ECDC MERS-CoV Epidemiological Update

 

# 9293

 

After a brief lull in cases during the summer, case reports of MERS – almost all originating from Saudi Arabia – are back on the rise over the past 60 days, with most of the cases coming from either the Riyadh or Taif region. 

 

Saudi officials have made repeated statements regarding these outbreaks and their response, including Saudi MOH On Recent MERS Cases In Riyadh earlier today.

 

The ECDC has produced an updated Epidemiological assessment of the ongoing MERS situation emanating from the Arabian peninsula, and as we’ve come to expect from them, it comes with some very impressive charts and graphics.

 

I’ve only excerpted some of the highlights of the report, so follow the link below to read it in its entirety:

 

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

•  05 Nov 2014

​Since the last ECDC epidemiological update of 22 October and as of 5 November 2014, Saudi Arabia has reported 22 new cases.

Worldwide situation

As of 05 November 2014, 929 laboratory-confirmed cases of MERS-CoV have been reported to the public health authorities worldwide, including 372 deaths. Most of the cases have occurred in the Middle East – Saudi Arabia, United Arab Emirates, Qatar, Jordan, Oman, Kuwait, Egypt, Yemen, Lebanon and Iran (Table 1).

<SNIP>

Current epidemiological situation in Saudi Arabia

The distribution of cases for the period 1 August to 31 October 2014 suggests an increasing trend in particular in Saudi Arabia (Figure 3). During this time period, Saudi Arabia contributed to 53 out of 56 cases. Qatar, Austria and Turkey reported each one case with a travel history to Saudi Arabia.

Specifically for Saudi Arabia:
• Of the 50 cases where age and sex is known, 41 were males (82%) (Figure 4). The median age for these cases was 60 years (ranging between 17 and 90 years)
• Of the 53 cases, 39 (74%) had unspecified comorbidities reported
• All cases were reported to be symptomatic
• Nine of the cases were classified as healthcare workers
• Six cases reportedly had recent contact with an animal. Of these, three were specified as camels and two people reported to have drank camel milk

The MoH in Saudi Arabia is updating its clinical operations protocol for MERS-CoV for handling patients who are suspected to, or have the disease. They state that 70 percent of recent MERS-CoV cases have been resulting from secondary infections, mainly acquired in the hospital.

<SNIP>

Conclusions

• The number of cases notified reflects an increasing trend in reporting cases from July to October 2014.

• As in the past, secondary transmission in hospital continues to play an amplifying role in the transmission of the disease.

• The majority of MERS-CoV cases are still being reported from the Arabian Peninsula, specifically from Saudi Arabia, and all cases have epidemiological links to the outbreak epicentre.

• The latest importation to the EU (Austria) and to Turkey are not unexpected and do not indicate a significant change in the epidemiology of the disease.

• Importation of MERS-CoV cases to the EU remains possible. However, the risk of sustained human-to-human transmission remains very low in Europe.

The conclusions and recommendations of the updated risk assessment of 16 October 2014 remain valid.

ECDC: Epidemiological Update On MERS-CoV

Coronavirus – Credit CDC PHIL

 

# 8709

 

In the wake of the news this week that KSA has `found’  scores of previously unannounced MERS cases (Saudi MOH: Review Finds 113 Additional MERS Cases), the ECDC has released a new epidemiological update.  

 

As usual, the ECDC has produced an information-dense, graphic rich, report that gives us a great overview of the situation – at least based on the information that is being made available by the affected countries.

 

While the case numbers, and apparent fatality rate, have increased with this announcement, the ECDC feels this new information does not change the ECDC risk assessment of 31 May 2014, which states (in part):

 

Currently, the risk of human infections and sustainable human-to-human transmission in Europe remains low. However, the number of human MERS cases reported from the Arabian Peninsula has increased rapidly in the past few months. Specifically, several healthcare associated clusters in Saudi Arabia and UAE have been reported which have been responsible for large numbers of cases. Given the current increase in nosocomial infections and travel associated cases of MERS in the Arabian Peninsula, and the large number of people travelling between the Arabian peninsula and Europe, it is likely that more cases will be imported and detected in the EU/EEA. Continued vigilance in assessing patients with travel history to the affected region is warranted.

 

Follow the link below to access the full epidemiological report, including all five graphs and charts.

 

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

05 Jun 2014

​Since April 2012 and as of 4 June 2014, 815 cases of MERS-CoV infection have been reported by local health authorities worldwide, including 313 deaths.

On 3 June 2014, the Ministry of Health of Saudi Arabia updated the MERS case count with 113 previously unreported cases representing a 20% increase in the cumulative number of cases. The number of cases is 688 of which 353 have recovered, 282 have died and 53 are receiving care. These new cases have been retrospectively identified during a review of the data. Ninety-two of the 113 cases reported on 3 June were fatal, increasing the number of deaths from MERS-CoV in Saudi Arabia by 48% from 190 to 282, and raising the case-fatality ratio (CFR) from 33% to 41%. The retrospectively identified newly reported cases date back to May 2013. Information about age, gender, residence, probable place of infection, whether the case is sporadic/primary or part of a cluster of secondary transmission, health care associated transmission or not, and whether the case is a healthcare worker, is missing for these retrospectively reported cases. In addition, it is unclear whether these cases are meeting the WHO case definition for confirmed cases.

The MOH also announced new measures to improve the capacity and efficiency of Saudi laboratories and testing facilities.

On 27 May 2014, the Iranian health authorities reported two cases involving two middle-aged sisters, without travel history, but with contact with a person, who had influenza-like illness symptoms after travel to Saudi Arabia. One of the sisters has died.

On 31 May 2014 the Algerian health authorities reported two cases in middle aged men, who both had recent travel history to Saudi Arabia for performing Umrah. ECDC continues to monitor information on the situation on MERS-CoV worldwide. In earlier Rapid Risk Assessments, ECDC concluded that the risk of importation of MERS-CoV to the EU was expected to continue and the risk of secondary transmission in the EU remains low. The conclusions of the assessment provided in the ECDC rapid risk assessment (RRA) remains valid.

Conclusions

The cases and fatalities reported in batch by Saudi Arabia on 3 June improves  the completeness of data but does not significantly change the epidemiological pattern of the outbreak. The new cases have resulted in an increase in the case-fatality ratio, indicating that the observed trend of falling CFR over time can to some extent be explained by incompleteness of data and failure to report outcomes for already notified cases. The new information does not change the ECDC risk assessment of 31 May 2014.

