Italian MOH: Imported MERS-CoV Case in Italy

 

# 7346

News from the Italian Ministry of Health this afternoon indicating that they have detected, and isolated, that country’s first imported MERS-CoV case.

 

The (machine translated) press release.

New Coronavirus, first confirmed case in Italy

The patient is in isolation but at the moment is in good condition

· Ministry is closely monitoring the situation

By the Region of Tuscany has been reported a confirmed case of import of new infection Coronavirus (now called MERS-CoV = Middle East Respiratory Syndrome Coronavirus), a citizen of 45 years of foreign nationality, who lives in Italy, and that has recently been in Jordan for 40 days, where one of his sons seems to suffer from a flu unspecified.

 

The patient, who at admission had a high fever, cough and signs of respiratory failure, is currently hospitalized in isolation and is in good condition.

 

The confirmation of the diagnosis was made by the Institute of Health - Department of Infectious, Parasitic and Immune-Mediated.

 

The recognition of the Italian case occurred following the procedures outlined in the Circular that the Ministry of Health issued the Departments of Health of the Autonomous Regions and Provinces on May 16 last year to increase the degree of attention to persons with fever and respiratory symptoms from important by geographical areas in which there have been similar cases or who have witnessed a patient suffering from MERS-CoV, for submission to the specific test.

 

It is a virus whose almost-human transmission seems to be possible only where there have been prolonged close contact such as in a family or in a hospital ward.

 

With regard to international travel and trade routes, the World Health Organization does not recommend testing or other restrictions on entry to travelers in the member countries of the European Region.

 

The Ministry is closely monitoring the situation in close collaboration with the health authorities of the Region of Tuscany.

 

Please note that for the prevention of respiratory infections, the normal recommended hygiene measures for influenza (frequent hand washing, covering your mouth with a tissue when you sneeze, etc..), And that information about it can be found on the website of the Ministry of Health.

Date Posted: May 31, 2013, last update 31 May 2013

WHO: Updates On MERS-CoV & H7N9 – May 31st

 

 

# 7345

 

The World Health Organization has published two new updates today; an extensive (38 page) report on the H7N9 virus in China, and an updated summary and review of the literature on the MERS-CoV virus.

 

I’ve not had time to read the H7N9 report yet, but the link to the PDF, and a summation of what it covers, follows:

 

Overview of the emergence and characteristics of the avian influenza A(H7N9) virus as of 31 May 2013 pdf, 1.24Mb

Summary

This is an overview of the emergence and characteristics of avian influenza A(H7N9) virus infecting humans in China in early 2013. The public health and animal health investigations of the
outbreak were facilitated by rapid sharing of information and viruses. Epidemiologic studies and laboratory analyses of virus isolates have provided a vast amount of information in a very short time. Molecular and functional characterization of the virus revealed its possible origins and supported the development of diagnostic tests and vaccines as well as offering clinical guidance on antiviral therapy. Studies in animal models have started to shed light on pathogenicity and risk assessment. These activities have been essential in guiding disease control interventions and informing pandemic preparedness actions.   

 

 

 

The MERS-CoV Update follows:

 

 

MERS-CoV summary and literature update – as of 31 May 2013

Since April 2012, there have been 50 laboratory-confirmed cases of human infection with Middle East respiratory syndrome coronavirus (MERS-CoV). Thirty of these cases have died. Local transmission from non-human exposures appears to have occurred in several countries in the Middle East, including Jordan, Qatar, Saudi Arabia and the United Arab Emirates (UAE). Cases have also been reported by three countries in Europe—France, Germany, and the United Kingdom (UK)—and by Tunisia, in North Africa. All the European and North African cases have had a direct or indirect connection to the Middle East. However, in France, the UK and Tunisia, there has also been limited local transmission among close contacts who had not been to the Middle East but had been in contact with a sick traveler recently returned from the Middle East. No case has been reported in Jordan since April 2012.

 

The most recent cases have occurred in Saudi Arabia and Tunisia. Two laboratory-confirmed cases and one probable case of MERS-CoV have been reported by Tunisia. In this family cluster, the index case, who was not laboratory confirmed, was a male Tunisian who traveled to Qatar in late March. He then left Qatar briefly, returning a few days later. He remained in Qatar for about 3 weeks before returning home to Tunisia. He became ill 5 days later and died after a week. He tested negative for MERS-CoV, but the quality of the specimen may have been poor. Two adult children, one who traveled to Tunisia from Qatar and one who lives in Tunisia and had not traveled, also became ill, with mild symptoms, and both tested positive for MERS-CoV.

 

Five new cases of MERS-CoV infection were reported by the Saudi Arabian Ministry of Health on 28 May 2013. The cases occurred in the eastern province of Saudi Arabia, but are not from the Al-Ahsa area. They range in age from 56 to 85 years, three were male, and three of these five patients have died. All were reported to have multiple co-morbid conditions and were admitted to hospital between 12-24 May, with pneumonia or respiratory symptoms. An official from the Ministry of Health has been quoted as saying that all were patients in the same hospital and that two had shared a hospital room. None of the patients have family contacts in Al-Ahsa. The Ministry of Health is continuing investigations to determine source of transmission in this cluster. An additional case, a 61-year-old man with chronic renal failure and other chronic diseases, was reported from Al-Ahsa on 29 May.

 

Thus far, all clusters of cases have occurred in a health care setting or among close family contacts. Human-to-human transmission has been documented on several occasions in which secondary cases had not traveled to affected areas and is strongly suspected in others. Transmission does not appear to have extended beyond these clusters into the larger community in any of the events. The mode of transmission has not been defined in any of the clusters.

(Continue . . .)

 

CDC: Pandemic Planning Tips For Public Health Officials

Credit CDC

 

# 7344

 

With two emerging viruses (H7N9) and MERS-CoV on the horizon, the CDC and other public health agencies are talking seriously again about the need for pandemic planning.  

 

No one knows right now if either of these two viruses will spark a pandemic, but the optimum time to plan is always before a crisis begins.

 

Yesterday the CDC posted the following pandemic planning advice for public health officials at the state, local, tribal, and territorial levels.

 

 

 

Top 10 Influenza Pandemic Response Planning Tips for H7N9 Virus

CDC is closely monitoring the avian influenza A (H7N9) situation in China and is taking several preparedness measures. While no H7N9 cases have been detected in the United States or anywhere outside of China at this time and there is no evidence of sustained human-to-human transmission, CDC encourages state and local public health agencies to use this time to review and reinforce their pandemic preparedness plans in case the situation escalates. CDC has developed these Top 10 Influenza Pandemic Response Planning Tips to help senior public health officials at the state, local, tribal, and territorial levels identify the most critical capabilities and activities needed to assure jurisdictional readiness for an influenza pandemic response.

