Thursday, July 4, 2013

UK Cluster Commentary #Coronavirus #MERS

An excerpt from the Telegraph, in the previous post from ProMED:

In February [2013], 2 members of the same family died from the virus. One, a 39-year-old man, died in Birmingham having picked up the virus from his father, who had recently travelled to Saudi Arabia. The father then died around a month later in Manchester's Wythenshaw hospital. A female relative was also treated for mild MERS symptoms, raising fears of human-to-human [transmission].

From my Case List - on that specific incident:



Date Report:  2/11/13 [Case #10]
Name:  Abid Hussain (60) -  Father.  Index Case.
From:  Winson Green, UK Resident
Onset:  1/24/13 (Arrived back on 1/28, unwell)
Adm:   1/31  Wythenshawe Hospital, Manchester,  ICU with severe lower resp. tract infection.
Notes:  Arrived back to UK from Mecca Saudi Arabia on 1/28. 10 days before onset he visited Pakistan from 12/16-January 20, 2013 and Saudi Arabia from January  20-28th.  Lab specimens from 2/1/13 revealed both influenza A H1N1pdm09 and NCoV (novel coronavirus) Alive.  In Coma.
DOD:  3/19 – 10th Death, 17 Cases

  
Date Report:  2/13/13 [Case #11]
Name:  Khalid (39) - son to Abid above. 
From:  UK resident
Adm:   2/9  Queen Elizabeth Hospital, Birmingham.  ICU with resp. sym’s.
Onset:  2/6
Note:  Diagnosed with Brain Cancer.  Caught Coronavirus when Father first returned from Mecca in Saudi Arabia (where he went to pray for Son’s Health)
DOD:  2/17

Date Report:  2/15/13 [Case #12]
Name: Daughter to Index Case & Sister of Khalid (above)
From:  UK resident
Onset:  2/5 typical influenza-like sym’s ..
Adm:  no.   Patient is recovered from mild respiratory illness.

Note:  Wife tells story. Father, Son and Daughter.  Son diagnosed with brain cancer.  Father goes to Mecca in Saudi Arabia to pray for Son (Khalid).  When he first came back from Saudi Arabia he infects his Son.  Son died of Coronavirus.  Father is in a coma.  Daughter caught it, but immunity was fine and she survived.

ProMED: UK - One Fatality #Coronavirus #MERS

This is the case that is referred to below:

Date Report:  9/22
Name:  Male (49)
From:  Qatar
Notes:  Travelled to Mecca, Saudi Arabia
Onset:  9/3 respiratory sym’s
Adm:  9/11 Transferred to UK via air ambulance
Adm:  9/7 ICU, in Doha, Qatar
Notes:  developed renal failure.  Still hospitalized as of 2/13/13.
Confirmation:  9/21

From ProMED
Published Date: 2013-07-03 19:25:39
Archive Number: 20130703.1803607
In this update:
[1] Saudi Arabia - 2 fatalities
[2] UK - one fatality


[2] UK - one fatality
Date: 3 Jul 2013
Source: UK Telegraph [edited]
Excerpt:
A man being treated in a London hospital for a lethal, SARS-like Middle Eastern virus has died. The man, a Qatari national, had been admitted to a private clinic in London in September [2012] before being transferred to the specialist centre at Guy's and St Thomas' Hospital.

He was diagnosed as suffering from the MERS virus -- Middle East Respiratory Syndrome -- which has affected 77 people worldwide, with 43 deaths.

"Guy's and St Thomas' can confirm that the patient with severe respiratory illness due to novel coronavirus [MERS-CoV] sadly died on Friday [28 Jun 2013], after his condition deteriorated, despite every effort and full supportive treatment," said Robin Wilkinson, a spokesman for the hospital.

The death of the Qatari man brings to 3 the number of victims who have died in the UK.

In February [2013], 2 members of the same family died from the virus. One, a 39-year-old man, died in Birmingham having picked up the virus from his father, who had recently travelled to Saudi Arabia. The father then died around a month later in Manchester's Wythenshaw hospital. A female relative was also treated for mild MERS symptoms, raising fears of human-to-human [transmission].

The disease is spread by people coughing or sneezing and can cause breathing difficulties, lung damage and pneumonia.