• More on MERS-CoV

Taiwan CDC: Death Of H7N9 Tourist & Epidemiological Assessment

 

# 8198

 

We’ve a pair of new statements from Taiwan’s CDC on Mainland China’s H7N9 outbreak this morning, the first of which notifies us of the death of the 86 year-old tourist who was diagnosed on December 31st (see Taiwan CDC Reports Second Imported H7N9 Case).

 

The slightly syntax challenged machine translation indicates that the patient was removed from isolation on January 14th, after found to be no longer shedding the virus, but succumbed yesterday due to complications of pneumonia and septic shock.

 

The first two cases of H7N9 flu cases imported because of severe pneumonia complicated by septic shock, died on January 20 (2014-01-21)

Command Center announced to (102) imported the first two cases of H7N9 influenza cases in the December 31 was confirmed yesterday (1/20) evening due to severe pneumonia and septic shock and death, the case for the Chinese mainland, Changzhou City, Jiangsu Province, 86 year-old male, diagnosed at the onset and during late December to Taiwan tourism. The case was later hospitalized, after repeated sputum collection, extracts, etc. throat swabs and bronchoscopy specimens, H7N9 influenza virus tests were negative, then on Jan. 14 released from quarantine treatment, except for pneumonia duration of symptoms, hospitalization, death yesterday.

Command Center, said after the case diagnosed, health units that for the general contacts and close contacts to keep track of which close contacts (including family members, tour guides, drivers, and other health care professionals and patients in the same ward) has appeared in the relevant The test results were negative symptoms, to track where they are not found to have an infected person.

 

Given its close proximity to the Chinese mainland, and the fact that it has already seen two imported H7N9 cases, it is not surprising that this avian flu virus commands a fair amount of attention on Taiwan’s CDC webpage.  In a statement regarding today’s 6 newly announced cases from Guangdong and Zhejiang provinces, they caution:

 

Command Center pointed out that mainland China after the autumn series of confirmed cases of H7N9 flu, do not rule out the epidemic in mainland China Southern has a tendency to expand, to remind people to mainland China should avoid live bird markets and birds out of the street, the city, and contact with poultry and birds bird carcasses. Also reminds physicians should ask history and history of exposure to strengthen patient travel, such as found in line with the definition of H7N9 flu patient notification, shall promptly notify the health authority and the cautious response.

 

While it hasn’t appeared on the English language portal of Taiwan’s CDC website, we’ve the following (machine translated) epidemiological assessment of the H7N9 situation on the mainland, that finds that while there are no signs of sustained human-to-human transmission of the virus, with the upcoming Spring Travel Festival it is imperative that local people in Taiwan and travelers to China pay attention to personal hygiene and avoid contact with birds.

 

This assessment notes the increased number of cases reported, a geographic southward expansion in cases, and an increasing number of younger patients being infected than we saw last year.  Severity (among detected cases) remains high, and most cases appear to have had contact with birds, or have visited live bird markets.

 

Nearly leave the Central Epidemic Command Center assessment of the recent H7N9 influenza increased risk of imported cases, urged people to continue to prevent, physicians remain vigilant (2014-01-21)

H7N9 influenza Central Epidemic Command Center today (1/21) held its 21st meeting, on the Chinese mainland will be in the epidemiology of influenza H7N9 virus characteristics information, the assessment autumn H7N9 flu cases have occurred on the likelihood and impact of domestic affected. The results showed that, H7N9 flu is not yet confirmed there are signs of sustained human to human transmission, but with the increasing trend of the epidemic in mainland China Southern, China after H7N9 flu autumn imported increased risk, especially the Spring Festival leave almost expected that our country recently may still have imported cases, but have been expanded to the risk of imported cases of the outbreak is low, appealed to the local people in Taiwan and mainland China should pay attention to go to personal hygiene and avoid contact with birds.

Command Center pointed out that after the autumn H7N9 flu cases in China are more concentrated in Zhejiang Province and Guangdong Province, mainland China does not rule out the epidemic has expanded south trend, increasing the proportion of young population, severity of the disease is still high and most have live bird markets and poultry Bird history of exposure, based on current information on the disease and related research data analysis, before and after the autumn H7N9 influenza virus gene sequences important sites with similar autumn, although some genes with a variety of avian viruses to produce recombinant phenomenon, but the human respiratory virus Cell adhesion is still not as seasonal flu viruses, the experimental data show that the spread of the virus in the force difference between mammals and for resistance to antiviral agents without diffusion phenomenon is not yet confirmed that there are signs of sustained human to human transmission. Chinese New Year holidays approaching, the number of Chinese people from the mainland and from the significant increase in the risk of imported cases are also expected to rise, but the ability to present the spread of the virus has not changed, resulting in a low probability of local cases.

Again I want to go to the command center in mainland China and local Taiwanese people should be implemented hand-washing and other personal hygiene measures to avoid the bird out of the local live poultry markets and street, city, and contact with poultry and birds dead birds, eating chickens, ducks, geese and eggs cooked to order to avoid infection. When you return home if fever or flu-like symptoms, they should inform the airline personnel and airport and port of quarantine officers; such as after returning the above symptoms should wear a mask and seek medical advice and inform the physician contact history and travel history. Also reminds physicians should ask history and history of exposure to strengthen patient travel, such as found in line with the definition of H7N9 flu patient notification, shall promptly notify the health authority and the cautious response. Latest epidemic diseases and other related information can be found in the Agency website (http://www.cdc.gov.tw) the "H7N9 flu Corner" and "International Travel Information" area, or call the toll-free hotline and caring people informed epidemic 1922 ( or 0800 - 001922) contact.

Hong Kong CHP: H7N9 Epidemiological Update – Dec 7th

 

 

# 8052

 

As we’ve come to expect from Hong Kong’s CHP, we’ve another highly detailed update on the epidemiological investigation into their latest H7N9 case this morning.  As with the case earlier this week, close contacts are being quarantined while scores of others are under medical supervision.

 

 

Epidemiological investigation and follow-up actions by CHP on second confirmed human case of avian influenza A(H7N9)

A spokesman for the Centre for Health Protection (CHP) of the Department of Health (DH) today (December 7) provided an update on the second confirmed human case of avian influenza A(H7N9) in Hong Kong affecting a man aged 80.

"The Serious Response Level under the Government's Preparedness Plan for Influenza Pandemic has been activated while the CHP's epidemiological investigation and follow-up actions are currently in full swing," the spokesman remarked.

"The patient had been transferred to Princess Margaret Hospital (PMH) under isolation. His current condition remains stable," he said.

