Korea: MERS Cases Jump To 18

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Although a somewhat cryptic machine translation, we've an announcement from the Korean Health & Human Welfare department of three more positive MERS cases.

Middle East respiratory syndrome caused additional titles in three, cumulative 18 people

Date 2015-06-01 [ Last Updated: 2015-06-01 ] 

Hwangsangcheol personnel department of the central administration Homers Headquarters
Middle East respiratory syndrome caused additional patients in three, cumulative 18 people

- B 2 Hospital inpatient , inpatient another family three people , including one confirmed positive -

□ The Ministry of Health and Welfare Mon., June 1st , the Middle East Respiratory Syndrome ( Homers ) was released three additional cases of confirmed positive test result .

○ today identified three patients with end- all of which are confirmed positive in around 5.15 to 5.17 days in hospital as a patient or family to the ward , such as the first patient , Homers genetic test conducted in accordance with symptoms such as fever continues in hospital B , Sound pressure was transferred to the isolation beds.

As if the story weren't convoluted enough, there is also an unconfirmed media report (see FluTrackers  South Korea - Media report: Confirmed coronavirus MERS case rode on a bus for 1.5 hours while symptomatic - June 1, 2015)  that - if true - could have resulted in additional exposures to the virus outside of the hospital.

Hopefully we'll get an English language report that will help clarify this story.

Thus far we've not seen any community acquired cases of MERS in Korea, Hong Kong, or Mainland China. The next couple of weeks will be crucial in determining whether that status can be maintained.

Abu Dhabi: Two Asymptomatic MERS Cases Clear Virus, Leave Hospital

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The two truck drivers (mentioned in my last blog) who tested positive for the MERS earlier this month virus after the camels they were transporting from Oman to the UAE proved infected, have been released from hospital isolation after successfully clearing the virus.

First the news report, then I'll be back with a little bit more on why this matters.

HAAD: Two MERS CoV cases test negative and leave hospital 

31/05/2015 03:02:00 PM 

ABU DHABI, 31st May, 2015 (WAM) - The Health Authority - Abu Dhabi, HAAD, have announced that the two individuals who were in isolation in hospital with MERS Coronavirus (MERS CoV) have now tested negative for the virus, and left the hospital. 

HAAD said in a statement today that the cases were confirmed positive through active case finding, and were kept in isolation at hospitals as a precautionary measure. They were able to clear the virus themselves without any treatment. 

HAAD confirmed that it is coordinating with the Ministry of Health and other authorities in the country, and has taken all necessary measures as per international standards and recommendations from the World Health Organisation, WHO. 

The Ministry of Health confirmed that it is monitoring the situation closely to ensure the health and safety of everyone. 

Both of these patients have been described as `asymptomatic' in the HAAD releases and the WHO updates, and their detection and isolation was the result of routine testing after the camels they were transporting tested positive for the MERS coronavirus.

Were it not for this rather serendipitous finding, they'd never have known they were infected, and might have passed the virus on to others. 

While it is unknown whether asymptomatic cases can spread the virus on to others, some studies have suggested it is possible (see Study: Possible Transmission From Asymptomatic MERS-CoV Case), and the lack of obvious epidemiological links between many community acquired cases certainly raises the question.


Unknown also is the extent of asymptomatic carriage of the MERS virus.

Limited contact testing of asymptomatic (or mildly symptomatic) contacts of known cases has turned up a substantial number, and in November of 2013, we looked at a study published in The Lancet that  calculated  for every case identified, there were likely 5 to 10 that went undetected. 

How many there really are?  Well, that's the $64 question. 

Until we can quantify both the risks and incidence of asymptomatic carriage of MERS, our understanding of the true transmissibility and severity of the the virus is likely to remain skewed.

WHO MERS-CoV Update - Korea May 31st

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The World Health Organization has posted an update on the 12th MERS case from South Korea.

Middle East respiratory syndrome coronavirus (MERS-CoV) – Republic of Korea 

Disease outbreak news 31 May 2015 

On 30 May 2015, the National IHR Focal Point of the Republic of Korea notified WHO of an additional confirmed case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV). 

Details of the case are as follows:

The 12th case is a 49-year-old male who is the husband of the 11th case that was reported in a previous DON on 30 May. The patient took care of his wife during her hospitalization from 15 to 17 May. During this period, he shared the same ward with the first case. The patient developed symptoms on 21 May and was admitted to hospital. As symptoms persisted, he was later transferred to the nationally designated medical centre. The patient tested positive for MERS-CoV on 29 May. Contact tracing of household contacts and healthcare contacts is ongoing for the case.

Globally, WHO has been notified of 1149 laboratory-confirmed cases of infection with MERS-CoV, including at least 431 related deaths.

Oman Reports 6th MERS Case

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Although Oman has only reported a small handful of MERS cases over the past three years, its camels are known to carry  high levels of antibodies to the virus (see Lancet: Camels Found With Antibodies To MERS-CoV-Like Virus). 

Earlier this month two truck drivers transporting camels from Oman to the UAE were found to be asymptomatically infected (see WHO: Asymptomatic MERS-CoV Case – UAE). 