 

These suggestions are designed to help jurisdictions identify remaining influenza pandemic preparedness operational gaps and improve readiness for potential response. This is not an exhaustive list of all the steps necessary for a sustained influenza pandemic response, but it is intended to give senior public health officials a quick guide for accelerated planning. CDC recommends jurisdictions review their respective H1N1 after-action reports and other relevant data to better assess operational requirements.

1. Regularly visit the CDC avian influenza (H7N9) information page for the latest information on the rapidly evolving H7N9 outbreak in China. H7N9 content includes CDC guidance documents such as interim guidance for infection control and antiviral treatment recommendations.
2. Review existing jurisdictional influenza pandemic plans including vaccine administration/mass vaccination plans, community mitigation plans, plans for requesting, receiving, distributing, and dispensing Strategic National Stockpile (SNS) assets, worker safety plans, and risk communication plans, among others. Identify and address any operational gaps.
3. Verify state and local supplies and caches of antiviral drugs, respiratory protective devices, and personal protective equipment.
4. Ensure that H7N9 virus can be rapidly detected and characterized. CDC has completed work on new laboratory diagnostic test materials that can be used specifically to identify cases of human infection with the new avian influenza A (H7N9) virus.
5. Develop and utilize redundant methods for communicating with and contacting providers/clinicians including but not limited to Health Alert Network (HAN) messaging. Prepare to disseminate messages on testing guidance, treatment guidelines, case definition, and worker safety guidance.
6. Identify the relevant subject matter experts within your jurisdiction’s public health emergency preparedness and immunization programs, as well as other influenza subject matter experts, such as those in agricultural agencies to develop strategies to ensure animal health is part of public health preparedness planning.
7. Assure that key staff members within your jurisdiction know how to contact CDC’s domestic H7N9 epidemiology/lab team and reinforce the need to call CDC with any questions or to consult on cases. Contact CDC 24/7 at 770-488-7100.
8. Test communication systems and platforms to assure operability. Update as needed.
9. Plan how your vaccination program would operationalize a pandemic vaccine prioritization scheme.
   1. Identify and vaccinate potential priority populations such as healthcare workers, critical infrastructure personnel, young children, and other pediatric and adult groups (e.g., pregnant women and other high-risk groups).
   2. Strategize how to engage, enroll, and communicate with providers not currently enrolled in the Vaccines for Children program. Nontraditional providers may include adult medical providers, occupational health providers that care for critical infrastructure personnel, pharmacies, and community health centers.
   3. Plan for potentially administering significantly more vaccine than was available during the 2009 H1N1 response.
10. Assure administrative readiness for a large-scale influenza pandemic event. This includes the ability to rapidly procure, execute contracts, and hire staff/contractors. Identify and address any legal barriers.

Delving Into The Oseltamivir Dosage Study

 

Photo Credit – Wikipedia

 

# 7344

 

One of the concerns during a severe pandemic is our finite supply of antiviral medications. The standard adult dose of oseltamivir (Tamiflu ®) is 75mg twice a day for 5 days, or a course of 10 pills.

But as we’ve seen in Southeast Asia with H5N1 (and more recently with H7N9), many patients have required larger antiviral doses for a longer period of time, and yet many still do not survive.

 

In 2007, at the height of the H5N1’s expansion, some doctors began treating patients with double the dose for double the time, essentially 40 pills over 10 days (see Prudence and the Pill). 

 

A rate that is sustainable when cases are few, but would quickly exhaust our stockpiles of antivirals in a severe pandemic.

 

Which makes the headline being carried by the media this morning, stemming from a study that appeared in the BMJ yesterday, of particular interest:

 

 

No benefit of double dose antiviral drug for severe influenza

Findings have major implications for stockpiling drugs during pandemics, say experts

 

And if you stop there, or simply read the press release, you might come away with the idea that a double dose of oseltamivir (Tamiflu ®) is a waste of time, and valuable resources, when treating an avian flu patient.

But that’s not exactly what the study says.

 

First, a link to the open access double-blind randomized trial, conducted across 13 hospitals in four southeast Asian countries between 2007 and 2010, comparing the relative effectiveness of the standard dose of oseltamivir (Tamiflu ®) vs a double dose.

 

Effect of double dose oseltamivir on clinical and virological outcomes in children and adults admitted to hospital with severe influenza: double blind randomised controlled trial

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3039 (Published 30 May 2013)

Cite this as: BMJ 2013;346:f3039

 

 

This is actually an impressive, well mounted study, certainly worth reading in its entirety. There were 326 patients, mostly children under the age of 15, enrolled in the trial.

 

The press release describes their methodology:

 

Patients received either standard dose oseltamivir (75 mg twice a day or children's equivalent) or double dose (150 mg twice a day or children's equivalent) for five days. Nose and throat swabs were then taken to test for virus levels.

 

Other outcomes including death, admission to intensive care, and help with breathing (mechanical ventilation) were also assessed.

 

The researchers found no differences between the treatment groups in virus levels on day five. There were also no differences in deaths or rates of adverse events between the different doses.

 

The authors mention a few important limitations to this study, including:

 

• Most of the patients were children under 15
• Most of the patients had low or normal BMI
• Only about 1/5th had underlying conditions
• Very few adults were included in the study
• Only 17 (of 326 cases) were H5N1, and of those, only 3 survived to day 5 of the trial.
• The average delay for treatment for H5N1 patients was 7 days vs. 5 days for seasonal flu
• All H5N1 cases met the criteria for clinical failure

 

The authors caution:

 

Thus, our findings are applicable primarily to the region where the study was conducted and other settings with similar characteristics of influenza epidemiology.

 

 

One is left to wonder how well these results would translate to a much older population, one likely to have a higher average BMI, far more (and different) underlying conditions, and in all likelihood would seek treatment sooner than did the patients in this study (average 5-7 days).

 

But assuming that these factors would not make huge differences in outcomes, the biggest limitation remains the lack of data on H5N1 avian influenza.

 

Only 17 patients were enrolled, treatment began (on average) a week after falling ill – well beyond the optimal `48 hour window’ - and only three patients survived.

 

So, while this trial found no value to doubling the dose for seasonal flu, there is insufficient evidence to judge whether doubling the dose for H5N1 (or presumably H7N9) would improve patient survival.

