WHO MERS-CoV Update – Oct 31st

Photo Credit – WHO

 

# 7926

 

My thanks to Gregory Hartl – spokesperson for the World Health Organization – for tweeting the link to the latest update on the MERS Coronavirus.   Today’s report catches up with four recently reported cases, one from Oman, and three from Saudi Arabia.

 

 

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

Disease outbreak news

31 October 2013 - WHO has been informed of an additional four laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV). These include the first laboratory-confirmed case from Oman and three additional laboratory-confirmed cases from Saudi Arabia.

The patient in Oman is a 68-year-old man from Al Dahkliya region who became ill on 26 October 2013 and was hospitalized on 28 October 2013. Preliminary epidemiological investigations revealed that he did not recently travel outside the country. However, investigations are currently ongoing to determine what exposures might be responsible for his infection

Of the three patients including one death reported from the Eastern Region in Saudi Arabia, one is a woman and two are men. The three patients, one of whom is a health care worker, had underlying medical conditions. Their ages range from 49 to 83 years old. All three patients reported having no contact with animals prior to their illness, while one patient was reported to have been in contact with a previously laboratory-confirmed case.

Globally, from September 2012 to date, WHO has been informed of a total of 149 laboratory-confirmed cases of infection with MERS-CoV, including 63 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.

(Continue  . . .)

KSA MOH Announces New MERS Case/Fatality

 

# 7925

 

Another parsimonious update from the Saudi MOH.  About all we learn is that a new (fatal) MERS-CoV case has been identified in the Eastern Province,  age 56, who apparently had contact with a previously confirmed case.

 

 

 

Health: the death of infected status (Corona) in the Eastern Province

12/27/1434

In the framework of the epidemiological investigation and ongoing follow-up carried out by the Ministry of Health for HIV (Corona) that causes respiratory syndrome Middle East MERS-CoV, the ministry announces the registration of deaths infected with the virus in the Eastern Province.

 

It is a citizen at the age of 56 years, mixing with confirmed cases, and they have several chronic diseases. Ngmayora God rest in peace.

Instead Of Cursing The Darkness

 

 

 

# 7924

 

When I wrote about the upcoming GridEX II exercise on Sunday (see GridEx 2013 Preparedness Drill) I mentioned National Geographic’s upcoming `docudrama’ movie  – American Blackout – and its mention in the CDC’s   Public Health Matters Blog.  I’ve now had a chance to watch the movie (and it’s UK counterpart) – and while neither is exactly Citizen Kane – both do a good job illustrating why it is important to be prepared for any type of emergency or disaster.

 

The plot in both movies is a cyber attack taking down the national grid.  And once down, it stays down for days.  And as you might expect, by day 2 or 3, a lot of unprepared people were getting pretty desperate.

 

Without electrical power, water and gasoline doesn’t pump, elevators and air conditioners don’t run, ATM machines and banks close, grocery stores can’t take debit or credit cards, and everything from cooking, to flushing toilets, becomes a major challenge.  Particularly in urban settings.

 

Having lived for more than a year `on the hook’ on a sailboat, I understand what its like to be off the grid.  But of course, I’d prepared for that.  I had solar panels, kerosene lanterns, battery operated devices, and other work arounds.   It wasn’t luxurious, or even comfortable a good deal of the time, but living aboard a boat in the tropics tends to make up for such things.

 

Today, I’ve `swallowed the anchor’, and live on dry land.  But I keep the much of the same gear I had aboard my sailboat, in case the power goes out.  Battery operated radios, LED lanterns (much improved over the old, hot, smelly kerosene lanterns),  a propane camp stove (with extra fuel) . . .  even a small solar panel to recharge batteries.

 

Not because I’m expecting a `100% grid-down’ situation as depicted in these movies, but because I live in hurricane country, and these tropical systems have a nasty habit of shutting off the juice for days or weeks at a time.  As do ice storms, tornadoes, blizzards, floods, earthquakes, severe thunderstorms and derechos across the nation.

 

Add in the real possibility of solar storms, cyber attacks, and good old fashioned equipment failures, and the odds of your spending a few days without electrical power over  the next couple of years go up appreciably.

 

If a disaster struck your region today, and the power went out, stores closed their doors, and water stopped flowing from your kitchen tap for the next 7 days  . . .  do you have:

 

• A battery operated NWS Emergency Radio to find out what was going on, and to get vital instructions from emergency officials?
• A decent first-aid kit, so that you can treat injuries?
• Enough non-perishable food and water on hand to feed and hydrate your family (including pets) for the duration?
• A way to provide light (and in cold climates, heat) for your family without electricity?   And a way to cook?  And to do this safely?
• An emergency plan, including meeting places, emergency out-of-state contact numbers, and in case you must evacuate, a bug-out bag?
• Spare supply of essential prescription medicines that you or your family may need?

 

If your answer is `no’, you have some work to do.  A good place to get started is by visiting Ready.gov.

 

Unfortunately, a lot of people make the wrong choices when they do prepare.  They buy candles instead of battery operated lights, they use generators inside their house or garage, or resort to dangerous methods to cook or to heat their homes. 

 

As a result, when the power goes out, house fires and carbon monoxide poisonings go up. Each year hundreds of Americans are killed, and thousands affected, by CO poisoning.

 

In Carbon Monoxide: A Stealthy Killer I wrote in depth on the issue, but a few tips from the CDC include:

Prevention Guidelines

You Can Prevent Carbon Monoxide Exposure

• Do have your heating system, water heater and any other gas, oil, or coal burning appliances serviced by a qualified technician every year.
• Do install a battery-operated CO detector in your home and check or replace the battery when you change the time on your clocks each spring and fall. If the detector sounds leave your home immediately and call 911.
• Do seek prompt medical attention if you suspect CO poisoning and are feeling dizzy, light-headed, or nauseous.
• Don't use a generator, charcoal grill, camp stove, or other gasoline or charcoal-burning device inside your home, basement, or garage or near a window.
• Don't run a car or truck inside a garage attached to your house, even if you leave the door open.
• Don't burn anything in a stove or fireplace that isn't vented.
• Don't heat your house with a gas oven.

Food safety after a power outage is another concern, and is something I covered a couple of years ago in USDA: Food Safety When The Power Goes Out.

 

The USDA maintains a Food Safety and Inspection website with a great deal of consumer information about how to protect your food supplies during an emergency, and how to tell when to discard food that may no longer be safe to consume.