Today Oman's Ministry of Health has announced their 6th MERS case, and the first one detected since last January's cluster of three cases (see WHO: Oman Reports 3rd MERS Case Of 2015).

Health Ministry Records New Coronavirus Case 

The Ministry of Health affirmed that it recorded a new case with Middle East Respiratory Syndrome Coronavirus (MERS-COV). The new case is the sixth from the total number of cases recorded in the Sultanate, where the last case was diagnosed in January this year. 

This case is related to a 75-years-old patient suffering from severe pneumonia and high fever. The condition of the patient is stable and under observation and treatment in referral hospital. 

The Ministry of Health confirms the continuation of its efforts to monitor and control the disease through the affective epidemic monitoring system in-force, as well as the readiness of all referral hospitals to handle with such cases. Whereas, the Ministry proceed the preventive health procedures with the other relevant authorities. 

The Ministry calls all citizens and residents to adhere with advices and guidance that effectively contribute to overcome a lot of health problems and infections including respiratory diseases, foremost of which are; public hygiene, cleaning hands and following the proper health practices while coughing and sneezing. 

Saudi MOH: 4 More MERS Cases In Hafuf

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For the past six weeks we've been following a slowly escalating cluster of MERS cases from the town of Hafuf (aka `Hafoof') in the Northeastern part of the country.

The index case was 61 year-old male who fell ill on April 16th, and reported a history of contact with camels. 

Since then (starting May 5th) we’ve seen a steady procession of additional cases, all described as `contacts of a previously suspected or confirmed case’, come out of Hafuf.   Some were described as household members, for others the relationship was not specified.


As of yesterday, that cluster stood at 14.  Today the MOH announced 4 more cases along with two recent deaths (plus 1 in Taif).  And as with all of the other cases, these all appear to be part of the same cluster.

Korean Cluster Grows To 15

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We don't have a lot of information yet (it is almost 2am in Korea), but following announcement very recently went up on the Korean Health and Human Welfare website confirming another two MERS cases.

Middle East Respiratory Syndrome Patients additional two people occur , the cumulative 15 people

- B hospital patient , another patient two people , including a family one positive confirmation -

□ Department of Health and Human Services has announced the Middle East Respiratory Syndrome ( Homers ) confirmed two additional cases of positive test results .

○ today confirmed that two of the patients , one patient ( male , 35 years) patients who are admitted to the same ward with the first patient in hospital B ,

○ remaining one patient ( male, 35 years) ( inpatients in general , the current home of isolation ) mother was admitted to the same ward is the son munbyeong daily .

WHO MERS-CoV Update - Korea May 30th

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Middle East respiratory syndrome coronavirus (MERS-CoV) – Republic of Korea 

Disease outbreak news 30 May 2015 

Between 26 and 29 May 2015, the National IHR Focal Point of the Republic of Korea notified WHO of additional confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV). This DON describes the 8 additional cases and provides an update on the 3 cases of MERS-CoV infection reported in a previous DON on 24 May.
Details of the cases are as follows:

• The first case was reported in the DON of 24 May. The patient is a 68 year-old male with the following travel history: 18-29 April, Bahrain; 29-30 April, United Arab Emirates; 30 April to 1 May, Bahrain; 1-2 May, the Kingdom of Saudi Arabia; 2 May, Bahrain; and 2-3 May, Qatar. He arrived at Incheon International airport via Qatar on 4 May. The patient was asymptomatic on arrival. He developed symptoms on 11 May and sought medical care at a local clinic from 12 to 15 May. The patient was then admitted to hospital on 15 May and discharged on 17 May. On the day of discharge, he went to another clinic. Between 17 and 20 May, the patient visited another hospital. He tested positive for MERS-CoV on 20 May and was transferred to the nationally designated treatment facility for isolation. Currently, the patient is in stable condition. He has no history of exposure to known risk factors. Investigation of the source of infection is ongoing.

• The second case was reported in the DON of 24 May. The patient is a 64 year-old female who is the wife of the first case. She has no comorbidities. The patient did not travel abroad. She took care of her husband during his hospitalization from 15 May. The patient developed symptoms on 18 May and was transferred to the nationally designated medical centre. She tested positive for MERS-CoV on 20 May. Currently, the patient is in stable condition.

• The third case was reported in the DON of 24 May. The patient is a 76 year-old male who shared a hospital room with the first case on 16 May. He developed symptoms on 20 May and was transferred to the nationally designated medical centre. The patient tested positive for MERS-CoV on the same day. Currently, he is in stable condition.

• The fourth case is a 46 year-old female who is the daughter of the third case. The patient took care of her father during his hospitalization from 16 to 20 May. During this period, she shared the same room with the first case. The patient had been under monitoring since 21 May and developed symptoms on 25 May. She was transferred to the nationally designated medical centre and tested positive for MERS-CoV on 25 May. Currently, the patient is in stable condition.

