Sunday, March 31, 2019

Saudi MOH: 1 Secondary MERS Case In Al Kharj















#13,970


On Wednesday (3/27) the Saudis reported a primary MERS case (57 M, with camel contact) in Al Kharj.  Although details are scant, today we are informed of a secondary case - presumably a contact of the above case - from the same city.

It isn't clear from the brief report below whether this is a household contact, or perhaps a hospital acquired infection.

https://www.moh.gov.sa/en/CCC/events/national/Documents/Epiwk14-19.pdf
Today's case brings the Saudi total for 2019 to 114 cases, which is nearly double the pace of the first quarter of 2018.


A Curious Report From Guyana













#13,969


Six years ago today (March 31st, 2013) and nearly 7,000 blogs ago, we saw the first announced human infections from a new type of highly virulent (in humans) avian H7N9 virus in China (see China: Two Deaths From H7N9 Avian Flu).

This outbreak was surprising on a number of fronts.
  • First, the virus was an avian H7 subtype, and while we'd seen human infections before with H7N7 and H7N2, and H7N3 (see A Brief History Of H7 Avian Flu Infections) they were almost always mild.
  • Second, while the H7N9 virus was LPAI (low path) in birds, it was highly virulent - and often deadly - in humans.
  • H7N9 quickly became the world's top novel flu threat as it continued to spread across China, evolving into dozens of new clades, subclades, and eventually even spawning an HPAI version.          
This was neither the first, nor was it the last, `surprise' disease outbreak of the past dozen years. 
  • Less than a year earlier (2012), a new SARS-like virus - initially called nCoV, but later dubbed MERS-CoV - emerged in the Middle East.  Since then more than 2000 cases have been confirmed, but the real burden is likely higher.
  • In the spring of 2009 a novel swine-origin H1N1 virus jumped from North American pigs and sparked the first pandemic in 40 years. 
  • In 2014, a small festering Ebola outbreak in West Africa - an area that had never before reported the disease - turned into a multi-country epidemic that would  claim well over 11,000 lives.
  • Also in 2014, we saw the first human infections with a new HPAI H5N6 subtype in China, which continues to fester 5 years later. 
  • In 2016, the arrival of a little known mosquito-borne virus to the Americas - Zika - would force the WHO to declare a PHEIC (Public Health Emergency of International Concern) after thousands of children were born with Zika-related birth defects.
We could expand this list to include Cholera in Haiti and Yemen, Yellow Fever in Central Africa and Brazil, and 2017's plague epidemic in Madagascar.  It's a big world, and when it comes to emerging and re-emerging infectious diseases, it never stays quiet for very long. 
Which is why organizations like FluTrackers, and ProMed Mail, and bloggers like Crof and myself, spend so much time weeding through government reports and media accounts of disease outbreaks around the globe. 
Many, perhaps most, of these reports are over-hyped, or are false alarms. Often  reports of `unknown' or `mystery' outbreaks turn out, upon closer inspection, to  be something less than mysterious (see WHO Update On `Unknown Disease' Reported In Mali - Epidemic Malnutrition).
But the H7N9 epidemic announced in China 6 years ago began with reports (carried by FluTrackers) of three patients hospitalized with `atypical pneumonia' three weeks earlier.  
So, we track, and document `odd' reports from all over the world with the knowledge that most will turn out to be nothing of consequence, but every once in awhile we may stumble across something of value.

While it is too soon to know which category the following item will fall into, it has some of the characteristics flublogians look for.  An outbreak of what is described as a `unknown respiratory infection', the quarantining (or isolation) of a number of patients, and a potential exposure to a known vector of exotic viruses. 
In this case, it involves Chinese workers employed cleaning bat guano from a Manganese mine in Guyana.  One has reportedly died, while more than a half dozen are hospitalized.
Although I ran across the story a few hours ago, the newshounds at FluTrackers were way ahead of me, compiling reports overnight (see thread Guyana: Health authorities probe if respiratory infection killed 1 Chinese national, sickened 8 others).

While Hemorrhagic Dengue was initially  mentioned as one possible cause of the illness, the most recent report (see below) has the virus still unidentified.


Death of Chinese worker unconfirmed

Minister of Public Health, Volda Lawrence, said the disease or virus which resulted in the death of a Chinese national, and have left eight other persons including a Guyanese hospitalized, has not been identified.

On Saturday, seven of the men who were cleaning a manganese tunnel at Matthew’s Ridge, North West District last week, were air-dashed to the city after the men contracted a virus or disease. They were part of a team of nine (eight Chinese and one Guyanese); however, one of the Chinese men died while receiving treatment on Saturday and one of the other survivors remained in Matthew’s Ridge.

