#MERS #Coronavirus Saudi Arabia MOH Sites Conflicted

The Ministry Of Health site in arabic:

http://www.moh.gov.sa/HealthAwareness/Corona/PressReleases/Pages/default.aspx


The MOH Site in English:

http://www.moh.gov.sa/en/HealthAwareness/Corona/Pages/AboutCorona.aspx

#MERS #Coronavirus Saudi Arabia: Total 43; Died 26; ICU 10; Healed 7

June 15, 2013
Translation/Excerpt:
 
The ministry said in a statement that the number of people living in the Kingdom of Corona virus has risen to 43 people, including 26 people died, seven are similar to heal, while still the owners of ten cases under intensive medical care and medical stone.

http://mokhtsar-sa.com/node/21489 

Tunisia Scans People Entering Country -- No New Cases #MERS #Coronavirus

June 15, 2013
Excerpt/Translation

In a statement to a reporter and agency Anatolia, denied the head of epidemiology at the Institute «Pastor» government in Tunis, Afif bin Saleh record any new infections with the virus, indicating that it was laying all measures dealing with the prevention of pilgrims Tunisians heading to the holy land, to ensure their protection from infection virus 'Corona'.

The «Bin Saleh» importance of job carried out by the National Committee, which has been tasked recently by the Tunisian government to monitor cases of HIV infection, and the preparation of the system and the protective solid against him, pointing out that he is organizing awareness campaigns to abide by the personal hygiene, especially with regard to washing hands, Due to the possibility for direct infection between people by touch, he said.

He 'Bin Saleh' to the importance of the role played by health centers affiliated to the ministry in border control, which scans people coming into the country, and make sure not to get them symptoms of infection with the 'Corona'.

http://www.almasryalyoum.com/node/1847591 

#MERS #Coronavirus Egypt: Luxor Calling For Health Checks At Airport

June 15, 2013
Translation


Warned Bakri Dardeer, director of the Justice and Development in Luxor, officials of the Ministry of Health of the spread of virus "Corona" in Egypt. pointed out, in a statement on Saturday that the new virus spread to areas of several in Saudi Arabia and some parts of the Gulf and Middle East region, and began to penetrate all the walls prevention. stressed Dardeer that the virus may also afflicts animals beside humans, where infect most of these viruses المكللة kind animal and one usually including monkeys, cats and dogs. demanded lifting of the state of maximum alert, and be very careful of the infection, which may be carried by travelers from abroad to home , especially the Gulf states and transported to Egypt without being subject to detect quarantine ports. added that the symptoms of common colds and severe acute respiratory syndrome severe, calling for officials of the Ministry of Health medical examination on arrivals from the Gulf states, ensure the safety of citizens and reduce the spread of the virus in Egypt .

http://tinyurl.com/kxxhx8j

Lancet: Coinfection With H7N9 & H3N2

A great post from Mike Coston, at Avian Flu Diary
June 15, 2013

While it hardly seems fair, it is possible for a human to be infected by more than one respiratory virus at the same time. This can not only confuse and complicate a patient’s diagnosis and treatment, it can – in rare instances – result in the creation of a new, hybrid virus....

Continued: http://afludiary.blogspot.com/2013/06/lancet-coinfection-with-h7n9-h3n2.html

China: Suzhou City A Bit Nervous over Nurse with Respiratory Infection

June 15, 2013
Translation
 
(Reporter Wu Shang) yesterday, Suzhou City, Northern General Hospital, said, twice the provincial expert consultation, hospital care respiratory medicine more concentrated fever was diagnosed the cause, as an ordinary viral respiratory infections and do not have strong contagious. 　　"After two provincial-level expert consultation, and their cause has been identified, that is, the common cold." Sheng a Northern General Hospital, said, according to the expert consultation result, these medical symptoms are fever, jargon is a virus respiratory infections, is actually cold, no serious contagious. 　　According Shengyuan Zhang said, as the number of health care focused symptoms, it is because a nurse first infection, probably in the 5th or so, the nurse fever, fatigue and other symptoms, followed by respiratory medicine hospital care have emerged over the same symptoms. 　　For why only focus on the hospital's medical staff respiratory medicine fever, but not in patients with intermediate transmission, Shengyuan Zhang introduction, because respiratory medicine contact with the patient when the medical staff generally work with a mask, and once back in the office he took it down, resulting in No cross-contamination between the patient, but only in respiratory medicine healthcare transmission. According to reports, after isolation and treatment, at present, has been basically no fever medical patients with high fever.

http://roll.sohu.com/20130615/n378894832.shtml 

386 Sichuan students hospitalized with infectious diarrhea

Last night I reported this situation, and today we have a diagnosis.

CHENGDU, June 15 (Xinhua) -- A total of 386 students of a school in southwest China's Sichuan Province who were hospitalized on Thursday with food poisoning-like symptoms have been confirmed as victims of infectious diarrhea, local authorities said on Saturday.

As of 10:30 a.m. Saturday, 231 of the hospitalized students from Meishan Yingtian School still remained in hospital under observation, said the Dongpo District government of the city of Meishan.
No students have been found with critical conditions, said the district government.

Around 5:20 p.m. on Thursday, some students were found with symptoms of vomiting, dizziness and fever at Meishan Yingtian School, a private operation with over 1,300 students in its kindergarten, primary, junior and high-school grades.
Experts from the provincial disease control and prevention center have sealed up food samples from the school's dining hall.

Government authorities in Meishan City have started food safety checks in all schools in the city.
Further investigation and diagnosis are under way.
 

http://news.xinhuanet.com/english/china/2013-06/15/c_132457384.htm 

Pune India NIV keeps a close watch on migratory birds for #H7N9 virus

June 15, 2013
Excerpts:

Regional centres, partners testing hundreds of samples

The National Institute of Virology (NIV) has stepped up surveillance on migratory birds in different parts of the country even as human-to-human transmission of bird flu is yet to be established and the chances of infection in India are found to be low.