As of 4pm today, contact tracing conducted by the CHP has located 19 close contacts and over 130 other contacts.

Details are as follows:

(A) Nineteen close contacts of the patient have been quarantined and prescribed with Tamiflu prophylaxis, including:

1. Thirteen patients (including two with non-specific symptoms) who had stayed in the same cubicle with the confirmed patient in Tuen Mun Hospital (TMH);
2. His five family members, who have remained asymptomatic, have been quarantined in PMH; and
3. The taxi driver who had taken the patient and his family members from Shenzhen Bay Port Border Control Point (SBP BCP) to TMH on December 3 was located. He has remained asymptomatic and has been quarantined in PMH.

The specimens of the 18 close contacts all tested negative for the avian influenza A(H7N9) virus upon preliminary laboratory testing by the Public Health Laboratory Services Branch (PHLSB) of the CHP while the result of the remaining sample belonging to an asymptomatic close contact is pending. They will be put under quarantine for 10 days since their last contact with the patient. During isolation, if their health conditions change, further testing and surveillance will be conducted.

(B) Over 130 other contacts, including other relatives of the patient, healthcare workers (HCWs) of TMH and the ambulance service, relevant hospital visitors as well as an immigration control officer at SBP BCP, are all under medical surveillance. Among them, four HCWs of TMH who presented with non-specific symptoms tested negative for the avian influenza A(H7N9) virus.

As regards the first confirmed case, the 36-year-old female patient is still under isolation at Queen Mary Hospital in a critical condition. As of 4pm today, no additional close contacts of this case have been identified. The number of close contacts located remains at 17 while there are now 230 other contacts under medical surveillance. The 17 close contacts remain under quarantine for 10 days since their last contact with the patient. During isolation, if their health conditions change, further testing and surveillance will be conducted.

The epidemiological investigation into the two cases by the CHP, including contact tracing and tracing the source of infection, is ongoing.

Locally, enhanced surveillance over suspected cases in public and private hospitals is under way. The CHP will continue to maintain liaison with the World Health Organization (WHO), the Mainland and overseas health authorities to monitor the latest developments and obtain timely and accurate information. Local surveillance activities will be modified according to the WHO's recommendations.

"All border control points (BCPs) have implemented disease prevention and control measures. Thermal imaging systems are in place at BCPs for body temperature checks of inbound travellers. The DH has liaised with the Auxiliary Medical Service and the Civil Aid Service to deploy additional manpower at BCPs to conduct random temperature checks using handheld devices. Suspected cases will be immediately referred to public hospitals for follow-up investigation," the spokesman said.

Regarding health education for travellers at BCPs, the distribution of health education pamphlets, display of posters on avian influenza A(H7N9) in departure and arrival halls, in-flight public announcements, environmental health inspection and the provision of regular updates to the travel industry via meetings and correspondence have all been escalated. The DH will keep a close eye on the latest developments and adopt corresponding port health measures.

"We have enhanced our publicity and health education on the prevention of avian influenza. The CHP has also sent letters to government departments and related organisations to reinforce our health advice on the prevention of avian influenza," the spokesman added.

(Continue . . . )

 

HK CHP: Update On H7N9 Epidemiological Investigation & Response

Credit CHP

 

# 8041

 

The impressiveness of  Hong Kong’s CHP’s public health response to their first (apparently) imported case of H7N9 is only matched by their willingness to publicly disclose every step along the way.

 

Today, we’ve another long update, which contains the good news that so far – no other H7N9 positive cases have been detected.

 

 

Epidemiological investigation and follow-up actions by CHP on confirmed human case of avian influenza A(H7N9)

The Centre for Health Protection (CHP) of the Department of Health (DH) today (December 4) provided an update on the first confirmed human case of avian influenza A(H7N9) in Hong Kong.

"The CHP's epidemiological investigation, enhanced disease surveillance, port health measures and health education have been in full swing since the Government escalated the response level under the Preparedness Plan for Influenza Pandemic from 'Alert' to 'Serious'," a spokesman for the DH remarked.

As of 2pm today, no additional close contacts have been identified. The number of close contacts located remains at 17 while there are over 220 other contacts. Details are as follows:

(A) Specimens of the 17 close contacts all tested negative for the avian influenza A(H7N9) virus upon preliminary laboratory testing by the Public Health Laboratory Services Branch (PHLSB) of the CHP. They were prescribed with the antiviral Tamiflu prophylaxis and have to be quarantined for 10 days since their last contact with the patient. During isolation, if their health conditions change, further testing and surveillance will be conducted. They include:

1. Ten home contacts (including four with non-specific symptoms);
2. A female collateral aged 33, who visited Shenzhen with the patient; and
3. Six patients in Tuen Mun Hospital who stayed in the same cubicle with the confirmed patient (including one with non-specific symptoms).
   

Asymptomatic close contacts will be arranged to stay in the quarantine centre in Lady MacLehose Holiday Village in Sai Kung. It has been equipped with basic residential facilities, including suitable bungalows, rooms and activity premises.

(B) Over 220 other contacts, including two private doctors whom the patient consulted, their clinic staff, patients and accompanying relatives, health-care workers of Tuen Mun Hospital, Queen Mary Hospital and the ambulance service, and relevant hospital visitors, have remained well so far. Medical surveillance is ongoing and they have been offered Tamiflu prophylaxis.

The epidemiological investigation by the CHP, including contact tracing and tracing the source of infection, is ongoing.

"Upon the PHLSB's analysis, the genes of the virus of the confirmed case do not show any significant difference from the avian influenza A(H7N9) viruses isolated from human cases detected so far in the Mainland. There is also no evidence of genetic reassortment nor resistance to Tamiflu. We will continue to liaise and share the gene sequence based on established arrangements," the spokesman stressed.

Locally, enhanced surveillance over suspected cases in public and private hospitals is under way. The CHP will continue to maintain liaison with the World Health Organization (WHO), the Mainland and overseas health authorities to monitor the latest developments and obtain timely and accurate information. Local surveillance activities will be modified according to the WHO's recommendations.

"All border control points (BCPs) have implemented disease prevention and control measures. Thermal imaging systems are well in place at BCPs for body temperature checks of inbound travellers. The DH has liaised with the Auxiliary Medical Service and the Civil Aid Service to deploy additional manpower at BCPs to conduct random temperature checks using handheld devices," the spokesman remarked.

The Port Health Office of the DH has maintained liaison with the Shenzhen Entry-Exit Inspection and Quarantine Bureau while being on the alert for travellers and also cross-boundary students with fever or other symptoms. Suspected cases will be immediately referred to public hospitals for follow-up investigation.

