CDC: Síndrome respiratorio coronavirus de Oriente Medio (MERS-CoV)

El Síndrome Respiratorio Coronavirus de Oriente Medio (MERS-CoV), también conocido anteriormente como "nuevo coronavirus (nCoV)”, fue identificado en el 2012 en Arabia Saudita. A la mayoría de las personas infectadas con el MERS-CoV les da una enfermedad respiratoria aguda grave con síntomas de fiebre, tos y dificultad para respirar. Cerca de la mitad muere. Un número pequeño de los casos reportados tuvieron una enfermedad respiratoria leve. Los investigadores están tratando de descubrir la fuente del MERS-CoV y cómo se propaga. No se han reportado casos en los Estados Unidos.

Casos y muertes por el MERS,
abril del 2012 hasta el presente

Actualizado el 7 de noviembre de 2013

Países	Casos (muertes)
Arabia Saudita	125 (53)
Catar	7 (3)
Emiratos Árabes Unidos	6 (2)
Francia	2 (1)
Italia	1 (0)
Jordania	2 (2)
Omán	1 (0)
Reino Unido	3 (2)
Túnez	3 (1)
Total	150 (64)

Para más información visite la página de laOrganización Mundial de la Salud (OMS).

Este virus es diferente a todos los otros tipos de coronavirus encontrados hasta ahora en las personas. También es diferente al coronavirus que causó el SRAG (síndrome respiratorio agudo grave) en el 2003. Sin embargo, al igual que el virus del SRAG, el nuevo coronavirus es muy similar a los detectados en murciélagos.

¿Qué son los coronavirus?

Los coronavirus llevan su nombre por las puntas en forma de corona que tienen en su superficie. Son virus comunes que la mayoría de las personas contraen en algún momento de sus vidas. Por lo general causan enfermedades leves a moderadas de las vías respiratorias superiores.

Los coronavirus también pueden afectar a los animales. La mayoría de estos coronavirus generalmente solo infectan a una especie animal o, como mucho, a un pequeño número de especies estrechamente relacionadas. Sin embargo, el coronavirus del SRAG puede infectar a personas y animales, incluidos los monos, las civetas de palmera del Himalaya, los perros mapaches, gatos, perros y roedores.

Socios globales se esfuerzan por saber más acerca del MERS

La Organización Mundial de la Salud (OMS), los CDC y otros socios están aprendiendo más acerca del MERS. También se esfuerzan por entender mejor los posibles riesgos para la salud del público. Para más información, lea el artículo (en inglés) Actualización: Enfermedad respiratoria grave asociada con un nuevo coronavirus a nivel mundial, 2012-2013.

No hay advertencias de salud relacionadas con el MERS para los viajeros con respecto a ningún país

La Organización Mundial de la Salud (OMS) no ha emitido ninguna advertencia de salud para los viajeros con relación al MERS para ningún país.

Para obtener más información sobre la situación con el MERS y consejos para las personas que viajan al exterior, consulte el Aviso de los CDC para los viajeros (en inglés): Un nuevo coronavirus llamado "MERS-CoV" en la península Arábica.

http://www.cdc.gov/spanish/especialesCDC/Coronavirus/ 

Spanish MERS case triggers flight contact tracing

Lisa Schnirring | Staff Writer | CIDRAP News

Nov 07, 2013

 

Excerpt:

The European Centre for Disease Prevention and Control (ECDC) said today in an updated risk assessment that the 61-year-old woman with no known underlying health conditions was in Saudi Arabia from Oct 2 to Nov 1. She visited Medina, then Mecca and had no known contact with animals.
Her symptoms began Oct 15 with cough and fever, and she was seen at a hospital emergency department of a Mecca hospital on Oct 28 and 29, where health workers diagnosed her as having pneumonia, based on chest x-ray findings.
Spain's health ministry told CIDRAP News that it has relayed more details about the case to European health authorities, including that the woman refused to be hospitalized in Saudi Arabia and was hospitalized in Madrid on Nov 1 when she arrived back in Spain.
According to the ECDC, the patient was sick during the flight and needed oxygen treatment while she was aboard.
The health ministry said she was in Medina from Oct 2 through Oct 10 and in Mecca from Oct 11 through Nov 1.
The patient is still listed in stable condition and has not required intensive care, according to the health ministry.  She was placed in a private room on Nov 1, and her medical team instituted respiratory isolation measures on Nov 4 when they suspected the woman was infected with MERS-CoV.
Initial lab tests for MERS-CoV on three different samples were positive on Nov 5, and further tests are ongoing to confirm the findings, the ECDC said. The health ministry said viral isolation is in progress.
Spanish health officials started contact tracing yesterday, focusing on the woman's family members, healthcare workers, and passengers and airline staff who had close contact with the woman, the ECDC said. It added that no residents from other EU countries were seated within two rows of the patient.
Spain's health ministry said 11 passengers who sat within two rows of the woman have been identified, but information about their resident countries are still pending.
The list of the woman’s contacts so far also includes 18 health workers at the Madrid hospital, 7 patients who had contact with her in the emergency department, and 14 family members, including 4 who are under age 5. Spain's health ministry said nasopharyngeal swabs will be obtained from all of the contacts.

http://www.cidrap.umn.edu/news-perspective/2013/11/spanish-mers-case-triggers-flight-contact-tracing
 

ECDC Updated Rapid Risk Assessment #MERS #Coronavirus - November 6, 2013

[editing below is mine]

Source  and  date  of  request  ECDC  internal  decision,  6  November  2013.

ECDC  internal  response  team    Denis  Coulombier,  Tarik  Derrough,  Josep  Jansa,  Kaja  Kaasik-­Aaslav,  Daniel  Palm,  Pasi  Penttinen,  Juliana  Reyes-­ Uruena,  Bertrand  Sudre.
Acknowledgements:  Coordinating  Centre  for  Health  Alerts  and  Emergencies,  Madrid,  Spain 


Public Health Issue
This  eighth  update  of  the  rapid  risk  assessment  of  the  MERS-­CoV  outbreak  is  intended  to  provide  expert  opinion  on   the  risk  for  Europe  with  regards  to  the  probable  case  of  MERS  reported  by  Spain  on  5  November. 

