Friday, September 19, 2014

Saudi MOH Announces 3rd Recent MERS Case In Taif






The slow uptick in MERS cases reported out of Saudi Arabia over the past 10 days continues today with the announcement of KSA’s 7th case this month – which is also the third case reported from Taif  in the past 7 days. 





NPM14: Your Daily Threats Assessment Briefing


Photo Credit- NOAA Know your Risk


Note: Today is day 19 of National Preparedness Month, and this is one of a series of updated blogs and articles about personal preparedness that I am featuring this month.

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Every day the President of the United States, along busy CEOs, investors, emergency planners, and public health officials receive specialized Daily Intelligence briefings outlining current or anticipated threats, along with other vital information.


While you may not hold the fate of nations, a billion dollar portfolio, or a fortune 500 company in your hands you do have a need to know your risks if you want you and your family to be prepared for a disaster.


And those risks can, and do, change on a daily basis. Particularly those involving climate and weather.


Fortunately, the Internet makes it easy to create a short list of websites to visit each day (I do so early each morning) that in a few short minutes will give you an early warning of what threats might be expected in the next few days.


Depending where you live, and where your personal interests lie, you will probably want to customize your `daily briefing’.  But to get you started, a quick tour of mine.


Note: I quickly scan these websites for news, alerts, or forecasts of interest for my region.  I certainly don’t attempt to read them in depth each day.


First stop, The National Weather Service’s Daily Briefing - which replaces the recently discontinued NOAAWatch’s Daily Briefing – and provides an excellent overview of the natural threats facing the nation.



My second stop is usually NOAA’s Storm Prediction Center, which looks ahead as far as a week for areas that may expect severe weather.  At a glance I can see when, and where, weather trouble is expected.  This is particularly important during the spring and summer tornado season.


And during hurricane season, I also swing by the National Hurricane Center website each morning (and if there is an active storm, several times each day).


Although the sun remains unusually quiet, I also swing by or NOAA’s SPACE WEATHER PREDICTION CENTER for the latest on solar activity. 


And last, but not least, I visit the FEMA Blog to see what they are keeping an eye on.


During the day and overnight, I rely on NOAA WEATHER RADIO (NWR) and Twitter to follow @FEMA, @NHC_Atlantic, @NOAA and @CraigAtFEMA for real-time emergency alerts.


Like having an emergency kit and a first aid kit - having a weather radio is an important part of being prepared.


Of course, just knowing about the threats isn’t enough. You have to make use of that information.


To learn how to prepare as an individual, family, business owner, or community I would invite you to visit the following sites and use THIS LINK to access some of my recent preparedness blogs.





While some people lie awake at night worrying about disasters, I’ve discovered that being prepared is the key to sleeping well.

Preparing is easy.

It’s worrying that’s hard.

Guinea: Ebola Health Team Members Killed By Villagers



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Details continue to emerge on the horrific slaying of (reports range from 7 to 9) members of an Ebola health team this week in Wome - a small village near Nzerekore in the southern part of Guinea - with this latest report from the BBC.


19 September 2014 Last updated at 04:58 ET

Ebola outbreak: Guinea health team killed

Nine members of a team trying to raise awareness about Ebola have been killed by villagers using machetes and clubs in Guinea, officials say.

Some of the bodies - of health workers, local officials and journalists - were found in a septic tank in a village school near the city of Nzerekore.

Correspondents say many villagers are suspicious of official attempts to combat the disease.


A government delegation, led by the health minister, had been dispatched to the region but they were unable to reach the village by road because a main bridge had been blocked.

(Continue . . .)


One of the huge problems in combating Ebola has been the belief – perpetuated in some cases even by local media – that Ebola is either not real, or part of some evil plot hatched by the western world (see WaPo article Largest Liberian Newspaper: US Government Manufactured Ebola, AIDS Virus) to kill Africans.


All of which makes working in the hot zone doubly dangerous. 


