Study: A Single Mutation In H5N1 HA Enhances Replication In Mice

Credit CDC PHIL

 

 

# 6975

 

 

A study today - authored by Hassan Zaraket, Olga A. Bridges, Charles J. Russell - links a single mutation (lysine-to-isoleucine at position 58 in the H5N1 HA2 subunit) to increased replication in mice.

 

And not by just a little . . . by a hundred fold or better.

 

The study, which is scheduled to be formally published in the May issue of the Journal of Virology , can be accessed at the following link: 

 

The pH of Activation of the Hemagglutinin Protein Regulates H5N1 Influenza Virus Replication and Pathogenesis in Mice

Hassan Zaraket, Olga A. Bridges, Charles J. Russell5

Department of Infectious Diseases, St. Jude Children's Research Hospital 

Department of Microbiology, Immunology & 8 Biochemistry, College of Medicine, The University of Tennessee Health Science Center

 

This is a fairly technical paper, and so non-virologists who find it tough sledding may wish to move on to the accompanying editorial and the press release.

 

The editorial, which is somewhat less daunting, is available at:

 

A New Determinant of H5N1 Influenza Virus Pathogenesis in Mammals

Terence S. Dermody, Rozanne M. Sandri-Goldin, and Thomas Shenk

 

This study involved doing work with a recombinant H5N1 virus that produces enhanced virulence in mice. Therefore, a good deal of this editorial addresses the steps taken to minimize the risks, DURC (Duel Use Research of Concern) compliance, and the ultimate decision to publish the results.

 

Note: These researchers did not seek to increase the virus’s transmissibility, only gauge its replication and mortality in a mammalian species.

 

 

This editorial lists benefits from this type of research that include: by identifying which genetic changes favor a lower pH optimum of HA activation, it may be possible to identify which strains are the most dangerous to humans.

 

Additionally, introducing a mutation that increases replication into a H5N1 vaccine seed strain could conceivably speed up vaccine production.

 

Obviously aware that the publication of this study might raise some eyebrows in the biosecurity world, the authors of the accompanying editorial conclude by writing:

 

 

Reasonable people may disagree about whether the work reported by Zaraket et al. (1) is DURC. We note that a designation of DURC should not necessarily preclude conduct of the research or communication of the findings.

 

The study in this issue of JVI was thoughtfully considered by experts in influenza virus research, biosafety and biosecurity, scientific publication, and the U.S. government.

 

Following this consideration, we concluded that the benefits of publication outweigh any potential risks. Given the concerns raised about the possibility of DURC in this study, we think that describing the process used to evaluate the manuscript is an important

 

 

The following press release from American Society for Microbiology  provides us with the easiest layman’s explanation (once you get past the title) for what was done, and what it means.

 

Mutation altering stability of surface molecule in acid enables H5N1 infection of mammals

A single mutation in the H5N1 avian influenza virus that affects the pH at which the hemagglutinin surface protein is activated simultaneously reduces its capacity to infect ducks and enhances its capacity to grow in mice according to research published ahead of print today in the Journal of Virology.

 

"Knowing the factors and markers that govern the efficient growth of a virus in one host species, tissue, or cell culture versus another is of fundamental importance in viral infectious disease," says Charles J. Russell of St. Jude Children's Research Hospital, Memphis, TN, an author on the study. "It is essential for us to identify influenza viruses that have increased potential to jump species, to help us make decisions to cull animals, or quarantine humans." The same knowledge "will help us identify targets to make new drugs that stop the virus… [and] engineer vaccines."

<SNIP>

 

When influenza viruses infect birds, the hemagglutinin surface protein of the virus is activated by acid in the entry pathway inside the host cell, enabling it to invade that cell. In earlier work, Russell and collaborators showed that a mutant version of the influenza H5N1 virus called K58I that resists acid activation, loses its capacity to infect ducks. Noting that the upper airways of mammals are more acidic than infected tissues of birds, they hypothesized, correctly, that a mutation rendering the hemagglutinin protein resistant to acid might render the virus more infective in mammals.

 

In this study the investigators found that K58I grows 100-fold better than the wild-type in the nasal cavities of mice, and is 50 percent more lethal. Conversely, the mutant K58I virus failed completely to kill ducks the investigators infected, while the wild-type killed 66 percent of ducks, says Russell. "A single mutation that eliminates H5N1 growth in ducks simultaneously enhances the capacity of H5N1 to grow in mice. We conclude that enhanced resistance to acid inactivation helps adapt H5N1 influenza virus from an avian to a mammalian host.

 

"These data contribute new information about viral determinants of influenza virus virulence and provide additional evidence to support the idea that H5N1 influenza virus pathogenesis in birds and mammals is linked to the pH of [hemagglutinin] activation in an opposing fashion," Terence S. Dermody of Vanderbilt University et al. write in an editorial in the journal accompanying the paper. "A higher pH optimum of [hemagglutinin] activation favors virulence in birds, whereas a lower pH optimum… favors virulence in mammals."

 

Based on this and another study, "…surveillance should include phenotypic assessment of the [hemagglutinin] activation pH in addition to sequence analysis," Dermody writes.

 

The journal carefully considered whether to publish the paper, because it raised issues of "dual use research of concern" (DURC), writes Dermody. DURC is defined as "Life sciences research that, based on current understanding, can be reasonably anticipated to provide knowledge, information, products, or technologies that could be directly misapplied to pose a significant threat with broad potential consequences to public health and safety, agricultural crops and other plants, animals, the environment, materiel, or national security," according to a US government policy document.

 

However, both the National Institute of Allergy and Infectious Diseases and the St. Jude Institutional Biosafety Committee concluded that the study failed to meet the definition of DURC. Clinching the case, "the addition of the key mutation in the Russell paper to other previously reported mutations would not result in an even more virulent H5N1 influenza virus," says Dermody.

 

 

 

I

APIC: The Persistence Of CRE

CDC Guidance For Control Of CRE

 

# 6974

 

Less than two weeks ago, in CDC HAN Advisory: Increase In CRE Reports In The United States, we looked at the growing concerns over the incidence of Carbapenem-resistant Enterobacteriaceae (CRE) colonization or infection across the nation.

 

Enterobacteriaceae comprise a large family of Gram-negative bacteria that range from harmless strains to pathogenic invaders, and includes such familiar names as Salmonella, Escherichia coli, Klebsiella and Shigella.

 

Carbapenem-resistant Enterobacteriaceae are varieties that have developed resistance to a class of antibiotics called carbapenems, which are often the drug of last resort for treating difficult bacterial infections.

