Saturday, April 19, 2014

Referrals: VDU Blog & Branswell On MERS-CoV


Credit VDU Blog 


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The earliest known human infections with the MERS coronavirus occurred just over two years ago at a hospital in Jordan, and over the first year produced barely a handful of confirmed cases across the Arabian peninsula.  Just over a year ago (March 26th, 2013) the World Health Organization was only reporting a total of 17 cases (11 Fatalities).


An average of 1.5 cases reported per month during the first year.


Cases began  a steady climb – particularly in Saudi Arabia – beginning last spring. From March 26th, 2013 to March 26, 2014 the official tally grew to 200 laboratory-confirmed cases, including 85 deaths.  Roughly  a 10 fold increase over the previous 12 months.


Or an average of 15.25 cases reported per month during the second year.


Over the past three weeks, we’ve seen roughly 80 cases reported (numbers are approximate as not all have been confirmed by the WHO). These come primarily from a pair of large clusters in KSA and the UAE – which together account for more than 25% of all of the cases reported to date.  And it is likely that we’ll see more cases announced in the coming days.


Given the number of mild or asymptomatic cases detected to date – it’s a pretty good bet that we are only counting a subset of the actual number of infections.


A disturbing trend that Dr. Ian Mackay charts, and discusses, in his latest blog. Ian also calls for the quick release of sequences from recent cases, so that we can determine if this is `MERS-CoV Mk II’ – a new & improved coronavirus model for 2014.


Follow the link to read:


MERS-CoV cases continue steep climb thanks most to 2 healthcare-related clusters...

The Jeddah cluster | Jeddah | Kingdom of Saudi Arabia.

It is the biggest of any of the clusters of MERS-CoV cases within the Kingdom of Saudi Arabia, MERS-central (0 to date. It has seeded at least 2 internationally exported cases (a fatal case in Malaysia and now a case in Greece). It totals 53 cases so far; the tally for this cluster began after the onset of illness in the first case, 6-Apr.

The paramedic cluster | Abu Dhabi | United Arab Emirates

Happening simultaneously and right next door is a cluster of cases that began 28-Mar. It stands at 14 cases as I compose this; most recent with an onset of 14-Apr.

These dates, starting points and information are all up in the air of course.

(Continue . . . )

In much the same vein,  Helen Branswell overnight has published a terrific overview of where these latest outbreaks stand – and concerns being voiced by scientists – in her article:

SARS revisited? Sharp jump in cases, hospital outbreaks raise MERS concerns

By Helen Branswell, The Canadian Press April 18, 2014

TORONTO - It’s beginning to feel like SARS revisited.

For some of the scientists and doctors who helped the world battle the 2003 SARS outbreak, the recent rapid rise in human infections in several Middle Eastern countries caused by a cousin virus is creating a sense of sharp unease.

Cases of Middle Eastern respiratory syndrome — MERS — have shot up markedly in the past month, driven it appears by outbreaks in hospitals or among health-care workers in Jeddah, Saudi Arabia, and in Abu Dhabi, in the United Arab Emirates.

(Continue . . .)

Friday, April 18, 2014

Greece: MOH On 1st Imported Case Of MERS-CoV



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My thanks to Gert van der Hoek on Flutrackers for finding the first press account, and Sharon Sanders for the Greek MOH press release, announcing that country’s first MERS coronavirus case.   As with the Malaysian religious pilgrim who died earlier this week (see Malaysian MOH Statement On Imported (Fatal) Case Of MERS-CoV), this patient recently traveled to Jeddah.


You’ll find the (only slightly syntax-challenged) machine translation below:




Press Release KEEL for MERS-coronavirus.

April 18th, 2014

Press Release KEEL for MERS-coronavirus.

Athens, 1 8 April 2014


The HCDCP inform a laboratory confirmed case of infection with MERS - coronavirus in patients aged 69 years, a Greek resident of Saudi Arabia, who is hospitalized in stable condition.

The clinical picture of the patient was reviewed after arriving in our country on 17/04/2014 from Jeddah Saudi Arabia because of prolonged febrile for which was estimated at the district hospital. Due compatible clinical and epidemiological history of the patient was tested and found positive in two consecutive molecular tests in Greek Pasteur Institute.

