WHO Adds Lambda VOI (Variant of Interest) To Their Watchlist

 

#16,022

While the COVID pandemic is far from over, it is receding again as the Northern Hemisphere enters the summer months.  The latest summary from the WHO's weekly (June 15th) Epidemiological Report reads:

Overview

In the past week, the number of new COVID-19 cases and deaths continued to decrease, with over 2.6 million new cases and 72 000 new deaths reported globally. While the number of cases reported globally now exceeds 175 million, over the past week, the lowest weekly case incidence since February 2021 was reported. Declines in the number of new weekly cases, compared to the previous week, were reported across all Regions except for the African Region. The number of new deaths reported in the past week decreased across all the regions except for the African and South-East Asia Regions.

In this edition, a special focus update on variants is provided, including a newly designated variant of interest (VOI), along with the geographical distribution of variants of concern (VOCs) Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1) and Delta (B.1.617.2). This edition also includes an update about strengthening public health intelligence through event-based surveillance, specifically learning from the COVID-19 pandemic.

All regions of the world - with the exception of Africa - are reporting declines in cases.  The trend in Africa (up 44% over last week), is concerning however. 

The World Health Organization also announced the addition of a new Variant of Interest, dubbed Lambda (C.37), which was first reported in Peru last fall.  They describe it as:

VOI Lambda

On 14 June 2021, a variant assigned to Pango lineage C.37, GISAID clade GR/452Q.V1, NextStrain clade 20D, was designated as a global VOI, and assigned the WHO label “Lambda”. This variant has been monitored as an alert for an extended period, and upon more information and updated assessments, is now considered as meeting the VOI working definition based upon evidence of continued emergence and suspected phenotypic implications.

Lambda has been associated with substantive rates of community transmission in multiple countries, with rising prevalence over time concurrent with increased COVID-19 incidence. The earliest sequenced samples were reported from Peru in August 2020. 

As of 15 June 2021, over 1730 sequences have been uploaded to GISAID from 29 countries/territories/areas in five WHO regions. 

Elevated prevalence has been noted particularly in South America in countries such as Chile (31% overall prevalence among submitted sequences 6since first detected in this location to date), Peru (9%), Ecuador (8%), and Argentina (3%). 

Authorities in Peru reported that 81% of COVID-19 cases sequenced since April 2021 were associated with Lambda. 

Argentina reported increasing prevalence of Lambda since the third week of February 2021, and between 2 April and 19 May 2021, the variant accounted for 37% of the COVID-19 cases sequenced.

In Chile, prevalence of Lambda has increased over time, accounting for 32% of sequenced cases reported in the last 60 days – co-circulating at similar rates to variant Gamma (33%), but outcompeting variant Alpha (4%) over the same period. 

Lambda carries a number of mutations with suspected phenotypic implications, such as a potential increased transmissibility or possible increased resistance to neutralizing antibodies. 

It is characterised by mutations in the spike protein, including G75V, T76I, del247/253, L452Q, F490S, D614G and T859N; however, there is currently limited evidence on the full extent of the impact associated with these genomic changes, and further robust studies into the phenotypic impacts are needed to better understand the impact on countermeasures and to control the spread.

Further studies are also required to validate the continued effectiveness of vaccines.

The World Health Organization currently lists 4 VOCs (Variants of Concern) and 7 VOIs (Variants of Interest), and continues to monitor dozens more.  Whether Lambda has what it takes to challenge the more worrisome VOCs remains to be seen.

 For now, the Delta Variant appears to be of most concern (see UK PHE Technical Briefing, Revised Risk Assessment, & Household Transmission Study On COVID Variant B.1.617.2 (Delta)).

COCA Call (Tomorrow, June 17th): Evaluating and Caring for Patients with Post-COVID Conditions

 

#16,021

Although a similarly themed COCA call was scheduled for June 3rd, it was postponed, and will now be held tomorrow (June 27th) with a different set of presenters. 

COCA Calls are often technical, and are of greatest interest to clinicians and healthcare providers, but also may be of interest to the general public.