 

And in an accompanying editorial, Ian Barr and Aeron Hurt of the WHO Collaborating Centre for Reference and Research on Influenza, would appear to agree:

 

What is clear is that double dose oseltamivir is unlikely to significantly improve the clinical outcomes of severe cases of seasonal influenza, although there were probably insufficient data to determine if this was also true for people infected with A(H5N1).

 

It is worth noting that last month, in CDC Interim Guidance On H7N9 Antiviral Treatment, we saw the CDC’s recommendation that for hospitalized patients:

 

The optimal duration and dose of therapy are uncertain in severe or complicated influenza. Pending further data, longer courses of treatment (e.g., 10 days of treatment) should be considered for severely ill hospitalized H7N9 patients.

 

And in a discussion this morning on this study between Gregory Hartl – spokesperson for the World Health Organization and FluTrackers – Hartl had this to say.

 

 

While the success rate of treatment with oseltamivir for avian flu has been less than stellar, in Study: Antiviral Therapy For H5N1, we saw the largest study to date on outcomes of H5N1 patients who either received, or did not receive, antiviral treatment.

 

The research appears in the IDSA’s  Journal of Infectious Diseases. The bottom line is essentially out of 308 cases studied, the overall survival rate was a dismal 43.5%.

 

But . . . of those who received at least one dose of Tamiflu . . .  60% survived . . .  as opposed to only 24% who received no antivirals.

 

And importantly, most of these patients did not receive antivirals within the first critical 48 to 72 hours of infection.

 

Over the next few months I suspect we’ll get a much better idea of the efficacy of oseltamivir for treating avian flu, and optimal dosing in adult patients, from China’s experience with the H7N9 virus.

China Terminates H7N9 Emergency Response

H7N9 Affected areas – Credit Laidback Al FluTrackers

 

# 7343

 

Two months and 130+ cases after we first learned of the emerging H7N9 virus (see More Details Emerge On Shanghai H7N9 Case), China today has announced the termination of their emergency response to the H7N9 outbreak.

 

Only one new case has been reported in recent weeks (see  Beijing Reports 2nd H7N9 Case), a dramatic drop in cases which has been attributed to the closing of live markets and the return of warmer weather.

 

Few experts believe the virus has gone for good, however, and many have deep concerns it will return once live markets are reopened, or when cooler temperatures return in the fall.

 

So two reports this morning. 

 

First, the announcement of the end of the emergency response, followed by a statement from the Chinese CDC warning of the dangers of re-opening live markets.

 

H7N9 emergency response program ends

Updated: 2013-05-31 10:43

( chinadaily.com.cn)

All areas affected by the H7N9 bird flu have ended emergency responses as of May 28, xinhuanet.com reported.

 

The epidemic will be under routine monitoring as it has been deemed controllable and there has been no evidence of human-to-human transmission, the report said.

 

The Chinese mainland reported 130 confirmed H7N9 cases as of May 27, of which 36 ended in death.

 

The first case of human infection of H7N9 virus was announced in Shanghai on March 31, with 10 provinces and cities reporting cases in the following two months.

 

Shanghai was also the first city to call off the emergency response, on May 10, and Zhoukou city in Central China's Henan province was the last.

 

 

This next article is machine translated, and is slightly syntax-challenged.

 

Chinese CDC experts: do not advocate live poultry markets open

May 31, 2013 07:23:00
Source: China News Network

Original title: China CDC epidemiologist: do not advocate live poultry markets open

BEIJING, Suzhou, May 30 (Reporter Wu pupil) in recent days, some farmers market in Suzhou city of live poultry stalls have opened, but was immediately ordered to stop trading the local business sector. 30, China CDC epidemiologist Zeng Guang, chief expert came to Suzhou, the city's disease control and medical personnel to carry out the lecture. Turning to whether to suspend the live poultry trade liberalization, the experts made it clear that not support it.

 

Beijing health authorities 28 Nisshin confirmed case of human H7N9 avian influenza infection, the discovery of the confirmed case patient was a 6-year-old boy. People have been previously rumored, H7N9 avian influenza virus in the summer may die. Zeng Guang said that at present, H7N9 virus transmission is not clear, but for cooked chicken, ducks and other poultry products do not need to panic.

 

Speaking of whether you want to pause live poultry trade liberalization, the experts made it clear that not support it. "Open live poultry market, I do not advocate." Zeng said.

 

Zeng Guang, also introduced in the world, live poultry market in the country, are very few in the country. "They are duck, designed duck, chicken, special chicken, it's not coming from the retail feeding. Kill, do not kill their own people, in the professional protection, the central slaughtering, because in the recycling process, prone to mutation . "

 

Affected by avian influenza, Suzhou since April 8 banned live poultry trade, has not been lifted

 

 

There are strong cultural and economic factors at work here, and so it remains to be seen how long, and how effectively, authorities can keep live markets closed in Eastern China.

 

While the news out of China has slowed, the World Health Organization, in their H7N9 GAR Update of two days ago, warned:

 

Until the source of infection has been identified and controlled, it is expected that there will be further cases of human infection with the virus.

 

All of which suggests that while cases may be few and far between in the short run, the threat posed by the virus has not disappeared.

WHO: Hartl On The Rumored MERS Case In Morocco

 

 

# 7342

 

Earlier today several Arabic media sources reported on a suspected coronavirus case – recently returned from the UAE – who was being tested in Morocco (see Crofsblog A MERS case in Morocco? & FluTrackers  thread.).

 

Just before noon, EDT today, Gregory Hartl – spokesperson for the WHO (who has been terrific at getting information out quickly) – released this update on twitter.

 

It can sometimes take repeated testing to confirm or exclude a diagnosis of MERS-CoV, so these results are tentative. But this is the latest information we have at the moment.

NEJM: Targeted vs Universal Decolonization For ICU Patients

 

UPDATED:   Maryn Mckenna – who is Flublogia’s resident expert in all things antimicrobial – has just posted a blog post on this important story on her Superbug Blog.

To Prevent MRSA In Hospitals, Don’t Prevent Only MRSA

• By Maryn McKenna
• 05.30.13 10:54 AM

 

# 7341

 

HCAIs (Health care associated Infections) or HAIs (Hospital acquired infections) constitute a major threat to life, health, and the cost of medical care in this country, and around the world.

 

This oft quoted assessment from the CDC on the burden of Hospital Acquired Infections in the United States is from 2010.