• The fifth case is a 50 year-old, male health professional who treated the first case on 17 May. The patient had been self-isolated and under monitoring since 22 May. He developed symptoms on 25 May and was transferred to the nationally designated medical centre. He tested positive for MERS-CoV on 26 May. Currently, he is in stable condition.

• The sixth case is a 71 year-old male who shared the same ward with the first case during his hospitalization from 15 to 17 May. The patient, who has comorbidities, developed symptoms on 24 May and visited an emergency department. He tested positive for MERS-CoV on 28 May.

• The seventh case is a 28 year-old, female health professional who was involved in the first case’s care between 16 and 17 May. Her self-isolation started from 21 May and she developed symptoms. As symptoms worsened, the patient was transferred to the nationally designated medical centre on 27 May. She tested positive for MERS-CoV on 28 May. The patient, who has no comorbidities, is currently in stable condition.

• The eighth case is a 46 year-old female health professional who treated the first case on 15 May. The patient, who has no comorbidities, developed symptoms and was transferred to the nationally designated medical centre on 26 May. She tested positive for MERS-CoV on 29 May. Currently, the patient is in stable condition.

• The ninth case is a 56 year-old male who shared the same ward with the first case during his hospitalization from 15 to 17 May. The patient had been hospitalized since 9 May for an unrelated medical condition. He tested positive for MERS-CoV on 29 May.

• The 10th case is a 79 year-old female who shared the same ward with the first case during his hospitalization from 15 to 17 May. The patient, who has comorbidities, developed symptoms on 20 May and was isolated on 28 May. She tested positive for MERS-CoV on 29 May.

• The 11th case is a 49 year-old female who shared the same ward with the first case during his hospitalization from 15 to 17 May. The patient, who has comorbidities, developed symptoms on 21 May and was isolated on 28 May. She tested positive for MERS-CoV on 29 May.

Contact tracing of household contacts and healthcare contacts is ongoing for the cases.
Globally, WHO has been notified of 1147 laboratory-confirmed cases of infection with MERS-CoV, including at least 431 related deaths.

WHO MERS-CoV Update : China's 1st Case

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The World Health Organization has published an update on the first MERS case in China, imported to that country by an infected businessman from South Korea.

Middle East respiratory syndrome coronavirus (MERS-CoV) – China

Disease outbreak news 30 May 2015

On 29 May 2015, the National Health and Family Planning Commission (NHFPC) of China notified WHO of one confirmed case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV).

Details of the case are as follows:

The case is a 44 year-old male from the Republic of Korea. The patient is the son of the third MERS-CoV case and the younger brother of the fourth MERS-CoV case that were reported in a previous DON on 30 May. He developed symptoms on 21 May. The patient flew to China, Hong Kong Special Administrative Region on 26 May and subsequently travelled to Huizhou through point of entry in Shenzhen City, Guangdong Province. The local health authority found him on 27 May and immediately transferred him to a designated hospital for isolation. He tested positive for MERS-CoV on 29 May.
The Chinese Government has taken the following surveillance and control measures:

• Actively treating the patient and strengthening hospital infection control measures;

• Testing of the patient samples and sequencing the virus and ensuring laboratory biosafety;

• Strengthening of the emergency surveillance, in particular fever screening in outpatient settings;

• Strengthening tracing, management and health monitoring of close contacts;

• Ensuring risk communication to the public.

Globally, WHO has been notified of 1148 laboratory-confirmed cases of infection with MERS-CoV, including at least 431 related deaths.

WHO advice

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

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures. 

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to. 

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked. 

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.

ECDC: Epidemiological Update On MERS-CoV - May 30th

ECDC- MERS Activity By Month

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The ECDC has published a new epidemiological update on MERS today which provides us with the best English-language description of the Korean MERS cluster we've seen to date, along with the index case's travel history. 

One of the pieces of information that we don't seem to be getting from the Koreans is the condition of these cases.  

The history of infection in the Middle East has been that MERS can produce a wide spectrum of illness, ranging from asymptomatic to life-threatening.  The fact that we don't have any clue as to the severity of illness among these cases is a curious omission. 

Follow the link below for the full report, including several graphs and charts. 

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

30 May 2015
Recent developments 

South KoreaOn 20 May 2015, the South Korean Centers for Disease Control and Prevention reported a case of Middle East respiratory syndrome coronavirus (MERS-CoV) in a 68-year-old man, with recent travel history to Middle East. According to WHO, the man had the following travel history:  

• 18-29 April, Bahrain;

• 29-30 April, United Arab Emirates;

• 30 April to 1 May, Bahrain;

• 1-2 May, the Kingdom of Saudi Arabia;

• 2 May, Bahrain; and

• 2-3 May, Qatar.

The case arrived at Korea’s Incheon International airport via Qatar on 4 May, while being asymptomatic. On 11 May, he developed cough and fever and sought medical care at an outpatient clinic between 12 and 15 May. He was hospitalised on 15 May, discharged on 17 May and readmitted same evening in another hospital after presenting to the emergency department. On 20 May he tested positive for MERS-CoV and was transferred to the nationally designated treatment facility for isolation. The patient has no history of exposure to known risk factors in the 14 days prior to detection. Investigation of the source of infection is ongoing. [1] 

As of 30 May, the index case has resulted in eleven secondary cases:

• One patients sharing his room and four patients admitted in the same ward;

• Three healthcare workers having cared for the index case;

• Three among close family members: the wife of the index case, and the son and daughter of a patient admitted in the same ward.

