French MOH Statement On UN Employee Evacuated From Sierra Leone With Ebola

 

# 9278

 

As of Friday’s WHO Ebola Response Situation Report:

 

A total of 523 health-care workers (HCWs) are known to have been infected with EVD up to the end of 29 October: 82 in Guinea; 299 in Liberia; 11 in Nigeria; 127 in Sierra Leone; one in Spain; and three in the United States of America (two were infected in the USA and one in Guinea). A total of 269 HCWs have died.

 

While a number of these infections are believed to have been acquired from community contact – or in settings where the HCW did not know they were dealing with a possible Ebola case – this illustrates just how dangerous working in the Ebola hot zone can be for healthcare workers. 

 

Overnight the French Ministry of Health has confirmed that they have accepted for treatment an unidentified UN worker from Sierra Leone with the Ebola virus.  This is the second such evacuation to France since the outbreak began, the first being a French nurse who was successfully treated in September.

 

 

(Machine translation)

France hosts a confirmed Ebola cases after medical evacuation

November 2, 2014

The French authorities have agreed to respond positively to the request of the World Health Organization (WHO) and welcome in France a person employed by an agency of the United Nations and victim of Ebola virus.

This person, who works in Sierra Leone in the fight against Ebola has been medicalized and secure a medical evacuation by special plane. The entire circuit support was secured from the off Freetown and the plane ride to the hospital in isolation in high-security room dedicated to the Army Instruction Bégin (St. Hospital mended), where she receives medical attention.

There are no other confirmed cases of Ebola in the area.

Marisol Touraine, Minister of Social Affairs, Health and Women's Rights, said that France is fully committed to the fight against the terrible epidemic of Ebola strikes the West Africa and takes its international commitments taken medical care for humanitarian workers mobilized by non-governmental organizations and UN agencies to fight the virus in affected countries.

EID Journal: New Introductions Of EV-71 Subtype C4 To France – 2012

Photo Credit University of Iowa

 

# 8807

 

Human Enterovirus 71 (EV-71) – which is most often reported in Asia and the Western Pacific region - is one of more than 60 non-polio enteroviruses (NPEVs) known to cause cause human illness, and that primarily affect children under the age of 10.

 

While EV-71 is most frequently linked to severe outbreaks of HFMD (Hand, Foot, & Mouth Disease), it is also capable of producing serious neurological illnesses – including poliomyelitis-like paralysis (AFD or Acute Flaccid Paralysis), encephalitis, and sometimes death.

 

It should be noted that HFMD can be caused by a variety of viruses, and most of the time, it is generally mild and only rarely requires medical attention.  It is, however, highly contagious and spreads via close personal contact, droplets (through coughing or sneezing), the fecal-oral route, or contact with contaminated objects and surfaces (fomites).

 

The most common cause of HFMD in North America and Europe is the Coxsackie A16 virus, and more rarely the Coxsackie A10 virus. In recent years, we’ve also seen the emergence of the Coxsackie A6 virus which has been linked to somewhat more severe HFMD cases (see MMWR: Coxsackievirus A6 Notes From The Field).

But it is Enterovirus 71 that has been linked to the most severe cases of HFMD – particularly across Asia - with serious outbreaks recorded over the past 18 years in places like China, Taiwan, Malaysia, Hong Kong and Cambodia. 

 

Like other RNA viruses we monitor, EV71 is constantly evolving, creating new strains or lineages, and as a result we’ve seen repeated outbreaks over the years. During the late 1990s and early 2000s, genotypes C1, C2, B3, and B4 were most commonly reported as sparking outbreaks in Malaysia, Singapore, and Taiwan.

 

But by 2005, emerging genotype C4 had replaced B4 in Taiwan, while in China C4 (which had split into 2 distinct lineages, C4a and C4b) caused major HFMD outbreaks in 2007–2009 (see Phylogenetic analysis of Enterovirus 71 circulating in Beijing, China from 2007 to 2009.)