 

And in mid February, in MMWR: Denver Hospital Outbreak Of NDM-Producing CRKP, we looked at an outbreak that occurred in 2012.

 

From APIC (Association for Professionals In Infection Control) we get a news release detailing just how persistent these CRE infections can be.

 

Superbug CRE may endure in patients one year after initial infection: study

02/27/2013

Patients who tested positive for carbapenem-resistant Enterobacteriaceae (CRE) took an average of 387 days following hospital discharge to be clear of the organism, according to a new study published in the March issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

 

The study was conducted in the Shaare Zedek Medical Center, a 700-bed university-affiliated general hospital in Jerusalem, Israel. The research team analyzed follow-up cultures from 97 CRE-positive patients who had been discharged from the medical center between January 2009 and December 2010.

 

The average time until cultures became negative was 387 days. At three months, 78 percent of patients remained culture positive; at six months, 65 percent remained positive; at nine months, 51 percent, and at one year 39 percent of patients remained positive, meaning they could potentially become re-infected or transmit the germ to others.

 

Risk factors for extended carriage included the number of hospitalization days, whether and how often the patient was re-hospitalized, and whether the patient had an active infection as opposed to colonization without signs of active disease.

 

This is one of the first studies to determine length of CRE duration after hospital discharge and provides vital insight into treating formerly CRE-positive patients upon readmission as to limit the spread of this virulent and often deadly pathogen.

 

The authors state, “Patients with multiple hospitalizations or those who were diagnosed with clinical CRE disease should be assumed to have a more extended duration of CRE coverage and should therefore be admitted under conditions of isolation and cohorting until proven to be CRE-negative. These measures will reduce the hospitalization of CRE-positive patients among the general patient population, potentially preventing the spread of CRE.”

 

CRE are extremely difficult-to-treat, multidrug-resistant organisms that are emerging in the United States. A CRE strain of Klebsiella pneumoniae recently spread through the National Institutes of Health hospital outside Washington, DC, killing six people. Because of increased reports of these multidrug-resistant germs, the Centers for Disease Control and Prevention recently alerted clinicians about the need for additional prevention steps to prevent transmission.

(Continue . . . )

 

 

The study is called (link not live yet):

 

 

Duration of carriage of carbapenem-resistant Enterobacteriaceae following hospital discharge

by Frederic S. Zimmerman, Marc V. Assous, Tali Bdolah-Abram, Tamar Lachish, Amos M. Yinnon and Yonit Wiener-Well

American Journal of Infection Control, Volume 41, Issue 3 (March 2013).

 

 

Other recent blogs on the threat of growing antibiotic resistance include:

 

ECDC: Multidrug Resistant Infections Increasing In Europe

EID: Environmental NDM-1 Detected In Vietnam

MMWR: NDM-1 Transmission In Rhode Island

Netherlands: Large Nosocomial KPC Outbreak

 

In March of 2012 (see Chan: World Faces A `Post-Antibiotic Era’), World Health Organization Director-General Margaret Chan – delivering the  keynote address to the Conference on Combating Antimicrobial Resistance in Copenhagen, Denmark - painted a bleak picture of the future of antibiotic availability if action is not taken.

 

The D-G’s entire remarks may be viewed on the WHO’s website at Antimicrobial resistance in the European Union and the world, but I’ve excerpted a few choice statements below, after which you’ll find a link to the World Health Organization’s latest publication on antibiotic resistance.

 

Excerpts from D-G Chan’s March 14th, 2012 speech.

 

Antimicrobial resistance is on the rise in Europe, and elsewhere in the world. We are losing our first-line antimicrobials. Replacement treatments are more costly, more toxic, need much longer durations of treatment, and may require treatment in intensive care units.

 

<SNIP>

 

If current trends continue unabated, the future is easy to predict. Some experts say we are moving back to the pre-antibiotic era. No. This will be a post-antibiotic era. In terms of new replacement antibiotics, the pipeline is virtually dry, especially for gram-negative bacteria. The cupboard is nearly bare.

 

<SNIP>

 

A post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.

 

The evolving threat of antimicrobial resistance - Options for action

Authors:
World Health Organization

 

And for a far more complete discussion of antimicrobial resistance issues, I can think of no better primer than Maryn McKenna’s book SUPERBUG: The Fatal Menace of MRSA. Maryn’s SUPERBUG Blog, continues to provide the best day-to-day coverage of these issues.

WHO: Estimated Health Risks From The Fukushima Radiation Release

 

 

# 6973

 

The World Health Organization has today published a 172-page Health risk assessment from the nuclear accident after the 2011 Great East Japan earthquake and tsunami, based on a preliminary dose estimation  based on a preliminary estimate of radiation doses published in May 2012.

 

First some excerpts from the press release, then I’ll be back with a little more.

 

Global report on Fukushima nuclear accident details health risks

News release

28 February 2013 | GENEVA - A comprehensive assessment by international experts on the health risks associated with the Fukushima Daiichi nuclear power plant (NPP) disaster in Japan has concluded that, for the general population inside and outside of Japan, the predicted risks are low and no observable increases in cancer rates above baseline rates are anticipated.

 

The WHO report ‘Health Risk Assessment from the nuclear accident after the 2011 Great East Japan Earthquake and Tsunami based on preliminary dose estimation’ noted, however, that the estimated risk for specific cancers in certain subsets of the population in Fukushima Prefecture has increased and, as such, it calls for long term continued monitoring and health screening for those people.

 

Experts estimated risks in the general population in Fukushima Prefecture, the rest of Japan and the rest of the world, plus the power plant and emergency workers that may have been exposed during the emergency phase response.

 

“The primary concern identified in this report is related to specific cancer risks linked to particular locations and demographic factors,” says Dr Maria Neira, WHO Director for Public Health and Environment. “A breakdown of data, based on age, gender and proximity to the nuclear plant, does show a higher cancer risk for those located in the most contaminated parts. Outside these parts - even in locations inside Fukushima Prefecture - no observable increases in cancer incidence are expected.”

 

In terms of specific cancers, for people in the most contaminated location, the estimated increased risks over what would normally be expected are:

• all solid cancers - around 4% in females exposed as infants;
• breast cancer - around 6% in females exposed as infants;
• leukaemia - around 7% in males exposed as infants;
• thyroid cancer - up to 70% in females exposed as infants (the normally expected risk of thyroid cancer in females over lifetime is 0.75% and the additional lifetime risk assessed for females exposed as infants in the most affected location is 0.50%).

