Study: Novel & Variant Swine Influenzas In Korean Pigs

Since pigs can be infected by more than one flu virus at the same time, it is possible for two viruses to swap genetic material (reassort), resulting in a new hybrid strain.

# 7621

 

We’ve more evidence today that nature’s laboratory continues to produce new, and possibly troublesome, flu viruses from a report that appeared yesterday in the journal Influenza and other Respiratory Viruses.

 

Swine are considered excellent `mixing vessels’ for influenza because they are susceptible to a variety of human, swine, and avian strains of flu.  As such, they have the opportunities to be co-infected by two different strains simultaneously.

 

The most common swine flu viruses are H1N1, H1N2, H3N1, H3N2, and H2N3. These viruses, when they jump to humans, are called variant viruses (e.g. H3N2v).

 

Starting in 2011, the H1N1v virus was found to have acquired the M (matrix) gene from the 2009 H1N1 pandemic virus. Since then, this M gene has been showing up regularly in all three swine variant viruses (H1N1v, H1N2v, H3N2v).

 

The CDC has speculated that `This M gene may confer increased transmissibility to and among humans, compared to other variant influenza viruses.’ – CDC HAN 2012

 

The concern with these variant swine flu infections, as with any novel flu, is that each new human exposure provides the virus another opportunity to better adapt to human physiology.

 

All of which brings us to a new study that has not only found the first evidence of H3N2v in swine outside of the United States, but also finds a new H3N1 reassortant virus that appears to transmit well among ferrets and replicate well in human cell lines.

 

Excerpts from the study’s abstract follow, after which I’ll return with more:

 

Emergence of H3N2pM-like and novel reassortant H3N1 swine viruses possessing segments derived from the A (H1N1)pdm09 influenza virus, Korea

Philippe Noriel Q. Pascua, Gyo-Jin Lim, Hyeok-il Kwon, Su-Jin Park, Eun-Ha Kim, Min-Suk Song, Chul Joong Kim, Young-Ki Choi

Article first published online: 30 AUG 2013

Result

We identified reassortant H3N2 (H3N2pM-like) and H3N1 swine viruses containing A(H1N1)pdm09-like segments in Korean pigs that are genetically closely related to strains recently detected in pigs and humans in North America.

 

Although the H3N2pM-like and novel H3N1 reassortants demonstrated efficient replication in mice and ferrets, all the H3N1 strains exhibited growth advantage over the representative H3N2pM-like virus in human airway cells.

 

Interestingly, A/swine/Korea/CY02-07/2012(H3N1) and A/swine/Korea/CY03-13/2012(H3N1) reassortants were more readily transmitted to respiratory-droplet-contact ferrets compared with the H3N2pM-like (A/swine/Korea/CY02-10/2012) isolate. Furthermore, serologic evaluation showed poor antigenicity to contemporary reference human seasonal H3N2 vaccine strains.

Conclusions

We report here for the first time the isolation of H3N2pM-like viruses outside North America and of novel reassortant swine H3N1 viruses with A(H1N1)pdm09-derived genes. Apart from further complicating the genetic diversity of influenza A viruses circulating in domestic pigs, our data also indicate that these strains could potentially pose threat to public health asserting the need for continuous virus monitoring in these ecologically important hosts.

 

 

One of the biggest lessons learned from the past few years was that influenza viruses don’t always follow the script.

 

Not only did the last pandemic virus emerge from the `wrong’ species (pigs instead of birds), it came from the `wrong’ continent (North America instead of Asia) and from a completely unexpected lineage (H1N1).

 

While pigs have long been considered potential mixing vessels for influenza viruses, today that threat is taken more seriously than it was in the past. The continued evolution in swine viruses, particularly reassorting with `humanized’ strains like H1N1pdm, is of particular concern.

 

 

 

Undoubtedly, influenza reassortments happen all the time and mostly outside the view of scientists. Most are viral flashes in the pan, are unable to compete with more biologically fit flu viruses, and quickly disappear into the evolutionary dustbin.

 

But occasionally, the right genetic combination will be generated, and a new emerging virus is born.

 

All of which highlights the need for continual and enhanced surveillance of humans, livestock, and wild birds for emerging viral threats. Because it isn’t a question of if another pandemic will emerge.

 

It’s only a matter of when.

New York State’s New HCW Flu Vaccination Policy

Photo Credit – CDC PHIL

 

 

# 7620

 

Four years ago (2009), with the specter of the H1N1 pandemic looming, the state of New York attempted to mandate that all health care workers (HCWs) receive a yearly flu shot.

 

But due to a shortage of pandemic H1N1 vaccine that fall, and vigorous protests (and threats of legal action) by employees, in October of 2009 we saw New York Rescind Mandatory Flu Shots For HCWs.

 

Since that time, the debate over mandatory flu vaccinations for HCWs has raged. While the CDC only recommends the flu shot, many professional medical organizations have adopted policies calling for mandatory vaccination of health care workers.

 

APIC Calls For Mandatory Flu Vaccination For HCWs

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

 

While many infection control experts see this as a long overdue step in patient and co-worker protection, some HCWs see this as an infringement of their rights to decide what will be injected into their bodies (see HCWs: Refusing To Bare Arms & HCWs: Developing a Different Kind Of Resistance).

 

In July of this year, the CDC reported – after seeing increases in the update of flu vaccines by HCWs over the past few years – that last year (2012-13) saw little improvement over the previous year (see CDC: Uptake Of Flu Vaccine By HCWs).

 

• Available as PDF  [627 KB, 15 pages]

 

In recent years a growing number of medical facilities have implemented mandatory flu vaccination as a condition of employment, including Seattle’s Virginia Mason Medical Center and BJC Healthcare of St. Louis, Missouri  (see here and here).

 

Some states have begun to consider laws requiring HCW immunization, including last October when Rhode Island Adopts New Flu Vaccination Requirements For HCPs.

 

Earlier this month, New York state quietly passed a regulation that would require – once flu season begins – for all health care workers either to be vaccinated against influenza, or `wear a surgical or procedure mask while in areas where patients or residents may be present’.

 

Essentially, this approach allows HCWs with medical or ethical objections to flu vaccination to opt out and elect to wear a surgical facemask during flu season when in close contact with patients.

The entire regulation may be read at this link.

 

Critics point out that we really don’t know just how effective masks are in preventing the transmission of influenza to patients. The assumption is, by helping to contain respiratory secretions, they would help reduce transmission. 