In a late night interview following a high-level meeting on the developing issue, the health minister said doctors have not yet determined what the illness is; however, they continue to run a number of tests.

Minister Lawrence disclosed that “all the patients have displayed the same signs and symptoms which include pain, fever, headache and respiratory distress.”
(Continue . . . )

This could, admittedly, be almost anything; seasonal H1N1 or H3N2, histoplasmosis or other fungal infection (from bat guano), Dengue, etc.   
But bats are also known carriers of coronaviruses, Henipaviruses like Nipah and Hendra, and more recently, have been shown capable of carrying novel flu viruses (see Curr. Opinion Virology: Viruses In Bats & Potential Spillover To Animals And Humans).
Regardless of whether this report turns out to be anything of note, the next big public health threat is likely already quietly evolving somewhere in the world, just waiting for the right host, and the right opportunity, to begin its world tour. 
The big question is not what, or when, or from where.

The only question that really matters is; will we be ready for it when it comes?

Saturday, March 30, 2019

Japan MAFF: 17th Farm Hit With Classical Swine Fever ( 6th in a Week)




















#13,968

Japan's bad week for Classical Swine Fever (CSF) outbreaks continues, as just 7 days ago they reported their 12th Farm Outbreak Of Classical Swine Fever since the virus appeared 6 months ago.  
A week later, that number has risen to 17, with the announcement of a 6th new farm - this time in Gifu Prefecture - testing positive. 
Classical Swine Fever (not to be confused with `swine flu') is caused by a highly contagious (to pigs, not to people) Pestivirus in the family Flaviviridae.  Similar in impact to African Swine fever, both viruses can have a devastating impact on the pork industry.

CSF appeared on a Gifu farm last September, the first occurrence of the virus in Japan in 26 years, and in addition to the farms affected, has been detected in more than 200 wild boar in Gifu and Aichi Prefectures.

Excerpts from today's MAFF press release follow:
Confirmation of suspected affected animals of swine fever in Gifu Prefecture, about (17 cases eyes domestic)

2019 March 30,
the Ministry of Agriculture, Forestry and Fisheries
Today, suspected affected animals of swine fever has been confirmed in a pig farm in Gifu Prefecture Minokamo.
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, that there is a risk that cause the spread of the disease, thank you for your cooperation as strictly refrain from such as that could infringe on the privacy of those farmers.

1. Overview of the occurrence farm


Location: Gifu Prefecture Minokamo
breeding situation: 674 head
2. Background
(1) Gifu Prefecture, March 29 (Friday), from the farm, received a report of a breeding pig has exhibited abnormal, we conducted a site inspection by animal health inspectors.
(2) the same day, because the suspicion of swine fever is caused by the inspection at the Livestock Hygiene Service Center, was subjected to a thorough examination, today (March 30 (Saturday)), has been confirmed to be a suspected affected animals of swine fever directly below.
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) Since the spread of infection prevention, strengthening the disinfection of peripheral generation farm, we set up a disinfection point to the main road.
(3) For the investigation of such infection route, and dispatch the epidemiological investigation team of the country.
(4) aims to ensure the early detection and early notification of the disease.
(5) strive to relevant ministries and sufficient cooperation, producer, consumer, we will endeavor to provide accurate information to the distributors and the like.
(6) 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.
(7)
In order to investigate and prevent the spread of such infection route, it will assume all the possibilities investigation.
(Continue . . . )

Until last September, Japan had been one of only 35 countries (see map below) that has been certified by the OIE as being free of the disease with their last outbreak reported in the early 1990s.

 With Japan's suspension last September, that number now stands at 34.



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

Friday, March 29, 2019

CDC FluView Week 12: Activity Elevated, But Down Slightly - H3N2 Dominates


https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm














#13,967

On the heels of yesterday's CDC HAN Advisory (see HAN #0418: Influenza Season Continues with an Increase in Influenza A(H3N2) Activity) we have the latest (week 12) FluView report which shows the level of flu activity remains elevated, but it has dropped slightly over last week.




This year's flu season, which likely has several more weeks to go, began in mid-December, and is turning into one of the longest in recent memory.

While the winter of 2018 started out with a relatively mild H1N1 virus, an emerging clade (3C.3a) of the H3N2 strain began to make a move in early February, reinvigorating this year's influenza season.