Regarding health education to travellers at BCPs, distribution of health education pamphlets, the display of posters on avian influenza A(H7N9) in departure and arrival halls, in-flight public announcements, environmental health inspection and the provision of regular updates to the travel industry via meetings and correspondence have all been escalated. The DH will keep a close eye on the latest developments and adopt corresponding port health measures.

"We have enhanced publicity and health education on the prevention of avian influenza. Meanwhile, consulates, foreign domestic helpers' associations and non-governmental organisations serving ethnic minorities have been notified of the case, the latest developments and the preventive measures. Health educational materials are being distributed through them," the spokesman added.

An array of key publicity materials of the CHP, including those on avian influenza, influenza, guidelines for proper hand washing and personal and environmental hygiene in various languages, including Indonesian, Hindi, Nepali, Urdu, Thai and Tagalog, can be accessed in the CHP's website

(www.chp.gov.hk/en/submenu/424.html).

The CHP's hotline (2125 1111) has been set up for public enquiries and operates from 9am to 6pm. As of 4pm today, 37 enquiries were received.

"Travellers, especially those returning from avian influenza A(H7N9)-affected areas, with fever or respiratory symptoms are reminded to immediately wear facial masks, seek medical attention and reveal their travel history to doctors. Health-care professionals should also pay special attention to patients who might have had contact with birds, poultry or their droppings in affected areas," the spokesman advised.

The spokesman also urged travellers not to visit live poultry markets in the affected areas and to avoid direct contact with poultry, birds and their droppings. If contact has been made, they should thoroughly wash their hands with soap and water.

Members of the public should remain vigilant and are reminded to take heed of the following preventive advice against avian influenza:

• Poultry and eggs should be thoroughly cooked before eating;
• Wash hands frequently with soap, especially before touching the mouth, nose or eyes, handling food or eating; after going to the toilet or touching public installations or equipment such as escalator handrails, elevator control panels or door knobs; or when hands are dirtied by respiratory secretions after coughing or sneezing;
• Cover the nose and mouth while sneezing or coughing, and hold the spit with a tissue and put it into a covered dustbin;
• Avoid crowded places and contact with fever patients; and
• Wear a mask when respiratory symptoms develop or when taking care of fever patients.

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

Ends/Wednesday, December 4, 2013
Issued at HKT 20:11

ECDC MERS-CoV Epidemiological Update – Oct 4th

 

Credit ECDC – Communicable Disease Threats

 

# 7836

 

It’s been just over a week since the last major ECDC Rapid Risk Assessment on the MERS Coronavirus was issued (see MERS-CoV: ECDC Rapid Risk Assessment – September), and since then six more cases have been added to the ECDC’s list, all hailing from Saudi Arabia.

 

While not exactly an explosion in cases - the steady trickle of new reports, the similarities between MERS-CoV and the SARS virus of a decade ago, and the sizable gaps in our knowledge over the source and potential spread of this virus – have all contributed to a well-found wariness among public health officials around the globe.

 

As part of their weekly Communicable Disease Threats publication, ECDC published the following epidemiological summary yesterday.

 

 

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

Opening date: 24 September 2012 Latest update: 3 October 2013

Epidemiological summary

As of 3 October 2013, there have been 139 laboratory-confirmed cases of MERS-CoV worldwide, including 60 deaths.

All cases have either occurred in the Middle East or have had direct links to a primary case infected in the Middle East. Saudi Arabia has reported 117 symptomatic or asymptomatic cases including 49 deaths, Jordan two cases, who both died, United Arab Emirates five cases, including one fatality and Qatar three cases, including two deaths. Twelve cases have been reported from outside the Middle East: in the UK (4), Italy (1), France (2), Germany (2) and Tunisia (3).

In France, Tunisia and the United Kingdom, there has been local transmission among patients who have not been to the Middle East but have been in close contact with laboratory-confirmed or probable cases. Person-to-person transmission has occurred both among close contacts and in healthcare facilities. However, with the exception of a possible nosocomial outbreak in Al-Ahsa, Saudi Arabia, secondary transmission has been limited. Sixteen asymptomatic cases were reported by Saudi Arabia and two by the UAE. Seven of these cases were healthcare workers.

The Ministry of Health of Saudi Arabia updated its Health Regulations for travellers to Saudi Arabia for the Umrah and Hajj pilgrimage regarding MERS-CoV and now recommends that the elderly, those with chronic diseases, pilgrims with immune deficiency, malignancy and terminal illnesses, pregnant women and children coming for Hajj and Umrah this year should postpone their journey.

WHO published a travel advice on MERS-CoV for pilgrims on 25 July 2013.

On 18 September WHO has issued an interim recommendation to laboratories and stakeholders involved in laboratory testing for Middle East respiratory syndrome coronavirus (MERS-CoV).

The WHO third meeting of the Emergency Committee was held by teleconference on, 25 September 2013. The Committee concluded that it saw no reason to change its advice to the Director-General. Based on the current information, and using a risk-assessment approach, it was the unanimous decision of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met.

ECDC assessment

The continued detection of MERS-CoV cases in the Middle East indicates that there is an ongoing source of infection present in the region. The source of infection and the mode of transmission have not been identified.There is therefore a continued risk of cases occurring in Europe associated with travel to the area. Surveillance for cases is essential, particularly with expected increased travel to Saudi Arabia for the Hajj in October.

The risk of secondary transmission in the EU remains low and could be reduced further through screening for exposure among patients presenting with respiratory symptoms and their contacts, and strict implementation of infection prevention and control measures for patients under investigation.

(Continue . . . )

 

While the risks of seeing secondary transmission outside of the Middle East are considered low at this time, with nearly two million international visitors expected for the Hajj this month, there are legitimate worries that some of these visitors could carry the virus home with them. Public health agencies around the globe are ramping up surveillance and testing in order to detect, and isolate, any cases as soon as possible.

 

Accordingly, we’ve seen a steady stream of guidance documents prepared and released by the World Health Organization, the ECDC, and the CDC regarding surveillance, testing, isolation of patients, and treatment of cases over the past couple of months, including:

 

CDC: Infection Control Guidance For Home Care Of MERS-CoV Cases

MMWR: Updated MERS-CoV Guidance For The Public, Clinicians & Public Health Workers

WHO: Homecare Advice For Mild MERS-CoV Cases

 

 

This latest ECDC Communicable Disease Threats publication also summaries outbreaks of Pertussis, Poliomyelitis, West Nile Virus, and Dengue.  