The HCDCP has taken all necessary actions to track and monitor the contacts of the patient both during the voyage to Athens, in cooperation with the Civil Aviation Authority, the Aerougeionomeio and the airline, and during his stay in Greece in collaboration with the hospital inpatient, where they have done the necessary actions. All measures to prevent and control spread of the disease to safeguard public health in accordance with the guidelines of HCDCP, the European CDC and the World Health Organization (W OY ) have already been implemented. The patient with actions of the National Health Operations Centre (CERECO) is transferred to a special unit of respiratory diseases.

As already mentioned in our previous update (press release 03/06/2013) the MERS-coronavirus is a new member of the family of coronaviruses, which in 2012 was recognized as pathogenic for humans. The coronaviruses include both viruses that cause the common cold, and this causes the syndrome SARS. This new virus has no direct relationship with any of the other known coronaviruses, but disease accompanied by significant mortality.

Until 17 April 2014 declared the World Health Organization (WHO) total 243 laboratory confirmed cases of MERS - coronavirus including 93 deaths. Features according to the WHO last incident declared on 17.4.2014 concerns traveler from Jeddah in Malaysia.

The Greek case is 10 the case of infection with MERS - coronavirus diagnosed in Europe (in 5 different European countries: United Kingdom, Germany, France, Italy).

Until today confirmed cases of the disease occur mainly acute respiratory infection with fever, cough, and dyspnea, while highlighting the criticality of the application of strict rules of infection control to prevent the spread of infection in the hospital environment.

The precautionary measures are recommended for protection against MERS - coronavirus are those applicable to other viral respiratory infections, namely to avoid close contact with people who show symptoms of the disease (coughing, sneezing) and have recently traveled to areas risk (Arabian Peninsula). It highlights the search prompt medical evaluation in travelers returning from the Arabian Peninsula and exhibit similar symptoms within 14 days of their arrival.

The HCDCP is constantly vigilant regarding any further incidents detection in hospitals in the country. Under the International Health Regulations ( IHR ) and the EU obligations of the country HCDCP has been updated through the Early Warning System ( EWRS ) The European k as CDC (ECDC), and the World Health Organization (WHO) about the incident and the steps taken in our country.

The HCDCP informs that in accordance with international epidemiological data and because they have taken in our country all appropriate public health measures are not expected spread of the disease and there is no reason for concern for the general population.


The plot, as they say, thickens . . . .


Saudi MOH Announces 6 More MERS Cases In Jeddah (1 Fatal)


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This is the second update today from the Saudi MOH, which when added to the earlier one (see Saudi Arabia Announces 6 More MERS Cases – In Riyadh), makes an even dozen new coronavirus cases out of Saudi Arabia today.


Three are listed as asymptomatic, including 1 health care worker (age 26) and a 13 year-old.  A second health care worker (age 60) is listed in stable condition, while a 49 year-old is in intensive care.  The fatality is listed as as being 53 years of age.


Based on FluTracker’s MERS Case Line Listing, this brings to 51 the number of cases in this cluster, along with 8 deaths (or 52 and 9 if you count the religious pilgrim who died this week in Malaysia with recent travel history to Jeddah.)   Additionally, 22 (42%) are described as being Health Care Workers.



Health: Registration 6 cases of infection (Corona) new in Jeddah


In the context of the work of epidemiological investigation and ongoing follow-up carried out by the Ministry of Health for the virus, "Corona" that causes respiratory syndrome Middle East MERS-CoV, the ministry made ​​public for the registration of six new cases of the virus in Jeddah.

The first resident at the age of 53 years old has passed away, may he rest in peace.

The second citizen at the age of 49 years old and receiving treatment for intensive care, asking God his healing.

The third citizen working field of health at the age of 60 years, and his condition is stable.

The fourth resident operates the domain of health and at the age of 26 years, and has no symptoms.

The fifth resident to contact with a confirmed case at the age of 38 years, and has no symptoms.

The sixth resident Mkhalt of confirmed cases at the age of 13 years, and has no symptoms.

In this context, and in order from the Ministry of Health to provide all Avradalmojtma media and social networking guidelines of health and medical advice on HIV corona virus that causes AIDS Middle East, respiratory, and inform them of the developments around it, they invite everyone to access the link on the disease through the Ministry's website www / coronanew, or communicate via toll-free phone 8002494444 or 937 center or through the expense of the ministry in saudimoh @ Twitter

We wish for all health and safety.

KSA: Red Crescent Orders Ambulances & ERs To Accept MERS Cases



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Over the past several days there have been reports (mostly on twitter) indicating that some hospitals and/or ambulances were refusing to accept  patients with MERS-like symptoms.  Most of these tweets have been cryptic and difficult to verify, but today we have a report that appears to validate at least some of these reports.


