Date: Fri 5 Oct 2012
Source: NBC News, Associated Press (AP) report [edited]
http://vitals.nbcnews.com/_news/2012/10/05/14241074-hundreds-may-be-at-risk-in-meningitis-outbreak?lite
The
potential scope of the meningitis outbreak that has killed at least 5
people widened dramatically Thu 4 Oct 2012, as health officials warned
that hundreds, perhaps thousands, of patients who got steroid back
injections in 23 states could be at risk. Clinics and medical centers
rushed to contact patients who may have received the apparently
fungus-contaminated shots and the FDA urged doctors not to use any
products at all from the Massachusetts pharmacy that supplied the
suspect steroid solution. It is not clear how many patients received
tainted injections, or even whether everyone who got one will get sick.
So
far, 35 people in 6 states -- Tennessee (25), Virginia (4), Maryland
(2), Florida (2), North Carolina (1) and Indiana (1) -- have contracted
fungal meningitis, and 5 of them have died, according to the CDC. All
had received steroid shots for back pain, a highly common treatment.
In
an alarming indication the outbreak could get a lot bigger,
Massachusetts health officials said the pharmacy involved, the New
England Compounding Center [NECC] of Framingham, MA, has recalled 3 lots
consisting of a total of 17 676 single-dose vials of the steroid,
preservative-free methylprednisolone acetate. An unknown number of those
vials reached 75 clinics and other facilities in 23 states between July
2012 and September 2012, federal health officials said. Several hundred
of the vials, maybe more, have been returned unused, a Massachusetts
official said.
But many other vials were used. At a
clinic in Evansville, Indiana, more than 500 patients got injections
from the suspect lots, officials said. At 2 clinics in Tennessee, more
than 900 patients, perhaps many more, did.
The
investigation began about 2 weeks ago after a case was diagnosed in
Tennessee. The time from infection to onset of symptoms is anywhere from
a few days to a month, so the number of people stricken could rise.
Investigators
this week found contamination in a sealed vial of the steroid at the
New England company, according to FDA officials. Tests are under way to
determine if it is the same fungus blamed in the outbreak. The company
has shut down operations and said it is working with regulators to
identify the source of the infection.
"Out of an
abundance of caution, we advise all health care practitioners not to use
any product" from the company, said Ilisa Bernstein, director of
compliance for the FDA's Center for Drug Evaluation and Research.
The
type of fungal meningitis involved is not contagious like the more
common forms. It is caused by a fungus often found in leaf mold and is
treated with high-dose antifungal medications, usually given
intravenously in a hospital. The common mold _Aspergillus_ was cultured
from 5 patients, the CDC said Thursday [4 Oct 2012].
The
New England company is what is known as a compounding pharmacy. These
pharmacies custom-mix solutions, creams, and other medications in doses
or in forms that generally aren't commercially available. Other
compounding pharmacies have been blamed in recent years for serious and
sometimes deadly outbreaks caused by contaminated medicines. Compounding
pharmacies are not regulated as closely as drug manufacturers, and
their products are not subject to FDA approval.
A
national shortage of many drugs has forced doctors to seek custom-made
alternatives from compounding pharmacies. The New England company at the
center of the outbreak makes dozens of other medical products, state
officials said. But neither the company nor health officials would
identify them.
The company said in a statement Thursday
[4 Oct 2012] that despite the FDA warning, "there is no indication of
any potential issues with other products." It called the deaths and
illnesses tragic and added: "The thoughts and prayers of everyone
employed by NECC are with those who have been affected."
A 2011 state inspection of the Framingham facility gave the business a clean bill of health.
[Byline: Mike Stobbe]
http://www.promedmail.org/direct.php?id=20121005.1326188
Saturday, October 6, 2012
ProMED: NOVEL CORONAVIRUS - SAUDI ARABIA (11): CLINICAL, LABORATORY AND EPIDEMIOLOGICAL INVESTIGATIONS
[editing in red is mine]
In this update:
[1] UK - HPA investigation findings, Eurosurveillance
[2] UK - Clinical and laboratory findings, Eurosurveillance
[3] Saudi Arabia - ongoing investigations, newswire
[4] USA - current recommendations, MMWR
******
[1] UK - HPA investigation findings, Eurosurveillance
Date: 4 Oct 2012
Source: Eurosurveillance Volume 17, Issue 40, 4 Oct 2012 [edited]
http://eurosurveillance.org/ViewArticle.aspx?ArticleId=20292
Rapid communications
The United Kingdom Public Health response to an imported laboratory confirmed case of a novel coronavirus in September 2012
--------------------------
On [22 Sep 2012], a novel coronavirus, very closely related to that from a fatal case in Saudi Arabia 3 months previously, was detected in a previously well adult transferred to intensive care in London from Qatar with severe respiratory illness. Strict respiratory isolation was instituted. Ten days after last exposure, none of 64 close contacts had developed severe disease, with 13 of 64 reporting mild respiratory symptoms. The novel coronavirus was not detected in 10 of 10 symptomatic contacts tested.
The outbreak of severe acute respiratory syndrome (SARS) in 2003, which led to 8422 cases and 916 deaths worldwide [1], highlighted the potential for newly emerging zoonotic coronaviruses to transmit from person to person, especially in healthcare settings, and to cause severe human illness.
On [22 Sep 2012], the Health Protection Agency (HPA) in London, United Kingdom (UK), confirmed infection with a novel coronavirus in a patient in a London hospital who had been transferred from Qatar 11 days previously. This patient represents the 2nd confirmed case of severe acute respiratory illness caused by this novel coronavirus. The 1st case was identified in a Saudi Arabian national who died in June 2012 [2,3]. We describe the exposure history, the public health response and follow-up of close contacts of the case in London.
Case exposure history and laboratory investigations
The case is a previously well 49-year-old male who travelled to Saudi Arabia from [31 Jul 2012 to 18 Aug 2012], where he and several of his travelling companions developed rhinorrhoea and fever (Figure 1). On [18 Aug 2012], he travelled to Qatar, where his respiratory symptoms resolved 3 days later. While in Qatar, he spent time on a farm, where he keeps camels and sheep, although no direct contact with these animals was reported.
On [3 Sep 2012], he reported a mild respiratory illness. Six days later, he required hospitalisation due to development of bilateral pneumonia. His condition worsened, and he subsequently required intubation and ventilation. On [12 Sep 2012], he was transferred by air ambulance to an intensive care unit in London, where acute renal impairment was also detected. Due to further deterioration, he was transferred to another London hospital on [20 Sep 2012] [3].
Following the report on ProMED-mail on [20 Sep 2012] [2] of the detection of a novel coronavirus (until further taxonomic denomination, herewith referred to as hCoV-EMC) in a Saudi Arabian patient who had died from severe respiratory illness and renal failure, and as no diagnosis had been established despite investigations for common causes of pneumonia and pathogens endemic to the Middle East, the patient in London was investigated for novel coronavirus infection. On [21 Sep 2012], a coronavirus was detected in respiratory tract samples using a pan-coronavirus PCR assay, and on [22 Sep 2012] sequencing of the PCR amplicon showed a sequence very closely related to the hCoV-EMC detected in the earlier patient from Saudi Arabia [4]. The virus belongs to the genus beta-coronavirus, with closest relationship to bat coronaviruses [4].
Figure 1. Timeline of disease and travel history of novel coronavirus case, London, August to September 2012 [available at above URL link]
Public health management
The identification of a novel coronavirus of the same group as the SARS-CoV, with 2 clinically severe human cases including one fatality, led to a public health response being mounted to isolate the case, identify and test close contacts and to prevent onward transmission. Once the patient was found to have a novel coronavirus infection, he was isolated in a negative-pressure single room, and full personal protective equipment (PPE), including gowns, gloves, eye protection and high filtration masks were worn by staff and other contacts. Interim case and close contact definitions were developed [5].
A possible case was defined as: any person with acute respiratory syndrome which includes fever (greater than or equal to 38 C), or history of fever and cough requiring hospitalisation, or with suspicion of lower airway involvement (clinical or radiological evidence of consolidation) not explained by another infection or aetiology with history of either travel to or residence in Saudi Arabia or Qatar, or close contact with a confirmed case in the 10 days before onset of illness.
A close contact was defined as the following:
- Healthcare and social care workers: workers who provided direct clinical or personal care or examination of a symptomatic confirmed case or within close vicinity of an aerosol generating procedure AND who was not wearing full personal protective equipment (PPE) at the time. Full PPE is defined as a correctly fitted high filtration mask (FFP3), gown, gloves and eye protection.
- Household: any person who had prolonged face-to-face contact with the confirmed case(s) any time during the illness after onset in a household setting.
- Other close contacts: any person who had prolonged face-to-face contact with a confirmed case while symptomatic in any other enclosed setting and who was not wearing a mask, e.g. school, visitor to the hospital to the bed side of a symptomatic confirmed case.
These definitions were used as the basis for identifying further possible cases and contacts. Guidelines were developed on the investigation and public health management of these cases and their close contacts.
Identification and follow-up of individuals who had close contact with the case at any time during his symptomatic period from entry into the UK up until implementation of full isolation on [21 Sep 2012] (including healthcare workers and family), was rapidly initiated by HPA staff and staff from the London hospitals' Infection Control Teams. Close contacts were followed up for a period of 10 days from the date of last exposure to the index case. If contacts developed respiratory illness in this period, they were asked to self-isolate in their homes (or were isolated in hospital if requiring admission).
The hospital in Qatar was informed to allow them to initiate appropriate follow-up for those who had been in contact with the patient.
HPA rapidly developed and published advice to health professionals, the public and travellers [5]. The case was immediately reported under the International Health Regulations to the World Health Organisation and through the European Union Early Warning and Response System (EWRS). Extensive laboratory work was undertaken to characterise the virus and develop new diagnostic tools [3].
Initial epidemiological investigation and preliminary findings
Close contacts of the case were followed up to determine the transmissibility of this novel coronavirus. This included collection of information on clinical illness, virological swabbing of contacts who had respiratory symptoms, and collection of paired sera from all contacts to determine whether there was evidence of recent infection.
It is likely that the patient's infection was acquired in Qatar as he was in Qatar for the 16 days prior to the onset of his most recent respiratory illness in September [2012]. The earlier, mild upper respiratory tract infection, which began during his visit to Saudi Arabia, resolved 2 weeks before onset of the present illness.
By [4 Oct 2012], tracing of contacts had identified 64 persons, among healthcare workers, family and friends, who were reported to have been in close contact with the confirmed case while he was symptomatic in the UK (Figure 2). Ten days after the date of last respective exposure, none of the close contacts had developed severe respiratory disease requiring hospital admission. Interim results have identified 13 close healthcare worker contacts with mild, self-limiting respiratory symptoms. These contacts were self-isolated in their homes until asymptomatic. In addition, one hospitalised patient who had potential contact with the case and subsequently became unwell was identified and subsequently tested negative using a pan-coronavirus assay [4]. The novel coronavirus has not been detected in any of the 10 symptomatic healthcare worker contacts tested by [4 Oct 2012].
Four possible cases with a history of recent travel from Saudi Arabia or Qatar have also been identified and investigated in the UK since active case finding commenced. Although the likelihood of novel coronavirus infection in any of these was considered low, strict infection control measures were taken. For 3 of them, samples were available, and the novel coronavirus was not detected. A 4th case, who died at the beginning of September [2012], remains under investigation.
