Thursday, January 31, 2019

Saudi MOH: 2 Secondary, Community-Acquired MERS Cases In Wadi Aldwasir

Original Map Credit Wikipedia


















#13,824


The recent uptick in MERS cases continues on this last day of January with an announcement of two unusual secondary, community-acquired MERS cases in Wadi Aldwasir.

Most of the time, the Saudi MOH uses five basic designations for MERS cases:
  • Primary, community-acquired (i.e.  no known risk contact)
  • Primary, community-acquired with camel contact (direct)
  • Primary, community-acquired with camel contact (indirect)
  • Secondary, household contact
  • Secondary, Hospital acquired
Two days ago, in Saudi MOH: 11th MERS Case Of 2019, the MOH reported on a 38 y.o. male from Wadi Aldwasir hospitalized with the MERS virus was designated as primary, community acquired with camel contact (see below).
 
https://www.moh.gov.sa/en/CCC/events/national/Documents/Epiwk5-19.pdf


Without providing any specifics, today the MOH reports two more cases from Wadi Aldwasir - both of which are described simply as secondary, community acquired - which would seem to suggest a cluster not linked to a household or healthcare facility.

  
https://www.moh.gov.sa/en/CCC/events/national/Documents/Epiwk5-19.pdf


Clusters of MERS cases - particularly in homes or healthcare settings - have long demonstrated that in close quarters and under the right conditions, the MERS virus transmits reasonably well between humans.  There are other venues - workplaces, for instance - where similar close contact could occur.
The good news so far is in the broader community, overt clustering of cases has been quite rare, although there are concerns over undetected chains of limited (asymptomatic or mildly symptomatic) transmission of the virus. 
Until we get some specifics on this cluster, including the epidemiological links between cases, it is impossible to know how much added significance one should attach to this report. In all honesty, it could even be a typo.

Hopefully details on these cases will be included in the next WHO EMRO MERS Summary, due out around the 10th of February, and we'll continue to monitor the region for any additional reports.
Today's announcement raises the Saudi total to 14 for the month of January, and (assuming no more cases are reported today) a total of 18 for the month when you include neighboring Oman.
For more on the concerns over community transmission of the MERS virus, you may wish to revisit:

J. Korean Med Sci: Atypical Presentation Of A MERS Case In A Returning Traveler From Kuwait

mBio: High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia

AJIC:Intermittent Positive Testing For MERS-CoV

JIDC: Atypical Presentation Of MERS-CoV In A Lebanese Patient

A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia)

 

Wednesday, January 30, 2019

Japan: Another Suspected Outbreak Of CSF Connected To Yesterday's Outbreak

 
       Arrival of CSF



#13,823


Yesterday, in Gifu Prefecture Reports A 7th Farm Outbreak Of Classical Swine Fever, we saw the first new farm outbreak of CSF in Japan since late December.  Today, investigators suspect another farm - which recently received pigs from yesterday's site - may be infected. 

In addition, we have the latest OIE Notification, and tally of wild boar affected in Gifu and Aichi Prefectures.

For the implementation of additional quarantine measures pertaining to swine fever which occurred in Gifu Prefecture (7 cases th)

2019 January 30,
the Ministry of Agriculture, Forestry and Fisheries Gifu Prefecture, in relation to classical swine fever which occurred in pig farm of the prefecture Kakamigahara on January 29 (Tuesday), will conduct the additional quarantine measures in epidemiology related farm.
1. Overview of the epidemiological related farm Location:
Gifu Prefecture this Chao City
rearing conditions: fattening pigs 867

2. Background January 29 (Tuesday), Gifu Prefecture, was carried out on-site inspection for the epidemiological related farm of Motosu that pigs have been sold from the pig farm of Kakamigahara that swine fever of 7 case was in the prefecture has occurred , for pigs with symptoms to suspect the swine fever has been confirmed, we conducted a thorough examination of the pig, today (January 30 (Wednesday)), has been confirmed to be a suspected affected animals of swine fever.
3. of future correspondence As epidemiological related farm of Kakamigahara 7 case was of classical swine fever has occurred in Gifu Prefecture farm, and the epidemic prevention measures necessary culling and baked buried 却等 of breeding pigs of the farm carried out quickly and accurately.