ECDC Epidemiological Update On Novel Coronavirus

Photo Credit ECDC

 

 

# 7242

 

From the ECDC we’ve got a new epidemiological assessment of the novel coronavirus outbreak in Saudi Arabia that is, not surprisingly, somewhat hamstrung by the lack of data on these latest cases.

 

For more on the paucity of data on this outbreak, you may wish to revisit A Confusing Coronavirus Picture In Saudi Arabia.

 

This from the ECDC.

 

 

Epidemiological update: additional confirmed cases of novel coronavirus in Kingdom of Saudi Arabia

07 May 2013

 

ECDC

In the last five days, 13 new confirmed cases of novel coronavirus (nCoV) infection have been reported by the Ministry of Health of the Kingdom of Saudi Arabia [1].

 

Information on the 13 new cases is limited at present and investigations are underway by Saudi Arabian authorities. It seems however that they were all associated with a cluster of cases in Al-Ahsa in the Eastern Province of Saudi Arabia linked to the same healthcare facility with onset dates over a 3 week period (14 April-1 May 2013) [1].

 

There are now 30 cases, of which 18 are known to have died, since the earliest identified cases in Jordan with onset dates in April 2012. Prior to the Al-Ahsa cluster, the most recent case reported was from the EU area and was an imported case that came from the United Arab Emirates to Germany on March 19 for medical care and reported by the Robert Koch Institute [2].

 

To date, 22 of the 30 nCoV cases have been reported by Saudi Arabia. There have been 6 cases diagnosed in Europe, two in Germany and 4 in the United Kingdom. Of these, three were persons coming for medical care and one was arriving to the UK while unwell. This latter case resulted in two associated person-to-person transmissions in the same family in the UK, one in a domestic setting and one in a hospital setting [3]. There have been extensive investigations among the close contacts in Europe, including using serological testing.  No evidence of additional person-to-person transmission has been identified in Germany or in the UK.

 

Surveillance and clinical guidance for nCoV has been published by WHO [4,5] with related ECDC guidance to EU Member States available on this website [6].

 

ECDC continues to monitor information on the situation of nCoV worldwide and will be reviewing its 19 February 2013 rapid risk assessment in the light of this new development. The recommendations of the 19 February 2013 rapid risk assessment can be found in reference [7].

References:
1. ProMed. Novel coronavirus – Eastern Mediterranean (18): Saudi Arabia http://www.promedmail.org/direct.php?id=20130505.1693290

2. RKI. Aktualisierung der Risikoeinschätzung des RKI zu Erkrankungsfällen durch das neuartige Coronavirus (hCoV-EMC)  26 March 2013 http://www.rki.de/DE/Content/InfAZ/C/Corona/Risikoeinschaetzung.html

3. The Health Protection Agency (HPA) UK Novel Coronavirus Investigation team. Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. Euro Surveill. 2013;18(11):pii=20427. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20427

4. WHO. Interim surveillance recommendations for human infection with novel coronavirus - update 18 March 2013
http://www.who.int/entity/csr/disease/coronavirus_infections/InterimRevisedSurveillanceRecommendations_nCoVinfection_18Mar13.pdf

5. Interim guidance document on clinical management of severe acute respiratory infections when novel coronavirus is suspected: what to do and what not to do. http://www.who.int/csr/disease/coronavirus_infections/InterimGuidance_ClinicalManagement_NovelCoronavirus_11Feb13u.pdf

6. ECDC  Public Health Development  Novel Coronaviruses - New guidance by WHO  - surveillance, applied epidemiological studies and clinical guidance.

7. ECDC Risk Assessment severe respiratory disease associated with a novel coronavirus, 19 February 2013.

 

Chinese Science Bulletin: Early H7N9 Risk Analysis

 

Heat map – Credit Laidback Al  FluTrackers

 

 

# 7206

 

From the open access journal Chinese Science Bulletin, we’ve an early epidemiology and risk analysis of the emerging H7N9 virus in China that paints a particularly worrisome picture of where these authors believe this outbreak might be headed.

 

 

Epidemiological and risk analysis of the H7N9 subtype influenza outbreak in China at its early stage

ZHUANG QingYe, WANG SuChun, WU MeiLi, LIU Shuo, JIANG WenMing, HOU GuangYu, LI JinPing, WANG KaiCheng, YU JianMin, CHEN JiMing & CHEN JiWang

1 China National Avian Influenza Professional Laboratory, China Animal Health and Epidemiology Center, Qingdao 266032, China;
2 China National Avian Influenza Professional Laboratory, China Animal Health and Epidemiology Center, Qingdao 266032, China;
3 The Institute for Personalized Respiratory Medicine, University of Illinois at Chicago, IL 60612, USA

Received April 11, 2013; accepted April 23, 2013

Dozens of human cases infected with H7N9 subtype avian influenza virus (AIV) have been confirmed in China since March, 2013. Distribution data of sexes, ages, professions and regions of the cases were analyzed in this report.

 

The results showed that the elderly cases, especially the male elderly, were significantly more than expected, which is different from human cases of H5N1 avian influenza and human cases of the pandemic H1N1 influenza.

 

The outbreak was rated as a Grade III (severe) outbreak, and it would evolve into a Grade IV (very severe) outbreak soon, using a method reported previously. The H7N9 AIV will probably circulate in humans, birds and pigs for years. Moreover, with the driving force of natural selection, the virus will probably evolve into highly pathogenic AIV in birds, and into a deadly pandemic influenza virus in humans.

 

Therefore, the H7N9 outbreak has been assumed severe, and it is likely to become very or extremely severe in the future, highlighting the emergent need of forceful scientific measures to eliminate any infected animal flocks. We also described two possible mild scenarios of the future evolution of the outbreak.

 

(Continue . . .)

 

While conceding that this virus could `disappear naturally, or maintain its low pathogenicity in birds and limited transmission ability in humans for a long period’, the authors articulate eight reasons why they believe this outbreak poses – in their words – an `enormous risk’.

 

Rather than mangle their work by selectively excerpting pieces, I’ll invite you to follow the link to read this analysis in its entirety. 

 

I suspect that this paper will induce a fair amount of heartburn among Chinese officials who are trying to reassure the public over this outbreak.  

 

As to whether these researchers have got this analysis right?

 

I believe they make some very good points, but that’s really above my pay grade. Besides, I make it a practice not to try to predict what flu viruses are apt to do.

 

I simply accept that novel flu viruses are unpredictable, and fully capable of wreaking havoc on a global scale, and so they ought not be underestimated.