Adding to the challenges of educating the public, the literacy rates in West Africa are among the lowest on the continent, with Guinea coming in 49th (29.5%) out of 52 African nations.  Sierra Leone fares only slightly better (35.1%) and Liberia is just shy of midway in the pack, with a literacy rate of 57.5% (source The African Economist).


How much of a chill this latest tragedy will put on Ebola outreach efforts in the more remote areas of Guinea remains to be seen, but this incident – and the Health Ministry’s inability to launch a timely rescue mission -  illustrates how little actual control the government has over some regions of their country.

Saudi MOH: Review Finds 19 `Historical’ MERS Cases Prior to June 2014


Saudi Arabia


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Yesterday there were 732 MERS cases reported by the Saudi MOH, and today that number climbs to 748: all  stemming from of an audit of cases from before June 3rd of this year, and mostly arising from Jeddah.  


While 19 cases were added to the tally - 1 duplicate case, and 2 false positives were removed -  resulting in a net gain of 16 cases.


While the number of identified MERS cases has remained reassuringly stable over the summer, earlier studies have suggested that the bulk of those infected  - being either mildly ill, or asymptomatic – are never identified. Given the apparent seasonality of MERS we would need to get through an entire winter-spring cycle without seeing a spike in cases before attaching too much significance to this pause.


Despite the somewhat self-congratulatory tone of this press release, we continue to see only the bare minimum of information released on recent cases out of Saudi Arabia, and we’ve yet to see results from the long-promised case control study (see KSA Announces Start To Long-Awaited MERS Case Control Study).




​JEDDAH 18 September 2014. The Ministry of Health released information today about 19 historical (old) cases of MERS-CoV, as part of an ongoing review of patient data. Each of these cases had a date of onset prior to 3 June, 2014.

Since launching a comprehensive response to MERS-CoV earlier this year, the number of reported cases in Saudi Arabia has declined dramatically.

Other aspects of MoH response include public health education, new procedures and equipment to quickly identify and treat patients and promotion of best practice to prevent the spread of MERS-CoV between healthcare workers.

The new information was discovered during an ongoing validation process designed to ensure the accuracy of MERS-CoV historical infection data. The review, undertaken by an independent auditor, is part of MoH’s effort to minimize data discrepancies, with the goal of capturing information that enables healthcare workers to better control the disease.

MoH is conducting a retrospective analysis that includes a case-by-case review to better understand how to capture patient data in a more timely and complete way. It has also stepped up efforts to communicate to healthcare workers the requirement for quick and accurate reporting of infectious disease information. The new data has been shared with the World Health Organization.

Many of the additional cases were identified through a review of patient records at hospitals that perform on-site laboratory testing. All but three of the cases were in Jeddah.

Further revisions to the overall MERS-CoV statistics include:

1. The status of 18 cases was changed from active to recovered, while the categorization of three cases was changed from active to deceased
2. One duplicate case was identified and deleted
3. In addition, two cases reported 9 June and 26 August, were subsequently identified as a false positive and have been removed from the statistics.

This effort complements the on-going implementation of the Health Electronic Surveillance Network (HESN), a comprehensive, integrated public health information system that helps public health workers collaborate to manage individual cases, outbreaks, immunizations, and medical inventories. Regular reviews are part of the MoH effort to introduce internationally accepted standards for due diligence, and can result in changes to reporting statistics arising from reclassification, retrospective investigation, consolidation of cases and laboratory data, and enhanced surveillance outcome.

In total, MoH had identified 748 laboratory-confirmed cases of MERS-CoV as of 18 September, 2014. 



Update:   Shortly after posting this blog I found the Dr. Ian Mackay on his VDU blog has written an open letter to the Saudi MOH requesting the release of additional information on MERS cases.    Follow the link to read:


To the Saudi Arabian Ministry of Health: A request for missing data on retrospective MERS-CoV detections

From: Ian M Mackay

To: The Office of the Minister of Health, Kingdom of Saudi Arabia

I write to humbly ask for your help on a matter of infectious disease communication. I ask that you please consider completing the already near-complete public data picture for all retrospectively confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) that have occurred on your soil. I ask that this be publicly released for analysis, and suitably acceptable citation, by all. The Ministry of Health has already made a number of advances in tracking and communicating new cases of MERS-CoV, addressing criticisms along the way. But there remain some small but epidemiolgically important gaps in an otherwise complete set of data that could be easily closed.

