WHO Ebola Assessment – Guinea & Nigeria

Credit CDC

 

 

# 8071

 

 

Although it is hard to find anything other than apocalyptic doom and gloom coming out of media reports on the Ebola outbreak in Western  Africa, the World Health Organization reports some encouraging signs – at least in Guinea and Nigeria – as outlined in the following statement mailed to journalists this morning.

 

Ebola assessment
19 August 2014

Ebola virus disease

Situation in Nigeria and Guinea: some encouraging signs

The outbreak of Ebola virus disease in West Africa continues to evolve, with cases confirmed in Guinea, Liberia, Nigeria, and Sierra Leone. At present, no cases have been confirmed anywhere else in the world outside these four countries.

Nigeria

The situation in Lagos, Nigeria, where the first imported case was detected in July, looks reassuring. At present, the city’s 12 confirmed cases are all part of a single chain of transmission. Those infected by the initial case include medical staff involved in his treatment, a patient in the same hospital, and a protocol officer in very close contact with the patient.

The initial patient was vomiting frequently during travel and upon arrival. No one on the same flight was infected.

The full recovery to date of one infected contact is additional good news. It counters the widespread perception that infection with the Ebola virus is invariably a death sentence. Evidence suggests that early detection and supportive therapy increase the prospects of survival.

Intensive contact tracing, conducted by Nigerian health officials and staff from the US Centers for Disease Control and Prevention, has not, so far, identified any further confirmed cases outside the initial transmission chain.

The index case arrived in Lagos on 20 July and died on 25 July. The 21-day incubation period has lapsed. All 12 cases were confirmed in a WHO-approved laboratory.

The intensity of the search and monitoring effort raises cautious optimism that further spread of the virus in Nigeria can be stopped. The search for additional cases continues, as does the current high level of vigilance.

Guinea

The outbreak in Guinea, where the virus made its first appearance in West Africa last December, is less alarming than in Liberia and Sierra Leone.

Public awareness of the facts about Ebola is higher there than in the other affected countries. Innovative solutions are being found. For example, respected community leaders have been used to secure the cooperation of 26 villages that were highly resistant to outside help.

The opening of these villages has resulted in a surge of reported cases. These are cases that were previously concealed; their reporting should not be interpreted as a sudden upsurge in Guinea’s outbreak.

However, the outbreak is not under control. As recent experience shows, progress is fragile, with a real risk that the outbreak could experience another flare-up. A case in a previously unaffected area was reported last week, indicating continuing spread to new areas.

WHO media contacts:
Gregory Härtl
Telephone: +41 22 791 4458
Mobile: +41 79 203 6715
Email: hartlg@who.int
Fadéla Chaib
Telephone: + 41 22 791 3228
Mobile:+ 41 79 475 55 56
Email: chaibf@who.int

WHO MERS-CoV Summary Update #13 – January 20th

Credit WHO Summary Update #13

 

# 8194

 

 

The World Health Organization has today published a 5-page (PDF file) summary update on the MERS coronavirus, along with selected MERS-CoV Literature, and upcoming MERS-CoV Activities and guidance.

 

Included are new details on the two `probable’ MERS cases detected in Spain last November (see Spain Reports First MERS-CoV Case & Spain: MOH Statement On MERS-CoV Case).

Due to its length I’ve only included some excerpts.  Follow the link for the entire document, and links to guidance, recent additions to the literature, and WHO MERS related activities.

 

Middle East respiratory syndrome coronavirus (MERS-CoV) summary and literature update–as of 20 January 2014

Since April 2012, 178 laboratory-confirmed of human infection with Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported to WHO, including 76 deaths (Figure 1).  The median age of all lab-confirmed cases (n=178) is 52 years; this varies by the presumed type of exposure. For primary cases, those who have no history of exposure to other human cases, median age is 58 years; for secondary cases, those who appear to have been infected by other humans, median age is 44 years.   Overall, 62% are male; distribution by sex also varies by presumed exposure 76% male among primary cases; 53% among secondary cases).  To date, affected countries in the Middle East include Jordan, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates UAE)and; in Europe countries affected include: France, Germany, Italy and the United Kingdom (UK) and; and in North Africa: Tunisia.  All cases have a link to the Middle East. For those cases reported outside the Middle East, the link is either through recent travel to the region or exposure to a patient who acquired infection in the region. Since the last update of 22 November 2013, 21 laboratory-confirmed cases, including seven deaths, were reported to WHO. The geographic distribution of these 21 cases is 14 cases, including four deaths, from Saudi Arabia; six cases, ncluding two deaths,  from UAE; and one fatal case from Oman (Figure 2).  

