Saturday, July 13, 2013

#MERS #Coronavirus Saudi Arabia Hajj and Umrah Requirements

July 12, 2013
Ministry of Health issued health requirements that must be met in coming for Umrah and Hajj 1434 H as part of precautionary measures for disease virus Koruna new (MERS-COV) and so out of the keenness of the Government of the Custodian of the Two Holy Mosques in maintaining the health of everyone and provide an atmosphere healthy and safe, God willing, for the pilgrims and pilgrims to perform This all rites smoothly and health and contentment.

I have included these requirements issued by the ministry's recommendation to postpone the performance of Umrah and Hajj this year for the elderly and people with chronic diseases as patients heart, kidney, respiratory and diabetes, as well as patients with immune deficiency congenital and acquired, in addition to ill tumors, as well as pregnant women and children.

It also included requirements set of tips and guidance health awareness for citizens, residents and pilgrims of them; pollutants to wash your hands thoroughly with soap and water or disinfectant other allocated to it, especially after coughing and sneezing, as well as the use of tissue when coughing or sneezing and dispose of the waste basket, in addition to not touch eyes, nose and mouth by hand, and the reduction of direct contact with the injured and non-participation tools personal, as well as the wearing of masks in crowded locations, and maintaining personal hygiene as a whole.
These requirements also included on the next to get a valid certificate of vaccination against meningitis before the advent of the Kingdom of not less than 10 days and not more than 3 years, as well as get a certificate of vaccination against polio-affected countries, according to specific requirements.

Also included stipulations importance of vaccination against seasonal flu vaccine, especially for people with chronic diseases such as heart, kidney, diabetes and respiratory and neurology as well as diseases of HIV congenital and acquired, and metabolic diseases, as well as pregnant women and children less than 5 years and those with obesity.

Friday, July 12, 2013

Cambodia: #H5N1 Death in 3 Year Old - 14th Death

July 12, 2013
A three-year-old boy from Cambodia's eastern Prey Veng province has been confirmed positive for the avian influenza H5N1, bringing the number of the cases to 14 so far this year, a joint statement by the World Health Organization and Cambodian Health Ministry said Friday.

Only five cases out of the 14 cases this year survived.

The 14th victim was confirmed positive for H5N1 on Wednesday, the statement said, adding that the boy was admitted to the Kantha Bopha Hospital with fever, dyspnea and cough Monday.

"At the hospital, he was treated with Tamiflu and is currently in stable condition,"it said.

"There were recent deaths among poultry in the village and the boy was likely to be exposed to sick and dead poultry before he became sick,"it added.


Precautions in place as UAE reports first Mers virus case

Olivia Olarte-Ulherr / 12 July 2013

Those closest to an 82-year-old Emirati man who has become the second UAE resident to be diagnosed with the deadly novel coronavirus are being tested, the Abu Dhabi Health Authority says.

The patient has multiple myeloma as a result of the coronavirus, also known as the Middle Eastern Respiratory Syndrome Coronavirus (Mers-CoV), and is currently in the ICU at one of the hospitals in Abu Dhabi.

This is the second case of the Mers-CoV infection in an Abu Dhabi resident but the first case to be diagnosed within the UAE.
In March, a 73-year-old Abu Dhabi man died in a German hospital from the Sars-like virus.
Last month, the Lancet medical journal reported that the deadly disease had its origins in the UAE and Qatar after tests showed that the Abu Dhabi man died of similar strain of the virus to the Doha man who was treated in Germany six months prior.

Health Authority — Abu Dhabi (HAAD) customer service and corporate communications director Dr Jamal Mohammed Al Kaabi told Khaleej Times the authority was doing tests on “everybody around the patient”.
“Since December last year, we requested hospitals to monitor the situation and it is through this monitoring that we found out about this patient,” he said.

The HAAD was coordinating with the Ministry of Health (MoH) and other authorities in the country and had taken the necessary measures as per the international standards and recommendations of the World Health Organisation (WHO).

“We are doing everything required by the WHO,” Al Kaabi stressed.