Onset dates range from 11 May for the index case, until 28 May for the two most recent nosocomial cases, according to the Korean Centers for Disease Prevention and Control.
The son of the patient admitted in the same ward travelled to Hong Kong, Guangdong province, China, on 26 May 2015. He was admitted and isolated in a hospital in Hong Kong on 27 May 2015. This patient was confirmed positive for MERS-CoV infection on 29 May. [2]

United Arab EmiratesThe United Arab Emirates have reported in May 2015 two asymptomatic cases found through enhanced surveillance. According to WHO, both cases had a history of contact with MERS-CoV infected camels imported from Oman. The United Arab Emirates have reported 76 cases of MERS-CoV since 13 July 2013. Twenty-nine of the 76 cases were healthcare workers.

QatarSince the last rapid risk assessment on 7 March 2015, Qatar has reported three additional cases. All cases were male. One of the cases had frequent contact with camels.

Saudi ArabiaSince the last rapid risk assessment on 7 March 2015, Saudi Arabia has reported 72 additional cases and 40 deaths. Of the 72 cases, 78% (n=56) were male. The average age for 72 cases was 53 years, ranging from 20 to 93 years. Twenty-one of the 72 cases were classified as having contact to a confirmed case either in the community or hospital.  Five of the 72 cases were healthcare workers. Eight of the 72 cases reported animal contact and seven reported to have drank camel milk.

Worldwide situation
Since April 2012 and as of 30 May 2015, 1 172 cases (including 479 deaths) of MERS-CoV have been reported by health authorities worldwide (Figure 1).

Conclusion 

The importation of a case of MERS-CoV to a third country is not unexpected and has happened in the past. On several occasions, notably in France and in the UK, it has resulted in secondary transmission among patients and healthcare workers in contact with the imported cases, as well as among close relatives of cases. However, clusters of this size have not been observed so far outside of the Arabian Peninsula. WHO indicates that there is currently no indication that the virus behaves differently than in other instances in the past and that there is no indication of sustained transmission from person to person. It is the first time that an imported case results in a secondary transmission affecting another country. 

ECDC’s conclusion continues to be that the MERS-CoV outbreak poses a low risk to the EU. Because of the continued risk case importation to Europe after exposure in the Middle East, international surveillance for MERS-CoV cases remains essential. 

Although sustained human-to-human transmission is unlikely, secondary transmission in unprotected close contacts, including healthcare settings, remains possible, as currently seen in South Korea. 

An overview of MERS-CoV infection is presented in an ECDC fact sheet [3], which also provides a detailed overview of measures to be taken by health professionals for case management and treatment.

Hong Kong: Two `Contacts' Of MERS Case Refuse Quarantine

Lady MacLehose Holiday Village in Sai Kung

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Quarantines - like jury duty - while often an expedient means to an end, aren't exactly warmly embraced by those caught up by them.  Some people will go to extremes to avoid either.

Here in the United States - except in extraordinary circumstances - `quarantine' is likely to mean staying home and limiting household contacts for a prescribed period of time.  

But in places like Hong Kong - where the memory of SARS remains fresh - quarantine usually means a two-week stay at the Lady MacLehose Holiday Village in Sai Kung (description below).

Lady MacLehose Holiday Village
Special Notice

In view of the latest development regarding Middle East Respiratory Syndrome (MERS), the Lady MacLehose Holiday Village has turned into a quarantine centre from 29 May 2015 onwards. Camping services at the Village are suspended until further notice.

For enquiries, please contact the staff of the Village on 2792 3084. 

Located within Sai Kung Country Parks at Pak Tam, Sai Kung, the Lady MacLehose Holiday Village has an air of tranquility and presents a charming view of the woody hillsides. Each bungalow, which can accommodate 3 to 15 persons, is self-contained with a sitting room, bedroom(s) and a toilet with shower facilities. The Camp has a capacity of 280 campers. Hirers please note that Camp facilities, such as bungalows, recreational facilities, canteen, etc., are located on different spots of a slope and connected by pavements.

Despite the amenities offered, getting people to willingly (and abruptly) drop everything and move into a quarantine camp isn't always easy, as the following Xinhua News report shows.

Two People Refuse To Go Into MERS Quarantine  

English.news.cn   2015-05-30

16:00:26

HONG KONG, May 30 (Xinhua) -- Two Korean nationals having close contact with a Middle East Respiratory Syndrome (MERS) patient who passed through Hong Kong are refusing to go into quarantine, said Health Secretary Ko Wing-man. 

The two Korean nationals are among 18 plane passengers who sat close to the MERS patient, probably against medical advice, Ko said. 