H7N9, the human strain of bird flu, was detected in China this year. After the NIV got permission from the ministry of forests, it kept check on migratory birds with help from its 10 regional centres and network partners in India testing hundreds of samples. However, it is yet to come across any positive H7N9 cases.

NIV director Dr DT Mourya said migratory birds were being tracked and tracheal and cloacal swabs were being collected. “Migratory birds could be positive carriers and that’s why extensive surveillance is required with poultry-to-human transmission being closely watched. Our migratory bird surveillance project i old and hence we decided to track H7N9 with help of our network partners,” he said.

http://www.dnaindia.com/pune/1848155/report-niv-keeps-a-close-watch-on-migratory-birds-for-h7n9-virus

Pune National Institute of Virology: On The Lookout for #Coronavirus #MERS

Pune is in India.  It's the second largest State in Maharashtra.
June 15, 2013
Excerpts

Surveillance on for MERS-coronavirus; post-Haj period crucial, say scientists 

Even as the World Health Organisation (WHO) has sounded an alert on the novel MERS-CoV (Middle East Respiratory Syndrome Coronavirus) stating this newest viral threat has the potential to become a pandemic, Pune’s National Institute of Virology (NIV) has already started collecting samples from hospitals across India looking for presence of any ‘novel’ virus in case of an unexplained severe respiratory illness.

“Screening for the novel coronavirus is now part of our influenza surveillance programme. While coronavirus is not something new, the MERS-CoV strain had not been identified in humans earlier. The reason it is being feared is because of its severity as more than 60% infected persons have died. Also, little is known about it so far like transmission and clinical impact,” said Dr D T Mourya, director, NIV.

NIV director said that specimens of severe pneumonia cases reported across the country are being collected to screen for the novel MERS-CoV, but all have tested negative.

Dr Manju Chaddha, deputy director at NIV who heads the influenza research division, explained that scientists and clinicians have been told to look out for any viruses that cannot be sub-typed or which are novel.
“Currently we perform standard tests to determine patient’s specimen tests for any of known influenza virus sub-types. However, after the tests if it is found that the specimen is negative for all of them, then the alert should be sounded. Since what we are looking for is something unique, we have asked hospitals to refer us cases where the cause is unknown or unexplained,” she said.

“Thousands of our pilgrims would travel to Middle East and there is increased risk especially given the crowds. Not only will we have to educate our travellers but also work out a surveillance strategy for the post-Haj pilgrim period,” said Mourya.

http://www.dnaindia.com/pune/1848154/report-niv-on-the-lookout-for-novel-virus

346 students hospitalized in SW China - Sichuan Province

June 14, 2013

CHENGDU, June 14 (Xinhua) -- A total of 346 students at a school in southwest China's Sichuan Province have been hospitalized since Thursday evening after exhibiting signs of illness, local authorities said Friday.

The publicity department of the Dongpo District of the city of Meishan said the students were from the Yingtian Middle School.

As of Friday afternoon, 216 students are being treated in a local hospital, including 45 who are seriously ill. Another 130 students remain in the hospital for observation.

Experts from the provincial disease control and prevention center are investigating the incident.

http://news.xinhuanet.com/english/china/2013-06/14/c_132455696.htm

21 doctors, nurses Infected with Pneumonia, Hospitalized, in E China - Anhui Province

June 14, 2013

HEFEI, June 14 (Xinhua) -- Twenty-one doctors and nurses in east China's Anhui Province have been hospitalized after being diagnosed with viral pneumonia, local health authorities said Friday.

The medical workers have been quarantined for treatment and none of their infections are critical, according to a statement from the municipal health bureau of the city of Suzhou.

All of the infected work in the department of respiratory care at the General Hospital of the Wanbei Coal-Electricity Group.

One nurse began to show symptoms of fever, headache and coughing on the night of June 5, with the rest exhibiting symptoms soon afterward, the bureau said.

Twenty-one of the department's employees had been diagnosed and hospitalized as of Tuesday, the bureau said, adding that no new cases have been reported since then.

The bureau said tests for viral pneumonia have not yet been completed, although two respiratory experts from another hospital diagnosed them with viral pneumonia.

The Suzhou Disease Prevention and Control Center has taken samples from some the patients.
Feng Lizhong, a publicity official from the provincial health department, said the case represents an ordinary pneumonic infection and is not a public health issue.
 

 

http://news.xinhuanet.com/english/china/2013-06/14/c_132455785.htm 

Egypt Prepares Hospitals for Emergency of #Coronavirus MERS

June 14, 2013

Dr. Abdul Ati Abdel-Alim, Undersecretary of the Ministry of Health for Preventive Medicine, said the ministry raised the degree of readiness of all hospitals chest and fever, in anticipation of the emergence of any cases of infected «Corona» after warnings the Ministry of Health shift virus epidemic, stressing that the ministry is equipped with some of the hospitals in Cairo and other governorates rooms isolate, to receive any cases of infected 'Corona'.

And reduced «Abdul Alim» fears felt by some citizens of transmission of the disease to Egypt, stressing that the system of disease surveillance, followed by Egypt of the strongest surveillance systems in the world, stressing at the same time to raise the alert hospitals fever and chest Abbasia and Imbaba and some hospitals nationwide, as well as the central laboratory processing, and sampling survey throat and sputum samples from individuals from countries carrier of the virus.

He revealed «Abdul Alim» for a meeting, this week, at the headquarters of the World Health Organization in Cairo, includes those responsible for Preventive Medicine states the Middle East and North Africa, to discuss ways to combat the virus and prevent its spread, and after that caused the deaths of 55 cases, including 38 cases in Saudi Arabia .