Figure 2. Outcome of close contact follow-up 10 days or more since last exposure to index case with a novel coronavirus infection, London, September 2012 (n=64) [available at above URL link]
Public health implications
We present a case of severe respiratory illness resulting from a novel coronavirus acquired in the Middle East. The clinical picture is similar to that of a case previously described from Saudi Arabia and caused by a closely related virus. Although cases of SARS, for which the causative agent SARS-CoV is in the same group of coronaviruses, were reported with incubation periods beyond 10 days, 95 percent were reported to have an incubation period of less than 10 days [6]. In the light of this finding, the case of novel coronavirus that we report appears to have been acquired in Qatar based on the known time course of the patient's infection and other available information, unless the illness had an unusual biphasic nature or a very long incubation period.
After 10 days of follow-up, there has been no confirmed evidence of ongoing person-to-person transmission resulting in severe disease or milder laboratory confirmed infection among close contacts, despite extensive active contact tracing. Completion of case-contact investigation, including serological testing when available, will determine whether mild or asymptomatic infection among close contacts has occurred. In addition, serological investigation in the countries of origin of the 2 confirmed cases should be considered to look for evidence of possible previous infection in the general population. Studies in animals are also necessary to determine whether there is an animal reservoir for this infection and what it might be.
Early detection and investigation of cases of severe respiratory illness among travellers returning from countries where infection with novel coronavirus has been reported and their close contacts will support the further elucidation of the epidemiological characteristics of this novel virus. An outbreak of severe respiratory illness of unknown aetiology was reported from the Middle East earlier in 2012 [7]. Work needs to be undertaken to determine whether a novel coronavirus has been circulating more widely in the general population in the Middle East already for some time or whether the virus was more recently introduced from an unknown animal reservoir.
References:
1. World Health Organization (WHO). WHO final summary SARS, 15 August 2003: Summary table of SARS cases by country, 1 November 2002 - 7 August 2003. Geneva; WHO; 2003. Available from: http://www.who.int/csr/sars/country/2003_08_15/en/index.html
2. ProMED-mail. Novel coronavirus - Saudi Arabia: human isolate. Archive Number: 20120920.1302733. 20 September 2012. Available from: http://www.promedmail.org/?p=2400:1000
3. Corman VM, Eckerle I, Bleicker T, Zaki A, Landt O, Eschbach-Bludau M, et al. Detection of a novel human coronavirus by real-time reverse-transcription polymerase chain reaction. Euro Surveill. 2012;17(39):pii=20285. Available from: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20285
4. Bermingham A, Chand MA, Brown CS, Aarons E, Tong C, Langrish C, et al. Severe respiratory illness caused by a novel coronavirus, in a patient transferred to the United Kingdom from the Middle East, September 2012. Euro Surveill. 2012;17(40):pii=20290. Available from: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20290
5. Health protection Agency (HPA). Algorithm for investigation and management of possible cases of severe acute respiratory illness associated with a novel coronavirus. London; HPA; 2012. Available from: http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/Page/1317136202637
6. Lessler J, Reich NG, Brookmeyer R, Perl TM, Nelson KE, Cummings DA. Incubation periods of acute respiratory viral infections: a systematic review. Lancet Infect Dis. 2009; 9(5):291-300. [abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/19393959]
7. European Centres for Disease Control (ECDC). Communicable Disease Threats Report (Week 18, 29 April-5 May 2012). Stockholm; ECDC: 2012 Available from: http://ecdc.europa.eu/en/publications/Publications/CDTR%20online%20version%204%20May%202012.pdf
[Reported by: R G Pebody1, M A Chand1, H L Thomas1,2,3, H K Green1, N L Boddington1, C Carvalho1,3, C S Brown1, S R Anderson1, C Rooney1, E Crawley-Boevey1, D J Irwin1, E Aarons4, C Tong4, W Newsholme4, N Price4, C Langrish4, D Tucker4, H Zhao1, N Phin1, J Crofts1, A Bermingham1, E Gilgunn-Jones1, K E Brown1, B Evans1, M Catchpole1, J M Watson1
1. Health Protection Agency (HPA), London, United Kingdom
2. Field Epidemiology Training Programme (FETP), Health Protection Agency, London, United Kingdom
3. European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
4. Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, United Kingdom]
In this update:
[1] UK - HPA investigation findings, Eurosurveillance
[2] UK - Clinical and laboratory findings, Eurosurveillance
[3] Saudi Arabia - ongoing investigations, newswire
[4] USA - current recommendations, MMWR
******
[1] UK - HPA investigation findings, Eurosurveillance
Date: 4 Oct 2012
Source: Eurosurveillance Volume 17, Issue 40, 4 Oct 2012 [edited]
http://eurosurveillance.org/ViewArticle.aspx?ArticleId=20292
Rapid communications
The United Kingdom Public Health response to an imported laboratory confirmed case of a novel coronavirus in September 2012
--------------------------
On [22 Sep 2012], a novel coronavirus, very closely related to that from a fatal case in Saudi Arabia 3 months previously, was detected in a previously well adult transferred to intensive care in London from Qatar with severe respiratory illness. Strict respiratory isolation was instituted. Ten days after last exposure, none of 64 close contacts had developed severe disease, with 13 of 64 reporting mild respiratory symptoms. The novel coronavirus was not detected in 10 of 10 symptomatic contacts tested.
The outbreak of severe acute respiratory syndrome (SARS) in 2003, which led to 8422 cases and 916 deaths worldwide [1], highlighted the potential for newly emerging zoonotic coronaviruses to transmit from person to person, especially in healthcare settings, and to cause severe human illness.
On [22 Sep 2012], the Health Protection Agency (HPA) in London, United Kingdom (UK), confirmed infection with a novel coronavirus in a patient in a London hospital who had been transferred from Qatar 11 days previously. This patient represents the 2nd confirmed case of severe acute respiratory illness caused by this novel coronavirus. The 1st case was identified in a Saudi Arabian national who died in June 2012 [2,3]. We describe the exposure history, the public health response and follow-up of close contacts of the case in London.
Case exposure history and laboratory investigations
The case is a previously well 49-year-old male who travelled to Saudi Arabia from [31 Jul 2012 to 18 Aug 2012], where he and several of his travelling companions developed rhinorrhoea and fever (Figure 1). On [18 Aug 2012], he travelled to Qatar, where his respiratory symptoms resolved 3 days later. While in Qatar, he spent time on a farm, where he keeps camels and sheep, although no direct contact with these animals was reported.
On [3 Sep 2012], he reported a mild respiratory illness. Six days later, he required hospitalisation due to development of bilateral pneumonia. His condition worsened, and he subsequently required intubation and ventilation. On [12 Sep 2012], he was transferred by air ambulance to an intensive care unit in London, where acute renal impairment was also detected. Due to further deterioration, he was transferred to another London hospital on [20 Sep 2012] [3].
Following the report on ProMED-mail on [20 Sep 2012] [2] of the detection of a novel coronavirus (until further taxonomic denomination, herewith referred to as hCoV-EMC) in a Saudi Arabian patient who had died from severe respiratory illness and renal failure, and as no diagnosis had been established despite investigations for common causes of pneumonia and pathogens endemic to the Middle East, the patient in London was investigated for novel coronavirus infection. On [21 Sep 2012], a coronavirus was detected in respiratory tract samples using a pan-coronavirus PCR assay, and on [22 Sep 2012] sequencing of the PCR amplicon showed a sequence very closely related to the hCoV-EMC detected in the earlier patient from Saudi Arabia [4]. The virus belongs to the genus beta-coronavirus, with closest relationship to bat coronaviruses [4].
Figure 1. Timeline of disease and travel history of novel coronavirus case, London, August to September 2012 [available at above URL link]
Public health management
The identification of a novel coronavirus of the same group as the SARS-CoV, with 2 clinically severe human cases including one fatality, led to a public health response being mounted to isolate the case, identify and test close contacts and to prevent onward transmission. Once the patient was found to have a novel coronavirus infection, he was isolated in a negative-pressure single room, and full personal protective equipment (PPE), including gowns, gloves, eye protection and high filtration masks were worn by staff and other contacts. Interim case and close contact definitions were developed [5].
A possible case was defined as: any person with acute respiratory syndrome which includes fever (greater than or equal to 38 C), or history of fever and cough requiring hospitalisation, or with suspicion of lower airway involvement (clinical or radiological evidence of consolidation) not explained by another infection or aetiology with history of either travel to or residence in Saudi Arabia or Qatar, or close contact with a confirmed case in the 10 days before onset of illness.
A close contact was defined as the following:
- Healthcare and social care workers: workers who provided direct clinical or personal care or examination of a symptomatic confirmed case or within close vicinity of an aerosol generating procedure AND who was not wearing full personal protective equipment (PPE) at the time. Full PPE is defined as a correctly fitted high filtration mask (FFP3), gown, gloves and eye protection.
- Household: any person who had prolonged face-to-face contact with the confirmed case(s) any time during the illness after onset in a household setting.
- Other close contacts: any person who had prolonged face-to-face contact with a confirmed case while symptomatic in any other enclosed setting and who was not wearing a mask, e.g. school, visitor to the hospital to the bed side of a symptomatic confirmed case.
These definitions were used as the basis for identifying further possible cases and contacts. Guidelines were developed on the investigation and public health management of these cases and their close contacts.
Identification and follow-up of individuals who had close contact with the case at any time during his symptomatic period from entry into the UK up until implementation of full isolation on [21 Sep 2012] (including healthcare workers and family), was rapidly initiated by HPA staff and staff from the London hospitals' Infection Control Teams. Close contacts were followed up for a period of 10 days from the date of last exposure to the index case. If contacts developed respiratory illness in this period, they were asked to self-isolate in their homes (or were isolated in hospital if requiring admission).
The hospital in Qatar was informed to allow them to initiate appropriate follow-up for those who had been in contact with the patient.
HPA rapidly developed and published advice to health professionals, the public and travellers [5]. The case was immediately reported under the International Health Regulations to the World Health Organisation and through the European Union Early Warning and Response System (EWRS). Extensive laboratory work was undertaken to characterise the virus and develop new diagnostic tools [3].
Initial epidemiological investigation and preliminary findings
Close contacts of the case were followed up to determine the transmissibility of this novel coronavirus. This included collection of information on clinical illness, virological swabbing of contacts who had respiratory symptoms, and collection of paired sera from all contacts to determine whether there was evidence of recent infection.
It is likely that the patient's infection was acquired in Qatar as he was in Qatar for the 16 days prior to the onset of his most recent respiratory illness in September [2012]. The earlier, mild upper respiratory tract infection, which began during his visit to Saudi Arabia, resolved 2 weeks before onset of the present illness.
By [4 Oct 2012], tracing of contacts had identified 64 persons, among healthcare workers, family and friends, who were reported to have been in close contact with the confirmed case while he was symptomatic in the UK (Figure 2). Ten days after the date of last respective exposure, none of the close contacts had developed severe respiratory disease requiring hospital admission. Interim results have identified 13 close healthcare worker contacts with mild, self-limiting respiratory symptoms. These contacts were self-isolated in their homes until asymptomatic. In addition, one hospitalised patient who had potential contact with the case and subsequently became unwell was identified and subsequently tested negative using a pan-coronavirus assay [4]. The novel coronavirus has not been detected in any of the 10 symptomatic healthcare worker contacts tested by [4 Oct 2012].