Hong Kong's health authorities have made plans for the 18 plane passengers to go into quarantine for two weeks at the Lady MacLehose Holiday Village in Sai Kung. But two of them are refusing to be tested and isolated, Ko said, adding that authorities can only contact them by phone. 

Ko said the Immigration Department is tracking them down, and the government could force them to be quarantined using Hong Kong laws.

As the incubation period of the disease could be more than ten days, the two could spread the deadly virus, he added.

During the SARS epidemic twelve years ago, no city was harder hit than Hong Kong, which saw 1750 cases and 286 deaths.  It took a while, but eventually the virus was contained (see Hong Kong’s Coronavirus Response), with quarantines regarded as perhaps the most effective weapon in the public health department’s arsenal.

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

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

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

 

As we've discussed often, some people can contract MERS and not show symptoms.  

Whether or not asymptomatic carriers can transmit the virus to others is still up for debate, but the high number of `unknown risk exposures' among Saudi cases makes it at least a plausible risk (see WHO EMRO: Scientific Meeting Reviews MERS Progress & Knowledge Gaps). 

Although one could argue that we are going about this the hard way, our knowledge and understanding of the MERS virus is likely to grow considerably over the coming weeks as Korea, Hong Kong, and mainland China learn to deal with its recent arrival. 

A pity that after three years we still don't have a proper case-control study from the Saudis, as many of those questions might already have been answered.

Korean Statement On 13th MERS Case

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Overnight there have been media reports of a 13th MERS case in Korea, this morning we've the following (translated) statement indicating that the husband of a previously identified case (#12) has now tested positive.

Date 2015-05-30 [Last Updated: 2015-05-30]
Middle East Respiratory Syndrome adding one people occur, the cumulative 13 people
- 12th in the patient's spouse at B hospital care -

□ Department of Health and Human Services, today announced the test results Homers one additional case was confirmed as positive.

○ 12th patient today confirmed the patient's spouse (male, 49 years) caring for a spouse from 5.15 to 5.17 days in hospital B had since been admitted to the same hospitals with fever symptoms, make a final positive genetic test Homers It is, was transferred to a state-designated isolation wards.

□ Department of Health and Human Services is dispatched on-site response team (director, and overstated 2 1 team for 8 people) from 5.29 days in the B hospital premises, monitoring of the contact, and take measures such as rapid tests.

○ geumbeon case further testing is in progress, in addition to the cases it has continuously dedicated to the management.
○ self-isolation was lifted for six people gihayeo 5.30 days for the first 0:00 of close contacts.
 

Interestingly, and as an indication of the degree of tension in Korea due to this outbreak,  attached to this statement there is a warning to the public regarding the spreading of rumors.

Attachment

         Rumors related matters advised
       
         Recent Comments portals and SNS mainly

Unconfirmed rumors are true or are recklessly wandering .

" For the time being XX do not go the hospital .XX hospital icu that do closing , I hope that yen hokyeona not going near the hospital .

""XX came out a little Homers virus now confirmed in the area very contagious those who are well . "

         " The airborne infection began . "

         " Dining out should not be outside, not even to be ferns are "

         " WHO 's actions proved Homers are not meaningful at all . "

Above 

Generating local and hospital patients , infections such as information referring to the articleInfection , treatments and information for the prevention of unidentifiedI tell the truth and no relationship at all .

Including patient care for patients with medical staff , patients and families who are classified as intimate contact, such as contact , home quarantine , hospital isolation are being managed through such , another patient who is safe and appropriate care was in the hospital Action was to receive .

In this way intentionally we will take strict measures to punish such right through the tree spread rumors about the investigation .

In addition , when the MER Suga doubt the Middle East, such as a fever after visiting Homers Hotline (043-719-7777) to report in , please .

H5N2: Minnesota Reports 4 Probable Infections, Iowa Reports 2

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While MERS has most of our attention today the plight of poultry farmers in the upper Midwest remains dire as six more farms (2 in Iowa, 4 in Minnesota) were announced as `presumed positive' for the HPAI H5N2 virus.

Minnesota, which had gone 10 days without a new infection, has now reported 14 new outbreaks since Tuesday.    Today's four new findings are:

Iowa - the hardest hit state having lost 28 million birds - reports additional outbreaks in two counties that have already seen multiple outbreaks.

TWO PROBABLE CASES OF HIGHLY PATHOGENIC AVIAN INFLUENZA IN WRIGHT AND SAC COUNTIES

CDC considers the risk to people to be low
DES MOINES – The Iowa Department of Agriculture and Land Stewardship is responding to two probable cases of highly pathogenic avian influenza (HPAI) in Wright and Sac counties. The Department has quarantined the premise and once the presence of the disease is confirmed, all birds on the property will be humanely euthanized to prevent the spread of the disease.

Wright 5 - A pullet farm with an estimated 400,000 birds that has experienced increased mortality. Initial testing showed it positive for H5 avian influenza. Additional confirmatory testing is pending from the APHIS National Veterinary Services Laboratories (NVSL) in Ames.

Sac 7 – Turkey farm with an estimated 42,000 birds that has experienced increased mortality. Initial testing showed it positive for H5 avian influenza. Additional confirmatory testing is pending from the APHIS National Veterinary Services Laboratories (NVSL) in Ames.