In December 2012, the HAAD issued a circular to all healthcare providers on the necessary notification and reporting mechanisms of any suspected coronavirus cases.
That included clinical assessment, isolation and collection of specimens for laboratory tests.
Samples taken from suspected cases, such as bronchoalveolar lavage, tracheal aspirate, pleural fluid or sputum, should be kept on ice and sent to the Shaikh Khalifa Medical City (SKMC) laboratory for analysis.
SKMC is the testing centre for the Sars-like virus in the emirate.
Any suspected cases of coronavirus infection should be notified to HAAD, Al Kaabi said.
MoH officials Khaleej Times spoke with on Friday said they were not able to make further comment at this stage, but state news agency Wam reported the MoH had made an assurance the virus was not presently a public health concern and did not require a travel ban.
The ministry also added that it was “monitoring the situation closely to ensure the health and safety of everyone,” Wam said.

The new case brings the total number of laboratory-confirmed cases of Mers-CoV infection worldwide to 80

Emirati man diagnosed with MERS virus

 [This patient was hospitalized for cancer, when the diagnosis of Coronavirus MERS-CoV happened]

 (Wam) / 12 July 2013

An 82-years old UAE national diagnosed with novel Coronavirus (MERS-CoV) while being hospitalised in one of the hospitals in Abu Dhabi.

The patient is male with multiple myeloma and currently admitted in the ICU.

UAE Announces First Case of MERS Virus Infection

This is not the first case in the UAE.  My information shows a 73yo reported in March 2013.
Date Report:  3/26/13 – 17 Total Confirmed, 11 Deaths

Name:  73yo

From:  United Arab Emirates

Onset:  3/14

Adm:  3/19  Munich Klinikum Schwabing Hospital Flown from UAE

in private Jet,  on day 11 of illness

Confirmation:  3/23/13

DOD:  3/25/13

Note:  Died on day 18 of illness. 50 people being monitored medically.  Unchanged.

The full virus genome was combined with four other available full genome sequences in a maximum likelihood phylogeny, correlating branch lengths with dates of isolation. The time of the common ancestor was halfway through 2011. Addition of novel genome data from an unlinked case treated 6 months previously in Essen, Germany, showed a clustering of viruses derived from Qatar and the United Arab Emirates.

July 12, 2013
The Emirati citizen, who contracted the SARS-like virus, suffers from cancer and is being treated in hospital in the capital, Abu Dhabi health authority said in a statement carried by WAM state news agency late Thursday.
The authority said that this was the first case to be diagnosed in the UAE, Ahramonline reported.
In May, France said a 65-year-old man was in hospital after being diagnosed with the coronavirus after a holiday in Dubai. But the UAE health ministry said at the time no cases of the virus had been recorded in the country.