Four possible cases with a history of recent travel from Saudi Arabia or Qatar have also been identified and investigated in the UK since active case finding commenced. Although the likelihood of novel coronavirus infection in any of these was considered low, strict infection control measures were taken. For 3 of them, samples were available, and the novel coronavirus was not detected. A 4th case, who died at the beginning of September [2012], remains under investigation.
Figure 2. Outcome of close contact follow-up 10 days or more since last exposure to index case with a novel coronavirus infection, London, September 2012 (n=64) [available at above URL link]
Public health implications
We present a case of severe respiratory illness resulting from a novel coronavirus acquired in the Middle East. The clinical picture is similar to that of a case previously described from Saudi Arabia and caused by a closely related virus. Although cases of SARS, for which the causative agent SARS-CoV is in the same group of coronaviruses, were reported with incubation periods beyond 10 days, 95 percent were reported to have an incubation period of less than 10 days [6]. In the light of this finding, the case of novel coronavirus that we report appears to have been acquired in Qatar based on the known time course of the patient's infection and other available information, unless the illness had an unusual biphasic nature or a very long incubation period.
After 10 days of follow-up, there has been no confirmed evidence of ongoing person-to-person transmission resulting in severe disease or milder laboratory confirmed infection among close contacts, despite extensive active contact tracing. Completion of case-contact investigation, including serological testing when available, will determine whether mild or asymptomatic infection among close contacts has occurred. In addition, serological investigation in the countries of origin of the 2 confirmed cases should be considered to look for evidence of possible previous infection in the general population. Studies in animals are also necessary to determine whether there is an animal reservoir for this infection and what it might be.
Early detection and investigation of cases of severe respiratory illness among travellers returning from countries where infection with novel coronavirus has been reported and their close contacts will support the further elucidation of the epidemiological characteristics of this novel virus. An outbreak of severe respiratory illness of unknown aetiology was reported from the Middle East earlier in 2012 [7]. Work needs to be undertaken to determine whether a novel coronavirus has been circulating more widely in the general population in the Middle East already for some time or whether the virus was more recently introduced from an unknown animal reservoir.
References:
1. World Health Organization (WHO). WHO final summary SARS, 15 August 2003: Summary table of SARS cases by country, 1 November 2002 - 7 August 2003. Geneva; WHO; 2003. Available from: http://www.who.int/csr/sars/country/2003_08_15/en/index.html
2. ProMED-mail. Novel coronavirus - Saudi Arabia: human isolate. Archive Number: 20120920.1302733. 20 September 2012. Available from: http://www.promedmail.org/?p=2400:1000
3. Corman VM, Eckerle I, Bleicker T, Zaki A, Landt O, Eschbach-Bludau M, et al. Detection of a novel human coronavirus by real-time reverse-transcription polymerase chain reaction. Euro Surveill. 2012;17(39):pii=20285. Available from: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20285
4. Bermingham A, Chand MA, Brown CS, Aarons E, Tong C, Langrish C, et al. Severe respiratory illness caused by a novel coronavirus, in a patient transferred to the United Kingdom from the Middle East, September 2012. Euro Surveill. 2012;17(40):pii=20290. Available from: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20290
5. Health protection Agency (HPA). Algorithm for investigation and management of possible cases of severe acute respiratory illness associated with a novel coronavirus. London; HPA; 2012. Available from: http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/Page/1317136202637
6. Lessler J, Reich NG, Brookmeyer R, Perl TM, Nelson KE, Cummings DA. Incubation periods of acute respiratory viral infections: a systematic review. Lancet Infect Dis. 2009; 9(5):291-300. [abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/19393959]
7. European Centres for Disease Control (ECDC). Communicable Disease Threats Report (Week 18, 29 April-5 May 2012). Stockholm; ECDC: 2012 Available from: http://ecdc.europa.eu/en/publications/Publications/CDTR%20online%20version%204%20May%202012.pdf
[Reported by: R G Pebody1, M A Chand1, H L Thomas1,2,3, H K Green1, N L Boddington1, C Carvalho1,3, C S Brown1, S R Anderson1, C Rooney1, E Crawley-Boevey1, D J Irwin1, E Aarons4, C Tong4, W Newsholme4, N Price4, C Langrish4, D Tucker4, H Zhao1, N Phin1, J Crofts1, A Bermingham1, E Gilgunn-Jones1, K E Brown1, B Evans1, M Catchpole1, J M Watson1
1. Health Protection Agency (HPA), London, United Kingdom
2. Field Epidemiology Training Programme (FETP), Health Protection Agency, London, United Kingdom
3. European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
4. Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, United Kingdom]
Human SARS Virus Genomic Replikin™ Count Rises to the Level that Preceded the 2003 Lethal SARS Outbreak
Human SARS Virus Genomic Replikin™ Count Rises to the Level that Preceded the 2003 Lethal SARS Outbreak (via PR Newswire)
LONDON, Oct. 5, 2012 /PRNewswire/ -- The identification of the virus responsible for a second case of SARS-like respiratory virus, "London1_novel CoV 2012", has raised concerns over the risk of the disease spreading (1). These concerns may be justified given the observed rise in virus's genomic Replikin…
HPA: Epidemiological protocols and forms for comprehensive assessment of early novel coronavirus cases and their close contacts in the United Kingdom
“The First Few Hundred (FF100)” Enhanced Case and Contact Protocol v3.0
Summary
The epidemiological and virological investigation of the first cases of acute respiratory infection associated with novel coronavirus and their close contacts is essential in order to inform guidance and policy in directing the United Kingdom’s (UK) public health response.
The epidemiological methods to guide data collection for the comprehensive assessment of the “first few hundred cases and their close contacts” are set out in this document. The protocol outlines the investigation of persons with laboratory confirmed novel coronavirus infection, along with their close contacts.
http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317136300809
Summary
The epidemiological and virological investigation of the first cases of acute respiratory infection associated with novel coronavirus and their close contacts is essential in order to inform guidance and policy in directing the United Kingdom’s (UK) public health response.
The epidemiological methods to guide data collection for the comprehensive assessment of the “first few hundred cases and their close contacts” are set out in this document. The protocol outlines the investigation of persons with laboratory confirmed novel coronavirus infection, along with their close contacts.
http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317136300809
Swine flu outbreak in Midwest prompts reminders about safety precautions at SC State Fair
[Please see the right side-bar for more information on H3N2v]
Saturday, Oct. 06, 2012
Saturday, Oct. 06, 2012
South Carolina health officials are taking advantage of
publicity about a new strain of swine flu that sickened hundreds of
people in Indiana and Ohio this summer to remind people to take
precautions while visiting livestock exhibitions.
Avoid petting pigs in those exhibitions, and wash your hands after touching any livestock or their enclosures.
The S.C. State Fair, which opens Wednesday, includes the largest of the dozens of public livestock shows in the state. The State Fair for years has posted warning signs in livestock enclosures about the danger of disease transmission, and hand-washing stations popped up in the barns a few years ago during the last swine flu scare.
-snip-
Humans and pigs both have flu viruses, and usually they don’t affect the other species. But every once in a while a variant develops that can jump from pigs to humans or humans to pigs. A H3N2 variant that popped up last year in pigs began moving to humans this year.
Symptoms in people have been mild, and the variant hasn’t jumped easily from person to person. Spread has been limited to people who have had direct contact with infected pigs. About 305 cases have been confirmed in 10 states, none in the Southeast, according to the Centers for Disease Control and Prevention.
Full article: http://www.thestate.com/2012/10/06/2470272/swine-flu-outbreak-in-midwest.html#.UHAdNxgXqkI
Avoid petting pigs in those exhibitions, and wash your hands after touching any livestock or their enclosures.
The S.C. State Fair, which opens Wednesday, includes the largest of the dozens of public livestock shows in the state. The State Fair for years has posted warning signs in livestock enclosures about the danger of disease transmission, and hand-washing stations popped up in the barns a few years ago during the last swine flu scare.
-snip-
Humans and pigs both have flu viruses, and usually they don’t affect the other species. But every once in a while a variant develops that can jump from pigs to humans or humans to pigs. A H3N2 variant that popped up last year in pigs began moving to humans this year.
Symptoms in people have been mild, and the variant hasn’t jumped easily from person to person. Spread has been limited to people who have had direct contact with infected pigs. About 305 cases have been confirmed in 10 states, none in the Southeast, according to the Centers for Disease Control and Prevention.
Full article: http://www.thestate.com/2012/10/06/2470272/swine-flu-outbreak-in-midwest.html#.UHAdNxgXqkI
Public response to the 2009 influenza A H1N1 pandemic: a polling study in five countries
The Lancet Infectious Diseases, Early Online Publication, 5 October 2012
doi:10.1016/S1473-3099(12)70206-2
Cite or Link Using DOI
Cite or Link Using DOI
Dr Gillian K SteelFisher PhD a 
,
, Summary
Background
Many
important strategies to reduce the spread of pandemic influenza need
public participation. To assess public receptivity to such strategies,
we compared adoption of preventive behaviours in response to the 2009
H1N1 influenza pandemic among the public in five countries and examined
whether certain non-pharmaceutical behaviours (such as handwashing) were
deterrents to vaccination. We also assessed public support for related
public health recommendations.
Methods
We
used data from simultaneous telephone polls (mobile telephone and
landline) in Argentina, Japan, Mexico, the UK, and the USA. In each
country, interviews were done in a nationally representative sample of
adults, who were selected by the use of random digit dial techniques.
The questionnaire asked people whether or not they had adopted each of
various preventive behaviours (non-pharmaceutical—such as personal
protective and social distancing behaviour—or vaccinations) to protect
themselves or their family from H1N1 at any point during the pandemic.
Two-tailed t tests were used for statistical analysis.
Findings
900
people were surveyed in each country except the USA where 911 people
were contacted. There were wide differences in the adoption of
preventive behaviours between countries, although certain personal
protective behaviours (eg, handwashing) were more commonly adopted than
social distancing behaviours (eg, avoiding places where many people
gather) across countries (53—89% vs 11—69%). These
non-pharmaceutical behaviours did not reduce the likelihood of getting
vaccinated in any country. There was also support across all countries
for government recommendations related to school closure, avoiding
places where many people gather, and wearing masks in public.
Interpretation
There
is a need for country-specific approaches in pandemic policy planning
that use both non-pharmaceutical approaches and vaccination.
Funding
US Centers for Disease Control and Prevention and the National Public Health Information Coalition.
EMPRES-i FAO Listing of Low Pathogenic Avian Influenza H5N1 Domestic & Wild Poultry Outbreaks in the U.S. & Mexico Since 2004
From EMPRES-i FAO (Global Animal Disease Information System)
This is a listing of Low Pathogenic Avian Influenza H5N1 Outbreaks in wild and domestic poultry in the United States since 2004.