Event Background
On  6  November  2013,  Spain  reported  a  case  of  MERS-­CoV  infection  in  a  61-­year-­old  female  with  no  known  chronic   conditions.  She  stayed  in  Saudi  Arabia  from  2  October  to  1  November  2013,  initially  in  Medina,  then  in  Mecca  for   the  Hajj.  No  contacts  with  animals  or  confirmed  cases  were  reported.  
She  flew  from  Jeddah  to  Madrid  on  1  November  2013.
The  onset  of  symptoms  was  reported  as  of  15  October  2013  (cough,  fever)  and  she  was  seen  at  the  emergency   ward  in  Mecca  Hospital  on  28  and  29  October  where  pneumonia  was  diagnosed  through  chest  x-­ray.  
During  the  return  flight  she  was  symptomatic  and  required  oxygen  while  in  the  aircraft.  She  was  taken  to  a   hospital  in  Madrid,  admitted  with  the  diagnosis  of  pneumonia  and  isolated  as  per  guidelines.  This  patient  is  now  in   a  stable  condition.
On  5  November  2013,  initial  PCR  laboratory  test  for  MERS-­CoV  screening  was  positive  on  three  different  samples.   Further  tests  for  case  confirmation  are  pending.  
On  6  November,  the  Spanish  authorities  implemented  contact-­tracing  activities  around  family  members  of  the  case,   healthcare  personnel  and  patients  that  had  been  in  close  contact  with  the  case.  Passengers,  as  well  as  staff  and   crew  from  the  airline,  that  had  been  in  close  contact  with  the  case  are  also  being  traced.  Naso-­pharyngeal  samples   will  be  collected  from  them.  No  residents  from  other  EU/EEA  countries  appear  to  be  on  the  list  of  passengers   seated  within  two  rows  of  the  index  case.

Epidemiological  situation  worldwide
As  of  7  November  2013,  there  have  been  151  laboratory-­confirmed  cases  of  MERS-­CoV  worldwide,  including  64   deaths.  All  cases  have  either  occurred  in  the  Middle  East  or  have  had  direct  links  to  a  primary  case  infected  in  the   Middle  East.

Saudi  Arabia  has  reported  125  symptomatic  and  asymptomatic  cases  including  53  deaths;;  Jordan  two  cases,  both   of  whom  died;;  United  Arab  Emirates  five  cases,  including  one  fatality;;  Qatar  five  cases,  including  two  deaths;;  and   Oman  one  case.  

Thirteen  cases  have  been  reported  from  outside  the  Middle  East:  in  the  UK  (4),  France  (2),  Tunisia  (3),  Germany   (2),  Italy  (1)  and  Spain  (1).
ECDC  risk  assessment  for  the  EU

This  is  the  13th  case  reported  outside  of  the  Middle  East,  the  tenth  reported  in  EU/EEA  Member  States,  the  first   reported  in  Spain  and  the  first  reported  in  the  EU/EEA  Member  States  since  May  2013.

This  case  would  correspond  to  an  imported  case  in  the  EU,  following  exposure  in  Saudi  Arabia  and  being   symptomatic  during  the  Hajj.  The  risk  that  the  EU  would  see  importation  of  new  cases  was  stressed  in  the  ECDC   rapid  risk  assessment  published  on  24  September,  and  therefore,  this  situation  was  expected.
 
The  Spanish  authorities  have  implemented  tracing  activities  consistent  with  WHO  and  ECDC  recommendations.   Therefore,  the  risk  for  further  spread  in  the  EU/EEA  countries  is  considered  extremely  low.    

Conclusions  
The  first  case  of  MERS-­CoV  infection  reported  in  Spain  should  remind  EU  citizens  of  the  risk  for  contracting  MERS-­ CoV  through  exposure  while  travelling  to  the  Middle  East.  As  indicated  in  previous  risk  assessments,  such  cases  are   expected  to  be  reported  in  the  EU,  and  in  particular,  among  pilgrims  returning  from  the  Hajj.  

EU/EEA  Member  States  are  investigating  potential  cases  presenting  suggestive  symptoms  on  return  from  the   Middle  East.  Until  this  case,  all  investigations  turned  out  to  be  negative,  but  this  finding  confirms  the  need  to   pursue  efforts  to  rapidly  investigate  possible  cases.

http://www.ecdc.europa.eu/en/publications/Publications/mers-cov-risk-assessment-6-november-2013.pdf

#MERS #Coronavirus Oman and UAE New Cases with Map

This is a collection of various articles, bringing you all the details we have right now.
All are excerpts.  Below is a map of the recent case in Oman and UAE.

Case(s) in Oman & UAE - link: https://maps.google.com/maps/ms?msid=203813299286646113648.0004ea9839a8f061c38c5&msa=0&ll=23.785345,53.613281&spn=13.465257,15.095215

Oman reports first Mers coronavirus case
October 30, 2013
Oman has reported its first case of the deadly Mers coronavirus, a local newspapers said on Wednesday, the fourth Arab country where the strain has been found since it emerged in Saudi Arabia last year. Omani newspapers quoted Health Affairs Undersecretary Mohamed bin Saif Al Hosni as saying that the patient was admitted to a hospital in Nizwa, an oasis town south-west of Muscat, suffering from a chest infection. Oman Observer said the man, who was in stable condition, had the virus after contact with a person from outside the country.
http://tinyurl.com/my68bxk


Oman coronavirus patient monitored by experts
October 31, 2013
The first coronavirus case is being closely monitored by a team of experts, according to Dr Ahmad Bin Mohammad Al Saeedi, Oman’s Minister of Health. Addressing the local media on Wednesday at the end of the 60th Session of the WHO Regional Committee for the Eastern Mediterranean, the minister confirmed that the patient was a senior citizen and was also diabetic. “The man complained of a severe chest infection and was diagnosed with coronavirus at around 7.30pm on Tuesday,” he said....http://tinyurl.com/klrsufn