CDC Study Analyzes H7N9 Viruses’ Disease Characteristics and Transmissibility

[editing is mine]
July 10, 2013
A study published today in Nature by CDC researchers presents findings from animal studies conducted by CDC to better understand the transmissibility and disease characteristics of influenza A (H7N9) viruses isolated in China in late March. Understanding the properties of H7N9 viruses that contribute to human disease and the capacity of these viruses to spread between people is a critical component of the public health response to this emerging disease threat.
The study’s key findings indicate that H7N9 viruses are capable of causing infection in a direct contact animal model, but the viruses would need to undergo additional adaptation to spread more easily by droplets or through the air. Person to person transmission, especially by respiratory droplet transmission (such as through coughs and sneezes) is a necessary precondition for the virus to become capable of causing a pandemic.
These findings support the conclusions drawn from China’s investigations of human H7N9 cases so far. China has found no clear evidence of sustained human-to-human spread of the H7N9 virus. Human cases of H7N9 virus infection in China reported have been primarily associated with exposure to infected poultry. Currently no human cases of H7N9 virus infection have been reported in the United States.
The paper describes the results of multiple studies conducted on two H7N9 viruses obtained from fatal human H7N9 cases from China. The studies were conducted in ferrets, mice and human epithelial cells. Ferrets are considered the best small mammal for studying flu virus infection and are commonly used as a tool for the risk assessment of emerging flu viruses that may pose a risk to public health.
The ferret studies revealed that the H7N9 viruses spread readily among ferrets placed in the same cage. However, the viruses were less capable of respiratory droplet transmission, which the researchers tested by placing infected ferrets in cages adjacent to cages housing naive ferrets. Compared to a human seasonal flu virus from last season, the H7N9 viruses were considerably less capable of transmitting by the respiratory route.
Other study findings indicated that the H7N9 virus did not cause severe disease in the ferrets and did not spread systemically to the spleen, kidney, liver, or intestinal tract. The lack of systemic spread by H7N9 is different from H5N1 (another avian influenza virus that can cause severe disease in humans). Systemic spread is considered an indicator of severe disease.
In addition to ferrets, CDC researchers also studied the H7N9 virus in mice. Compared with ferrets, the virus caused more lethal illness in the mice, and the virus was more capable of replicating in the lungs of mice compared with other avian and human seasonal viruses tested in the study. Also notable, the H7N9 virus was able to easily infect mice, whereas human seasonal flu viruses typically require prior host adaptation to be able to efficiently infect mice.
The mouse studies also revealed that H7N9 virus can pass through the eyes to infect the respiratory tract. As a result, the eyes represent a possible portal of entry for the H7N9 virus. This finding supports CDC’s existing flu recommendations to avoid touching the eyes, nose or mouth to help prevent spread of germs. It also supports the recommendation for health care providers to wear eye protection when caring for patients with confirmed or suspected H7N9 infection.
The remaining study findings analyzed the H7N9 virus’s ability to replicate in cells derived from human epithelial cells. Epithelial cells are found in the human respiratory tract and are the primary site where flu viruses replicate in humans. CDC researchers found that the H7N9 virus demonstrated a 20- to 400-fold increase in replication at the two-day mark when compared with a human seasonal flu virus and two other avian flu viruses genetically related to the H7N9 virus. Compared with a human seasonal H3N2 virus, the H7N9 virus exhibited an 80,000-fold increase in replication at 24 hours.
The studies in mice and ferrets corroborated this finding, as considerably more H7N9 virus was produced and detected in the respiratory tracts of ferrets and mice compared with the amount of virus produced by seasonal flu virus infection. This suggests the H7N9 viruses have the capacity to reproduce quickly and produce a large amount of virus within the cells of mammals and human airway cells. However, the viruses’ ability to replicate was determined to be better suited to the higher temperatures found in the lower airways (lungs) versus the lower temperatures found in the upper airways of mammals.
The study, entitled “Pathogenesis and transmission of A (H7N9) avian influenza virus in ferrets and miceExternal Web Site Icon” is available for online viewing via Nature’s website.

Study puts troubling traits of H7N9 avian flu virus on display

[editing is mine]
From the University of Wisconsin-Madison
July 10, 2013

The emerging H7N9 avian influenza virus responsible for at least 37 deaths in China has qualities that could potentially spark a global outbreak of flu, according to a new study published today (July 10, 2013) in the journal Nature.
An international team led by Yoshihiro Kawaoka of UW-Madison and the University of Tokyo conducted a comprehensive analysis of two of the first human isolates of the virus from patients in China. Their efforts revealed the H7N9 virus’s ability to infect and replicate in several species of mammals, including ferrets and monkeys, and to transmit in ferrets — data that suggests H7N9 viruses have the potential to become a worldwide threat to human health.
“H7N9 viruses have several features typically associated with human influenza viruses and therefore possess pandemic potential and need to be monitored closely,” says Kawaoka, one of the world’s leading experts on avian flu.
Normally, avian influenza viruses do not infect humans, with the exception of the highly pathogenic H5N1 strains. However, the H7N9 virus has so far infected at least 132 humans, killing more than 20 percent of those infected, and several instances of human-to-human infection are suspected.  
The new study suggests that the ability of the H7N9 virus to infect and replicate in human cells may be due to just a few amino acid changes in the genetic sequence of the virus. “These two features are necessary, although not sufficient, to cause a pandemic,” says Kawaoka, explaining that the influenza virus depends on host cells, which it hijacks to make new virus particles and sustain the chain of infection.
In monkeys, the H7N9 virus was shown to efficiently infect cells in both the upper and lower respiratory tract. Conventional human flu viruses are typically restricted to the upper airway of infected nonhuman primates.
“If H7N9 viruses acquire the ability to transmit efficiently from person to person, a worldwide outbreak is almost certain since humans lack protective immune responses to these types of viruses,” according to Kawaoka.
Transmission studies conducted by Kawaoka’s group in ferrets — animals that, like humans, infect one another through coughing and sneezing and that are a standard model for studies of influenza in mammals — showed that one of the H7N9 strains isolated from humans can transmit via respiratory droplets, though not as efficiently as human influenza viruses. The limited aerosol transmission observed in ferrets adds to concerns about the potential threat as avian flu viruses typically lack that ability, Kawaoka notes.
Complicating the H7N9 picture is the fact that the H7N9 virus does not kill poultry, which promises to make surveillance much more difficult. “We cannot simply watch out for sick or dead birds. Rather, tests have to be performed to determine whether or not a bird is infected. Considering the vast number of poultry, this is a daunting task.”
The positive news conveyed in the new Nature report is that most of the H7N9 strains tested were somewhat sensitive to antiviral drugs effective against the seasonal flu virus, although one isolate, which appears to be a mix of two variants of the H7N9 virus, seemed to resist neuraminidase inhibitors like Tamiflu.
Further research is needed, Kawaoka argues, to support vaccine development, to assess the risks, and to better understand why the H7N9 viruses infect humans so efficiently.
The H7N9 research was supported by grants from the National Institute of Allergy and Infectious Diseases Public Health Service, grant numbers AI099274, AI058113 and HHSN266200700010C. Additional support was provided by the Japan Initiative for Global Research Network on Infectious Diseases from the Ministry of Education, Culture, Sports, Science and Technology; as well as from the Japanese Ministry of Health, Labour and Welfare; and the Japan Science and Technology Agency.