At the start of the flu season (Week 44) Clade 3C.3a comprised only 4% of H3N2 viruses characterized, but today makes up roughly 90% of the H3 viruses in the country. This upstart clade is, unfortunately, less well inhibited by this year's vaccine. 
This recent rise led to a 30 day delay in the selection of the H3N2 component for next fall's Northern Hemisphere flu vaccine, which was finally announced a week ago (see WHO Selects Fall H3N2 Flu Shot Component: Clade 3C.3a).

As a result of this mid-season surge of H3N2, the CDC's 2018-2019 U.S. Flu Season: Preliminary Burden Estimates are slowly inching up into the moderately severe range (see graphic at top of blog).

Some excerpts from today's FluView report follow:


2018-2019 Influenza Season Week 12 ending March 23, 2019


All data are preliminary and may change as more reports are received.
An overview of the CDC influenza surveillance system, including methodology and detailed descriptions of each data component, is available at http://www.cdc.gov/flu/weekly/overview.htm.

Synopsis:

Influenza activity decreased but remains elevated in the United States. Influenza A(H1N1)pdm09 viruses predominated from October to mid-February and influenza A(H3N2) viruses have been more commonly identified since late February. Small numbers of influenza B viruses have also been reported. Below is a summary of the key influenza indicators for the week ending March 23, 2019
  • Viral Surveillance:The percentage of respiratory specimens testing positive for influenza viruses in clinical laboratories decreased. Nationally, during the most recent three weeks, influenza A(H3) viruses were reported more frequently than influenza A(H1N1)pdm09 viruses and in all 10 HHS Regions.
    • Virus Characterization:The majority of influenza viruses characterized antigenically are similar to the cell-grown reference viruses representing the 2018–2019 Northern Hemisphere influenza vaccine viruses. However, an increasing proportion of influenza A(H3N2) viruses are antigenically distinguishable from A/Singapore/INFIMH-16-0019/2016 (3C.2a1), a cell-propagated reference virus representing the A(H3N2) component of 2018-19 Northern Hemisphere influenza vaccines.
    • Antiviral Resistance:The vast majority of influenza viruses tested (>99%) show susceptibility to oseltamivir and peramivir. All influenza viruses tested showed susceptibility to zanamivir.
  • Influenza-like Illness Surveillance:The proportion of outpatient visits for influenza-like illness (ILI) decreased to 3.8%, and remains above the national baseline of 2.2%. All 10 regions reported ILI at or above their region-specific baseline level.
    • ILI State Activity Indictor Map: 20 states experienced high ILI activity; Puerto Rico and 13 states experienced moderate ILI activity; New York City, the District of Columbia and seven states experienced low ILI activity; 10 states experienced minimal ILI activity; and the U.S. Virgin Islands had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in Puerto Rico and 34 states was reported as widespread; 14 states reported regional activity; the District of Columbia and two states reported local activity; the U.S. Virgin Islands reported sporadic activity; and Guam did not report.
  • Influenza-associated Hospitalizations A cumulative rate of 52.5 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported. The highest hospitalization rate is among adults 65 years and older (167.0 hospitalizations per 100,000 population).
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the system-specific epidemic threshold in the National Center for Health Statistics (NCHS) Mortality Surveillance System.
  • Influenza-associated Pediatric Deaths: One influenza-associated pediatric death was reported to CDC during week 12.

  (Continue . . . )

While it is late in the season,  if you haven't gotten a flu shot, you should seriously consider doing so, even if it is less effective against this new clade. You should continue to practice good flu hygiene (covering coughs, washing/ sanitizing hands, and staying home if you are sick), as well.

And if you get sick, call your doctor.  Early treatment with antivirals can shorten your illness, and for some patients, be life saving.

Saudi MOH: 2 More MERS Cases For Epi Week #13 (n=7)















#13,966



After a very quiet Epi week #12, where only one case was reported from Saudi Arabia, over the past 3 days Saudi Arabia has reported 6 new cases (see here, and here).
Three of these six cases hail from Hufoof (aka Hofuf), and are listed as `primary' without camel contact. This would suggest community acquired cases with no identified source of exposure. 
Three such cases, reported over 3 days, from the same town (pop. 660K) is a bit unusual.  Today's second case is a 75 y.o. male from Al Khafji - which is on the border with Kuwait - with reported recent camel contact.
  
https://www.moh.gov.sa/en/CCC/events/national/Documents/Epiwk13-19.pdf



Despite an impressive first quarter of cases for 2019, we haven't seen any indication of sustained or efficient transmission of the MERS virus in the Middle East.
That said, a 2017 study found the virus's basic reproduction number (R0 : pronounced R-nought) was inching closer to the magic number of 1.0, which is what is required for an outbreak to have `legs' (see A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia).
Making any spike in MERS activity a concern, and with expected influx of tens of thousands of religious pilgrims to KSA for the Holy Month of Ramadan (May 5th-Jun 4th), well worth our continued attention.