 

But by how much?  No one knows.

 

Of course, flu vaccines aren’t close to being 100% effective either.

 

Most years (see CIDRAP: The Need For `Game Changing’ Flu Vaccines), protection from the flu shot runs under 60% for healthy adults, and probably even less for those over 65 or with weakened immune systems.

 

While admittedly imperfect solutions - given the increased risk to patients of serious illness or death from influenza - reasonable measures that can reduce the spread of the flu in the healthcare environment are increasingly being considered. 

 

Love the idea or hate it – short of an overturn in the courts – the requirement for annual flu vaccinations in HCWs appears to be gaining traction across the country.

WHO: MERS-CoV Update – August 30th

Coronavirus – Credit CDC PHIL

 

 

# 7619

 

The World Health Organization has posted a GAR update on 4 MERS-CoV cases; the two cases reported on Wednesday (see Saudi Arabia Reports 2 More MERS-CoV Cases) along with two asymptomatic contacts of one of those cases which ProMed Mail reported yesterday.

 

 

Middle East respiratory syndrome coronavirus (MERS-CoV) - update

Disease Outbreak News

30 August 2013 - WHO has been informed of an additional four laboratory-confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Saudi Arabia.

 

The first patient is a 55-year-old man with an underlying medical condition from Medina who became ill on 17 August 2013 and is currently hospitalised.

 

The second patient is a 38-year-old man with an underlying medical condition from Hafar al-Batin who became ill on 8 August 2013 and died on 17 August 2013.

 

The third and the fourth cases are family contacts of the second patient. Both the cases, a 16-year-old boy and a seven year-old girl, tested positive for the MERS-CoV virus. They are both healthy and do not have any symptoms of illness.

 

Globally, from September 2012 to date, WHO has been informed of a total of 108 laboratory-confirmed cases of infection with MERS-CoV, including 50 deaths.

(Continue . . . )

 

Webcast: Dr. Ziad Memish On The Upcoming Hajj & MERS-CoV

Credit Wikipedia

 

 

# 7618

 

 

My thanks to @HelenBranswell for the reminder.

 

At 11 am EDT today, Dr. Ziad A. Memish – Deputy Health Minister for Saudi Arabia – will take part in a webcast from the University of Florida’s Emerging Pathogens Institute.

 

You’ll be able to watch online at this link.

 

 

The Hajj and MERS-CoV: Saudi Strategies to Reduce Transmission Risk

Date: Friday, August 30, 2013

Speaker:

Dr. Ziad A Memish, MD, FRCP(Can), FRCP (Lon), FRCP(Edin), Deputy Minister for Public Health, Kingdom of Saudi Arabia

Time and location:

CGRC 101 - Cancer Genetics Institute Auditorium or view from your desktop.

Dr. Memish obtained his MD from University of Ottawa 1987, American Board of Internal Medicine, 1991 (FRCPC) Fellowship of the Royal College of Physicians and Surgeons of Canada in Internal Medicine, 1992 (ABID) American Board of Infectious Diseases, 1992 (CIC) American Certification of Infection Control, 1992 (FRCPC) Fellowship of the Royal College of Physicians and surgeons of Canada in Infectious Diseases, 1993 (FACP) Fellow of the American College of Physicians. He has presented many abstracts internationally and published more than 200 peer reviewed papers and chapters in books. He was awarded a medal from the First Degree - the highest award on a National level in Saudi Arabia for achievements in the field of infectious diseases and infection control.

To view from your desktop click here.

JID: A Pair Of H7N9 Studies

# 7617

 

The IDSA’s Journal of Infectious Diseases published a pair of new studies on the H7N9 virus yesterday that don’t exactly break new ground, but do add to what we’ve learned from earlier studies.

 

While full access to these studies requires a subscription, we can glean the basics from their abstracts.

 

The first looks at the transmissibility and pathogenicity of the H7N9 virus in ferrets, and finds (as we’ve seen previously in Nature: Limited Airborne Transmission Of H7N9 Between Ferrets & Science: H7N9 Transmissibility Study In Ferrets) that this emerging avian flu virus could be transmitted between ferrets (albeit at low levels) via respiratory droplets.

 

The Novel Avian-Origin Human A (H7N9) Influenza Virus Could be Transmitted between Ferrets via Respiratory Droplets

Lili Xu1,†, Linlin Bao1,†, Wei Deng1,†, Libo Dong3,†, Hua Zhu1, Ting Chen1, Qi Lv1, Fengdi Li1, Jing Yuan1, Zhiguang Xiang1, Kai Gao1, Yanfeng Xu1, Lan Huang1, Yanhong Li1, Jiangning Liu1, Yanfeng Yao1, Pin Yu1, Xiyan Li2, Weijuan Huang2, Xiang Zhao2, Yu Lan2, Junfeng Guo2, Weidong Yong1, Qiang Wei1, Honglin Chen3, Lianfeng Zhang1 and Chuan Qin1,*

Abstract

The outbreak of human infections caused by the novel avian-origin H7N9 subtype influenza viruses in China since March 2013 underscores the need to better understand the pathogenicity and transmissibility of these viruses in mammals.

 

In a ferret model, the H7N9 influenza virus was found to be less pathogenic than a H5N1 virus but was comparable with the 2009 pandemic H1N1 virus, based on the clinical signs, mortality, virus dissemination, and histopathological analyses. The H7N9 virus could replicate in the upper and lower respiratory tract, heart, liver, and olfactory bulb.

 

It is worth noting that the H7N9 virus exhibited low level of transmission between ferrets via respiratory droplets. There were four mutations in the virus isolated from the contact ferret which were D678Y in PB2, R157 K in HA(H3 numbering), I109T in NP, and T10I in NA. These data emphasized that the avian-origin H7N9 subtype influenza virus has the ability to transmit between mammals, highlighting the potential of human-to-human transmissibility.

 

The second study looks for the source of human infection with the H7N9 virus, and finds – as we’ve seen suggested before (see OIE Statement On Live Markets And H7N9) – that live market birds appear to be the major contributing factor.