For people in the second most contaminated location of Fukushima Prefecture, the estimated risks are approximately one-half of those in the location with the highest doses.

 

The report also references a section to the special case of the emergency workers inside the Fukushima NPP. Around two-thirds of emergency workers are estimated to have cancer risks in line with the general population, while one-third is estimated to have an increased risk.

 

The almost-200-page document further notes that the radiation doses from the damaged nuclear power plant are not expected to cause an increase in the incidence of miscarriages, stillbirths and other physical and mental conditions that can affect babies born after the accident.

 

“The WHO report underlines the need for long-term health monitoring of those who are at high risk, along with the provision of necessary medical follow-up and support services,” says Dr Maria Neira, WHO Director for Public Health and Environment. “This will remain an important element in the public health response to the disaster for decades.”

(Continue . . . )

 

 

This press release deals primarily with the relative increases in risk among populations living or working very close to the Fukushima nuclear accident who received the highest exposure to radiation.

 

While relative risk is a valid way of looking at this accident’s impact - it is also helpful to look at the absolute risk (which is done in the FAQ and in the actual report) - particularly when looking at cancers that have a low baseline rate.

 

• The largest increase in relative risk was for developing thyroid cancer among infant girls in their lifetime. The baseline rate in Japan is roughly .75% (1 in 133). Those living closest to the radiation leaks are expected to see a 70% increase, which elevates the absolute risk to approximately 1.25% (1 in 80).

 

• Another example is breast cancer, which carries a lifetime risk of 5.53% (1 in 18).  The 6% increase in females exposed as infants raises that to 5.89% (1 in 17).

 

• Lifetime leukemia risks in infant boys is estimated at roughly .60% (1 in 165). Adding in the extra Fukushima radiation exposure adds an additional 7% risk, which raises absolute risk to .64%  (1 in 156).

 

None of which is meant to minimize the overall impact of this nuclear accident in the least, or the devastating individual and family impacts that these additional cancers will bring.

But it does help to put these numbers in perspective.

 

Additional resources from WHO on the Fukushima radiation release include:

 

• Japan nuclear concerns
• Ionizing radiation
• FAQs: Japan nuclear concerns

 

And lastly, as the press release notes, cancers are not the only serious long-term health consequences from the Fukushima disaster.

 

As well as the direct health impact on the population, the report notes that the psychosocial impact may have a consequence on health and well-being. These should not be ignored as part of the overall response, say the experts.

Referral: Reuters - Sleuthing NCoV

 

 

Photo Credit NIAID

 

# 6972

 

The novel coronavirus (NCoV) that has been confirmed in more than a dozen individuals with epidemiological links to the Middle East remains an enigma, with questions regarding its origin, prevalence, and mode of transmission largely unanswered.

 

Today Reuters has an excellent analysis featuring Michael Osterholm (Director of CIDRAP), Mike Skinner (from Imperial College London), flu virologist Wendy Barclay (also at Imperial College London),  Professor of Virology Ian Jones (from Britain's University of Reading), and Volker Thiel (of the Institute of Immunobiology at Kantonal Hospital in Switzerland) discussing their various concerns regarding this emerging pathogen.

 

Follow the link to read:

 

Analysis - Emerging deadly virus demands swift sleuth work

By Kate Kelland, Health and Science Correspondent

LONDON | Wed Feb 27, 2013 1:23pm GMT

 

 

A small sampling of recent blogs on this topic include:

 

Eurosurveillance: Contact Investigation Of NCoV Case Hospitalized In Germany

 

WHO Update on Novel Coronavirus (NCoV)

 

ECDC Updated Risk Assessment On NCoV

HPA: Pandemrix Vaccine Linked To Childhood Narcolepsy In England

 

# 6971

 

Pandemrix was the adjuvanted pandemic H1N1 flu shot developed by GlaxoSmithKline (GSK) and distributed to more than 30 countries beginning in the fall of 2009. This vaccine included a squalene-based component called AS03, used as a adjuvant.

 

Adjuvants are additives that are used to increase the immune response to a vaccine. Their use can allow the `stretching’ of the vaccine supply, as shots can contain a smaller amount of antigens.

 

While they have been used in Europe and in Canada, adjuvanted flu vaccines have not been licensed for use in the United States.

 

Roughly a year after the vaccine was deployed, we began to see reports of an unusual rise in the number of children in Finland (a country where Pandemrix was used) diagnosed with a rare neurological disorder called narcolepsy.

 

For early coverage of this story, you may wish to revisit Finland Suspends Use of Pandemrix Vaccine and EMA To Review Pandemrix Vaccine, both of which I wrote in August of 2010.

 

Despite some conflicting and incomplete data the European Medicines Agency issued a statement in July of 2011 recommending:

 

In persons under 20 years of age Pandemrix to be used only in the absence of seasonal trivalent influenza vaccines, following link to very rare cases of narcolepsy in young people.

 

Finland also convened a Narcolepsy Task Force (see Finland: Task Force Report On Pandemrix-Narcolepsy Link) that confirmed an association – as yet unexplained – between receipt of the vaccine and an increase in narcolepsy in children between the ages of 4 and 19.

 

In September of 2012, the ECDC released a 164 page technical report called Narcolepsy In Association With Pandemic Influenza Vaccination in which the summary found:

 

The case–control study confirms an association between vaccination with Pandemrix® and an increased risk of narcolepsy in children and adolescents (5 to 19 years of age) in Sweden and Finland that originally reported on this issue (signalling countries). No such association was found in adults in these two countries.

 

 

Fast forward to yesterday, and we have a press release from the HPA on a study – just published in the BMJ - that has also found a link between the Pandemrix vaccine and childhood narcolepsy in the UK. 

 

First a link to the study, then some excerpts from the HPA release.

 

 

Risk of narcolepsy in children and young people receiving AS03 adjuvanted pandemic A/H1N1 2009 influenza vaccine: retrospective analysis

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f794 (Published 26 February 2013)

Cite this as: BMJ 2013;346:f794

 

Conclusion The increased risk of narcolepsy after vaccination with ASO3 adjuvanted pandemic A/H1N1 2009 vaccine indicates a causal association, consistent with findings from Finland. Because of variable delay in diagnosis, however, the risk might be overestimated by more rapid referral of vaccinated children.

(Continue . . . )

 

While unproven, the authors raise the possibility that the adjuvanted vaccine – rather than directly causing narcolepsy – might have accelerated the process in children who would eventually have gone on to develop the disorder. 