Click on chart to enlarge:
http://empres-i.fao.org/eipws3g/#h=1
Click on chart to enlarge:
Friday, October 5, 2012
CDC: Persons with Meningitis Linked to Epidural Steroid Injections, by State
Persons with meningitis linked to epidural steroid injections:
Florida: 2 cases
Indiana: 3 cases
Maryland: 2 cases, including 1 death
Michigan: 4 cases
North Carolina: 1 case
Tennessee:29 cases, including 3 deaths
Virginia: 6 cases, including 1 death
http://www.cdc.gov/hai/outbreaks/meningitis-map.html
Multistate Meningitis Outbreak Investigation
October 5, 2012
Summary:
CDC is coordinating a multistate investigation of meningitis among patients who received epidural steroid injections (medication injected into the spine). Several of these patients have had strokes related to the meningitis. In several patients, the meningitis was found to be caused by a fungus that is common in the environment but rarely causes meningitis. This form of meningitis is not contagious. The source of the fungus has not yet been identified, and the cause of infections in the other patients is still being assessed.
Meningitis and Stroke Associated with Potentially Contaminated Product: Health Alert Network (HAN)
[PDF - 207 KB]
Interim Instructions for Clinical Teams Regarding Diagnostic Testing [PDF - 76 -KB]
Interim Treatment Options [PDF - 80 KB]
Additional Federal Agencies Involved: FDA
http://www.cdc.gov/hai/outbreaks/meningitis.html
CDC is coordinating a multistate investigation of meningitis among patients who received epidural steroid injections (medication injected into the spine). Several of these patients have had strokes related to the meningitis. In several patients, the meningitis was found to be caused by a fungus that is common in the environment but rarely causes meningitis. This form of meningitis is not contagious. The source of the fungus has not yet been identified, and the cause of infections in the other patients is still being assessed.
CDC Recommendations for Clinicians:
Meningitis and Stroke Associated with Potentially Contaminated Product: Health Alert Network (HAN)
[PDF - 207 KB]Interim Instructions for Clinical Teams Regarding Diagnostic Testing
[PDF - 76 -KB]Interim Treatment Options
[PDF - 80 KB]Additional Federal Agencies Involved: FDA
Patient Information:
Is the source of the outbreak known?
CDC is investigating medications and products that are associated with this outbreak of meningitis. At this point, there is not enough evidence to determine the original source of the outbreak, however there is a link to an injectable steroid medication. The lots of medication that were given to patients have been recalled by the manufacturer.
What are the states that received the implicated product?
California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Texas, and West Virginia
What is meningitis?
Meningitis refers to inflammation of the protective membranes covering the brain and spinal cord known as the meninges. The inflammation is usually caused by an infection frequently with a bacteria or virus, but meningitis can also be caused by less common pathogens such as fungi. The severity of illness and the treatment for meningitis differ depending on the cause. Thus, it is important to know the specific cause of meningitis.
What is fungal meningitis?
Fungal meningitis occurs when the protective membranes that cover the brain and spinal cord are infected with a fungus. Fungal meningitis can develop after a fungus spreads through the bloodstream from somewhere else in the body, as a result of the fungus being introduced directly into the central nervous system, or by direct extension from an infected body site next to the central nervous system.
Is fungal meningitis common after epidural injections?
Epidural injections are generally very safe procedures, and complications are rare. Fungal meningitis is an extremely rare cause of meningitis overall, including after epidural injections. The type of epidural medication given to patients affected by this outbreak is not the same type of medication as that given to women during childbirth.
What are the symptoms of fungal meningitis?
Symptoms of fungal meningitis are similar to symptoms of other forms of meningitis, however they often appear more gradually and can be very mild at first. In addition to typical meningitis symptoms, like headache, fever, nausea, and stiffness of the neck, people with fungal meningitis may also experience confusion, dizziness, and discomfort from bright lights. Patients might just have one or two of these symptoms.
Is the source of the outbreak known?
CDC is investigating medications and products that are associated with this outbreak of meningitis. At this point, there is not enough evidence to determine the original source of the outbreak, however there is a link to an injectable steroid medication. The lots of medication that were given to patients have been recalled by the manufacturer.
What are the states that received the implicated product?
California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Texas, and West Virginia
What is meningitis?
Meningitis refers to inflammation of the protective membranes covering the brain and spinal cord known as the meninges. The inflammation is usually caused by an infection frequently with a bacteria or virus, but meningitis can also be caused by less common pathogens such as fungi. The severity of illness and the treatment for meningitis differ depending on the cause. Thus, it is important to know the specific cause of meningitis.
What is fungal meningitis?
Fungal meningitis occurs when the protective membranes that cover the brain and spinal cord are infected with a fungus. Fungal meningitis can develop after a fungus spreads through the bloodstream from somewhere else in the body, as a result of the fungus being introduced directly into the central nervous system, or by direct extension from an infected body site next to the central nervous system.
Is fungal meningitis common after epidural injections?
Epidural injections are generally very safe procedures, and complications are rare. Fungal meningitis is an extremely rare cause of meningitis overall, including after epidural injections. The type of epidural medication given to patients affected by this outbreak is not the same type of medication as that given to women during childbirth.
What are the symptoms of fungal meningitis?
Symptoms of fungal meningitis are similar to symptoms of other forms of meningitis, however they often appear more gradually and can be very mild at first. In addition to typical meningitis symptoms, like headache, fever, nausea, and stiffness of the neck, people with fungal meningitis may also experience confusion, dizziness, and discomfort from bright lights. Patients might just have one or two of these symptoms.
U.S. government names SARS a select agent, restricting labs that work on virus
The Centers for Disease Control has added SARS to the list of select agents in the United States, a move designed to try to ensure the virus stays within the confines of highly regulated laboratories.
The addition, which the CDC first proposed over two years ago, was given legal status this week when the revised select agent list was published in the U.S. Federal Registry.
The timing of the move is both ironic and co-incidental.
SARS has faded from view since its frightening outbreak was contained mid-way through 2003. Before the virus was brought under control, however, 32 countries reported a total of 8,422 cases and 916 deaths, according to the World Health Organization.
But there has been a resurgence of SARS talk in the past 10 days or so triggered by the World Health Organization's announcement that a newly discovered coronavirus has killed a Saudi Arabian man and severely sickened a man from Qatar. The Qatari remains in critical condition in a British hospital.
SARS is a member of the coronavirus family.
"Should SARS CoV" - coronavirus - "be intentionally or accidentally introduced into the population of the United States, as evidenced by the 2002-2003 multi-national outbreaks, the consequences could be significant," CDC spokesperson Jason McDonald explained in an emailed response to questions about the motivation for the move.
Adding the SARS virus to this list means only U.S. laboratories registered with the Federal Select Agent Program can work on the virus.
Laboratories that aren't registered with the program but which have samples of the SARS virus or SARS genetic material must either apply for status with the program, transfer that material to a registered laboratory or provide the program with proof that they have destroyed the material.
One of the key figures behind Canada's SARS fight said the move is a wise one.
"I think there's reason to be concerned and reason to be smart about it. And do you have to go to this length? Well, probably," said Dr. Donald Low, chief microbiologist at Toronto's Mount Sinai Hospital.
Mount Sinai, which treated many SARS patients, for a period had a collection of SARS samples under lock and key in special freezers.
"I don't think we have any left now. I think we got rid of all the tissue and everything," Low said, adding the material was incinerated.
Canada was one of the countries worst hit by SARS, with 375 probable and suspected cases and 44 deaths. Most of the cases occurred in Toronto.
Canada does not have a select agent program. In this country, research with the SARS virus and other disease agents is governed by the Human Pathogens and Toxins Act, which was enacted in 2009. It classifies SARS as a "risk group 3 pathogen". More deadly virus such as Ebola are risk group 4.
During the SARS outbreak, infectious disease experts hoped that if they could halt spread in people, they could stop what was clearly an animal virus from establishing itself in the human population. The idea was to put SARS "back in the box."
The theory proved correct. When scientists learned how the virus spread and hospitals learned how to spot SARS cases, a combination of quarantine for people exposed to the virus and protective gear for health-care workers broke the chains of transmission.
But the virus has reappeared three times since SARS was contained, each time the result of a lab accident. At least 13 people - six infected in labs and seven contacts of those lab workers - contracted SARS in three separate lab accidents in the fall of 2003 and spring of 2004. Two of the accidents were in China and the third was in Singapore.
The report on the revisions to the select agent list in the Federal Registry acknowledges that when it first proposed adding SARS, the CDC received a few complaints from universities, public health laboratories and government and commercial facilities.
The critics claimed it would hinder research on the virus, calling the requirements of registering for and complying with the Select Agent Program "an onerous burden."
But other responses supported the move and in the end the CDC pushed on with the proposal. The lethality of the virus - about 11 per cent of cases died - as well as the fact there are no vaccines to stop it or drugs to treat it are among the reasons the CDC cited to support its decision.
The arrival on the scene of a new coronavirus may awaken interest in SARS research. And the move to restrict which labs can work on the virus and under what circumstances may reignite criticism in some quarters of the U.S. research community.
But Dr. Michael Osterholm of the Center for Infectious Diseases Research and Prevention at the University of Minnesota said the emergence of the new virus underscores why it is important to be careful with SARS.
"It just points out that coronaviruses can and will likely return ... including the SARS virus. So I think the attention paid to the coronavirus in general is appropriate," he said.
"It's important that we just not let this virus get out again."
McDonald said CDC records suggest 123 entities in the United States had SARS viruses at some point in time.
Of those, 66 are already registered with the select agent program. Of the remainder, only four still possess SARS coronaviruses. "And we are working with them to get registered with the select agent program."
Despite the fact SARS is on the select agent list, U.S. government regulations do not require researchers who work with the virus to do so in the highest containment setting, BSL4 laboratories. Most SARS research can be done in BSL2 labs, though some more dangerous experiments must be done in BSL3, McDonald said.
http://www.lethbridgeherald.com/world-news/us-government-names-sars-a-select-agent-restricting-labs-that-work-on-virus-20121005.html
Wednesday, October 3, 2012
When New Diseases Emerge, Experts Are Faster On The Uptake
October 3, 2012
Scientists have recently discovered three new human viruses.
One, from the Arabian Peninsula, causes severe pneumonia and kidney failure. Another sent two Missouri farmers to the hospital with severe fatigue and low blood platelets. The third, in central Africa, causes a new kind of hemorrhagic fever.
The most striking thing about all three new viruses is that they were found on the basis of just two or three human cases. That's a long way from where the world was 10 years ago, when another new virus popped up in Asia and quickly went global.
Continued: http://www.npr.org/blogs/health/2012/10/03/162150791/why-experts-can-pounce-on-new-diseases-faster-as-they-emerge
Scientists have recently discovered three new human viruses.
One, from the Arabian Peninsula, causes severe pneumonia and kidney failure. Another sent two Missouri farmers to the hospital with severe fatigue and low blood platelets. The third, in central Africa, causes a new kind of hemorrhagic fever.
The most striking thing about all three new viruses is that they were found on the basis of just two or three human cases. That's a long way from where the world was 10 years ago, when another new virus popped up in Asia and quickly went global.
Continued: http://www.npr.org/blogs/health/2012/10/03/162150791/why-experts-can-pounce-on-new-diseases-faster-as-they-emerge
Tuesday, October 2, 2012
Philippine Airport Officials on Alert After SARS Threat
[We previously reported on the Philippine Health Minister's comments here]
October 2, 2012
Manila: Alarmed by coronavirus, a new strain of virus that causes severe acute respiratory syndrome (SARS), Philippine health department ordered authorities to revive machines that monitor temperatures of people who arrive at air and sea ports nationwide, a senior official said.