4. Other
(1) pig cholera, swine, is a disease of wild boar, it does not infect humans. In addition, it does not meat of infected pigs on the market.
(2) the farm, you have to refrain from the movement of breeding pigs from the time the suspicion of swine fever has occurred.
(3) interview in the field, thank you for your cooperation as strictly refrain from such that there is a risk that cause the spread of the disease. In particular, for coverage of using a helicopter that might interfere with the epidemic prevention work, thank you so strictly avoided.
(4) in the future, so we will endeavor to provide quick and accurate information, so as not to be confused by such relations of production and consumers, such as who is unfounded rumor, thank you for your cooperation.

Japan's most recent OIE Notification (#14) on this epizootic - which began last September - adds 8  new outbreaks (Farm #7, and 7 involving wild boar).

http://www.oie.int/wahis_2/public/wahid.php/Reviewreport/Review?page_refer=MapFullEventReport&reportid=29352


From this notification's Epidemiological Comments:

1. 7th affected farm On 28th Jan. several pigs were found to have high fever and respiratory symptoms and reported to the Gifu Central Livestock Hygiene Service Centre (LHSC). Official veterinarians of the Gifu Central LHSC immediately visited the farm to conduct clinical inspection and found a pig dead. Official veterinarians conducted necropsy examination of the dead pig at the Gifu Central LHSC. The tissue samples of the dead pig were tested for Classical Swine Fever (CSF) virus by RT-PCR at the Gifu Central LHSC and found to be positive on 29th Jan. Movement and shipment restriction are imposed on the farms within a radius of 3km and 10km on the affected farm respectively. Stamping-out is being carried out on the affected farm. 
 2. 6th Affected farm Removal of movement restriction zone (MRZ): On 00:00 of 26th January, movement restrictions, which were established within 3km radius of the affected farm, were lifted as 28 days have passed after the completion of full implementation of control measures (stamping out, disinfection etc.) at the 6th affected farm. 

3. Summary of the wild boar surveillance: As of the 28st of January, 689 wild boars (73 dead and 616 captured) in Gifu prefecture have been tested and 105 (38 dead and 67 captured) were found to be positive for CSF by RT-PCR since 13th of September. 53 wild boars (12 dead and 41 captured) in Aichi prefecture have been tested and 6 were found to be positive (1 dead and 5 captured) for CSF by RT-PCR since 14th of September. Among the other prefectures, 156 dead wild boars in 36 prefectures were tested and all were found to be negative by RT-PCR since the 14th of September(*). (*): All prefectures are requested to conduct CSF testing on dead wild boars.


Saudi MOH Reports 12th MERS Case Of January

2019 MERS Cases - Saudi Arabia


















#13,822


The recent uptick in MERS cases in Saudi Arabia continues today with the 12th case of the new year - that of a 65 y.o. male from Buraidah with reported camel contact.  This is the second camel-linked case reported in the past two days.

https://www.moh.gov.sa/en/CCC/events/national/Documents/Epiwk5-19.pdf


A quick check today of Oman's Ministry of Health shows no update on the 4 MERS cases reported there yesterday, and as of this writing I've found nothing on the WHO.int or EMRO websites.

WHO Novel Flu Summary & Risk Assessment - January 2019

http://www.fao.org/ag/againfo/programmes/en/empres/H7N9/situation_update.html
H7N9 Infections - Credit FAO - Dec 5th Update














 #13,821


Since China's massive nation-wide poultry vaccination campaign, which began during the summer of 2017, we've seen a huge decline in avian flu outbreak reports in poultry - and infections in humans - particularly in Asia, but also around the globe. 
H7N9 infections have not been reported in over 6 months, and we've only seen a handful of H5N6 and H9N2 cases reported out of China in the past year.
There are always concerns that cases and outbreaks go unreported, particularly from low-resource countries where testing and surveillance is rarely (if ever) done - and from some countries which have a history of not advertising disease outbreaks. 
But assuming those are more-or-less constants, there's little doubt that the incidence of avian flu has declined sharply over the past 18 months. 
How long that happy status will continue is anyone's guess, but influenza virus evolution continues around the world on numerous fronts - often hidden from view - and history tells us that nature always bats last.

The World Health Organization has published their latest Summary and Risk assessment, which reports one human infection with the H9N2 virus in Guangdong Province, China (see Guangdong Province Reports Human H9N2 Infection).

First, some excerpts from this relatively brief update, then I'll return with a bit more on the H9N2 virus.