 

 

Relationship between domestic and wild birds in live poultry market and a novel human H7N9 virus in China

Chengmin Wang1,*, Jing Wang2,*, Wen Su1, Shanshan Gao1, Jing Luo1, Min Zhang1, Li Xie2,*, Shelan Liu3, Xiaodong Liu4, Yu Chen4, Yaxiong Jia4, Hong Zhang1, Hua Ding2 and Hongxuan He1,#†

Abstract

To trace the source of the avian H7N9 viruses, we collected 99 samples from 4 live poultry markets and the family farms of 3 patients in Hangzhou city of Zhejiang province, China.

 

We found almost all positive samples came from chickens and ducks in live poultry markets. These results strongly suggest that the live poultry markets are the major source of recent human infections with H7N9 in Hangzhou city, Zhejiang province of China.

 

Therefore, control measures are needed, not only in the domestic bird population, but also in the live poultry markets to reduce human H7N9 infection risk.

Although the vast majority of positive H7N9 bird and environmental samples have come from live bird markets - not poultry farms - there remain many questions over how this virus could have spread so rapidly and across such a wide swath of China, only via live market birds.

 

Many observers still believe we are missing pieces to this epidemiological puzzle.

 

If the virus makes a return visit this fall, nailing down (and hopefully, interrupting) the source of transmission will be the top priority for public health authorities.

WHO Update: Influenza At The Human-Animal Interface

Credit WHO

 

 

# 7616

 

Like many other diseases that plague mankind - influenza didn’t begin in humans - its original host species appears to be waterfowl. But gradually, and probably as a result of the domestication of ducks and geese thousands of years ago, it made its way into man and other species.

 

What once was predominantly an avian virus can now be found circulating in humans, canines, swine, equines, and even some sea mammals.

 

This intersection of man and other species, and their sharing of viruses (zoonotic transmission), has increasingly been recognized as a driving factor in emerging infectious diseases, and even the creation of pandemics.

 

The age of emerging infectious diseases in humans really began in earnest about 10,000 years ago when humans began to domesticate – and live in close proximity to – other animals (see The Third Epidemiological Transition).   

 

Tuberculosis, which now infects 1/3rd of humanity, likely jumped from domesticated goats and cattle.  Measles probably evolved from canine distemper and/or the Rinderpest virus of cattle.  

 

Other zoonotic nasties include Babesiosis, Borrelia (Lyme), Nipah, Hendra, Malaria, Hantavirus, Ebola, Leptospirosis, Q-Fever, bird flu . . . the list is long and growing.

 

Roughly 70% of the infectious diseases that afflict man are believed to have begun in some other species, and new ones (think MERS-CoV, H7N9, H5N1, SFTS, etc. ) continue to show up each year. 

 

Yesterday the World Health Organization updated their monthly Influenza at the human-animal interface, that looks at recent activity in zoonotic influenza viruses.

 

A few highlights below, but follow the link to read it in its entirety.

 

Summary and assessment as of 29 August 2013

Human infection with avian influenza A(H5N1) viruses

 
From 2003 through  29  August  2013,  637  laboratory-confirmed human cases with avian influenza  A(H5N1) virus infection have been officially reported to WHO from 15 countries, of which 378 died.

Since the last update on 4 July 2013, four new laboratory-confirmed human cases with influenza
A(H5N1) virus infection were reported to WHO from Cambodia. One of these died.

  
All cases are considered to be sporadic cases, with no evidence of community-level transmission. As influenza A(H5N1) virus is circulating widely in poultry in Cambodia, additional sporadic human cases or small clusters might be expected in the future. 

Table 1: Laboratory-confirmed human cases of avian influenza A(H5N1) virus infection (4 July 2013- 29 August 2013)

 

Overall public health risk assessment for avian influenza A(H5N1) viruses: Whenever influenza viruses are circulating in poultry, sporadic infections or small clusters of human cases are possible, especially in people exposed to infected household poultry or contaminated environments. However,  this influenza A(H5N1) virus does not currently appear to transmit easily among people as such, the risk of community-level spread of this virus remains low. 

Human infection with other non-seasonal influenza viruses

 
Avian influenza A(H7N9)

China has reported two cases of human infection with avian influenza A(H7N9) virus since the last
update of 4 July 2013. The first patient was a 61-yr-old woman from Hebei Province who had onset of illness on 10 July. The second was a 51-yr-old woman from Guangdong province with onset on 27 July 2013. As of 16 August 2013, 135 human cases with influenza A(H7N9) infection were reported to WHO, including 44 deaths. Most human cases presented with pneumonia.

 

Most human A(H7N9) cases have reported contact with poultry or live animal markets. Knowledge about the main virus reservoirs and the extent and distribution of the virus in animals remains limited.

 

Given the reports of additional human cases, combined with the likely continued circulation of the virus in poultry, reports of additional human cases and infections in animals would not be unexpected, especially as the Northern Hemisphere autumn approaches. 

Although four small family clusters have been reported among previous cases, evidence does not
support sustained human-to-human transmission of this virus.

 

Influenza A(H3N2) variant virus infections in humans

 

The United States of America (USA) reported 16 cases of human infection with influenza A(H3N2)v this year in Illinois (1), Indiana (14) and Ohio (1). Only one person was hospitalized and no deaths have occurred. All cases reported close contact with swine in the week before illness onset and no ongoing human-to-human transmission has been identified.

 

Limited serological studies indicate that adults may have some pre-existing immunity to this virus
but children do not. Seasonal vaccines do not provide cross-protection to influenza A(H3N2)v in adults or children. Three candidate vaccine viruses specific for A(H3N2)v have been developed in the USA and could be used to produce an (H3N2)v vaccine if needed.

 

Overall public health risk assessment for influenza A(H3N2)v viruses: Further human cases and small
clusters may be expected as this virus is circulating in the swine population in the USA and the season of
agricultural fairs is ongoing.

 
Close monitoring of the situation, including continued characterization of viruses to detect any changes, is warranted.

(Continue . . . )

 

 

We live in an amazingly complex and interconnected world, where what happens in a live poultry market in China, a pig operation in Belarus, or even at a cockfight in Indonesia can ultimately impact the health of people around the world.

 

Oceans and long distances are no longer barriers to the spread of diseases. An emerging virus can literally hop a plane in Beijing, and be in New York or London in less than 24 hours.

 

So we watch these spillovers of diseases from animals to humans – no matter how small they may first appear to be – with extreme interest.  As we saw in 2009 with the novel H1N1 virus, given the right conditions, a new virus can sweep the world in a matter of months.