Oman reports first case of deadly MERS virus
November 1, 2013
The WHO said the patient in Oman is a 68-year-old man from Al Dahkliya region who became ill on Oct. 26.
...the World Health Organisation (WHO) said on Thursday, and it also confirmed the first MERS case in Oman.
"Investigations are currently ongoing to determine what exposures might be responsible for his infection," it said.   http://tinyurl.com/lujz5dq

One corona virus case discovered in Abu Dhabi  
November 7, 2013
The Abu Dhabi Health Authority has announced the discovery of a Corona virus-inflicted case in one of Abu Dhabi’s hospitals. The visiting Omani patient, who is 75 years old, suffered from respiratory problems during the month of October, when he was hospitalised and diagnosed and is currently receiving treatment in the intensive care unit of the hospital.
http://tinyurl.com/n6ddtgw

 

#H7N9 China Jiangsu Province Revises Influenza Pandemic Contingency Plan

November 7, 2013
Excerpt - Translation

"H7N9 bird flu coming or not a doubt , the key is to look at how early detection and timely response ." Jiangsu Province CDC director Zhouming Hao said that Jiangsu Province has been revised "influenza pandemic contingency plan" , so to cope with various influenza more targeted and maneuverability.

Dongguan started " people infected with H7N9 avian influenza contingency plans " Ⅲ level emergency response , all health institutions in the area of ​​deployment of emergency monitoring settings. Currently there are 13 Dongguan sentinel surveillance , health department checked weekly influenza sentinel samples delivered .

http://politics.people.com.cn/n/2013/1107/c70731-23469610.html

Hong Kong Sec. for Food & Health Bureau: Human Infections with #H7N9 Inferred Poultry Infection - Strong Consensus Only, Not Fact

November 7, 2013
Excerpt/Translation:

KO: Strengthening H7N9 surveillance measures

Ko Wing Man, said expert opinion is that if human infection with avian influenza A H7N9, can be inferred poultry should also have infection, but this is an inference.Therefore, at present only a strong consensus that is relevant in this respect, because in fact no scientific evidence.

http://www.news.gov.hk/tc/categories/health/html/2013/11/20131107_180252.shtml?pickList=highlight

#H7N9 Guangdong 3yo Case Was Picked Up From Routine Monitoring for Flu-Liike Illness

My previous post did not mention that this case was found during routine surveillance....

November 5, 3013
Excerpt -Translation

It is reported that children, male, 3 years, 5 months, Suining, Sichuan, who now live in Changping Town, Dongguan Yuan Shan Pui Village.4 November afternoon, Dongguan City CDC in Changping hospital for routine monitoring of influenza-like illness were detected in an H7 subtype avian influenza virus nucleic acid positive specimens, 5 November morning by the Guangdong Provincial Center for Disease Control Experiment Room review was positive, with the case of clinical symptoms, epidemiological and laboratory test results to determine the human infection of H7N9 avian influenza confirmed cases.

http://boxun.com/news/gb/china/2013/11/201311051636.shtml#.Untx7JTk-DM

Taiwan "Mainland Affairs Council" travel alert issued #H7N9

November 7, 2013
Translation

According to Taiwan's TVBS website reported one case of H7N9 flu in Guangdong new confirmed cases, Taiwan's "Mainland Affairs Council" on the 6th morning issued a yellow travel alert for this region.

"MAC" reminded people to enter the H7N9 avian influenza in winter a good season, prevention efforts can not relax, if you want to go to the people of Guangdong business trip or tourism, we must pay special attention to their own health and safety.

http://sn.ifeng.com/lvyoupindao/youfenxiang/detail_2013_11/07/1433009_0.shtml

Hong Kong: Ko Wing Man: Anti-H7N9 measures up to high standards

From the Hong Kong Government News Network

November 6, 2013

   Secretary for Food and Health Ko Wing-man said that influenza will start at 20 degrees or less active, Mainland twelve weeks prior to the emergence H7N9 cases. Hong Kong's existing supply of live poultry for the H7N9 risk management measures has reached a very high level, some experts believe that is enough, some experts have proposed to do more to follow up with the Mainland authorities.    Ko Wing Man today (November 6) Inspection "2013-14 Annual Government Vaccination Programme" implementation after meeting with the media, said that since last year, East outbreak H7N9 avian flu, the Hong Kong health care system and food safety authorities have taken a series of measures, there has been no let up, and today there are meeting risk assessment.    He said that the current H7N9 virus genes have not found major changes, so to maintain the level of risk assessment. The Government will strengthen the temperature probe in the port of entry, and strengthen education, improve cross-boundary students and other health conscious. Hospitals, in addition to the prevention of various diseases with high morbidity winter and seasonal flu, we will also strengthen against H7N9 in "Early diagnosis and isolation", and other infection control measures.    Speaking recently, Dongguan City, a year-old boy diagnosed with avian influenza A H7N9 infection, he said that the mainland still had for the boy to be inspected poultry markets, has introduced a series of poultry wholesale and retail markets for the control of measures, including cleaning, suspension and "clear day" and other similar policies in Hong Kong. He attended the annual event tomorrow to Shenzhen inspection and quarantine seminar will follow up with the Mainland authorities prevention and control measures.    Ko Wing Man said Hong Kong has two annual seasonal influenza season, mainly between winter to spring. Government has embarked on influenza vaccination and subsidy schemes were hospitalized chronic high-risk groups of people vaccinated, children and the elderly and funding to private clinics vaccinated.    He said that the flu itself is not a serious illness, but there are few people, especially low resistance and chronic diseases, seasonal flu might arise from the more dangerous complications. If large-scale outbreak of influenza in Hong Kong, while avian invasion, there may make two kinds of influenza virus in the same recombinant human body, when flu may be more severe or high pathogenicity, so I hope the public will receive the seasonal flu vaccine.
http://www.news.gov.hk/tc/categories/health/html/2013/11/20131106_154647.lin.shtml 

Detectado un caso importado del nuevo #coronavirus en España

 El Ministerio de Sinidad

La paciente había viajado a Arabia Saudí

La paciente, que permaneció durante el mes de octubre en Arabia Saudí, se encuentra en situación favorable y estable

El caso no supone riesgo para la salud pública en España

Las autoridades sanitarias han seguido los procedimientos nacionales e internacionales para la atención de este caso

6 de noviembre de 2013. El Ministerio de Sanidad, Servicios Sociales e Igualdad ha notificado la detección de un caso importado en España con resultados positivos de laboratorio para la infección humana por el nuevo coronavirus.