October 2, 2012
Manila: Alarmed by coronavirus, a new strain of virus that causes severe acute respiratory syndrome (SARS), Philippine health department ordered authorities to revive machines that monitor temperatures of people who arrive at air and sea ports nationwide, a senior official said.
“The department of health is
watching coronavirus closely because it’s a SARS-like virus,” explained
Abigail Valte, deputy presidential spokesperson.
“A team from the Bureau of
Quarantine is also on alert for any possible illnesses that may be
carried by (Filipino) citizens or tourists who come to the country,”
said Valte, adding, “We have dealt with illnesses like that [in the
past].”
But the World Health
Organization (WHO) has not advised special screening of temperature of
people arriving at air and seaports as a measure to contain the spread
of coronavirus.
Continued: http://gulfnews.com/news/world/philippines/philippine-airport-officials-on-alert-after-sars-threat-1.1083847
Continued: http://gulfnews.com/news/world/philippines/philippine-airport-officials-on-alert-after-sars-threat-1.1083847
Monday, October 1, 2012
A new rhabdovirus from a patient with hemorrhagic fever
1 October 2012
Hemorrhagic
fevers are among the most graphic viral diseases, inspiring movies,
novels, and a general fear of infection. They are characterized by an
abrupt onset and a striking clinical course involving bleeding from the
nose and mouth, vomiting with blood, and bloody diarrhea. The most
famous hemorrhagic fevers are produced by infection with filoviruses
like Ebola virus, but members of three other viral families – Arenaviridae, Bunyaviridae, and Flaviviridae
– can also cause this syndrome. The isolation of a novel rhabdovirus
from an African with hemorrhagic fever suggests that members of a fifth
viral family can also cause this disease.
Three cases of hemorrhagic fever that occurred in the spring of 2009 were noteworthy because none of the typical viral suspects could be detected in one patient. Two were young (13, 15 year old) students in the village of Mangala, Bas-Congo province, Democratic Republic of Congo. They lived near each other and went to the same school. Both arrived at the local health center with typical symptoms of hemorrhagic fever, and both died 2-3 days later. The third case was a 32 year old male nurse at the health center who was involved in the care of the other two patients. He developed symptoms of hemorrhagic fever but recovered within a few days.
Deep sequence analysis of RNA extracted from the serum of patient #3 revealed the presence of a novel rhabdovirus, provisionally named Bas-Congo virus (BASV). Phylogenetic analyses reveal that BASV is substantially diverged from the two main human rhabdoviruses, rabies virus and Chandipura virus (ten of the 160 known species of rhabdoviruses have been isolated from humans). BASV is more related to viruses of the Tibrogargan group and the Ephemerovirus genus, which contain arthropod-borne viruses that infect cattle, but clusters separately in an independent branch of the phylogenetic tree.
Continued:
http://www.virology.ws/2012/10/01/a-new-rhabdovirus-from-a-patient-with-hemorrhagic-fever/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+VirologyBlog+%28virology+blog%29&utm_content=Google+Reader
Hemorrhagic
fevers are among the most graphic viral diseases, inspiring movies,
novels, and a general fear of infection. They are characterized by an
abrupt onset and a striking clinical course involving bleeding from the
nose and mouth, vomiting with blood, and bloody diarrhea. The most
famous hemorrhagic fevers are produced by infection with filoviruses
like Ebola virus, but members of three other viral families – Arenaviridae, Bunyaviridae, and Flaviviridae
– can also cause this syndrome. The isolation of a novel rhabdovirus
from an African with hemorrhagic fever suggests that members of a fifth
viral family can also cause this disease.Three cases of hemorrhagic fever that occurred in the spring of 2009 were noteworthy because none of the typical viral suspects could be detected in one patient. Two were young (13, 15 year old) students in the village of Mangala, Bas-Congo province, Democratic Republic of Congo. They lived near each other and went to the same school. Both arrived at the local health center with typical symptoms of hemorrhagic fever, and both died 2-3 days later. The third case was a 32 year old male nurse at the health center who was involved in the care of the other two patients. He developed symptoms of hemorrhagic fever but recovered within a few days.
Deep sequence analysis of RNA extracted from the serum of patient #3 revealed the presence of a novel rhabdovirus, provisionally named Bas-Congo virus (BASV). Phylogenetic analyses reveal that BASV is substantially diverged from the two main human rhabdoviruses, rabies virus and Chandipura virus (ten of the 160 known species of rhabdoviruses have been isolated from humans). BASV is more related to viruses of the Tibrogargan group and the Ephemerovirus genus, which contain arthropod-borne viruses that infect cattle, but clusters separately in an independent branch of the phylogenetic tree.
Continued:
http://www.virology.ws/2012/10/01/a-new-rhabdovirus-from-a-patient-with-hemorrhagic-fever/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+VirologyBlog+%28virology+blog%29&utm_content=Google+Reader
Killers on the loose: the deadly viruses that threaten human survival
Could the next big animal-human disease wipe us out?
Excerpt:
The Next Big One is a subject that disease scientists around the world often address. The most recent big one is Aids, of which the eventual total bigness cannot even be predicted – about 30 million deaths, 34 million living people infected, and with no end in sight. Fortunately, not every virus goes airborne from one host to another. If HIV-1 could, you and I might already be dead. If the rabies virus could, it would be the most horrific pathogen on the planet. The influenzas are well adapted for airborne transmission, which is why a new strain can circle the world within days. The Sars virus travels this route, too, or anyway by the respiratory droplets of sneezes and coughs – hanging in the air of a hotel corridor, moving through the cabin of an aeroplane – and that capacity, combined with its case fatality rate of almost 10%, is what made it so scary in 2003 to the people who understood it best.
A worker disinfects a poultry farm in China after an outbreak of the
deadly H5N1 strain of bird flu in 2006. Photograph: China Photos/Getty
Images
Human-to-human transmission is the crux. That capacity is what separates a bizarre, awful, localised, intermittent and mysterious disease (such as Ebola) from a global pandemic. Have you noticed the persistent, low-level buzz about avian influenza, the strain known as H5N1, among disease experts over the past 15 years? That's because avian flu worries them deeply, though it hasn't caused many human fatalities. Swine flu comes and goes periodically in the human population (as it came and went during 2009), sometimes causing a bad pandemic and sometimes (as in 2009) not so bad as expected; but avian flu resides in a different category of menacing possibility. It worries the flu scientists because they know that H5N1 influenza is extremely virulent in people, with a high lethality. As yet, there have been a relatively low number of cases, and it is poorly transmissible, so far, from human to human. It'll kill you if you catch it, very likely, but you're unlikely to catch it except by butchering an infected chicken. But if H5N1 mutates or reassembles itself in just the right way, if it adapts for human-to-human transmission, it could become the biggest and fastest killer disease since 1918.
It got to Egypt in 2006 and has been especially problematic for that country. As of August 2011, there were 151 confirmed cases, of which 52 were fatal. That represents more than a quarter of all the world's known human cases of bird flu since H5N1 emerged in 1997. But here's a critical fact: those unfortunate Egyptian patients all seem to have acquired the virus directly from birds. This indicates that the virus hasn't yet found an efficient way to pass from one person to another.
Two aspects of the situation are dangerous, according to biologist Robert Webster. The first is that Egypt, given its recent political upheavals, may be unable to staunch an outbreak of transmissible avian flu, if one occurs. His second concern is shared by influenza researchers and public health officials around the globe: with all that mutating, with all that contact between people and their infected birds, the virus could hit upon a genetic configuration making it highly transmissible among people.
"As long as H5N1 is out there in the world," Webster told me, "there is the possibility of disaster… There is the theoretical possibility that it can acquire the ability to transmit human-to-human." He paused. "And then God help us."
We're unique in the history of mammals. No other primate has ever weighed upon the planet to anything like the degree we do. In ecological terms, we are almost paradoxical: large-bodied and long-lived but grotesquely abundant. We are an outbreak.
And here's the thing about outbreaks: they end. In some cases they end after many years, in others they end rather soon. In some cases they end gradually, in others they end with a crash. In certain cases, they end and recur and end again. Populations of tent caterpillars, for example, seem to rise steeply and fall sharply on a cycle of anywhere from five to 11 years. The crash endings are dramatic, and for a long while they seemed mysterious. What could account for such sudden and recurrent collapses? One possible factor is infectious disease, and viruses in particular.
The dangers presented by zoonoses are real and severe, but the degree of uncertainties is also high. There's not a hope in hell, as Webster told me, of predicting the nature and timing of the next influenza pandemic. Too many factors vary randomly.
I have asked not just Webster, but many other eminent disease scientists the same two-part question: 1) will a new disease emerge, in the near future, sufficiently virulent and transmissible to cause a pandemic on the scale of Aids or the 1918 flu, killing tens of millions of people?; and 2) if so, what does it look like and whence does it come? Their answers to the first part have ranged from maybe to probably. Their answers to the second have focused on various viruses prone to mutation, especially those for which the reservoir host is some kind of primate.
But the difficulty of predicting precisely doesn't oblige us to remain blind, unprepared and fatalistic. We can at least be vigilant; we can be well prepared and quick to respond. The scientists are on alert. They are our sentries. But we, too, should understand in some measure the basic outlines and dynamics of the situation. We should appreciate that these recent outbreaks of new diseases, as well as the recurrence and spread of old ones, are part of a larger pattern, and that humanity is responsible for generating that pattern. We should recognise that they reflect things that we're doing, not just things that are happening to us.
Link to complete article: http://www.guardian.co.uk/society/2012/sep/28/deadly-viruses-ebola-marburg-sars?newsfeed=true
Excerpt:
The Next Big One is a subject that disease scientists around the world often address. The most recent big one is Aids, of which the eventual total bigness cannot even be predicted – about 30 million deaths, 34 million living people infected, and with no end in sight. Fortunately, not every virus goes airborne from one host to another. If HIV-1 could, you and I might already be dead. If the rabies virus could, it would be the most horrific pathogen on the planet. The influenzas are well adapted for airborne transmission, which is why a new strain can circle the world within days. The Sars virus travels this route, too, or anyway by the respiratory droplets of sneezes and coughs – hanging in the air of a hotel corridor, moving through the cabin of an aeroplane – and that capacity, combined with its case fatality rate of almost 10%, is what made it so scary in 2003 to the people who understood it best.
A worker disinfects a poultry farm in China after an outbreak of the
deadly H5N1 strain of bird flu in 2006. Photograph: China Photos/Getty
Images
Human-to-human transmission is the crux. That capacity is what separates a bizarre, awful, localised, intermittent and mysterious disease (such as Ebola) from a global pandemic. Have you noticed the persistent, low-level buzz about avian influenza, the strain known as H5N1, among disease experts over the past 15 years? That's because avian flu worries them deeply, though it hasn't caused many human fatalities. Swine flu comes and goes periodically in the human population (as it came and went during 2009), sometimes causing a bad pandemic and sometimes (as in 2009) not so bad as expected; but avian flu resides in a different category of menacing possibility. It worries the flu scientists because they know that H5N1 influenza is extremely virulent in people, with a high lethality. As yet, there have been a relatively low number of cases, and it is poorly transmissible, so far, from human to human. It'll kill you if you catch it, very likely, but you're unlikely to catch it except by butchering an infected chicken. But if H5N1 mutates or reassembles itself in just the right way, if it adapts for human-to-human transmission, it could become the biggest and fastest killer disease since 1918.