 

A Consumer's Guide to Food Safety: Severe Storms and Hurricanes

This illustrated PDF version (2.1MB) is recommended for printing.

 

While preparedness may seem like a lot of work, it really isn’t.  You don’t need an underground bunker, an armory, or 2 years worth of dehydrated food.  But you do need the basics to carry on for a week or two, and a workable family (or business) emergency/disaster plan.

 

For more information on how to prepare, I would invite you  to visit:

 

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

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

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

 

And you can use this link to read earlier NPM (National Preparedness Month) posts on this blog

Cambodia MOH Reports 22nd H5N1 Case Of The Year

Credit FAO Empres Report

 

# 7923

 

While we continue to watch the emerging H7N9 virus, a fresh reminder this morning that the H5N1 virus is still circulating in poultry, and occasionally sickening and killing humans.  Cambodia today reports their 22nd human infection of the year – that number now eclipsing the aggregate of all previous cases reported between 2005 and the end of 2012.

 

2005 – 4 cases                     2010 – 1 case

2006 – 2 cases                     2011 – 8 cases

2007 – 1 case                       2012 - 3 cases

2008 – 1 case                       2013 – 22 cases

2009 – 1 case                      

 

So far, all of the cases this year appear to be widely scattered and have been linked to direct contact to infected poultry. There are no indications of human-to-human spread of the virus.  

 

22nd New Human Cases of Avian Influenza H5N1 in Cambodia in 2013

 
30 October 2013

The Ministry of Health (MoH) of the Kingdom of Cambodia wishes to advise members of the public that one new human case of avian influenza has been confirmed for the H5N1 virus. This is the 22nd case this year and the 43rd person to become infected with the H5N1 virus in Cambodia. Of the 43 confirmed cases, 32 were children under 14, and 26 of the 43 were female. In addition, only 11 cases out of the 22 cases this year survived.

The 22nd case, a 6-year-old girl from Romdoul village, O Romdoul commune, Phnom Preuk district, Battambang province confirmed positive for human H5N1 human avian influenza on 24th October 2013 by Institut Pasteur du Cambodge. The girl developed fever on 14th October 2013. On 15th October 2013, her parents sought treatment for her in the village. The girl’s condition worsened and the girl was referred to the Jayavarman VII Hospital in Siem Reap. On 19th October 2013 she was admitted to the Jayavarman VII Hospital with fever, cough, abdominal pain, running nose, sore throat and dyspnea. Laboratory samples were taken on 22nd October and Tamiflu administered on 24th October. The girl is currently in a stable condition.

(Continue . . . )

 

The report goes on to state that chickens and ducks had recently died in the girl’s neighborhood, and they were investigating if she’d had direct contact with any of them.

Human infections with the H5N1 virus – while relatively rare - are always a concern:

• Because of the high fatality rate among known cases
• And because each time the virus jumps from its normal (avian) host to a human (or other mammal), it gives it another opportunity to adapt and change.

 

Despite hundreds (perhaps thousands) of such opportunities to date, the virus remains poorly adapted to human physiology.  It can produce severe illness – even death – but only rarely is transmitted on to another person.

 

For now, H5N1 is primarily a threat to poultry, and to a lesser extent, those who work with, or come in close contract with, infected poultry.

 

The concern, of course, is that over time the virus will adapt further and someday pose a pandemic threat to humans.

The Lancet: Poultry Market Closure Effect On H7N9 Transmission

Credit FAO 

 

# 7922

 

We’ve a report in The Lancet this morning that quantifies the benefits of closing live poultry markets in order to curb the spread of the H7N9 virus.  This infection control practice  – while costly, and not particularly popular among many in China – was credited with dramatically reduced the number of human infections with the virus in a very short period of time last spring.

 

Since that time, caveats about visiting live poultry markets have been included in nearly every public health statement issued by Hong Kong (and others) to travelers headed to mainland China. Last month Zeng Guang, chief epidemiologist at the China’s CDC, urged:

 

. . . .  the public to take precautions such as to avoid staying in public places for long and to be aware of good personal hygiene, including frequent hand-washing. In addition, to prevent H7N9 infection, "people shouldn't go to live poultry markets", he said. - Chinese CDC: Be Alert For H7N9

 

While poultry markets were closed in April and May in H7N9 affected regions, most have since re-opened, sparking fears that another round of human H7N9 cases may emerge this winter.

 

 

Effect of closure of live poultry markets on poultry-to-person transmission of avian influenza A H7N9 virus: an ecological study

Hongjie Yu MD a †, Joseph T Wu PhD e †, Dr Benjamin J Cowling PhD e , Qiaohong Liao MD a, Vicky J Fang MPhil e, Sheng Zhou MD a, Peng Wu PhD e, Hang Zhou MD a, Eric H Y Lau PhD e, Danhuai Guo PhD f, Michael Y Ni MPH e, Zhibin Peng MD a, Luzhao Feng MD a, Hui Jiang MD a, Huiming Luo MD b, Qun Li MD c, Zijian Feng MD c, Yu Wang PhD d, Dr Weizhong Yang MD d , Prof Gabriel M Leung MD e

Findings

85 human cases of avian influenza A H7N9 virus infection were reported in Shanghai, Hangzhou, Huzhou, and Nanjing by June 7, 2013, of which 60 were included in our main analysis. Closure of LPMs reduced the mean daily number of infections by 99% (95% credibility interval 93—100%) in Shanghai, by 99% (92—100%) in Hangzhou, by 97% (68—100%) in Huzhou, and by 97% (81—100%) in Nanjing. Because LPMs were the predominant source of exposure to avian influenza A H7N9 virus for confirmed cases in these cities, we estimated that the mean incubation period was 3·3 days (1·4—5·7).

Interpretation

LPM closures were effective in the control of human risk of avian influenza A H7N9 virus infection in the spring of 2013. In the short term, LPM closure should be rapidly implemented in areas where the virus is identified in live poultry or people. In the long term, evidence-based discussions and deliberations about the role of market rest days and central slaughtering of all live poultry should be renewed.

 

 

We’ve seen in China, Indonesia, and in other countries attempts to close or strictly regulate live bird markets in the past – only to be met with tremendous public resistance (see 2009 blog China Announces Plan To Shut Down Live Poultry Markets In Many Cities).  Their ambitious plan, announced 4 years ago to `shut live poultry markets in all large and medium-sized cities throughout China’, obviously never happened.

