MERS Advisories Go Up In Some US Airports

Credit CDC – WFAA TV News

 

 

# 8619

 

With the second imported case of MERS in two weeks making headlines, it isn’t surprising that the CDC has recently upgraded their Traveler’s Alert level for the Middle East to countries in or near the Arabian Peninsula (see map below) and have posted notices in more than 20 major airports around the country.

 

Credit CDC

 

 

Curiously, there is no mention of avoiding camels, or camel products, in the CDC’s Traveler’s Advisory or in this newly released airport signage. 

 

Although the exact mode of transmission to humans remains uncertain, many Arabian camels have been found to carry the MERS Coronavirus (see here, here, & here) and camel exposure has been linked to at least some human infections.  

 

Canada’s PHAC MERS Middle East Traveler’s advice includes:

• Avoid close contact with all wild or farmed animals, such as bats and camels.

  • If you have chronic medical conditions, your risk may be higher.
  • If you must visit a farm, make sure you practise good hygiene and wash your hands before and after contact with animals.

Hong Kong’s CHP routinely advises traveler’s to the Middle East:

* Avoid going to farms, barns or markets with camels;
* Avoid contact with animals (especially camels), birds, poultry or sick people during travel;

 

Although a bit less restrictive, the  World Health Organization has this to say in their MERS FAQ regarding the risks of camel exposure:

Until more is understood about MERS, 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 contact with camels, drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

 

And lastly, the Saudi Ministry of Agriculture – which has long protested any connection between camel exposure and MERS, issued strict precautionary measures last Sunday (see Saudi Ministry Of Agriculture Issues Warnings On Camels), which includes reducing exposure to camels, and the wearing of PPEs (masks, gloves) when in close contact with them.

 

The Agriculture Minister said in the press release posted on a number of health measures that Must be adhered to, Including: NOT to approach direct from camel than it needed with the necessary health precautions and wear protective respiratory masks When dealing with camels, and the need to wash hands with soap Before and after touching the camels, we recommend wearing protective gloves , especially in Cases of Cases of birth and dealing with diseased or dead.

 

All of which makes the absence of any mention of camels in the CDC’s advice a bit surprising.

 

 

H7N9: Hong Kong’s CHP Issues New Years Travel Advice

Credit CDC Traveler’s Health Lunar New Years

 

 

# 8213

 

As we discussed just over a week ago (see China: Spring Festival Concerns Over H7N9) the next few weeks will China’s most important holiday (Lunar New Year), when hundreds of millions of people across Asia return to their home towns to celebrate this tradition with family and friends.

 

The Spring festival travel began about a week ago,  and will run about 6 weeks.  With the New Year falling on January 31st this year,  we are already seeing this tremendous annual human migration begin.

 

One which will see more than  3 billion passenger journeys – mostly by crowded train – made in China over the next 30 to 40 days.

 

All of which provides plenty of opportunities for infectious diseases (including both avian and human influenzas, mosquito borne illnesses, tuberculosis, etc.) to spread quickly between towns large and small.  And with the rise in the number of avian H7N9 flu infections the past couple of weeks, that has public health officials on alert.

This from Hong Kong’s CHP.

DH urges travellers to take precautions against avian influenza during Lunar New Year 

24 January 2014

With the Lunar New Year around the corner, a spokesman for the Department of Health (DH) today (January 24) urged members of the public who are planning to travel outside Hong Kong during the festive season to take precautions against avian influenza.

The spokesman said, "In view of the three imported human cases of avian influenza A(H7N9) confirmed in Hong Kong and multiple cases reported in various provinces and municipalities on the mainland recently, the activity of avian influenza virus is expected to be higher in the winter season. Maintaining good personal and environmental hygiene at all times is thus of paramount importance to prevent infection."

As severe infection can result in respiratory failure, multi-organ failure and even death, the spokesman appealed to all travellers to remain vigilant and take heed of the following preventive measures:

Before your trip:
-----------------

* If you have flu-like symptoms (e.g. fever, cough, sore throat and shortness of breath), postpone your trip until you have recovered.
* Bring along adequate face masks and alcohol hand-rub.

During your trip:
-----------------

* Do not visit live poultry markets and farms. Do not have direct contact with poultry, birds and their droppings. If contact has been made, wash your hands thoroughly with soap and water.
* Cook poultry and eggs thoroughly before eating.
* Avoid crowded places and contact with fever patients.
* If you develop flu-like symptoms, put on a face mask and consult a doctor as soon as possible.

After your trip:
----------------

* If you develop flu-like symptoms, put on a face mask, consult a doctor promptly and inform your doctor of your travel history.
* Do not bring raw meat (including poultry and game) without a health certificate into Hong Kong.