It got to Egypt in 2006 and has been especially problematic for that country. As of August 2011, there were 151 confirmed cases, of which 52 were fatal. That represents more than a quarter of all the world's known human cases of bird flu since H5N1 emerged in 1997. But here's a critical fact: those unfortunate Egyptian patients all seem to have acquired the virus directly from birds. This indicates that the virus hasn't yet found an efficient way to pass from one person to another.
Two aspects of the situation are dangerous, according to biologist Robert Webster. The first is that Egypt, given its recent political upheavals, may be unable to staunch an outbreak of transmissible avian flu, if one occurs. His second concern is shared by influenza researchers and public health officials around the globe: with all that mutating, with all that contact between people and their infected birds, the virus could hit upon a genetic configuration making it highly transmissible among people.
"As long as H5N1 is out there in the world," Webster told me, "there is the possibility of disaster… There is the theoretical possibility that it can acquire the ability to transmit human-to-human." He paused. "And then God help us."
We're unique in the history of mammals. No other primate has ever weighed upon the planet to anything like the degree we do. In ecological terms, we are almost paradoxical: large-bodied and long-lived but grotesquely abundant. We are an outbreak.
And here's the thing about outbreaks: they end. In some cases they end after many years, in others they end rather soon. In some cases they end gradually, in others they end with a crash. In certain cases, they end and recur and end again. Populations of tent caterpillars, for example, seem to rise steeply and fall sharply on a cycle of anywhere from five to 11 years. The crash endings are dramatic, and for a long while they seemed mysterious. What could account for such sudden and recurrent collapses? One possible factor is infectious disease, and viruses in particular.
The dangers presented by zoonoses are real and severe, but the degree of uncertainties is also high. There's not a hope in hell, as Webster told me, of predicting the nature and timing of the next influenza pandemic. Too many factors vary randomly.
I have asked not just Webster, but many other eminent disease scientists the same two-part question: 1) will a new disease emerge, in the near future, sufficiently virulent and transmissible to cause a pandemic on the scale of Aids or the 1918 flu, killing tens of millions of people?; and 2) if so, what does it look like and whence does it come? Their answers to the first part have ranged from maybe to probably. Their answers to the second have focused on various viruses prone to mutation, especially those for which the reservoir host is some kind of primate.
But the difficulty of predicting precisely doesn't oblige us to remain blind, unprepared and fatalistic. We can at least be vigilant; we can be well prepared and quick to respond. The scientists are on alert. They are our sentries. But we, too, should understand in some measure the basic outlines and dynamics of the situation. We should appreciate that these recent outbreaks of new diseases, as well as the recurrence and spread of old ones, are part of a larger pattern, and that humanity is responsible for generating that pattern. We should recognise that they reflect things that we're doing, not just things that are happening to us.
Link to complete article: http://www.guardian.co.uk/society/2012/sep/28/deadly-viruses-ebola-marburg-sars?newsfeed=true
Sunday, September 30, 2012
WHO: Revised interim case definition – novel coronavirus
Interim case definition as of 29 September 2012
If the respiratory disease is unexplained, appropriate clinical specimens should be sent for laboratory investigation. Rapid progress has been made in the characterization of the novel coronavirus, and in the development of sensitive and specific diagnostic assays. WHO is collaborating with partner laboratories to make these available as quickly as possible. It is anticipated that the first batch of reagents, together with information and testing algorithms, will be available for urgent testing within the coming days.
Until then, WHO is able to provide contact information of laboratories willing and able to test for the presence of the novel coronavirus. For further details, national authorities should contact their respective International Health Regulations Contact Point at their WHO Regional Office.
Appropriate infection control measures should be instituted while the patient is under investigation. Should Member States require further guidance on Infection Prevention and Control, please refer to WHO interim guidelines on Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care (WHO/CDS/EPR/2007.6).
If laboratory data, including histopathological examination of fatal cases, cannot be obtained because the patient has died before specimens are taken, clinical specimens cannot otherwise be obtained, or appropriate laboratory testing for other pathogens is not available, then the patient may meet criteria for “Probable Case” as defined below.
* Currently, these areas would include only Qatar and Saudi Arabia (as of 29 September 2012).
** Close contact includes:
Case finding and classification scheme for Severe Acute Respiratory Infections associated with novel coronavirus infection:
The following scheme is recommended for identifying cases that should be tested for infection with the novel coronavirus recently described. The goals of this scheme are to ensure a systematic approach to appropriate identification and investigation of patients who may be infected with the virus without overburdening health care systems with unnecessary testing. It should be noted that this information was developed based on data from two confirmed cases and as such some degree of clinical judgment is required where individual cases are concerned.Patients to be investigated (referred to as “Patient Under Investigation”):
- A person with an acute respiratory infection, which may include fever (≥ 38°C , 100.4°F) and cough; AND
- suspicion of pulmonary parenchymal disease (e.g. pneumonia or Acute Respiratory Distress Syndrome (ARDS)) based on clinical or radiological evidence of consolidation; AND
- travel to or residence in an area where infection with novel coronavirus has recently been reported or where transmission could have occurred;* AND
- not already explained by any other infection or aetiology, including all clinically indicated tests for community-acquired pneumonia according to local management guidelines.
Management of Patients Under Investigation:
Patients falling into this category should undergo routinely available laboratory tests as clinically indicated according to local management guidelines for Community-Acquired Pneumonia to determine the presence of other potential primary aetiologies of pneumonia. Examples of other aetiologies might include streptococcus pneumoniae, hemophilus influenza type B, legionella pneumophila, other recognized primary bacterial pneumonias, influenza, and respiratory syncytial virus. It is not necessary to wait for all test results for other pathogens to be available before testing for novel coronavirus. In addition, patients with a clear history and clinical presentation consistent with chemical pneumonitis or smoke inhalation should not be considered as a patient under investigation.If the respiratory disease is unexplained, appropriate clinical specimens should be sent for laboratory investigation. Rapid progress has been made in the characterization of the novel coronavirus, and in the development of sensitive and specific diagnostic assays. WHO is collaborating with partner laboratories to make these available as quickly as possible. It is anticipated that the first batch of reagents, together with information and testing algorithms, will be available for urgent testing within the coming days.
Until then, WHO is able to provide contact information of laboratories willing and able to test for the presence of the novel coronavirus. For further details, national authorities should contact their respective International Health Regulations Contact Point at their WHO Regional Office.
Appropriate infection control measures should be instituted while the patient is under investigation. Should Member States require further guidance on Infection Prevention and Control, please refer to WHO interim guidelines on Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care (WHO/CDS/EPR/2007.6).
Management of case contacts
Any person who has had close contact** with a probable or confirmed case while the probable or confirmed case was ill should be carefully monitored for the appearance of respiratory symptoms. If symptoms develop with the first 10 days following the contact, the individual should be considered a “Patient Under Investigation” regardless of the severity of illness and investigated accordingly.If laboratory data, including histopathological examination of fatal cases, cannot be obtained because the patient has died before specimens are taken, clinical specimens cannot otherwise be obtained, or appropriate laboratory testing for other pathogens is not available, then the patient may meet criteria for “Probable Case” as defined below.
Case definitions for reporting
Probable Case
- A person fitting the definition above of a “Patient Under Investigation” with clinical, radiological, or histopathological evidence of pulmonary parenchyma disease (e.g. pneumonia or ARDS) but no possibility of laboratory confirmation either because the patient or samples are not available or there is no testing available for other respiratory infections, AND
- close contact** with a laboratory confirmed case, AND
- not already explained by any other infection or aetiology, including all clinically indicated tests for community-acquired pneumonia according to local management guidelines.
Confirmed Case
A person with laboratory confirmation of infection with the novel coronavirus.Reporting:
WHO requests that probable and confirmed cases be reported within 24 hours of being classified as such, through the regional focal point for International Health Regulations at the appropriate WHO Regional Office.* Currently, these areas would include only Qatar and Saudi Arabia (as of 29 September 2012).
** Close contact includes:
- anyone who provided care for the patient including a health care worker or family member, or had other similarly close physical contact;
- anyone who stayed at the same place (e.g. lived with, visited) as a probable or confirmed case while the case was symptomatic.
Seasonal Influenza vs. Variant Influenza
This is last weeks chart of the Seasonal Influenza thru the CDC. To view the weekly stats of our seasonal flu (chart below), click on the category in the right side bar entitled: "Worldwide Update on Influenza Activity". In the chart below, the 2009 H1N1 is our seasonal H1N1 from the pandemic in 2009. The A(H3) is part of our seasonal flu, and therefore part of the flu shot that you receive. I don't know what would be in the A (Subtyping not performed) statistic below, and the B is also part of our normal Seasonal Flu, and covered in our yearly flu shots.
As part of the reorganization of this blog.I have simplified the page. Specifically, the right side-bar has been organized to categorize the influenza strains that post a danger that are not part of our weekly seasonal influenza surveillance. Note the list of influenza's. They are all found on the right side-bar of this blog. You can read about them and familiarize yourself with them.
As part of the reorganization of this blog.I have simplified the page. Specifically, the right side-bar has been organized to categorize the influenza strains that post a danger that are not part of our weekly seasonal influenza surveillance. Note the list of influenza's. They are all found on the right side-bar of this blog. You can read about them and familiarize yourself with them.
- Coronavirus - This new coronavirus has been laboratory confirmed in only two cases globally to date: both occurred between July - September 2012. Tranmission appears to be very limited as, if it were very contagious, we would have expected to have seen more cases in other countries or the people caring for these two cases, the first of which occurred over three months ago.
- H1N1 Ontario - The H1N1 variant influenza virus (H1N1v) is a non-human influenza virus that normally circulates in animals and rarely infects humans. When these viruses infect humans, they are termed “variant” viruses.
The H1N1v virus doesn't spread easily from swine to people—and even less easily from person to person. In most cases, the virus causes only mild illness in people. Currently the human case in Ontario is in critical condition. - H1N1v - A recently adopted naming convention for viruses that commonly circulate in swine uses a “v” (for “variant”) when these viruses infect humans, regardless of whether the virus contains the 2009 H1N1 M gene. Following this convention, the Wisconsin virus will be called H1N1v. The virus identified in Wisconsin has genes from avian, swine and human influenza viruses, making it a so-called “triple reassortant” (tr) virus. Triple reassortant viruses have been circulating in U.S. swine since the 1990s. However the virus detected in Wisconsin is different from earlier triple reassortant influenza A H1N1 viruses in swine (tr-H1N1) in that it has acquired the matrix [M] gene) from the 2009 influenza A (H1N1) virus.
- H3N2v - This genetic change (acquisition of the 2009 H1N1 virus matrix [M] gene) has been seen in triple reassortant H3N2 viruses that have infected 12 people since August 2011. (These cases occurred in West Virginia (2), Indiana (2), Pennsylvania (3), Maine (2), and Iowa (3).) These variant H3N2 viruses are being called “H3N2v.”
- H5N1 - When humans become ill with H5N1 virus infection, severe illness and death may occur. Sporadic human cases mainly occur after contact with infected poultry that were sick or dead, and have been reported in 15 countries. H5N1 influenza viruses have been circulating among birds for many years, some are highly pathogenic, and infections in humans are uncommon. There have been no recent changes that pose any additional risk to humans.