 

Which is precisely why the CDC, along with other public health agencies, are taking prudent steps towards increasing their pandemic preparedness (see H7N9 Preparedness: What The CDC Is Doing).

Not because they are necessarily convinced that this virus will spark the next pandemic.

 

But because they know it could.

H7N9: ECDC Epidemiological Update – April 26th

Credit ECDC

 

# 7195

 

The ECDC has a new epidemiological update out this morning, which includes the imported case to Taiwan. While not surprising, the `money quote’ from this assessment is:

An increasing incidence of sporadic cases and expansion of geographic spread in China and possibly neighbouring countries are expected over the coming weeks. Individual imported human cases to Europe cannot be ruled out and countries need to prepare for detecting and diagnosing such cases.

 

Follow the link for all of the charts and graphs.

 

 

Epidemiological update of 26 April: avian influenza A(H7N9) virus in China

26 Apr 2013

ECDC

Since 31 March 2013, one hundred and twelve (112) cases of human infection with avian influenza A(H7N9) virus have been reported from eight provinces in eastern China. Onset of disease has been between 19 February and 18 April 2013 in: Zhejiang (44), Shanghai (33), Jiangsu (24), Henan (4), Anhui (4), Beijing (1), Shandong (1) and Taiwan (1). The date of disease onset is currently unknown for fourteen patients.

 

Most cases have developed severe respiratory disease. Twenty three patients have died (case-fatality ratio=21%). The median age is 62 years with a range between 4 and 91 years; 33 out of 112 patients are female.

 

The Chinese health authorities are responding to this public health event by enhanced surveillance, epidemiological and laboratory investigation and contact tracing. The animal health sector has intensified investigations into the possible sources and reservoirs of the virus. The authorities reported to the World Organisation for Animal Health (OIE) that avian influenza A(H7N9) was detected in samples from pigeons, chickens and ducks, and in environmental samples from live bird markets ('wet markets') in Shanghai, Jiangsu, Anhui and Zhejiang provinces. Authorities have closed markets and culled poultry in affected areas.

 

The source and mode of transmission have not been confirmed. The outbreak is caused by a reassortant avian influenza virus with low pathogenicity for birds, hence it does not cause the signal 'die-offs' in poultry associated with highly pathogenic strains of avian influenza viruses. Genetic analyses of the isolates have shown changes which suggest that the H7N9 virus may have greater ability to infect mammalian species, including humans, than most other avian influenza viruses. Pathogenicity for humans appears to be high and higher age appears to be a risk factor for disease.

 

The most likely scenario is that the influenza A(H7N9) virus is spreading undetected in poultry populations and occasionally infecting humans who have close contact with poultry or poultry products but this will have to be validated as further data become available.

 

At the present time there is no evidence of sustained human-to-human transmission. Close to 2 000 close contacts of confirmed cases are reported to have been followed up. There is one family cluster with two confirmed cases for which human-to-human transmission cannot be ruled out but where common exposure is the most likely explanation. In addition, the virus has been detected in one asymptomatic carrier in Beijing.

 

An increasing incidence of sporadic cases and expansion of geographic spread in China and possibly neighbouring countries are expected over the coming weeks. Individual imported human cases to Europe cannot be ruled out and countries need to prepare for detecting and diagnosing such cases.

 

Critical developments that would change this assessment would be evidence of sustained human-to-human transmission and detection of avian influenza A(H7N9) in bird populations in Europe.

 

ECDC has published the Supporting diagnostic preparedness for detection of avian influenza A(H7N9) viruses in Europe guidance for laboratories on 24 April 2013.

 

ECDC is preparing an EU case definition for A(H7N9).

 

ECDC is closely monitoring developments and is continuously re-assessing the situation in collaboration with WHO, US CDC, China CDC and other partners.

 

This epidemiological update does not change the conclusions and recommendations of the updated risk assessment published on April 12.

Related links:

• ECDC Rapid Risk Assessment on avian influenza A(H7N9) virus in China, 12 April 2013
• Diagnostic preparedness in Europe for detection of influenza A(H7N9) viruses 
• Epidemiological update 18 April 2013: avian influenza A(H7N9) virus in China
• More on avian influenza on ECDC website

External links:

• WHO: question and answers on human infection with influenza A(H7N9) virus, China (updated 5 April 2013)
• Chinese Center for Disease Control and Prevention: question and answers about human infection with A(H7N9) avian influenza virus (published 31 March 2013)
• Updates on avian influenza A(H7N9) by Chinese Center for Disease Control and Prevention

 

 

ECDC: Epidemiological Update On H7N9

 

Map Credit ECDC

 

# 7142

 

The ECDC continues to provide some of the timeliest, and most comprehensive, assessments of the emerging H7N9 virus via their frequent Epidemiological Updates.  Below you’ll find their latest update.

 

 

Epidemiological update of 15 April: avian influenza A(H7N9) virus in China

15 Apr 2013

ECDC

Since 31 March 2013, sixty cases of human infection with influenza A(H7N9) have been reported from six provinces in eastern China with a combined population of about 330 million. Onset of disease has been between 19 February and 9 April 2013 in: Shanghai (24), Jiangsu (16), Zhejiang (15), Anhui (2), Henan (2)and Beijing (1). See Figure 1 below. The date of disease onset is currently unknown for five patients. Most cases have developed severe respiratory disease and only three cases are reported to have mild clinical course. Thirteen patients died (case-fatality ratio=21%). The median age is 65 years with a range between 4 and 87 years; 17 of them are females.

 

The Chinese health authorities are responding to this public health event by enhanced surveillance, epidemiological and laboratory investigation and contact tracing. The animal health sector has intensified investigations into the possible sources and reservoirs of the virus. The authorities reported to the World Organisation for Animal Health (OIE) that avian influenza A(H7N9) was detected in samples from pigeons, chickens and ducks, and in environmental samples from live bird markets ('wet markets') in Shanghai, Jiangsu, Anhui and Zhejiang provinces. Authorities have closed markets and culled poultry in affected areas.

 

The source and mode of transmission have not been confirmed. The outbreak is caused by a reassortant avian influenza virus with low pathogenicity for birds, hence it does not cause the signal 'die-offs' in poultry associated with highly pathogenic strains of avian influenza viruses. Genetic analyses of the isolates have shown changes which suggest that the H7N9 virus may have greater ability to infect mammalian species, including humans, than most other avian influenza viruses. Pathogenicity for humans appears to be high and higher age appears to be a risk factor for disease.