Michigan Reports 1st H3N2v Case Of 2013

 

Credit CDC

 

# 7615

 

Compared to last year, when more than 300 cases of H3N2v were reported across the country (mostly associated with livestock exposure at county & state fairs),  2013 has seen relatively few cases of swine variant influenza reported.

 

Prior to today, just 16 cases have been reported to the CDC over the summer.  Nevertheless, the CDC and local public health departments remain on alert for new cases, and it is likely that some cases go unidentified.

 

Last weekend, in CDC Updates H3N2v County & State Fair Advice, we looked at the latest guidance from the CDC for fairgoers and exhibitors.

 

On July 5th, the CDC released a HAN Advisory On H3N2v, alerting doctors to the possibility that more cases could turn up this summer.

 

Also in July the CDC also released two new interim guidance documents on H3N2v for local public health agencies; one on case definitions, and the other on surveillance and specimen collection.

 

The CDC’s most recent assessment of the risk of H3N2v reads:

 

CDC Assessment

It's possible that sporadic infections and even localized outbreaks among people with this virus will continue to occur. While there is no evidence at this time that sustained human-to-human transmission is occurring, all influenza viruses have the capacity to change and it's possible that this virus may become widespread. Illness associated with H3N2v infection so far has been mostly mild with symptoms similar to those of seasonal flu. Like seasonal flu, however, serious illness, resulting in hospitalization and death is possible. In 2012, for example, 309 infections with H3N2v were detected. Of these cases, 16 people were hospitalized and one of these people died. Most of the people who were hospitalized and the person who died had one or more health or age factor that put them at high risk of serious flu-related complications.

People at high risk of serious complications from seasonal influenza and H3N2v include children younger than 5, people with certain chronic conditions like asthma, diabetes, heart disease, weakened immune systems, pregnant women and people 65 years and older.

CDC has issued guidance for people attending fairs where swine might be present this fair season, including additional precautions for people who are at high risk of serious flu complications. Limited serologic studies indicate that adults may have some pre-existing immunity to this virus while children do not. Most cases of H3N2v infection have occurred in children who have little immunity against this virus.

 

Today Michigan reports their first detection of a swine variant flu infection this year, that of a child who was exposed to an infected pig at the Berrien County Youth Fair, which ran from August 12th to the 17th.

 

 

Here is a link to the Berrien County Health Department’s announcement of today’s case.

 

 

First Case of Influenza A H3N2 Variant Detected for 2013

FOR IMMEDIATE RELEASE: August 29, 2013

LANSING – Today, August 29, 2013, the Michigan Departments of Community Health (MDCH), and Agriculture and Rural Development (MDARD), along with the Berrien County Health Department (BCHD) have identified one case of an H3N2 variant (H3N2v) in a child who was a swine exhibitor at the recent Berrien County Youth Fair, which took place August 12-17, 2013.

 

The child, who was not hospitalized, is reported to have contracted H3N2v after exposure to swine at the fair. In addition, a sick pig from the fair tested positive for Influenza A H3N2 at the National Veterinary Services Laboratories in Ames, Iowa. MDCH, MDARD, and BCHD are working with the Berrien County Youth Fair (BCYF) board to reach out to swine exhibitors who attended the fair to identify additional illnesses. As a precaution, Michigan public health agencies have conducted an extensive multi-state outreach to meat processing plants that were identified as being in receipt of live swine from the fair. These facilities have been made aware of the potential exposure to their employees, symptoms of illness, and given instruction on seeking care and testing. MDARD has notified managers at eight additional fairs scheduled to take place in the coming weeks, and asked them to reach out to swine exhibitors and the fair veterinarians about the H3N2v case and to use proper safety measures to prevent spreading illnesses.

 

“Influenza is common to swine and is not a food safety concern,” said Dr. James Averill, MDARD Animal Industry Division Director and State Veterinarian. “Berrien County Youth Fair had hand washing stations, posters, and good biosecurity practices in place, and it’s important that all fairs continue these practices.”

 

Symptoms of H3N2v infection in people are similar to those of seasonal flu viruses and can include fever and respiratory symptoms, such as cough and runny nose, and possibly other symptoms, such as body aches, nausea, vomiting, or diarrhea. Infections with influenza viruses (including variant viruses like H3N2v) can sometimes cause severe disease, even in healthy people. This can include complications, such as pneumonia, which may require hospitalization, and sometimes results in death. People who are at high risk of developing complications if they get influenza include children younger than 5 years of age, people 65 years of age and older, pregnant women, and people with certain long-term health conditions, such as asthma, diabetes, heart disease, weakened immune systems, and neurological or neurodevelopmental conditions.

 

“While this variant flu virus has rarely been shown to spread from person to person, we remain on the look-out for such secondary cases. In addition, any individual with flu-like-symptoms at this time, prior to the traditional flu season, should contact their medical provider and local health department,” said Dr. Rick Johansen, Medical Director of the BCHD.

 

The incubation period (the time it takes from exposure to illness) for this influenza, like the usual seasonal influenza, is 1 to 7 days; and most commonly 2 days. Therefore, it is unlikely that there will be new cases from direct exposure at the recent Berrien County Youth Fair. Early treatment works best and may be especially important for people with a high risk condition. Currently there is no vaccine for H3N2v and the seasonal flu vaccine will not protect against H3N2v.

 

"While Michigan did see a handful of H3N2v cases in 2012, this first case for 2013 should serve as an important reminder of the simple steps that can be taken to protect our health as we would with any flu season," said Dr. Matthew Davis, Chief Medical Executive with the MDCH. "Washing your hands, covering your nose and mouth when you sneeze or cough, and staying home when you feel sick are some of the best ways to protect yourself and others from becoming ill. This serves as a good reminder for Michigan residents that everyone 6 months and older should get a seasonal flu vaccine each year."

Below are some steps that you can take to protect yourself and prevent the spread of any illness:

• Avoid close contact with sick people.
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
• Do not eat or drink in livestock barns or show rings.
• Avoid touching your eyes, nose and mouth. Germs spread this way.
• If you are sick, stay home from work or school until your illness is over.
• Avoid contact with pigs if you have flu-like symptoms. Wait 7 days after your illness started or until you have been without fever for 24 hours without the use of fever-reducing medications, whichever is longer. If you must have contact with pigs while you are sick, take the protective actions listed above.
• Get an annual influenza vaccination.

For more information about H3N2v, visit www.cdc.gov/flu/swineflu/h3n2v-basics.htm.