(Continue . . . )

Thursday, September 18, 2014

CDC: 18 States With Confirmed EV-D68




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Over the past two days four more states have confirmed cases of EV-D68 – a respiratory virus that has recently begun to spread widely in the United States.  In yesterday’s update -  WHO GAR Notice On Enterovirus D68 – we also looked at confirmed and suspected cases in Alberta and British Columbia, Canada.


While only a small percentage of those infected are made ill enough to require hospitalization, this virus has sent thousands of kids to clinics and hospital emergency rooms over the past month (see CDC EV-D68 Update & FAQ).


Given the rapid spread of this virus, it seems likely that it if it isn’t already in your state, it will be soon.  So now is the time to take special care to observe good `flu hygiene’; wash your hands often, cover coughs and sneezes, avoid touching your face with unwashed hands, and stay home if you are sick.



States with Lab-confirmed Enterovirus D68

From mid-August to September 18, 2014, a total of 153 people from 18 states were confirmed to have respiratory illness caused by EV-D68. The 18 states are Alabama, Colorado, Connecticut, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Minnesota, Missouri, Montana, Nebraska, New Jersey, New York, Oklahoma, Pennsylvania, and Virginia. The cases of EV-D68 infection were confirmed by the CDC or state public health laboratories that notified CDC.

In the upcoming weeks, more states will have confirmed cases of EV-D68 infection.

  • The primary reason for increases in cases is that several states are investigating clusters of people with severe respiratory illness, and specimens are still being tested for EV-D68. It can take a while to test specimens and obtain lab results. That’s because the testing is complex and slower, and can only be done by CDC and a small number of state public health laboratories. As the backlog of specimens is processed, the number of states and confirmed cases will likely increase. These increases will not necessarily reflect changes in real time, or mean that the situation is getting worse.
  • Some of the increase will be from new EV-D68 infections since people are more likely to get infected with enteroviruses in the summer and fall. We are currently in the middle of the enterovirus season.

As investigations progress, we will have a better understanding of the trends for EV-D68

WHO Ebola Roadmap Update – Sept 18th




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Although it has been two days since their last update, today’s Ebola roadmap appears to only add one day’s worth of data to the case count tally, with a jump of 372 cases between September 13th and 14th.


Deaths over the same period jumped by 167 cases.


The good news is that the situations in both Nigeria and Senegal appear to have stabilized, with no new cases reported in the month of September.  Several hundred contacts of cases are still under observation.


WHO: Ebola Response Roadmap Situation Report

18 September 2014


The total number of probable, confirmed and suspected cases (see Annex 2) in the current outbreak of
Ebola virus disease (Ebola) in West Africa was 5335, with 2622 deaths, as at the end of 14 September 2014
(table 1). Countries affected are Guinea, Liberia, Nigeria, Senegal and Sierra Leone. Figure 1 below shows
the total number of cases by country that have been reported in each epidemiological week between the
start of 30 December 2013 (start of epidemiological week 1) and end 14 September 2014 (epidemiological
week 37: 8 to 14 September).




Although unrelated to the West African Ebola outbreak, the following update on the DRC Ebola outbreaks is also included:



As at 15 September 2014, there have been 71 cases (53 confirmed and probable, 18 suspected) of Ebolavirus disease (EVD) reported in the Democratic Republic of the Congo (DRC). In total, 40 deaths have been reported. 11% of cases have occurred among health-care workers have been diagnosed with EVD. 95% of 403 listed contacts were seen on 15 September. This outbreak is unrelated to that affecting Guinea, Liberia, Nigeria, Senegal and Sierra Leone.