Saturday, February 16, 2019

Macao Health Notified Of Human H9N2 Case In Yunnan Province, China


Macao's Health Bureau has posted what appears to be the first acknowledged H9N2 case of 2019 - reported to them by Chinese authorities - involving an 8 year old female in Yunnan Province.
In 2018, China reported 7 human cases (see FluTrackers List), although given the limited surveillance and testing, the actual number is likely far higher. Serological studies suggest human infection occurs  more often than official case counts would have us believe
The relevant portion of the announcement reads:
Yunnan confirmed case of human infection cases of H9N2 bird flu
source: Health Bureau
Release date: At 19:09 on February 15 2019

Health Bureau today (February 15) received the Mainland health authorities notified, Yunnan Province confirmed case of human infection of H9N2 avian influenza. According to the briefing refers the patient was an 8-year-old female student, now living in Lushui City, Yunnan Province, on January 27 symptoms, are less severe.

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Admittedly, not much in the way of details, but we may get more in the next WHO update.  Two weeks ago we saw a belated announcement of a case from December 2018 (see Taiwan CDC Notified Of Human H9N2 Case In Hunan Province, China).

Avian H9N2 can be found in poultry across much of Asia and parts of the Middle East, and is famous for its ability to mix its genes (via reassortment) with other viruses in order to produce new - potentially dangerous - new hybrids (see J. Virology:Genetic Compatibility of Reassortants Between Avian H5N1 & H9N2 Influenza Viruses).
Despite relatively few reported human infections - which have been generally mild or moderate - H9N2 viruses continue to evolve, and are showing signs of better adaptation to mammalian hosts (see Virology: Receptor Binding Specificity Of H9N2 Avian Influenza Viruses).
So, while H9N2 may not be at the top of our pandemic threats list, it is regarded as having at least some pandemic potential (see CDC IRAT SCORE), several candidate vaccines have been developed, and it continues continues to evolve and interact with other avian viruses.

Friday, February 15, 2019

WHO MERS Update - Saudi Arabia


The World Health Organization has published a MERS update for Saudi Arabia for the month of January. Unfortunately, the cutoff date of this report only allows the inclusion of the first 3 MERS cases from the Wadi Aldwasir outbreak, which now numbers 39 cases.
Two other clusters - one in Riyadh (3 cases) and 1 in Jeddah (2 cases) are also included.
The spreadsheet only indicates the first Wadi Aldwasir case had camel contact, while the 2nd and 3rd were exposed to a MERS case.  We still don't know under what circumstance they were exposed.

Over the first 15 days of February, Saudi Arabia has reported an additional 48 cases (YTD= 62), with 35 of those from Wadi Aldwasir. This marks the biggest monthly number of cases in KSA since June of 2017 (which also saw 48 cases), and there are nearly two weeks to go in February.

Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
Disease outbreak news
15 February 2019

From 1 January through 31 January 2019, the International Health Regulations (IHR) National Focal Point of Saudi Arabia reported fourteen additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including three deaths. Details of these cases can be found by following the link to a separate document after this paragraph.
Of the 14 cases reported in January, eight are from three separate clusters of cases. Cluster 1 involves three cases (listed as cases 1, 2 and 3) in Riyadh Province and cluster 2 involves two cases (listed as cases 4 and 5) in the city of Jeddah. Cluster 3 involves three cases (listed as cases 11, 13 and 14) in the city of Wadi Aldwaser and is currently ongoing.
More details regarding the outbreak in Wadi Aldwaser and the implementation of interventions by the Ministry of Health (MoH) in Saudi Arabia will be provided in the next update.

The link below provides details of the fourteen reported additional cases.
MERS-CoV cases reported between 1 January and 31 January 2019 xls, 118kb
From 2012 through 31 January 2019, the total number of laboratory-confirmed MERS-CoV cases reported globally to WHO under IHR (2005) is 2 298 with 811 associated deaths. The total number of deaths includes the deaths that WHO is aware of to date through follow-up with affected member states.
WHO risk assessment

Infection with MERS-CoV can cause severe disease resulting in high mortality. Humans are infected with MERS-CoV from direct or indirect contact with dromedary camels. MERS-CoV has demonstrated the ability to transmit between humans. So far, the observed non-sustained human-to-human transmission has occurred mainly in health care settings.

As of 15 February 2019, there is an ongoing outbreak of MERS in Wadi Aldwaser, which includes cases 11, 13 and 14 reported in the separate document linked above. WHO will provide details of the additional cases involved in this outbreak as well as intervention measures implemented by the MoH. The notification of additional cases does not change the overall risk assessment.

WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East, and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to dromedary camels, animal products (for example, consumption of camel’s raw milk), or humans (for example, in a health care setting). WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.

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Saudi MOH Announces 39th Wadi Aldwasir MERS Case

Original Map Credit Wikipedia


The Wadi Aldwasir outbreak continues - albeit at a slower pace the last 3 days - with the 39th case reported since January 29th.  Once again, today's patient acquired the infection in a healthcare setting, although we don't know if this is a Healthcare worker or an exposed patient.