 

A new report from CDC updates previous estimates of healthcare-associated infections. In American hospitals alone, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year. Of these infections:

• 32 percent of all healthcare-associated infection are urinary tract infections
• 22 percent are surgical site infections
• 15 percent are pneumonia (lung infections)
• 14 percent are bloodstream infections

 

Since 2008 the Centers for Medicare & Medicaid Services (CMS) have adopted a `no pay’ rule for `preventable infections’, or medical mistakes associated with hospital stays in order to encourage facilities to improve procedures and patient safety.

 

The problem is that many people entering hospitals are colonized – but not necessarily infected – with bacteria like MRSA. When hospitalized, invasive procedures (needle sticks, catheterization, PICC lines, etc) can turn a benign colonization into a life threatening infection.

 

And their bacteria can be transferred to other patients, staff, or visitors as well.

 

We’ve covered HAIs often in this blog, including:

 

HPA: Healthcare-Associated Infection (HCAI) Survey

A Barrier To Good Hand Hygiene

Study: Hospital Uniforms And Bacteria

Study: HAIs, Universal Surveillance, & MRSA

 

Today, a look at a large study -involving 74 adult ICUs and 74,256 patients between 2009-2011 – published yesterday in the  NEJM - that compared three HAI prevention strategies for ICU patients.

 

1. MRSA screening and isolation of colonized patients;
2. Targeted decolonization (screening, isolation, & 5 day decolonization regimen of MRSA carriers)
3. Universal decolonization (decolonization of all patients without screening - ie. twice-daily intranasal mupirocin x 5 days, daily bathing with chlorhexidine-impregnated cloths for the entire stay)

 

The results showed that bloodstream infections were cut by more than 40% with universal decolonization. The CDC – which was a participant in this study – has the press release below, after which I have a link to the NEJM study itself.

 

MRSA study: simple steps slash deadly infections in sickest hospital patients

Bloodstream infections cut by more than 40 percent in study of more than 74,000 patients

 

A new study on antibiotic-resistant bacteria in hospitals shows that using germ-killing soap and ointment on all intensive-care unit (ICU) patients can reduce bloodstream infections by up to 44 percent and significantly reduce the presence of methicillin-resistant Staphylococcus aureus (MRSA).  Patients who have MRSA present on their bodies are at increased risk of developing a MRSA infection and can spread the germ to other patients.

 

Researchers evaluated the effectiveness of three MRSA prevention practices: routine care, providing germ-killing soap and ointment only to patients with MRSA , and providing germ-killing soap and ointment to all ICU patients.   The study found:

• Routine care did not significantly reduce MRSA or bloodstream infections.
• Providing germ-killing soap and ointment only to patients with MRSA reduced bloodstream infections by any germ by 23 percent.
• Providing germ-killing soap and ointment to all ICU patients reduced MRSA by 37 percent and bloodstream infections by any germ by 44 percent.

The study, REDUCE MRSA trial, was published in the New England Journal of Medicine and took place in two stages from 2009-2011. A multidisciplinary team from the University of California, Irvine, Harvard Pilgrim Health Care Institute, Hospital Corporation of America (HCA) and the Centers for Disease Control and Prevention (CDC) carried out the study.  A total of 74 adult ICUs and 74,256 patients were part of the study, making it the largest study on this topic to date.

 

You can read the NEJM Editorial on REDUCE MRSA Trial, and the study at the link below.

Targeted versus Universal Decolonization to Prevent ICU Infection

Susan S. Huang, M.D., M.P.H., Edward Septimus, M.D., Ken Kleinman, Sc.D., Julia Moody, M.S., Jason Hickok, M.B.A., R.N., Taliser R. Avery, M.S., Julie Lankiewicz, M.P.H., Adrijana Gombosev, B.S., Leah Terpstra, B.A., Fallon Hartford, M.S., Mary K. Hayden, M.D., John A. Jernigan, M.D., Robert A. Weinstein, M.D., Victoria J. Fraser, M.D., Katherine Haffenreffer, B.S., Eric Cui, B.S., Rebecca E. Kaganov, B.A., Karen Lolans, B.S., Jonathan B. Perlin, M.D., Ph.D., and Richard Platt, M.D. for the CDC Prevention Epicenters Programthe AHRQ DECIDE Network and Healthcare-Associated Infections Program

May 29, 2013DOI: 10.1056/NEJMoa1207290

Full Text of Results...

Conclusions

In routine ICU practice, universal decolonization was more effective than targeted decolonization or screening and isolation in reducing rates of MRSA clinical isolates and bloodstream infection from any pathogen. (Funded by the Agency for Healthcare Research and the Centers for Disease Control and Prevention; REDUCE MRSA ClinicalTrials.gov number, NCT00980980.)

 

It is an impressive result, and reduced not only MRSA, but bloodstream infections by any pathogen. It may very well affect the way ICU admissions are handled in the future.

 

One caveat from the authors was that extensive use of these antimicrobials could eventually lead to bacteria developing resistance to mupirocin and chlorhexidine.

 

The authors conclude by writing:

 

In conclusion, we found that universal decolonization prevented infection, obviated the need for surveillance testing, and reduced contact isolation. If this practice is widely implemented, vigilance for emerging resistance will be required.

Grady Norton: The First Hurricane Forecaster

 

Note: Today is day five of National Hurricane Preparedness Week, and the focus today is on forecasting.

 

A couple of years ago I took a look at the life of legendary hurricane forecaster Grady Norton, and at how hurricane forecasting technology has changed over the past 50 years.

 

Today, a (slightly updated) repeat of that column for those who missed it.

 

 

# 7340

 

For those of a certain age who can remember growing up along the Gulf or Atlantic coasts in the 1950’s - before the advent of weather satellites - the technology we have at hand today is truly remarkable.

 

Our satellites today can probe deep into storm clouds and detect wind speeds, water vapor, precipitation, and heat energy of storm systems a thousand miles from the nearest weather observation post.

 

Three different views from space, taken May 26th, 2011 1345Z – NOAA

 

Weather forecasting began a new age when on April 1st 1960,  Tiros I - the world's first weather satellite - was launched into Earth orbit from Cape Canaveral, Florida.

 

For the first time, we had a `god's eye view' of earth. Regions of our globe where once cartographers could only inscribe "Here there be Dragons' could be watched 24 hours a day.

 

Our view of our world changed, practically overnight.

 

It was a wondrous day for everyone, except possibly for members of the Flat Earth Society. Below is the first television picture from earth orbit.

 

I was six years old, and I remember it like it was yesterday.