Influenza at the human-animal interface
 
Summary and assessment, 14 December 2018 to 21 January 2019
New infections 1 : Since the previous update, one human infection with an avian influenza A(H9N2) virus was reported.

Risk assessment: The overall public health risk from currently known influenza viruses at the human-animal interface has not changed, and the likelihood of sustained human-to-human transmission of these viruses remains low. Further human infections with viruses of animal origin are expected.
IHR compliance: All human infections caused by a new influenza subtype are required to be reported under the International Health Regulations (IHR, 2005). 2 This includes any influenza A virus that has demonstrated the capacity to infect a human and its heamagglutinin gene (or protein) is not a mutated form of those, i.e. A(H1) or A(H3), circulating widely in the human population. Information from these notifications is critical to inform risk assessments for influenza at the human-animal interface.
Avian Influenza Viruses
Current situation:
Avian influenza A(H5) viruses
Since the last update on 13 December 2018, no new laboratory-confirmed human cases of influenza A(H5) virus infections were reported to WHO. According to reports received by the World Organisation for Animal Health (OIE), various influenza A(H5) subtypes continue to be detected in birds in Africa, Europe and Asia. Overall, the risk assessment has not changed.
Avian influenza A(H7N9) viruses
Since the last update on 13 December 2018, no new laboratory-confirmed human cases of influenza A(H7N9) virus infections were reported to WHO. There have been no publicly available reports from animal health authorities in China of influenza A(H7N9) virus detections in animals in recent months. 3 Overall, the risk assessment has not changed.
Avian influenza A(H9N2) viruses
Since the last update on 13 December 2018, one new laboratory-confirmed human case of influenza A(H9N2) virus infection was reported to WHO. On 3 January 2019, China reported the detection of avian influenza A(H9N2) virus in a 32-year-old woman from Guangdong, with an onset of illness on 19 December 2018. The illness was reportedly mild, but she was hospitalized on 25 December 2018.
The woman did not report exposure to live poultry. During epidemiological investigations, no further cases among family members were reported. Avian influenza A(H9N2) viruses are enzootic in poultry in China.
1For epidemiological and virologic features of human infections with animal influenza viruses not reported in this
assessment, see the yearly report on human cases of influenza at the human -animal interface published in the Weekly
Epidemiological Record. Available at: www.who.int/wer/en/
2 World Health Organization. Case definitions for the four diseases requiring notification in all
circumstances under the International Health Regulations (2005). Available at: www.who.int/ihr/Case_Definitions.pdf
3 Food and Agriculture Organization of the United Nations. H7N9 Situation Update.
http://www.fao.org/ag/againfo/programmes/en/empres/H7N9/situation_update.html
Risk Assessment:
1. What is the likelihood that additional human cases of infection with avian influenza A(H9N2) viruses will occur?
Most human cases are exposed to the A(H9N2) virus through contact with infected poultry or contaminated environments. Human infection tends to result in mild clinical illness. Since the virus continues to be detected in poultry populations, further human cases can be expected.
2. What is the likelihood of human-to-human transmission of avian influenza A(H9N2) viruses?
No case clusters have been reported. Current epidemiological and virologic evidence suggests that this virus has not acquired the ability of sustained transmission among humans, thus the likelihood is low.
3. What is the likelihood of international spread of avian influenza A(H9N2) virus by travelers?
Should infected individuals from affected areas travel internationally, their infection may be detected in another country during travel or after arrival. If this were to occur, further community level spread is considered unlikely as this virus has not acquired the ability to transmit easily among humans.
        (Continue . . . .)

Despite relatively few documented human infections (see FluTrackers List) - and having a reputation for causing generally less severe human illness than its avian H5 & H7 cousins - LPAI H9N2 is still considered an important player in the avian flu world.


So, while H9N2 may not be at the top of our pandemic threats list, it is regarded as having at least some pandemic potential (see CDC IRAT SCORE), and several candidate vaccines have been developed over the years.