"We still don't know exactly what killed him," said Dr Jon Bible, a virus expert at Guy's and St Thomas'. "In the end, his lungs were worn down, so secondary infection is the real problem. The virus effectively turns your lungs to jelly."

Known cases of the illness have quadrupled since April 2013, and it is deadlier than SARS, which killed 774 people in 2003. SARS killed one in 10 affected people; MERS has proved fatal in 65 per cent of cases.

Continued:  http://beta.promedmail.org/direct.php?id=20130703.1803607

Wednesday, July 3, 2013

WHO: 13th New Human Case of Avian Influenza H5N1 in Cambodia in 2013

[editing is mine]
 
Joint news release of the Ministry of Health of the Kingdom of Cambodia and World Health Organization

The Ministry of Health (MoH) of the Kingdom of Cambodia wishes to advise members of the public that one more new human case of avian influenza has been confirmed positive for the H5N1 virus. This is 13th case this year and the 34th person to become infected with the H5N1 virus in Cambodia. Of the 34 confirmed cases, 23 were children under 14, and 21 of the 34 were female. In addition, there were only 4 cases out of 13 cases this year survived.
The 13th case, a six-year-old girl from Preyleu village, Bantheay Meas commune, Bantheay Meas district in Kampot province was confirmed positive for human H5N1 avian influenza on 28th June 2013 by Institut Pasteur du Cambodge. She developed fever and headache on 24th June. On 26th June her condition worsened with cough and dyspnea and she was taken to a private clinic. On 28th June, the girl was admitted to Kantha Bopha Hospital with fever, dyspnea and cough. In Kantha Bopha Hospital, the girl was treated with Tamiflu but died later in the night.
There have been recent poultry deaths in the village and the girl was likely to be exposed to sick and dead poultry before she became sick.

The 11th case, a five-year-old girl from Tep Rom village, Veal Ponn commune, Thpong district in Kampong Speu province tested positive for influenza A (H1N1) on 30 January 2013. After random retrospective re-testing of samples, it was confirmed on 2nd May that the girl was also infected with the H5N1 human avian influenza virus. The girl has recovered.

The 12th case, a 58-year-old man from Sangkat Chroy Chorng Va, Khan Roeusey Keo, Phnom Penh, tested positive for influenza on 9 January 2013. After routine retrospective testing of samples, it was confirmed on 21st June that the man was also co-infected with the H5N1 human avian influenza virus. He was discharged from the Khmer-Soviet Friendship Hospital and has recovered.
 
"Avian influenza H5N1 remains a serious threat to the health of all Cambodians. This is the 13th case of H5N1 infection in humans this year. Children also seem to be most vulnerable and are at high risk because they like to play where poultry are found. I urge parents and guardians to keep children away from sick or dead poultry and prevent them from playing with chickens and ducks. Parents and guardians must also make sure children wash their hands with soap and water after any contact with poultry. If they have fast or difficult breathing, they should seek medical attention at the nearest health facility and attending physicians must be made aware of any exposure to sick or dead poultry,” said H.E. Dr. Mam Bunheng, Minister of Health. 

The Ministry of Health's Rapid Response Teams (RRT) are currently in the village to identify the girl’s close contacts, any epidemiological linkage among the 13 cases and initiate preventive treatment as required. In addition, a public health education campaign is being conducted in the village to inform families on how to protect themselves from contracting avian influenza. The government's message is - wash hands often; keep children away from poultry; keep poultry away from living areas; do not eat dead or sick poultry; and all poultry eaten should be well cooked. 

H5N1 influenza is a flu that normally spreads between sick poultry, but it can sometimes spread from poultry to humans. Human H5N1 avian influenza is a very serious disease that requires hospitalization. Although the virus currently does not easily spread among humans, if the virus changes it could easily be spread like seasonal influenza. Hence, early recognition of cases is important.