CDC HAN #0418: Influenza Season Continues with an Increase in Influenza A(H3N2) Activity

https://emergency.cdc.gov/han/han00419.asp











#13,965


Normally by the end of March we are seeing the last gasp of the winter flu season, sometimes punctuated by a surge in late-season Influenza B cases.  This year, however, is a departure from normal.
What began as a relatively mild, H1N1 flu season last fall has morphed into a more severe H3N2 season over the past 6 weeks, with a rapidly surging H3N2 3C.3a clade leading the charge (see graphic below).

We've been following this dramatic rise in 3C.3a for a couple of months, including in:
CDC FluView Week 11: Flu Season Continues Strong As H3N2 Continues To Climb
WHO Selects Fall H3N2 Flu Shot Component: Clade 3C.3a
CDC FLuView Week 8: Flu Remains Elevated - H3N2 Clade 3C.3a Continues Rise
WHO: (Partial) Recommended Composition Of 2019-2020 Northern Hemisphere Flu Vaccine
 
We'll get a new FluView report in a few hours, but yesterday afternoon the CDC released the following HAN (Health Alert Network) advisory, on late season H3N2, and advice to clinicians on the benefits of early treatment with antivirals.

Influenza Season Continues with an Increase in Influenza A(H3N2) Activity

Distributed via the CDC Health Alert Network
March 28, 2019 1415 ET (2:15 PM ET)
CDCHAN-00419

CDC reminds clinicians to have a high suspicion for influenza and recommends rapid antiviral treatment of high-risk patients with suspected influenza.

Summary


The Centers for Disease Control and Prevention (CDC) is issuing this health advisory to notify clinicians that influenza activity remains high in the United States, with an increasing proportion of activity due to influenza A(H3N2) viruses, continued circulation of influenza A(H1N1) viruses, and low levels of influenza B viruses. Influenza should be considered as a possible diagnosis for patients with respiratory illness while local influenza activity remains elevated. Because influenza A(H3N2) viruses may be associated with severe disease in older adults, this health advisory serves as a reminder that early empiric treatment with influenza antiviral medications is recommended for hospitalized and high-risk patients, especially those 65 years and older. Antiviral treatment should be started as soon as possible after illness onset and should not wait for laboratory confirmation.

Background
In the United States, influenza activity remains elevated and widespread, and the season is likely to last several more weeks (see CDC FluView report for details: https://www.cdc.gov/flu/weekly/index.htm). Earlier in the season, influenza A(H1N1) viruses were predominant in most of the country. Although A(H1N1) viruses continue to circulate and remain predominant for the season overall, during the three weeks ending March 16, influenza A(H3N2) viruses have been identified more frequently than A(H1N1) viruses in most of the country. In the past, A(H3N2) virus-predominant influenza seasons have been associated with more hospitalizations and deaths in people 65 years and older than A(H1N1) virus-predominant seasons. Influenza vaccine effectiveness is generally lower against influenza A(H3N2) viruses than against A(H1N1) or B viruses [1]. In addition, one genetic clade of A(H3N2) viruses, the 3C.3a clade, has recently become predominant among circulating A(H3N2) viruses and according to laboratory testing these viruses are antigenically distinct from the A(H3N2) virus included in this season’s vaccine.

CDC recommends antiviral medications for treatment of influenza, regardless of a patient’s influenza vaccination status. Antiviral treatment has been shown to have clinical and public health benefit in reducing illness and severe outcomes of influenza based on evidence from randomized controlled trials, meta-analyses of randomized controlled trials, and observational studies during past influenza seasons and during the 2009 H1N1 pandemic [2–9]. Influenza antiviral medications are most effective in treating influenza and reducing complications when treatment is started early (within 48 hours of illness onset). However, some studies suggest clinical benefit among hospitalized patients and young children with febrile illness even when treatment starts three to five days after illness onset [10–16].

Recommendations
All Hospitalized, Severely Ill, and High-Risk Patients with Suspected or Confirmed Influenza Should Be Treated with Antivirals
Antiviral treatment is recommended as early as possible for any patient with suspected or confirmed influenza who:1) Is hospitalized—treatment is recommended for all hospitalized patients;2) Has severe, complicated, or progressive illness—this may include outpatients with severe or prolonged progressive symptoms or patients who develop complications such as pneumonia but who are not hospitalized;3) Is at high risk for influenza complications but not hospitalized—this includes
Adults 65 years and older.