As the Department receives final confirmations of the disease updated information will be posted to the Iowa Department of Agriculture and Land Stewardship’s website at www.iowaagriculture.gov/avianinfluenza.asp.


The Center for Disease Control (CDC) and Iowa Department of Public Health considers the risk to people from these HPAI H5 infections in wild birds, backyard flocks and commercial poultry, to be low. No human infections with the virus have ever been detected and there is no food safety risk for consumers.

The hot summertime temperatures which are hoped will soon diminish the spread of H5N2 remain elusive in the upper Midwest, with temperatures running from the lower 60s to the lower 70s today in both Iowa and Minnesota.

Korean MERS Cluster Grows to 12

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My thanks to Sharon Sanders of FluTrackers for picking up the official report on two additional MERS cases (#11 & #12) in Korea.


This from the Korean Department of Health & Human Services.

Add the Middle East Respiratory Syndrome 2 persons occur , the cumulative 12 people

- B among hospital inpatients two people tested positive confirmation Homers -

□ Department of Health and Human Services has today confirmed a positive test result Homers two additional cases who were released .

○ today identified two patients both B in hospitals 5.15 to 5.17 during the first days as patients hospitalized on the same ward with patients , conducted in accordance with the lasting fever is confirmed by the final positive Homers genetic testing , state-designated isolation wards It was transported .

These two patients were apparently in the same ward as the index case.  While we've seen large nosocomial outbreaks in Saudi Arabia and the UAE, this is the first time we've seen this sort of spread outside of the Middle East.

Meanwhile, In Saudi Arabia . . .

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While Korea, China, and Hong Kong are grabbing the MERS headlines right now, Saudi Arabia - which has by far the lion's share of MERS cases - reports three more today.  

Two from Hafuf - which has seen a total of 14 cases over just 5 weeks - and one from Taif, which has now reported 4 cases over the past couple of weeks.

All 14 cases from Hafuf appear to be epidemiologically linked, although the details are sketchy. Today's case from Taif is also linked to a previously identified case.

MERS: Hong Kong Updates Their Contact Tracing Efforts

Credit HK Gov

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Having dealt with 13 imported cases of H7N9 over the past couple of years - and the required contact tracing, testing, and quarantining of exposed individuals that goes along with that - Hong Kong is already well practiced to handle their current MERS crisis.

As we've seen previously, they even keep a Holiday Camp - with a capacity of 280 people - on standby for use as a temporary quarantine facility.  

We've an update on their contact tracing efforts - which are still in progress - indicating that they've already located 12 of 29 close contacts of the Korean businessman who passed through Hong Kong 3 days ago while symptomatic with MERS.


There are, however, a number of people who may have been exposed who are no longer within Hong Kong's jurisdiction.   The government is urging those who were on the same flight, or bus, as the infected traveler to come forward.

MERS contacts being traced

May 29, 2015

The Centre for Health Protection is tracing people who may have come into contact with a Korean man infected with the Middle East Respiratory Syndrome virus.

The centre's Controller Dr Leung Ting-hung told a press briefing this evening that 158 passengers were on board Asiana Airlines flight OZ 723 on May 26. Among them, 80 were in the same cabin, including 29 who were sitting within two rows of the MERS patient.

Dr Leung said that among the 29 people who came into close contact with the man, 12 have been traced - three are Korean and nine are Chinese. They are being sent to a quarantine camp later today for a two week observation period. About 10 people have left Hong Kong.

The centre will start medical surveillance for others who were on the same flight and buses as the patient. He had travelled from Hong Kong International Airport to Huizhou in Guangdong on two buses operated by Eternal East Cross-Border Coach with number plates PJ 2595 and HN 5211.

The centre also discovered that three passengers from the PJ 2595 cross-border bus had transferred to a seven-seater vehicle in Sha Tau Kok.

The Government urged passengers who were on the same flight or bus as the man to come forward for medical assessment.

Anyone who may have had contact with the MERS patient should call the hotline at 2125 1111, which will be open until 9pm today.

The centre has issued letters to doctors and hospitals to alert them to the latest situation and urges the public and healthcare sector to heighten vigilance against the disease.

Although the terms are often used interchangeably by the public (and sometimes the media), the CDC defines the difference between quarantine and isolation this way:

• Isolation applies to persons who are known to be ill with a contagious disease.
• Quarantine applies to those who have been exposed to a contagious disease but who may or may not become ill.

In 2013 I wrote about the successful use of both quarantine and isolation in Hong Kong, Singapore, and Canada in controlling the 2003 SARS outbreak (see EID Journal: A Brief History Of Quarantine.)

While unlikely to be popular among those caught up in one - particularly early in an outbreak - quarantines may be one of the most effective tools that public health officials have in their arsenal.

 That said, the value of quarantines tends to diminish quickly as the number of cases, and geographic spread of a disease, increases.