Among the six new cases reported from UAE, three were from one family  in Abu Dhabi,  including a 32-year-old pregnant woman who died on 2 December 2013. Before her death, the woman gave birth to a healthy baby, who had no evidence of MERS-CoV infection. One of the recent cases from UAE was a 33-year-old health care worker who provided direct care for a 68-year-old patient with laboratory-confirmed MERS-CoV infection. The health care worker subsequently developed severe disease requiring mechanical ventilation and haemodialysis, and died.

 

Among the new cases reported from Saudi Arabia, seven are classified as sporadic (no contact with a probable or confirmed MERS-CoV patient) and seven as secondary cases (infection presumed to be acquired by transmission from another human case). Of the seven secondary cases, six are health care workers who were reported to be asymptomatic.  

<SNIP>

 

Summary assessment

Infections acquired in health care facilities currently account for more than half of secondary cases. Health care workers and other patients in contact with cases both appear to be at risk. Thus far, transmission in health care facilities does not appear to persist over long periods of time or extend into the community. Most secondary cases who acquired infection  in this setting have been mild or asymptomatic; however, several have had severe disease and have died, including workers who provided care for infected patients.   Health care providers should be reminded of the need for universal precautions and for infection control measures to be implemented even before the cause of a patient’s illness has been determined. Patients for whom clinical suspicion of MERS-CoV is high should be managed as potentially infected, even if an initial test on a nasopharyngeal swab is negative. Repeat testing should be done when the clinical and epidemiological picture suggests MERS-CoV when initial testing is negative, preferably on specimens from the lower respiratory tract. Infection control guidelines for both home care settings and health care facilities can be found on the WHO MERS-CoV website.

Despite the  initial report of probable MERS-CoV cases in Spain, follow-up laboratory testing was unable to confirm MERS-CoV infection in these two patients using specific RT-PCR assays.  The women, who had been on an extended visit to Saudi Arabia, raised initial concerns about possible infection related to the pilgrimage of Hajj, which occurred 13 to 18 October 2013. However, other than these two unconfirmed cases, there were no other reports of Hajj-related MERS-CoV patients, despite extensive testing in nearly every country  from which Hajj pilgrims originated. At this point, it is clear that neither significant transmission nor exportation of MERS-CoV occurred in association with the Hajj.

The confirmation of MERS-CoV virus in camels in Qatar supports  an earlier report of MERS-CoV in a camel in Saudi Arabia and serologic evidence of MERS-CoV in camels from Canary Islands, Egypt, Jordan, Oman and UAE.  The earliest findings of antibodies in camels from 2003 in UAE suggest that a similar virus has been circulating in animals for at least a decade. However, most primary human cases do not have a history of direct exposure to animals. More work is needed to determine the route of transmission to humans and the types of exposures that result in infection. 

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WHO MERS-CoV Summary & Update – Sept 20th

Photo Credit WHO

 

# 7797

 

 

The World Health Organization has released a second MERS update today, this time a detailed summary and literature update on what we know about the MERS coronavirus.  Due to its length, I’ve only excerpted portions.  Follow the link to read it in its entirety.

 

A few selected excerpts (bolding mine):