 

Purchasing live market birds is deeply ingrained in the culture, as it reassures the buyer that the bird is both fresh and healthy.   

 

When dealing with a highly pathogenic (in poultry) virus like H5N1 - where birds often sicken and die - vendors and the public can usually see the effect of the virus.  Not so with H7N9, as birds can carry it and remain healthy, while in humans it can produce severe illness.

 

Convincing vendors, and the public, that their perfectly healthy looking duck or chicken is a threat to human health can be a tough sell. 

 

Add to that the economic impact of closing live markets – the often conflicting goals and mandate of  China’s Ministry of Agriculture - and prospects for a quick and permanent solution to the sale of live market birds appears low.

Referral: Dr. Mackay On MERS-CoV Testing

Coronavirus – Credit CDC PHIL

 

# 7921

 

 

Dr. Ian Mackay has a informative post this morning on his Virology Down Under blog on the recently announced rapid blood test for MERS-CoV.   As readers who follow this blog already know, lab tests are not always definitive.   First  a link to Ian’s piece, then I’ll be back with a bit more.

 

New MERS-CoV laboratory test: takes 10-minutes but what can it tell you?

 

The two main measures of the accuracy of any diagnostic test are sensitivity and specificity.

• Sensitivity is defined as the ability of a test to correctly identify individuals who have a given disease or condition.

• Specificity is defined as the ability of a test to exclude someone from having a disease or illness.

 

While a rapid MERS-CoV test would be a great boon to surveillance, our experience with Rapid Influenza test kits (see MMWR: Evaluating RIDTs) has not been all that encouraging.

 

According to the CDC:

The rapid tests vary in terms of sensitivity and specificity when compared with viral culture or RT-PCR. Product insert information and research publications indicate that:

• Sensitivities are approximately 50-70%
• Specificities are approximately 90-95%

 

But of course, this is a different test, a different collection method, and a different virus.  As Dr. Mackay points out, we need to see some real-world data on how well this new test works in the field.

 

We also know a lab test can have excellent sensitivity and specificity under laboratory conditions – but if the sample collected from the patient doesn’t contain enough virus (or is improperly stored or transported) – then the best test in the world won’t be accurate.

Testing for MERS has often relied on taking throat swabs - which can be sub-optimal when trying to detect deep lung infections. As we’ve seen with H5N1, H7N9, and MERS-CoV -  false negatives can result.

 

The World Health Organization issued the following testing recommendations for MERS last summer (see WHO: Revised MERS-CoV Case Definitions), for precisely this reason.

 

Inconclusive testing: Patients with an inconclusive initial testing should undergo additional virologic and serologic testing to determine if the patient can be classified as a confirmed MERS-CoV case. It is strongly advised that lower respiratory specimens such as sputum, endotracheal aspirate, or bronchoalveolar lavage fluid be used when possible. If patients do not have signs or symptoms of lower respiratory tract infection and lower track specimens are not available or clinically indicated, both nasopharyngeal and oropharyngeal swab specimens should be collected.

If initial testing of a nasopharyngeal swab is negative in a patient who is strongly suspected to have MERS-CoV infection, patients should be retested using a lower respiratory specimen tract or a repeat nasopharyngeal specimen with additional oropharyngeal specimen if lower respiratory tract specimens are not possible, and paired acute and convalescent sera.

 

A reminder, that at least with lab tests,  `No’ doesn’t always mean `no’.

France: MOH Statement On Negative MERS-CoV Case

 

 

 

France’s Le ministère des Affaires sociales et de la Santé (Ministry of Social Affairs and Health) has issued the following statement confirming what we learned last night (see Media Reports: French Coronavirus Suspect Tests Negative).

 

 

No new cases of infection with coronavirus (MERS-CoV) in France

A new probable cases of infection with coronavirus (MERS-CoV) was reported on Oct. 28 at the Institute of Health Surveillance (VS). The Pasteur Institute in Paris, which was entered for additional expertise, just communicate negative about this case. This patient is not infected with the coronavirus. The two cases identified in May 2013 therefore remain the only two confirmed cases in France to this day.

The Ministry of Social Affairs and Health noted that in France, so far, the contamination have been reported in the following two situations:

• or after a trip to the Arabian Peninsula with occurrence of respiratory symptoms and fever within 14 days of the return;
• or after close contact with a person infected with coronavirus.

Any person in any of these situations should contact their physician or center and 15 mention the trip in the Arabian Peninsula or close contact.

24 October 2013, the balance of the World Health Organization (WHO) reported 144 cases worldwide, including 62 deaths since September 2012. WHO does not recommend travel restrictions with the countries concerned.

The information on coronavirus established by the Department can be reached toll-free Monday through Saturday from 9 am to 19 pm (0800 13 00 00).

 

Meanwhile, in Egypt – despite denials by the government that a suspect case on Monday had MERS-CoV (see Egypt Testing Suspected MERS-CoV Case) – rumors continue to appear in the local press that this was a MERS case, and that two or three others are being tested.

 

FluTrackers is keeping a log of these news reports, which you can follow here and here.

 

Given the fragmented government, and general chaos in the region, it is probably worth keeping an eye on these reports.

CDC: H7N9 Update

 

# 7919

 

 

While the MERS coronavirus continues to make threatening noises in the Middle East, influenza viruses have traditionally posed the greatest pandemic threat, and so no one is ignoring the recently emerged H7N9 virus.  Avian flu, like seasonal flu strains, transmit more frequently during the winter months, which has many agencies preparing (see Hong Kong: held an Avian Influenza Drill) for what they fear could be a busy season ahead.

 

In recent weeks we’ve seen cautionary press releases from the FAO (see FAO Warns On Bird Flu), the Chinese CDC: Be Alert For H7N9, and the World Health Organization’s recent Influenza at the human-animal interface Summary and assessment.

 

On Monday the CDC issued an update of their own, which cautions that H7N9 likely has a `seasonal’ pattern, and that we should not be surprised to see more cases emerge over the coming months as winter sets in in China.