The spread and diversity of EV71 – Credit WHO

 

As shown in the chart above, the more aggressive C4 genotype – which first appeared in China in 1998 - has made significant inroads across much of Asia and the Western Pacific over the past 15 years. 

In 2012, we saw an outbreak of EV-71 in Cambodia that claimed the lives of dozens of children (see Updating The Cambodian EV71 Story), while last year, in Australia: Acute Flaccid Paralysis & EV71, we looked at a report that described 5 recent cases of acute flaccid paralysis (AFP) in children who tested positive for the EV71 virus.

 

Although EV-71 was first described in a California infection in 1969, and outbreaks of EV-71 associated HFMD were recorded in Europe, North America, and Australia back in the 1970s (see BMJ article on Challenges of EV-71) the genotypes circulating in Asia today have evolved to become more virulent than those of 40 years ago.

 

As with many other infectious diseases, there are genuine concerns that EV-71 may, through repeated introductions via international travel, spread beyond Asia and the Pacific to get a foothold in Europe and North America. While large outbreaks have not occurred outside of Asia yet, there is no good reason known why they couldn’t in the future.

 

All of which serves as prelude to a new Dispatch from the EID Journal, which documents recent introductions of the EV-71 C4 subtype to France.  The bottom line – which comes from the author’s conclusions – reads: The phylogenetic data are consistent with 3 independent virus introductions, presumably from China, and are compatible with a more global circulation of subgenogroup C4 enteroviruses

 

 

Volume 20, Number 8—August 2014

Dispatch

New Introductions of Enterovirus 71 Subgenogroup C4 Strains, France, 2012

Abstract

In France during 2012, human enterovirus 71 (EV-A71) subgenogroup C4 strains were detected in 4 children hospitalized for neonatal fever or meningitis. Phylogenetic analysis showed novel and independent EV-A71 introductions, presumably from China, and suggested circulation of C4 strains throughout France. This observation emphasizes the need for monitoring EV-A71 infections in Europe.

Conclusions

In 2012, EV-A71 C4 strains were detected in France in 4 children hospitalized for neonatal fever or meningitis. Although EV-A71 C4 strains have circulated extensively in China since 2008, this virus has rarely been detected in Europe. In France, 133 cases of EV-A71 infections were reported during January 2000–May 2013 (9) (I. Schuffenecker, unpub. data). EV-A71 C2 infections have been predominant since 2007; however, only 5 cases of EV-A71 C4 infection have been identified in the country since 2004. Our Bayesian analyses excluded a direct evolution of the 2012 EV-A71 C4 strains from the earlier 2004 European virus lineage. The phylogenetic data are consistent with 3 independent virus introductions, presumably from China, and are compatible with a more global circulation of subgenogroup C4 enteroviruses. In 2013, the C4 subgenogroup also emerged in Russia, where it was associated with an outbreak of 78 reported cases, including 1 fatal case of meningoencephalitis (14).

Many cases of fatal encephalitis have been associated with EV-A71 C4 infection outbreaks in China (6), which highlights the neurovirulence of EV-A71 strains. Rare acute flaccid paralysis cases have also been reported in Australia through the national poliomyelitis surveillance program (15).

Although the prevalence of neurologic cases associated with EV-A71 infection is currently low in Europe, the recent circulation of EV-A71 C4 in France and in Rostov, Russia (along the eastern border with Europe), underscores the need for improved surveillance of neurologic manifestations associated with EV infection and of the incidence of HFMD within communities. In addition, careful monitoring for the possible introduction and circulation of new EV-A71 genogroups and subgenogroups should be conducted.