• Since the last update, 37 new laboratory-confirmed cases of MERS-CoV have been reported; these include 34 cases from KSA and three cases from Qatar
• Two cases previously counted as confirmed have been reclassified as probable on the basis of further clarifications of the case definition (see MERS-CoV: WHO Update Sept 20th)
• Nine new cases were reported to be sporadic, i.e. cases that were reported to have no prior contact with another known case and including cases that were the first case within a cluster. Of these, 56% were female; the median age was 53 years; and 89% had at least one underlying condition reported.
• Eighty-nine percent were severely ill or died. Eight of these cases were probably exposed to the virus in KSA (six in Riyadh, one in Medina, one in Hafr Al Batin) and one in Qatar. The median age and gender balance of these nine new cases represents a shift compared with earlier cases. Up until mid-July 2013, the median age of sporadic cases was 59.5 years and 83% were male.
• Patients with positive serological tests in the absence of PCR or sequencing data continue to be classified as probable cases, pending more work on the validation of serological tests.
• The recent upsurge in case reporting is of concern and represents both an increase in sporadic cases and several coincident clusters of infection in contacts. These clusters are under close observation by health authorities to detect signs of further onward transmission. The reason for the increase in sporadic cases is unknown but could be the result of increased surveillance, an expansion of the virus in the unknown reservoir, seasonal variation, or a change in exposure patterns
• The discovery of antibodies reactive with MERS-CoV in Egyptian camels imported from Sudan and other East African countries is consistent with the previous report by a lab in the Netherlands (see last update).  . . . . It is also unclear whether camels, even if they are infected with the virus, play a role in transmission to humans
• Countries outside of the affected region should maintain a high level of vigilance, especially those with large numbers of travellers or guest workers returning from the Middle East. Surveillance should be enhanced in these countries according to WHO guidelines along with infection control procedures in health care facilities.

There is a lot more in this update, including summaries of recent research papers, so follow the link to read:

 

Middle East respiratory syndrome coronavirus (MERS-CoV) summary and literature update – as of 20 September 2013

Since April 2012, 130 laboratory-confirmed and 17 probable cases of human infection with Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported to WHO. Affected countries in the Middle East include Jordan, Kingdom of Saudi Arabia (KSA), the United Arab Emirates (UAE), and Qatar; in Europe countries affected include: France, Germany, the United Kingdom (UK) and Italy; and in North Africa: Tunisia. Infections presumably acquired through exposure to non-human sources have all occurred in the Middle East; limited transmission in the countries of Europe and North Africa has occurred in close contacts of recent travellers from the Middle East. No new countries have reported MERS-CoV cases since the last update; the last exported case to a country outside the Middle East was in June 2013.

 

Since the last update, 37 new laboratory-confirmed cases of MERS-CoV have been reported; these include 34 cases from KSA and three cases from Qatar. In addition, one previously reported probable case in Tunisia has now been confirmed as a result of additional laboratory testing. Two cases previously counted as confirmed have been reclassified as probable on the basis of further clarifications of the case definition. Of the 130 confirmed cases, 58 (45%) have died. Seventy-seven of 124 confirmed cases (63%) for which sex is known were male and the median age of the 125 confirmed cases with known age is 50 years (range, 14 months to 94 years).

 

Nine new cases were reported to be sporadic, i.e. cases that were reported to have no prior contact with another known case and including cases that were the first case within a cluster. Of these, 56% were female; the median age was 53 years; and 89% had at least one underlying condition reported. Eighty-nine percent were severely ill or died. Eight of these cases were probably exposed to the virus in KSA (six in Riyadh, one in Medina, one in Hafr Al Batin) and one in Qatar. The median age and gender balance of these nine new cases represents a shift compared with earlier cases. Up until mid-July 2013, the median age of sporadic cases was 59.5 years and 83% were male.

Three recent outbreaks are described below:

• Five cases were reported in Medina. The first Saudi case reported was a 55-year-old male who had probable contact with a 59-year-old Qatari male, who was in Medina at the time of onset of illness. The remaining cases were contacts of confirmed cases and included two asymptomatic health care workers identified through contact tracing. One additional health care worker, who died in the course of his illness, was reported without information about contact with other confirmed cases. None of the cases was reported to have performed pilgrimage while in Medina.
• Two clusters were reported in Riyadh. In a cluster of six cases, one male index case aged 53 years is thought to have infected five other cases, including two health care workers. Both health care workers experienced mild illness. In the second cluster, all three cases were health care workers. A 41 year old Filipino healthcare worker who did not have any contact to confirmed cases of MERS-CoV infections acquired the disease from an unknown source and is thought to have transmitted it to two more healthcare workers. During this same period of time, an additional four sporadic cases were reported (mentioned above) with no contact with known cases, and five with no information on exposure.
• The first case of the cluster in Hafr Al Batin was a 38-year-old male with onset of illness in early August. Five family members ranging in age from 7 to 79 years subsequently became infected. Two children aged 3 and 18 years and one 74 year-old female were also reported as contacts of a known case but their connection with this family was not reported.

For further details regarding the cases please refer to:

• Disease Outbreak News

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