As always, If you are unable to attend the live presentation, these (and past) webinars are archived and available for later viewing at this LINK.  Details on this week's presentation follow:

Evaluating and Caring for Patients with Post-COVID Conditions

Free Continuing Education

Overview

During this COCA Call, clinicians will learn about the Centers for Disease Control and Prevention’s new interim guidance which provides a framework for healthcare providers in their initial assessment, evaluation, management, and follow-up of persons with possible post-COVID conditions. Post-COVID conditions refer to the wide range of physical and mental health consequences experienced by some patients that are present four or more weeks after SARS-CoV-2 infection, including by patients who had initial mild or asymptomatic acute infection. Post-COVID conditions are still being characterized and include symptoms such as cognitive difficulties, fatigue, headache, dyspnea, and palpitations. Subject matter experts, physicians, and patient representatives from across the United States collaborated to develop the new guidance. Rapid recognition by healthcare providers of patients with post-COVID conditions and multidisciplinary care using the assessments and approaches described in this guidance could improve the wellbeing and treatment of people with post-COVID conditions.

Presenters

Jennifer R. Chevinsky, MD, MPH

Epidemic Intelligence Service Officer

Post-COVID-19 Conditions Unit

COVID-19 Response

Centers for Disease Control and Prevention

Alex Vosooney, MD

Chair, Subcommittee on Clinical Recommendations and Policies

American Academy of Family Physicians

Michael Saag, MD

Professor of Medicine

Director, UAB Center for AIDS Research

University of Alabama Birmingham

Call Materials

To be posted. Please check back.

Call Details

When:

Thursday, June 17, 2021,

2:00 PM – 3:00 PM ET

A few minutes before the webinar begins, please click on the link below to join: https://www.zoomgov.com/j/1607826639?pwd=L25SbzNYUi80SVo1dUZzV1hnRi9MUT09external icon

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Dial-in US:+1 669 254 5252 or +1 646 828 7666 or +1 669 216 1590 or +1 551 285 1373

Webinar ID:160 782 6639

Passcode: 183098

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International numbers available: https://www.zoomgov.com/u/adiXYg7cFexternal iconAdd to Calendar

The CDC released new guidance yesterday for clinicians in dealing with Post-COVID Conditions, which is available at:

Evaluating and Caring for Patients with Post-COVID Conditions: Interim Guidance
Updated June 14, 2021
 
This content is a more detailed version of the Post-COVID Conditions: Information for Healthcare Providers page. This page is also distinct from the Post-COVID Conditions webpage which is intended for the general public.

Table of Contents

› Key Points

Background

General Clinical Considerations

Patient History and Physical Exam

Assessment and Testing

Management of Post-COVID Conditions

Public Health Recommendations

Future Directions and Resources

Key Points

• The term “Post-COVID Conditions” is an umbrella term for the wide range of physical and mental health consequences experienced by some patients that are present four or more weeks after SARS-CoV-2 infection, including by patients who had initial mild or asymptomatic acute infection.
• Based on current information, many post-COVID conditions can be managed by primary care providers, with the incorporation of patient-centered approaches to optimize the quality of life and function in affected patients.
• Objective laboratory or imaging findings should not be used as the only measure or assessment of a patient’s well-being; lack of laboratory or imaging abnormalities does not invalidate the existence, severity, or importance of a patient’s symptoms or conditions.
• Healthcare professionals and patients are encouraged to set achievable goals through shared decision-making and to approach treatment by focusing on specific symptoms (e.g., headache) or conditions (e.g., dysautonomia); a comprehensive management plan focusing on improving physical, mental, and social wellbeing may be helpful for some patients.
• Understanding of post-COVID conditions remains incomplete and guidance for healthcare professionals will likely change over time as the evidence evolves.

V. Evolution: Genomic Evolution, Transmission Dynamics, and Pathogenicity of Avian H5N8 Viruses Emerging in China, 2020

#16,020

Although the pandemic has garnered the bulk of our attention, we've also been keeping a close eye on the gradual return and spread of Avian H5 viruses (primarily H5N8) following a 3-year hiatus across much of the globe.  

While once - along with H7N9 - atop our pandemic worry list, both subtypes went to ground following China's massive poultry vaccination campaign of 2017. 