Globally since 2003, there have been 632 laboratory confirmed human cases of H5N1 avian influenza with 376 related deaths.
The Ministry of Health will continue to keep the public informed of developments via the MoH website www.cdcmoh.gov.kh where relevant health education materials can also be downloaded.
For more information on human influenza please call the MoH Influenza Hotline numbers: 115 (free call); 012 488 981 or 089 669 567

or contact:

Ministry of Health of Cambodia
Dr Sok Touch: Tel +855 12 856 848
Dr Ly Sovann: Tel +855 12 825 424

World Health Organization
Dr Pieter Johannes van Maaren: Tel +855 23 216 610
Dr Reiko Tsuyuokoa: Tel: +855 23 216 610


http://www.wpro.who.int/mediacentre/releases/2013/20130703/en/index.html 

CIDRAP: Cambodian man survived H5N1 coinfection

Cambodian health officials have identified another H5N1 avian influenza case, in a 58-year-old man who tested positive for flu in January but whose samples revealed co-infection with H5N1 in routine retrospective tests.
The man's infection was announced yesterday in a joint statement from Cambodia and the World Health Organization (WHO). It included news of the recent death of a 6-year-old girl from H5N1 and another retrospective H5N1 case, that of a 5-year-old girl, that was confirmed in early May.
The man is from Phnom Penh and was first tested for flu on Jan 9. He had been hospitalized in Khmer-Soviet Friendship Hospital and has since recovered. The statement didn't say what other strain the man had along with H5N1.
The man's illness was counted as Cambodia's 12th H5N1 case so far this year, and his infection and the 6-year-old girl's death raise the country's cumulative total to 34 cases, of which 28 were fatal. The two new Cambodian cases raise the global H5N1 count to 632 cases and 376 deaths, according to the WHO.
Jul 2 WHO/Cambodia joint statement
Jul 2 CIDRAP News story "Cambodian girl dies from H5N1 infection"

http://www.cidrap.umn.edu/news-perspective/2013/07/flu-scan-jul-03-2013 

China - National Influenza Center Director: H7N9 this fall and winter will be back