 

 

Sure the pictures were grainy, and the resolution laughable by today's standards, but for the first time we could watch from aloft and observe how and where hurricanes formed.

 

It meant we were no longer solely dependent on ship's reports and Hurricane Hunter aircraft to know if disaster lay just beyond the horizon.

It meant more than 12 hours warning to prepare for a storm.

 

TIROS 1 could take and transmit about 1 picture an hour, and only during daylight hours. Infrared capability – which allowed 24 hour coverage - was added to later `birds'.

 

Today, our reconnaissance satellites can take 40 pictures an hour, and see right through the clouds and measure rainfall, winds and even sea water temperatures. As a result, hurricane forecasting has improved tremendously over the past 50 years.

 

For those with an interest in how it was done before the advent of weather satellites and supercomputers, I’ve a bit of a treat today.

 

A profile of the first great hurricane forecaster – Grady Norton.

 

First, during the 1950’s there was a little remembered TV series called The Man Behind The Badge.  Hosted by Charles Bickford, the show profiled public servants who had made important contributions to public safety.

 

In 1955 a dramatized tribute to legendary hurricane forecaster Grady Norton was broadcast.  Grady had passed away suddenly of a stroke just a few months before while tracking Hurricane Hazel.

 

 

October 10th, 1954 Daytona News-Journal Article.

 

This 30 minute show stars Milburn Stone (of Gunsmoke Fame), and is hosted by a nostalgia TV site called LIKE Television.   It’s a fictionalized story, but I think you’ll find it well worth viewing.

 

Click the image below to view the show.

I

 

Norton became the Chief Hurricane Forecaster at the Jacksonville Weather Bureau Hurricane center in 1935 and famously forecast the track of the 200+ MPH Labor Day storm that year, providing 12 critical hours of warning to the Keys and South Florida.

 

 

In 1943 the Hurricane forecasting office moved to Miami, as a joint effort of the National Weather Service, Air Force, and Navy.  Norton remained their Chief forecaster and most public spokesperson until his death in 1954.

 

It wasn’t until the mid-1960s that the NHC as we know it today was established as its own entity, separate from the National Weather Service.

 

While  the first director of the National Hurricane Center is listed as Gordon Dunn (1965–1967), Grady Norton is widely regarded as that agency’s first `unofficial’ director.

 

When meteorologists talk about Grady Norton today, they do so with considerable wonder and awe. His uncanny ability to track storms based on little more than ships reports was the stuff of legend.

 

While primitive by today’s standards, the work done by Grady Norton and other pioneers of meteorology during the first half of the last century deserves mention and remembrance.

 

Despite the limited technology of the day, they undoubtedly saved a lot of lives.

 

For a look at how forecasting is done today, you can watch the following short video from the National Hurricane Center.

 

Tomorrow, day six of hurricane preparedness week, we’ll be looking at planning for the storm’s arrival. If you haven’t already downloaded the updated Tropical Cyclone Preparedness Guide, now would be an excellent time to do so.

Branswell: Saudis Investigate New MERS-CoV Cases

 

 

#7339

 

News on the MERS coronavirus has been coming in fast and furious over the 24 hours, with several new studies published, and reports of a new cluster in Saudi Arabia (see here, here, and here).

 

There is probably no one better able to pull all of this information together - and present it in a cogent fashion - than Helen Branswell of the Canadian Press.

 

Overnight Helen published a long report that includes an interview with KSA’s deputy minister of health, Dr. Ziad Memish who talks about the investigation into a new cluster of cases, and the Saudi experience that the incubation period of the virus may exceed two weeks.

 

Very much worth reading in its entirety, this from Canada.com.

 

 

Saudis investigating possible second hospital outbreak of MERS cases

By Helen Branswell, The Canadian Press May 29, 2013

TORONTO - Authorities in Saudi Arabia are investigating whether there is a new cluster of MERS coronavirus cases linked to a hospital in the eastern part of the country, a separate incident from a previously reported large hospital outbreak there.

 

A case reported Wednesday and five reported Tuesday may be linked to a hospital, said the country's deputy minister of health, Dr. Ziad Memish. He would not reveal the name of the town or the hospital

(Continue . . .)

WHO: MERS-CoV Update – May 29th

 

Photo Credit - WHO

 

# 7338

 

A few details today from the World Health Organization on the five new MERS cases reported yesterday in Saudi Arabia. We learn that three have died, one remains hospitalized in critical condition, and one has been released.

 

All five are reportedly not part of the Al-Ahsa hospital cluster, although we get no other solid epidemiological details, beyond the fact that they all apparently had multiple visits to a local hospital.

 

 

This brings us to 49 laboratory confirmed cases, 27 deaths, and roughly a dozen `probable’ cases.

 

 

Middle East respiratory syndrome- coronavirus - update

29 May 2013 - The Ministry of Health in Saudi Arabia has notified WHO of an additional five laboratory-confirmed cases with Middle East respiratory syndrome coronavirus (MERS-CoV).

 

All five patients are from the Eastern region of the country, but not from Al-Ahsa, where an outbreak began in a health care facility in April 2013. The patients had underlying medical conditions which required multiple hospital visits. The government is conducting investigations into the likely source of infection in both the health care and the community settings.

 

The first patient is a 56-year-old man with underlying medical conditions, who became ill on 12 May 2013 and died on 20 May 2013. The second patient is an 85-year-old woman with underling medical conditions who became ill on 17 May and is currently in critical condition. The third patient is a 76-year-old woman with underlying medical conditions who became ill on 24 May 2013 and was discharged from the hospital on 27 May 2013. The fourth patient is a 77-year-old man with underlying medical conditions who became ill on 19 May and died on 26 May 2013. The fifth patient is a 73-year-old man with underlying medical conditions who became ill on 18 May and died on 26 May 2013.

 

Additionally, a patient earlier reported from Al-Ahsa, an 81-year-old woman has died. The government is continuing to investigate the outbreaks in the country.

 

In France, the first laboratory-confirmed case in the country, with recent travel from the United Arab Emirates has died.

 

Globally, from September 2012 to date, WHO has been informed of a total of 49 laboratory-confirmed cases of infection with MERS-CoV, including 27 deaths.

 

WHO has received reports of laboratory-confirmed cases originating in the following countries in the Middle East to date: Jordan, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). France, Germany, Tunisia and the United Kingdom also reported laboratory-confirmed cases; they were either transferred for care of the disease or returned from the Middle East and subsequently became ill. In France, Tunisia and the United Kingdom, there has been limited local transmission among patients who had not been to the Middle East but had been in close contact with the laboratory-confirmed or probable cases.