Some pockets of HPAI H5 remained, of course, and we saw scattered reports from Russia, Eastern Europe, and the Middle East in 2018-2019, but nothing on the scale that we'd seen prior to 2017. And reports of human infections with H5N1, H7N9 and H5N6 all but disappeared. 

While China's H7N9 remains greatly suppressed, since early in 2020 we've seen a resurgence of HPAI H5 - in particular HPAI H5N8 - both in Europe and Asia.  While related to the subtype that sparked the 2016 European epizootic (clade 2.3.4.4b), these new incursions were described as `genetically distinct' from past incarnations we'd seen. 

Pre-Print: Novel Incursion of a HPAI H5N8 Virus in the Netherlands, October 2020

Influenza virus evolution is driven primarily by antigenic drift (replication errors), and antigenic shift (reassortment).  Generally, reassortment (see below) causes the most dramatic changes. 

A reassortment of a far more benign H5N8 virus in either China or Russia over the summer of 2016 led to Europe's largest avian epizootic on record (see EID Journal: Reassorted HPAI H5N8 Clade 2.3.4.4. - Germany 2016).

Other reassortment events, often in China, have led to further expansion of HPAI H5 viruses, including the infamous 2005 bird die off at Qinghai Lake, China signaling the emergence of clade 2.2 (aka QH05) of the H5N1 virus, when then quickly moved into Europe and the Middle East.

Over the past year we've seen a number of suspicious bird die offs, both in Russia and in China, which often indicate the emergence of a new, more virulent (at least in birds), avian flu subtype. Over the summer of 2020, Russia reported die offs of wild birds, and outbreaks in poultry, due to HPAI H5N8.

Followed last fall by Europe's second largest avian epizootic on record, with - you guessed it - a `genetically distinct' H5N8 virus.

Since then we've seen several H5N8 related wild bird die offs in China (see here , here, and here)  - and most notably - in February of 2021, Russia reported the first confirmed human infections with avian H5N8 (see Russian Media Reports 7 Human Infections With Avian H5N8).

While how much of a threat avain H5N8 will pose in the future is unknown, in May the CDC Added Zoonotic Avian A/H5N8 To Their IRAT List, while last March the WHO called for the creation of a Candidate Vaccine Virus (CVV) for this new H5N8 virus (see WHO: Candidate Vaccine Viruses for Pandemic Preparedness - March 2021). 

In May, in Science: Emerging H5N8 Avian Influenza Viruses, we looked at a cautionary report by two well respected Chinese scientists who warn on the zoonotic potential of H5N8. 

PERSPECTIVE PUBLIC HEALTH

Emerging H5N8 avian influenza viruses
Weifeng Shi1,2,
George F. Gao3,4

Today we've another look at the quiet evolution of HPAI H5N8 in China, this time published in Virus Evolution, that describes the rapid rise last summer of an antigenically distinct H5N8 virus that is lethal to chickens and mice, that is similar to the Russian Zoonotic strain, and shows signs of mammalian adaptation.

Genomic evolution, transmission dynamics, and pathogenicity of avian influenza A (H5N8) viruses emerging in China, 2020

 

Jiahao Zhang, Xudong Li, Xiaomin Wang, Hejia Ye, Bo Li, Yiqun Chen, Junhong Chen, Tao Zhang, Ziwen Qiu, Huanan Li ... Show more

 

Virus Evolution, Volume 7, Issue 1, January 2021, veab046, https://doi.org/10.1093/ve/veab046

Published:

 

06 May 2021

PDF

 

Abstract

Multiple recent outbreaks of highly pathogenic H5N8 viruses originating in aquatic birds frequently occurred in most European countries, Russia, South Korea, and Japan during the winter of 2020–21, and one zoonotic event of poultry workers infected with novel H5N8 viruses were reported in Russia. 

Strikingly, these novel H5N8 viruses had emerged and been co-circulating in wild birds and poultry in multiple provinces of China during 2020–21. In China, the population of aquatic birds has risen significantly in the past twenty years, and China is regarded as the largest reservoir for influenza viruses carried in aquatic birds across the globe. Hence, the co-circulation of these novel H5N8 viruses poses an alarming threat to not only poultry industry but also human health. 