- H5N1 Clade 2.3.2.1 - Over time, H5N1 viruses have evolved into different groups, called “clades.” Since 2007, 12 different clades of H5N1 viruses have been identified. The FAO report and subsequent media stories focused on an H5N1 virus that has been given a nomenclature (name) of “clade 2.3.2.1”. The clade 2.3.2.1 viruses are very active viruses and are spreading more widely in poultry and wild birds. While this increases the possibility of human exposures to infected birds or poultry, it does not increase their ability to infect and transmit between people. However, as part of the U.S. government’s pandemic preparedness activities, a 2.3.2.1 vaccine virus candidate to protect humans against this virus already has been created so that vaccine production could begin rapidly if this virus were to change to infect humans and spread easily from person to person. The vaccine virus candidate is an exact match to currently circulating 2.3.2.1 viruses.
- Worldwide Update on Influenza Activity - weekly updates on the World's Influenza Activity are to be found here. The chart above, in this post, can be found at this link.
Recombinomics: Human Betacoronavirus 2c EMC/12 - Human SARS CoV Match
September 28, 2012
The Ron Fouchier Viroscience lab at the Erasmus Medical Centef has released the complete sequence (30118 BP) of an isolate, Human betacoronavirus 2c EMC/2012, from the recent fatal case (60M) from Saudi Arabia (at Genbank). The lab is to be congratulated for its rapid release of this important sequence.
Earlier the Health Protection agency had released a 208 BP fragment from a case from Qatar (47M requiring an ECO machine for breathing), which was 99.5% identical to the above sequence, confirming the emergence of a novel human cornavirus from group 2c, which was most closely related to bat coronavirus sequences from isolates from Guangdong Province. The full sequence was also most closely related to these group 2c bat isolates, which is incorporated in the name assigned to the isolate by the Fouchier lab.
The group 2c coronaviruses are distinct for the human SARS CoV, which maps to group 2b. However, coronavirus rapidly evolve via homologous recombination and portions of genes show regions of identity of high homology with coronavirus segments from other species or phylogenetic groups.
An example of this type of homology is seen for positions 14628-14656 which match to the polymerase gene in pp1a, where 28 of the 29 positions match human SARS CoV (see list here).
Correction: The above match is with human HKU-1, which is from group 2a. Example with human SARS Cov (group 2b) here (24/25 matches at positions 15475-15499).
The rapid evolution via recombination with sequence present in human SARS CoV raise concerns of human adaptation and species jumping of a novel coronavirus which produces severe and fatal disease in humans.
http://www.recombinomics.com/News/09281201/Beta_CoV_SARS.html
The Ron Fouchier Viroscience lab at the Erasmus Medical Centef has released the complete sequence (30118 BP) of an isolate, Human betacoronavirus 2c EMC/2012, from the recent fatal case (60M) from Saudi Arabia (at Genbank). The lab is to be congratulated for its rapid release of this important sequence.
Earlier the Health Protection agency had released a 208 BP fragment from a case from Qatar (47M requiring an ECO machine for breathing), which was 99.5% identical to the above sequence, confirming the emergence of a novel human cornavirus from group 2c, which was most closely related to bat coronavirus sequences from isolates from Guangdong Province. The full sequence was also most closely related to these group 2c bat isolates, which is incorporated in the name assigned to the isolate by the Fouchier lab.
The group 2c coronaviruses are distinct for the human SARS CoV, which maps to group 2b. However, coronavirus rapidly evolve via homologous recombination and portions of genes show regions of identity of high homology with coronavirus segments from other species or phylogenetic groups.
An example of this type of homology is seen for positions 14628-14656 which match to the polymerase gene in pp1a, where 28 of the 29 positions match human SARS CoV (see list here).
Correction: The above match is with human HKU-1, which is from group 2a. Example with human SARS Cov (group 2b) here (24/25 matches at positions 15475-15499).
The rapid evolution via recombination with sequence present in human SARS CoV raise concerns of human adaptation and species jumping of a novel coronavirus which produces severe and fatal disease in humans.
http://www.recombinomics.com/News/09281201/Beta_CoV_SARS.html
A Few Older Articles on the H3N2v
[These are older articles, that I am discovering today. All boding is mine]
http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/aug1012serology.html
CDC: (I'll put this over on the right side-bar for future reference):
Influenza A (H3N2) Variant Virus Outbreaks
Continued with links to many resources.
http://www.cdc.gov/flu/swineflu/h3n2v-outbreak.htm
Study: Children, middle-aged most vulnerable to variant H3N2
CIDRAP: Robert RoosNews Editor
Aug 10, 2012 (CIDRAP News) – A serologic study from Canada suggests that children and middle-aged adults have little or no immunity to the swine-origin variant H3N2 influenza virus (H3N2v), but about half of adolescents and young adults have some degree of immunity as measured by antibody levels.
The researchers also found that seasonal flu vaccines used in the past two seasons did not improve participants' ability to mount an immune response to H3N2v. Their report was published this week in the Journal of Infectious Diseases.Given the results, "A specific vaccine would be needed in the event A(H3N2)v establishes epidemic spread," says the study, which was led by Danuta M. Sowronski, MD, of the British Columbia Centre for Disease Control as first author.-snip-
The CDC has prepared a candidate vaccine for the novel virus, and clinical trials are expected this fall.
A CDC expert, Jacqueline Katz, PhD, said the Canadian findings generally agree with previous smaller studies conducted by her agency and a group in Norway. But she said the study is much larger and offers greater insight into the age-related differences in seroprotection against H3N2v. Katz is chief of the immunology and pathogenesis branch of the CDC's Influenza Division.
"Overall, the three studies agree that there is negligible cross-reactive antibody to the H3N2v virus detected in younger children," Katz said. The work also confirms previous findings that seasonal trivalent flu vaccine containing an H3N2 strain does not trigger much of a cross-reactive response to the novel virus, she added."What's novel about Skowronski's study is it's the largest to date and had the ability to look more closely at different age groups," she said. "They have quite an interesting finding that middle-aged adults, ages 40 to 69, show a substantial reduction in the level of cross-reactive antibody compared with younger adults."The Norwegian study had a similar finding, but in a tighter age-group of adults, she said, adding that further research is warranted to try to find an explanation for the phenomenon.Katz concurred with the Canadian team's suggestion that different childhood exposures may be a reason for the age-related differences in seroprotection."It may be that that particular group [middle-aged adults] had a different exposure, that they saw an earlier H3N2 virus for the first time, and didn't have the same robustness of response to the viruses from the 1990s that are closest to the H3N2v strain," she said. "We're interested in looking into that a little more.""When you do genetic and antigenic analysis, you can see that viruses from the early 1990s are genetically most closely related to the hemagglutinin of the H3N2 variant viruses," Katz said. "So it does make sense that individuals who were of an age to be exposed to those in the early 1990s and made a robust response may have the highest cross-reactive antibody response to the variant strain."
CDC: (I'll put this over on the right side-bar for future reference):
Influenza A (H3N2) Variant Virus Outbreaks
Since July 2012, there have been outbreaks of H3N2 variant viruses with the matrix (M) gene from the 2009 H1N1 pandemic virus in multiple U.S. states. Investigations into H3N2v cases indicate that the main risk factor for infection is prolonged exposure to pigs, mostly in fair settings. Found in U.S. pigs in 2010 and humans in July 2011, this virus appears to spread more easily from pigs to people than other variant viruses. Though limited person-to-person spread with this virus has occurred, no sustained community spread of H3N2v has been detected at this time. Associated illness so far has been mostly mild with symptoms similar to seasonal flu and most cases have occurred in children who have little immunity against this virus. Like seasonal flu, however, serious illness, resulting in hospitalization and death is possible. People at high risk of serious complications from H3N2v include children younger than 5, people with certain chronic conditions like asthma, diabetes, heart disease, weakened immune systems, pregnant women and people 65 years and older. These people are urged to avoid pigs and pig arenas at fairs this season. The Centers for Disease Control and Prevention (CDC) is working with states to respond to these outbreaks and continues to monitor the situation closely.
Continued with links to many resources.
http://www.cdc.gov/flu/swineflu/h3n2v-outbreak.htm
A Research Project on the H3N2 strain that's part of this years Seasonal Flu Shot
These are snippets regarding the H3N2 strain that is incorporated in this years Seasonal Vaccine (flu shot). It is not to be confused with the H3N2v, which you can read up on, from documents located on the right side-bar. All editing below is mine.
FDA U.S. Food & Drug Administration News Release:
And lastly, this piece from the Clinical Virology Symposim, April 2012:
FDA U.S. Food & Drug Administration News Release:
The H3N2 information starts on Slide 18 of 65FDA approves vaccines for the 2012-2013 influenza season
The U.S. Food and Drug Administration announced today that it has approved the 2012-2013 influenza (flu) vaccine formulation for all six manufacturers licensed to produce and distribute the vaccines in the United States.Each year experts from the FDA, the World Health Organization, the Centers for Disease Control and Prevention (CDC), and other public health experts study influenza virus samples and global disease patterns to identify virus strains likely to cause the most illness during the upcoming flu season.Based on that information and the recommendations of the FDA’s Vaccines and Related Biological Products Advisory Committee, the strains selected for inclusion in the 2012-2013 flu vaccines are:
- A/California/7/2009 (H1N1)-like virus
- A/Victoria/361/2011 (H3N2)-like virus
- B/Wisconsin/1/2010-like virus.
The manufacturers licensed to produce the nation’s 2012-2013 flu vaccines and the brand names of the vaccines for the upcoming flu season are:http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm315365.htm
- Afluria, manufactured by CSL Limited;
- Fluarix, manufactured by GlaxoSmithKline Biologicals;
- FluLaval, manufactured by ID Biomedical Corporation;
- FluMist, manufactured by MedImmune Vaccines Inc.;
- Fluvirin, manufactured by Novartis Vaccines and Diagnostics Limited; and
- Fluzone, Fluzone High-Dose and Fluzone Intradermal, manufactured by Sanofi Pasteur.
Influenza A(H3N2) virus activity, September 2011 - January 2012 (posted 17 February 2012)
page 37:
http://tinyurl.com/9qjg62n
And lastly, this piece from the Clinical Virology Symposim, April 2012:
DETECTION OF ANTIGENIC DRIFT AMONG RECENT INFLUENZA A H3N2 VIRUSES THROUGH VIROLOGIC SURVEILLANCE
Wendy Sessions, Angie Foust, Lizheng Guo, Rebecca Garten, John Barnes, Kyung Park, Elisabeth Blanchard, Teresa Wallis, Henrietta Hall, Thomas Rowe, Jan Mabry, Alexander Klimov, and Xiyan XuVirus Surveillance and Diagnosis Branch, Influenza Division, Centers for Disease Control and PreventionInfluenza A H3N2 viruses first appeared in humans in 1968 and since then have co-circulated along with influenza A H1N1 (seasonal or pdm09) and influenza B. The H3N2 subtype has been associated with significant morbidity and mortality compared to the other human influenza viruses. During the 2011-2012 influenza season, influenza A H3N2 has been the dominant subtype circulating in the United States although, as of February, activity has remained low. This differs from the previous season, when H3N2 was the predominant virus however influenza B and H1N1pdm09 also circulated widely.