 

H7N9 Update

October 28, 2013 -- Rare, sporadic human infections with H7N9 in China have been reported since the end of May, following a surge of more than 130 cases with illness onset during the month of April. Most recently, China reported to the World Health Organization that two cases of H7N9 infection were detected there in October. Information about these cases was posted on the WHO website on October 16 and October 24. These are the first cases of H7N9 reported since August 11 and bring the total number of cases reported to 137, including 45 deaths. These most recent cases are not unexpected and do not change the risk assessment for H7N9 at this time.

As CDC indicated in May 2013, evidence suggests that there is a seasonal pattern to the circulation of avian influenza viruses, with activity declining in warmer seasons and increasing in cooler weather. This suggests that H7N9 activity – among birds and people – might increase again in China as the weather turns cooler. It’s likely that H7N9 cases will continue to be detected this winter in China, however, it’s not possible to predict how many cases there will be.

The most recent case of H7N9 in China reportedly occurred in a farmer who had contact with live poultry, suggesting that exposure to infected birds continues to be the main source of infection with this virus. There is no indication that the epidemiology of H7N9 has changed; China continues to report that there is no evidence of sustained human-to-human transmission with this virus. If more clusters of human-to-human spread, or evidence of sustained human-to-human spread were detected, the risk assessment for H7N9 would change. In the meantime, H7N9 preparedness efforts by the U.S. government have continued over the summer and CDC along with its global health partners are continuing to watch this situation closely.

 

The CDC recently updated their guidance for the treatment and prophylaxis of H7N9 as well.  You can access those documents at the links below:

 

H7N9: Updated CDC Guidance For Antiviral Treatment

H7N9: CDC Guidance On Antiviral Chemoprophylaxis

Media Reports: French Coronavirus Suspect Tests Negative

 

Photo Credit NIAID

 

# 7918

 

 

My thanks to Gert van der Hoek on FluTrackers for picking up a report from BFM TV (link) announcing the negative results.  A similar report (below) appears in Le Figaro and Le Monde.

Given the abundance of caution necessary to deal with this virus, it is inevitable that we will see a certain number of suspected or `probable’ cases turn out to be negative.

I would note that so far, anyway, the Ministry of Health’s website has not posted an update, indicating a negative test.

 

 

No new cases of coronavirus in France (Department of Health)

•  By The Figaro.fr with AFP   Updated on 29/10/2013 at 22:31

The tests performed by the Institut Pasteur on a new patient suspected of being infected with coronavirus in France were negative, tonight announced the Ministry of Health. "The two cases identified in May 2013 therefore remain the only two confirmed cases in France to this day," the ministry said in a statement. France had announced earlier in the day a new probable cases of coronavirus infection, affecting one in the north of the country back 'of Saudi Arabia , a country where the disease has already made ​​a hundred deaths. Person, 43 years old, returning from a trip to Saudi Arabia, was hospitalized in Tourcoing (Nord) since Monday and his condition was "stable".

(Continue . . .)

 

Oman Announces 1st MERS-CoV Case

 

# 7917

 

While we await news on the suspected case in France (see France: MOH Statement On Suspected MERS-CoV Case), the Oman Observer has published a report of that country’s first MERS-CoV case.  Details are fairly sparse at this time, but this report vaguely suggests the virus was contracted after `contact with someone from outside the Sultanate’.

 

 

Sultanate reports first case of coronavirus

Wednesday 30th, October 2013 / 01:25 Written by Oman Observer

in Head stories

By A Staff Reporter -

MUSCAT — The Sultanate yesterday reported the first case of the deadly MERS coronavirus. This was announced by Mohamed bin Saif al Hosni, Under-Secretary for Health Affairs.

Giving details of the case, he said that the situation is under control and there is no need for panic. The affected patient is undergoing treatment at a hospital and his condition is stable.

The official said the patient got the disease after contact with someone from outside the Sultanate and more details of the case will be known in few days.

Symptoms of MERS-CoV infection include renal failure and severe acute pneumonia, which often result in a fatal outcome. The first patient had a “7-day history of fever, cough, expectoration and shortness of breath.” MERS has an estimated incubation period of 12 days.

(Continue . . .)

 

 

A second report (translated from Arabic) appears in the Oman Daily:

 

 

The discovery of the first case b 'Corona' in Oman

Wrote - Khaled infection: the Ministry of Health announced yesterday the discovery of the first case of infected Coruna province's internal review of the injured to a health center, Nizwa.

Following the laboratory diagnosis of his injury was confirmed with the virus. Was transferred directly to the Nizwa Hospital Reference.

Infected and return the situation to one of the sons of Nizwa injured after what felt short of breath as pulmonary informed sources from the Ministry of Health.

HE Dr Mohammed bin Saif Al Hosni, Undersecretary of the Ministry of Health for health affairs, in a press statement yesterday that the victim had gone to a referral hospitals to maintain after he felt one of the symptoms of pneumonia severe, pointing out that the patient's condition is stable, but he needs some oxygen does not need to Industrial breathing apparatus, expressing the hope that his condition will improve in the coming period.

 

WHO MERS-CoV Update – Qatar

Coronavirus - Photo Credit WHO

 

# 7916

 

 

The World Health Organization has updated the MERS-CoV situation in Qatar, adding 1 additional case  – a close contact of a confirmed case from nearly 2 weeks ago (see WHO MERS-CoV Update – Qatar) – who also has a common animal exposure as well.   As we’ve seen with some other younger patients, he appears to be experiencing a relatively mild illness.

 

 

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

Disease outbreak news

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

The patient is a 23-year-old man who was identified as a close contact of a previously laboratory-confirmed case as part of the epidemiological investigation. He is a worker in the animal barn owned by the previously laboratory-confirmed case. The man developed mild symptoms of illness and is in good condition. Preliminary investigations revealed that he did not recently travel outside the country.

Globally, from September 2012 to date, WHO has been informed of a total of 145 laboratory-confirmed cases of infection with MERS-CoV, including 62 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.

(continue . . . )

 

 

Meanwhile, we are watching developments in France, where a patient is currently being tested for the virus (see France: MOH Statement On Suspected MERS-CoV Case).

WHO: Confirmation Of Polio In Syria

Syria - Credit Wikipedia

 

# 7915

 

 

The World Health Organization has posted a GAR (Global Alert & Response) update on the polio situation in Syria (see earlier blog BBC: Polio Confirmed In Syria – WHO) confirming the discovery of wild poliovirus type1 (WPV1) in Syria.