Se trata de una mujer residente en España, nacida en Marruecos, que había viajado a Arabia Saudí y que se encuentra ingresada en el Hospital Puerta de Hierro de Majadahonda (Madrid), donde se han tomado todas las medidas sobre el caso, así como sobre los posibles contactos según los procedimientos de actuación consensuados entre este Ministerio y las CC AA.

La paciente, que ingresó el pasado 1 de noviembre, permanece en situación favorable y estable. Las muestras analizadas en el Centro Nacional de Microbiología han resultado positivas a infección por el nuevo coronavirus.

El Ministerio y la Comunidad de Madrid están procediendo a la identificación de todos los contactos estrechos de la paciente, tal y como se recomienda en los procedimientos acordados a nivel nacional e internacional.

Un caso importado, en el que se han establecido todas estas medidas, no supone riesgo para la salud pública en España.

Siguiendo lo establecido en el Reglamento Sanitario Internacional, el Ministerio de Sanidad, Servicios Sociales e Igualdad lo ha notificado a la Organización Mundial de la Salud, así como a la red europea de alerta rápida (EWRS), con los que se mantiene un estrecho seguimiento de la situación, junto con la Consejería de Sanidad de la Comunidad de Madrid.

NUEVO CORONAVIRUS

El coronavirus causante del síndrome respiratorio de Oriente Medio fue identificado en el año 2012 en Arabia Saudí. La mayoría de las personas afectadas por este virus respiratorio presenta enfermedad respiratoria aguda con síntomas de fiebre, tos y dificultad respiratoria.

Hasta la fecha se han notificado 150 casos confirmados, 125 de ellos en Arabia Saudí. Todos los casos se han registrado en cinco países de Oriente Próximo (Arabia, Jordania, Emiratos Árabes Unidos, Qatar y Omán). En Europa se han registrado casos, todos ellos importados de esta zona, en otros cuatro países: Reino Unido (dos casos), Alemania (dos casos), Francia (un caso) e Italia (un caso).

Para más información sobre el coronavirus puede consultarse la página web del Ministerio de Sanidad, Servicios Sociales e Igualdad.

http://www.msssi.gob.es/profesionales/saludPublica/ccayes/alertasActual/corVir.htm.

http://www.msssi.gob.es/gabinete/notasPrensa.do?id=3081

Spain has first MERS case; woman went to Hajj

November 6, 2013
Excerpt:
The woman was already sick before she left the Kingdom of Saudi Arabia, a World Health Organization expert said Wednesday.
“She became symptomatic while she was in KSA,” said Dr. Anthony Mounts, the WHO’s point person for the new virus, a cousin of the coronavirus that caused the 2003 SARS outbreak.
“We understand that she did perform the Hajj and came back and was admitted to hospital in Spain and was tested there.”
It appears the woman had some contact with the health-care system while in Saudi Arabia, but the details of that are not yet clear.
“I believe that she was checked, but I don’t think that she was so severe at that time,” said Mounts.
“I don’t know anything about whether or not they tested there. … That’s one of the things that we’re still trying to get information on.”

http://metronews.ca/news/world/846723/spain-has-first-mers-case-woman-went-to-hajj/

CDC: Surveillance for Avian Influenza A(H7N9), Beijing, China, 2013

Emerging Infectious Diseases

Volume 19, Number 12—December 2013

 

Peng Yang, Xinghuo Pang, Ying Deng, Chunna Ma, Daitao Zhang, Ying Sun, Weixian Shi, Guilan Lu, Jiachen Zhao, Yimeng Liu, Xiaomin Peng, Yi Tian, Haikun Qian, Lijuan Chen, and Quanyi Wang 

Author affiliations: Beijing Center for Disease Prevention and Control, Beijing, China; Beijing Research Center for Preventive Medicine, Beijing; Capital Medical University School of Public Health, Beijing

Abstract

During surveillance for pneumonia of unknown etiology and sentinel hospital–based surveillance in Beijing, China, we detected avian influenza A(H7N9) virus infection in 4 persons who had pneumonia, influenza-like illness, or asymptomatic infections. Samples from poultry workers, associated poultry environments, and wild birds suggest that this virus might not be present in Beijing.

-snip-

Conclusions

Clinical manifestations of human infections with influenza A(H7N9) virus found in Beijing included pneumonia, ILI, and asymptomatic infection. Although patients infected with this virus in China have so far had lower respiratory tract infections (6,7), our findings suggest that infection with influenza A(H7N9) virus could cause a wide spectrum of clinical illness.
The first patient infected with influenza A(H7N9) virus in Beijing was found by surveillance for pneumonia of unknown etiology, which was initially designed for finding patients with severe acute respiratory syndrome or influenza A(H5N1) virus infection. Although hospital-based surveillance is less efficient in finding mild and asymptomatic infections, it may be the most feasible approach for identifying severe cases of infection with influenza A(H7N9) virus.
The second patient infected with influenza A(H7N9) virus, the 6-year-old boy, was found through sentinel hospital and laboratory-based surveillance. Before emergence of influenza A(H7N9) virus, surveillance was conducted by using cell culture–based virus isolation techniques. To increase assay sensitivity and rapidity, real-time PCR preceding virus isolation was adopted to replace the strategy of only using virus isolation. In addition, because only specimens positive for seasonal influenza viruses were subjected to virus isolation, this procedure could help avoid the risk for propagating influenza A(H7N9) virus from unknown specimens, as is caused by conducting virus isolation directly in biosafety level 2 laboratories. Our findings and those of another report (8) demonstrated that patients infected with influenza A(H7N9) virus only had ILI. Therefore, the strategy of PCR preceding virus isolation should be the preferred option during sentinel hospital and laboratory-based surveillance.
Live poultry is the major source of avian influenza A(H7N9) (6, 9–11). In addition, migratory birds may participate in multiple reassortment events for emergence of H7N9 subtype virus (1,12). Therefore, the role of wild birds in transmission of avian influenza A(H7N9) virus to poultry or humans should not be ignored. In our samples from poultry workers, associated poultry environments, and wild birds, influenza A(H7N9) virus was not found, which suggests that this virus might not be present in Beijing.
In conclusion, human infections with H7N9 virus can cause a wide spectrum of clinical illnesses. Surveillance of patients with pneumonia of unknown etiology is preferred for early detection of severe cases. PCR is recommended for screening in sentinel hospital and laboratory-based surveillance of influenza A(H7N9).