CDFA/USDA Update On Virulent Newcastle Disease - Southern California - Utah


Affected Areas In California

















#13,820

In May of 2018 Virulent Newcastle Disease (vND) reappeared in Southern California - after an absence of 15 years in the United States - and began to spread among backyard exhibition poultry.
Until mid-December, all of the outbreaks had been in backyard birds, but on December 14th the virus was discovered in commercial table egg pullets in Riverside county, marking the first such detection in American commercial poultry in 15 years.
Since then two additional commercial operations have been hit (see USDA Confirms 3rd Commercial Poultry Flock Hit With Virulent Newcastle Disease) and 10 days ago we learned the virus had been exported to a backyard exhibition flock in Utah.

As of December 21st, 2018 - just prior to the government shutdown - the USDA's official count of Newcastle outbreaks/detections in Southern California sat at 231 cases of vND in California.
  • 104 in San Bernardino County
  • 87 in Riverside County 
  • 39 in Los Angeles County 
  • 1 in Ventura County. 
Yesterday, with the wheels of government once again in motion, the USDA updated their Newcastle website and outbreak count.
Virulent Newcastle Disease (vND)
Last Modified: Jan 29, 2019 
Virulent Newcastle disease, formerly known as exotic Newcastle disease, is a contagious and fatal viral disease affecting the respiratory, nervous and digestive systems of birds and poultry. The disease is so virulent that many birds and poultry die without showing any clinical signs.

Virulent Newcastle disease is not a food safety concern.  No human cases of Newcastle disease have ever occurred from eating poultry products.  Properly cooked poultry products are safe to eat.  

In very rare instances, people working directly with sick birds can become infected with mild symptoms, such as conjunctivitis.  These are easily prevent with personal protective equipment.

Since May 18, USDA has confirmed 314 cases of vND in California, including 107 in San Bernardino County, 166 in Riverside County, 40 in Los Angeles County and 1 in Ventura County. USDA also confirmed 1 case in Utah County, Utah:

Of the 83 cases reported in Southern California over the past five weeks, 79 (95%) occurred in Riverside County.

While the economic impact of this outbreak has been limited, there are still concerns we could see a repeat of the last outbreak in commercial poultry - back in 2003 - which led to the depopulation of 3.16 million birds at a cost of $161 million.  
Prior to that, in 1971, an outbreak in Southern California led the culling of 12 million birds.
In order to promote awareness, and hopefully contain this prolonged outbreak, California's Department of Food and Agriculture has a number of resources available on their Newcastle webpage.

More information on Virulent Newcastle Disease

Tuesday, January 29, 2019

Saudi MOH: 11th MERS Case Of 2019

Credit Saudi MOH


#13,819


The Saudi MOH has announced their 11th MERS case of 2019 - this time involving a 38 y.o. male from Wadi Aldwasir with reported camel contact.  They have also announced the deaths of two community acquired cases from Epi Week 4


https://www.moh.gov.sa/en/CCC/events/national/Documents/Epiwk5-19.pdf


When added to the 4 MERS cases announced overnight from Oman - already gives January 2019 50% more cases (n=15) than was reported in the first month of 2018 (n=9)

Credit WHO EMRO

Given the strong likelihood that a significant number of cases go unreported (see EID Journal: Estimation of Severe MERS Cases in the Middle East, 2012–2016), any improvements in surveillance, testing, or reporting could easily account for this increase.

Nevertheless, less than a year ago - in the WHO List Of Blueprint Priority Diseases - we saw MERS-CoV listed among the 8 disease threat in need of urgent accelerated research and development.
List of Blueprint priority diseases
(SNIP)
The second annual review occurred 6-7 February, 2018. Experts consider that given their potential to cause a public health emergency and the absence of efficacious drugs and/or vaccines, there is an urgent need for accelerated research and development for*:
  • Crimean-Congo haemorrhagic fever (CCHF)
  • Ebola virus disease and Marburg virus disease
  • Lassa fever
  • Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS)
  • Nipah and henipaviral diseases
  • Rift Valley fever (RVF)
  • Zika
  • Disease X

So any uptick in MERS cases, no matter how small, is worthy of our attention.