Translation out of China.  editing is mine.
7/3/13
National Influenza Center director Shu Yuelong team studies have shown that the virus can cause excessive body immunity, need close monitoring, development of vaccines dialogue character     Shu Yuelong China CDC deputy director of the virus, the National Influenza Center, World Health Organization Influenza Reference and Research Collaboration Director of the Centre. The world's first novel H7N9 isolates of avian influenza virus people. Dialogue motivation     it is a kind of virus, both seasonal flu virus receptor binding, but also easy with avian influenza virus receptor binding; also in humans off "cytokine storm", causing infections in critical condition. Today, the new issue of "Nature" magazine published scientific research team, Professor Shu Yuelong article, said a large number of biological characteristics indicate, H7N9 avian influenza virus to humans remains a major threat to the H7N9 continued close monitoring and research in order to allow humans have to resist This new recombinant viruses.     This spring, the Chinese come and gone H7N9, exactly what are the "secret"? Yesterday, the Beijing News reporter Shu Yuelong exclusive dialogue with the "Nature" magazine synchronization opened to the public in the dark side of H7N9.[Infectious]     H7N9 vulnerable people who can not infect humans     Beijing News: This year the H7N9 outbreak seems to have ended?     Shu Yuelong: I firmly believe, H7N9 avian influenza virus in poultry is still popular among asymptomatic.     Beijing News: Now the virus to carry out research mainly focus on what areas?     Shu Yuelong: This new reassortant viruses have a lot of mystery that we have not solved, for example, why the sudden emergence of the virus? Why would infect humans? Will not transmissible among humans? Why most infected illness so heavy?H7N9 outbreak in humans in future What is the risk? This is the main problem we are studying.    Beijing News: What are some of these new research findings?     Shu Yuelong: We found that H7N9 avian influenza virus is with the "sides" of the virus, both like the seasonal flu virus, easy and human upper respiratory tract, such as tracheal cells combined; also equipped with highly pathogenic avian influenza virus of H5N1 characteristics, people can go to the lower respiratory tract and the lungs cell receptor binding. This finding explains why H7N9 H5N1 more susceptible than people.     Beijing News: the more susceptible people, do you mean the possibility of human to human transmission occurs H7N9, H5N1 is much greater than that?     Shu Yuelong: Not necessarily. Because our study also found that, H7N9 avian influenza virus replication in human tracheal low capacity, much lower than the ability to replicate in the lungs, which led directly to H7N9 avian influenza virus is not yet effective human transmission.     Beijing News: Influenza viruses change quickly, if there is one day, H7N9 mutations, it will have the ability to person to person?     Shu Yuelong: This is most likely. Therefore, we are on the one hand to study and find out the person's upper and lower respiratory H7N9 replication efficiency of different reasons such as scientific issues, the other hand to strengthen the monitoring, always find the virus to mutate.【】 Virulence     virus causes severe hyperimmune cited     Beijing News: You are in "Nature" magazine mentioned in the article, H7N9 infection in humans will happen "cytokine storm", causing symptoms of infection in critically ill. What is a "cytokine storm"?     Shu Yuelong: When the H7N9 avian influenza virus infection in people after the body's immune system will automatically start to resist. But when there is excessive, intense immune response disorder, it will cause a lot of abnormally elevated cytokine expression, thus causing pathological damage to human tissue. This phenomenon has been aptly called a "cytokine storm."     Beijing News: "cytokine storm" in other influenza virus who have not come across?     Shu Yuelong: H5N1 infection in people, he will rise to a "cytokine storm." This explains why the H7N9 and H5N1 avian influenza virus infection in people after heavier than the symptoms, mortality is also high. Of course, the "cytokine storm" just cause infections occur in critically ill one of the main symptoms. There is a chronic infection itself, can lead to exacerbations. Also, what kind of person, there will be immune overreaction, now is not very clear.     Beijing News: "cytokine storm" can find ways to curb?     Shu Yuelong: Under certain conditions, reduce the immune response may inhibit the "cytokine storm" is valid. Such as Tamiflu and other neuraminidase inhibitor class of drugs for the H7N9 avian influenza infection in clinical treatment is effective, but there have been a pair of Tamiflu-resistant virus, once it will affect the anti-viral drug treatment should therefore be closely monitored its drug resistance. [Prevention]     H7N9 whereabouts of "hidden" difficult to find out the     Beijing News: the very real problem, do you think this year, autumn and winter, H7N9 will comeback do?     Shu Yuelong: I think it would, because the virus does not disappear automatically.     Beijing News: Reserve now developed a vaccine against H7N9 is very urgent?    Shu Yuelong: very urgent. So far, the world has not yet developed H7N9 vaccine success.Development of vaccines, with such technical reserves, and future people else fight this vaccine are two different things.     Maybe for H7N9 vaccines have been developed, never be used, but as a national public health system, to protect public health, need to have this ability to withstand potentially dangerous.     Beijing News: Why human H7N9 infections were more severe symptoms, but the infection of H7N9 in poultry almost asymptomatic?     Shu Yuelong: This is the most confusing and worrying doubts, but also H7N9 dark side. Although it is on the route of infection with H5N1, there are many similarities, but is completely different, H5N1 on poultry and people, can bring fatal injuries. So, when H5N1 struck, people can more clearly see where it is; while H7N9 in poultry popular among not the disease, it is difficult to ascertain its whereabouts.Just like a "black box", how to open the "black box", agriculture and health sectors need to work together to find the "key."     Beijing News: Now is not the epidemic, do you think that how to track H7N9?     Shu Yuelong: I appeal to health and agriculture departments should strengthen active surveillance for H7N9, including active surveillance among poultry, as well as in human syndromic surveillance. Our country is now established a comprehensive monitoring system for influenza-like symptoms, and unexplained pneumonia reporting system. If a person has flu-like symptoms, unexplained pneumonia, if the reasons for other viral infections were excluded, what should be screened for H7N9 infection. Calm the nation's public health system does not mean you can sit back and relax.     Beijing News: In the group of healthy birds, monitor H7N9 easy to do it?     Shu Yuelong: not easy, but I hope that the agricultural sector can be sustained in animals active surveillance.     Beijing News: It is necessary to carry on the healthy population screening for H7N9 do?     Shu Yuelong: not necessary.     Original title: Shu Yuelong: "H7N9 this fall and winter will be back"     This article Source: Beijing News (Boxun boxun.com)
http://boxun.com/news/gb/china/2013/07/201307040559.shtml#.UdSuZD772DM 

Five Topics Discussed on First Day Activities High-Level Preparatory (HLP) Meeting for the 66th Session of the WHO-SEARO - One is Pandemic Influenza Preparedness