 

 

Among the challenges of controlling EV71 outbreaks are:

• Although at least three vaccine candidates have recently completed Phase III trials, none are currently commercially available.
• A moving viral target, with new strains evolving and emerging over time
• Many children can carry (and shed) the virus asymptomatically (see Incidence Rates of Enterovirus 71 Infections in Young Children during a Nationwide Epidemic in Taiwan, 2008–09)
• Patients may shed virus for month or longer (see Long persistence of EV71 specific nucleotides in respiratory and feces samples of the patients with Hand-Foot-Mouth Disease after recovery)

 

For now, control and prevention are limited to promoting good hygiene, and removing children with signs of the disease from child care or school environments.  For more on HFMD, including the more severe Enterovirus-71 (EV-71), you may wish to revisit the following blogs:

 

The Emerging Threat Of EV71

China: A Recombinant EV-71

HFMD Rising In China

China Sounds Alert Over EV-71 Virus

Suspected Q Fever Outbreak in France

Credit CDC

 

# 8656

 

Q fever is a zoonotic disease caused by exposure to the Coxiella burnetii bacterium - primarily carried by cattle, sheep, and goats – but that are capable of infecting a variety of animals, including humans.  Bacterium are excreted though milk, urine, and feces - and during birthing - they can be shed in high numbers through the placenta and amniotic fluid.

 

Coxiella burnetii are environmentally very hardy; resistant to heat, desiccation, and many common disinfectants, allowing it to persist in the environment and spread to other hosts, often carried on barnyard dust which may be blown over a wide area.

 

The bacterium can also be transmitted through tick bites, ingestion of unpasteurized contaminated milk, or even (rarely) through human-to-human transmission.  The CDC describes the symptoms of the disease and course of illness on their Q fever website:

 

Although most persons with acute Q fever infection recover, others may experience serious illness with complications that may include pneumonia, granulomatous hepatitis (inflammation of the liver), myocarditis (inflammation of the heart tissue) and central nervous system complications. Pregnant women who are infected may be at risk for pre-term delivery or miscarriage. The estimated case fatality rate (i.e. the proportion of persons who die as a result of their infection) is low,  at < 2% of hospitalized patients. Treatment with the correct antibiotic may shorten the course of illness for acute Q fever.

 

While the number of cases diagnosed in the United States each year is small (avg 150), the infection is likely underreported here, and around the world.   Between 2007 and 2010 we saw a protracted outbreak in the Netherlands, which affected thousands of people (see  Q-Fever In The Netherlands).

 

Today, we’ve a report (h/t Gert van der Hoek on FluTrackers) out of France, where an outbreak of atypical pneumonia north of Marseilles is suspected to be due to Q Fever. This from La Provence.com.

 

Alert outbreak of Q fever

Valréas / Published Thursday, 22/05/2014 at 2:43 p.m.

Since May 16, 23 people of all ages are presented to the emergency hospital Valréas (Vaucluse) for flu-like symptoms with high fever and a diagnosis of pneumonia .

Following all of these elements and different tips and recommendations ARS Paca, a warning and management system was immediately drawn to the emergency Valréas: it was established an early listing of patients for tracking and linking with the LRA. The establishment of a broad-spectrum antibiotic treatment in symptomatic patients awaiting serological results was ordered, suitable for children and people with allergies.

" To this day, even if arguments matching beam directed to an outbreak of Q fever from animal sources, we remain cautious in the absence of biological evidence , "says one official. Q fever is a zoonotic (transmissible from vertebrate animals to humans illness), common in farming areas.

If people experience the symptoms described, they must always go to the emergency room or make an appointment with their doctor. They must be treated to avoid complications.

Currently, this is a suspected outbreak, based on symptomology. Lab confirmation can take time. 

 

According to the CDC : Doxycycline is the first line treatment for all adults, and for children with severe illness. Treatment should be initiated immediately whenever Q fever is suspected.

Lest anyone think that Q fever is a problem for places other than the United States, last December CIDRAP NEWS  reported on the results of an investigation into a  multistate outbreak in 2011.

 

Multistate 2011 Q fever outbreak had high rate of symptomatic cases

The first reported US multistate outbreak of Q fever, in 2011, involved 21 people, with an unusually high percentage of them having symptoms, according to results of a cross-sectional investigation published yesterday in Vector-Borne and Zoonotic Diseases.