WHO: MERS-CoV Update On Qatari Cases

 

# 7614

 

Yesterday the World Health Organization’s Global Alert & Response (GAR) page updated us on 8 recent Saudi MERS cases (see WHO: MERS-CoV Update - August 28th). today they confirm two cases from Qatar we learned about over the past week (see SCH Statement On Latest Qatari MERS-CoV Case).

 

Interestingly, one detail which we’d seen earlier this week in the SCH statement, isn’t mentioned in this WHO update   . . .  the assertion that the 29-year-old Qatari case had an exposure to an earlier case.

 

Here are excerpts from today’s announcement:

 

Middle East respiratory syndrome coronavirus (MERS-CoV) - update

Disease Outbreak News

29 August 2013 - WHO has been informed of an additional two laboratory-confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Qatar.

 

The patients include a 59-year old man with an underlying medical condition who became ill on 15 August 2013. He is currently hospitalised and is in stable condition.

 

Preliminary epidemiological investigations reveal that the patient travelled to Medina, Saudi Arabia for 6 days and returned to Qatar on 15 August 2013. He did not take part in Umrah and did not visit to Al-Masjid an-Nabawi in Medina. Further investigation is on-going.

 

The second patient is a 29-year-old man with an underlying medical condition who had no history of recent travel outside the country.

 

The results of both the cases were confirmed by an international reference laboratory. A total of 138 healthcare workers, family and community contacts have been screened in the country and so far all tested negative for MERS-CoV infection.

 

Globally, from September 2012 to date, WHO has been informed of a total of 104 laboratory-confirmed cases of infection with MERS-CoV, including 49 deaths.

(Continue . . . )

 

Branswell: Universal Flu Vaccines & The `Canadian Problem’

 

 

# 7613

 

The most intriguing read of the morning, by far, is Helen Branswell’s long report that looks at a study that raises some red flags on the prospects of creating the Holy Grail of immunology; the Universal Flu Vaccine.

 

The problem, which we’ve discussed before, has recently been dubbed VAERD – or Vaccine Associated Enhanced Respiratory Disease.

Since no one covers these issues better than Helen, I’ll step aside and invite you to read her entire article, after which I’ll be back with a little more.

 

Study raises red flag for universal flu vaccine

By: Helen Branswell The Canadian Press, Published on Wed Aug 28 2013

Phenomenon, known as the “Canadian problem,” sees vaccination against one strain of flu actually seems to raise the risk of severe infection after exposure to a related but different strain

 

It is worth noting that 4 years ago, Helen Branswell, was among the first to report on the so-called `Canadian Problem’ (see Branswell On The Canadian Flu Shot Controversy).

 

 

First stop, the link to the study and abstract, which appears in the Journal Science Translational Medicine:

 

Sci Transl Med 28 August 2013:
Vol. 5, Issue 200, p. 200ra114
Sci. Transl. Med. DOI: 10.1126/scitranslmed.3006366

Research Article

Influenza

Vaccine-Induced Anti-HA2 Antibodies Promote Virus Fusion and Enhance Influenza Virus Respiratory Disease

Surender Khurana, Crystal L. Loving, Jody Manischewitz, Lisa R. King, Phillip C. Gauger, Jamie Henningson, Amy L. Vincent, and Hana Golding

 

For those looking for more can examine contributing author Phillip C. Gauger’s 2012 186-page PhD dissertation - Characterization of vaccine-associated enhanced respiratory disease (VAERD) in swine administered an inactivated δ-cluster influenza vaccine and challenged with pandemic A/H1N1 virus - which is available from Iowa State University’s Digital Repository.  

 

We’ve looked at other research studies in the past which dealt with related issues of OAS (Original Antigenic Sin) and ADE (Antigenic Dependent Enhancement), which you may wish to revisit. 

 

Eurosurveillance: H7N9 Virus-Host Interactions & Age Shift

EID Journal: Revisiting The `Canadian Problem’

 

Last September, in ICAAC: Ferreting Out The `Canadian Problem’, we saw an interview with Dr. Danuta Skowronski, who was involved in the original Canadian studies, and who had recently duplicated the vaccine effect using ferrets in a double-blind study.

 

How VAERD and OAS and ADE all tie together, and their implications for the creation of a universal flu vaccine remains poorly understood.

 

What we are learning is that the human immune response is far more complex than we ever imagined and the constantly-changing antigenic face of influenza adds an even greater layer of complexity.

 

While the development of a `universal flu vaccine’ is a laudable (and hopefully, obtainable) goal – given the limits of our current understanding of our own immune system – a degree of caution remains warranted as research moves forward.

WHO: MERS-CoV Update - August 28th

Photo Credit WHO

 

# 7612

 

The World Health Organization has posted an update on the MERS Coronavirus on their GAR (Global Alert & Response) website this afternoon, catching up on 8 recently reported cases out of Saudi Arabia.

 

This update does not include the two cases reported this morning (see Saudi Arabia Reports 2 More MERS-CoV Cases) or the two Qatari cases (see SCH Statement On Latest Qatari MERS-CoV Case).

 

 

 

Middle East respiratory syndrome coronavirus (MERS-CoV) - update

Disease Outbreak News

28 August 2013 - WHO has been informed of an additional eight laboratory-confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Saudi Arabia.

 

The two cases who died were 54 and 51 years-old from Riyadh, who were suffering from pre-existing chronic illnesses. The other patients include:

• a 50-year-old woman with an underlying medical condition, from Riyadh, who became ill on 1 August 2013 and is currently hospitalized, now off mechanical ventilation;
• a 59-year-old woman with underlying medical conditions, from Riyadh, who became ill on 23 July 2013 and is currently hospitalized in intensive care unit and is in critical condition;
• a 50-year-old woman with underlying medical conditions, from Riyadh, who is currently hospitalized in intensive care unit;
• a 70-year-old man with underlying medical conditions, from Riyadh, who is currently hospitalized in intensive care unit;
• a 31-year-old man with underlying medical conditions, from Asir, who is currently hospitalized in intensive care unit; and
• a 55-year-old man from Asir who is a contact of a confirmed case, and is asymptomatic.

Globally, from September 2012 to date, WHO has been informed of a total of 102 laboratory-confirmed cases of infection with MERS-CoV, including 49 deaths.