Director General of Disease Control and Environmental Health Ministry of Health, Prof.. dr. Tjandra Yoga Aditama, Sp.P, MARS, DTM & H, DTCE, led the delegation of the Republic of Indonesia (delegation) at the High-Level Preparatory (HLP) Meeting for the 66th Session of the WHO-SEARO , which will take place from 1 to 4 July 2013 in the New Delhi . This activity was participated by 11 member states of the WHO-SEARO.
In his email to the Center for Public Communication (seventh), Prof.. Tjandra said that there are 5 topics of discussion on the first day of the event (1/7). The fifth topic of the discussion, namely: 1)Technical discussions regarding the recording of births and deaths; 2) Implementation of the International Health Reguation (IHR) 2005: 3) Target Elimination of Measles in 2020 and Rubella Prevention; 4) aPenyaki Ttidak Diseases (PTM), and 5 ) Pandemic Influenza Preparedness.
According to Prof. Tjandra, countermeasures related Communicable Diseases (PTM) delegation said that Indonesia has done PTM control programs. In addition, Indonesia also commented on the need to incorporate oral cancer as regional targets SEARO region. In Indonesia, smokeless tobacco is not yet widely found. However, the number of smokers who threatened oral cancer continue to show an increasing trend.
Moreover, Prof Tjandra also convey important issues related to Pandemic Influenza Preparedness , namely: WHO needs to speed up the execution of the Standard Material Transfer Agreement (SMTA). Furthermore, the necessary coordination between WHO-SEARO with member states in determining the distribution of partnership contribution , as well as priorities for member countries experiencing H5N1 cases in the region.
Other things, the activities of the Regional Committee, WHO SEARO will be conducted in September 2013, where one of the agenda is the election of the Regional Director of WHO SEARO new.
This information is released by Center for Public Communication, Secretariat General of the Ministry of Health. For further information, please contact Halo MOH hotline <country code> lokal> 500-567; SMS 081 281 562 620, fax (021) 52921669, website www. depkes.go.id and e-mailkontak@depkes.go.id .

WHO: Revised interim case definition for reporting to WHO – Middle East respiratory syndrome coronavirus (MERS-CoV)

[this will be located on the right side-bar for your easy reference]

Interim case definition as of 03 July 2013
These case definitions have been revised based on new information collected since the previous definitions were published. WHO will continue to review and update them as new information becomes available.

Probable case

Three combinations of clinical, epidemiological and laboratory criteria can define a probable case:
  • A person with a febrile acute respiratory illness with clinical, radiological, or histopathological evidence of pulmonary parenchymal disease (e.g. pneumonia or Acute Respiratory Distress Syndrome)
    AND
    Testing for MERS-CoV is unavailable or negative on a single inadequate specimen1
    AND
    The patient has a direct epidemiologic-link with a confirmed MERS-CoV case2.
  • A person with a febrile acute respiratory illness with clinical, radiological, or histopathological evidence of pulmonary parenchymal disease (e.g. pneumonia or Acute Respiratory Distress Syndrome)
    AND
    An inconclusive MERS-CoV laboratory test (that is, a positive screening test without confirmation)3
    AND
    A resident of or traveler to Middle Eastern countries where MERS-CoV virus is believed to be circulating in the 14 days before onset of illness.
  • A person with an acute febrile respiratory illness of any severity
    AND
    An inconclusive MERS-CoV laboratory test (that is, a positive screening test without confirmation)3
    AND
    The patient has a direct epidemiologic-link with a confirmed MERS-CoV case2.

Confirmed case

A person with laboratory confirmation of MERS-CoV infection4.

