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

#MERS #Coronavirus France Seven Suspected, 6 From Same Family, Some Hospitalized

November 2, 2013

Seven people were hospitalized Friday at the Purpan Hospital in Toulouse for a hint of coronavirus . Six of them belong to the same family . The seventh is a 73 year old woman .
Six members of the same familySix members of the same family were hospitalized Friday night, grandparents , parents and two children . All returned on October 28, a trip to Saudi Arabia. But only grandparents have respiratory symptoms and fever over 38 degrees . The father has his flu-like symptoms . They were admitted to the Infectious Diseases Hospital Purpan and samples were taken to determine if they are infected with novel coronavirus coronavirus now called the Middle East (MERS -CoV) respiratory syndrome. According to Dominique Soulie , the communications manager of Toulouse University Hospital , the two children and their mother who showed no clinical signs were discharged home on Saturday with strict instructions isolation . Their father and grandparents remain under observation until test results expected for Sunday night at the earliest , but they have " no clinical signs of severity ."
A seventh person hospitalizedAnother person was also hospitalized for the same suspicion Purpan coronavirus . It is a 73 year old woman who also returned from a pilgrimage to Mecca . In his case, according to Dr. Raynaud of the Regional Health Agency (ARS) , analyzes invalidated the hypothesis cornavirus but remains under observation.
Two cases in France to dateOnly two confirmed cases of coronavirus were previously identified in France . The first patient died on May 28, 2013 when he was hospitalized in intensive care in Lille. The second patient, who had also been quarantined, today is no longer carrying the virus by the medical team of the hospital in Lille. He remains hospitalized , according to the Ministry of Health. He shared a room and the first patient and was a confirmed transmission of the virus between humans case .
A hotlineThe Ministry of Health has set up a hotline , free contacted from Monday to Saturday from 9 am to 19 pm 0800 13 00 00 . It is for people who, after a trip to the Arabian Peninsula , would present respiratory symptoms ( cough, shortness of breath and difficulty breathing ... ) and fever within 14 days after the return or close contact with a person infected with this new virus.The disease causes pneumonia and renal failure may also occur primarily by gastrointestinal symptoms ( diarrhée. ..) .
145 cases of coronavirus in the worldIn his latest report of 29 October 2013, the World Health Organization (WHO) reported a total of 145 cases worldwide, including 62 deaths since September 2012. WHO does not recommend travel restrictions with the countries concerned .The new virus responsible for the disease , designated by the WHO as the respiratory syndrome in the Middle East (Middle East Respiratory Syndrome , MERS) , belongs to the same family as the head of the severe acute respiratory syndrome virus (SARS ), which had is nearly 800 deaths worldwide in 2003.

http://midi-pyrenees.france3.fr/2013/11/02/7-personnes-hospitalisees-toulouse-pour-un-soupcon-de-coronavirus-350303.html 

WHO Middle East respiratory syndrome coronavirus (MERS-CoV) - update 10/29/13

31 October 2013 - WHO has been informed of an additional four laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV). These include the first laboratory-confirmed case from Oman and three additional laboratory-confirmed cases from Saudi Arabia.

The patient in Oman is a 68-year-old man from Al Dahkliya region who became ill on 26 October 2013 and was hospitalized on 28 October 2013. Preliminary epidemiological investigations revealed that he did not recently travel outside the country. However, investigations are currently ongoing to determine what exposures might be responsible for his infection

Of the three patients including one death reported from the Eastern Region in Saudi Arabia, one is a woman and two are men. The three patients, one of whom is a health care worker, had underlying medical conditions. Their ages range from 49 to 83 years old. All three patients reported having no contact with animals prior to their illness, while one patient was reported to have been in contact with a previously laboratory-confirmed case. 

Continued:  http://www.who.int/csr/don/2013_10_31/en/index.html

Study: SARS Virus Originated From Bats In China

By Esther Tanquintic-Misa | November 1, 2013 9:26 AM EST

Excerpt (editing is mine)

Scientists from Australia, the U.S. and China Thursday confirmed that the severe acute respiratory syndrome (SARS) virus, which killed more than 750 people worldwide in 2002 and 2003, originated from horseshoe bats in China.
-snip-
Scientists Thursday said it was the first time the live virus was successfully isolated from bats to ultimately confirm that they are the virus' forerunner.
"The results will help governments design more effective prevention strategies for SARS and similar epidemics," the statement said.

"Our results - in addition to the recent demonstration of MERS-CoV in a Saudi Arabian bat, and of bat CoVs closely related to MERS-CoV in China, Africa, Europe and North America - suggest that bat coronaviruses remain a substantial global threat to public health."