  • Children younger than two years. Although all children younger than five years are considered at higher risk for complications from influenza, the highest risk is for those younger than two years.
  • People with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), and metabolic disorders (including diabetes mellitus).
  • People with neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy, or spinal cord injury).
  • People with immunosuppression, including that caused by medications or by HIV infection.
  • Women who are pregnant or postpartum (within two weeks after delivery).
  • People younger than 19 years who are receiving long-term aspirin therapy.
  • American Indians and Alaska Natives.
  • People with extreme obesity (i.e., body-mass index is equal to or greater than 40).
  • Residents of nursing homes and other chronic-care facilities.
Antivirals in Non-High Risk Patients with Uncomplicated Influenza
Antiviral treatment can benefit other individuals with influenza. While current guidance focuses on antiviral treatment of those with severe illness or at high risk of complications, antiviral treatment may be prescribed for any previously healthy (non-high risk) outpatient with suspected or confirmed influenza who presents within two days after illness onset. Clinical judgment—considering the patient’s disease severity and progression, age, likelihood of influenza, and time since onset of symptoms—is important when making antiviral treatment decisions for outpatients who are not at increased risk for influenza complications.
        (Continue . . . .)

Japan MAFF: 15th & 16th Farm Struck By Classical Swine Fever (CSF)





















#13,964



It's been a bad week for Japan's containment of Classical Swine Fever, with today's announcement of the 4th and 5th farms in less than a week to be  diagnosed with the disease, while adjacent farms are still being tested.
Six days ago, the 12th farm since September 2018 was announced infected, followed two days ago by the 13th, and yesterday by the 14th - all from Aichi Prefecture.
Today, two more farms in Aichi - one epidemiologically linked to the 13th farm (in Seto) and one to the 14th farm (in Tahara) - are confirmed infected, making this the worst week (by far) since the virus re-emerged last year.

Translated details on the two new farms, and on a special meeting which has been called by MAFF to address this escalation, follow:

About holding of the confirmation of suspected affected animals of swine fever (15 cases and 16th case was in Japan) and "Ministry of Agriculture, Forestry and Fisheries swine fever epidemic prevention headquarters" in Aichi Prefecture 

2019, March 29,
the Ministry of Agriculture, Forestry and Fisheries

Today, suspected affected animals of swine fever has been confirmed in a pig farm in Seto City, Aichi Prefecture, and Tahara. In response to this, the Ministry of Agriculture, Forestry and Fisheries will hold today know 10: 00 "the Ministry of Agriculture, Forestry and Fisheries pig cholera epidemic prevention headquarters". 


Interview in the field, that there is a risk that cause the spread of the disease, thank you for your cooperation as strictly refrain from such as that could infringe on the privacy of those farmers. 


"Ministry of Agriculture, Forestry and Fisheries swine fever epidemic prevention headquarters" is private. However, you can only camera shooting at the beginning.
1. Seto pig farm (15 cases eyes domestic)
Overview of occurrence farm

Location: Seto City, Aichi Prefecture
breeding situation: 1,441 head


Circumstances

March 27 (Wednesday), Aichi Prefecture, in a pig farm in the prefecture Seto City, where in connection with swine fever has occurred, was carried out the inspection of swine fever in the adjacent farm of movement restricted area, 1 for farm pig, today (March 29 (Friday)), it is suspected affected animals of swine fever has been confirmed.
2. Tahara pig farm (16 case was in Japan)
Overview of occurrence farm

Location: Aichi Prefecture Tahara
breeding situation: 997 head


Circumstances

(1) March 28 (Thursday), Aichi Prefecture, received a report of a breeding pig from the prefecture Tahara farm has exhibited abnormal, we conducted a site inspection by animal health inspectors.
(2) the same day, because the suspicion of swine fever is caused by the inspection at the Livestock Hygiene Service Center, was subjected to a thorough examination, today (March 29 (Friday)), has been confirmed to be a suspected affected animals of swine fever directly below.