Notes

Inconclusive testing: Patients with an inconclusive initial testing should undergo additional virologic and serologic testing to determine if the patient can be classified as a confirmed MERS-CoV case. It is strongly advised that lower respiratory specimens such as sputum, endotracheal aspirate, or bronchoalveolar lavage fluid be used when possible. If patients do not have signs or symptoms of lower respiratory tract infection and lower track specimens are not available or clinically indicated, both nasopharyngeal and oropharyngeal swab specimens should be collected. If initial testing of a nasopharyngeal swab is negative in a patient who is strongly suspected to have MERS-CoV infection, patients should be retested using a lower respiratory specimen tract or a repeat nasopharyngeal specimen with additional oropharyngeal specimen if lower respiratory tract specimens are not possible, and paired acute and convalescent sera.
Asymptomatic cases: The demonstration of asymptomatic infection is useful for epidemiological investigations and should be pursued as part of case investigations, however, the burden of proof must be higher due to the risk misclassification because of false positive tests due to laboratory contamination. Generally, in most viral infections, an immunological response such as development of specific antibodies would be expected even with mild or asymptomatic infection and as such serological testing may be useful as additional confirmation of the diagnosis. Additional steps to reconfirm asymptomatic cases, or any case in which the diagnosis is suspect, could include re-extraction of RNA from the original clinical specimen and testing for different virus target genes, ideally in an independent laboratory.

1An inadequate specimen would include a nasopharyngeal swab without an accompanying lower respiratory specimen, a specimen that has had improper handling, is judged to be of poor quality by the testing laboratory, or was taken too late in the course of illness.
2A direct epidemiological link may include:
• Close physical contact
• Working together in close proximity or sharing the same classroom environment
• Traveling together in any kind of conveyance
• Living in the same household
• The epidemiological link may have occurred within a 14 day period before or after the onset of illness in the case under consideration.
3Inconclusive tests may include:
• A positive screening test without further confirmation such as testing positive on a single PCR target
• A serological assay considered positive by the testing laboratory.
4Currently confirmatory testing requires molecular diagnostics including either a positive PCR on at least two specific genomic targets or a single positive target with sequencing on a second. However, the interim recommendations for laboratory testing for MERS-CoV should be consulted for the most recent standard for laboratory confirmation (http://www.who.int/csr/disease/coronavirus_infections/en/). See also notes on asymptomatic cases in this document. 


http://www.who.int/csr/disease/coronavirus_infections/case_definition/en/index.html

WHO: Case - control study to assess potential risk factors related to human illness caused by Middle East Respiratory Syndrome Coronavirus (MERS - CoV)

Version  2
Date:  03  July  2013
Contact:  Dr  Anthony  Mounts    mountsa@who.int

Acknowledgement
This  document  was  adapted  from  a  protocol  developed  by  the  Consortium  for  the  Standardization  for   Influenza  Seroepidemiology  (CONSISE),  a  global  partnership  aiming  to  develop  influenza  investigation   protocols  and  standardize  seroepidemiology  to  inform  public  health  policy  for  pandemic,  zoonotic  and   seasonal  influenza.  This  international  partnership  was  created  out  of  a  need,  identified  during  the  2009   H1N1  pandemic,  for  better  (standardized,  validated)  seroepidemiological  data  to  estimate  infection   attack  rates  and  severity  of  the  pandemic  virus  and  to  inform  policy  decisions.  More  information  on  the   CONSISE  network  can  be  found  on  their  website:  www.CONSISE.tghn.org. 
 
Protocol  Summary
This  investigation  will  provide  data  to  evaluate  exposures  and  risk  factors  for  human  cases  of  Middle  East   Respiratory  Syndrome  Coronavirus  (MERS-­‐CoV)  to  determine  those  that  are  related  to  infection.  This   protocol  outlines  a  case-­‐control  study  and  the  epidemiological  methods  to  guide  data  collection  to  assess   risk  factors  for  illness  caused  by  MERS  coronavirus  (MERS-­‐CoV)  infection.  Health  care  personnel  and  the   evaluation  of  other  contacts  are  addressed  in  a  separate  protocol.  
Comments  for  the  user’s  consideration  are  provided  in  purple  text  throughout  the  document  as  the  user   may  need  to  modify  methods  slightly  because  of  the  local  context  in  which  this  study  will  be  carried  out.