This is the 23rd nosocomial infection in this outbreak. Eight of those are apparently asymptomatic or have experienced only mild symptoms, as they remain in home isolation.

WADI ALDWASIR CASES Since January 29th

While details are frustratingly lacking, there appear to have been at least 3 clusters of cases in Wadi Aldwasir.
  • 6 cases have been listed as secondary, household contacts
  • 2 cases have been listed as secondary, community-acquired
  • 23 cases have been listed as secondary, healthcare-acquired.
At this point we don't know if more than one household, or more than one healthcare facility, is involved and the circumstances surrounding the two secondary, community-acquired cases remains unspecified.
So the number of clusters could be higher. 
Additionally there are 9 Primary (community acquired) cases, of which 5 reported recent camel contact.  As we've seen, however, recent camel contact does not preclude another avenue of infection.

The good news is, the number of new cases continues to drop, suggesting that the outbreak is being brought under control. 

Taiwan BAPHIQ: ASF Positive Pork Products Brought In By Passengers From Vietnam

 Recently Confiscated Items - Credit BAPHIQ


In what may turn out to be an escalation in Asia's African Swine Fever crisis - which began more than six months ago with its arrival in China - we learn today that a pork product carried into Taiwan by a traveler from Vietnam has tested positive for the virus. 
While not completely unexpected (see FAO: African swine fever (ASF) threatens to spread from China to other Asian countries)  - should these products be confirmed to come from Vietnamese pigs - this would raise the stakes considerably. 
While Vietnam's Ministry of Agriculture (MARD) has yet to report an outbreak, they share an extremely porous border with China, and a search of the Vietnamese press for African Swine Fever (dịch tả lợn Châu Phi) returns an almost daily barrage of stories and warnings about the disease.

First a brief except from an English language Taiwanese media report on today's announcement.
Taiwan COA: Pork sample from Vietnam tests positive for African Swine Fever

This is the first time a product sample from outside China has tested positive for ASF, the Council of Agriculture revealed Friday
By Duncan DeAeth,Taiwan News, Staff Writer
2019/02/15 17:44

TAIPEI (Taiwan News) – Taiwan’s Council of Agriculture (COA) has announced that it will hold a press conference, Feb. 15, to announce that the African Swine Fever (ASF) virus has been detected in pork products from the nations of Vietnam.

The troubling announcement is a very likely indicator that the ASF epidemic in China has crossed the southern border into Vietnam, which will force Taiwan to increase scrutiny of travelers from the Southeast Asian country. 
(Continue . . . )
For more details we turn to excerpts from a translated announcement from Taiwan's BAPHIQ (Bureau of Animal Plant Health Inspection & Quarantine) - which not only describes the recent interception of the ASF contaminated product from Vietnam - but adds to the growing list of contaminated pork products confiscated from travelers from China (see previous blog Taiwan Intercepts More ASF Contaminated Food Products).

Continued monitoring at the border, Vietnamese tourists carrying pork products first detected the African swine fever virus gene

African swine fever Central Disaster Response Center today (15), said that to guard against the invasion of African swine fever, the Council of Agriculture Prevention and Quarantine Bureau from 107 in August starting from the airport, port passenger not into the airport (port) disposal of tank farm of Chinese mainland pork products sampling, detection of African swine fever virus sent to the Council of Agriculture animal health Research Institute (livestock Wei), prevention and Quarantine Bureau and from between 107 in November from increased pork products from Vietnam samples for examination.
Council of Agriculture confirmed today for the first time since the Vietnam passenger carrying illegal pork sandwich detected positive African swine fever virus gene, Prevention and Quarantine Bureau has today officially inform the competent authorities in Vietnam.
Another two pork products from mainland China also today confirmed detection of African swine fever virus gene, mainland China meat has reached a total 22 cases, the epidemic is still grim display in mainland China.
Response Center added that, in addition to the case of Vietnam, today and another two pork products from mainland China also confirmed detection of African swine fever virus gene, mainland China has reached a total of 22 cases, show mainland China has not slowed down the epidemic; the first of which 21 Example Taichung airport passenger January 30th of entry Hong Kong flight, abandons box sampled pork dry (Jiangsu Province, three squirrels), 22 cases are born in mainland China visitors February 5 from Macao immigration Taichung Airport violations carry pork dry (to Iraq were, origin unknown) was seized and fined 200,000 yuan cut, due to non-payment of fines has been refused entry.
Finally Response Center to remind people traveling abroad do not carry immigration animal and plant products, especially meat, and do not net purchase of foreign meat sent to Taiwan, and offenders will be subject to heavy penalties, do not defy the law.
While the ASF virus doesn't infect humans, the ramifications of its continued global spread could certainly impact the public's health and well-being. 