 

Polio in the Syrian Arab Republic

29 October 2013 - Following reports of a cluster of 22 acute flaccid paralysis (AFP) cases on 17 October 2013 in the Syrian Arab Republic, wild poliovirus type 1 (WPV1) has been isolated from ten of the cases under investigation. Final genetic sequencing results are pending to determine the origin of the isolated viruses. Wild poliovirus had not been detected in the Syrian Arab Republic since 1999.

 

Most of the cases are very young (below two years of age), and were un- or under-immunized. Estimated immunization rates in the Syrian Arab Republic declined from 91 percent in 2010 to 68 percent in 2012.

 

Even before this laboratory confirmation, health authorities in the Syrian Arab Republic and neighbouring countries had begun the planning and implementation of a comprehensive outbreak response. On 24 October 2013, an already-planned large-scale supplementary immunization activity (SIA) was launched in the Syrian Arab Republic to vaccinate 1.6 million children against polio, measles, mumps and rubella, in both government-controlled and contested areas.

 

Implementation of an SIA in Deir Al Zour province commenced promptly when the first ‘hot cases’ were reported. Larger-scale outbreak response across the Syrian Arab Republic and neighbouring countries is anticipated to begin in early November 2013, to last for at least six to eight months depending on the area and based on evolving epidemiology.

 

Given the current situation in the Syrian Arab Republic, frequent population movements across the region and subnational immunity gaps in key areas, the risk of further international spread of wild poliovirus type 1 across the region is considered to be high. A surveillance alert has been issued for the region to actively search for additional potential cases.

 

WHO’s International Travel and Health recommends that all travellers to and from polio-infected areas be fully vaccinated against polio.

 

 

 

 

France: MOH Statement On Suspected MERS-CoV Case

 

 

UPDATED 1630 hrs EDT 10/19

At this time the Media Reports: French Coronavirus Suspect Tests Negative 

 

# 7914

 

From France’s Le ministère des Affaires sociales et de la Santé (Ministry of Social Affairs and Health) we get the following (machine translated) press release on this morning’s reported `probable’ MERS-CoV Case.

 

NOTE: My thanks to Dr.Ian Mackay for bringing it to my attention, but the machine translation of this statement provides `cases’ plural instead of `case’ singular’. There is another French case, apparently still alive, but hospitalized since last May, but this statement only refers to one new case.

 

 

New probable cases of infection with coronavirus (MERS-CoV) in France

A new probable cases of infection with coronavirus (MERS-CoV) was reported on Oct. 28 at the Institute of Health Surveillance (VS). The Pasteur Institute in Paris was seized for further expertise and confirmation of this case. The new case, if confirmed, would be the third case reported in France. The first two cases were identified in May 2013.

It is a 43-year-old returned from a stay in Saudi Arabia. She was hospitalized in isolation since 28 October in northern France. His condition is stable, this day.

A thorough epidemiological investigation surrounding this case was implemented immediately without waiting for confirmation of this case. All persons who had close contact with the patient are informed today by the health authorities of steps to follow.

The Ministry of Social Affairs and Health noted that in France, so far, the contamination have been reported in the following two situations: either after a trip to the Arabian Peninsula with occurrence of respiratory symptoms and fever 14 days after the return, or after close contact with a person infected with coronavirus.

Any person in any of these situations should contact their physician or center and 15 mention the trip in the Arabian Peninsula or close contact.

24 October 2013, the balance of the World Health Organization (WHO) reported 144 cases worldwide, including 62 deaths since September 2012. WHO does not recommend travel restrictions with the countries concerned.

The information on coronavirus established by the Department can be reached toll-free Monday through Saturday from 9 am to 19 pm (0800 13 00 00).

 

France: Testing A Suspected MERS-CoV Case

Photo Credit NIAID

 

 

# 7913

 

Over the past 20 minutes numerous wire reports have appeared in the French press indicating that a 43-year-old, recently returned form Saudi Arabia, is hospitalized in isolation with a suspected MERS-CoV infection (h/t Makoto_au_Japon) .

 

While a similar report yesterday from Egypt turned out to be a false alarm (see Egypt Testing Suspected MERS-CoV Case), no one is willing to risk complacency in the face of a possible infection. 

 

Some of the (machine translated) coverage includes:

 

29/10/2013 at 12:23

HEALTH A new case of coronavirus in France

A new probable cases of infection with coronavirus (MERS-CoV) was reported Monday at the Institut de Veille Sanitaire (VS).

 

"It is a 43-year-old returned from a stay in Saudi Arabia. She was hospitalized in isolation since 28 October in northern France. His condition is stable, this day, "says the Ministry of Health.

Two cases have been previously registered in France: the first patient died on May 28 when he was hospitalized in intensive care in Lille.

 

A more complete account appears in LADEPECHE.fr

 

A new probable case of MERS-CoV in France

Published on 29/10/2013 at 11:15

A new probable cases of infection with coronavirus (MERS-CoV) was reported on Oct. 28 at the Institute of Health Surveillance (VS). The Pasteur Institute in Paris was seized for further expertise. If confirmed, this would be the third case reported in France.

The patient, a 43-year-old returned from a stay in Saudi Arabia, was hospitalized in isolation since 28 October in northern France. His condition is currently considered "stable". A thorough epidemiological investigation surrounding this case was implemented immediately without waiting for confirmation. All persons who had close contact with the patient are informed today by the health authorities of steps to follow.

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BBC: Polio Confirmed In Syria - WHO

Syria - Credit Wikipedia

 

# 7912

 

While not surprising, given the reports last week (see WHO: Reports Of Suspected Polio In Syria & ECDC Risk Assessment : Suspected Polio In Syria),  this morning the BBC and Reuters are both reporting that the World Health Organization has announced positive poliovirus test results for 10 of the 22 AFD (acute flaccid paralysis) cases reported.  Test results are pending for the remaining cases.

 

While 22 cases may not seem like a lot, the reality is that only about 1%-2% of those infected develop paralysis. Meaning that 22 AFP cases are simply the tip of a much larger viral iceberg, and could involve more than 2,000 additional infections.

 

I expect we’ll get a formal announcement from the World Health Organization later today, but for now we have this from the BBC:

 

Syria polio outbreak confirmed by WHO

The World Health Organization (WHO) has confirmed 10 cases of polio in Syria - the first outbreak in the country in 14 years.

The UN body says a further 12 cases are still being investigated. Most of the 22 people who have been tested are babies and toddlers.