3. of future correspondence 

On the basis of the "specific livestock epidemic quarantine guidelines for classical swine fever", was held today morning minutes to 10: 00, "the Ministry of Agriculture, Forestry and Fisheries pig cholera epidemic prevention headquarters", we will consider as soon as possible about the future of the epidemic prevention measures.
Ministry of Agriculture, Forestry and Fisheries swine fever epidemic prevention headquarters
Date: 2019, March 29 (Friday) at 10:00 am
Location: Ministry of Agriculture, Forestry and Fisheries Main Building third floor the first special conference room (door No. book 335)
Location: Tokyo, Chiyoda Subdivision Kasumigaseki 1-2-1
(Continue . . . )

While similar in appearance to African Swine Fever, which is currently spreading in China and Vietnam - Classical Swine Fever is caused by a different virus (genus Pestivirus, family Flaviviridae).
Both diseases are highly contagious, and can be economically devastating for pork producers, but neither disease is considered a human health threat.  
While commercial pigs are the biggest concern, the virus has rapidly become endemic in local pigs (thus far, only in Gifu & Aichi Prefectures), as described by the latest OIE Notification below.
Summary of the wild boar surveillance
As of the 25th of March, 890 wild boars (130 dead and 760 captured) in Gifu prefecture have been tested and 228 (83 dead and 145 captured) were found to be positive for CSF virus (CSFV) by RT-PCR since 13th of September. 140 wild boars (16 dead and 124 captured) in Aichi prefecture have been tested and 13 were found to be positive (2 dead and 11 captured) for CSFV by RT-PCR since 14th of September. Among the other prefectures, 255 wild boars (232 dead and 23 captured) in 40 prefectures were tested and all were found to be negative for CSFV by RT-PCR since the 14th of September.
While much of Japan's transmission of the virus is likely farm-to-farm, the existence of the virus in wild boar provides a reservoir for the virus, making eradication more difficult.

WHO MERS Update - Saudi Arabia

image
Credit WHO


#13,963


It's been just over a month since the WHO last updated us on MERS in Saudi Arabia,  and while we've seen a slowdown in cases during the month of March, there remains a backlog of cases from late January and much of February that have yet to be published.
Overnight the WHO has released a new update that looks at 19 cases with onset dates between January 31st and February 25th, which occurred in areas outside of the hard-hit town of Wadi Aldawasir.
The last WHO update (Feb 26th) covered the first 39 cases reported from Wadi Aldwasir between January 29th and February 13th.  Today's update promises:
A separate Disease Outbreak News will provide an update on the outbreak in Wadi Aldwasir which affected 49 cases and resulted in seven deaths in February making a total of 52 cases since the onset of the outbreak.
Two small clusters are described (in Buraidah & Riyadh). As usual, details on the individual cases are provided via the attached xls spreadsheet file.

Middle East respiratory syndrome coronavirus (MERS-CoV) – The Kingdom of Saudi Arabia

Disease Outbreak News: Update
29 March 2019

From 1 through 28 February 2019, the National IHR Focal Point of Saudi Arabia reported 68 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 10 deaths. Of the 68 MERS cases reported in February, 19 cases occurred in cities other than Wadi Aldwasir.

This Disease Outbreak News update describes the 19 cases. Among these cases, fifteen were sporadic, and four were reported as part of two unrelated clusters. Cluster 1 involved two cases in Buridah city; and Cluster 2 involved two cases in Riyadh city. The link below provides details of the 19 reported cases.
MERS-CoV cases reported from 1 February through 28 February 2019 xls, 116kb
A separate Disease Outbreak News will provide an update on the outbreak in Wadi Aldwasir which affected 49 cases and resulted in seven deaths in February making a total of 52 cases since the onset of the outbreak.

From 2012 through 28 February 2019, the total number of laboratory-confirmed MERS cases reported globally to WHO is 2374 with 823 associated deaths. The global number reflects the total number of laboratory-confirmed cases reported to WHO under IHR to date. The total number of deaths includes the deaths that WHO is aware of to date through follow-up with affected member states.
WHO risk assessment

Infection with MERS-CoV can cause severe disease resulting in high morbidity and mortality. Humans are infected with MERS-CoV from direct or indirect contact with infected dromedary camels. MERS-CoV has demonstrated the ability to transmit between humans, especially from close unprotected contact with infected patients. So far, the observed non-sustained human-to-human transmission has occurred mainly in health care settings.

The notification of these additional cases does not change WHO’s overall risk assessment of MERS. WHO expects that additional cases of MERS will be reported from the Middle East, and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to dromedary camels, animal products (e.g. consumption of camel’s raw milk), or humans (e.g. in a health care setting). WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.

(Continue . . . )

Thursday, March 28, 2019

Saudi MOH Announces 2 More Primary MERS Cases














#13,962

After a very slow Epi Week 12, where Saudi Arabia only reported 1 MERS case, week 13 has picked up the pace again with 5 cases over the past 5 days.  
Curiously, the 4th case of the week (a 53 y.o. female from Hufoof) is the second primary (no camel contact) female case from Hufoof reported in the past two days. 
The 5th case - a 78 y.o. male from Riyadh - is listed as `primary' with recent camel contact.