 

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 has convened an Emergency Committee under the International Health Regulations (IHR) to advise the Director-General on the status of the current situation. The Emergency Committee, which comprises international experts from all WHO Regions, unanimously advised that, with the information now available, and using a risk-assessment approach, the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met.

KSA: A Travel Warning With A Pinch Of Irony

 

# 7611

 

 

Saudi Arabia, which has seen scores of infections and more than 40 deaths from the MERS coronavirus, has issued a warning for its citizens traveling to Nepal – which is currently experiencing outbreaks of H5N1 in poultry.

 

While we’ve recently heard rumors of suspected human infections (see Nepal: EDCD Denies H5N1 Report) – to date no human cases have been reported.

 

This from the Saudi Press Agency.

 

Foreign Ministry advises Saudi citizens on outbreak of bird flu in Nepal

Riyadh, Shawwal 21, 1434, Aug 28, 2013, SPA -- The Foreign Ministry advised all citizens not to travel to Nepal until the announcement of the end of the state of emergency and the demise of the risk of bird flu for their own safety.

 

It also called on nationals who are in Nepal to leave.

 

This was due to the Nepali authorities' announcement of the state of emergency to cope with an outbreak of bird flu raising the degree of risk to residents in Nepal and visitors.

--SPA  15:05 LOCAL TIME 12:05 GMT

 

 

 

Based on this, you have to wonder what kind of travel warning they would consider appropriate for people traveling to the Kingdom.

EID Journal: Novel Bat Coronaviruses, Brazil and Mexico

Credit CDC Bat Safety

 

 

# 7610

 

All things considered, the past couple of decades have turned out to be busy ones for Chiroptologists (scientists who study bats). Increasingly these winged mammals are being viewed as naturals hosts for, and potential vectors of, a number of newly recognized emerging infectious diseases.

 

Long known for carrying rabies, over the past 20 years scientists have discovered that bats can also harbor such viral nasties as Marburg, Ebola, Nipah, Hendra, and a variety of coronaviruses (including SARS).

 

Quite surprisingly, in March of 2012, we also learned of a new H17 flu subtype – the first ever known to infect bats (see A New Flu Comes Up To Bat).

 

Last week’s discovery a of match to a segment of the MERS-CoV in a bat sample (see EID Journal: Detection Of MERS-CoV In Saudi Arabian Bat, once again points towards bats as being the likely animal host for an important emerging virus.

 

Yesterday the CDC’s EID Journal published a letter from researchers who sampled bats in Mexico and Brazil, and like similar studies in Europe, Africa, and Asia (see  EID Journal: EMC/2012–related Coronaviruses in Bats, Coronavirus `Closely Related’ To HK Bat Strains), they found a number novel coronaviruses among them.

While none were matches for either SARS or MER-CoV, notably one was a Betacoronavirus – as are MERS and SARS.  I’ve provided some excerpts below, but follow the link to read it in its entirety.

 

Letter

Novel Bat Coronaviruses, Brazil and Mexico

Luiz Gustavo Bentim Góes¹, Sicilene Gonzalez Ruvalcaba¹, Angélica Almeida Campos, Luzia Helena Queiroz, Cristiano de Carvalho, José Antonio Jerez, Edison Luiz Durigon, Luis Ignacio Iñiguez Dávalos, and Samuel R. Dominguez

 

To the Editor: Bats are now recognized as natural reservoirs for many families of viruses that can cross species barriers and cause emerging diseases of humans and animals. Protecting humans against emerging diseases relies on identifying natural reservoirs for such viruses and surveillance for host-jumping events.

 

The emergence of the Middle East respiratory syndrome coronavirus (MERS-CoV) on the Arabian Peninsula (1) further justifies increased surveillance for coronaviruses (CoVs) in bats. MERS-CoV most likely is a zoonotic virus from a bat reservoir and is associated with high case-fatality rates among humans.

 

The existence of a diverse array of alphacoronaviruses in bats in the United States, Canada, and Trinidad has been reported (2–6). Recently, a possible new alphacoronavirus was detected in an urban roost of bats in southern Brazil (7), and a survey of bats in southern Mexico reported 8 novel alphacoronaviruses and 4 novel betacoronaviruses, 1 with 96% similarity to MERS-CoV (8). These findings expand the diversity and range of known bat coronaviruses and increase the known reservoir for potential emerging zoonotic CoVs.

 

<SNIP>

 

In summary, we found a novel alphacoronavirus in bats from Brazil and a novel betacoronavirus in a bat from Mexico. Both viruses were detected in bats with known or potential contact with humans. Because the bats we sampled were mostly adult males, the prevalence of CoVs that we identified is probably an underestimation of the true incidence of CoVs in these bat populations.

 

For bats of other species, incidence of CoVs among juvenile and female bats is higher (2,9). Furthermore, we used a non-nested, broadly conserved CoV PCR, which might have limited the sensitivity of CoV RNA detection.

 

The finding of a novel betacoronavirus in insectivorous bats in the New World is noteworthy. Three human CoVs (229E, SARS-CoV, and MERS-CoV) all have animal reservoirs of closely related viruses in Old World insectivorous bats (10) from which they most likely emerged, either directly or indirectly, into the human population.

 

Ongoing surveillance for CoVs in wildlife and increased research efforts to better understand the factors associated with CoV host-switching events are warranted.

 

None of this is meant to demonize bats, as they play an important role in our ecosystem. However, bats are increasingly being associated with diseases deadly to humans. 

 

To learn how you can stay safe when bats are near, the CDC offers the following advice.

 

Take Caution When Bats Are Near

Saudi Arabia Reports 2 More MERS-CoV Cases

 

 

# 7609

 

Overnight the Saudi Ministry of Health announced two new MERS cases (one fatal) on the Arabic side of their Ministry website.  An English language version of the statement has not yet been posted.

 

Details, as usual, are scant.  We basically know the patient’s ages (55 & 38), their general outcome (1 in intensive care, the other died), and their general location.

 

Here is a machine translation of the Arabic announcement.

 

 

(Health): Registration of cases of HIV (Corona) Medina and deaths drilling subcontractor

10/22/1434

The Ministry of Health for the registration of cases of the Mirs MERS_CoV Corona virus in Medina, a resident at the age of 55 years; he suffers from chronic kidney failure and is currently receiving treatment in intensive care - God's lips.

The ministry also announced the state registration of new HIV and death of a citizen in Batin at the age of 38 years; where was admitted to hospital, and had suffered severe pneumonia and respiratory failure have died - God bless his soul.