Investigators queried people associated with the index goat farm in Washington state as well as 16 other farms that bought goats from the index farm or housed goats at the index farm for breeding.

Of 109 people contacted, 21 (19%) from Washington or Montana met the outbreak case definition and had a Coxiella burnetii phase 2 immunoglobulin G titer of 1:128 or greater by immunofluorescence assay. Of the case-patients, 15 (71%) were symptomatic. The authors said a typical symptomatic rate is about half of patients.

Evidence of C burnetii infection was detected in all 17 goat herds sampled (13 in Washington, 3 in Montana, and 1 in Oregon) by polymerase chain reaction, enzyme-linked immunosorbent assay, or both.

Goat-specific Q fever risk factors included direct contact with a newborn goat, exposure to a dead or weak newborn, living on a property with goats, and direct contact with "birth/afterbirth products."

The authors said that after their investigation Washington and Montana implemented a herd management plan to encourage best disease-control practices, reduce the possibility of future outbreaks, and promote communication between public health and agriculture officials.
Dec 18 Vector Borne Zoonotic Dis abstract

 

For more on the diagnosis and treatment of Q Fever, the CDC along with Medscape, produced an expert commentary last year:

The Price Of Vigilance

Photo Credit WHO

UPDATED :   Not unexpectedly, the suspected cases in France referenced below have reportedly tested negative for the MERS coronavirus, and will be released from the hospital.  A h/t to Pathfinder on FluTrackers for the update.

# 7931

 

The inevitable result of the emergence of a pair of novel viruses (H7N9 & MERS-CoV) - and the call by the World Health Organization for all member nations to `continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns’  - is that anyone with a recent travel history to the Middle East or to China, and who presents to a hospital with fever and/or flu-like symptoms, is going to probably be tested, and isolated, until these viruses can be ruled out.

Over the past several months, we’ve seen Hong Kong’s CHP announce the isolation, and testing, of more than a dozen cases recently arrived from the Middle East – none of whom tested positive for the virus. 

Last week we saw similar negative tests announced by both France and Egypt (see France: MOH Statement On Negative MERS-CoV Case &  Egypt Testing Suspected MERS-CoV Case).

Similarly, Hong Kong reported a number of negative H7N9 tests over the summer.

 

As we’ve seen with suspected cases of H5N1 over the years, many are tested, but very few actually prove positive for the virus.

 

And the reason is fairly simple:  The early symptoms for MERS-CoV, H5N1, H7N9 ; Fever, malaise, respiratory symptoms, even pneumonia . . . are virtually identical to a host of other (far more common) viral infections like influenza and rhinoviruses.

If MERS or Avian flu is even a possibility, then prudence dictates immediate isolation and testing – at least until the cause of the illness can be identified, and novel viral infections ruled out.  And since these viruses pose a potential larger public health  threat - testing for them is newsworthy – even though most of these tests will prove negative.

 

Yesterday, reports began to emerge (see FluTrackers Thread) of a family in Toulouse, France – with recent travel history to Saudi Arabia - who are being tested for the MERS coronavirus. This morning, an update from Le Parisien. 

Despite the headline, we still don’t know if any of these people have the MERS virus.

 

Coronavirus: three people hospitalized in Toulouse

Published on 03.11.2013, 12:13 PM | Updated: 12:58

Seven people, including six of the same family were hospitalized Friday in Toulouse (Haute-Garonne) for a hint of coronavirus MERS. This Sunday, three of them are still under observation at the Purpan Hospital. | (DR)

Seven people, including six of the same family were hospitalized Friday in Toulouse (Haute-Garonne) for a hint of coronavirus. This Sunday, three of them are still under observation at the Purpan Hospital. Two had flu-like symptoms after a trip to the Middle East.

These are the grandparents who showed signs of difficulty breathing and fever over 38 degrees, tells France 3 Midi-Pyrenees .