In this study, we sequenced full-length genomes of these H5N8 viruses circulating in China. Phylogenetic analysis demonstrated that poultry-origin H5N8 viruses in China fell within wild birds-origin clade 2.3.4.4b H5N8 viruses from Europe during 2020–21, and notably, were genetically closely related to human-infecting H5N8 viruses in Russia. Moreover, they possessed several molecular markers associated with mammalian adaption. 

Bayesian coalescent analysis showed that these H5N8 viruses might have introduced into China during June–September 2020, suggesting that these H5N8 viruses might have introduced via wild bird migration or poultry trade. Besides, we also found that the effective population size of clade 2.3.4.4b H5N8 viruses dramatically increased during the winter season of 2020/21, as is consistent with previous increase of genetic diversity during the winter seasons of 2013/14 and 2016/17, which indicated that the wild bird migration accelerates the genetic diversity of these H5N8 viruses during the winter season of 2020/21. 

Notably, these novel H5N8 viruses were lethal to chickens and mice, highly transmissible to ducks, and were antigenically distinct from 2.3.4.4h H5 viruses circulating in China, posing considerable threats to public health. Our findings offer novel insights into the evolution and risk assessment of H5N8 viruses during the winter season of 2020–21.

          (Continue . . . )

In addition to H5N8, we've also seen an uptick in human H5N6 infections in China, the first known Human Avian H10N3 Infection In China, an as-yet unconfirmed report of human H5N1 infections in Nigeria (see The ECDC On The Recent Nigeria H5N1 Report Of Suspected Human Infections), and a recent surge in H5 avian flu activity in the Middle East. 

Since it is summer in the Northern Hemisphere, avian flu activity is currently somewhat restricted, but come the fall tens of millions of birds will leave their high-latitude roosting sites and head south for the winter. 

We can't predict what kind of avian flu season they are going to bring, but we can see that avian flu activity is ramping up globally, and is evolving in worrisome directions.  While we've still got our hands full dealing with the coronavirus pandemic, we ignore other potential zoonotic threats at our own peril.  

CDC Elevates Delta (B.1.617.2) Variant to VOC & Lancet Report On Hospitalizations & Vaccine Effectiveness

 

Global Spread of Delta Variant  - Credit CDC

#16,019

While the COVID Delta variant was designated a VOC (Variant of Concern) by the UK, and the WHO, more than a month ago - so far - it has played only a minor role in COVID's spread in the United States, and until yesterday was classified as a VOI (Variant of Interest). 

The last CDC update (as of 5/22/21) showed only 2.5% of the country's COVID cases were due to the Delta variant.

But forward looking projections suggest that its share will more than double by the next update, and longer term, B.1.617.2 appears on track to challenge B.1.1.7 for dominance in the U.S. later this  summer.  

Add in the UK's increasingly dour Risk Analyses (below), which includes concerns over reduced vaccine effectiveness, and the CDC's decision to elevate Delta to a VOC was highly expected. 

Yesterday's Lancet report of double the hospitalization risk from this variant, and the UK's decision (also yesterday) to hold off on lifting their lockdown for another 30 days due to rising cases, only further confirms the concern over this growing threat. 

Late yesterday the CDC published an updated:

SARS-CoV-2 Variant Classifications and Definitions

Updated June 14, 2021

Key Points

• Genetic variants of SARS-CoV-2 have been emerging and circulating around the world throughout the COVID-19 pandemic.

• Viral mutations and variants in the United States are routinely monitored through sequence-based surveillance, laboratory studies, and epidemiological investigations.

• A US government interagency group developed a Variant Classification scheme that defines three classes of SARS-CoV-2 variants:

Variant of Interest

Variant of Concern

Variant of High Consequence

• The B.1.1.7 (Alpha), B.1.351 (Beta), P.1 (Gamma), B.1.427 (Epsilon), B.1.429 (Epsilon), and B.1.617.2 (Delta) variants circulating in the United States are classified as variants of concern.