Japan: Gifu Prefecture Reports A 7th Farm Outbreak Of Classical Swine Fever


Arrival of CSF













#13,818


Since last September - and for the first time in 26 years - Japan has been dealing with outbreaks of Classical Swine Fever (CSF), a disease similar to African Swine Fever (ASF), but caused by a different virus (genus Pestivirus, family Flaviviridae).
We've continued to see reports of wild boar infected with CSF in both Gifu and Aichi Prefectures (see Updating Japan's Classical Swine Fever Outbreak), but it's been just over a month since the last farm reported an outbreak (see Gifu Prefecture Reports A 6th Farm Outbreak Of Classical Swine Fever).
Today Japan's MAFF (Ministry of Agriculture, Forestry & Fisheries) reports a 7th farm - again in Gifu Prefecture - hit by the virus.  The (translated) announcement follows:

Confirmation of suspected affected animals of swine fever in Gifu Prefecture for (7 cases th)

2019 January 29,
the Ministry of Agriculture, Forestry and Fisheries Today, suspected affected animals of swine fever has been confirmed in a pig farm in Gifu Prefecture Kakamigahara.
We are taken all possible measures for the quarantine measures for the disease.
The farm has to refrain from the movement of breeding pigs from the time the suspicion of swine fever has occurred.
Interview in the field, thank you for your cooperation as strictly refrain from such that there is a risk that cause the spread of the disease.
1. Overview of the occurrence farm

Location: Gifu Prefecture Kakamigahara
feeding situation: breeding pigs 127 pigs, fattening pig 1,535 head
2. Background
(1) Gifu Prefecture, January 28 (Monday), received reports from the farm of the pig to cough into the pig pen, pig exhibiting heat generation is large, animal health inspectors have conducted a site inspection.
(2) the same day, because the suspicion of swine fever is caused by the inspection of in the middle Livestock Hygiene Service Center, was subjected to a thorough examination, today (January 29 (Tuesday)), confirmed that the suspected affected animals of swine fever it was done.
3. of future correspondence

On the basis of the "specific livestock epidemic quarantine guidelines for classical swine fever", and taken all possible measures for the following quarantine measures, and the like.

(1) The farm breeding pigs slaughtered and baked burial, and carried quickly and accurately quarantine measures necessary for setting of the movement restriction zone.
(2) for the farm of movement restricted area, it will be carried out as soon as possible occurrence status check inspection.
(3) Since the spread of infection prevention, strengthening the disinfection of peripheral generation farm, we set up a disinfection point to the main road.
(4) for the investigation of such infection route, and dispatch the epidemiological investigation team of the country.
(5) aims to ensure the early detection and early notification of the disease.
(6) strive to relevant ministries and sufficient cooperation, producer, consumer, we will endeavor to provide accurate information to the distributors and the like.
(7) thorough guidance on compliance with the Standards of Rearing Hygiene Management of intrusion prevention, etc. to the farm disinfection and wild animals of the farm.
(8) In order to investigate and prevent the spread of such infection route, it will assume all the possibilities investigation.
4. Other
(1) pig cholera, swine, is a disease of wild boar, it does not infect humans. In addition, it does not meat of infected pigs on the market.
(2) the farm, you have to refrain from the movement of breeding pigs from the time the suspicion of swine fever has occurred.
(3) interview in the field, thank you for your cooperation as strictly refrain from such that there is a risk that cause the spread of the disease. In particular, for coverage of using a helicopter that might interfere with the epidemic prevention work, thank you so strictly avoided.
(4) in the future, so we will endeavor to provide quick and accurate information, so as not to be confused by such relations of production and consumers, such as who is unfounded rumor, thank you for your cooperation.
Prior to today's announcement - across 6 Japanese farms and/or agricultural research centers -- the OIE had reported a total of 8,675 swine culled or lost. Farm # 6 in late December was, by far, the largest outbreak with over 7,500 head.
Today's report should push that number over 10,000.

Last September the OIE withdrew/suspended Japan's hard won status as being free of Classical Swine Fever (see OIE Statement), leaving only 34 countries with that coveted designation.

http://www.oie.int/animal-health-in-the-world/official-disease-status/classical-swine-fever/map-of-csf-official-status/


Even as Japan struggles to contain Classical Swine Fever, they must also worry about the spread of African Swine Fever from nearby China - and like many other Asian nations - are taking steps to try to prevent its import (see Japan MAFF: ASF Virus Detected In Luggage At Hokkaido Airport). 
As our world becomes increasingly interconnected, by both trade and travel, the risks of inadvertently spreading agricultural diseases like ASF, CSF, and others are only expected to grow.
Even though ASF has never been reported in North America, the potential exists for its arrival from China, Europe, or Africa. Last month the USDA released a new African Swine Fever Factsheet that discusses their preparations for a possible introduction of the virus into this country.
(Excerpt)

Keeping ASF Out

Because of the concern over ASF, USDA recently reviewed and further strengthened its longstanding stringent protections against the spread of the disease.These include:
  • Collaborating with states, industry and producers to ensure everyone follows on-farm biosecurity and best practices (including for garbage feeding in states where that is allowed);
  • Restricting imports of pork and pork products from affected countries; and
  • Working with CBP staff at ports of entry to increase passenger and baggage screening for prohibited products from affected countries.