1.0  Scientific Background and Rationnale
The  novel  Coronavirus  now  known  as  Middle  East  Respiratory  Syndrome  Coronavirus  (MERS-­‐CoV)  was   first  detected  in  a  patient  living  in  Saudi  Arabia  in  September  of  2012.  Since  that  time,  sporadic  cases,     small  clusters,  and  in  large  outbreaks  have  been  reported  in  several  countries.  While  the  source  of  the   virus  is  currently  unknown,  it  is  thought  to  originate  in  animals.  Human-­‐to-­‐human  transmission  has  also   been  documented  on  multiple  occasions.  Although  finding  the  putative  animal  reservoir  is  an  important   step  in  controlling  spread  of  the  virus,  a  more  immediate  need  is  to  understand  the  route  and  mode  of   transmission  to  humans,  and  the  types  of  exposures  that  result  in  infection.  Several  possibilities  exist,   including  direct  contact  with  an  infected  animal,  which  could  be  either  the  reservoir  species  or  an   intermediate  host  species;  contact  with  or  consumption  of  unprocessed  animal  products;  contact  with   the  environment  where  an  infected  animal  has  recently  been;  or  consumption  of  a  food  or  beverage   which  has  been  contaminated  by  animal  excreta.  All  of  these  have  been  implicated  in  other  zoonotic   infections.  Learning  the  mode  of  transmission  to  humans  will  allow  measures  to  be  taken  to  interrupt   transmission.      This  investigation  will  provide  data  to  evaluate  risk  factors  for  infection  by  reviewing   exposures  of  known  cases  and  comparing  them  to  rates  of  exposure  in  similar  uninfected  individuals  in   the  general  population.  
Current  information  on  the  MERS-­‐CoV  and  cases  can  be  found  on  the  WHO   website:  http://www.who.int/csr/disease/coronavirus_infections/en/index.html.    
A  separate  protocol  is  available  specifically  for  assessment  of  exposed  Health  Care  Personnel  and   contacts  of  cases  (see  http://consise.tghn.org/articles/novel-­‐coronavirus-­‐MERS-­‐CoV/).     

1.1 Objectives
The  data  collected  from  this  study  will  be  used  to  refine/update  recommendations  for  surveillance  and   case  definitions,  to  characterize  the  key  epidemiological  transmission  features  of  MERS-­‐CoV  virus,  help   understand  spread,  severity,  spectrum  of  disease,  impact  on  the  community  and  to  inform  operational   models  for  implementation  of  countermeasures  such  as  case  isolation,  contact  tracing  and  quarantine.
The  primary  objective  of  this  study  is  to:   • Identify  modifiable  non-­‐human  exposures  that  lead  to  human  MERS-­‐CoV  infection

Complete Document:  http://www.who.int/csr/disease/coronavirus_infections/MERSCoVCaseControlStudyPotentialRiskFactors_03Jul13.pdf  

CDC gives updated guidelines for handling H5N1 influenza virus

Hong Kong CHP: Avian Influenza Report

VOLUME 9, NUMBER 26
Reporting period: Jun 23 – Jun 29, 2013 (Week 26)
(Published on Jul 3, 2013)
 
Summary
1.
There were no new confirmed human cases of
avian influenza A(H5N1) reported by
the World Health Organization (WHO).
#
 
2.
From 2008 to 2012, 32 to 73 confirmed
human cases of avian influenza A(H5N1)
were reported to WHO annually. In 2013 (as
of Jun 29), 20 cases were reported by WHO.
 
3.
No new confirmed human cases of avian
influenza A(H7N9) were reported by WHO
and the National Health and
Family Planning Commission (NHFPC) during the reporting
period. As of June 29, a total of 132 cases were reported.
 
chart (continued)

CDC - Protection by Face Masks against Influenza A(H1N1)pdm09 Virus on Trans-Pacific Passenger Aircraft, 2009

Volume 19, Number 9—September 2013

Research

Lijie Zhang1, Zhibin Peng1, Jianming Ou1, Guang Zeng1, Robert E. Fontaine, Mingbin Liu, Fuqiang Cui, Rongtao Hong, Hang Zhou, Yang Huai, Shuk-Kwan Chuang, Yiu-Hong Leung, Yunxia Feng, Yuan Luo, Tao Shen, Bao-Ping Zhu, Marc-Alain Widdowson, and Hongjie YuComments to Author 
Author affiliations: Chinese Center for Disease Control and Prevention, Beijing, China (L. Zhang, Z. Peng, G. Zeng, M. Liu, F. Cui, H. Zhou, Y. Feng, Y. Luo, T. Shen, B.-P. Zhu, H. Yu); Fujian Center for Disease Control and Prevention, Fuzhou, China (J. Ou, R. Hong); Nanchang Center for Disease Control and Prevention, Nanchang, China (M. Liu); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (R. E. Fontaine, M.-A. Widdowson); China–US Collaborative Program on Emerging and Re-emerging Infectious Diseases, Beijing (Y. Huai); Hong Kong Department of Health, Hong Kong, China (S.-K. Chuang, Y.-H. Leung)