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Egypt Testing Suspected MERS-CoV Case

 

 

*** UPDATED *** 

Overnight, via both Crofsblog (see Egypt: Suspected MERS case tests negative) and FluTrackers (see post) multiple Arabic media sources are reporting that this patient tested negative for the MERS coronavirus.

 

 

# 7911

 

With the caveat that anyone recently returned from Saudi Arabia who develops pneumonia (which could be due to a variety of viral,bacterial, or fungal causes) within 10 days would be tested for the novel coronavirus, multiple reports have emerged in Egypt’s Arabic press over the past few hours regarding a woman who is in intensive care, and who is recently returned from Riyadh.

 

This is cold & flu season, and so this could be anything.  Nevertheless, appropriate precautions are being taken, tests are being conducted, and results should be known tonight or on Tuesday.

Sharon Sanders on FluTrackers has a thread with several  media reports on this case, and Crof has the story as well (LINK)  via a tweet by @MERS_inSaudi . Some excerpts include:

 

Suspicion of injury lady returning from Saudi Arabia virus ' Corona ' in Mansoura

Masry Al-Youm dialogue « Maha Rabat » Health Minister

Walid Ibrahim Taibo and Majdi

The Ministry of Health and Population, obtaining a sample of the lady suspect bird flu Pfirs , the ' Corona ' , for analysis central labs in the ministry , is expected to be completed by the analysis results and announced , on Tuesday evening.

A medical source said the ministry , Monday , said that « the Ministry of Health held a woman from the city of Mansoura Dakahlia Governorate , on suspicion of being infected with HIV Corona , a housewife (28 years), and was present in Riyadh, Saudi Arabia, to accompany her husband since 4 months and returned to Cairo since the days » .

He added that « Ms. developed symptoms of infection immediately after returning to Cairo , and was suspected of being infected with the virus, the ministry detaining hospital issued and viruses Mansoura and get a sample to be analyzed central labs , to make sure her or not, it exists now in intensive care in hospital as a result of her pneumonia » .

The Ministry of Health has got random samples of 500 pilgrims returning from Saudi Arabia after performing Hajj, in anticipation to carry them for any viruses are contagious, especially « Corona » which has spread in the Kingdom during the last period , as the ministry work Kart follow-up to a random collection of pilgrims, for a period of 10 days starting from the date of return , kart and distributed to health directorates in the governorates its Haj to follow his health during that period and detained at a hospital diets if any symptoms appear .

 

Today .. Announce the results of analyzes of the first suspected case of injury b «Corona»

Said Dr. Magdy Hegazy, Undersecretary of the Ministry of Health to Dakahlia , that the results of analyzes of samples suspected of injury in Ross "Corona", will appear on Monday evening or Tuesday morning.

The Hegazy, for " in Tu, the suspect in his suffering from severe pneumonia, and symptoms similar to Ross Corona, what summoned and put in a room isolation hospital chest Balmain Photos of in order to take the necessary precautions, and continued: "The proven his pal in Ross will conduct a comprehensive survey of its people and the region live in her to avoid the outbreak in Ross. "

The Chest Hospital Balmain pictures of detained yesterday a patient suspected of suffering by the Ross "SK" after the onset of symptoms of the disease, and impounded the Health Directorate b Dakahleya custody of the issuance of any data on the situation by conducting the necessary tests; fear of provoking public opinion, where is this is the first case.

WHO Update: Cholera Outbreak In Mexico

Cholera In The Americas 10/12 – 10/13 - Credit PAHO

 

# 7910

 

 

A follow up to a couple of posts earlier this month (see ECDC: Epidemiological Update On Cholera In Mexico & WHO GAR Update: Cholera In Mexico) the World Health Organization has issued a new update on the Cholera situation in Mexico. 

 

The good news here is, the rate of new cases being reported has decreased significantly in recent weeks.

 

Cholera in Mexico – update

Disease outbreak news

28 October 2013 - The Ministry of Health in Mexico has reported an additional five cases of infection with Vibrio cholerae O1 Ogawa toxigenic.

The five cases occurred in the geographic zone of la Huasteca, an area where urbanization, availability of drinking water and basic sanitation services are limited.

From 9 September to 25 October 2013, a total of 176 confirmed cases, including one death, of infection with Vibrio cholerae O1 Ogawa toxigenic has been reported in the country. Of these, two are from the Federal District, 157 cases from the state of Hidalgo, nine from the state of Mexico, two from the state of San Luis Potosi and six from the state of Veracruz. Eighty-nine of the total confirmed cases are women and 87 are men. Fifty-seven cases have been hospitalized.

An antimicrobial susceptibility test for Vibrio cholerae O1 Ogawa toxigenic was conducted by the Institute of Epidemiological Diagnostics and Reference (InDRE) which demonstrated that the bacterium was susceptible to the medicines doxycycline and chloramphenicol, with reduced susceptibility to ciprofloxacin and resistance to trimethoprim/sulfamethoxazole.

The health authorities of Mexico continue to strengthen outbreak investigation and surveillance at the national level and continue to ensure the availability and quality of care in medical units. Health professionals at different levels of the health care system are being trained in prevention, treatment and control of the disease. Measures are being implemented to ensure access to drinking water and basic sanitation at the community level. Awareness campaigns, particularly around safe water and food consumption are being carried out in Spanish and indigenous languages.

This is the first local transmission of cholera recorded since the 1991-2001 cholera epidemic in Mexico. The genetic profile of the bacterium obtained from patients in Mexico presents high similarity (95%) with the strain that is currently circulating in three Caribbean countries (Haiti, Dominican Republic and Cuba), and is different from the strain that had been circulating in Mexico during 1991-2001 epidemic.

WHO does not recommend that any travel or trade restrictions be applied to Mexico with respect to this event.

Nature: Receptor Binding Of H7N9

Flu Virus binding to Receptor Cells – Credit CDC

 

# 7909

 

For an influenza virus to infect a host, the virus must bind (attach) itself to the surface of a cell.  To do that influenza viruses have an RBS - Receptor Binding Site (the area of its genetic sequence that allows it to attach to, and infect, host cells) that – like a key slipping into a padlock -`fit’ the host’s receptor cells.