 

The most likely scenario is that of A(H7N9) spreading undetected in poultry populations and occasionally infecting humans who have close contact with poultry or poultry products but this will have to be validated as further data become available.

 

At this time there is no evidence of sustained human-to-human transmission. More than 1 000 close contacts of confirmed cases are reported to have been followed up without evidence of person-to-person transmission.

 

There is one family cluster with two confirmed cases for which human-to-human transmission cannot be ruled out but where common exposure is the most likely explanation.

 

The rapid geographic spread and the increase of confirmed cases is likely to be the result of strengthened case finding and increased testing. A(H7N9) test kits have been distributed to over 400 laboratories across China and this increased ascertainment is expected to provide important epidemiological information.

 

An increasing incidence of sporadic cases and expansion of geographic spread in China and possibly neighbouring countries are expected over the coming weeks. Individual imported human cases to Europe cannot be ruled out and countries need to prepare for detecting and diagnosing such cases. Critical developments that would change this assessment would be evidence of sustained human-to-human transmission and detection of avian influenza A(H7N9) in bird populations in Europe.

 

ECDC is closely monitoring developments and is continuously re-assessing the situation in collaboration with WHO, US CDC, China CDC and other partners.

ECDC published an updated risk assessment on April 12.

Related links:

• ECDC Rapid Risk Assessment on avian influenza A(H7N9) virus in China, 12 April 2013
• Epidemiological update 12 April 2013: avian influenza A(H7N9) virus in China
• More on avian influenza on ECDC website

External links:

• WHO: question and answers on human infection with influenza A(H7N9) virus, China (updated 5 April 2013)
• Chinese Center for Disease Control and Prevention: question and answers about human infection with A(H7N9) avian influenza virus (published 31 March 2013)
• Updates on avian influenza A(H7N9) by Chinese Center for Disease Control and Prevention

ECDC Epidemiological Update On H7N9

 

# 7101

 

 

Although the numbers cited (24 cases, 7 deaths) in the ECDC’s latest epidemiological update reflect patient reports through yesterday (see updated Chinese Media Reporting 4 New H7N9 Cases (28 Total) -  the charts, maps and summary are excellent resources of what is presently known about this emerging bird flu virus.

 

 

Epidemiological update: Novel influenza A virus A(H7N9) in China

09 Apr 2013

On 31 March 2013, the Chinese health authorities announced that they identified a novel influenza A(H7N9) virus in three seriously ill patients.

 

As of 8 April 2013, 24 human cases of infection with influenza A(H7N9) virus have been reported in four provinces of China: Shanghai (11), Anhui (2), Jiangsu (8) and Zhejiang (3). Of these patients, seven people have died, fourteen show severe and three mild symptoms. No epidemiological link has been identified among the patients.

 

More than 650 close contacts of the confirmed cases are being closely monitored. There are reports of a small family cluster of disease around the first patient, but this has not been confirmed by laboratory data.

 

The source of these infections and the mode of transmission are yet to be determined. This is the first time that human infection with influenza A(H7N9) virus has been identified.

 

The Chinese health authorities are responding to this public health event by enhanced surveillance, epidemiological and laboratory investigation and contact tracing. The animal health sector has intensified investigations into the possible sources and reservoirs of the virus. The authorities reported to the World Organisation for Animal Health (OIE) that A(H7N9) was detected in samples from pigeons and chickens and in environmental specimens from three markets in Shanghai. These markets have been closed and the live poultry were culled.

 

The influenza A viruses from the first three patients were non-subtypeable and were sent to the WHO Influenza Collaborating Centre at the Chinese Centre for Disease Control and Prevention (CCDC). The genetic comparison indicated that these cases were caused by a novel reassortant avian influenza virus with avian origin genes from both A(H7N9) and A(H9N2). No similar viruses have been seen before. In addition, A(H7N9) differs from A(H7) and A(H9) viruses that have been seen previously in Europe.

 

No vaccine is currently available for this subtype of the influenza virus. Preliminary test results suggest that the virus is susceptible to the neuraminidase inhibitors (oseltamivir and zanamivir).

 

At this time, there is no evidence of on-going human-to-human transmission. More sporadic cases are expected to be reported. The risk of disease spread to Europe is considered low, although individual cases coming from China cannot be ruled out.

 

(Continue . . . )

 

ECDC Epidemiological Update On H7N9

 

Location of Outbreak - Credit ECDC

 

 

# 7080

 

The ECDC has just published a brief epidemiological update on the H7N9 avian flu outbreak in China.

 

Included is a very handy listing of cases with age, sex, date of onset (when available), severity, status, and possible route of exposure.

 

(click to view chart/Report)

 

Epidemiological update: Seven new confirmed cases of novel influenza A virus, A(H7N9) in China

05 Apr 2013

ECDC

Since the last epidemiological update of 3 April, seven additional cases including two fatalities were reported by Chinese authorities. For the first time a child, aged four years, was reported. The other six cases are aged between 48 and 79 years. The date of symptom onset was 20 and 29 March 2013 for the two newly reported cases for whom it is available (Table 1 and Figure 2). No new provinces were affected.

 

There are now sixteen confirmed cases including six deaths. The median age is 50 years with a range between 4 and 87 years; six of them are females. The date of symptom onset of cases was between 19 February and 29 March 2013 (Table 1 and Figure 2). To date, four adjacent provinces are affected: Shanghai, Jiangsu (6 cases each), Zhejiang (3) and Anhui (1) (Figure 1).  

(Continue . . .)

WER: Update On Human Cases Of Influenza At Human-Animal Interface

 

# 7041

 

This week the World Health Organization’s Weekly Epidemiological Record (WER) is devoted to a review of human infections by novel (swine & avian) flu viruses over the course of 2012. 

 

The bulk of this epidemiological analysis focuses on the 32 lab-confirmed H5N1 cases reported last year, but attention is also paid to a pair of H7N3 last year in Mexico, and a spate of swine H1N1v, H1N2v, and H3N2v (variant) infections across North America, as well.

 

 

The full report is called: 

 

Update on human cases of influenza at the human–animal interface, 2012

This report describes the epidemiology of the 32 laboratory-confirmed human infections with highly pathogenic avian influenza (H5N1) virus that were reported to WHO from 6 countries during 2012, and summarizes the information on other zoonotic influenza infections – A(H3N2) variant, A(H1N1), A(H1N2) and A(H7N3) – reported in 2012 in humans.