 

A significant dip in the `background rate’ of narcolepsy over the next few years in countries that saw a spike after 2009 ASO3 vaccination would help give this theory more weight.

 

A paucity of safety trials on children, and the public’s memories of the 1976 Swine Flu vaccine debacle, led the HHS to decide not to allow adjuvants in the pandemic flu vaccines deployed in the United States, despite urging by the global community.

 

The HPA has put together the following summary.

 

Pandemic flu vaccination linked to narcolepsy in UK children

27 February 2013

Health Protection Agency (HPA) scientists have found evidence of an association between Pandemrix flu vaccination and narcolepsy in children in England, according to the findings of a study published in the British Medical Journal. These findings are consistent with previous studies from Finland and Sweden which identified a similar association.

 

In collaboration with researchers from Papworth and Addenbrooke’s hospitals in Cambridge, the study looked at 75 children aged between four and 18 who were diagnosed with narcolepsy from January 2008 and who attended sleep centres across England. Eleven of these children had been vaccinated with Pandemrix before their symptoms began, seven of these within six months. This suggests a risk of narcolepsy following vaccination with Pandemrix of around one in every 55,000 doses of the vaccine.

 

The Pandemrix vaccine was recommended for use in children at risk of serious complications from influenza during the pandemic flu outbreak in 2009/10. It was also used occasionally in children during the 2010/11 flu season. Since July 2011 the use of Pandemrix in people under the age of 20 across Europe has been restricted.

 

Although prior to this study, there was no evidence to suggest an association in the UK, on the basis of the findings from Finland the HPA launched an in depth study in February 2011 with narcolepsy experts across England. This investigated whether there was evidence of an association between narcolepsy and Pandemrix as used in the UK.

 

Lead author Professor Liz Miller, a consultant epidemiologist with the HPA, said: "These findings suggest there is an increased risk in children of narcolepsy after Pandemrix vaccination and this is consistent with findings from studies in other European countries. However, this risk may be overestimated by more rapid referral of vaccinated cases. Long term follow up of people exposed to Pandemrix is needed before we can fully establish the extent of the association.

 

“Our findings have implications for the future licensing and use of adjuvanted pandemic vaccines. Further studies to assess the possible risk associated with other vaccines used in the pandemic, including those with and without adjuvants, are also needed to inform the use of such vaccines in the event of a future pandemic.”

 

Study co-author Dr John Shneerson, consultant physician from the Respiratory Support and Sleep Centre at Papworth Hospital in Cambridge, said: “Narcolepsy is thought to be due to a loss of function of a small group of cells in one of the sleep centres in the brain, as a result of an abnormal reaction of the body’s immune system. Pandemrix may have triggered an immune reaction against the sleep centre cells in those children who were genetically predisposed to develop narcolepsy. This study has been important in helping to shed light on the mechanism of how narcolepsy can develop.”

 

Narcolepsy is a chronic neurological disorder caused by the brain's inability to control sleep, particularly REM (dream) sleep. It leads to excessive daytime sleepiness usually accompanied by sudden episodes of muscle weakness triggered by strong emotions such as laughter – this is known as cataplexy. Narcolepsy has a genetic component but this has to be triggered by other factors in order for the condition to appear. 20,000 people in the UK are through to have narcolepsy - drug treatment and lifestyle measures are usually effective in relieving the symptoms.

Ends

 

The exact mechanism behind this Pandemrix-Narcolepsy link remains a medical mystery. Our understanding of this neurological disorder is very limited, as well.  

 

The absolute risk of a child developing narcolepsy from the Pandemrix flu shot appears appears to be about 1 in 55,000. The authors warn that:

 

`Our findings have implications for the future licensing and use of adjuvanted pandemic vaccines’.

 

While a handful of countries had reported increases in post-vaccination narcolepsy, the link between the AS03 adjuvanted vaccine and childhood narcolepsy in the UK has not, until now, been quantified.

 

This study found the increased risk was similar to that previously reported from Finland.

WHO/Cambodian MOH Statement On Latest H5N1 Fatality

# 6970

 

The World Health Organization and Cambodia’s MOH have released the following joint statement on the 9th H5N1 case of 2013, which is now posted on the UN Cambodia website.

 

Ninth New Human Case of Avian Influenza H5N1 in Cambodia in 2013

Joint Press Release from the Ministry Of Health and the World Health Organization (WHO)

Phnom Penh, 27 February 2013

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.

 

The ninth case, a 35-year-old man from Kbal Ou village, Me Sar Chrey commune, Stueng Trang district in Kampong Cham province, was confirmed positive for influenza H5N1 on 23 February 2013 by Institut Pasteur du Cambodge.

 

He developed fever on 8 February 2013 and his condition worsened on 10 February 2013 with fever, frequent cough, and dyspnea. Local private practitioners initially treated him but his condition further deteriorated.

 

On 13 February he was admitted to the Kampong Cham Hospital with fever, severe cough and dyspnea and was immediately treated with Tamiflu. He developed pneumonia on 21 February and was transferred to Calmette Hospital in Phnom Penh. Unfortunately, despite intensive medical care he died on 25 February.

 

There is evidence of recent deaths among poultry in the village and the man had history of coming into contact with sick poultry prior to becoming sick. The man is the ninth person this year and the 30th person to become infected with the H5N1 virus, and the 27th person to die from complications of the disease in Cambodia.

 

Of the 30 confirmed cases, 20 were children under 14, and 19 of the 30 were female.

 

"Avian influenza H5N1 remains a serious threat to the health of all Cambodians. This is the ninth case of H5N1 infection in humans this year,” said HE Dr. Mam Bunheng, Minister of Health.

 

(Continue . . . )

 

 

Despite many opportunities to do so, the virus has not managed to adapt well enough to humans to pose a pandemic threat.  Nevertheless, the potential for this status quo to change exists, and so the WHO provides this risk assessment:

 

Public health risk assessment of avian influenza A(H5N1) viruses:

Any time influenza viruses are circulating in poultry, sporadic infections or small clusters of human cases are possible especially in people exposed to infected poultry kept in households.

However, currently, this H5N1 virus does not appear to transmit easily among people and therefore the risk of community level spread of this virus remains low. Therefore, the public health risk associated with this virus remains unchanged.

Pakistan: Another Polio Vaccination Related Murder

 

 

# 6969

 

The murderous vendetta against polio vaccination teams in Pakistan continues with word today that a policeman was killed in the northwestern town of Mardan while guarding a team of polio vaccination workers.