Thursday, July 11, 2013

WHO Middle East respiratory syndrome coronavirus (MERS-CoV) - update July 11, 2013

The Ministry of Health (MoH) in Saudi Arabia has announced an additional laboratory-confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the country.
The patient is a 66 year-old man from Asir region with an underlying health condition. He is currently in critical but stable condition.
In addition, a Qatari patient earlier confirmed with MERS-CoV infection, who was being treated in the United Kingdom died on 28 June 2013.
Globally, from September 2012 to date, WHO has been informed of a total of 81 laboratory-confirmed cases of infection with MERS-CoV, including 45 deaths.
Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.
Health care providers are advised to maintain vigilance. Recent travelers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. Specimens from patients’ lower respiratory tracts should be obtained for diagnosis where possible. Clinicians are reminded that MERS-CoV infection should be considered even with atypical signs and symptoms, such as diarrhea, in patients who are immunocompromised.
Health care facilities are reminded of the importance of systematic implementation of infection prevention and control (IPC). Health care facilities that provide care for patients suspected or confirmed with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients, health care workers and visitors.
All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.
WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.
WHO has convened an Emergency Committee under the International Health Regulations (IHR) in order to be prepared for a change in the situation. The Emergency Committee, which comprises international experts from all WHO Regions, will provide expert technical advice to the WHO Director-General in accordance to the IHR (2005). The first meeting of the Committee took place on 9 July 2013 and a further meeting is scheduled for next week. 

Tuesday, July 9, 2013

Middle East Respiratory Syndrome #Coronavirus (MERS-CoV) Statement by WHO Director-General, Dr Margaret Chan 9 July 2013

Statement by WHO Director-General, Dr Margaret Chan
9 July 2013

Cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) have been reported regularly to WHO since 2012. In order to take an independent expert view of the situation and to be prepared for any further action, should it be required, the Director-General convened a meeting of the International Health Regulations Emergency Committee. The Emergency Committee is composed of international experts from a variety of relevant disciplines and all Regions of WHO, their task is to provide expert technical advice to the Director-General in accordance with the IHR (2005).1
The first meeting of the Committee was held on Tuesday, 9 July 2013, from 12:00 to15:00 Geneva time (CET).
After reviewing data on the current situation provided by the Secretariat, and information presented to the Committee by officials of several States Parties which have, or have had, cases of MERS-CoV, and after further deliberation, the Committee considered that additional information was needed in a number of areas.
The Committee also considered it needed time for further discussion and consideration. In this regard, it noted that a second Committee meeting is set to be held Wednesday, 17 July 2013, at 12:00 Geneva time (CET). 