"Now that animals, including bats, and humans live closer together as our population expands globally, the opportunity for direct transmission of these dangerous viruses becomes more and more of an issue," Crameri stressed.

http://au.ibtimes.com/articles/518709/20131101/sars-bats-china-csiro.htm#.UnPzVyTlX_s

#MERS #Coronavirus France MOH Probable Case

From the France Ministry of Health
October 29, 2013

A new probable cases of infection with coronavirus (MERS -CoV) was reported on Oct. 28 at the Institute of Health Surveillance ( VS). The Pasteur Institute in Paris was seized for further expertise and confirmation of this case . The new case , if confirmed , would be the third case reported in France . The first two cases were identified in May 2013.
It is a 43 -year-old returned from a stay in Saudi Arabia. She was hospitalized in isolation since 28 October in northern France . His condition is stable, this day.
A thorough epidemiological investigation surrounding this case was implemented immediately without waiting for confirmation of this case . All persons who had close contact with the patient are informed today by the health authorities of steps to follow.
The Ministry of Social Affairs and Health noted that in France , so far, the contamination have been reported in the following two situations : either after a trip to the Arabian Peninsula with occurrence of respiratory symptoms and fever 14 days after the return , or after close contact with a person infected with coronavirus .

Any person in any of these situations should contact their physician or center and 15 mention the trip in the Arabian Peninsula or close contact .
24 October 2013, the balance of the World Health Organization (WHO) reported 144 cases worldwide, including 62 deaths since September 2012. WHO does not recommend travel restrictions with the countries concerned .
The information on coronavirus established by the Department can be reached toll- free Monday through Saturday from 9 am to 19 pm (0800 13 00 00) .

http://www.social-sante.gouv.fr/actualite-presse,42/communiques,2322/nouveau-cas-probable-d-infection,16445.html?utm_source=twitterfeed&utm_medium=twitter 

WHO Middle East respiratory syndrome coronavirus (MERS-CoV) - update October 29, 2013

29 October 2013 - WHO has been informed of an additional laboratory-confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Qatar.
The patient is a 23-year-old man who was identified as a close contact of a previously laboratory-confirmed case as part of the epidemiological investigation. He is a worker in the animal barn owned by the previously laboratory-confirmed case. The man developed mild symptoms of illness and is in good condition. Preliminary investigations revealed that he did not recently travel outside the country.
Globally, from September 2012 to date, WHO has been informed of a total of 145 laboratory-confirmed cases of infection with MERS-CoV, including 62 deaths.

Continued:
http://www.who.int/csr/don/2013_10_29a/en/index.html 

MERS-CoV antibodies not found in children in 2010-11 or adults from 2012

From Virology Down Under Blog:
October 27, 2013

 Gierer and colleagues from the German primate center and the University of Dammam in Saudi Arabia, have presented the findings of their study of antibodies to the Middle East respiratory syndrome coronavirus (MERS-CoV).

The publication, in Emerging Infectious Diseases (ahead of print - you can find it here, at least until it's other link here starts working), measured the antibodies capable of blocking infection by MERS-CoV, called "neutralising antibodies" with a method they have described before. The assay was not validated with multiple MERS-CoV-positive patient sera, but appeared specific in the testing completed.

Patient samples from the area served by King Fahd Hospital were obtained from:

1. Children (158 sera, 77 female, mean age 12 months) admitted to hospital with lower respiratory tract infections during 12-months form May 2010. 
2. Adult (110 plasma samples, all males, mean age 28-years, upper limit of 52-years) blood donors 

No sera or plasma had neutralising MERS-CoV antibodies.

The authors conclude that <2.3% of children and <3.3% pod adults were seropositive though, because that accounts for the upper limit of the confidence intervals. They also note that their sampling of hospitalized children couldhave missed an antibody response (because it takes time to develop) if they had only just been admitted to hospital for MERS-CoV. 

http://virologydownunder.blogspot.com.au/2013/10/mers-cov-antibodies-not-found-in.html 

Study: Uncommon #H5N1 mutations may transmit in mammals

Excerpt
CIDRAP

A study assessing H5N1 avian flu mutations as the virus spreads in ferrets found that mutations that were present in as few as 5.9% of the viruses infecting one ferret could be transmitted to another, according to data published this week in Nature Communications.

US and Japanese researchers, including Yoshihiro Kawaoka, DVM, PhD, of the University of Wisconsin, used data from transmission studies already conducted by Kawaoka in 2011 on engineered H5N1 strains. Publication of that controversial work was originally halted but later allowed by US biosecurity experts.

The team used deep sequencing to identify genetic mutations that happened as the virus replicated in and transmitted between ferrets. They found that during transmission natural selection acts strongly on hemagglutinin (HA), the protein the virus uses to attach to host cells.

They found that within-host genetic diversity in HA increases during replication but is dramatically reduced upon transmission via respiratory droplets—to only one or two distinct HA segments, a small portion of the viral genome.

However, the discovery that mutations present in only 5.9% of the viruses infecting one ferret could be transmitted to another suggests that even rare mutations could be transmitted if they have an evolutionary advantage, according to a Science Daily story on the study.