 

After a noticeable drop in cases reported during and just after Ramadan, KSA has now reported 10 new cases over the past 10 days, including 3 deaths.

 

The Hajj, which is expected to see several million religious pilgrims from around the world  descend upon Mecca, is now just over 6 weeks away.

ECDC Comment On MERS-CoV Detection In A Bat

Credit Wikipedia

 

 

# 7608

 

The ECDC has published their comment on last week’s news (see EID Journal: Detection Of MERS-CoV In Saudi Arabian Bat) that Dr. Ian Lipkin’s lab at Columbia University had detected a match to the MERS virus in a bat.

 

As we’ve seen from other analyses of this study (see Branswell: A Deeper Look At Yesterday’s MERS-CoV In Bats Story), this author points out that the complete virus MERS virus was not recovered from these bat samples, but rather, a viral segment was sequenced and matched.

 

 

You can find additional commentary on scientific issues on the ECDC’s Scientific advice webpage.   Follow the link for the full report, including cites.

 

 

MERS CoV isolated in a bat

27 Aug 2013

A study published in the Centers for Disease Control and Prevention journal Emerging Infectious Diseases by Memish et al. analyzed the presence of coronaviruses (including MERS-CoV) in 1.003 samples from wild bats collected in October 2012 and April 2013 in Saudi Arabia. Samples were collected in Bisha, Saudi Arabia, close to where the first patient with MERS-CoV was identified in September 2012 and in other regions where MERS-CoV cases have been found. Multiple alpha and beta coronavirus sequences were identified in 220 out of 732 roost feces samples and seven of 91 rectal swab samples or fecal pellets. One amplified sequence of MERS-CoV from a T. perforatus bat captured in October 2012 in Bisha matched 100% with the MERS-CoV cloned from the index case-patient in Bisha.

 

The authors conclude that bats might play a role in human infection although this does not exclude the possibility of other hosts.

 

ECDC comment, 26 August 2013:

Identifying the host/s and source of MERS-CoV is urgently needed to prevent further infections and spread of the disease. Bat species are a well-known reservoir of coronaviruses and the study of Memish et al. confirms this.

 

While the results from the study are intriguing, there are several limitations that might limit a conclusion that bats are the direct source of MERS-CoV in humans. In this study a total of 1,003 different samples were collected from 110 bats captured during two samplings (October 2012 and April 2013); of those 227 samples tested positive for coronavirus, only one was found positive for the human MERS-CoV. The information about the viral load of the MERS-CoV positive sample is missing and the failure of further sequencing might lead to the speculation of a very low virus load in the sample.

 

The amplified bat MERS-CoV sequence was very short and lies within a conserved region of the genome, however a divergence within other genomic regions cannot be ruled out. Furthermore the MERS-CoV sequence amplification product of this positive sample was retrieved only from newly established generic MERS-Coronavirus (nested RdRp) assay, while the World Health Organization  recommended MERS-CoV specific assays were negative.

 

All coronavirus sequences were detected in fecal pellets or from roost feces but not from serum, throat swab samples, or urine. It is unclear if other samples from this particular MERS-CoV positive animal were also available and tested in this study.

 

The possibility of transmitting virus via faeces from bats to humans has been discussed for rabies (Gibbons 2002, Johnson, Phillpotts et al. 2006) and might also been a route of transmission for MERS-CoV. Just as people have been infected with hantavirus while sweeping-up dried mouse droppings  humans (and camels) could be infected by inhaling dust mixed with dried contaminated bat, or other animal, excrement (Jonsson, Figueiredo et al. 2010, Richardson, Kuenzi et al. 2013).

 

This, and the study of Reusken et al. (Reusken, Haagmans et al. 2013) cited in the ECDC Public Health Development of 12 August 2013, provide evidence that MERS-CoV might be a zoonotic disease but it is still not clear how the disease progresses from animals to humans. The epidemiological investigations excluded so far direct animal contact of most of the MERS-CoV patients as the probable route of infection but indirect mechanisms could be involved.

 

The previously published ECDC risk assessment is still valid.

(Continue . . . )

 

Referral: Mackay On Respiratory Viruses In Health Care Workers

Photo Credit PHIL (Public Health Image Library)

# 7607

 

A topic we’ve touched on a number of times before (see EID Journal: Nosocomial Transmission Of 2009 H1N1 & A Hospital Is No Place For A Sick Person) is the carriage and transmission of respiratory viruses by healthcare workers to patients.

 

Today, Dr. Ian Mackay takes a look at a study on more than 300 ill and asymptomatic HCWs that screened them for a variety of respiratory viruses.  Follow the link below to read the intriguing findings:

 

Healthcare workers may stay on the job when ill and can be shedding viral RNA...

Tuesday, 27 August 2013

 

 

The asymptomatic carriage and shedding of viruses comes as less than a complete surprise, as we’ve seen evidence of this in the past (see The Very Common Cold, PLoS One: Influenza Viral Shedding & Asymptomatic Infections).

 

But as Ian points out, the more they test the more we learn.

 

One of the revelations that came out of CIDRAP’s 2009 H1N1 conference in Minneapolis (see CIDRAP On Business’s Biggest Concern) was group polling that showed that Hospitals were among the least likely to make it easy for employees to stay home if they were sick.

 

As a paramedic, I know that my colleagues and I worked `sick’ often, as I wrote back in 2009:

 

EMT’s and paramedics were a scarce resource, and since everyone was working at least a 56-hour-week . . .  trying to find someone to fill a shift was a major hassle.

 

So we worked with colds, with the flu, with aching backs, and Lord knows what else  . . . because the system required it.  And there were real (unwritten) punitive downsides to calling in sick. 

 

Thirty years later, it appears that many HCWs are still penalized if they are unwilling to work `sick’.  Sick leave for HCWs often comes out of an accrued PTO (Paid Time Off) account which combines vacation, holiday, and sick time off. 

 

Workers accrue hours based on shifts worked, and their seniority.

 

Employees who haven’t sufficient hours `banked’ (or part-time workers who aren’t usually enrolled in PTO plans), must take unpaid leave if they fall ill.

 

Live polling of the attendees at the 2009 CIDRAP conference indicated that industries other than Health Care, such as manufacturing, were more likely to give employees paid time off for the flu and for taking care of sick family members.

 

Obviously, working `sick’ is a risk to both patients and colleagues alike.