The most immediate involves the mass culling of pigs, which can deprive local populations of both the economic benefits and food protein of pork production. A particularly harsh blow for low-income, food-insecure regions of the world.
But as ASF (and Classical Swine Fever (CSF), Foot & Mouth Disease (FMD), & Avian Flu) spread, they also inhibit international trade, and can help compartmentalize counties and economies.
In recent months we've seen the spread not only of ASF in Asia and in Europe, but of CSF in Japan, and over the past couple of days, reports from Australia that FMD contaminated products have been intercepted at their airports.
Foot-and-mouth disease that threatens Australia's entire livestock industry detected in airport seizures
Meanwhile, the near silence from China's MOA on new outbreaks over the past 3 weeks has been almost deafening, with only one outbreak reported (Yongzhou City) since January 20th.

Thursday, February 14, 2019

OMAN: 4 New MERS Cases Reported

OMAN MOH Statement on MERS  Feb 14th


This afternoon there have been multiple Arabic media reports indicating that Oman's Ministry of Health had issued a new MERS statement, adding 4 new cases to the 6 reported over the past 16 days.
The problem is, there is (as of this writing) no official statement on the Oman MOH website.
What I have found, which appears to corroborate the media reports, is a tweet from the Oman MOH a few hours ago.  The writing is (unfortunately) in graphic format, and so regular translation software won't work.

So, with the caveat that we're relying on a media translation, the MOH release states:
Health issued a new statement about the # Corona
Thursday, 14 February 2019 7:17 PM
Ministry of Health

Monitoring - ether

The Ministry of Health issued a statement No. (4) on strengthening precautionary measures to control the Middle East respiratory syndrome "Corona" in the Sultanate.

According to Atheer, the statement reads as follows:

"The Ministry of Health in the latest update of the data on the Middle East respiratory syndrome (Corona) in the Sultanate, the number of cases recorded this year has reached ten cases and resulted in 4 deaths from different provinces of the Sultanate.

With the increase in the number of cases, the ministry will strengthen precautionary measures and prevention at the level of hospitals and health centers in order to promote the early detection of infected and reduce the spread of infection within the founder 
After going nearly 11 months without reporting a MERS case, on January 29th  the Omani MOH reported 4 MERS-CoV Cases, followed 6 days later (Feb 4th) with an update indicating a 5th MERS Case and 2 Deaths.

Yesterday, nine days later - Oman's MOH Reported A 6th MERS Case - and 24 hours later, they've announced 4 more.  All of the reports have been largely devoid of specifics.
Last Monday, the WHO published a MERS-CoV Update - Oman, which covered the first five cases, and stated all five are members of the same family, and live on a farm together.
Today's update from the MOH specifically mentions  `. . . ten cases and resulted in 4 deaths from different provinces of the Sultanate' which would suggest that - if all of these cases are epidemiologically related - it is no longer confined to a single family farm. 

Prior to this outbreak, Oman had only reported 11 MERS cases in the 7 years since the virus was first identified.  In just over 2 weeks, that total has nearly doubled. 

Stay tuned.  This story continues to evolve. 

Saudi MOH Announces 1 Additional MERS Case In Wadi Aldwasir (Deceased)

Original Map Credit Wikipedia


The MERS outbreak in Wadi Aldwasir continues to show some signs of slowing with only two cases reported over the past two days.  Today's case involves a 60 y.o. male - already deceased - who is listed as secondary, healthcare-acquired case.

Without onset dates, we can't tell if this is simply a belatedly reported case - or the patient wasn't discovered to be infected until he was near death.
The publicly available Saudi Surveillance data only provides limited information on each case, and as information changes, edits are made - sometimes days or even weeks after the original release - making it a work in progress.
Case classifications, outcomes, and other data can change, making it useful to go back over the 38 cases reported in from Wadi Aldwasir since late January, picking up those changes (see spreadsheet below).

This information will undoubtedly change, but so far we can glean the following:
  • Of the 38 cases reported to date, 4 are reported deceased & 3 as recovered
  • 9 cases are listed as Primary (community acquired), but only 5 of those  had recent camel contact 
  • 9 cases reported recent camel contact, but 4 are classified as a secondary contact of a known case
  • 10 cases are listed in Home isolation, suggesting either a mild or asymptomatic infection
  • 2 cases are listed as Secondary, community-acquired - but so far we don't really know under what circumstances that occurred.
  • 22 are listed as secondary, healthcare-acquired.   It isn't clear how many are Health care workers, and how many may be patients exposed in the hospital.
  • 5 cases are listed as secondary, household-contact - but we don't know if this is all in one household, or more than one
  • 6 cases are female, 32 are male.
  • 19 remain hospitalized (or their status hasn't been updated).
  •  Of the 61 cases reported by Saudi Arabia during the first 7 weeks of 2019, 38 are in Wadi Aldwasir. Of those, 29 are listed as secondary infections.
A lot of individual data points to ponder, but we'll have to await a more comprehensive report from the WHO, in order to make much sense of it.

Meanwhile, 23 other cases have been reported in KSA since the first of the year, with 12 of those in the capital city Riyadh.