H7N9 Avian Influenza A Virus and the Perpetual Challenge of Potential Human Pandemicity

Published 9 July 2013
  1. Anthony S. Faucia 


The ongoing H7N9 influenza epizootic in China once again presents us questions about the origin of pandemics and how to recognize them in early stages of development. Over the past ~135 years, H7 influenza viruses have neither caused pandemics nor been recognized as having undergone human adaptation. Yet several unusual properties of these viruses, including their poultry epizootic potential, mammalian adaptation, and atypical clinical syndromes in rarely infected humans, suggest that they may be different from other avian influenza viruses, thus questioning any assurance that the likelihood of human adaptation is low. At the same time, the H7N9 epizootic provides an opportunity to learn more about the mammalian/human adaptational capabilities of avian influenza viruses and challenges us to integrate virologic and public health research and surveillance at the animal-human interface.


  • Citation Morens DM, Taubenberger JK, Fauci AS. 2013. H7N9 Avian Influenza A Virus and the Perpetual Challenge of Potential Human Pandemicity. mBio 4(4):e00445-13. doi:10.1128/mBio.00445-13.

National Institute of Health: NIH scientists assess history, pandemic potential of H7 influenza viruses

Embargoed for Release: Tuesday, July 9, 2013


The emergence of a novel H7N9 avian influenza virus in humans in China has raised questions about its pandemic potential as well as that of related influenza viruses. In a commentary published online today, scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, address these questions by evaluating past outbreaks of H7 subtype influenza viruses among mammals and birds and comparing H7 viruses with other avian influenza viruses and strains.

In recent decades, the scientists write, avian H7 viruses have caused numerous influenza outbreaks among poultry in Europe and North America. Since at least 1918, none of these poultry-adapted viruses has evolved to widely infect humans or cause a pandemic. However, some of them have stably adapted to infect mammals such as horses, suggesting that these viruses might become adapted to and transmissible among other mammals, including humans. In particular, the novel H7N9 virus shares some genes with the H9N2 influenza virus subtype, which has also infected humans. This genetic relatedness may predispose it to more easily adapt to humans than other H7 viruses.

The possibility that H7N9 or another H7 virus may adapt to easily infect humans highlights a need for more research on how avian influenza strains adapt to mammals, especially humans, and better integration of influenza research between human and veterinary public health specialists, the study authors conclude.


Study authors Anthony S. Fauci, M.D., NIAID director; David M. Morens, M.D., senior advisor to the NIAID director; and Jeffery K. Taubenberger, M.D., Ph.D., section chief in NIAID’s Laboratory of Infectious Diseases are available to discuss the article.


To schedule interviews, please contact Nalini Padmanabhan, (301) 402-1663,
NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit
NIH...Turning Discovery Into Health®


Morens DM et al. H7N9 avian influenza and the perpetual challenge of potential human pandemicity. mBio. DOI: 10.1128/mBio.00445-13 (2013).

Why H7N9 Bird Flu Cases Arose So Quickly

Rachael Rettner, Senior Writer
Date: 03 July 2013
The H7N9 bird flu virus appears to be particularly well adapted to jump from birds to people, a new study from China finds.

In the study, the H7N9 virus was able to bind to receptors on both human and bird cells. That’s different from the H5N1 bird flu virus, which bound more strongly to receptors on bird cells, and the H1N1 flu virus, which bound more strongly to receptors on human cells.

The ability of H7N9 to bind to both "human type" and "avian type" receptors may be one reason why the virus was able to cause so many cases of infection so quickly, experts say.

"We are seeing more transmission, faster, with this H7N9 than we saw with H5N1," said Robert Webster, a bird flu expert at St. Jude Children's Research Hospital in Memphis, Tenn., who was not involved with the study.

The new virus first showed up in China in February, and so far, has infected 132 people, including 39 who have died.

Webster stressed that the receptor binding ability was not the only factor that makes the virus so worrying. Flu viruses have eight gene segments, and multiple changes in each of the segments are needed to allow the virus to transmit between people. Because of its genetic changes, H7N9 appears to be "closer" to becoming a transmissible virus compared to the H5N1 virus, Webster said.

So far, there have been no reports of sustained human-to-human transmission of H7N9. The new study also suggested one reason why this might be: The virus grows well in lung tissue, but not as well in the trachea — where it could be transmitted through a cough or sneeze. If the virus adapts to thrive farther up the respiratory tract, it may more easily pass between people.

The study also found that, as suspected, the general public  does not have immunity to H7N9, which means they are at risk for infection.

The pandemic threat of H7N9 "should not be underestimated," the researchers wrote in the July 4 issue of the journal Nature.