The Undersecretary for Preventive Medicine, in a statement to «Egyptian today», that the ministry took 174 samples of pilgrims returning from Saudi Arabia last year for analysis, and the results were free from the virus, also withdrew number 400 sample of citizens, who are suffering from the same symptoms of infection «Corona» and came also results free of injury, in addition to free other samples obtained by the ministry from 2000 infected with pneumonia on the level of the Republic of virus «Corona», pointing out that the ministry got samples of traveling to and from countries infected with the virus.

He stressed that the ministry is continuing to take measures to monitor the disease through hospitals diets, but will not impose restrictions on pilgrims or pilgrims traveling to Saudi Arabia until the arrival of assurances from the World Health Organization need to impose restrictions on travelers, while Dr Zine El Abidine Taher, Director of Infectious Diseases, the Leaders receive a daily report of the Directorate of Health Affairs, did not show the cases so far.

http://www.almasryalyoum.com/node/1844341 

#MERS #Coronavirus Saudi Arabia 3 New Cses Reported

English Version  
14 June 2013

Within the framework of the epidemiological surveillance of the novel Coronavirus (MERS-CoV), the Ministry of Health (MOH) has announced that three new confirmed cases of this virus have been recorded. The first case is a Saudi citizen in Taif governorate, aged 65 who is suffering from chronic diseases, and still at ICU receiving the proper treatment. The Second one is a Saudi female citizen in Taif governorate, aged 68 who is suffering from chronic diseases as well, and still at ICU receiving the proper treatment. However, the third case is a resident, aged 46 in Wadi Al-Dawaser, who passed away today, May Allah have mercy upon him.

Within the same vein, MOH has pointed out that it has tested 53 samples, where all of them have been proved negative, May Allah be praised.

http://www.moh.gov.sa/en/HealthAwareness/Corona/PressReleases/Pages/MediaStatement-2013-06-14-001.aspx 

#MERS #Coronavirus Case List

Updated

Saudi Arabia Cluster Stat:  12 Deaths, 22 Cases

Total Global cases:  58

Total Global Deaths:  33

Saudi Arabia:  46 Cases; 28 Deaths

France, Europe:  2

Tunisia, N Africa:  2 (3^rd probable)

Italy, Europe:  3

Saudi Arabia Cluster*

Case Number—Name—From--Onset—Condition—DOD

#1--59M—al Hofuf--4/14—Died--4/19*

#2--24M—al Hofuf--4/17—Died 5/29*

#3--87M—al Hofuf--4/17—Died--4/28*

#4--58M—al Hofuf--4/22—Died--5/29*

#5--94M—al Hofuf--4/22--Died--4/26*

#6--56M—al Hofuf--4/22—Died--4/30*

#7--56M—al Hofuf--4/22—Died--4/29*

#8--53F—al Hofuf--4/27--ICU Critical/Stable*--Recovered

#9--50M —al Hofuf--4/30—ICU Critical**--Recovered

#10-- Hussein al-Sheikh 33M—al Hofuf--4/28—Recovered, discharged.

#11—62F—al Hofuf--4/19—Died—5/3*

#12—71M—al Hofuf--4/15—Died—5/3*

#13—58F—al Hofuf--5/1—ICU Critical/Stable*--Recovered

#14—48M—al Hofuf—4/29—Died—6/9

#15—58M—al Hofuf—4/6—Recovered, discharged 5/3

#16—69F—al Hofuf—4/25—Died 5/8

#17—48M—al-Hofuf—4/24—Critical--Recovered

#18—81M—al-Hofuf—4/26—Critical--Recovered

#19—56M—al-Hofuf—5/7—Recovered, discharged

#20—45M HCW—al Hofuf—5/2—Critical—Recovered

#21—43F HCW—al Hofuf—5/8—Stable**--Recovered

#22—81F—HCF patient—4/28—Died 5/26

5/26 KSA MOH Announces 9 Recovered.

*1 Death reported is not noted in above list (60yo) by WHO (5/31) & KSA MOH (5/29)

6/1 – 3 Deaths Reported, not designated as “deaths” in list above.

France Cluster [visited Dubai]

Case Number—Name—From--Onset—Condition—DOD

#1—65(M)--Valenciennes—4/23—DOD 5/27

#2—50(M)—Valenciennes—hospitalized

Tunisia [visited KSA & Qatar]

Case Number—Name—From—Onset—Condition--DOD

#1—66(M)—Monastir Tunisia—4/30—Negative Conf.—Father--Died 5/10

#2—34(M)—Monastir Tunisia—confirmed--sibling--recovered (after 5/3)

#3—35(F)—Monastir Tunisia--confirmed—sibling—recovered (after 5/3)

Italy –[traveled to Jordan]

#1—45(M)—Florence—Approx. 5/24—Stable

#2—18mos.(F)—Florence—Adm 6/1—Discharged 6/5

#3—52(F)—Florence—Adm 6/1—Discharged 6/6

Saudi Arabia

Case Number—Name—From—Onset—Condition--DOD

#1—63(M)—Qassim—Died 5/20

#2—56(M)—Eastern Reg.—5/12—DOD 5/20*

#3—85(F)—Eastern Reg.—5/17—Critical*

#4—76(F)—Eastern Reg.—5/24—Discharged 5/27&

#5—77(M)—Eastern Reg.—5/19—DOD 5/26*

#6—73(M)—Eastern Reg.—5/28—DOD 5/26*

#7—61—Al-Ahsa—Reported on 5/29

#8—14(F)—Eastern Reg.—5/29--—Stable*

#9—83(M)—Al-Ahsa—5/27—DOD 5/31

#10—21M—Hafr Al-Batin—Died 6/12

#11—63F—Eastern Region—Stable

#12—75—Al-Ahsa—ICU—

#13—65—Taif, Mekkah Prov.—ICU

#14—68—Taif, Mekkah Prov.—ICU

#15—46—Riyadh Prov.—DOD 6/14

*multiple comorbidities

**with comorbidiity

#MERS #Coronavirus Saudi Arabia Mekkah Province, Taif, Confirmed Cases

Translation:

The first case of a citizen in the province of Taif, at the age of 65 years, and suffers chronic diseases, and is still receiving treatment in intensive care. And the second case of a citizen in the province of Taif [Mekkah Province], at the age of 68 years and also suffer chronic diseases, and still receiving treatment in intensive care. The third case is a resident in the province of and propellants Valley [Riyadh], at the age of 46 years, died today, God's mercy.
The ministry also shows that it was recently examined 53 were negative, thankfully.