Hong Kong Activates Alert Response To MERS-CoV

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With the news that China has now confirmed the symptomatic traveler who passed through Hong Kong on May 26th has tested positive for the MERS virus - and that Korea's cluster has increased by two since yesterday - Hong Kong's Centre for Health Protection has activated the ALERT response to the MERS Virus.

The Alert Response Level under the Government's Preparedness Plan for the Middle East Respiratory Syndrome (MERS) is activated
Middle East Respiratory Syndrome

Middle East Respiratory Syndrome Coronavirus (MERS-CoV), formerly known as novel coronavirus (NCoV), is a coronavirus which has not been identified in humans before and is different from any coronaviruses (including SARS-coronavirus) that have been found in humans or animals.
For details, please refer to the factsheet of Middle East Respiratory Syndrome.

Last year, in Hong Kong Unveils Their MERS-CoV Preparedness Plan, we examined this emergency response plan.  Alert is the lowest of three possible response levels (ALERT, SERIOUS & EMERGENCY).

Should local cases be confirmed in Hong Kong, the alert level would be raised to SERIOUS. 

In the meantime we are already seeing multiple reports of locals in Hong Kong being quarantined, isolated, or tested for the virus.

Very likely, most of these will turn out to be false alarms.  

But out of an abundance of caution - and after seeing the expansion of cases in Korea - the CHP is taking the threat seriously.

This from RTHK:

Three people quarantined with MERS symptoms

 Three people have been quarantined at Princess Margaret Hospital after showing symptoms of the potentially deadly Middle East Respiratory Syndrome, Center of Health Protection confirmed.

They were said to have sat close to a South Korean man -- who has now been confirmed as having Mers - on a flight from Incheon to Hong Kong on Tuesday.

The 44-year-old man, who briefly stopped over in the SAR before heading to the mainland, is now quarantined in a Huizhou hospital.

Guangdong health authorities have confirmed that the man has tested positive for the deadly virus.

The Center is calling on passengers who were on the same flight or bus as the patient to come forward for tests as soon as possible. --RTHK 

The good news here is that Hong Kong's CHP is one of the best equipped, and most experienced, public health agencies in the world when it comes to dealing with infectious disease outbreaks.

The agency was founded in direct response to Hong Kong's SARS experience (see SARS And Remembrance ).

This is an evolving story, and the next few days are likely to be a bit chaotic.


Stay tuned.

MERS: Chinese Case Positive - WHO Statement - Korean Cluster Grows To 9

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After more than 3 years of spreading - with the exception of 4 Middle Eastern Countries (Saudi Arabia, UAE, Jordan and Qatar) - no country in the world has seen more than 5 MERS cases.

This lack of ongoing transmission has led many health agencies to conclude that while imported cases are always possible, the risks of seeing local spread of the virus outside the Middle East are fairly low (see ECDC MERS Rapid Risk Assessment).

The events over the past 9 days in South Korea, however, may be changing that perception. 

Today the South Korean CDC announced two more positive MERS cases - while China announced the South Korean who traveled through Hong Kong to Guangdong Province has also tested positive - bringing the number of cases linked to South Korea's cluster to 10.

S. Korea traveler in China diagnosed with MERS

         2015/05/29 18:02

SEOUL, May 29 (Yonhap) -- A South Korean man who left for China after showing symptoms of the Middle East Respiratory Syndrome (MERS) was confirmed as a new case Friday, Seoul officials said, raising the total number of MERS patients here to 10.

The 44-year-old man departed for China on Tuesday despite his doctors advising against traveling after his fever rose to over 38 degrees Celsius, one of the common symptoms of MERS.

In tests conducted by Chinese health authorities, he was found to be infected with the potentially deadly virus, the health ministry here said.

(Continue . . )

With the escalating situation in Korea and China - and concerns running high in Hong Kong, the World Health Organization today announced that they have seen no signs of any change in the behavior of the MERS virus.  This media statement was emailed to journalists this morning:

FIRST CONFIRMED MERS-CoV CASE IN CHINA

Beijing, 29 MAY 2015 – China’s National Health and Family Planning Commission has notified the World Health Organization of a laboratory-confirmed case of Middle East Respiratory Syndrome coronavirus (MERS-CoV) in China. This is the first case of MERS-CoV in China.

The confirmed case is a Republic of Korea national in his mid-40s, who travelled to Guangdong province, China via Hong Kong Special Administrative Region (SAR)  on Tuesday May 26. The patient is a close contact of a confirmed MERS-CoV case in the Republic of Korea.

The patient is in isolation in a hospital in Huizhou, Guangdong province. We understand he is currently in a stable condition, and is being well cared for.

Chinese health authorities acted swiftly in response to the initial notification from the Republic of Korea that the close contact of a confirmed-MERS case had travelled to China earlier this week. For example:

• local health authorities are tracing all known close contacts of the patient;

• the Guangdong Health and Family Planning Commission dispatched an expert team to Huizhou to conduct epidemiological investigation and sampling;

• Hong Kong SAR health authorities are tracing close contacts of the patient during his transit through Hong Kong SAR.