Both were returned on October 28, a trip to Saudi Arabia and suffered samples to identify a potential novel coronavirus MERS-CoV. Their children and grandchildren have had to meet the same tests but showed no signs of the disease. Most have also been released from the hospital on Saturday but were forced into isolation at the moment. Only the son of the two travelers, the father of two children, remained in hospital. In parallel, a seventh person, a septuagenarian, was hospitalized after a pilgrimage to Mecca but emerged immediately.

(Continue . . . )

 

Mild infections have sometimes required more than one test to obtain a positive result, but we should have a better idea on whether this family Toulouse, France have the virus in the next 24 hours or so.    

 

With cold & flu season upon us, it is going to be even harder for clinicians to differentiate between common respiratory viruses and the more dangerous, but far rarer, MERS-COV and H7N9 avian flu viruses. So we can expect to see a steady stream of news items, like this one, alerting us to cases being tested.

 

All of which highlights the need for an accurate and rapid test for both of these viruses (see Referral: Dr. Mackay On MERS-CoV Testing).  Something that is being worked on, but that so far, remains elusive.

France: MOH Issues Rabies Alert

Credit WHO

 

# 7929

 

Earlier this summer Taiwan announced the detection of rabies on that island, ending its rabies-free status which was declared in 1961 (see Taiwan’s Rabies Outbreak). Since then, the number of rabid animals detected has grown rapidly, numbering now well over 100.  

 

Similarly, France has been more-or-less rabies-free (with a 2 year suspension starting in 2008 due to a dog, imported from Morocco, that infected other dogs) since 2001 – at least in non-flying mammals (bats). The CDC’s Yellow book states: Bat lyssaviruses have been reported throughout Europe, including areas that are reportedly free of rabies in other wild mammals.

 

Today we are learning  that a rabid kitten has been discovered in Argenteuil, near Paris,  and that 5 people exposed are receiving rabies shots. An appeal has been made by France’s Le ministère des Affaires sociales et de la Santé (Ministry of Social Affairs and Health) for anyone who may have had contact with this kitten to immediately seek medical aid.

 

 

Cases of animal rabies in the Val d'Oise - search people and animals in contact

November 1, 2013

The Pasteur Institute confirmed October 31, 2013 a case of rabies in a kitten found on 25 October 2013, rue Marguerite in ARGENTEUIL. The animal died October 28, 2013.It's a kitten about 2 months tricolor: white, black and Tan (see photo).

An epidemiological inquiry has been initiated to identify and support the people who could have come into contact with this kitten between October 8 and October 28, included. This period corresponds to the period during which he could transmit the disease.

 

Five people who had been in contact with the kitten have already been identified.

 

They have been supported and directed to a rabies centre for preventive treatmen

• People who have been bitten, scratched, scratched or licked on mucous membranes (mouth, eyes...) or a skin injured by this kitten

• or that the animal would have been in contact with this kitten, between October 8 and October 28, 2013 included

must call soon 08 11 00 06 95

accessible local number between 10 H 00 and 18 H 00 hours from 1 November 2013-

• Similarly, anyone who would have information to give about this kitten or his eventual owner is invited to contact this number. |

It is extremely important to find all persons, including the owner, or the animals that were in contact with the kitten, the mother and the other kittens of the scope.

The France being free of rabies since 2001, this kitten here parent were imported from another country, not free.

Rabies, a disease that should be treated quickly.

Rabies is a fatal disease if not treated in time. It is transmitted for about 15 days before the appearance of the first symptoms of the disease in the animal.

In humans, the preventive treatment of rabies human, administered after contact with the carrier animal, but before the onset of symptoms, is very effective.

Reminder of important recommendations

• Any dog or cat or other carnivore having bitten or scratched a person, must be presented to a veterinarian by its owner within 24 hours of the injury.