Oman MOH Reports 4 MERS-CoV Cases














#13,817

 
A very brief statement on the Oman Ministry of Health website informs us that the Sultanate has detected 4 new MERS cases.  Their last reported case was in March of 2018, while in 2017 they reported 2.

Acute Respiratory System (Corona) Statement on the recording of new cases of Middle East syndrome

29/1/2019

Four new cases of acute respiratory syndrome (SARS), known as Corona, have been recorded, bringing the total number of cases registered in the Sultanate to 18 cases from various governorates of the Sultanate since 2013
These cases receive the necessary health care in a reference hospital, while the Ministry confirms its continued efforts to control and control the disease through the effective epidemiological surveillance system in place and the readiness of all reference hospitals to deal with such cases, and the Ministry of Health and other relevant authorities Related health action.
The Ministry calls upon the Ministry of Health to take information from its source and urges citizens and residents to adhere to preventive measures to combat infection and healthy hygiene when sneezing and coughing.

Unfortunately, missing from this announcement are onset dates, locations, and any epidemiological links between patients. Oman, much like Saudi Arabia, tends to hold details close to the vest. 
Despite the dearth of information provided, one interesting statement does emerge; the total number of cases reported by Oman. 
As of last August, the ECDC's list of confirmed MERS cases showed a total of 11 cases from Oman.  Add today's 4 new cases, and that number should jump to 15.   But today's announcement cites 18.

https://ecdc.europa.eu/sites/portal/files/documents/RRA-Severe-respiratory-disease-associated-MERS-CoV-22nd%20update-29-aug-2018.pdf


Hopefully we'll be getting additional details on these cases from the Omani MOH, or the World Health Organization, in the days to come.
 

Monday, January 28, 2019

Another (Very) Curious Flu Report From India

image
Credit ECDC – 125 years of  Pandemic  History 

Caveat : Reports of `mystery' viruses are a staple in India's media, and usually turn out to be something less than initially reported.  So until proven otherwise, today's media report of supposed H2N3 cases - while possible - should be taken with a very large grain of salt.

 #13,816

Last November in A Couple Of Curious Flu Reports From India, we looked at reports (see Mumbai: Doctors suspect new H1N1 variants) of unusual flu symptoms - particularly among pregnant women - of hypertension, vomiting and diarrhea associated with a `flu-like' illness.
No other lab results are mentioned, and the article presented no evidence (beyond citing unusual symptomology) to support their theory.
Another article, published at the same time in the Times of India (Influenza 2.0), took a different tack, and instead suggested it was H3N2 - not an H1N1 variant - causing these unusual symptoms, while acknowledging that none of the samples sent to NIV had come back positive for the H3N2 virus.

Today the Times of India is reporting on an outbreak they state has tested positive for H2N3 (see Unknown virus claims 64 lives in Indore, India).
Since the Times prevents copying and pasting, I've found a second report - one that uses the Times of India as a source - published today in the Gulf News.

Make of it what you will.
Unknown virus claims 64 lives in Indore, India

The virus has identical symptoms of swine flu
Published: January 28, 2019 14:20

Dubia: An unknown virus has claimed 64 lives in and around the Indian city of Indore in Madhya Pradesh.

As reported by the Indian newspaper, Times of India, the virus has symptoms identical to swine flu.

According to the report, Dr Amit Malakar, Integrated Disease Surveillance Programme (IDSP) nodal officer from the Indian National Centre for Disease Control, said: “There is a common nature of virus found in the samples of these 64 patients. In most cases, it was found that the patient was suffering from cold and cough. The virus attacks the immune system and leads to death.”