Based on the evidence about MERS-CoV gathered to date, the virus does not seem to pass easily from person to person unless there is close contact. There is no evidence of sustained human-to-human transmission.

WHO is communicating closely with the Chinese health authorities to support their response to the case.

Meanwhile, Hong Kong's Centre For Health Protection has begun the difficult task of tracking, contacting, and when indicated - quarantining - those who may have been exposed when this Korean business man traveled through their region.

29 May 2015 Update on local response to latest situation of MERS   A spokesman for the Centre for Health Protection (CHP) of the Department of Health (DH) today (May 29) gave an update on the local response in view of the latest situation of Middle East Respiratory Syndrome (MERS). "Our immediate follow-up investigation and ongoing contact tracing of the Korean suspected case reported yesterday (May 28) revealed that there were 158 passengers onboard Asiana Airlines flight OZ 723 on May 26 and among them 80 were in the same cabin, including 29 passengers sitting within two rows of the suspected case. Contact tracing is now in full swing with the assistance of the airline concerned and the Immigration Department," the spokesman said. As regards the land transport from Hong Kong International Airport to Huizhou in Guangdong Province taken by the suspected case, the CHP's further investigation has revealed that contacts of the suspected case were in three vehicles operated by Eternal East Cross-Border Coach Mgt. Ltd. Details are as follows: (1) Bus from Hong Kong International Airport to Sha Tau Kok (plate No.: PJ 2595) Departure time: 3pm on May 26 The first coach taken by the suspected case travelled from Hong Kong International Airport to Sha Tau Kok. There were 21 passengers and one driver onboard. (2) Bus from Sha Tau Kok to Huizhou (plate No.: HN 5211) Departure time: 4.46pm on May 26 The suspected case transferred to another coach travelling from Sha Tau Kok to Huizhou. There were 13 passengers and one driver onboard. (3) Seven-seater car from Sha Tau Kok to Danshui (plate No.: NF 4501) Departure time: 4.36pm on May 26  Three passengers, who had taken PJ 2595 (travelling from Hong Kong International Airport to Sha Tau Kok), transferred to a seven-seater car from Sha Tau Kok to Danshui. There were three passengers and one driver onboard. The spokesman strongly appealed to passengers onboard Asiana Airlines flight OZ 723 who travelled from Korea to Hong Kong on May 26 and those onboard the three vehicles to call the CHP's hotline on 2125 1111 for further assessment or follow-up. The hotline will operate until 9pm today.  "We have made necessary preparations in advance and are ready for other disease control measures if necessary. The CHP has issued letters to doctors and hospitals to alert them to the latest situation. Members of the public and the health-care sector should heighten vigilance and stay alert to the latest situation," the spokesman added.

Parsing The USDA's Avian Flu Numbers

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Yesterday an article appeared on NPR’s http://harvestpublicmedia.org that examines some of the confusion surrounding the numbers on the USDA’ s APHIS Avian Flu list.

The author points out – correctly – that the main chart only depicts commercial flocks that have tested positive, and often runs several days behind what individual states have already report on their websites.  

Understandable as states often publish their `presumed positive’ outbreaks, but the USDA waits for confirmation.


Additionally, other types of detections (wild birds & captive wild birds) are listed separately. A small table of captive wild birds is posted below the main list, and the wild bird list (n=72 as of 5/14)  is maintained on a separate PDF file.

Both can be accessed from the APHIS Avian flu page, but they are easy to miss. 

As a result some news reports have been based solely on the main chart’s tallies, which is really just a subset of the total number.  While confusing, it would be even convoluted if all three types were combined.


First a link to the NPR report - well worth reading in its entirety - after which I’ll return with more.

Are the USDA's bird flu numbers accurate?
By:


Peggy Lowe
The avian influenza virus is moving fast and it’s already the largest outbreak ever in the U.S.

Since the beginning of May, we’ve watched and Tweeted what the U.S. Department of Agriculture has titled “ALL Findings” of bird flu. The updates come daily, about 3 p.m. Central, from a page run by the USDA’s Animal and Plant Health Inspection Service.

The latest update, posted Tuesday, looked like this:


The numbers are alarming. But are they accurate?

Yes. And no.

(Continue . . . ) 

The author also points out additional discrepancies between the number of outbreaks reported by the USDA and the OIE, and differences in the `flock size’.

Most of which can be attributed to the fact that the chain of transmission of information between agencies isn’t always as quick or efficient as the chain of transmission of the virus.

As to the question posed by the NPR article; Are the USDA's bird flu numbers accurate?

The USDA’s numbers are at best a `snapshot in time’ of lab confirmed cases, based on specific criteria (commercial flocks, wild bird, captive wild bird) - and due to delays in reporting and human error – (like all such numbers) are best consumed with a grain of salt.

That said, I don’t know of any place with 100% accurate and up-to-date figures. 

While far from perfect, the USDA’s numbers do provide us with a sense of the size and trajectory of the avian flu outbreak in this country.  

And while I don’t tend to quote their tallies very often (for many of the reasons stated above), when dealing with an extremely fluid situation, sometimes that’s the best you can hope for.