For Full Article:  http://wwwnc.cdc.gov/eid/article/19/12/13-0983_article.htm

CDC: Full Genome of Influenza A (H7N9) Virus Derived by Direct Sequencing without Culture

Emerging Infectious Diseases

Volume 19, Number 11—November 2013 

Xianwen Ren¹, Fan Yang¹, Yongfeng Hu¹, Ting Zhang¹, Liguo Liu¹, Jie Dong, Lilian Sun, Yafang Zhu, Yan Xiao, Li Li, Jian Yang, Jianwei Wang, and Qi Jin 

Author affiliations: MOH Key Laboratory of Systems Biology of Pathogens, Beijing, China

 

Abstract

An epidemic caused by influenza A (H7N9) virus was recently reported in China. Deep sequencing revealed the full genome of the virus obtained directly from a patient’s sputum without virus culture. The full genome showed substantial sequence heterogeneity and large differences compared with that from embryonated chicken eggs.

Continued full article:  http://wwwnc.cdc.gov/eid/article/19/11/13-0664_article.htm

 

 

CDC: Lack of MERS Coronavirus Neutralizing Antibodies in Humans, Eastern Province, Saudi Arabia

 Emerging Infectious Diseases - Ahead of Print

Volume 19, Number 12—December 2013

Stefanie Gierer¹, Heike Hofmann-Winkler¹, Waleed H. Albuali, Stephanie Bertram, Abdullah M. Al-Rubaish, Abdullah A. Yousef, Awatif N. Al-Nafaie, Amein K. Al-Ali, Obeid E. Obeid, Khaled R. Alkharsah, and Stefan Pöhlmann¹ 

Author affiliations: German Primate Center, Göttingen, Germany (S. Gierer, H. Hofmann-Winkler, S. Bertram, S. Pöhlmann); University of Dammam, Dammam, Saudi Arabia (W.H. Albuali, A.M. Al-Rubaish, A.A. Yousef, A.N. Al-Nafaie, A.K. Al-Ali, O.E. Obeid, K.R. Alkharsah).

 

Abstract

We used a lentiviral vector bearing the viral spike protein to detect neutralizing antibodies against Middle East respiratory syndrome coronavirus (MERS-CoV) in persons from the Eastern Province of Saudi Arabia. None of the 268 samples tested displayed neutralizing activity, which suggests that MERS-CoV infections in humans are infrequent in this province.

Complete article:  http://wwwnc.cdc.gov/eid/article/19/12/13-0701_article.htm

 

 

First case in Spain of the new #MERS #Coronavirus

MADRID, 6 Nov (IRIN) -

The Ministry of Health, Social Services and Equality has reported the detection of the first imported case in Spain with positive laboratory results for human infection similar to the new coronavirus that causes severe acute respiratory syndrome (SARS), which caused more than one hundred infections in the Middle East.

 

This is a woman living in Spain, born in Morocco, who had traveled to Saudi Arabia and is admitted to the Hospital Puerta de Hierro Majadahonda (Madrid), where they say that "we have taken all the measures on the case" as well as possible contacts as operating procedures agreed between the Ministry and communities.
 
The patient, who was admitted on November 1, remains in a favorable and stable, but the samples analyzed in the National Microbiology Center have tested positive to the new coronavirus infection.
 
Both the Ministry and the Community of Madrid are proceeding to identify all close contacts of the patient, as recommended in the procedures agreed at national and international level.
However, he insists, "an imported case in which all these measures have been established, no risk to public health in Spain".
 
Following the provisions of the International Health Regulations, the Ministry of Health, Social Services and Equality has notified the World Health Organization (WHO) and the European rapid alert network (EWRS), with which it maintains close monitoring of the situation, together with the Ministry of Health of the Community of Madrid.
 
This new coronavirus was identified last year in Saudi Arabia, where they have notified 125 of the 150 cases confirmed to date by WHO.
The remaining cases have been reported in five countries in the Middle East (Saudi, Jordan, United Arab Emirates, Qatar and Oman), while in Europe all reported cases are imported from that area. In particular, there have been cases in the UK (2), Germany (2), France (1) and Italy (1).
Most people affected by this respiratory virus acute respiratory disease presents with fever, cough and difficulty breathing.

http://www.europapress.es/salud/salud-bienestar/noticia-primer-caso-espana-nuevo-coronavirus-similar-sars-20131106175703.html 

#H7N9 Guangdong 3(M) Sym's Cough, No Fever, Lungs Fine, Contacts Confirmed Negative

November 6, 2013
Translation

Excerpt:
Guangdong authorities said the boy was infected with H7N9 virus in Suining, Sichuan people, now living in Changping Town, Dongguan Yuan Shan Pui Village, he had cough but no fever, and lungs was normal, the condition is stable, in Dongguan City People's Hospital of Infectious Diseases isolation treatment. Boy's seven close contacts are under medical observation, of which three people experience flu-like symptoms, has been tested for H7N9 virus confirmed all were negative. 
-snip-

Guangdong health department refers to the boy last month on the 27th, a few days before the onset of the disease, the parents had been brought to the village only Yuanshanbei market to buy dishes, but there is no contact with poultry. Hong Kong Centre for Food Safety department confirmed that the market has a 13 km range for the Hong Kong registered live poultry farms, but it will not stop temporarily for poultry farms in Hong Kong, the center will close liaison with the Mainland authorities to determine the appropriate corresponding actions.

http://boxun.com/news/gb/china/2013/11/201311062004.shtml#.Uno6c5Tk-DM 

Hong Kong Food and Health Bureau officials: HK #H7N9 avian influenza prevention measures has reached a high level

November 6, 2013
Translation

People November 6 hearing, according to the Hong Kong Government News Network News, Hong Kong Secretary for Food and Health Ko Wing-man said that as the temperature dropped to 20 degrees below, the Mainland has begun H7N9 cases, our existing risk management measures for live poultry has been reached a very high level, the Government will pay close attention to the relevant circumstances.