 

Avian adapted flu viruses, like the H5N1 virus, bind preferentially to the alpha 2,3 receptor cells found in the gastrointestinal tract of birds.  While there are some alpha 2,3 cells deep in the lungs of humans, for an influenza to be successful in a human host, most researchers believe it needs to a able to bind to the α2-6 receptor cell found in the upper airway (trachea).

 

We’ve seen studies over the summer that the emerging H7N9 virus in China – unlike the H5N1 virus – has shown signs of adapting to mammalian physiology (see Nature: Biological Features Of H7N9).   Among the findings:

 

• Unlike the H5N1 virus – which binds preferentially to avian receptor cells (a2,3-linked sialic acid) -  H7N9 binds to both the avian and human (a2,6-linked sialic acid) receptor cells.

• This dual receptor cell binding ability likely enhances the virus’s ability to transmit from birds to humans.

• The virus appears to replicate well in the lower human respiratory tract - but less well in the trachea – which may have helped to limit its ability to spread from human-to-human.

• Once infected, the virus often produces severe illness in humans, and patients tested showed increased serum levels of chemokines and cytokines, suggesting the possibility of infection inducing a `cytokine storm’.

• There appears to be little  or no community immunity to H7 viruses.

 

Today, we’ve another study appearing in the Journal Nature that looks at the ability of the H7N9 virus to bind to human receptor cells (in vitro), that finds the virus better adapted to human receptor cells than earlier H7N9 viruses, but perhaps still not quite ready for prime time.

 

 

Adaptation of novel H7N9 influenza A virus to human receptors

J. C. F. M. Dortmans, J. Dekkers, I. N. Ambepitiya Wickramasinghe, M. H. Verheije, P. J. M. Rottier, F. J. M. van Kuppeveld, E. de Vries & C. A. M. de Haan

ABSTRACT

The emergence of the novel H7N9 influenza A virus (IAV) has caused global concerns about the ability of this virus to spread between humans. Analysis of the receptor-binding properties of this virus using a recombinant protein approach in combination with fetuin-binding, glycan array and human tissue-binding assays demonstrates increased binding of H7 to both α2-6 and α2-8 sialosides as well as reduced binding to α2-3-linked SIAs compared to a closely related avian H7N9 virus from 2008. These differences could be attributed to substitutions Q226L and G186V. Analysis of the enzymatic activity of the neuraminidase N9 protein indicated a reduced sialidase activity, consistent with the reduced binding of H7 to α2-3 sialosides. However, the novel H7N9 virus still preferred binding to α2-3- over α2-6-linked SIAs and was not able to efficiently bind to epithelial cells of human trachea in contrast to seasonal IAV, consistent with its limited human-to-human transmission.

 

 

The entire study is open-access, and quite detailed regarding methods and materials.  The authors sum up their findings in the discussion:

 

The results indicate that, in comparison to avian H7N9 virus, the human H7N9 virus displays increased binding to α2-6 as well as α2-8 sialosides and reduced binding to α2-3-linked SIAs. Still, whereas all seasonal/pandemic IAVs bind more efficiently to α2-6- than to α2-3-linked sialosides, the human H7 protein binds more efficiently to α2-3- than α2-6-linked SIAs and is not able to efficiently bind to epithelial cells of human trachea. From these results we conclude that the human H7N9 virus has not (yet) adapted its HA protein to such an extent that it results in a receptor-binding profile similar to that of pandemic/seasonal IAV.

 

For more on the evaluation of the emerging H7N9 virus, you may wish to revisit:

 

Nature: H7N9 Pathogenesis and Transmissibility In Ferrets & Mice

Nature: Limited Airborne Transmission Of H7N9 Between Ferrets

Eurosurveillance: Genetic Analysis Of Novel H7N9 Virus

Pediatrics: Influenza-Associated Pediatric Deaths

 

Credit CDC FluView

 

# 7908

 

Since reporting became mandatory in 2004, yearly pediatric influenza deaths have ranged from a low of 35 during the 2011-2012 flu season to a high of 282 during the 2009—2010 pandemic. The number of flu-related pediatric deaths displayed in the chart above is likely under stated since only those patients who are tested for influenza, test positive, and then are subsequently reported to the CDC are counted. 

 

In the aftermath of the H1N1 pandemic of 2009, the CDC estimated that the likely number of pediatric deaths in the United States ranged from 910 to 1880, or anywhere from 3 to 6 times higher than reported.

 

Regardless of the true number, influenza exacts a tragic toll each year among children in the United States (and around the world).

 

Today, scientists from the Influenza Division and Epidemic Intelligence Service of the Centers for Disease Control and Prevention (CDC) have published a review of pediatric deaths related to influenza infection over the past 8 years in the Journal Pediatrics.

 

Influenza-Associated Pediatric Deaths in the United States, 2004–2012

Karen K. Wong, MD, MPH, Seema Jain, MD, Lenee Blanton, MPH, Rosaline Dhara, MPH, Lynnette Brammer, MPH, Alicia M. Fry, MD, MPH, and Lyn Finelli, DrPH

ABSTRACT (Excerpts)

RESULTS: From October 2004 through September 2012, 830 pediatric influenza–associated deaths were reported. The median age was 7 years (interquartile range: 1–12 years). Thirty-five percent of children died before hospital admission. Of 794 children with a known medical history, 43% had no high-risk medical conditions, 33% had neurologic disorders, and 12% had genetic or chromosomal disorders. Children without high-risk medical conditions were more likely to die before hospital admission (relative risk: 1.9; 95% confidence interval: 1.6–2.4) and within 3 days of symptom onset (relative risk: 1.6; 95% confidence interval: 1.3–2.0) than those with high-risk medical conditions.

CONCLUSIONS: Influenza can be fatal in children with and without high-risk medical conditions. These findings highlight the importance of recommendations that all children should receive annual influenza vaccination to prevent influenza, and children who are hospitalized, who have severe illness, or who are at high risk of complications (age <2 years or with medical conditions) should receive antiviral treatment as early as possible.

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We’ve looked at other studies on influenza in pediatric patients in recent years, including:

 

BMJ: Risk Factors For Children With Pandemic Flu which identified some predictors of severe H1N1 infection and potentially fatal outcomes in children:

• History of chronic lung disease
• History of cerebral palsy/developmental delay
• Signs of chest retractions (difficulty breathing)
• Signs of dehydration
• Requires oxygen to keep blood levels normal
• Heart rate that exceeds normal range (tachycardia) relative to age

 

A report from last spring from the CDC: About 90% Of Pediatric Flu Fatalities Were Unvaccinated in the 2012-2013 flu season (to that date).