 

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.

 

Health care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. Specimens from patients’ lower respiratory tracts should be obtained for diagnosis where possible. Clinicians are reminded that MERS-CoV infection should be considered even with atypical signs and symptoms, such as diarrhoea, in patients who are immunocompromised.

 

Health care facilities are reminded of the importance of systematic implementation of infection prevention and control (IPC). Health care facilities that provide care for patients suspected or confirmed with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients, health care workers and visitors.

 

All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.

 

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

 

WHO continues to closely monitor the situation.

Lancet: Clinical Findings On 2 French MERS-CoV Cases

 

 

# 7337

 

From The Lancet today, our first good look at the details of an apparent nosocomial transmission of the novel coronavirus at a hospital in France. First a link to the report, then a link to a Helen Branswell article on the prolonged incubation period observed in this case.

 

Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission

Benoit Guery, Julien Poissy, Loubna el Mansouf, Caroline Séjourné, Nicolas Ettahar, Xavier Lemaire, Fanny Vuotto, Anne Goffard, Sylvie Behillil, Vincent Enouf, Valérie Caro, Alexandra Mailles, Didier Che, Jean-Claude Manuguerra, Daniel Mathieu, Arnaud Fontanet, Sylvie van der Werf, and the MERS-CoV study group*

Summary

Background Human infection with a novel coronavirus named Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia and the Middle East in September, 2012, with 44 laboratory-confirmed cases as of May 23, 2013. We report detailed clinical and virological data for two related cases of MERS-CoV disease, after nosocomial transmission of the virus from one patient to another in a French hospital.

Findings

(Excerpt)

The two patients shared the same room for 3 days. The incubation period was estimated at 9–12 days for the second case. No secondary transmission was documented in hospital staff despite the absence of specific protective measures before the diagnosis of MERS-CoV was suspected. Patient 1 died on May 28, due to refractory multiple organ failure.

Interpretation Patients with respiratory symptoms returning from the Middle East or exposed to a confirmed case should be isolated and investigated for MERS-CoV with lower respiratory tract sample analysis and an assumed incubation period of 12 days. Immunosuppression should also be taken into account as a risk factor

 

The article (which is of most interest to clinicians) provides a detailed review of the clinical findings on both patients, including lab results, radiographs and CT scans, and genetic analysis of specimens. 

 

Helen Branswell, who can always be counted upon to cut through the clutter, looks at one of the key findings – that the incubation period for the second patient may have been as long as 12 days.

 

MERS incubation period may be longer than suspected, study of French cases hints

By: Helen Branswell, The Canadian Press

Wednesday, May. 29, 2013 at 11:10 AMTORONTO - A new study suggests the incubation period for the new MERS coronavirus may be longer than has been believed up until now.

 

French doctors report that a man who caught the virus from an infected patient he shared a hospital room may have gone 12 days before developing symptoms.

 

They suggest people who have symptoms of the disease and have travelled to the Middle East or have been in contact with a known MERS patient within the past 12 days should be isolated and investigated as a possible case.

(Continue . . .)

WHO Update On H7N9 – May 29th

 

 

# 7336

 

The World Health Organization has posted an update on the H7N9 virus, reflecting the case reported yesterday (see Beijing Reports 2nd H7N9 Case) of a 6 year-old boy who fell ill on the 21st, and was treated for three days at a local hospital.

 

 

Human infection with avian influenza A(H7N9) virus – update

29 May 2013 - The National Health and Family Planning Commission, China notified WHO of an additional laboratory confirmed case of human infection with Avian Influenza A(H7N9) virus.

 

The patient is a six-year-old boy reported from Beijing who became ill on 21 May 2013 and is in stable condition.

 

To date, WHO has been informed of a total of 132 laboratory-confirmed cases, including 37 deaths.

 

Authorities in affected locations continue to maintain surveillance, epidemiological investigations, close contact tracing, clinical management, laboratory testing and sharing of samples as well as prevention and control measures. City and provincial governments have started to normalize their emergency operations into their routine surveillance and response activities.

 

So far, there is no evidence of sustained human-to-human transmission.

 

Until the source of infection has been identified and controlled, it is expected that there will be further cases of human infection with the virus.

 

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions.

 

WHO continues to work with Member States and international partners to monitor the situation. WHO will provide updates as the situation evolves.

Taiwan To Downgrade H7N9 Travel Advisory To China

 

# 7335

 

In response to the recent drop in H7N9 cases reported from the mainland, Taiwan will lower their Level-2 travel advisory to most affected areas of China to a Level-1 on June 1st, with the exception of travel to Beijing, where a fresh case was reported yesterday.

 

First, excerpts from the Focus Taiwan report, then a link to the Taiwan DOH announcement.

 

Taiwan to adjust H7N9 travel advisories for China June 1

2013/05/29 21:14:42

Taipei, May 29 (CNA) Taiwan will downgrade its H7N9 travel advisory for various Chinese destinations from June 1, except for Beijing, the Central Epidemic Command Center said Wednesday.

 

The center has maintained a Level-2, or yellow color-coded, travel alert for eight Chinese provinces and two cities since late April over H7N9 avian flu concerns.

 

"Starting June 1, the travel advisory will be downgraded to Level-1 for those destinations, except for Beijing," said Chang Feng-yi, director-general of the Centers for Disease Control (CDC), who concurrently heads the epidemic command center.

 

(Continue . . .)

The syntax-challenged machine translation of the Taiwan DOH statement can be accessed at the link below.

 

Mainland China confirmed a new human infection with H7N9 influenza epidemic command center with the need to revise the definition of H7N9 flu travel advisory proposals scheduled for 6/1 onwards

 

 

While the closure of live markets  and the return of warm weather are believed to have contributed to the drop in H7N9 cases, many experts fear the virus will reappear once the live markets are reopened, or cooler weather returns in the fall.

France: Hospital Statement On MERS-CoV Fatality, Surviving Patient

 

Lille France – Credit Wikipedia

 

# 7334

 

In their first update in more than a week, yesterday the Centre Hospitalier Regionale et Universitaire de Lille  announced the death of one of their two MERS-CoV patients (see Media: France’s 1st MERS-CoV Patient Dies), and provided a brief update on the condition of the surviving patient.

 

The second patient, who became infected while sharing a room with their index case (before his infection was diagnosed), remains in very serious condition and on ECMO.