Despite the recent drop off in case reports, the first quarter of 2019 is running at nearly double the rate we saw a year ago.  While concerning, thus far we've seen no signs of enhanced or efficient community transmission of the virus.


Japan MAFF: 3rd Classical Swine Fever Outbreak in Less Than A Week




















#13,961


We've been watching the slow spread of Classical Swine Fever (CSF) across central Japan since last September, with just 6 farms affected in the second half of 2018.  In January a 7th farm was affected, followed in February by 3 more.
Today Japans Ministry of Agriculture (MAFF) announces the 4th farm outbreak of March, and the third report of the past 5 days.  As with yesterday's report, today's outbreak is in Aichi Prefecture.
While similar in appearance to African Swine Fever - which recently arrived in China and Vietnam - and both are capable of causing devastating losses in pig herds, neither is considered a human health threat.

We've two reports from MAFF this morning. First, the initial notification on the 14th farm, followed by a second report ordering the quarantining of several adjacent farms following the discovery of their joint sharing of facilities (`composting house, composting facility and carcass storage facility') with the infected farm.


Confirmation of affected animals of swine fever in Aichi Prefecture, about (14 domestic case was)

2019 March 28,
the Ministry of Agriculture, Forestry and Fisheries
Today, pig cholera affected animal has been confirmed in pig farm in Aichi Prefecture, Tahara.
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: Aichi Prefecture Tahara
breeding situation: 1,647 head

2. Background
(1) Aichi Prefecture, March 27 (Wednesday), from the farm, received a report of a breeding pig has exhibited abnormal, we conducted a site inspection by animal health inspectors.
(2) the same day, because the suspicion of swine fever is caused by the inspection at the Livestock Hygiene Service Center, where to send the material to Noken mechanism Animal Health Research Institute (Note), was carried out precision inspection, today (March 28 Thursday), was found to be an affected animal of swine fever.
(Note) specialized research institutions on the only animal health in Japan
(Continue . . . . )


About conduct of additional epidemic prevention measures pertaining to swine fever (14 domestic cases) which occurred in Aichi prefecture

March 28, 2019
Ministry of Agriculture, Forestry and Fisheries

Aichi Prefecture will carry out additional epidemic prevention measures at epidemiologically related farms on today's (Thursday, March 28) pig cholera (14 cases in Japan) that has occurred at a pig farming farm in Tahara, Tokyo.
1. Overview of epidemiological farms

Overview: Today (Thursday, March 28), adjacent to a farm in Tahara City, Aichi Prefecture, where the disease has been confirmed for hog cholera (14 cases in Japan), facilities such as compost houses are jointly used 3 farm

Location: Tahara City, Aichi Prefecture
The feeding situation: 5,972
2. Background and future response
(1) Today (Thursday, March 28) There is no clear boundary for each farm in the pig farming area where the pig farm of Tahara City, Aichi Prefecture, where the disease of pig cholera was confirmed, and the work in the center The road is used by 4 farms including outbreak farms, and it is confirmed by the investigation of Aichi Prefecture that the composting house, composting facility and carcass storage facility are jointly used.
(2) For this reason, it is judged that the possibility that the virus has invaded other farms is extremely high through the use of a joint facility or vehicle etc. We decided to take epidemic measures as all the pigs which we raise in each farm in pig farming area as pseudo-affected animals.
 (Continue . . . )

In addition to the 14 farms infected, more than 240 wild boar in two Prefectures (Gifu n=228, Aichi n=13) have been found to be infected with CSF since last September.
Even as Japan attempts to contain their first outbreak of CSF in 26 years, they are keeping a wary eye on the spread of African Swine Fever in nearby China and Vietnam, and are taking steps to try to prevent its import (see Japan MAFF: ASF Virus Detected In Luggage At Hokkaido Airport).

Wednesday, March 27, 2019

Saudi MOH: 3 MERS Cases For Epi Week 13















#13,960

After a remarkable February, which saw 68 MERS cases reported from Saudi Arabia, we've seen a noticeable slowdown in reports the past two weeks, with only one case reported during Epi week 12, and 3 cases reported so far in Epi Week 13.
All of the human infections reported over the past two weeks have been widely scattered (Medina, Khameres Meshalt, Al Kharj, Hufoof) primary cases - two of which had reported camel contact - while two others did not. 
The details on week 13 cases follows:
https://www.moh.gov.sa/en/CCC/events/national/Documents/Epiwk13-19.pdf



Despite an active start to 2019, we haven't seen any indication of sustained or efficient transmission of the MERS virus in the Middle East. 
That said, a 2017 study found the virus's basic reproduction number (R0 : pronounced R-nought) was inching closer to the magic number of 1.0, which is what is required for an outbreak to have `legs' (see A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia).
Making any spike in MERS activity a concern, and with expected influx of tens of thousands of religious pilgrims to KSA for the Holy Month of Ramadan (May 5th-Jun 4th), well worth our continued attention. 