The public are also advised to observe cough etiquette at all times by covering the nose and mouth while sneezing or coughing, holding the spit with a tissue and putting it into a covered dustbin. They should wash hands with liquid soap and water properly, especially when they are dirtied by respiratory secretions, e.g. after sneezing, and clean hands with alcohol-based hand rub when they are not visibly soiled.

 

The public may visit the CHP's avian influenza page (www.chp.gov.hk/en/view_content/24244.html) and website (www.chp.gov.hk/files/pdf/global_statistics_avian_influenza_e.pdf) for more information on avian influenza-affected areas.

Ends/Friday, January 24, 2014

WHO: Interim Travel Advice On MERS-CoV For KSA Pilgrimages

Credit Wikipedia

 

 

# 7514

 

The World Health Organization has released interim travel advice for those planning to visit the Kingdom of Saudi Arabia (KSA) for this year’s Umrah or Hajj.  In an emailed media release, the WHO describes this interim advice as:

 

It provides guidance to national authorities of countries from which pilgrims will be travelling in the coming months for Umra and Hajj for the prevention, detection and management of imported cases of MERS-CoV.

 

At this time, the risk to an individual pilgrim of contracting MERS-CoV is considered very low. WHO does not recommend the application of any travel or trade restrictions or entry screening.

 

WHO encourages countries to raise awareness of this travel advice to reduce the risk of MERS-CoV infection among pilgrims and those associated with their travel, including transport operators and ground staff, and about self-reporting of illness by travelers. 

 

The following interim advice is available on the WHO International Travel and Health web page:

 

Kingdom of Saudi Arabia - travel advice on MERS-CoV for pilgrimages

World Health Organization interim travel advice on MERS-CoV for pilgrimages to the Kingdom of Saudi Arabia

I. Introduction

An outbreak of the Middle East respiratory syndrome coronavirus (MERS-CoV), first reported in 2012, has affected nine countries to date. WHO is coordinating the global response to this emerging virus according to the International Health Regulations (IHR 2005). This paper provides guidance to national authorities of countries from which pilgrims will be travelling in the coming months for Umra and Hajj for the prevention, detection and management of imported cases of MERS-CoV. At this time, the risk to an individual pilgrim of contracting MERS-CoV is considered very low.

II. Effective communication of risk information

It is important for countries to use all practical and effective means possible to communicate information on a range of issues before, during and after Umra and Hajj to all key groups, including the following:

• travellers to Umra and Hajj, particularly vulnerable groups within this population;
• public health officials;
• health care staff responsible for the care of ill pilgrims;
• public transportation and tourism industries; and
• the general public.

2.1. Actions to take before Umra or Hajj

• Countries should advise pilgrims that pre-existing major medical conditions (e.g. chronic diseases such as diabetes, chronic lung disease, immunodeficiency) can increase the likelihood of illness, including MERS-CoV infection, during travel; thus, pilgrims should consult a health care provider before travelling to review the risk and assess whether making the pilgrimage is advisable.
• Countries should make information known to departing pilgrims and travel organizations on general travel health precautions,¹ which will lower the risk of infection in general, including illnesses such as influenza and traveller’s diarrhoea. Specific emphasis should be placed on:
  • washing hands often with soap and water. When hands are not visibly dirty, a hand rub can be used;
  • adhering to good food-safety practices, such as avoiding undercooked meat or food prepared under unsanitary conditions, and properly washing fruits and vegetables before eating them;
  • maintaining good personal hygiene;
  • avoiding unnecessary contact with farm, domestic, and wild animals.
• Health advisories should be made available to all departing travellers to Umra or Hajj by working with the travel and tourism sectors and placing such materials at strategic locations (eg. travel agent offices or points of departure in airports).
  • different kinds of communication, such as health alerts on board planes and ships, and banners, pamphlets and radio announcements at international points of entry, can also be used to reach travellers.
  • travel advisories should include current information on MERS-CoV and guidance on how to avoid illness while travelling.
• Current WHO guidelines, or their national equivalents, on surveillance,² infection prevention and control measures³ and clinical management⁴of MERS-CoV should be distributed to health care practitioners and health care facilities.
• Countries should ensure that there are adequate laboratory services for testing for MERS-CoV and that information on laboratory services and clinical referral mechanisms is known to health care providers and facilities.
• Medical staff accompanying pilgrims should be up to date on MERS-CoV information and guidance, including how to recognize early signs and symptoms of infection, who is considered to be in a high-risk group, and what to do when a suspected case is identified, as well as on simple health measures to reduce transmission.