Abstract

In response to several influenza A(H1N1)pdm09 infections that developed in passengers after they traveled on the same 2 flights from New York, New York, USA, to Hong Kong, China, to Fuzhou, China, we assessed transmission of influenza A(H1N1)pdm09 virus on these flights. We defined a case of infection as onset of fever and respiratory symptoms and detection of virus by PCR in a passenger or crew member of either flight. Illness developed only in passengers who traveled on the New York to Hong Kong flight. We compared exposures of 9 case-passengers with those of 32 asymptomatic control-passengers. None of the 9 case-passengers, compared with 47% (15/32) of control-passengers, wore a face mask for the entire flight (odds ratio 0, 95% CI 0–0.71). The source case-passenger was not identified. Wearing a face mask was a protective factor against influenza infection. We recommend a more comprehensive intervention study to accurately estimate this effect.

-snip-
Discussion:
Excerpt:
In summary, this outbreak probably resulted from a common source exposure to influenza A(H1N1)pdm09 virus on the New York to Hong Kong flight. Wearing a face mask was associated with a decreased risk for influenza acquisition during this long-duration flight. Border entry screening did not detect case-passengers during the influenza incubation period. We recommend a more comprehensive intervention study to accurately estimate the protective effect of face masks for preventing influenza virus transmission on long-distance flights.

http://wwwnc.cdc.gov/eid/article/19/9/12-1765_article.htm 

CDC: Emergency Department Visit Data for Rapid Detection and Monitoring of Norovirus Activity, United States

Ahead of Print
Emerging Infectious Diseases
Volume 19, Number 8—August 2013  

Research  


Abstract
Noroviruses are the leading cause of gastroenteritis in the United States, but timely measures of disease are lacking. BioSense, a national-level electronic surveillance system, assigns data on chief complaints (patient symptoms) collected during emergency department (ED) visits to 78 subsyndromes in near real-time. In a series of linear regression models, BioSense visits mapped by chief complaints of diarrhea and nausea/vomiting subsyndromes as a monthly proportion of all visits correlated strongly with reported norovirus outbreaks from 6 states during 2007–2010. Higher correlations were seen for diarrhea (R = 0.828–0.926) than for nausea/vomiting (R = 0.729–0.866) across multiple age groups. Diarrhea ED visit proportions exhibited winter seasonality attributable to norovirus; rotavirus contributed substantially for children <5 years of age. Diarrhea ED visit data estimated the onset, peak, and end of norovirus season within 4 weeks of observed dates and could be reliable, timely indicators of norovirus activity.

Brian RhaComments to Author , Sherry Burrer, Soyoun Park, Tarak Trivedi, Umesh D. Parashar, and Benjamin A. Lopman Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (B. Rha, S. Burrer, S. Park, T. Trivedi, U.D. Parashar, B.A. Lopman); McKing Consulting Corporation, Atlanta (S. Park)

Continued:  http://wwwnc.cdc.gov/eid/article/19/8/13-0483_article.htm

Cambodia Case Comments

Updated 7/3/13
If the information on the latest case in Cambodia is accurate, the onset date was 4 days before the death.

The girl was confirmed positive for human H5N1 avian influenza on Friday last week [28 Jun 2013] by L'Institut Pasteur du Cambodge, the statement said, adding that she developed fever and headache last Monday [24 Jun 2013], and her condition worsened with cough and dyspnea.

Kampot Province
Date:  7/2/13
Name:  6(F)
From:  Preyleu Village, Meas Commune, Bantheay Meas District, Kampot Province
Adm:  6/28 Kantha Bopha Hospital, fever, dyspnea & cough
Reconciled:  6/26 Private Clinic, cough & dyspnea
Onset:  6/24 fever, headache
Confirmed:  6/28
DOD:  6/28/13
Note:  13th case this year.  9th death this year.  

Click on map to enlarge