From Wikipedia:
Taif (Arabic الطائف aṭ-Ṭā’if) is a city in the Mecca Province of Saudi Arabia at an elevation of 1,879 m (6,165 ft) on the slopes of the Sarawat Mountains (Al-Sarawat Mountains). It has a population of 521,273 (2004 census). Each summer the Saudi Government moves from the heat of Riyadh to Ta'if. The city is the centre of an agricultural area known for its grapes, roses and honey.

http://www.moh.gov.sa/HealthAwareness/Corona/PressReleases/Pages/MediaStatement-2013-06-14-001.aspx

#MERS #Coronavirus Saudi Arabia MOH Reports 46 Cases; 28 Deaths

The Ministry of Health Website has reported 46 cases and 28 deaths.
http://www.moh.gov.sa/HealthAwareness/Corona/Pages/AboutCorona.aspx

United States Flu Season Recap - Moderately Severe

June 13, 2013
CIDRAP

In a snapshot of the flu season that just wrapped up, the US Centers for Disease Control and Prevention (CDC) said today that 2012-13 made its mark for several reasons, including a peak percentage of doctors' visits for flulike illness that, at 6.1%, was one of the highest since the current reporting system began in 1997. Writing in Morbidity and Mortality Weekly Report (MMWR), the CDC said the rate of flu hospitalizations in older people was the highest since the agency started collecting that information in the 2005-06 season. The number of pediatric flu deaths topped all years since data collection began, except for the 2009 H1N1 months. Flu activity, as measured by percentage of respiratory specimens testing positive, peaked early, by the week ending Dec 29. The H3N2 virus predominated until the end of February, when influenza B edged it out. The CDC warned that although flu activity is typically low during the summer, cases and sporadic outbreaks continue to be detected. It urged clinicians to keep their guard up and consider novel influenza viruses, especially in sick patients who have had swine exposure and in those who get sick after traveling to China.
Jun 14 MMWR report

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/jun1313fluscan.html

MERS-CoV vigilance rises in US

Robert Roos  News Editor

Jun 13, 2013 (CIDRAP News) – The Centers for Disease Control and Prevention (CDC) said today that more than 30 US patients have been tested for MERS-CoV (Middle East respiratory syndrome coronavirus), as clinicians asked questions about the criteria for testing people who show up in emergency rooms with suspicious symptoms. 

During a conference call to update clinicians on MERS-CoV, the CDC's Susan Gerber, MD, emphasized that no cases have been detected in the United States yet, but said the CDC has tested patients from various parts of the country since the virus was discovered last September. 

Gerber, a medical epidemiologist, didn't specify how many patients have been tested, but Mark Pallansch, PhD, director of the CDC's Division of Viral Diseases, told CIDRAP News that the CDC has tested more than 30 suspected cases, all with negative results. 

Continued:  http://www.cidrap.umn.edu/cidrap/content/other/sars/news/jun1313mers.html

The Lancet: MERS-CoV: in search of answers

Volume 381, Issue 9883, Page 2069, 15 June 2013
doi:10.1016/S0140-6736(13)61228-3
Anna Petherick

In recent weeks, researchers have uncovered key molecular and clinical details about this novel virus, but fundamental questions remain about how it spreads. Anna Petherick reports.

Middle East Respiratory Syndrome coronavirus (MERS-CoV) has been a cause for concern for months, with a steady trickle of new cases, often fatal, dating back to April, 2012. Until March of this year there were fewer than five confirmed infections per month, but April and May each saw 19 new cases, driven up by a cluster in the Al-Ahsa region in eastern Saudi Arabia. Most people now known to have caught MERS-CoV have done so from another human being.

Efforts to understand the infection have consequently been stepped up. A WHO team of experts tasked with trawling through the existing Saudi data has just returned from the country. It hopes to publish a report this month. Saudi Arabia's Ministry of Health has also agreed to send samples from animals that seem likely candidates to harbour the virus to the USA for analysis. This marks a positive shift in tone: last autumn, the same ministry stood accused of ordering the sacking of Ali Mohamed Zaki, the virologist who alerted the medical community to this new threat by posting an entry on proMED (an infectious disease news website), and who sent a sample abroad to find out what it could be.

The little acts of diplomatic progress of late could have a substantive public health benefit, by enabling researchers to answer the most important question about this virus: what non-human source acts as a conduit from which MERS-CoV can infect people? “It could be a food, an animal, or a contaminated product with virus on it from contact with an animal”, suggests Tony Mount, WHO's technical lead on this virus. “If we can stop that, if we can somehow manage to interrupt that transmission, then the outbreaks won't happen.” A close genetic relative of coronaviruses carried by pipistrelle bats, MERS-CoV is thought to have jumped from bats to something else, and from that something else to humans, repeating a pattern shared by other novel human viruses. The severe acute respiratory syndrome (SARS) pandemic of 2003 arose when a coronavirus hopped from bats to civet cats to people. And Nipah virus, which has caused many deaths in Bangladesh over the past 2 years, moved from bats to humans via date palm sap, a popular local drink.