It is reported that recently Dongguan, a year-old boy was diagnosed infected with influenza A H7N9 avian influenza virus, which also follow the Mainland Hong Kong side control measures. Ko Wing-man said that the government has launched influenza vaccination and subsidy schemes, and will enhance the winter influenza season between risk assessment and management, but also hope that people will try to seasonal influenza vaccinations. 

http://news.ifeng.com/mainland/special/h7n9/content-3/detail_2013_11/06/31019338_0.shtml

#H7N9 Guangdong Child's 3 Contacts Have Flu-like Sym's. Poultry Tests Negative

November 6, 2013
Translation

China news agency, Guangzhou, November 6 (Cheng Jingwei and Luo Yishan) - Guangdong Provincial Department of Agriculture said outside 6 pm, Changping Town, Dongguan City, Guangdong Province, occurred an H7N9 avian influenza infection in children, the local agricultural sector in accordance with the relevant Chinese Ministry of Agriculture guidelines to carry out emergency monitoring H7N9 avian influenza were collected within the relevant market in Dongguan Changping poultry population of 175 samples, the results were negative.

According to the Guangdong Provincial Health and Family Planning Commission of the 5th Bulletin, Dongguan, Guangdong, a 3-year-old five month boy was diagnosed with H7N9 avian influenza infection.  

Currently boy milder, and its seven close contacts of 3 people experience flu-like symptoms.

The child is in Suining, Sichuan, who now live in Changping Town, Dongguan Yuan Shan Pui Village.

This year, the agricultural sector across the province of Guangdong in accordance with the Guangdong provincial government and the Chinese Ministry of Agriculture, the arrangements and requirements, to carry H7N9 avian influenza surveillance.

Up to now, the province's total monitoring H7N9 avian flu samples 87,462 copies, except April and May have been published and processed two positive samples, all the other negative. This two positive samples in Dongguan Dongcheng District, Guangzhou Zengcheng City was found. It is reported that this year's May 24, Chinese Ministry of Agriculture, "the Ministry of Agriculture Bulletin No. 1950" H7N9 avian influenza has been adjusted to the two types of animal disease management.

http://news.ifeng.com/mainland/special/h7n9/content-3/detail_2013_11/06/31019865_0.shtml

Commentary: The Virulence of #H7N9 Cases in Autumn 2013

There have been 4 cases of avian influenza H7N9 in China, since it's reprieve during the Summer.  There was an abrupt slowdown in April, with one case in July, and one in August.  Then, October and November brought 4 cases.

3 of the 4 cases are in Zhejiang Province.  The 4th, in Guangdong Province.
After much research today, I was able to obtain the onset date for the 1st case this Autumn, Henan Liu Ji 35(M).  It is the interval from onset to critical condition that has me concerned.

3 of the 4 cases this Autumn are in critical condition.

The first case,  35(M) had an onset of 10/7.  In the article in the previous post of this blog, talks of how the onset was abrupt.  From onset to ICU was 4 days.

The second case, 67(M) was 5 days between onset and ICU. 
The third case, 64(F) was 3 days.
The fourth case, a child of 3(M), was 4-5 days.

Chronology of events of 1st #H7N9 Avian Influenza Case in October 2013

Zhejiang Province

Date of Report:  10/16/13

Name:  Henan Liu Ji 35(M)

From:  Shaoxing County, Zhejiang Province

Onset:  10/7/13

Adm: 10/8/13 Shaoxing City People’s Hospital

ICU on 10/11.

Confirmation:  Retested on 10/14.

Note:   1^st Case since 8/11/13.

Intubated, artificial liver treatment.  Unconscious.

Oct. 17:  Stable Condition

WHO: http://www.who.int/csr/don/2013_10_16/en/index.html

Excerpt:
Translation

October 3, after traveling back to Shaoxing Liu, the first time to call his brother reported safe.

"Over the phone, my brother's voice was tired, but could hear a lot of fun, full walk plus car, take a lot of road." Xiao Wu said his brother also mentioned that on the way careless ankle foot, swollen up and back the same day to a nearby store to do foot massage, the situation is a little better.

After the phone, nor how contact. Liu was sent to the hospital until after Xiao Wu was from my brother officer that her friends get sick after.

According to Liu's friends recalled, October 6, they also eat lunch together.That Liu's good appetite, eating with a lot, drank two bottles of beer.

But I did not expect, on the 7th, the rest in the dormitory Liu suddenly sick.  Morning, Liu got up behind a little dizzy, high body temperature, that may be just a cold, lying down to rest, he wanted something to eat, you can not eat two began vomiting, sweating, fever, and more serious symptoms.

In the evening, holiday, another worker came back to see Liu very ill, immediately go to a nearby pharmacy to buy anti-inflammatory drugs back.

The next day, Liu went to the town of a clinic, the doctor felt it should be common bacterial cold, give him to open up some cold medicine. 9, 10, two days, Liu are linked to saline in the clinic, but the situation did not improve.

Hospitalized in critical condition after receiving notice

11 afternoon, Liu after hanging saline, shortness of breath occurs, the doctor immediately dialed 120. Evening around 5:00, he was sent to the Shaoxing City People's Hospital emergency room, the temperature was 40.2 degrees.