Saudi Arabia’s Red Crescent Authority has issued orders to ambulances and emergency rooms that they must accept MERS cases, and render appropriate care. 


Unless they are attempting to solve a problem that doesn’t exist, it is reasonable to assume that there have been  at least some instances where people have been refused medical care over fears they have the MERS coronavirus.


Two reports, the first one from the Saudi Press Agency.


Red Crescent: Corona virus from within the emergency situations that must embrace.

Riyadh 18 jomada Al-akhera 1435 Ah April 18, 2014 s.p.a.

Saudi Red Crescent Authority confirmed that one of the functions of the emergency teams and centres in all regions of the Kingdom were directly infected by HIV cases/SK/so classified by the Board under emergency situations that must be carried out and provide treatment services are either on site or through transport until the injured to hospital.

The body said in a press release issued today that this action comes within the medical Protocol and emergency centres core business of body without exception.

It said the circular was all the difference in ambulatory centres or advanced air ambulance teams need to deal with all situations that are dangerous to human life and provide appropriate treatment by ambulatory teams directly, stressing that these cases can be diagnosed only after laboratory tests in the hospital.

He revealed that will stop any patient transfer ambulance squad reject suspected flu/SK/and referred for investigation and appropriate action will be taken after the completion of the investigation and announce it via the media.

He noted that emphasis was placed on all branches in the Kingdom to provide consumers and equipment such as masks and gloves and sterilization of the paramedics of the Red Crescent ambulance service to emergencies, whether a citizen or resident.

The body said in a statement that the goal is to detect any false or incorrect information is disseminated through the media or social media/new media/.


12: 17 pm


Another version of this story comes from Al Jazeera Online.



Red Crescent: We will stop work for any paramedic refuses to transfer the case of crowns

April 18, 2014 Last Updated 18:23

Stressed the Saudi Red Crescent Authority that it will halt any paramedic refuses to transfer a patient suspected wound infection (sk) from work and turn it to investigate and take appropriate action to them after the completion of the investigation with them and the declaration of the piece through the media.

Commission emphasized in a statement released today - Al-Jazeera received online copy of it - all the branches in the Kingdom of the importance of providing all the necessary hardware Kaloguenah gloves and tools sterilization of paramedics affiliates for the safety of workers in the field of ambulatory when directly these cases or other, indicating that they put the safety of their employees in the first place and foremost, but that does not absolve them from performing and humanitarian duty to save the lives of sick and injured with providing the best ambulance services for emergencies, both citizens and residents.

Authority said that the direct cases infected with HIV (Corona) of the functions of the difference ambulatory centers and affiliates in all regions of the Kingdom, noting that it is classified among the emergencies should be conducted and provide treatment services, both on-site or through the transport until it reaches the patient to the hospital.

Explained that it is through this press release, confirming the credibility and transparency of dealing him either with the beneficiaries of their services or media at the same time Authority aims to reveal any information "false" or incorrect and is published through the media or social media (new media

ECDC: MERS-CoV Epidemiological Update & Risk Assessment



Credit ECDC


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As part of their larger overall weekly Communicable Disease Threats report, the ECDC today has updated their assessment of the MERS outbreak in the Middle East. 


Middle East respiratory syndrome- coronavirus (MERS CoV) – Multistate

Opening date: 24 September 2012 Latest update: 17 April 2014

Epidemiological summary

Since April 2012 and as of 18 April 2014, 275 laboratory-confirmed cases of MERS-CoV have been reported by local health authorities worldwide, including 98 deaths and 64 healthcare workers. The following countries have reported MERS-CoV cases:

Saudi Arabia: 212 cases / 72 deaths
United Arab Emirates: 33 cases / 9 deaths
Qatar: 7 cases / 4 deaths
Jordan: 4 cases / 3 deaths
Oman: 2 cases / 2 deaths
Kuwait: 3 cases / 1 death
UK: 4 cases / 3 deaths
Germany: 2 cases / 1 death
France: 2 cases / 1 death
Italy: 1 case / 0 death
Tunisia: 3 cases / 1 death
Malaysia: 1 case / 1 death
Philippines: 1 case / 0 death

Fourteen cases have been reported from outside the Middle East: the UK (4), France (2), Tunisia (3), Germany (2), Italy (1), Malaysia (1) and Philippines (1). In France, Tunisia and the UK, there has been local transmission among patients who had not been to the Middle East, but had been in close contact with laboratory-confirmed or probable cases. Person-to-person transmission has occurred both among close contacts and in healthcare facilities.