"Fully avian viruses may act differently in nature," said lead author Thomas Friedrich, PhD, from the University of Wisconsin. "But the data suggest to us that it wouldn't take many viruses from a chicken to infect a person, if the right mutations were there—even if they were a tiny minority of the overall virus population."
Oct 23 Nature Comm abstract
Oct 23 Science Daily story

 http://www.cidrap.umn.edu/news-perspective/2013/10/flu-scan-oct-25-2013

WHO: Human infection with avian influenza A(H7N9) virus – update October 24, 2013 #H7N9

24 OCTOBER 2013 - The National Health and Family Planning Commission, China notified WHO of a new laboratory-confirmed case of human infection with avian influenza A(H7N9) virus.

The patient is a 67-year-old man from Zhejiang Province. He is a farmer, and has had contact with live poultry. He became ill on 16 October 2013, was admitted to a local township hospital on 18 October 2013, and was transferred to another hospital on 21 October 2013 as his condition deteriorated. He is currently in a critical condition.

To date, WHO has been informed of a total of 137 laboratory-confirmed human cases with avian influenza A(H7N9) virus infection including 45 deaths. Currently, four patients are hospitalized and 88 have been discharged. So far, there is no evidence of sustainable 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_10_24a/en/index.html

Nearly 1m pilgrims received medical aid this Haj #MERS #Coronavirus

October 27, 2013

RIYADH — Nearly half of the pilgrims who came from abroad for this year's Haj received various kinds of healthcare services during their stay in the holy cities, according to the Kingdom's deputy minister of health.

"A total of 997,379 pilgrims from various nationalities have received healthcare services of varying degrees," Ziad Maimish said while addressing the fourth Islamic Health Ministers Conference currently under way in the Indonesian capital Jakarta.

Maimish explained how the Kingdom was able to successfully organize an epidemic-free Haj at a time the entire world was apprehensive of a possible Middle East Respiratory Syndrome Coronavirus (MERS-CoV) outbreak during the annual pilgrimage.

Maimish cited a number of measures put in place by the Saudi health authorities to prevent any outbreak of contagious diseases among pilgrims.

These measures included policies formulated by the National Committee for Infectious Diseases on prevention and dealing with infections, levels of emergency preparedness and application of necessary measures to intensify early epidemiological surveillance, including special procedures for MERS-CoV.

In addition, the Health Ministry made available laboratory equipment and materials necessary to conduct quick tests and analysis for all viruses, vectors and pathogens. It also ensured the continuation of developing health centers in the holy cities of Makkah and Madinah.

The authorities also secured most modern diagnostic and therapeutic devices for ambulatory services to enable fast field treatment or hospital transfers. This was in addition to developing speedy ambulance tracking and directing services, Maimish said.

To face the MERS-CoV challenge, he said, the Saudi authorities installed a new laboratory at Mina Wadi Hospital, which is at the heart of the pilgrimage zone, for rapid conduct of tests for suspected cases and getting test results within a matter of hours.

This was in addition to existing laboratory facilities in Jeddah and Madinah.

Some 22,500 health workers from across the Kingdom arrived to staff 25 hospitals with 5,250 beds and 141 health centers at four main pilgrim centers. 

As part of this year's health guidelines for incoming pilgrims, the National Scientific Committee for Infectious Diseases recommended that people older than 65, children, pregnant women and those with underlying conditions should postpone their pilgrimage due to the MERS-CoV risk.

Maimish pointed out that the health authorities conducted random checks of pilgrims at air, land and sea ports of entry to monitor compliance with the preventive health measures for Haj. More than 2,000 healthcare professionals were deployed at various entry points to carry out this task.

As many as 613,050 external pilgrims were vaccinated at the entry points — 430,500 against polio and 182,550 against meningitis, Maimish said.

He added that in addition to detailed investigations of every suspected case, case-control studies for index cases and intensive follow-up of contacts with serological testing to improve understanding of the critical features of MERS-CoV infection were carried out.

This year’s Haj was termed critical by the World Health Organization (WHO) due to the looming MERS virus that has claimed at least 58 lives — mostly in Saudi Arabia — since it first emerged in 2012.

For the fourth consecutive year, WHO has been invited by the Ministry of Health to observe and to provide any required technical assistance during the Haj.

http://saudigazette.com.sa/index.cfm?method=home.regcon&contentid=20131027184826 
 

#MERS #Coronavirus Saudi Arabia 3 recorded cases of Corona virus in the East

Translation
October 27, 2013

 

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.

Second resident working in the health sector at the age of 54 years old, and has a chronic illness and receiving treatment for intensive care and in a stable condition.

Third citizen at the age of 49 years, receiving intensive care treatment and his condition is stable. We wish for all healing.

 

http://www.moh.gov.sa/CoronaNew/PressReleases/Pages/mediastatemenet-2013-10-26-001.aspx