"6:00, when my brother called me personally and asked me the next day there is no space to Shaoxing." Xiao Wu recalled that when his brother Liu consciousness fairly clear, but speak very laborious, panting . He put down the phone immediately arrived by car Shaoxing. On the road, the doctor gave him the phone call. Originally, Liu refused to enter ICU, doctors and nurses how to persuade his reluctant to plug the ventilator.

"I am very much aware of my brother, and he had no money, into the intensive care unit was big money, could not bear." Xiao Wu Xiao allow doctors to hasten the first push into the intensive care unit, the signature, payment of anything until it supplemented on.

Until 9:40, Xiao Wu rushed to the hospital emergency ward, Liu still struggling into the intensive care unit does not agree, "the doctor can only spend tranquilizers before my brother will stabilize." Kick tranquilizers, a small Liu began coma, was taken to the intensive care unit.

12 am, emergency department found Zhou Xiaowu, issued a critical condition notice.

Infected with H7N9 virus confirmed. 

http://news.ifeng.com/mainland/special/h7n9/content-3/detail_2013_10/16/30357237_0.shtml

WHO Human infection with avian influenza A(H7N9) virus – update 11/6/13

6 November 2013 - The National Health and Family Planning Commission, China notified WHO of two new laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus.
The first patient is a three-year-old boy from Guangdong Province who had contact with live poultry. He became ill on 29 October 2013, was admitted to a local hospital on 31 October 2013, and transferred to another hospital on 4 November 2013. He is currently in a stable condition.
The second patient is a 64-year-old woman from Zhejiang Province who is a farmer and had contact with live poultry. She became ill on 30 October 2013, was admitted to a local hospital on 31 October 2013, and was transferred to another hospital on 3 November. She is currently in a critical condition.
 
To date, WHO has been informed of a total of 139 laboratory-confirmed human cases with avian influenza A(H7N9) virus infection including 45 deaths. Currently, six patients are hospitalized and 88 have been discharged. So far, there is no evidence of sustained human-to-human transmission.
The Chinese government has taken the following surveillance and control measures:

• strengthening of epidemic surveillance and analysis;
• deployment of medical treatment;
• conducting public risk communication and information dissemination;
• strengthening international cooperation and exchanges; and
• is continuing to carry out scientific research.

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

http://www.who.int/csr/don/2013_11_06/en/index.html 

ProMED: Avian influenza, human (134): China (GD), H7N9, child

[bolding below is mine]
Excerpt:
Published Date: 2013-11-05 15:13:59
Subject: PRO/AH/EDR> Avian influenza, human (134): China (GD), H7N9, child
Archive Number: 20131105.2040007

Date: Tue 5 Nov 2013
Source: Xinhua News Agency [edited]
 -snip-

Communicated by:
ProMED-mail Rapporteur Mary Marshall
and Ryan McGinnis <ryan@bigstormpicture.com>

Comments at ProMED:
[This is another concerning report indicating that the H7N9 avian influenza virus has not gone away and that a new epidemic may recur with the onset of winter, in conjunction with the appearance of the non-avian seasonal influenza viruses. Furthermore in the initial avian H7N9 influenza virus epidemic children were rarely affected and then often only with mild or inapparent symptoms. The decline in H7N9 avian influenza virus cases in adults has been attributed, on the basis of convincing evidence, to the closure of urban poultry markets and general restrictions on the trading of live poultry.

The circumstances whereby the 3-year-old boy in Guangdong province became infected are not reported, and further speculation at this stage is unwise. The 2 recent cases in adults in mid-October 2013 occurred in Zhejiang Province and do not appear to be directly related to the Guangdong case on the basis of current information. More detailed information is awaited. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/7H*n.]

http://beta.promedmail.org/direct.php?id=20131105.2040007

#H7N9 China: 3-year-old boy infected with H7N9 bird flu

GUANGZHOU, Nov. 5 (Xinhua) -- A three-year-old boy was confirmed to have contracted H7N9 bird flu in south China's Guangdong Province on Tuesday.

The child, a native of Sichuan Province living in a village in Guangdong's Dongguan City, tested positive for the virus by the provincial disease prevention and control center, said a statement issued by the center.

The boy is receiving treatment at the People's Hospital of Dongguan City, and is in stable condition, the statement said.

This is the third H7N9 case reported in autumn in China, following two cases in Zhejiang Province on Oct. 15 and 23.

China reported 134 cases by the end of August, with 45 fatalities, according to the National Health and Family Planning Commission.

http://news.xinhuanet.com/english/china/2013-11/05/c_132861331.htm 

Cambodian toddler dies of #H5N1 bird flu, bringing cases to 23 so far this year

2013-11-04 

PHNOM PENH, Nov. 4 (Xinhua) -- A two-year-old girl from northwestern Pursat province died late last month from the H5N1 virus, bringing the number of the cases to 23 so far this year, a joint statement by the World Health Organization and the Cambodian Health Ministry said Monday.

Only 11 cases out of this year's 23 cases survived, the statement said.

The little girl was confirmed positive for human H5N1 avian influenza after she was admitted to the Jayavarman VII Hospital in Siem Reap province on Oct. 25 with fever, running nose, lethargy, dyspnea, cough and breathing difficulties.

"The girl died on Oct. 26," the statement said.

"Investigations in her village found that two months before the girl's illness, poultry had suddenly died at her grandparent's house, and the child often stayed with her grandparent in this house," it said.

"Human and animal investigations are underway to determine if the girl had direct exposure or handled the dead chickens."

"Avian influenza H5N1 remains a serious threat to the health of all Cambodians and more so far children seem to be most vulnerable and are at high risk," Health Minister Mam Bunheng said.

He called on parents and guardians to keep children away from sick or dead poultry and make sure children wash their hands with soap and water after any contact with poultry.

H5N1 influenza is a flu that normally spreads between sick poultry, but it can sometimes spread from poultry to humans, according to the WHO.