However, the outbreak appears to be dwindling this summer — there have been no reports of new H7N9 cases since the end of May. Shutting all the poultry markets in Shanghai, an action taken by China health officials, may have contributed to this decline, Webster said. But H7N9 may return in the colder months, he said.

Yahoo News: Concern at Undetected Cases As WHO holds #Coronavirus Talks


By Stephanie Nebehay  - 3 Hours ago

The novel coronavirus emerged in Saudi Arabia in April 2012. Jordan, Qatar, and the United Arab Emirates have reported laboratory-confirmed cases, as well as Tunisia and four European countries (Britain, France, Germany and Italy) among travelers returning from the Middle East.

Eight of the latest infections in Saudi Arabia were reported to be in people not displaying any symptoms of the disease, which can cause coughing, fever and pneumonia, the WHO said. Half of them were female health workers, and the rest children under 15 who had contact with confirmed cases.
The current pattern of disease could be consistent either with ongoing transmission of the virus in an animal population with "sporadic spillover" into humans resulting in small clusters of people becoming infected, or "unrecognized sustained spread of the virus among humans with occasional severe cases".

WHO experts said last month that countries at risk from MERS should put in place plans for handling mass gatherings, but the agency has stopped short of recommending restrictions on travel such as checks at airports and other entry points.

NBC News: Emergency MERS talks begin amid worries of wider outbreak

July 9, 2013

WHO spokesman Gregory Hartl said that all nine countries which have had cases of the new deadly disease were making presentations by videolink on Tuesday. "Our expectation is that there will not be a decision today," Hartl told Reuters.
A further closed-door session was set for Thursday, he said.

As was posted in the latest WHO Summary and Literature Update today, the possibility of unsustained transmission is a concern...

"The recent mild and asymptomatic cases raise concerns about the possibility of large numbers of milder cases going undetected," the WHO said in a statement posted on Tuesday.
"While it is clear that human-to-human transmission does occur, it is not clear whether transmission is sustained in the community," it said.
The current pattern of disease could be consistent either with ongoing transmission of the virus in an animal population with "sporadic spillover" into humans resulting in small clusters of people becoming infected, or "unrecognized sustained spread of the virus among humans with occasional severe cases".

WHO: MERS-CoV summary and literature update – as of 09 July 2013

[This has been updated and is located on the right side-bar under "Coronavirus Mers CoV",  for future reference.  Editing below is mine]

Since April 2012, 80 laboratory-confirmed cases of human infection with Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported to WHO. Forty-five of the confirmed cases have died (56%). Forty-nine of 75 cases (65%) for which the sex is known were male and the median age of the cases with known age is 51 years (range, 14 months to 94 years). Affected countries in the Middle East include Jordan, Qatar, Saudi Arabia and the United Arab Emirates (UAE); in Europe countries affected include France, Germany, the United Kingdom (UK) and Italy; and in North Africa, Tunisia. No new countries have reported MERS-CoV cases since the last update. All the European and North African cases have had a direct or indirect connection to the Middle East. However, in France, Italy, Tunisia and UK, there has been limited local transmission among close contacts that had not been to the Middle East.

Since the last update, 16 new laboratory-confirmed cases of MERS-CoV were reported by Saudi Arabia. Eight of the new cases were reported to be asymptomatic. Of the eight asymptomatic cases four were female health care workers, two from the Ta’if governorate and two from the Eastern Province of Saudi Arabia. The other four asymptomatic cases were children aged 7 to 15 years from Riyadh and the Eastern Province of Saudi Arabia who had contact with confirmed cases. For further details regarding the cases see Disease Outbreak News.

Summary assessment

With recent reports of asymptomatic and mild cases, the proportion of confirmed cases that have died of MERS-CoV infections is lower than previously reported, as is the average age, and the proportion of patients who are female has increased. It is noteworthy that these cases have been detected as part of contact investigations around severe cases. These severe cases were discovered as a result of surveillance activities that focus on finding severely affected patients. Index cases, the first cases occurring in a cluster, presumably are more likely to have had a non-human exposure as their source of infection and continue to be predominantly older males, perhaps providing a clue to the exposure that resulted in their infection. Whether the relative mildness of illness in contact cases is an artifact of surveillance and case-finding activities or represents a difference in virulence between sporadic infections acquired from non-human exposures and those acquired from human-to-human transmission is unknown.