In the first 18 days of April 2014, 57 cases (21% of total cases) have been reported, 29 of whom are healthcare workers (51%) and 21 are asymptomatic cases. In the United Arab Emirates, a cluster of 14 healthcare workers (including one case exposed in UAE and reported by the Philippines) has been reported during the past week. They all had had contact with a previously reported case, who died on 10 April 2014. Eight of the cases had mild symptoms and six were asymptomatic.

In Saudi Arabia, during the past week, 30 cases have all occurred in Jeddah, including 11 healthcare workers; five cases were fatal and eight were asymptomatic.

The first cases reported in Asia have occurred in people returning from the Middle East:

  • The case from the Philippines is an asymptomatic healthcare worker returning from the United Arab Emirates.
  • The case in Malaysia was in a 54-year-old man who returned from Saudi Arabia after Umrah on 29 March 2014. He developed symptoms (fever, coughing) around 8 April 2014. On 10 April 2014, he was admitted to hospital and died on 13 April 2014. The Malaysian health authorities are conducting prevention and control activities including monitoring close contacts of the case.

ECDC assessment

The source of MERS-CoV infection and the mode of transmission have not been identified, but the continued detection of cases in the Middle East indicates that there is an ongoing source of infection in the region. Dromedary camels are likely an important host species for the virus, and many of the primary cases in clusters have reported direct or indirect camel exposures. Almost all of the recently reported secondary cases, many of whom are asymptomatic or have only mild symptoms, have been acquired in healthcare settings. There is therefore a continued risk of cases presenting in Europe following exposure in the Middle East and international surveillance for MERS-CoV cases is essential. An international case-control study has been designed and proposed by WHO. Results of this or similar epidemiological studies to determine the initial exposures and risk behaviours among the primary cases are urgently needed.

The risk of secondary transmission in the EU remains low and can be reduced further through screening for exposure among patients presenting with respiratory symptoms and their contacts, and strict implementation of infection prevention and control measures for patients under investigation. The case detected in Malaysia last week had participated in the muslim pilgrimage Umrah. However, more details are needed on possible and suspected exposure events and it is possible that these cases were also infected when visiting healthcare facilities in the region.

The Malaysian authorities have asked all passengers travelling on the flights with the case detected in Malaysia on 29 March to be screened for health complaints.

The Philippines authorities have asked all passengers travelling with the Filipino case detected on 15 April to be screened for signs and symptoms of MERS-CoV infection, while the department of health is also actively contact tracing passengers.

(Continue . . . )

Saudi Arabia Announces 6 More MERS Cases – In Riyadh




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While we’ve been focused on the Jeddah cluster in Saudi Arabia, it wasn’t so very long ago (April 9th) when the capital city was the focus of most of their recent MERS cases.  Over the past 10 days KSA has announced 39 consecutive cases from Jeddah, but today we once again turn our attention toward Riyadh.


Today’s update revolves around five cases currently in intensive care, and a single fatality.  There is no mention of onset dates, routes of exposures, or occupations in this update.


Health: Registration 6 cases of infection (Corona) in Riyadh new


In the context of the work of epidemiological investigation and ongoing follow-up carried out by the Ministry of Health for the virus, "Corona" that causes respiratory syndrome Middle East MERS CoV Ministry announces the registration of six cases in Riyadh.

The first citizen at the age of 81 years is suffering from several chronic diseases, and is currently receiving treatment in intensive care.

The second is a citizen at the age of 32 years and also suffers from several chronic diseases, and is still receiving treatment in intensive care.

The third case was a citizen at the age of 78 years, as well as suffering from several chronic diseases where currently receiving treatment in intensive care.

But it is the fourth case of a resident at the age of 52 years and also suffers from several chronic diseases, is still receiving treatment in intensive care.

As for the fifth case it is also a resident at the age of 27 years old and suffers from a chronic disease, and is currently receiving treatment in intensive care, ask God healing them all.

The sixth case and they are resident at the age of 55 years, has died Ngmayora he rest in peace, where she was also suffering from chronic diseases.

In this context and in order from the Ministry of Health to provide all Avradalmojtma, media and social networking guidelines of health and medical advice on HIV corona virus that causes AIDS Middle East respiratory and inform them of the developments around it, they invite everyone to access the link on the disease through the Ministry's website www.moh / coronanew, or communicate via toll-free phone 8002494444 or 937 center or through a link saudimoh @ Twitter to get the information required.

God save our country from all evils.