The intermediary for MERS-CoV has proven surprisingly elusive. A group of Dutch researchers that identified the DPP4 receptor on the surface of lung cells as the foothold by which MERS-CoV enters the body, have struggled to infect other mammals, such as ferrets, mice, and hamsters. “We could show that the virus recognises a similar receptor in bats, and because bats and humans are genetically quite far apart you would expect many species in between to have a conserved receptor that allows the virus to enter”, explains Bart Haagmans, of the Erasmus University Medical Center in Rotterdam. Only rhesus macaques have succumbed—a fact of limited use in explaining outbreaks in the Middle East.

With greater political will where it counts, more widespread surveillance could be underway. At least four institutions have developed serological assays that do not seem to have been picked up by some of the places experiencing the greatest burden. These tests could be deployed to search for the animal conduit in markets and among Saudi Arabia's existing sentinel herds of goats, cattle, and sheep that are already monitored for tick-borne viruses in circulation.

Moreover, the assays could reveal whether infected individuals displaying only mild symptoms, with the potential to disseminate the virus, are more common than currently imagined. To date, two cases in Tunisia and one in the UK have not required admission to hospital. Representatives of Jordan's Ministry of Health and of the US Centers for Disease Control and Prevention are retrospectively probing the shadow of an outbreak in Amman to offer a response to this question, but it would be more pertinently answered in Al-Ahsa. “I think the Saudis have been a little bit reluctant to use one of these tests”, says Mount. “I hope they will very soon because I think that even in their current state [of verification], the assays are actually very useful.”

Perhaps MERS-CoV is of most concern where it is silent. That it has been picked up in travellers heading west from the Arabian Peninsula, but not in those heading east, is more likely a product of the relative intensity of surveillance in different countries, than it is a reflection of the underlying epidemiology. Most of the foreigners who comprise a third of Saudi Arabia's population emanate from Pakistan, India, the Philippines, and Indonesia—countries where large extended families often live in close quarters and hygiene can be poor. The international cooperation to combat MERS-CoV has been lauded. Now, say experts, it is time to take it up a notch.

 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961228-3/fulltext

WHO Middle East respiratory syndrome coronavirus (MERS-CoV) - update June 14, 2013

14 JUNE 2013 - The Ministry of Health in Saudi Arabia has announced an additional three laboratory-confirmed cases, including one death with Middle East respiratory syndrome coronavirus (MERS-CoV).

The first patient is a 63-year-old woman with underlying medical conditions from the Eastern region, the second patient is a 75-year-old man with underlying medical conditions from Al-Ahsa governorate and the third patient is a 21-year-old man from Hafar Al-Batin governorate who died. Additionally, a previously laboratory-confirmed case has died.

Globally, from September 2012 to date, WHO has been informed of a total of 58 laboratory-confirmed cases of infection with MERS-CoV, including 33 deaths.

WHO has received reports of laboratory-confirmed cases originating in the following countries in the Middle East to date: Jordan, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). France, Germany, Italy, Tunisia and the United Kingdom also reported laboratory-confirmed cases; they were either transferred there for care of the disease or returned from the Middle East and subsequently became ill. In France, Italy, Tunisia and the United Kingdom, there has been limited local transmission among patients who had not been to the Middle East but had been in close contact with the laboratory-confirmed or probable cases.

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. 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 diarrhoea, 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 continues to closely monitor the situation.

http://www.who.int/csr/don/2013_06_14/en/index.html 

Seasonal Flu Shots Update on Various Vaccines for Ages 2+, and another for Ages 3+

Very important information on this years Seasonal Flu Shots.  Especially if you have children.
Back in December 2012, we reported this:

December 18, 2012
The FDA has approved the first influenza vaccine intended to protect against four strains of the virus, drug maker GlaxoSmithKline announced in a press release.

Fluarix Quadrivalent is indicated for children aged 3 years and older and adults, and will be available in time for the 2013-2014 flu season. The new quadrivalent influenza vaccine will contain two influenza B strains instead of one, in addition to the two influenza A strains currently used in trivalent influenza vaccines. 
-snip-
http://www.clinicaladvisor.com/fda-approves-gsk-quadrivalent-flu-vaccine/article/273032/

A few days ago, we have this report:

June 10, 2013
Quadrivalent flu vaccine approved for kids younger than 2 years 
The FDA has approved a quadrivalent influenza vaccine for use in adults and children aged 6 months and older during the 2013-2014 season.
-snip-
Fluzone Quadrivalent (Sanofi Pasteur) will be the only influenza vaccine that protects children younger than 2 years against four strains of influenza, the manufacturer announced in a press release. 

Previously, the FDA approved FluMist Quadrivalent (Medimmune) for children aged 2 years and older, and Fluarix Quadrivalent (GlaxoSmithKline) for those aged 3 years and older. All three quadrivalent vaccines will include two strains of the influenza A and two strains of the influenza B subtypes.
-snip-
Fluzone Quadrivalent will be available as prefilled syringes and single-dose vials for intramuscular administration.
http://www.clinicaladvisor.com/quadrivalent-flu-vaccine-approved-for-kids-younger-than-2-years/article/297137/# 

#H7N9 China confirms 131 cases, 39 deaths

2013-06-09
BEIJING, June 9 (Xinhua) -- A total of 131 H7N9 avian flu cases have been reported on the Chinese mainland, including 39 that have ended in death, according to an update released Sunday by health authorities.
Of the total, 78 H7N9 patients have been discharged from hospitals after receiving treatment. The other 14 patients are being treated in hospitals, according to the National Health and Family Planning Commission.