 

Some highlights follow regarding the H5N1 virus (slightly reparagraphed for readability):

 

The epidemiological curve of human cases follows the same seasonal pattern seen in previous years, with larger numbers of cases in the months December to March (Figure 1). This curve follows the seasonal curve  of reported outbreaks in poultry. Of the human cases for the year, 72% (23/32 cases) were reported in the first 3 months of 2012 (1 January to 31 March).

Distribution by age and sex

In 2012, most cases occurred in children and young adults; 90% (29/32) were in people aged <40 years and 34% (11/32) in children aged <10 years. Cases ranged in age from 6 months to 45 years, with a median age of 18 years.

 

The median age of reported cases has varied annually since 2009: 5 years of age in 2009, 25 years in 2010 and 13 years in 2011. The median age of cases in Egypt remained high for the third consecutive year.

 

The median age in Egypt in 2009 was 3 years but rose to 27 years in 2010 and 21 years in 2011 and continued to increase in 2012 to 31 years. In 2012, Egypt reported fewer cases of H5N1 infection (11 cases) compared with previous years (39 cases in 2011, 29 cases in 2010, 39 cases in 2009).

 

In the past few years, the trend in Indonesia has been towards progressively younger cases. In 2012, the median age was 12 years, up from 8 years in 2011, but considerably down  from 34 years in 2010 and 20 for 2005–2011. Indonesia also reported a relatively low number of human cases in 2012: 9 cases were reported in 2012, 12 cases in 2011, 9 cases in 2010 and 21 cases in 2009, compared with 55 cases reported in 2006.

 

In 2012, equal numbers of male and female cases were reported overall, although this pattern was not uniform across countries or age groups. The sex difference was most prominent in Egypt where 82% (9/11) of cases were female. Data from all cases reported during 2003– 2012 show a similar 1:1.2 male:female ratio.

 

Clinical outcome

In 2012, the overall proportion of fatal cases among
those reported was 62.5% (20/32), slightly higher thanin the previous 3 years (55% in 2011, 50% in 2010, 44% in 2009) but similar to the average of all cases reported to WHO since 2003 (59% [360/610]). The proportion of confirmed cases with fatal outcomes varied among countries and age groups. The proportion of fatal cases among those reported was 100% in Indonesia (9/9) and Cambodia (3/3), and 0 (0/3) in Bangladesh. Considerable differences were also found across age groups.

While the number of confirmed human infections with the H5N1 virus have declined over the past several years, this report cautions:

Although the proportion of reported fatal human cases remains high, the finding of 3 human cases in 2012 with mild infection reinforces concerns that many milder cases of infection occur undetected. Recent reviews of H5 seroprevalence studies found little evidence that large numbers of cases of H5N1 infection are missed.12, 13

 

However, because of the variation in protocols and standards in the serological studies, as well as persistent questions about serological responses in exposed or infected humans, the frequency of subclinical infection or mild illness remains uncertain.

 

It is also likely that some severe and fatal cases were not diagnosed and thus missed.

The risks posed by the H5N1 virus, along with other emerging influenza viruses, remains very real.  In the discussion portion of this report, the authors write:

 

Influenza viruses are unpredictable. Their constant evolving nature raises concerns that these viruses could adapt or reassort with other influenza viruses, thereby gaining potential to become more transmissible to or more pathogenic in humans.

 

Continued monitoring of the occurrence of human infections with non-seasonal influenza viruses and ongoing characterization of the viruses to assess their pandemic risk are therefore critically important for public health.

 

Close collaboration with animal health partners allows information regarding viruses circulating in animal populations and human populations worldwide to be shared to improve assessment of global influenza risks to health.

 

WHO continues to stress the importance of global
monitoring of influenza viruses and recommends all
Member States to strengthen routine influenza surveillance. All human infections with non-seasonal influenza viruses should be reported to WHO under the International Health Regulations (2005).

ECDC: Epidemiological Update On NCoV

Photo Credit NIAID

 

# 7036

 

 

 

The ECDC has released a new epidemiological update (the last was on Feb 22nd) on the novel coronavirus this morning, with details on four new cases reported ince that time. 

 

They have also published  an updated table of all 17 cases available HERE.

 

 

 

Epidemiological update: additional confirmed cases of novel coronavirus including sixth case diagnosed in Europe

27 Mar 2013

ECDC

Since the ECDC epidemiological update of 22 February 2013, four new confirmed cases of novel coronavirus (nCoV) infection have been reported worldwide, totalling 17 cases and including eleven deaths. Three of the four recent cases have been reported by the Ministry of Health of Saudi Arabia to WHO on:

• 6 March 2013: a 69 year old male, with no recent history of travel or contact with a confirmed case, hospitalised on 10 February 2013 and who died on 19 February [1].
• 12 March 2013: a 39 year old male reported to have developed symptoms on 24 February and who died on 2 March while hospitalised. Potential exposures are under investigation [2].
• 23 March 2013: a patient with mild symptoms diagnosed with nCoV infection and hospitalised, who has since recovered. The mode and source of transmission has not been identified, but the case is known to be a contact of the above case reported on 12 March [3].

The fourth case was reported on 25 March by Robert Koch Institute (RKI), Germany, and is the second imported case to be reported in this EU Member State. The patient, a 73 year old male with underlying clinical conditions, had been hospitalised in United Arab Emirates and transferred to a hospital in Germany for specific clinical care where subsequent diagnosis of nCoV infection was confirmed. Despite intensive care treatment the patient died on 26 March [4]. Contact tracing and investigations are underway by German public health authorities.

 

Since the start of reporting, six cases have been diagnosed and cared for in Europe (Table 1). Three cases (2 in Germany and 1 in UK) came to Europe as part of transfer for care from countries in the Arabian Peninsula where they acquired their infection.  A fourth case became unwell while in the Arabian Peninsula, but may have acquired his infection in either Pakistan or the Arabian Peninsula, before travelling to the UK. Extensive contact tracing has been undertaken around the first two UK cases and first German case, by respective national public health authorities [5-7]. To date, this has revealed two cases occurring though human-to-human transmission in the UK. Testing of other persons as recommended by WHO and ECDC has not revealed additional cases [5-9].

 

Though the number of nCoV infections has increased this last month, most reported cases continue to be associated with the Arabian Peninsula, where contact tracing and epidemiological investigations by Public Health Authorities continue in order to identify the possible source of infection.

 

The ECDC update of the rapid risk assessment for the EU provided on 19 February and its recommendations remain valid [10]. ECDC has published today a Public Health Development highlighting recent updated surveillance and clinical guidance from WHO and providing ECDC advice in their application by EU Member States [11,12].

(Continue . . .)