2.2. Actions to take during Umra or Hajj

• Travellers who develop a significant acute respiratory illness with fever and cough (severe enough to interfere with usual daily activities) should be advised to:
  • minimize their contact with others to keep from infecting them;
  • cover their mouth and nose with a tissue when coughing or sneezing and discard the tissue in the trash after use and wash hands afterwards, or, if this is not possible, to cough or sneeze into upper sleeves of their clothing, but not their hands;
  • report to the medical staff accompanying the group or to the local health services.

2.3. Actions to take after Umra or Hajj

• Returning pilgrims should be advised that if they develop a significant acute respiratory illness with fever and cough (severe enough to interfere with usual daily activities) during the two weeks after their return, they should seek medical attention and immediately notify their local health authority.
• Persons who have had close contact with a pilgrim or traveller with a significant acute respiratory illness with fever and cough (severe enough to interfere with usual daily activities) and who themselves develop such an illness should be advised to report to local health authorities to be monitored for MERS-CoV.
• Practitioners and facilities should be alerted to the possibility of MERS-CoV infection in returning pilgrims with acute respiratory illness, especially those with fever and cough and pulmonary parenchymal disease (e.g. pneumonia or the acute respiratory distress syndrome). If clinical presentation suggests the diagnosis of MERS-CoV, laboratory testing,^5,6 in accordance with WHO’s case definition⁷ should be done and infection prevention and control measures implemented. Clinicians should also be alerted to the possibility of atypical presentations in patients who are immunocompromised.

III. Measures at borders and for conveyances

WHO does not recommend the application of any travel or trade restrictions or entry screening.

 

WHO encourages countries to raise awareness of this travel advice to reduce the risk of MERS-CoV infection among pilgrims and those associated with their travel, including transport operators and ground staff, and about self-reporting of illness by travellers.

 

As required by the IHR, countries should ensure that routine measures are in place for assessing ill travellers detected on board conveyances (such as planes and ships) and at points of entry, as well as measures for safe transportation of symptomatic travellers to hospitals or designated facilities for clinical assessment and treatment.

 

If a sick traveller is on board a plane, a passenger locator form⁸ can be used. This form is useful for collecting contact information for passengers, which can be used for follow-up if necessary.

H3N2v: CDC Offers Advice To Fair Goers

 

Credit Wikipedia

 

# 6455

 

In the wake of this week’s announcement of another fair-related outbreak of H3N2v influenza (see MMWR On The H3N2v Outbreak In LaPorte, Indiana), the CDC has put together a summary of the event and some advice to the fair-going public (and those who raise or come in contact with pigs).

 

 

I’ve only excerpted portions of this lengthy `Flu News’ report, follow the link to read it in its entirety.

 

CDC Reports Cases 14-17 of H3N2v Infection; Shares Advice for Safe Fair-Going

July 27, 2012 -- The state of Indiana this week reported the first novel influenza virus outbreak associated with a fair this season. Following reports of ill swine and humans during a fair in Indiana from July 8-14, samples were taken from swine and humans. Twelve swine were randomly sampled by Indiana state animal health officials, tested at Indiana and federal animal diagnostic laboratories, and found to be infected with swine influenza A (H3N2) viruses. Four people tested positive for influenza A (H3N2) variant virus.* Genetic testing confirmed that the viruses found in humans and those found in swine are nearly identical and both have the M gene from the pandemic H1N1 virus. These cases bring the total number of detected infections with the H3N2v virus containing the pandemic M gene in the United States since 2011 to 17.

<SNIP>

Take Action to Prevent the Spread of Flu Viruses Between People and Pigs**

• Wash your hands frequently with soap and running water before and after exposure to animals.
• Never eat, drink or put things in your mouth in animal areas and don’t take food or drink into animal areas.
• Young children, pregnant women, people 65 and older and people with weakened immune systems should be extra careful around animals.
• If you have animals – including swine – watch them for signs of illness and call a veterinarian if you suspect they might be sick.
• Avoid close contact with animals that look or act ill, when possible.
• Avoid contact with pigs if you are experiencing flu-like symptoms.

If you must come in contact with pigs while you are sick, or if you must come in contact with pigs known or suspected to be infected, or their environment, you should use appropriate protective measures (for example, wear protective clothing, gloves, masks that cover your mouth and nose, and other personal protective equipment) and practice good respiratory and hand hygiene.

Certain People at Higher Risk

“For influenza, certain people may be at higher risk of getting infected, or may be at higher risk for more severe outcomes,” says Jernigan. Studies conducted by CDC have indicated that children younger than 10 would have little to no immunity against H3N2v, whereas adults may have some cross-protective immunity. Most cases of H3N2v have occurred in children at this time. Other people who are at higher risk for seasonal flu-related complications include people with asthma, diabetes, heart disease or neurological disorders. “Prevention is especially important for these people,” says Jernigan.

(Continue . . .)