Continued:  http://news.xinhuanet.com/english/china/2013-06/09/c_132444838.htm

The duck genome and transcriptome provide insight into an avian influenza virus reservoir species (from Nature Genetics]

Nature Genetics  (2013)

doi:10.1038/ng.2657

Received  16 December 2012

Accepted  08 May 2013

Published online  09 June 2013 

 

Abstract:

The duck (Anas platyrhynchos) is one of the principal natural hosts of influenza A viruses. We present the duck genome sequence and perform deep transcriptome analyses to investigate immune-related genes. Our data indicate that the duck possesses a contractive immune gene repertoire, as in chicken and zebra finch, and this repertoire has been shaped through lineage-specific duplications. We identify genes that are responsive to influenza A viruses using the lung transcriptomes of control ducks and ones that were infected with either a highly pathogenic (A/duck/Hubei/49/05) or a weakly pathogenic (A/goose/Hubei/65/05) H5N1 virus. Further, we show how the duck's defense mechanisms against influenza infection have been optimized through the diversification of its β-defensin and butyrophilin-like repertoires. These analyses, in combination with the genomic and transcriptomic data, provide a resource for characterizing the interaction between host and influenza viruses.

Full Article:  http://www.nature.com/ng/journal/vaop/ncurrent/full/ng.2657.html

Duck Genome Provides New Insight Into Fighting Avian Influenza

3 days ago

The duck genome consortium, consisted of scientists from China Agricultural University, BGI, University of Edinburgh and other institutes has completed the genome sequencing and analysis of the duck (Anas platyrhynchos), one principal natural host of influenza A viruses, which caused a new epidemic in China since this February. This work reveals some noteworthy conclusions and provides an invaluable resource for unraveling the interactive mechanisms between the host and influenza viruses.

The new H7N9 bird flu strain killed 36 people and caused $6.5 billion loss to China's economy. As a natural host of influenza A viruses (including H5N1), the duck is known to often remain asymptomatic under influenza infection. To uncover the interactive mechanisms between the host and influenza viruses, researchers sequenced the genome of a 10-week-old female Beijing duck, and conducted transcriptomic studies on two virus-infected ducks.

This work yielded the draft sequence of a waterfowl-duck for the first time, and the data indicated that the duck, like the chicken and zebra finch, possessed a contractive immune gene repertoire comparing to those in mammals, and it also comprises novel genes that are not present in the other three birds (chicken, zebra finch and turkey).

By comparing gene expression in the lungs of ducks infected with either highly or weakly pathogenic avian influenza H5N1 viruses, the team identified genes whose expression patterns were altered in response to avian influenza viruses. They also identify factors that may be involved in duck host immune response to avian virus infection, including the avian and mammalian -defensin gene families.
Jianwen Li, project manager from BGI, says, "This study provides very important data to better understand the interaction between the host and the avian influenza. Scientists will be able to explore more deeply the mechanisms on the spread and infection of avian influenza."

http://www.infectioncontroltoday.com/news/2013/06/duck-genome-provides-new-insight-into-fighting-avian-influenza.aspx

Creative Commons License A Single Amino Acid Change Switches Avian Influenza H5N1 and H7N9 Viruses to Human Receptors

by Vincent Racaniello

Wednesday, June 12, 2013 at 06:45 AM EDT

Two back-to-back papers were published last week that provide a detailed analysis of what it would take for avian influenza H5N1 and H7N9 viruses to switch to human receptors.

Influenza virus initiates infection by attaching to the cell surface, a process mediated by binding of the viral hemagglutinin protein (HA) to sialic acid. This sugar is found on glycoproteins, which are polypeptide chains decorated with chains of sugars. The way that sialic acid is linked to the next sugar molecule determines what kind of influenza viruses will bind. Human influenza viruses prefer to attach to sialic acids linked to the second sugar molecule via alpha-2,6 linkages, while avian influenza viruses prefer to bind to alpha-2,3 linked sialic acids. (In the image, influenza HA is shown in blue on the virion (left) and as a single polypeptide at right. Alpha-2,3 linked sialic acid is shown at top).

Adaptation of avian influenza viruses to efficiently infect humans requires that the viral HA quantitatively switches to human receptor binding -- defined as high relative binding affinity to human versus avian receptors. Such a switch is caused by amino acid changes in the receptor binding site of the HA protein. The HA of the H1N1, H2N2, and H3N2 pandemic viruses are all derived from avian influenza viruses that underwent such a quantitative switch in binding from avian to human sialic acid receptors.
Avian H5N1 influenza viruses have not undergone a quantitative switch to human receptor binding, which is one of the reasons why these viruses do not undergo sustained human-to-human transmission. It has been possible to introduce specific amino acid changes in the H5 HA protein that enable these viruses to recognize human sialic acid receptors. Such changes were required to select variants of influenza H5N1 virus that transmit via aerosol among ferrets. However none of these viruses have quantitatively switched to human receptor specificity.

In the H5N1 paper, the authors compared the structure of an H5 HA bound to alpha-2,3 linked sialic acid with the structure of an H2 HA (its closest phylogenetic neighbor) bound to alpha-2,6 linked sialic acid, revealing substantial differences in the receptor binding site. To predict what residues could be changed in the H5 HA to overcome these differences, the authors developed a metric to identify amino acids within the receptor binding site that either contact the receptor or might influence the interaction. They examined these amino acids in different H5 HAs, and identified residues which might change the H5 HA to human receptor specificity. As a starting point they picked two H5 viruses that have already undergone amino acid changes believed to be important for human receptor binding. The changes were introduced into the HA of a currently circulating H5 HA by mutagenesis and then binding of the HAs to purified sialic acids and human tracheal and alveolar tissues was determined.

The HA ribosome binding site amino acid changes required for aerosol transmission of H5N1 viruses in ferrets did not quantitatively switch receptor binding of a currently circulating H5 HA from avian to human (the ferret studies were done using H5N1 viruses that circulated in 2004/05). The authors note that "These residues alone cannot be used as reference points to analyze the switch in receptor specificity of currently circulating and evolving H5N1 strains".

However introducing other amino acid changes which the authors predicted would be important did switch the H5 HA completely to human receptor binding. Only one or two amino acids changes are required for this switch in recently circulating H5 HAs.

