 days later on 22 Apr. The 3 newer cases (1st reported today 3 May 2013) had dates of onset 27 Apr 2013, 30 Apr 2013 and 28 Apr 2013, only this latter case (with date of onset 28 Apr 2013) is identified as a definite family contact of an earlier onset deceased patient.

Of these 10 newly reported cases, all 10 (100 percent) have a history of one or more comorbidities, suggesting a predisposition to more severe illness when confronted with a serious infection. The ages range from 24 years of age to 94 years of age, with the mean age of 57 years (by 10 year age cohorts: 20-29 years old - 1 case; 30-39 years old - 1 case; 40-49 years old - 0 cases; 50-59 years old - 6 cases, 60-69 years old - 0 cases; 70-79 years old - 0 cases; 80-89 years old - 1 case; 90-99 years old - 1 case).

According to information in yesterday's (2 May 2013) report (see Novel coronavirus - Eastern Mediterranean (16): Saudi Arabia, RFI 20130502.1686948), this cluster of cases are all from Ahsaa province. According to Wikipedia, "Al-Ahsa, sometimes Al-Hasa, El Hasa, or Hadjar is a traditional oasis region in eastern Saudi Arabia whose name is used by the Al-Ahsa Governorate, which makes up much of that country's Eastern Province. The oasis is located about 60 km inland from the Persian Gulf. Al-Ahsa is part of the region known historically as Al-Bahrayn, which includes the eastern coast of the Arabian Peninsula down to the borders of Oman, and also includes the island of Awal (modern-day Bahrain)." While Al-Ahsa is part of the Eastern Province, it is the largest area within the province and is often locally considered a province on its own. It is the major date producing region, with 10 000 hectares of agricultural lands, it produces approximately 21 000 tons of dates annually, has more than 30 000 farms producing fruits and vegetables and has more than 2 million palm trees. (seehttp://en.wikipedia.org/wiki/Al-Hasa for more details on the history of this region).

Of note, very early on in our reports on this nCoV, subscriber Merritt Clifton
Editor of Animal People, suggested that as a major date producing region of the world, it was possible that nCoV infected bats might be feeding on the dates as a possible link for the species jump of a bat CoV to either intermediate animal hosts or directly to humans, as seen with the Nipahvirus outbreaks in Bangladesh. The occurrence of a large cluster (10 cases with dates of onset in a 16 day period) occurring in the date producing region where presumably there is a high concentration of bats, is interesting and very suggestive.

We await further information on results of epidemiologic investigations on the cases in this cluster.

For the HealthMap/ProMED map of Saudi Arabia and the surrounding countries, see http://healthmap.org/r/1HAJ. For a map showing the location of Al-Ahsa, see http://en.wikipedia.org/wiki/Al-Hasa, and for maps of Saudi Arabia showing provinces, seehttp://mapsof.net/map/saudi-arabia-regions-map#.UYPOLkqxnts and http://mapsof.net/map/saudi-arabia-2003-cia-map#.UYPOpUqxnts. Note that Riyahd (where earlier cases were reported) - is not far from the location of Al-Ahsa. - Mod.MPP]

http://www.promedmail.org/