• To date, no variants of high consequence have been identified in the United States.

• Laboratory studies suggest specific monoclonal antibody treatments may be less effective for treating cases of COVID-19 caused by variants with the L452R or E484K substitution in the spike protein, the combination of K417N, E484K, and N501Y, or the combination of K417T, E484K, and N501Y substitutions in the spike protein.

• L452R is present in B.1.526.1, B.1.427 (Epsilon), and B.1.429 (Epsilon) lineages, as well as the B.1.617 (Kappa, Delta) lineages and sub-lineages.

• E484K is present in B.1.525 (Eta), P.2 (Zeta), P.1 (Gamma), and B.1.351 (Beta), but only some strains of B.1.526 (Iota) and B.1.1.7 (Alpha).

• The combination of K417N, E484K, and N501Y substitutions is present in B.1.351 (Beta).

• The combination of K417T, E484K, and N501Y substitutions is present in P.1 (Gamma).

Viruses constantly change through mutation. A variant has one or more mutations that differentiate it from other variants in circulation. As expected, multiple variants of SARS-CoV-2 have been documented in the United States and globally throughout this pandemic. To inform local outbreak investigations and understand national trends, scientists compare genetic differences between viruses to identify variants and how they are related to each other.

(SNIP)

Variant of Concern

A variant for which there is evidence of an increase in transmissibility, more severe disease (e.g., increased hospitalizations or deaths), significant reduction in neutralization by antibodies generated during previous infection or vaccination, reduced effectiveness of treatments or vaccines, or diagnostic detection failures.

Possible attributes of a variant of concern:

In addition to the possible attributes of a variant of interest

• Evidence of impact on diagnostics, treatments, or vaccines
• Widespread interference with diagnostic test targets
• Evidence of substantially decreased susceptibility to one or more class of therapies
• Evidence of significant decreased neutralization by antibodies generated during previous infection or vaccination
• Evidence of reduced vaccine-induced protection from severe disease
• Evidence of increased transmissibility
• Evidence of increased disease severity

Variants of concern might require one or more appropriate public health actions, such as notification to WHO under the International Health Regulations, reporting to CDC, local or regional efforts to control spread, increased testing, or research to determine the effectiveness of vaccines and treatments against the variant. Based on the characteristics of the variant, additional considerations may include the development of new diagnostics or the modification of vaccines or treatments.

Current variants of concern in the United States that are being closely monitored and characterized by federal agencies are included in the table below. The table will be updated when a new variant of concern is identified.

The Delta variant's new slot on the VOC list reads:

In addition to the (now 6) VOCs on the CDC's list, the CDC continues to monitor 7 VOIs, and keeps one eye on dozens more that today aren't considered as threatening. 

Despite the concerns over the Delta Variant's ability to evade some of the protection afforded by vaccines, the Lancet report mentioned above also found that the mRNA vaccines `. . . were effective in reducing the risk of SARS-CoV-2 infection and COVID-19 hospitalisation', but these effects on infection appeared to be diminished when compared to those with the Alpha VOC."

You can read the full correspondence at the link below:

CORRESPONDENCE 

SARS-CoV-2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness

Aziz Sheikh, Jim McMenamin, Bob Taylor, Chris Robertson

on behalf of Public Health Scotland and the EAVE II Collaborators

Published:June 14, 2021 DOI:https://doi.org/10.1016/S0140-6736(21)01358-1

While the Delta variant has ruined the UK's plans for a June 21st `Lockdown Exit Day', and seems poised to rise to dominance here in the United States later this summer, all evidence suggests that the greater the vaccine uptake, the less of an impact this variant will have on a community. 

Unfortunately, less than half the country is fully vaccinated, and the pace of COVID vaccine uptake has fallen in recent weeks, as restrictions have eased and the sense of urgency has diminished.

All of which means that the Delta variant still has an opening to exploit, as it's presence in the United States increases over the next few months. 

CDC HAN: Increased RSV Reports Across The Southern United States

 

Note: CDC HAN messages (Alert, Advisory, Update, or Info) are designed to ensure that communities, agencies, health care professionals, and the general public are able to receive timely information on important public health issues.