This work is important because it defines structural features in the receptor binding site of H5 HA that are critical for quantitative switching from avian to human receptor binding, a necessary step in the acquisition of human to human transmissibility. These specific residues can be monitored in circulating H5N1 strains as indicators of a quantitative switch to human receptor specificity.

Remember that switching of H5 HA to human receptor specificity is not sufficient to gain human to human transmissibility; what other changes are needed, in which genes and how many, is anyone's guess.
These authors have also published (in the same issue of Cell) a similar analysis of the recent avian influenza H7N9 virus which has emerged in China to infect humans for the first time. They model the binding of sialic acid in the H7 HA receptor binding site, and predict that the HA would have lower binding to human receptors compared with human-adapted H3 HAs (its closest phylogenetic neighbor). This prediction was validated by studies of the binding of the H7N9 virus to sections of human trachea: they find that staining of these tissues is less intense and extensive than of viruses with human-adapted HAs. They predict and demonstrate that a single amino acid change in the H7 HA (G228S) increases binding to human sialic acid receptors. This virus stains tracheal sections better than the H7 parental virus.

These results mean that the H7N9 virus circulating in China might be one amino acid change away from acquiring higher binding to human alpha-2,6 sialic acid receptors. I wonder why a virus with this mutation has not yet been isolated. Perhaps the one amino acid change in the viral HA exerts a fitness cost that prevents it from infecting birds or humans. Of course, as discussed above, a switch in receptor specificity is likely not sufficient for human to human transmission; changes in other genes are certainly needed. In other words, the failure of influenza H7N9 virus to transmit among humans can be partly, but not completely, explained by its binding properties to human receptors.

http://www.virology.ws/2013/06/11/a-single-amino-acid-change-switches-avian-influenza-h5n1-and-h7n9-viruses-to-human-receptors/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+VirologyBlog+%28virology+blog%29

Media Advisory: CDC's Advisory Committee on Immunization Practices Meeting

For Immediate Release: Tuesday, June 12, 2013
Contact: CDC Media Relations, Office of Communication
(404) 639-3286

Please Note the Need to RSVP

What

Meeting of the Advisory Committee on Immunization Practices (ACIP)

When

Wednesday, June 19th; 8:00 am - 5:30 pm ET
Thursday, June 20th; 8:00 am - 3:15 pm ET

Where

Centers for Disease Control and Prevention
1600 Clifton Road NE
Atlanta, GA 30329

Tom Harkin Global Communications Center (Building 19), Kent “Oz” Nelson Auditorium
For directions to CDC, please visit http://www.cdc.gov/about/resources/visitGuide.htm#direction

Webstream

If you cannot attend the meeting in person, it will be web streamed. More information can be found at http://www.cdc.gov/vaccines/acip/meetings/webcast-instructions.html

Background

An agenda for the meeting can be found at http://www.cdc.gov/vaccines/recs/acip/. The Advisory Committee on Immunization Practices (ACIP) consists of 15 experts in fields associated with immunization who have been selected by the Secretary of the U.S. Department of Health and Human Services to provide advice and guidance to the Secretary and the Assistant Secretary for Health, and the Director of the Centers for Disease Control and Prevention (CDC) on control of vaccine-preventable diseases.
The Committee develops written recommendations for   use of vaccines that are licensed in the United States; considerations include age for vaccine administration, number of doses and dosing interval, safety issues, and precautions and contraindications.
Special Note – reporters who wish to attend the meeting in person must RSVP to Jamila Jones, in CDC's Division of Public Affairs at jhoward2@cdc.gov by COB on Friday, June 14th. Space is limited, and only those reporters who RSVP will be guaranteed working space during the meeting.
To RSVP attendance at ACIP meeting, please contact 404-639-3286.

http://www.cdc.gov/media/releases/2013/a0612-immunization-practices.html

Coronavirus: The suspect in Tours was a false alarm

Two Suspected Cases of Coronavirus MERS reported earlier on June 11, have been confirmed negative.

June 12, 2013
Biological analyzes of French suspected of being infected with the new coronavirus returned negative, announced the Ministry of Health on Wednesday.

That's a relief: man hospitalized Tours for suspected contamination by the new coronavirus MERS was a false alarm. His analyzes were negative, said the Ministry of Health on Wednesday. The existence of a suspected case was confirmed Tuesday afternoon by health authorities after the radio France Bleu Touraine, based on medical sources, has announced two new infections in France.

Continued:  http://sante.lefigaro.fr/actualite/2013/06/12/20760-coronavirus-cas-suspect-tours-etait-fausse-alerte

#MERS #Coronavirus Italy - New Coronavirus. Tuscany. It ended the surveillance activities

June 12, 2013
It ended the health surveillance of all the people who had had close contact with the three cases new coronavirus infection (Mers: Middle East Respiratory Syndrome). The observation period (10 days after the last exposure monitoring) has been agreed with the competent offices of the Ministry of Health.

 Continued: http://www.quotidianosanita.it/regioni-e-asl/articolo.php?articolo_id=15450

#MERS Saudi Arabia MOH Conducts a Study on the Conglomeration of the Health Facilities Infections with Novel #Coronavirus

11 June 2013 

The Ministry of Health (MOH) has announced that it has finished, by the grace of Allah, a study on the conglomeration of  the health facilities infections with the Middle East Respiratory Syndrome – Corona Virus (MERS-COV) and its genetic serial order in an integrated manner, within a record period of time of infections outbreak occurred in Al-Ahsa governorate. Therefore an elite of researchers from the Kingdom of Saudi Arabia and the United Kingdom, in collaboration with scientists from University College London (UCL) and Wellcome Trust Sanger Institute (WTSI), have conducted an urgent study for the genetic characteristics arising from the outbreak of (MERS-COV). This is reckoned a positive step to follow-up the development and mutation of the virus over the time, meanwhile, helping in the diagnostic steps, and to find out a quick mechanism of diagnoses.