The report further states that according to officials, recently instead of H1N1, samples were found H2N3 positive and medicines given to swine flu positive patients were not effective.
        (Continue . . . . )

My first reaction was that the writer simply transposed H3N2 into H2N3 (easy enough to do), but that doesn't explain the `unknown virus' aspect, or why medicines (presumably oseltamivir) weren't effective. 
I've checked India's National Institute of Virology website,  and can find no corroboration.  But then, it appears the site hasn't been updated since December.
H2N3 would be a big story, if true (see below).  But for now, we have very little to go on. Hopefully we'll get some clarity soon.


The progression of human influenza pandemics over the past 130 years is believed to have been H2, H3, H1, H2, H3, H1, H1 . . . .
The oldest pandemic we can be certain of was the 1918 `Spanish Flu’, which killed anywhere between 40 million and 100 million people, and was caused by an H1N1 virus, followed by H2N2 in 1957, H3N2 in 1968, and H1N1 in 2009. 
But before that, the 1890-93 `Russian flu’ pandemic has generally been attributed to the H2N2 virus, while the H3N8 virus has been tentatively pegged as causing the 1900 epidemic (see Transmissibility and geographic spread of the 1889 influenza pandemic).  
Given this repeating pattern (and with H1N1 and and H3N2 monopolizing the global stage for the past four decades) it wouldn't be a complete shock were an H2Nx virus to reemerge after an absence of more than 50 years (circa 1968).
In 2012, in H2N2: What Went Around, Could Come Around Again, we looked at a study conducted by scientists working at St. Jude Children's Research Hospital - published in the Journal of Virology - that concluded that H2N2 could well pose a threat to humanity once again.

A press release on this research warned:
1950s pandemic influenza virus remains a health threat, particularly to those under 50
St. Jude Children's Research Hospital scientists report that avian H2N2 influenza A viruses related to 1957-1958 pandemic infect human cells and spread among ferrets; may aid identification of emerging threats.
And over the past dozen years we've seen a handful of H2 flu viruses pop up around the world in a variety of mammalian and avian hosts.  
While H2 viruses have not threatened human health in half a century, it is fair to say they are quite deservedly high on our watch list.

So while I have serious reservations over today's reports, we'll be watching this story in the days ahead for some sort of corroboration.

Sunday, January 27, 2019

Emerg. Microbe & Inf: MERS Infection In Non-Camelid Domestic Mammals




















#13,815

It took roughly a year after the first human infection with MERS-CoV was announced out of Saudi Arabia for dromedary camels to be identified as a host species for the MERS coronavirus (see 2013's The Lancet Camels Found With Antibodies To MERS-CoV-Like Virus).
While bats are believed to be the primary host reservoir for MERS, SARS, and an array of other novel pathogens (see Curr. Opinion Virology: Viruses In Bats & Potential Spillover To Animals And Humans), the hunt continues for other susceptible species where these viruses may reside.
Complicating this search, the MERS virus doesn't appear to leave long lasting fingerprints - in the form of detectable antibodies - once the host clears the infection.  
In April of 2016, in EID Journal: Antibody Response & Disease Severity In HCW MERS Survivors, we looked at a study that tested 9 Health care workers who were infected during the 2014 Jeddah outbreak (2 severe pneumonia, 3 milder pneumonia, 1 URTI, and 3 asymptomatic), that found only those with severe pneumonia still carried detectable levels of antibodies 18 months later.
Similar waning antibody detection has been reported in camels, which means seroprevalence studies may not provide an accurate picture of how many people - or other species - have been infected with this coronavirus in the past.

Over the past 6 years we've seen a number of studies that have attempted to either detect antibodies in other domestic animal species - or alternatively, tried to experimentally infect them - in order to identify other potential host species.

While most of these studies have come up empty, in 2016's EID Journal: MERS-CoV Antibodies In Alpacas - Qatar, serum samples from 15 alpacas and 10 camels were tested for IgG antibodies specific to the MERS virus. MERS-CoV–specific antibodies were detected in all of the alpaca samples (n=15) and in all but 1 camel (n=9) tested.

No evidence of current MERS-CoV infection (via RT-PRC testing) was detected among either herd.
Alpacas are part of the same biological family (Camelidae) as dromedaries, so this finding opened the door to finding MERS susceptibility in other camelids, including Bactrian camels, llamas, vicuñas, and guanacos.