 

It is a sad commentary that those who are most likely to get sick `in the line of duty’ are among the least likely to enjoy a liberal paid sick leave policy.

Kyrgyzstan: A Fatal Case Of Bubonic Plague

 

Credit CDC

 

 

# 7606

 

In recent decades, with the wide availability of suitable antibiotics, bubonic plague epidemics have become a rarity. The last really big plague outbreak was in India nearly 20 years ago, as summarized by the WHO.

During August 26-October 5, 1994, a total of 5150 suspected pneumonic or bubonic plague cases and 53 deaths were reported from eight states of India, primarily in the south-central and southwestern regions.

 

Although reports of plague were initially denied by Indian officials, the mass exodus of hundreds of thousands of panicked people from Surat spread the disease to 7 Indian states.

 

You can read Newsweek’s contemporaneous coverage of this event in The Plague of Panic.

 

 

 

 

 

 

 

 

 

Worldwide, on average, anywhere between 1,000 and 3,000 cases are reported each year, but most are isolated infections or (more rarely) small clusters.

 

Bubonic Plague (Yersinia Pestis) is a bacterial infection transmitted by fleas, carried by infected rats.   The infection generally sets up in the lymphatic system, resulting in the tell-tale buboes, or swollen lymph glands in the the groin, armpits, and neck.

Credit CDC

 

In rare cases Pneumonic Plague may develop.  Here the infected person develops a severe pneumonia, with coughing and hemoptysis (expectoration of blood), and may spread the disease from human-to-human.

 

The last major urban outbreak of plague in the United States occurred in 1924-25 in Los Angeles.  Since then, only scattered cases have been reported, with about 10-15 cases each year.

 

Which brings us to a series of news reports this morning out of Kyrgyzstan that indicates a 15-year old boy has died from bubonic plague, at least 100 contacts have been hospitalized and  `quarantined’, and antibiotics are being distributed in the area.  

 

The details vary between reports, and so a small smattering of the coverage follows:

 

First from Aljazeera:

 

Kyrgyzstan boy dies of bubonic plague

Health officials confirm 15-year-old's death was caused by the rodent-borne disease, but say an epidemic is unlikely.

Last Modified: 27 Aug 2013 05:12

Doctors in Kyrgyzstan have said a teenage boy has died of bubonic plague, but that an epidemic is not likely.

 

The death of the 15-year-old herder was confirmed on Monday, several days after his death in the Karakol regional hospital.

 

Health ministers said the boy, from the small mountain village Ichke-Zhergez in eastern Kyrgyzstan, died last Thursday after being diagnosed with bubonic plague, which is carried by rodents and caused millions of deaths throughout Europe in the 14th century.

(Continue. . . )

The BBC reports:

Boy dies of plague in Kyrgyzstan

A 15-year-old herder has died in Kyrgyzstan of bubonic plague - the first case in the country in 30 years - officials say.

 

The teenager appears to have been bitten by an infected flea.

 

The authorities have sought to calm fears of an epidemic and have quarantined more than 100 people.

(Continue . . .)

 

Other reports, such as this one from RIA Novosti, link the boy’s infection to the consumption of a barbecued marmot.

Kyrgyzstan on Plague Watch After Man Dies From Rodent Meal

 

Whatever the vector, the good news is that bubonic plague usually responds well to modern medical treatment.  This from the CDC:

 

How is plague treated?

Plague can be successfully treated with antibiotics. Once a patient is diagnosed with suspected plague they should be hospitalized and, in the case of pneumonic plague, medically isolated. Laboratory tests should be done, including blood cultures for plague bacteria and microscopic examination of lymph node, blood, and sputum samples. Antibiotic treatment should begin as soon as possible after laboratory specimens are taken. To prevent a high risk of death in patients with pneumonic plague, antibiotics should be given as soon as possible, preferably within 24 hours of the first symptoms.

 

Without treatment, however, mortality rates run 40%-60%.  Untreated, pneumonic plague is almost always fatal.

 

As long as the locals don’t flee, as we saw in India 20 years ago, and they take the antibiotics being dispensed, a localized epidemic of plague is unlikely.

 

For more on Plague, you may wish to visit the CDC’s Plague Website.

SCH Statement On Latest Qatari MERS-CoV Case

 

 

# 7605

 

We’ve some official statements this morning from Qatar’s Supreme Council of Health on their latest MERS-CoV case (see KUNA Reports New MERS-CoV Case In Qatar).  While there remains a lot we don’t know about this case, today we do learn:

 

The patient is a 29-year-old Qatari citizen who has a exposure to a confirmed case and suffers from asthma and several risk factors.

 

Unstated is the nature of his exposure, although in the past it has generally either been a family member or a HCW (Health Care Worker).

 

First, a machine translation from the Arabic side of the website (which doesn’t mention exposure at all), then the English Language version which does.

 

Supreme Council of Health announces new cases of "Corona"

Doha - Tuesday, August 27, 2013

The Supreme Council of Health registered new cases of virus infection Corona virus that causes AIDS Middle East respiratory patient's diagonal at the age of 29 years old Mkhalt a confirmed case suffers from asthma and several risk factors were detected upon diagnosis of the disease in the National Influenza Centre, were also sent samples to a reference laboratory abroad to confirm the diagnosis.

 

The patient receives a treatment in a critical condition currently in intensive care. The Council underlines the continued surveillance and monitoring of the disease and strengthen infection control measures and isolation of all cases of acute respiratory infections and to inspect all contacts in collaboration with Hamad Medical Corporation and the participation of all medical providers in the state.

 

 

SCH Reports New Corona Virus Case

Doha - Tuesday, 27 Aug 2013

The Supreme Council of Health (SCH) has reported a new Middle East Respiratory Syndrome corona virus case.

 

The patient is a 29-year-old Qatari citizen who has a exposure to a confirmed case and suffers from asthma and several risk factors.

 

SCH said in a press release that the patient was checked up and diagnosed with the disease in the National Influenza Laboratory, adding that samples were also sent to reference labs abroad to confirm the diagnosis.

 

The statement added that the patient, who is in a critical condition, is receiving treatment in the intensive care unit.

 

The SCH emphasized that surveillance and monitoring procedures are always tightening up and infection control for all cases of acute respiratory infections are also tightened up, stressing on continuing to check up all those who have exposure to confirmed cases in cooperation with Hamad Medical Corporation (HMC) and other medical service providers.