 The MOH spokesman, Dr. Khaled Marghalani, has pointed out that a full genetic serious taken from four Coronavirus cases detected in Al-Ahsa - the Eastern governorate - has been actually recorded on the GenBank database, which is available for all via GenBank web site, in concordance with the established norms, starting from today on Tuesday 11/6/2013 (corresponding to 2/8/1434 H). 

In this context, MOH has called upon all researchers and specialists from inside and outside the Kingdom, to refer to the GenBank on the following numbers of addition from kf186564 to kf186567; in order to view this information and benefit from this scientific step. MOH hopes that this step to contribute to the scientific development; so as to accelerate finding out a vaccine for this disease, and to learn more about this the virus, since there is hardly current information about it up to now, nor there is a vaccine or treatment for it.

Within the same vein, the World Health Organization (WHO) has released a press statement on its website:http://www.who.org, through its mission which visited the Kingdom recently. Within the statement, WHO has talked about the Kingdom’s expertise and experiences in dealing with the virus and identifying its characteristics through shedding more light on the epidemic forms of the virus, with referring to the limited information about this virus. Furthermore, it has expounded the ways of the virus transmission from one person to another and the way of its diagnosis and treatment. Over and above, WHO has showed the measures and procedures taken in the Kingdom to investigate and control its outbreak in Al-Ahsa. Finally, WHO has urged all countries, especially the Eastern Mediterranean region, to intensify the epidemiological surveillance procedures of this virus. It is noteworthy that MOH has published this statement on its website http :/ / www.moh.gov.sa.

http://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/News-2013-06-11-001.aspx

FLU NEWS SCAN: H7N3 in Mexico, H5N1 in smuggled bird, South American respiratory virus activity

June 12, 2013
CIDRAP

Jun 12, 2013

Mexico reports 8 more H7N3 outbreaks, culls 800,000 birds
Eight more outbreaks of H7N3 avian flu have struck Mexican chicken farms in recent weeks, prompting the destruction of more than 800,000 birds and the vaccination of 5 million more, Mexican authorities reported to the World Organization for Animal Health (OIE) today. The outbreaks involved two commercial layer farms, two heavy breeder flocks, three broiler flocks, and a backyard farm in four different states: Jalisco, Puebla, Guanajuato, and Aguascalientes. The number of susceptible birds totaled 1,049,220, of which 815,034 were destroyed to stop the outbreaks. The report says only three actual cases were reported but notes that information was missing. In Guanajuato, the outbreaks have prompted the vaccination of 5,512,080 chickens on breeder and layer farms. The earliest outbreaks started on Apr 4 and the latest on May 23. Mexico's last report to the OIE, on May 8, listed five outbreaks, which prompted the culling of 850,000 birds.
Jun 12 OIE report
May 8 CIDRAP News item on previous outbreaks

H5N1 found in smuggled exotic bird
The H5N1 avian flu virus was detected in a group of exotic birds from Asia that were found in suitcases at the Vienna, Austria, airport, the Czech News Agency (CTK) reported yesterday. The smugglers from the Czech Republic were headed back to their country when officers found the birds during a routine check with two sniffer dogs. The officers apprehended the smugglers and immediately handed the birds, many of which were dead, to health officials for testing, which revealed one of the dead birds was infected with H5N1. The London Daily Mail said today that the species included wild parrots and birds of paradise that had been sent from Bali to Qatar before they were stopped in Vienna. The remaining birds were culled, and people who were in contact with them have been notified and are receiving treatment, the story said.
Jun 11 CTK story
Jun 12 Daily Mail story

South America sees respiratory infection rise
Several South American countries are reporting high levels of acute respiratory infection levels, with increasing trends in most countries, but within expected levels for this time of year, the Pan American Health Organization (PAHO) reported today in its weekly update. So far respiratory syncytial virus (RSV) predominates in most countries, though the 2009 H1N1 flu virus is dominant in Brazil. RSV and seasonal flu viruses, mainly H1N1, are cocirculating in some countries, including Argentina, Chile, Colombia, and Venezuela. Locations seeing RSV cocirculation with H3N2 include Bolivia (La Paz), Ecuador, and Peru. The World Health Organization (WHO) said in its most recent flu update that flu activity is starting to increase in South America and South Africa, but levels are still low in Oceania.
Jun 12 PAHO influenza update
Jun 7 WHO flu update 

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/jun1213fluscan.html 

Map of Hafr Al-Batin, Eastern Province, Saudi Arabia

Location of the latest 21 year old Coronavirus MERS case in Saudi Arabia.  It is not near Medina.

Excerpt from previous report I posted tonight from CIDRAP:

In a brief statement today, the Saudi Ministry of Health (MOH) said a 21-year-old "resident" of the country died of a MERS-CoV infection and that two Saudi citizens are sick. The 21-year-old was living in Hafr Al-Batin, a city in the Eastern province but about 300 miles north of Al-Ahsa, site of a recent hospital-centered outbreak.

The young man died after being admitted to a hospital intensive care unit (ICU) at the beginning of this week, the MOH said. The ministry did not list his home country or give any other details about him. World Health Organization (WHO) officials have expressed concern that guest workers from developing countries such as the Philippines could contract the virus in Saudi Arabia and carry it back home.

The MOH said one of the other new cases involves a 63-year-old Saudi woman who lives in the Eastern region, has chronic diseases, and is in stable condition. The third case, the statement said, is in a 75-year-old Saudi who lives in Al-Ahsa governorate and is being treated in an ICU. The patient, whose gender was not listed, also has chronic health problems.

The three illnesses raise Saudi Arabia's MERS-CoV count to 43 cases and 27 deaths. Unofficially, they raise the global total to 58 cases and 33 deaths.