 

Over the past 2 and a half months we’ve seen horrific coordinated attacks made against aid workers, either involved with or associated with the Polio Vaccination drives in Pakistan.

 

The first attack (see Pakistan: 6 Polio Workers Murdered) was reported on December 18th, the next day (see Pakistan: Fresh Attacks On WHO/UNICEF Polio Workers) we learned of 3 more deaths, and on January 1st  the headlines read : 7 More Aid Workers Killed In Pakistan.

 

Since then, additional attacks have occurred. Pakistan is one of 3 countries where the polio virus is still endemic (the others being Afghanistan and Nigeria).

 

Nigeria has also seen violence directed at polio workers. Earlier this month we saw Nigeria: Nine Polio Workers Murdered, presumably as part of a larger effort to impose Sharia law in Nigeria by a militant Islamist group.

 

The Pakistan attacks appear related to the Taliban’s  condemnation of polio immunization campaigns after the use of a sham hepatitis vaccination campaign as a CIA cover in the pursuit of Osama Bin Laden (see Maryn McKenna’s Update: Pakistan, Polio, Fake Vaccines And The CIA).

 

This from AFP.

 

Policeman killed in fresh attack on polio team

AFP

PESHAWAR: A policeman was shot dead Tuesday while protecting a polio vaccination team, police said, bringing the death toll in such attacks to 20 since December.

 

No one has claimed responsibility for the killings.

 

Tuesday’s killing happened at Ghalla Dher on the outskirts of the northwestern town of Mardan, on the second day of a three-day local anti-polio campaign.

(Continue . . . )

Xinhua Reporting 9th Cambodian H5N1 Case

 

# 6967

 

Although a scan of the `usual suspects’ (WHO WPRO, Cambodian MOH, and the UN Cambodia site) has failed to turn up any official statement, China’s Xinhua News, Malaysia’s Bernama, and Thailand’s The Nation are all reporting on a 9th H5N1 case in Cambodia this year.

 

These media reports indicate that the victim is a 35 year-old male from Trung Trang district of Eastern Kampong Cham province, who died at Calmete Hospital in Phnom Penh on Tuesday several days after cooking and eating a dead duck.

 

Up until now, all eight cases reported this year in Cambodia have been clustered across four provinces (Phnom Penh, Takeo, Kampong Speu, Kampot) located in the southern part of the nation. 

 

Assuming this case is confirmed, it would add a fifth – more centrally located - province to that list; Kampong Cham.  All of the cases reported this year in Cambodia, save one (an 8 month old boy) have died.

 

This from Xinhua News.

 

Cambodia reports 9th bird flu case, 8th death so far this year

English.news.cn   2013-02-26 12:42:15
 

PHNOM PENH, Feb. 26 (Xinhua) -- Cambodia reported on Tuesday that a 35-year-old man died of Avian Influenza H5N1, bringing the death toll to eight and the number of cases to nine in 2013, health officials and victim's family said Tuesday.

 

The man, identified as Thoeun Doeun, lived in Trung Trang district of Eastern Kampong Cham province.

 

"He died of the bird flu virus last night after a four-day medical treatment at the Calmete Hospital in Phnom Penh," Suon Sokhy, younger sister of the victim, told Xinhua over telephone.

 

She said that her brother became sick after he took a dead duck to cook and ate.

 

"Doctor told me that he died of bird flu," she said.

 

Sonny Krishnan, communications officer with the World Health Organization (WHO) in Cambodia, confirmed the death on Tuesday.

 

Meanwhile, he appealed to people to be high vigilant over the virus, saying that home slaughtering and preparation of sick or dead poultry for food is hazardous.

 

"This practice must be stopped. The greatest risk of exposure to the virus is through the handling and slaughter of live infected poultry," he said.

 

<SNIP>

 

The country sees the worst outbreak of the virus this year since the disease was first identified in 2004. To date, the country has recorded 30 human cases of the virus, killing 27 people.

 

Other media carrying this story include:

 

Eighth Cambodian dies from bird flu this year - The Nation

Cambodia Reports 9th Bird Flu Case, 8th Death So Far This Year – Bernama

 

While Cambodia is experiencing an unusual level of H5N1 activity thus far in 2013, so far we’ve not seen any evidence of human-to-human transmission. 

 

For now, H5N1 remains primarily an avian adapted virus - and only rarely infects humans – usually as the result of direct contact with infected birds.

 

When an official statement from the World Health Organization, Cambodian MOH, or UN becomes available I’ll update this story.

Update: Hendra In Queensland, Nipah In Bangladesh

 

Credit WHO

 

# 6966

 

 

Hendra Virus (HeV) and Nipah Virus (NiV) are a pair of closely related members of the family known as Paramyxoviridae that can infect a wide range of hosts, including mammals, birds, and fish.

 

The Paramyxoviridae family includes such diverse viruses as aquaparamyxovirus that infect salmon, Newcastle disease for poultry, Morbilliviruses which include measles, rinderpest virus & canine distemper, and human RSV respiratory syncytial virus.

 

Hendra and Nipah, both discovered in the last decade of the 20th century, are sufficiently different from other members of the Paramyxoviridae family to have led to the creation of a new genus; Henipavirus.

Their host species are fruit bats, where they seem to reside with little ill effect.  Unfortunately, when they spillover into other species, they can be quite deadly.

 

Both are considered  biosecurity level 4 (BSL-4) pathogens.

 

Hendra first came to light after the deaths of 13 horses and a trainer in Hendra, a suburb of Brisbane, Australia in 1994. A stable hand, who also cared for the horses, was hospitalized, but survived.

 

Another outbreak was later identified as having taken place in MacKay, 1000 km to the north of Brisbane, the month before. Two horses died, and the owner was hospitalized several weeks later with meningitis. He recovered, but developed neurological symptoms and died 14 months later.

 

Over the past 18 years more than 40 outbreaks of Hendra virus – all involving horses – have been reported in Australia. At least four human fatalities have been linked to the virus as well.

 

Of the two, Nipah has been the deadliest, causing outbreaks primarily in India and Bangladesh. But the virus was first discovered in April of 1999 when an outbreak occurred at a pig farm in Malaysia.

 

During this initial outbreak, the virus jumped to local swine herds from bats, and infected more than 250 people, killing more than 100. The virus was then exported via live pigs to Singapore, where 11 more people died (see MMWR Update: Outbreak of Nipah Virus -- Malaysia and Singapore, 1999)

 

Over the past decade, Nipah has sparked a handful  of smaller outbreaks across Southern Asia with the greatest activity centered around Northern India and Bangladesh.