Japan MAFF: 13th Farm Affected By Classical Swine Fever - Aichi Prefecture




















#13,959

For the second time in 4 days (see Saturday's report)  Japan's Ministry of Agriculture (MAFF) has announced the detection of Classical Swine Fever (CSF) at a large farm - this time in Aichi Prefecture - and the 13th farm to be struck since the virus re-emerged in neighboring Gifu Prefecture last September. 
While similar in appearance to African Swine Fever, which is currently spreading in China and Vietnam - Classical Swine Fever is caused by a different virus (genus Pestivirus, family Flaviviridae).
Both diseases are highly contagious, and can be economically devastating for pork producers, but neither disease is considered a human health threat.  Unlike ASF, there is a vaccine available for Classical Swine Fever.
Confirmation of affected animals of swine fever in Aichi Prefecture, about (13 domestic case was)
2019, March 27,
the Ministry of Agriculture, Forestry and Fisheries
Today, pig cholera affected animal has been confirmed in pig farm in Seto City, Aichi Prefecture. 
 
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: Seto City, Aichi Prefecture
breeding situation: 4,140 head


2. Background
(1) Aichi Prefecture, March 26 (Tuesday), from the farm, received a report of a breeding pig has exhibited abnormal, we conducted a site inspection by animal health inspectors.
(2) the same day, because the suspicion of swine fever is caused by the inspection at the Livestock Hygiene Service Center, where to send the material to Noken mechanism Animal Health Research Institute (Note), was carried out precision inspection, today (March 27 Wednesday), was found to be an affected animal of swine fever.

(Note) specialized research institutions on the only animal health in Japan

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, that there is a risk that cause the spread of the disease, thank you for your cooperation as strictly refrain from such that there is a risk of infringing the privacy of the people of the farmers. 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.

The most recent OIE Notification (#21) - published yesterday - added Saturday's farm outbreak in Gifu Prefecture plus a dozen new reports of infected wild boar.   Their epidemiological summary follows:
1. The 12th affected farm (Yamagata city in Gifu, 22/03/2019) On the 22th of March, some pigs were found to have a low appetite and this was reported to the Gifu Central Livestock Hygiene Service Centre (LHSC). Official veterinarians of the LHSC immediately visited the farm to conduct a clinical inspection and blood sampling. The samples were tested for classical swine fever (CSF) virus by RT-PCR at the LHSC. The samples were found to be positive on the 23rd of March. Stamping out and disinfection of contaminated materials, tools and facilities were completed on the 26th of March. 

 2. The 9th affected farm (Tahara city in Aichi, 13/02/2019) Removal of shipment restriction zone (SRZ) and movement restriction zone (MRZ): On 00:00 of 17th of March, shipment restrictions, which were established within a 3-10 km radius of the affected farm, were lifted as 17 days have passed after the completion of full implementation of control measures (stamping out, disinfection etc.) at the 9th affected farm. On 00:00 of 25th March, movement restrictions, which were established within a 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 9th affected farm.
3. The 10th affected farm (Mizunami city in Gifu, 18/02/2019) Removal of movement restriction zone (MRZ): On 00:00 of 24th March, movement restrictions, which were established within a 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 10th affected farm.
4. Summary of the wild boar surveillance As of the 25th of March, 890 wild boars (130 dead and 760 captured) in Gifu prefecture have been tested and 228 (83 dead and 145 captured) were found to be positive for CSF virus (CSFV) by RT-PCR since 13th of September. 140 wild boars (16 dead and 124 captured) in Aichi prefecture have been tested and 13 were found to be positive (2 dead and 11 captured) for CSFV by RT-PCR since 14th of September. Among the other prefectures, 255 wild boars (232 dead and 23 captured) in 40 prefectures were tested and all were found to be negative for CSFV by RT-PCR since the 14th of September.
Until last September, Japan had been one of only 35 countries (see map below) that has been certified by the OIE as being free of the disease with their last outbreak reported in the early 1990s.

 With Japan's recent suspension, that number now stands at 34.


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