The recent mild and asymptomatic cases raise concerns about the possibility of large numbers of milder cases going undetected. While it is clear that human-to-human transmission does occur, it is not clear whether transmission is sustained in the community. The currently observed pattern of disease occurrence could be consistent either with ongoing transmission in an animal reservoir with sporadic spillover into humans resulting in non-sustained clusters, or unrecognized sustained transmission among humans with occasional severe cases. Detailed case contact investigations, increased surveillance in other countries of the region, and formal studies of non-human exposures of index cases are urgently needed to answer these questions. A new guideline for these case investigations has recently been published (see above).

The public health importance of asymptomatic cases is uncertain. More information is needed about the virus excretion patterns in persons without symptoms to understand the risk they may pose to non-infected persons. Experience from the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 suggests that very little if any transmission occurred from asymptomatic individuals. In addition, in the absence of symptomatic illness, the burden of proof must be higher because of the possibility of misclassification from false positive tests that result from laboratory contamination. In most viral infections, an immunological response, such as development of specific antibodies, would be expected even with mild or asymptomatic infection; as such, serological testing may be useful as additional confirmation of the diagnosis. Additional steps to reconfirm asymptomatic cases, or any case in which the diagnosis is suspect, could also include re-extraction of RNA from the original clinical specimen and testing for different virus target genes, ideally in an independent laboratory.

Complete document:

Saudi Arabia: Program starting Ramadan health, phone numbers, contacts if ill

Translation [original text at link below]

Launches the Ministry of Health represented by Information Center of Information and health education during the holy month of Ramadan its annual "Alu Ramadan health" for the tenth year in a row, which hosts a group of doctors, consultants and specialists in all disciplines, with a focus on public health and chronic diseases and specialists in the organization of taking medications during the fasting , comes from the ministry logo attention to the patient first, and attention to all segments of society.
The general supervisor of media relations and health education, Dr. Khalid Bin Mohammed Marghalani that this year's program will be available to all through the five main ways start by free line to the Ministry of Health on the number (8002494444), and through social networks via the expense of the ministry in Twitter @ SaudiMoh , and also calculated on Facebook SaudiMoh, as the information center this year, recording a television interview with doctors Consultants addresses the summary of the questions most heavily traded in the field of specialization and what has been received from the questions and inquiries during a meeting directly with the patients and users of health services through three methods prior to the broadcast directly on the channel ministry in YouTube MohPortal, as the specialists at the center is also preparing a news report about the meeting sent to be published in the media, from newspapers paper and websites in the next day. 
At the same context demonstrated Director of Information Center of Information and health education on behalf of pharmaceutical Albandara Bishi that the center will host the first day of Ramadan and the toll free number 8002494444 and the accounts of the ministry's social networking Dr Yahya bin Mohammed Abu seven consultant respiratory diseases from one o'clock noon to three o'clock in the afternoon, especially to asthmatics and others who suffer respiratory problems they have great difficulty in organizing their medicines Boukhakhathm the carrying out their duty of fasting during the holy month.
She explained that the consultant infectious diseases, Dr. Mazen bin Adnan Barre will travel to the center on Thursday, 09/02/1434 AH From one o'clock noon until three in the afternoon to answer questions from callers in all aspects of HIV Corona and other infectious diseases, diseases of the summer, as well as to benefit the most prominent public tips to perform the duty of fasting without health problems - God willing - especially as questions abound in this blessed month on how to organize and take medication, especially people with chronic and infectious diseases. 
reported that the center hosts on Sunday, 05/09/1434, diabetes consultant Dr. Aws ibn Abdullah Al-Zaid from one o'clock noon until three in the afternoon to answer questions from callers in all aspects of fasting diabetic patients especially since this category is particularly suffer more than others from some of the problems while carrying out their duty of fasting, as some feel down abruptly in sugar during fasting, others feel dizzy and jerk can not control them and so on. 
said that in the same week Center will host a consultant gastrointestinal endoscopes Dr. Abdul Rahman Bin Ali Rubaiaan, on Tuesday, 08/09/1434 from one o'clock noon until three o'clock pm, and on Wednesday, 09.09.1434 Center hosts Dr. visions bint Nasser Nasser specialist children from one o'clock noon until three o'clock in the afternoon. 
and has shown Albandara the Bishi that in the second week, will host the therapeutic feeding center advisory Dr. Cheers Saud, Oraini on Sunday, 13/9 / 1434 of one o'clock noon to three o'clock in the afternoon, the center also hosts an advisory Family and Community Medicine Dr. Munira Abdullah, Ba please on Monday 14/09/1434, from one o'clock noon until three o'clock in the afternoon, and on Wednesday, 15.9.1434 Center will host Dr. Jamil Hamza jurist orthopedic consultant from one o'clock noon until three o'clock in the afternoon.