 

Earlier this month, in Bangladesh: Updating The Nipah Outbreak, we looked at their latest outbreak, which at that time had infected 11 and killed eight.

 

Seasonal Nipah infections (Dec-May) have been linked to the consumption of raw (uncooked) date palm juice - which is `tapped’ from cuts in trees much in the same way as maple trees are for their syrup. Bats roost in these trees at night, and can easily contaminate the collection jars with urine or feces.

 

But this isn’t necessarily a dead end infection for Nipah, as humans can spread the virus amongst themselves as well (see EID Journal Person-to-Person Transmission of Nipah Virus in a Bangladeshi Community).

 

Today, an update from Bangladesh’s Institute of Epidemiology Diseases Control and Research (IEDCR), that brings the total number infected to 16, and the total number of deaths to 14.

 

Nipah Infection in 2013

Update on 23 February, 2013

Situation Update:

23 February 2013:  16 Nipah cases were identified among them 14died  (mortality rate 88%); 2 cases are still under treatment. These cases are from 11 districts (Gaibandha, Natore, Rajshahi, Naogaon, Rajbari, Pabna, Jhenaidah, Mymensingh, Nilphamari). Age distribution of cases are 8 months to 55 years among them 11 are male.

Nipah

Human Nipah virus (NiV) infection, an emerging zoonotic disease, was first recognized in a large outbreak of 276 reported cases in Malaysia and Singapore from September 1998 through May 1999.

Agent

NiV is a highly pathogenic paramyxovirus belonging to genus Henipavirus. It is an enveloped RNA virus.

Incubation period

The median incubation period of the secondary cases who had a single exposure to Nipah case was nine days (range 6–11 days) but exposure to onset of illness varies from 6-16 days. The median incubation period following single intake of raw date palm sap to onset of illness is 7 days (range: 2-12 days) in Bangladesh.

Transmission:

1. Drinking of raw date palm sap (kancha khejurer rosh) contaminated with NiV

1. Close physical contact with Nipah infected patients

Surveillance

Nipah surveillance began in 2006, Institute of Epidemiology, Disease Control and Research (IEDCR) in collaboration with ICDDR,B established Nipah surveillance in 10 District level Government hospitals of the country where Nipah outbreaks had been identified. Presently surveillance system is functioning in five hospitals of Nipah Belt.

 

 

Meanwhile, in Queensland, Australia a fresh horse death from Hendra is in the news, with four people who may have been exposed under observation.  This from Queensland BioSecurity.

 

 

New Hendra virus case confirmed in North Queensland

News release | 22 February, 2013

---

Biosecurity Queensland is managing a new Hendra virus case in the Tablelands area after a positive test result was received late last night.

 

Queensland Chief Veterinary Officer Dr Rick Symons said one horse had died on the property after becoming unwell over the weekend.

 

"Biosecurity Queensland is in the process of quarantining the property. There are other horses on the property and we will be working to determine what contact the infected horse had with these other animals," Dr Symons said.

 

"Testing and monitoring will then be undertaken over the next month.

 

"While under quarantine, restrictions will apply to moving horses and horse materials on and off the infected property."

 

An initial assessment from Queensland Health's Public Health Unit in Cairnshas identified four people who had contact with the infected horse.

 

Public health staff are now interviewing these people to determine whether any testing or treatment is required. All four people are thought to have had a low level of exposure to the infected horse.

 

Queensland's Chief Health Officer Dr Jeannette Young reassured the community that transmission of the virus required close contact with body fluids of the sick horse.

 

"There is no evidence the virus can be passed directly from flying foxes to humans, from the environment to humans, from humans to horses, or can be transmitted by airborne droplets," Dr Young said.

 

"Anyone who is concerned should contact 13 HEALTH (13 43 25 84).

 

"We stand ready to provide any assistance, counselling, information, testing or treatment that may be required."

 

Dr Symons said this was the second case of Hendra virus in Queensland this year.

(Continue . . . )

 

 

Nipah and Hendra are non-segmented, single-stranded negative-sense RNA viruses, and as such, are subject to a fairly high rate of mutation. 

 

A couple of years ago, when film maker Steven Soderbergh made the pandemic thriller `Contagion’, Professor Ian Lipkin - director of Columbia University’s Center for Infection and Immunity in New York – based its fictional MEV-1 virus on a mutated Nipah virus.

 

As I wrote in The Scientific Plausibility of `Contagion’, the Nipah virus isn’t currently a pandemic threat - and for now - shows no signs of becoming one. 

 

But some scientists worry that with a few choice mutations in the right spot in its genome, that status could one day change. So we watch these dramatic, albeit rare, spillovers of Nipah and Hendra from bats closely, for any signs of a greater threat.

ECDC: Influenza Activity At A Glance

 

 

 

# 6965

 

In addition to producing its comprehensive Weekly influenza surveillance overview (WISO), the ECDC this season has started releasing a weekly influenza infographic that quickly, and elegantly, conveys the highpoints of the latest surveillance data at a glance. 

 

You’ll find the Week 7 infographic below.

 

 

Although only an ocean apart, Europe and North America often report quite different seasonal flu patterns.

 

• While Influenza B has started to gain a greater share in recent weeks, for most of this 2012-13 flu season North America has been struggling against influenza A, and among which H3N2 has been the dominant strain.

 

• In Europe the mix between influenza A & B has been about even - and since week 52/2012 - Europe has reported an increasing proportion of H1N1pdm09 over seasonal H3N2.

 

A more complete surveillance analysis may be read at the link(s) below:

 

Substantial influenza activity in Europe but some signs of decline: ECDC weekly monitoring

22 Feb 2013

ECDC

During week 7, 19 of the 29 countries reporting indicated high/medium-intensity transmission and wide geographic spread of influenza. Eleven countries reported increasing trends, and ten countries reported decreasing trends, compared to thirteen countries reporting increasing trends and six reporting decreasing trends in the previous week (week 6).

 

Virological surveillance shows that the proportion of influenza-positive cases among sentinel specimens continues to be high (52%) but continued to decrease, as first observed in the previous week.

 

Since week 40/2012, an even distribution of influenza virus types has been observed, 50% each for type A and type B viruses. Among influenza A viruses, an increasing proportion of A(H1)pdm09 over A(H3) has been reported since week 52/2012.

On 8 February 2013, ECDC published its annual risk assessment for seasonal influenza 2012-2013 based on data up to week 03/2013.