#16,018

For more than a year - since the emergence of COVID-19 and the resultant adoption of social distancing, face cover wearing, and stringent hand hygiene by many individuals - regular garden variety respiratory infections have practically disappeared.  

The wavy line of red triangles at the bottom of the FluView Graphic above show the unprecedented low level of ILI - or Influenza-like Illness (including flu, Rhinovirus, RSV, Adenovirus, etc.) reported to the CDC over the winter.

We've seen similar drops around the globe, including for infectious diseases like Norovirus, measles, and Scarlet Fever.  And while a welcomed trend, it is one that can't be expected to last forever. 

More than a year ago, in COVID-19, The Next Flu Season, And The Temporary Immunity Hypothesis, we looked at some of the possible impacts of this pandemic induced hiatus from the usual panoply of respiratory ailments. 

Not the least of which is a general lowering of our resistance to those types of viruses. 

While the feared `twindemic' of flu and COVID did not appear last year, we are only a few months away from the next Northern Hemisphere flu season - and with people eschewing masks and spending more time in public - the risks of seeing a substantial flu season next fall are likely increasing.

While not necessarily a harbinger of what is to come, late last week the CDC released a HAN notice on increased interseasonal Respiratory Syncytial Virus (RSV) activity in parts of the Southern United States.  

This is notable as RSV normally peaks in the fall and winter months, and many children have now gone 15 months without any previous exposure to this virus.  With most states now dropping social distancing requirements, and the inevitable socialization that will occur over the summer,  there is a potential for further spread. 

And while a common infection in children, RSV can also affect adults, sometimes producing serious, even fatal, illness.  Since having an ILI anytime of the last 12 months has been a red flag for COVID, knowing that RSV is now circulating will be an important consideration for doctors. 

Increased Interseasonal Respiratory Syncytial Virus (RSV) Activity in Parts of the Southern United States

Distributed via the CDC Health Alert Network
June 10, 2021, 1:30 PM ET
CDCHAN-00443

Summary

The Centers for Disease Control and Prevention (CDC) is issuing this health advisory to notify clinicians and caregivers about increased interseasonal respiratory syncytial virus (RSV) activity across parts of the Southern United States. Due to this increased activity, CDC encourages broader testing for RSV among patients presenting with acute respiratory illness who test negative for SARS-CoV-2, the virus that causes COVID-19. RSV can be associated with severe disease in young children and older adults. This health advisory also serves as a reminder to healthcare personnel, childcare providers, and staff of long-term care facilities to avoid reporting to work while acutely ill – even if they test negative for SARS-CoV-2.

Background

RSV is an RNA virus of the genus Orthopneumovirus, family Pneumoviridae, primarily spread via respiratory droplets when a person coughs or sneezes, and through direct contact with a contaminated surface. RSV is the most common cause of bronchiolitis and pneumonia in children under one year of age in the United States. Infants, young children, and older adults with chronic medical conditions are at risk of severe disease from RSV infection. Each year in the United States, RSV leads to on average approximately 58,000 hospitalizations1 with 100-500 deaths among children younger than 5 years old2 and 177,000 hospitalizations with 14,000 deaths among adults aged 65 years or older.3

In the United States, RSV infections occur primarily during the fall and winter cold and flu season. In April 2020, RSV activity decreased rapidly, likely due to the adoption of public health measures to reduce the spread of COVID-19.4 Compared with previous years, RSV activity remained relatively low from May 2020 to March 2021.

However, since late March, CDC has observed an increase in RSV detections reported to the National Respiratory and Enteric Virus Surveillance System (NREVSS), a nationwide passive, laboratory-based surveillance network. CDC noted increases in laboratory detections and in the percentages of positive detections for both antigen and PCR testing in parts of HHS Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas). Due to limited testing outside of the typical RSV season, data are limited in some jurisdictions and may be incomplete for the most recent weeks.