China #H7N9 this fall or come back?

July 9, 2013

This spring, the Chinese come and gone H7N9, exactly what are the "secret"? China CDC deputy director of the virus, the National Influenza Center director Shu Yuelong recent media interview, said, H7N9 virus does not go away, and is currently still in the silent epidemic among poultry, but will be back this fall. Why human H7N9 infection for more severe symptoms, but the infection is almost asymptomatic H7N9 in poultry this problem, Shu Yuelong said that this is the most confusing and worrying doubts, but also H7N9 dark side. While it with H5N1 infection, there are many ways similar, but is completely different, H5N1 on poultry and people, can bring fatal injuries.
  Comments: It seems that prevention and control of H7N9 avian influenza virus, should alarm bells ringing. Health and agriculture departments should strengthen active surveillance for H7N9, including active surveillance among poultry, as well as in human syndromic surveillance. About H7N9, there are too many mysteries did not answer, calm does not mean you can sit back and relax.Reporter Zhaobing Hui

China #H7N9: Hainan poultry industry gradually resume production of poultry has been released into the province ordering

Translation out of China
July 9, 2013
Poultry industry in our province steady recovery in production

Foreign birds have been released into ordering, but is expected to continue in the second half egg prices   

At present, the province has been gradually emerging from the domestic poultry industry H7N9 bird flu impact, live poultry trading volume returned to normal levels of 86%, average daily trading volume of about 500,000, live chicken prices from 11 yuan / kg up to 15.8 yuan / kg. Provincial Agriculture Department has lifted the previous stage of poultry and poultry products for the province to introduce restrictions.   

It is reported by the domestic impact of H7N9 bird flu, the first half of the province's poultry slaughter 98,100,000, of which the island of 17.6 million, down 10.5 percent year on year respectively, 20.4%, live chicken slaughter price was 15.45 yuan / kg, before the advent cost price of 16 yuan / kg level, down 23.6%. 

 At present, the province has been steadily recovering live poultry, Wenchang daily sales from mid-April to 200,000 in mid-June rose to 400,000, the amount Sunrise Island rebounded from 16,000 to 80,000, slaughter price from April 11 yuan / kg up to now 15.8 yuan / kg. Live poultry trading volume has been restored to the normal 86%, average daily trading volume of approximately 500,000. Chicks, ducklings trading volume returned to normal 90% goose trading volume has returned to normal production levels, daily trading volume is 460,000 Qinmiao.


#MERS #Coronavirus Saudi Arabia - Hafr-Al-Batin Case & Contact Commentary

The recently reported case in Hafar Al-Batin, said to have a contact with a recently confirmed recovered patient is interesting.  While I do have a previous case in Hafar Al-Batin, I do not have a previous case that has recovered.  Hafar Al-Batin is located to the extreme north of the Country, near the Kuwait border.   It is located 480 km the north of Riyadh, 90 km from Kuwait  border and about 70 from the Iraq border. All the downtown and roads of Hafar Al-Batin are paved. It is connected with an international network of roads, connecting Saudi Arabia with Kuwait in the East and connecting the North with the Eastern Province.  There is much we do not know.

My information:

Date of Report:  7/6/13
Name:  56(F) Healthcare worker
From:  Hafar-Al-Batin, Eastern province, Saudi Arabia
Note:  Had contact with previously reported confirmed case who subsequently recovered and was discharged.  location is 300 miles north of Riyadh, 56 miles from Kuwait border.
Confirmed:  Positive.  Recovered 7/8.

Date of Report:  6/12
Name:  21(M)
From:  Hafar Al-Batin, Eastern Province, Saudi Arabia
Adm:  6/9 Hospital ICU
Note: map link:
DOD:  6/12