Resources:

• Weekly influenza surveillance overview, week 7/2013
• Risk assessment: Seasonal influenza 2012/13 in Europe (EU/EEA countries)
• Influenza in Europe at a glance: weekly infographic (.jpg)
• Watch ECDC video on seasonal influenza
• Read weekly influenza surveillance reports
• View influenza surveillance maps
• Learn more about influenza on ECDC website

SARS And Remembrance

 

Credit World Health Organization – May 2003

 

# 6964

 

 

This third week of February, the 21st day to be exact, is the 10th anniversary of the arrival of SARS (Severe Acute Respiratory Syndrome) to Hong Kong. While the virus had been percolating stealthily across rural China since the previous November, this was its first known border crossing.

 

The virus arrived via a 64-year-old Chinese physician from neighboring Guangdong Province who had recently treated atypical pneumonia cases at Zhongshan hospital.

 

Asymptomatic when he began his journey, by the time he checked into a 9th floor room of the Metropole Hotel, he was beginning to show signs of illness. Exactly how the virus was transmitted to a dozen guests or more staying at that four-star hotel may never be known.

 

Perhaps he coughed while standing in a crowded elevator, or contaminated door handles or the pen at the register when he signed in at the lobby. It was speculated he might have even vomited in the hallway.

 

In October of 2003, WHO issued a consensus document on the epidemiology of SARS that included:

 

– The implications of the Metropole Hotel outbreak are not yet fully understood.

Intensive investigations of circumstances surrounding the late-February outbreak in the Metropole Hotel, Hong Kong, which seeded the international spread of SARS, have not yet answered all questions. During this incident, the virus was transmitted to at least 16 guests and visitors, all linked to the 9th floor of the hotel. The results of environmental sampling on the carpet outside room 911, where the index case resided, and elevator areas show a hot zone (possibly vomitus or respiratory secretions). Samples were PCR positive for the virus 3 months after the index case spent a single night at the hotel. Although tests demonstrated the presence of SARS coronavirus RNA and not viable virus, this finding may have implications for the persistence of the virus in the environment.

 

The Metropole Hotel outbreak is recognized as a “superspreading event”. However, the index case did not have an unusually high viral load when tested on days 9 and 11 of illness.

 

By whatever means, Dr. Liu Jianlun – who died in a Hong Kong hospital two days later – became known as as the first international `super spreader’ of the disease.

The results of his fateful visit to Hong Kong are recounted below in the WHO document Severe acute respiratory syndrome (SARS): Status of the outbreak and lessons for the immediate future.

 

Days later, guests and visitors to the hotel’s ninth floor had seeded outbreaks of cases in the hospital systems of Hong Kong, Viet Nam, and Singapore.

 

Simultaneously, the disease began spreading around the world along international air travel routes as guests at the hotel flew home to Toronto and elsewhere, and as other medical doctors who had treated the earliest cases in Viet Nam and Singapore travelled internationally for medical or other reasons.

 

This still unidentified virus quickly began to show up in Vietnam, Singapore, and even Toronto – and hospital workers – unaware that a new, virulent and highly infectious pneumonia virus was before them, were exposed and infected.

 

By March 12th, after reviewing the situation in Hanoi, Hong Kong, and Beijing, WHO issues a global alert about cases of atypical pneumonia warning that Cases Of Severe Respiratory Illness May Spread To Hospital Staff.

 

Two days later (March 14th), three cases appeared in Singapore, brought in most likely by a flight attendant who had also stayed at the Metropole hotel in Hong Kong. 

 

The next day, the World Health Organization issues emergency travel advisory as it became apparent that whatever this virus was, it was spreading rapidly.

 

This syndrome, SARS, is now a worldwide health threat,” said Dr. Gro Harlem Brundtland, Director General of the World Health Organization. “The world needs to work together to find its cause, cure the sick, and stop its spread.”

 

While the virus was definitely on the move, eventually making it to more than 30 countries, no city was harder hit than was Hong Kong.

 

Between March 11th and June 6th, a total of 1750 cases were identified, and of those, 286 died.

 

In time, the virus was identified, and contained (see Hong Kong’s Coronavirus Response), with quarantine being the most effective weapon in the public health department’s arsenal. 

 

But not before nearly 8,000 were infected worldwide, and nearly 800 died.

 

Bad . . . but not as bad as it might have been.  In many ways we were lucky that time. 

 

Unlike with influenza, patients were not infectious until they displayed overt symptoms, making the identification and isolation of cases possible.

   

Last month, In EID Journal: A Brief History Of Quarantine, we looked at the long, successful history of this most basic of public health interventions, and how it was utilized during the SARS outbreak. I wrote:

 

During the 2003 SARS epidemic, Isolation was used in the United States for patients who were ill, but since transmission of the virus was very limited here, quarantine was not recommended for those exposed (cite).

 

In other countries, where transmission risks were greater, quarantines were used – quite successfully – in order to contain the virus. 

• Singapore was one of the first countries to mandate quarantines when more than 800 family members of SARS patients were ordered to stay in their homes. 
• Hong Kong sealed part of the Amoy Gardens Apartment complex after scores of cases erupted there, and later moved all remaining residents to two holiday camps where they were quarantined.
• And Toronto, Canada closed schools and quarantined thousands in their bid to contain the virus (see The SARS Experience In Ontario, Canada).

The graph below shows two distinct phases of disease transmission in Canada, both apparently dampened by the implementation of quarantines.

While the aggressiveness of quarantine measures taken in Toronto have been criticized by some (see Severe acute respiratory syndrome: Did quarantine help?), many experts have stated that quarantining those exposed (usually in their own homes) helped to halt the epidemic.

 

The full story of the SARS outbreak is both long, and fascinating, and I heartily recommend both Karl Taro Greenfeld’s  The China Syndrome: The True Story of the 21st Century's First Great Epidemic and David Quammen’s excellent book  Spillover: Animal Infections and the Next Human Pandemic.

 

The remembrance of this crisis has no doubt helped to amplify the concerns of the public - and health officials - in Asia, and around the world over the recent emergence of another coronavirus in the Middle East.

 

This novel coronavirus (NCoV) is not SARS, and so far it has failed to demonstrate an ability to spread as easily as did SARS.

Nevertheless, this week - along with a lot of media stories recalling the the 2003 SARS epidemic, we are seeing a number of cautionary statements from doctors and researchers regarding this NCoV.

 

Vigilance urged over new coronavirus 

 

Concerted efforts in enhancing surveillance and control measures for novel coronavirus

 

Not because they are convinced that this newest coronavirus presents an immediate or inevitable public health threat. But because the remarkable success in containing the 2003 SARS epidemic demonstrated the value of a swift, and coordinated, global public health response.