Cambodia sees the worst outbreak of the virus this year since it was first identified in 2004. To date, the country has recorded 44 human cases of the virus, and 31 people had died of it.

 http://news.xinhuanet.com/english/health/2013-11/04/c_132858269.htm

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

4 NOVEMBER 2013 - WHO has been informed of an additional laboratory-confirmed case of infection with Middle East respiratory syndrome coronavirus (MERS-CoV) from Saudi Arabia.

The patient is a 56-year-old woman with underlying medical conditions from the Eastern Region. She became ill on 26 October 2013 and died on 30 October 2013. She had no contact with animals, but had contact with a previously laboratory confirmed case.

Globally, from September 2012 to date, WHO has been informed of a total of 150 laboratory-confirmed cases of infection with MERS-CoV, including 64 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 travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations.

Patients diagnosed and reported to date have had respiratory disease as their primary illness. Diarrhoea is commonly reported among the patients and severe complications include renal failure and acute respiratory distress syndrome (ARDS) with shock. It is possible that severely immunocompromised patients can present with atypical signs and symptoms.

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) to advise the Director-General on the status of the current situation. The Emergency Committee, which comprises international experts from all WHO Regions, unanimously advised that, with the information now available, and using a risk-assessment approach, the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met.

http://www.who.int/csr/don/2013_11_04/en/index.html 

#MERS #Coronavirus Saudi Arabia MOH Update October 27, 2013

Here is a notice from the Saudi Arabia MOH, dated October 27.  I believe they are referring to the 83 year old in this post:

In the framework of the epidemiological investigation and ongoing follow-up carried out by the Ministry of Health for HIV (Corona) that causes respiratory syndrome Middle East MERS-CoV Ministry announces the registration of three cases infected with the virus in the Eastern Province.

First of citizenship at the age of 83 years, close contact with a confirmed case and has several chronic diseases and receive intensive care treatment and in stable condition.

That was dated on October 26th.  The following day, this was posted out of the Ministry of Health website:

Health announces the death of infected status (Corona) in the Eastern ProvinceIn the framework of Investigation epidemiological and continuous follow-up carried out by the Ministry of Health for HIV Corona virus that causes AIDS Middle East respiratory MERS-CoV Ministry announces the death if infected with the virus amount in advance in the Eastern Province at the age of 83 years old, and she has had several chronic diseases. Ngmayora God rest in peace.

http://www.moh.gov.sa/CoronaNew/PressReleases/Pages/mediastatemenet-2013-10-27-001.aspx 

#MERS #Coronavirus Saudi Arabia Ministry of Health Update 10/31/13

November 3, 2013
Translation

In the framework of the epidemiological investigation and ongoing follow-up carried out by the Ministry of Health for HIV (Corona) that causes respiratory syndrome Middle East MERS-CoV, the ministry announces the registration of deaths infected with the virus in the Eastern Province.

It is a citizen at the age of 56 years, mixing with confirmed cases, and they have several chronic diseases. Ngmayora God rest in peace.

http://www.moh.gov.sa/CoronaNew/PressReleases/Pages/mediastatemenet-2013-10-31-001.aspx 

#MERS #Coronavirus France -Results of 3 People Hospitalized

November 3, 2013 Translation HEALTH - Seven people were hospitalized at the CHU Purpan in the night from Friday to Saturday. Four of them came out Saturday while the other three were still in solitary confinement. Analytical results, reported Sunday night were negative. The direction of the Purpan Hospital announced Sunday evening that three people remained hospitalized for suspected coronavirus are not infected. The results of their tests are negative. Seven people were hospitalized in the night from Friday to Saturday at the infectious diseases hospital in Toulouse Purpan a hint of coronavirus (MERS-CoV). These were the six members of the same family and a woman of 73 years. The septuagenarian grandparents returned from a trip to Saudi Arabia on October 28. The latter showed respiratory symptoms and fever over 38 degrees. The father has also developed flu-like symptoms in the days that followed. According to the protocol, the six members of the family have been hospitalized. All were placed in isolation for observation and to carry out medical examinations. http://actualite.portail.free.fr/sciences/03-11-2013/soupccedilon-de-coronavirus-les-reacutesultats-des-trois-personnes-hospitaliseacutees-agrave-toulouse-sont-neacutegatifs-agrave-toulouse-pour-un-soupccedilon-de-coronavirus/

#MERS #Coronavirus Oman Confirmed Case, Contacts Are Screened

November 2, 2013

Coronavirus infection — By Conrad Prabhu — MUSCAT — Health authorities say they have begun screening family members, relatives, acquaintances and other individuals who may have come into contact with the patient diagnosed last week as Oman’s first confirmed case of MERS-Coronavirus (MERS-CoV). The objective, according to officials, is to make sure that none of these contacts may have been exposed to the deadly virus behind a simmering global outbreak that has so far claimed around 62 lives worldwide, chiefly in Saudi Arabia. Also as part of the screening effort, authorities are working to track down healthcare workers who may have first attended to the 68-year-old patient at a local health centre before he was transferred to the referral hospital at Nizwa.

Any contacts will be observed for any symptoms associated with the virus for a period of two weeks before they receive the all-clear, it is learnt. At the weekend, officials overseeing the investigation and management of Oman’s maiden coronavirus case travelled to Nizwa to ensure that well-established case detection, reporting and management procedures related to suspected coronavirus cases are stringently implemented in the health institutions concerned. Those procedures were formulated and rolled out earlier this year as part of preparedness plans formulated by the Health Ministry in anticipation of the odd case of coronavirus surfacing in the Sultanate. According to officials, the sensitisation of both public and private sector healthcare staff to the potential threat posed by the coronavirus began at the start of this year, when cases began surfacing around the Middle East and parts of Europe.

This sensitisation effort was achieved through regular awareness workshops and circulars that sought to enlighten frontline healthcare workers, as well as lab staff, about the precautions to be taken when faced with a suspect case. Meanwhile, the overall condition of the elderly patient, who is currently on a ventilator, is described as stable. A possible transfer to a suitably equipped tertiary hospital is among a number of options being weighed as part of the patient’s ongoing treatment, it is learnt.

http://main.omanobserver.om/?p=26856