The Influenza Division at CDC antigenically characterized nearly 450 H3N2 viruses collected between Sept 2011 thru Feb 2012 by the hemagglutination inhibition (HI) assay using post infection ferret antisera raised against the current vaccine strain, A/Perth/16/2009, and a panel of reference viruses. Of the H3N2 viruses tested, the proportion of viruses that demonstrated a > 8 fold reduction in HI titer to A/Perth/16/2009 virus has increased from < 2% to 17% in recent months. Most viruses tested were well inhibited by antisera raised to recent H3N2 viruses including A/Victoria/361/2011. A small subset of H3N2 viruses were further characterized in the plaque-reduction neutralization assay and results confirmed findings of the HI assay. These data indicate that an increasing proportion of recent viruses are antigenically distinct from current vaccine strain A/Perth/16/2009. In addition to antigenic characterization, a subset of viruses were genetically characterized by sequencing of the hemagglutinin (HA) and neuraminidase (NA) genes. Phylogenetic analysis indicates that the H3N2 viruses can be divided by shared amino acid changes into 7 genetic groups. The most recent viruses fall into group 3 and 6, with group 3 being the dominant and expanding group. A/Victoria/361/2011 is a representative virus from genetic group 3.
Similar findings were observed by other WHO Influenza Collaborating Centers located at Tokyo, Melbourne, Beijing, and London. Thus, during the recent WHO influenza vaccine selection meeting, the H3N2 component of the vaccine for the northern hemisphere 2012-2013 influenza season has been updated; A/Victoria/361/2011 H3N2-like virus has been recommended to replace the current vaccine strain.Virologic surveillance remains critical for detection of antigenic drift among the evolving influenza viruses and to ensure the vaccine strains match circulating viruses as close as possible to provide optimum protection.http://pascv.ivdnews.net/public/show_abstract/1223
Philippine Health Secretary Statement on potential Infectious Disease Threats
September 28, 2012
Excerpt:
MANILA, Philippines - The Department of Health (DOH) is preparing for the pilgrimage of Muslims to Mecca next month after the World Health Organization (WHO) monitored cases of a deadly new coronavirus linked to Saudi Arabia.
“Many (Filipinos) attend the Hajj. They would eventually come home to various destinations in our country. So (how to deal with them) is a challenge for us,”said Assistant Health Secretary Eric Tayag.
-snip-
Tayag could not give an assurance that the Philippines is prepared in case the new virus enters the country.
“This is new, there is really no data on this and there are only three cases reported. The WHO is closely monitoring this. And because it is new, the WHO found it wise to alert countries,”he added.
Tayag, however, assured the public that the contingency measures implemented by the country during the SARS epidemic are still in place.
“We were able to maintain the SARS (isolation) room in our hospitals and we have asked the RITM (Research Institute for Tropical Medicine of the DOH) to prepare its laboratory. We already have our surveillance system so the moment the WHO tells us, we will activate that,”he said.
But as a precautionary measure, Tayag advised the public to observe proper hygiene through regular handwashing and covering mouth and nose when coughing or sneezing since coronavirus could be transmitted through respiratory droplets.
“If you are three feet away from a person and this person coughs, you will not get the virus. That is the distance where the virus can be transferred to others,”he added.
The WHO is also reviewing the implementation of International Health Regulations (IHR) in the Western Pacific amid the threats posed by a new virus.
-snip-
Health Secretary Enrique Ona assured the people that the DOH is ready to respond to the new virus.
In a statement, Ona said the Philippines is “more prepared today in responding to potential infectious disease threats such as severe respiratory illness caused by a novel coronavirus being reported today from the Middle East.”
“Our experience in the previous global public health emergencies such as the SARS Coronavirus in 2002-2003, the Pandemic Influenza H1N1 in 2009-2010, has given us the necessary capacity to respond to similar threats,” he added.
The National Epidemiology Center will be in charge of public health surveillance in collaboration with the RITM and the Bureau of Quarantine.
Health and labor authorities have issued an advisory to OFWs who are planning to leave for Middle East, especially Saudi Arabia and Qatar, after WHO issued a Global Alert and Response (GAR) bulletin after the new virus was identified in United Kingdom last Saturday.
Excerpt:
MANILA, Philippines - The Department of Health (DOH) is preparing for the pilgrimage of Muslims to Mecca next month after the World Health Organization (WHO) monitored cases of a deadly new coronavirus linked to Saudi Arabia.
“Many (Filipinos) attend the Hajj. They would eventually come home to various destinations in our country. So (how to deal with them) is a challenge for us,”said Assistant Health Secretary Eric Tayag.
-snip-
Tayag could not give an assurance that the Philippines is prepared in case the new virus enters the country.
“This is new, there is really no data on this and there are only three cases reported. The WHO is closely monitoring this. And because it is new, the WHO found it wise to alert countries,”he added.
Tayag, however, assured the public that the contingency measures implemented by the country during the SARS epidemic are still in place.
“We were able to maintain the SARS (isolation) room in our hospitals and we have asked the RITM (Research Institute for Tropical Medicine of the DOH) to prepare its laboratory. We already have our surveillance system so the moment the WHO tells us, we will activate that,”he said.
But as a precautionary measure, Tayag advised the public to observe proper hygiene through regular handwashing and covering mouth and nose when coughing or sneezing since coronavirus could be transmitted through respiratory droplets.
“If you are three feet away from a person and this person coughs, you will not get the virus. That is the distance where the virus can be transferred to others,”he added.
The WHO is also reviewing the implementation of International Health Regulations (IHR) in the Western Pacific amid the threats posed by a new virus.
-snip-
Health Secretary Enrique Ona assured the people that the DOH is ready to respond to the new virus.
In a statement, Ona said the Philippines is “more prepared today in responding to potential infectious disease threats such as severe respiratory illness caused by a novel coronavirus being reported today from the Middle East.”
“Our experience in the previous global public health emergencies such as the SARS Coronavirus in 2002-2003, the Pandemic Influenza H1N1 in 2009-2010, has given us the necessary capacity to respond to similar threats,” he added.
The National Epidemiology Center will be in charge of public health surveillance in collaboration with the RITM and the Bureau of Quarantine.
OFWs warned
The Philippine Overseas Employment Agency (POEA) warned departing
overseas Filipino workers (OFWs) at the Ninoy Aquino International
Airport (NAIA) to observe proper hygiene to avoid contracting the
coronavirus when they go abroad.Health and labor authorities have issued an advisory to OFWs who are planning to leave for Middle East, especially Saudi Arabia and Qatar, after WHO issued a Global Alert and Response (GAR) bulletin after the new virus was identified in United Kingdom last Saturday.
WHO: Novel coronavirus infection - update - revised interim case definition
[This will be located on the right side-bar under Coronavirus, for future reference]
29 September 2012 - WHO has continued to monitor the situation. No additional confirmed cases have been reported and there is no evidence so far of person to person transmission of the novel coronavirus.
In order to ensure an appropriate and effective identification and investigation of patients who may be infected with the virus, without overburdening health care systems with unnecessary testing, a revised interim case definition has been issued by WHO (see related links to right of this page). It should be noted that this case definition was developed based on data from two confirmed cases and as such some degree of clinical judgment is required where individual cases are concerned.
WHO has been cooperating closely with the laboratories which were responsible for the confirmation of the presence of the novel coronavirus in the two confirmed cases. These laboratories have been working on the development of diagnostic reagents and protocols which can be provided to laboratories that are not in a position to develop their own, and these are now available. WHO is now seeking to broaden the number of laboratories that will be able to assist Member States with the detection or confirmation of this novel virus.
WHO has received offers of support from a number of major public health institutions around the world to assist with testing, should the need arise. The complete nucleic acid sequence of the virus has been uploaded to Genbank and the testing protocol, utilizing real-time PCR, has been published.
WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions are applied.
WHO continues to inform its Member States through the designated National Focal Points under the International Health Regulations (2005).
http://www.who.int/csr/don/2012_09_29/en/index.html
29 September 2012 - WHO has continued to monitor the situation. No additional confirmed cases have been reported and there is no evidence so far of person to person transmission of the novel coronavirus.
In order to ensure an appropriate and effective identification and investigation of patients who may be infected with the virus, without overburdening health care systems with unnecessary testing, a revised interim case definition has been issued by WHO (see related links to right of this page). It should be noted that this case definition was developed based on data from two confirmed cases and as such some degree of clinical judgment is required where individual cases are concerned.
WHO has been cooperating closely with the laboratories which were responsible for the confirmation of the presence of the novel coronavirus in the two confirmed cases. These laboratories have been working on the development of diagnostic reagents and protocols which can be provided to laboratories that are not in a position to develop their own, and these are now available. WHO is now seeking to broaden the number of laboratories that will be able to assist Member States with the detection or confirmation of this novel virus.
WHO has received offers of support from a number of major public health institutions around the world to assist with testing, should the need arise. The complete nucleic acid sequence of the virus has been uploaded to Genbank and the testing protocol, utilizing real-time PCR, has been published.
WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions are applied.
WHO continues to inform its Member States through the designated National Focal Points under the International Health Regulations (2005).
http://www.who.int/csr/don/2012_09_29/en/index.html
WHO: Novel coronavirus infection - update 9/28
As of 28 September 2012, no additional confirmed cases due to infection with the novel coronavirus have been reported to WHO.
WHO is working closely with the national authorities of the involved countries (Qatar, Saudi Arabia, United Kingdom) and international partners in order to better understand the public health risk from the novel coronavirus.
From the information available thus far, it appears that the novel coronavirus cannot be easily transmitted from person-to-person.
Given the severity of the two laboratory confirmed cases, WHO is continuing to monitor the situation in order to provide the appropriate response, expertise and support to its Member States.
Rapid progress has been made in the characterization of the novel coronavirus, and in the development of sensitive and specific diagnostic assays. WHO is collaborating with partner laboratories to make these available as quickly as possible. It is anticipated that the first batch of reagents, together with information and testing algorithms, will be available for urgent testing within the coming days.
Tests for novel coronavirus infection of patients under investigation - based on the case definition issued by WHO – are currently available by some partner laboratories. National Health Authorities can contact these laboratories through WHO.
WHO continues to inform its Member States through the designated National Focal Points under the International Health Regulations (2005).
No travel or trade restrictions have been recommended by WHO for Saudi Arabia or Qatar with respect to the novel coronavirus infections.
http://www.who.int/csr/don/2012_09_28/en/index.html
WHO is working closely with the national authorities of the involved countries (Qatar, Saudi Arabia, United Kingdom) and international partners in order to better understand the public health risk from the novel coronavirus.
From the information available thus far, it appears that the novel coronavirus cannot be easily transmitted from person-to-person.
Given the severity of the two laboratory confirmed cases, WHO is continuing to monitor the situation in order to provide the appropriate response, expertise and support to its Member States.
Rapid progress has been made in the characterization of the novel coronavirus, and in the development of sensitive and specific diagnostic assays. WHO is collaborating with partner laboratories to make these available as quickly as possible. It is anticipated that the first batch of reagents, together with information and testing algorithms, will be available for urgent testing within the coming days.
Tests for novel coronavirus infection of patients under investigation - based on the case definition issued by WHO – are currently available by some partner laboratories. National Health Authorities can contact these laboratories through WHO.
WHO continues to inform its Member States through the designated National Focal Points under the International Health Regulations (2005).
No travel or trade restrictions have been recommended by WHO for Saudi Arabia or Qatar with respect to the novel coronavirus infections.
http://www.who.int/csr/don/2012_09_28/en/index.html
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