 

The future of NCoV is highly uncertain right now. It could continue to threaten - or it could easily fizzle – finding itself unable to adapt well enough to humans to thrive. 

 

These are, as they say, early days.

 

But if NCoV does fade away, it might very well be due to the unsung efforts of local, regional, and global health officials and researchers (at the WHO, ECDC, CDC, CHP, HPA, etc) who are currently seeking to better understand this virus, and contain its spread.

 

The old saying is true, `When public health works, nothing happens’.

HPA: Not Investigating `4th’ Coronavirus Case

 

Coronavirus – Credit CDC PHIL

# 6963

 

A follow up to a blog on Thursday (Branswell: Possible 4th NCoV Case In UK Cluster), Professor Nick Phin at the HPA has written to ProMed Mail, to clarify that:

 

“ . . . we would like to confirm that the HPA is not currently investigating any 4th possible case associated with the UK cluster of novel coronavirus.”

The entire statement can be viewed at ProMed Mail at the following link:

 

NOVEL CORONAVIRUS - EASTERN MEDITERRANEAN (08): UNITED KINGDOM, 4TH CASE, NOT

Hong Kong: Hospitalized Patient Tests Negative For Coronavirus

Coronavirus – Credit CDC PHIL

 

# 6962

 

The recent detection of a mild NCoV case in the UK has prompted the World Health Organization to call for broader testing of `suspicious’ SARI (Severe Acute Respiratory Infection) cases around the world.  

 

Their latest recommendations reads:

 

WHO encourages all Member States (MS) to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns. Testing for the NCoV should be considered in patients with unexplained pneumonias, or in patients with unexplained, severe, progressive or complicated respiratory illness not responding to treatment, particularly in persons traveling from or resident in areas of the world known to be affected.

 

Any clusters of SARI or SARI in healthcare workers should be thoroughly investigated, regardless of where in the world they occur.

 

 

With only a couple of dozen confirmed (n=13) or suspected cases worldwide in just under a year, no one expects that very many of the patients that meet this criteria will test positive for the novel coronavirus.

 

Negative results, are likely to be far more common than positive ones.

 

This is the same pattern we’ve seen with H5N1 testing over the past decade, where the vast majority of `suspected’ cases have ended up being infected with something far less exotic - like seasonal flu. 

 

But NCoV is not only a novel coronavirus, it is a novel media story as well. In the short run, every case that gets tested is likely to garner some degree of press attention.

 

Yesterday, in Hong Kong: SFH Addresses NCoV Rumors, we saw Hong Kong’s Secretary for Food and Health, Dr Ko Wing-man, responses to press questions regarding a `suspected’ NCoV case being tested at a local hospital.

 

Today, we have a press release from the Centre For Health Protection (CHP) indicating that a traveler, recently returned from the Middle East, has tested negative for NCoV. 

 

23 February 2013

Fever patient tested negative for novel coronavirus 

The Centre for Health Protection (CHP) of the Department of Health (DH) received a report from Queen Elizabeth Hospital (QEH) today (February 23) of a suspected case of Severe Respiratory Disease associated with Novel Coronavirus.

 

The 40-year-old man, with good past health, presented with fever, cough, myalgia and runny nose since February 20. He attended the Accident and Emergency Department of QEH on February 22 and was admitted to the isolation ward of QEH on the same day. His current condition is stable.

 

Investigations by the CHP revealed that the patient travelled to Dubai with his family from January 24 to February 1, then to Tehran from February 1 to 20, and returned to Hong Kong on February 21. His family members travelled with him are all asymptomatic.

 

Preliminary laboratory test result for the patient's nasopharyngeal swab today showed that it tested negative for Novel Coronavirus associated with Severe Respiratory Disease but positive for influenza B.

 

"The CHP will continue its surveillance mechanism with public and private hospitals, practising doctors and the airport for any suspected cases of Severe Respiratory Disease associated with Novel Coronavirus," a DH spokesman remarked.

 

“No human infection with this virus has been identified so far in Hong Kong," the spokesman stressed.

 

The spokesman advised travellers returning from novel coronavirus-affected countries with respiratory symptoms to wear face masks, seek medical attention and reveal their travel history to doctors.

Ends/Saturday, February 23, 2013

 

Although the symptoms of `fever, cough, myalgia and runny nose’ fall outside of the typical SARI definition, the patient’s recent travel history was undoubtedly viewed as a `red flag’.

 

Hong Kong - having endured the brunt of the 2003 SARS epidemic - is understandably being aggressive in their screening efforts.

 

While better surveillance for this virus is certainly a good thing, the price of that vigilance is that we will undoubtedly see a lot of `suspect cases’ that turn out to be infected with a common respiratory viruses.

 

Although data is limited, for now NCoV does not appear to be widespread, or transmitting efficiently from human-to-human. 

 

Better surveillance, and continued epidemiological investigations, will tell us a good deal more about this emerging virus over the coming weeks and months.

 

UPDATE:  Shortly after posting this blog, the following statement was issued by Dr Ko Wing-man, SFH Hong Kong.

 

Secretary for Food and Health: I would like to mention here that yesterday a patient was admitted into a public hospital with fever and symptoms of upper respiratory infection. The patient also has a history of travel to the Middle East. Therefore, our frontline staff's alertness was heightened. The case was reported to the Centre for Health Protection this morning. At the same time, the hospital staff have obtained specimen from the patient to conduct a rapid test. Up to this stage, the report showed that the specimen tested positive for influenza B, but negative for Novel Coronavirus. We are still observing the patient. If necessary, we will repeat the test. However, up to this moment, the patient's specimen tested negative for Novel Coronavirus. I would like to reassure the public that the Government will be as transparent as possible. Whenever there is a suspected case, particularly patients with travel history to the Middle East that need to perform the rapid test, we will release information to the public as soon as possible.

 

Reporter: (On rumours of new Severe Respiratory Disease associated with Novel Coronavirus)

 

Secretary for Food and Health: We noticed that there were at least two incidents where rumours were subsequently proven untrue. These rumours will not affect the health care system. We will remain vigilant. However, spreading of such rumours is unhealthy. The public's attention may be diverted if there are too many untrue reports spreading around. It is important to have trust in the Government that it will be as transparent as possible. Thank you.

(Please also refer to the Chinese portion of the transcript.)

Ends/Saturday, February 23, 2013
Issued at HKT 20:16
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