 

The index patient returned from a visit to Dubai (spanning Apr. 9th-17th) and was hospitalized on April 23rd in Valenciennes in the north of France. He was subsequently transferred to Douai on the 28th, and then a week later, on to the hospital in Lille.

 

The following is a machine translation.

 

The University Hospital of Lille mourns First patient coronavirus

The University Hospital of Lille mourns death this afternoon of the first patient coronavirus hospitalized in the intensive care unit of the University Hospital Centre of Lille since May 9, 2013, the following a multi-organ failure.

 

The patient was placed in a chamber designed to allow its isolation since his admission to the University Hospital of Lille, and had benefited from taking supported by a dedicated team.

 

Teams Centre resuscitation SAMU 59, and cardiac surgery (unit Circulatory Support) of the University Hospital of Lille, have implemented all the material means and human resources to support the patient in the best conditions.

 

He had especially placed under extracorporeal support (ECMO: Oxygenation by extracorporeal member), to take over his lung function. Branch and all the teams present their sincere University Hospital condolences to the family.

 

The second patient coronavirus is meanwhile still hospitalized in Resuscitation of the University Hospital Centre, under cardiopulmonary bypass (ECMO). His condition remains stable but still very serious

 

Hurricane Preparedness Week: Inland Flooding

 

# 7332

 

Odds are, on the night of June 19th, 1972, no one sitting at home in New York state or Pennsylvania  gave much thought to a weak early season hurricane named Agnes that was making landfall on the Florida panhandle more than a thousand miles to their south.

 

But a week later Agnes would end up being the costliest hurricane in U.S. history up until that date.   And a life altering event for millions of people far removed from where she came ashore.

 

 

Amazingly, of the 122 deaths associated with this storm, only 9 occurred in Florida where Agnes made landfall. The rest - 113 fatalities - were caused by inland fresh water flooding, with New York and Pennsylvania suffering the highest loses.

 

NOAA  describes the flooding damage this way:

 

Hurricane Agnes was the costliest natural disaster in the United States at that time. Damage was estimated at $3.1 billion and 117 deaths were reported. Hardest hit was Pennsylvania, with $2.1 billion in damages and 48 deaths, making Hurricane Agnes the worst natural disaster ever to hit the state. The damage over Pennsylvania was so extreme, the entire state was declared a disaster area by President Richard Nixon.

 

While we tend to concern ourselves most over the rare CATEGORY 5 storm (like Andrew in 1992 or Camille in 1969), it is often the slow moving minimal hurricane or tropical storm that produces extensive damage hundreds . . . sometimes more than 1000 miles inland.

 

Other storms with far-reaching impact include:

• Hurricane Hazel, which had already devastated Haiti (400-1000 deaths) came ashore on the North-South Carolina border in August of 1954.  She claimed 95 lives in the United States and was responsible for as many as 100 deaths in Canada.
• The CAT 5 monster Camille, which claimed 143 lives along the Gulf coast also killed 113 people in associated flooding in Virginia.
• And Audrey, the horrific `surprise’ gulf coast CAT 4 storm of 1957 -that claimed more than 550 lives -  at least 15 of those victims were in Canada.

 

Which is why today’s focus in NOAA’s National Hurricane Preparedness Week is inland flooding.

 

 

For more on this week’s preparedness campaign, click on the graphic below, and watch the videos.

 

 

When it comes to getting the latest information on hurricanes, your first stop should always be the National Hurricane Center in Miami, Florida. These are the real experts, and the only ones you should rely on to track and forecast the storm.

 

If you are on Twitter, you should also follow @FEMA, @CraigatFEMA, @NHC_Atlantic, @NHC_Pacific and @ReadyGov.

 

And to become better prepared as an individual, family, business owner, or community to deal with hurricanes, or any other type of disaster: visit the following preparedness sites.

 

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

Saudi Arabia Reports 5 New MERS-CoV Cases

 

 

 

# 7331

 

A short report from KSA’s MOH, which is even more bereft of detail than usual, indicates that Saudi Arabia has diagnosed 5 new cases of novel coronavirus infection.

 

 

Ministry News

New Cases of the Novel Coronavirus Recorded in the Eastern Region

28 May 2013

Within the framework of the epidemiological surveillance of the novel Coronavirus (MERS-CoV), the Ministry of Health (MOH) has announced that five novel Coronavirus cases have been recorded among citizens in the Eastern Region, ranging in age from 73 to 85 years, but they have all chronic diseases.

 

The Saudi Ministry of Health also tweeted the announcement:

 

WHO: MERS-CoV Name Acceptable

Photo Credit NIAID

 

# 7330

 

 

There’s been an ongoing controversy over what we should call the novel coronavirus which has emerged out of the Middle East over the past 14 months. 

 

The virus has been confusingly dubbed novel coronavirus’, HCoV-EMC/2012, NCoV, HCoV, and HCoV-EMC (among others).

 

 

Three weeks ago, in Picking A Novel Name For A Novel Virus, we learned that  an international group of experts had proposed the name Middle East respiratory syndrome coronavirus (MERS-CoV).

 

Or simply MERS.

 

The choice has been slightly controversial, and it is not in universal usage yet. 

 

Today the World Health Organization – while expressing that they `generally prefer that virus names do not refer to the region or place  of the initial detection of the virus’ – has signaled their acceptance of this term.

 

 

Naming of the Novel Coronavirus

28 May 2013

As of 23 May 2013, the novel coronavirus, which was first detected in March 2012, has caused 44 cases, including 22 deaths. In the majority of cases identified to date, this novel virus has produced severe diseases.

 

Several countries in the Middle East have been affected, including Jordan, Qatar, Saudi Arabia, and the United Arab Emirates (UAE).  Most recently, Tunisia has reported 1 probable and 2 confirmed cases of human infection with the novel coronavirus, with history of travel to the Arabian Peninsula for two of them.  Cases with direct or indirect  connection to the Middle East have also been reported by France, Germany, and the United Kingdom. 

This disease represents a significant public health risk under the International Health Regulations (IHR2005). WHO has issued recommendations for enhanced surveillance and precautions for the testing and management of suspected cases, and is working closely with countries and international partners.

 

The Coronavirus Study Group of the International Committee on Taxonomy of Viruses has published a proposed new designation for the novel coronavirus, the Middle East Respiratory Syndrome Coronavirus (MERS-CoV).

Given  the experience in previous international public health events, WHO generally prefers that virus names do not refer to the region or place  of the initial detection of the virus.  This approach aims at minimizing unnecessary  geographical discrimination that could be based on coincidental detection rather than on the true area of emergence of a virus. 