Since this elevated interseasonal activity is a deviation in the typical circulation patterns for RSV, at this time it is not possible to anticipate the likely spread, peak, or duration of activity with any certainty. Health officials also identified increased interseasonal RSV circulation in parts of Australia during late 2020 and in South Africa in early 2021. Still, RSV did not reach seasonal peak levels in most regions or result in widespread circulation.5-7

Due to reduced circulation of RSV during the winter months of 2020–2021, older infants and toddlers might now be at increased risk of severe RSV-associated illness since they have likely not had typical levels of exposure to RSV during the past 15 months. In infants younger than six months, RSV infection may result in symptoms of irritability, poor feeding, lethargy, and/or apnea with or without fever. In older infants and young children, rhinorrhea and decreased appetite may appear one to three days before cough, often followed by sneezing, fever, and sometimes wheezing. Symptoms in adults are typically consistent with upper respiratory tract infections, including rhinorrhea, pharyngitis, cough, headache, fatigue, and fever. There is no specific treatment for RSV infection other than symptom management.

Recommendations

1. Clinicians and caregivers should be aware of the typical clinical presentation of RSV for different age groups.
2. Clinicians should consider testing patients with a negative SARS-CoV-2 test and acute respiratory illness or the age-specific symptoms presented above for non-SARS-CoV-2 respiratory pathogens, such as RSV. Real-time reverse transcription-polymerase chain reaction (rRT-PCR) is the preferred method for testing for respiratory viruses.
3. Clinicians should report laboratory-confirmed RSV cases and suspected clusters of severe respiratory illness to local and state health departments according to their routine reporting requirements.
4. Healthcare personnel, childcare providers, and staff of long-term care facilities should avoid reporting to work while acutely ill – even if they test negative for SARS-CoV-2.
5. Clinicians can review weekly updates to the NREVSS website and refer to surveillance data collected by local hospitals and health departments for information on RSV circulation trends in their area.

Regardless of what happens with RSV this summer, influenza, measles, Scarlet Fever, and a host of other viral infections are still out there, waiting for us to drop our COVID protections, so they can flourish once again. 

Saudi Arabia Reports A MERS-CoV Case In Taif

#16,017

Before COVID emerged, MERS-CoV was the coronavirus of greatest concern, having infected more than 2000 people in the Middle East since 2012 and killing about 35% of them.  Carried by camels, it can spread from human-to-human in close quarters, like households and hospitals. 

But since COVID emerged, reporting on MERS from Middle East - and in particular from Saudi Arabia, where 90% of previous cases had been reported - has all but ceased. 

Granted, the Saudis have never been particularly eager to share details on the virus, or their number of cases, and have shut down reporting for months at a time in the past (see 2018's The Saudi MOH Breaks Their Silence On MERS-CoV).  

And last year, WHO EMRO went a full year without posting their regular monthly MERS update (see WHO EMRO Updates A Year's Worth Of MERS-COV Reports From Saudi Arabia).  They've since gone another 6 months without posting an update (EMRO Link). 

The Saudi MOH MERS-Cov reporting website often goes weeks without updating (today still reflecting Epi week 22, even though this is Epi Week 24), and still shows no direct link to the list of 2021 cases (of which we know of 9). 

Screenshot (today) From Saudi MOH MERS-CoV Landing page

But there is a list of 2021 cases buried on the MOH website, you just have to know where to look. 

Here we find that a case was reported last week (Epi week 23), but never posted on the MOH surveillance page.  The patient is a 63 y.o. male from Almwaith City, Taif, who had prior camel contact. 

Given that - until 2020 - we've seen an average of well over 200 cases a year out of Saudi Arabia since 2012, it is difficult to say how representative these 9 reported cases in 2021 are of their MERS-Cov situation. 

Even during the best of times Saudi Surveillance and reporting was estimated to be picking up only a fraction of the actual MERS cases in the Kingdom (see EID Journal: Estimation of Severe MERS Cases in the Middle East, 2012–2016).

While it is possible that the incidence of MERS - like influenza - has dropped precipitously since the arrival of COVID-19, it is also possible that limited, and over taxed resources have led to a reduction in case reporting.

Either way, as long as MERS circulates in camels - and occasionally jumps to humans - it remains a credible public health threat. 

And one we need better, and more consistent, surveillance and reporting on.