Later in 2016, in Study: Experimental Infection Of Goats, Sheep & Horses With MERS-CoV, we looked at a study that reassuringly found that:

Minimal or no virus shedding was detected in all of the animals. During the four weeks following inoculation, neutralizing antibodies were detected in the young goats, but not in sheep or horses.
Four months later, in December of 2016, in EID Journal: Livestock Susceptibility to Infection with MERS-CoV, researchers experimentally inoculated llamas, pigs, sheep, and horses with the MERS virus, and found that pigs & llamas both shed the virus from the nose, and seroconverted.
Given the susceptibility of pigs to other coronaviruses (see mBio: PEDV - Porcine Epidemic Diarrhea Virus - An Emerging Coronavirus and Swine Enteric Coronavirus Diseases), this understandably raised concerns.
A 2017 study (see EID Journal: Domestic Pig Unlikely Reservoir for MERS-CoV) confirmed that while pigs can be experimentally infected with the MERS virus, they did not develop clinical disease and only shed small quantities of the virus, making them unlikely to spread the disease.

All of which brings us to yet another study, which not only expands the range of domestic species tested to include cattle, sheep, goats, donkeys, buffaloes, mules, and horses - but also extended testing far beyond Saudi Arabia - to include Egypt, Tunisia, and Senegal. 
They found goats and sheep were the most likely to exhibit antibodies to MERS-CoV (or a MERS-like coronavirus), but evidence of prior infection was also detected in 1 cow and 3 donkeys.
While the discovery of MERS-like antibodies in sheep, goats, donkeys and a cow open up new avenues for investigation, it really doesn't tell us much about their role in spreading the virus, either to their own species, or to humans.

The full study is lengthy and quite detailed (PDF available at link below), and well worth reading in its entirety.  I've only excerpted a couple of short passages.

Middle East respiratory syndrome coronavirus infection in non-camelid domestic mammals
Ahmed Kandeil, Mokhtar Gomaa, Mahmoud Shehata, Ahmed El-Taweel, Ahmed E. Kayed, Awatef Abiadh, show all
Pages 103-108 | Received 17 Oct 2018, Accepted 03 Dec 2018, Published online: 16 Jan 2019

Download citation https://doi.org/10.1080/22221751.2018.1560235
ABSTRACT

Dromedary camels are natural host of the Middle East respiratory syndrome coronavirus (MERS-CoV). However, there are limited studies of MERS-CoV infection of other domestic mammals exposed to infected dromedaries. We expanded our surveillance among camels in Egypt, Tunisia, and Senegal to include other domestic mammalian species in contact with infected camels.
A total of 820 sera and 823 nasal swabs from cattle, sheep, goats, donkeys, buffaloes, mules, and horses were collected. Swabs were tested using RT-PCR and virus RNA-positive samples were genetically sequenced and phylogenetically analysed. Sera were screened using virus microneutralization tests and positive sera (where available) were confirmed using plaque reduction neutralization tests (PRNT).
We detected 90% PRNT confirmed MERS-CoV antibody in 35 (55.6%) of 63 sera from sheep collected from Senegal, two sheep (1.8%) of 114 in Tunisia and a goat (0.9%) of 107 in Egypt, with titres ranging from 1:80 to ≥1:320. We detected MERS-CoV RNA in swabs from three sheep (1.2%) of 254 and five goats (4.1%) of 121 from Egypt and Senegal, as well as one cow (1.9%) of 53 and three donkeys (7.1%) of 42 from Egypt.
Partial sequences of the RT-PCR amplicons confirmed specificity of the results. This study showed that domestic livestock in contact with MERS-CoV infected camels may be at risk of infection. We recommend expanding current MERS-CoV surveillance in animals to include other livestock in close contact with dromedary camels. The segregation of camels from other livestock in farms and live animal markets may need to be considered.
        (SNIP)
In summary, we provide evidence of MERS-CoV, or a very closely related virus, infection of domestic live-stock (other than camels) in close contact with camels,106A. Kandeil et al. suggesting that spill over infection to other livestock may occur. Our data does not prove MERS-CoV can be sustained by transmission within these other live-stock species in the absence of camels as the primary source of infection.
However, if other domestic live-stock such as sheep may be infected by MERS-CoV, they may also be a risk factor for human infection.
Our findings highlight the need for further field studies of domestic livestock, especially those that are in close contact with dromedary camels and also the need for experimental studies infecting livestock such as sheep using MERS-CoV isolates from Africa. Our findings may raise the need to segregate other livestock from dromedary camels in farms and live animal markets.
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