 

And yet another study in the Journal Pediatrics from August of 2012 (see Study: Kids, Underlying Conditions, And The 2009 Pandemic Flu) that found a high number of fatalities among kids with underlying neurologic conditions.

 

And lastly, in 2011 in MMWR: Influenza-Associated Pediatric Deaths 2010-2011 we looked at the first non-pandemic flu season after the end of the 2009 pandemic.  As with today’s study, they found just under half (49%) of these pediatric deaths occurred in children who had no ACIP defined high risk medical conditions. These children also saw a shorter interval between illness onset and death (4 days versus 7 days), and were more likely to die at home or in the emergency department.

 

While the flu vaccine admittedly delivers lower protection – particularly among the elderly – than we’d like, among children its effectiveness appears higher.  CIDRAP’s 2011 meta-analysis (see CIDRAP: A Comprehensive Flu Vaccine Effectiveness Meta-Analysis) found:

 

TIV showed efficacy in preventing influenza during 8 of 12 flu seasons (67%) with a combined efficacy of 59% among healthy adults (aged 18–65 years).

And among children aged 2-7, the LAIV proved even more protective, showing efficacy in 9 out of 12 flu seasons (75%) with a pooled efficacy of 83%. 

 

Last year, the the CDC has estimated flu vaccine effectiveness in children at 64% (aged 6 months to 17 years old).  While lower than hoped for, this is still a moderate level of protection.   Which is why the CDC states:

 

CDC recommends annual flu vaccination as the first and best step in preventing influenza. CDC recommends antiviral drugs as a second line of defense against flu for those people who are seriously ill and those who are at high risk of flu complications, even if they have been vaccinated.

 

To this I would add rigorous `flu hygiene’ – particularly during the flu season, but applicable year round; frequent handwashing, avoiding touching your face, covering coughs & sneezes, and staying home if sick.  For the latest updated information from the CDC about the current flu season, you may wish to visit:

 

What You Should Know for the 2013-2014 Influenza Season

GridEx 2013 Preparedness Drill

 

# 7907

 

One of the realities of modern living is how utterly dependent we’ve all become on having a steady supply of electricity in our homes and places of work.  Few Americans know what it would be like, or are prepared to cope, with a prolonged power outage.

We’re not talking hours here.  We’re talking days or even weeks with no electricity.

 

While it might seem a remote possibility, in truth, it happens with surprising frequency in this country – usually connected with an extreme, but localized weather event such as a hurricane, tornado, or ice storm.  For coastal residents from Texas to New England, it isn’t unheard of to be without power for a week or longer after a major hurricane.

 

An even bigger concern is a massive grid failure, either due to a natural event (solar flare, CME or other natural disaster),  cyber or criminal attack, or simply an overload of an ageing power distribution system.  

Tonight  the National Geographic Channel will run a 2-hour movie dramatization of what a 10-day national blackout might look like.   You can view the 1 minute trailer on Youtube. 

While it might be easy to dismiss this as just another improbable disaster movie, I can assure you that everyone from FEMA to the CDC to Homeland Security takes this threat seriously.   This week, the CDC’s Public Health Matters blog  discusses tonight’s movie, and the need for Americans to be prepared for prolonged power outages.

 

American Blackout

Categories: General, Natural Disasters, Preparedness

October 24th, 2013 10:46 am ET  -  Blog Administrator

By Kristen Nordlund

This Sunday night there might be a few things vying for your attention – it’s Game 4 of the World Series, the Packers face the Vikings, and there’s a new episode of The Walking Dead. In addition to sports and the undead, the National Geographic Channel is debuting a movie about what happens when the lights go out. Literally.

American Blackout chronicles five groups of people during a ten-day power outage caused by cyber criminals.  How realistic is this scenario? Considering that since 2000 there have been more than 60 wide-scale power outages, including one in India lasting two days and affecting 670 million people, and it might not seem so far-fetched.

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It is the job of the North American Electric Reliability Corporation (NERC) to "ensure the reliability of the North American bulk power system", a mandate given to it in 2006 as a result of the 2003 Northeast blackout which affected more than 50 million people in the United States and Ontario, Canada.  

 

In April of 2009, NERC issued a public notice warning that the grid was `vulnerable’ to cyber attack, and that same year  the National Academy of Sciences produced a 134 page report on the potential damage that a major solar flare could cause in Severe Space Weather Events—Understanding Societal and Economic Impacts (see Solar Storms, CMEs & FEMA).

 

Both scenarios could produce prolonged, widespread, and devastating power outages that could last weeks or even months (see NPR report Solar Storms Could Be Earth's Next Katrina).

 

Which is why NERC will be conducting a massive drill in mid-November, to determine their ability to respond to a full grid-down situation, caused by a cyber-attack.  This is to be a simulated attack, and no power outages are planned for this exercise.

 

Admittedly, no one knows when, or even if, a major grid failure will occur.  Just like we don’t know what next spring’s tornado season will bring, when the next major earthquake or CAT 5 hurricane will strike, or whether a devastating pandemic is in the offing in the next few years. 

What we do know, is that major disasters happen every year, and affect millions of people. And those who are better prepared to deal with them, generally have an easier time of it.  

 

Sadly, too few people take preparedness seriously, as evidenced by the numbers in this CDC Infographic.

 

Last September was National Preparedness Month (NPM2013), and I, along with many other coalition members, devoted a good deal of time towards spreading the preparedness message.

 

The goal of NPM2013 is to foster a culture of national preparedness, and to encourage everyone to plan and be prepared to deal with any disaster where they can go at least 72 hours without electricity, running water, local services, or access to a supermarket.

 

These are, of course, minimum goals.

 

Disruptions that accompany hurricanes, floods, pandemics, and yes . . . even massive grid down scenarios  . .  can potentially last for days or even weeks, and so – if you are able to do so - being prepared for 10 days to 2 weeks makes a good deal of sense (see When 72 Hours Isn’t Enough).

 

While a 100% failure of the grid may be far down your list of `probable’ threats, the common sense steps you take to prepare for any disaster will serve you well during a prolonged blackout.  For more on `all hazards’ preparedness, I’d invite you to visit:

 

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

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

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

 

And you can use this link to read earlier NPM preparedness posts on this blog.