WHO did not convene a group to discuss the naming of this virus.  The proposed name  -  MERS-CoV -  represents a consensus that is acceptable to WHO. It was built on consultations with a large group of scientists. 

Reference: De Groot RJ, et al. Middle East Respiratory Syndrome Coronavirus (MERS-CoV):
Announcement of the Coronavirus Study Group. J Virol. Published ahead of print 15 May 2013.
doi:10.1128/JVI.01244-13.

Beijing Reports 2nd H7N9 Case

Credit Wikipedia

 

# 7329

 

 

Today the Beijing Department of Health announced the detection of their 2nd lab-confirmed H7N9 case – this time in a 6 year-old-boy who fell ill and was seen at a local hospital on May 21st, and was treated for three days for fever, sore throat, headache and enlarged tonsils.  

 

It appears that H7N9 was not suspected, and he recovered sufficiently enough to return to a daycare facility on May 24th.

 

Samples taken from the child were analyzed on May 28th, and found to be positive for the H7N9 virus. The child was subsequently returned to the hospital for observation, and surveillance of his contacts is underway.  

 

Currently none have shown signs of illness.

 

This machine translation from  the Beijing Municipal Health Bureau.

  

City people infected with H7N9 avian influenza into the routine monitoring strategy effective proactive monitoring found the city the second case of human infection with H7N9 avian influenza

Time :2013-05-28

May 28, 2013 morning, the Beijing Center for Disease Control reported that in Beijing large-scale conventional ILI pathogen monitoring, from the Peking University People's Hospital for treatment of influenza-like illness found in one case of human infection with the H7N9 avian influenza. At 16:00 on May 28th, Beijing clinical expert confirmed that the case.

 

Children Xu, male, 6 years old, Junan County, Linyi City, Shandong Province, household, now living in the Haidian District. May 21 children with fever and sore throat, headache, Peking University People's Hospital for treatment, family history of exposure to poultry denied, visiting doctors examination showed bilateral tonsil enlargement and purulent secretions III degree, given anti-inflammatory, symptomatic other treatment; May 22 to 24, patients in the hospital receiving daily infusion therapy; May 23 afternoon, the body temperature returned to normal, the symptoms disappeared; May 24 afternoon back to nursery reopened.

 

Children in the treatment period, the Peking University People's Hospital, according to "national influenza surveillance program" collected specimens were sent to CDC centralized testing. According to urban levels of testing and retesting results, May 28 children with a diagnosis of human infection with the H7N9 avian flu after being sent to the Beijing Ditan Hospital for further observation and treatment.

 

Children currently in good health, have normal body temperature for 5 days. The case is the second in Beijing reported cases of human infection of H7N9 avian influenza confirmed cases.

 

In accordance with the National Health and Family Planning Commission issued the "human infection with H7N9 avian influenza prevention and control program (2nd Edition)" provides an initial verification of their close contact with 50 people, all the staff have all been implemented medical observation measures currently no abnormality symptoms.

(Continue . . .)

 

The detection of another mild H7N9 case – once again in a child – is a reminder of how little we actually know about how this virus is being acquired, and transmitted in China.

 

FluTrackers has an ongoing thread on this case, and new reports will probably show up there first.

The Lancet: Antiviral Resistance In Two H7N9 Patients

 

# 7328

 

On Sunday, in The Taiwan H7N9 Patient & Antiviral Resistance, we looked at Taiwan’s only H7N9 patient, who spend more than a month in the hospital, and who developed resistance to oseltamivir while undergoing treatment.

 

Today, the Lancet carries a report of two more cases (out of 14 studied) – this time in Shanghai – who developed resistance to our first line antivirals during their course of treatment for the H7N9 virus.

 

The authors found that a mutation R292K (Arginine to Lysine at position 292 in the NA) – also known as Arg292Lys – already known to confer antiviral resistance to seasonal flu (see Resistant influenza A viruses in children treated with oseltamivir: descriptive study), appeared in two patients after several days of oseltamivir therapy.

 

The article, which is available as a PDF file, is called:

 

Association between adverse clinical outcome in human disease caused by novel influenza A H7N9 virus and sustained viral shedding and emergence of antiviral resistance

Yunwen Hu, Shuihua Lu, Zhigang Song, Wei Wang, Pei Hao, Jianhua Li, Xiaonan Zhang, Hui-Ling Yen, Bisheng Shi, Tao Li, Wencai Guan, Lei Xu, Yi Liu, Sen Wang, Xiaoling Zhang, Di Tian, Zhaoqin Zhu, Jing He, Kai Huang, Huijie Chen, Lulu Zheng, Xuan Li, Jie Ping, Bin Kang, Xiuhong Xi, Lijun Zha,Yixue Li, Zhiyong Zhang, Malik Peiris, Zhenghong Yuan

Interpretation: Reduction of viral load following antiviral treatment correlated with improved outcome. Emergence of  NA Arg292Lys mutation in two patients who also received corticosteroid treatment led to treatment failure and a poor  clinical outcome.

 

The emergence of antiviral resistance in A/H7N9 viruses, especially in patients receiving corticosteroid therapy, is concerning, needs to be closely monitored, and considered in pandemic preparedness planning.

 

 

While most of the H7N9 patients we’ve had information about appear to have benefited from oseltamivir treatment, we have seen a worrying number of failures.

 

Helen Branswell has more on this in her article:

 

Study warns drug resistance develops easily with new H7N9 bird flu

By: Helen Branswell, The Canadian Press

Tuesday, May. 28, 2013 at 8:01 AM |

TORONTO - A new study warns that resistance to the main flu drug Tamiflu seems to develop easily in infections with the new H7N9 bird flu.

 

The authors say early treatment with Tamiflu or other drugs in that class is still the best approach for treating these cases when they arise.

(Continue . . . )

 

 

 

Of note, both patients received relatively low-dose corticosteroid treatment (40mg/day) during part of their hospitalization, and researchers question whether this might have contributed to their development of resistance.

 

Higher dose steroid treatment (250-500+ mg/day) has been tried for both H5N1 and SARS in the past. While patients often showed showed short-term improvement, long-term survival rates were less than encouraging. 

 

The good news here is we are getting patient treatment and outcome data on these H7N9 infections from China with remarkable speed, and in far greater detail, than we ever did for H5N1 or SARS.

 

Which means that if this virus does manage to spread beyond the Chinese mainland, doctors around the world will have a much better idea of what they will be dealing with.