The animal is the subject of a health surveillance by the veterinarian for 15 days;

• If bitten, immediately clean the wound with SOAP and water, rinse thoroughly and apply an antiseptic solution. It is essential to quickly consult a doctor, who will be able to according to the context guide the person bitten to a rabies centre.

• do not manipulate the wild animals or stray especially when they are found sick or wounded

 

Despite the availability of rabies prophylaxis and treatment shots, about 60,000 people die each year from the virus – mostly in Asia.   This from the World Health Organization’s  Rabies Fact Sheet.

 

Rabies

Fact Sheet N°99
Updated July 2013

---

Key facts

• Rabies occurs in more than 150 countries and territories.
• More than 55 000 people die of rabies every year mostly in Asia and Africa.
• 40% of people who are bitten by suspect rabid animals are children under 15 years of age.
• Dogs are the source of the vast majority of human rabies deaths.
• Wound cleansing and immunization within a few hours after contact with a suspect rabid animal can prevent the onset of rabies and death.
• Every year, more than 15 million people worldwide receive a post-exposure vaccination to prevent the disease– this is estimated to prevent hundreds of thousands of rabies deaths annually.

France: MOH Statement On Negative MERS-CoV Case

 

 

 

France’s Le ministère des Affaires sociales et de la Santé (Ministry of Social Affairs and Health) has issued the following statement confirming what we learned last night (see Media Reports: French Coronavirus Suspect Tests Negative).

 

 

No new cases of infection with coronavirus (MERS-CoV) in France

A new probable cases of infection with coronavirus (MERS-CoV) was reported on Oct. 28 at the Institute of Health Surveillance (VS). The Pasteur Institute in Paris, which was entered for additional expertise, just communicate negative about this case. This patient is not infected with the coronavirus. The two cases identified in May 2013 therefore remain the only two confirmed cases in France to this day.

The Ministry of Social Affairs and Health noted that in France, so far, the contamination have been reported in the following two situations:

• or after a trip to the Arabian Peninsula with occurrence of respiratory symptoms and fever within 14 days of the return;
• or after close contact with a person infected with coronavirus.

Any person in any of these situations should contact their physician or center and 15 mention the trip in the Arabian Peninsula or close contact.

24 October 2013, the balance of the World Health Organization (WHO) reported 144 cases worldwide, including 62 deaths since September 2012. WHO does not recommend travel restrictions with the countries concerned.

The information on coronavirus established by the Department can be reached toll-free Monday through Saturday from 9 am to 19 pm (0800 13 00 00).

 

Meanwhile, in Egypt – despite denials by the government that a suspect case on Monday had MERS-CoV (see Egypt Testing Suspected MERS-CoV Case) – rumors continue to appear in the local press that this was a MERS case, and that two or three others are being tested.

 

FluTrackers is keeping a log of these news reports, which you can follow here and here.

 

Given the fragmented government, and general chaos in the region, it is probably worth keeping an eye on these reports.

Lancet: MERS-CoV – New Disease, Old Lessons

Coronavirus – Credit CDC PHIL

# 7431

 

The Lancet today has published two related MERS-CoV articles, one of which we examined several weeks ago when it was released early online (see Lancet: Clinical Findings On 2 French MERS-CoV Cases). 

 

The new article - Middle East respiratory syndrome: new disease, old lessons  by Charles D Gomersall & Gavin M Joynt – consolidates what has been learned from the imported case in France (and its nosocomial transmission), along with sparse details from cases in the Middle East, and discusses their findings.

 

Of the two French cases which provide a good deal of the clinical data used in their discussion, one died in late May (see France’s 1st MERS-CoV Patient Dies), while the other (the index case’s roommate) remains in critical condition a month later.

 

The original Lancet article (published online May 30th) provides a detailed review of the clinical findings on both patients, including lab results, radiographs and CT scans, and genetic analysis of specimens.

 

Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission

Benoit Guery, Julien Poissy, Loubna el Mansouf, Caroline Séjourné, Nicolas Ettahar, Xavier Lemaire, Fanny Vuotto, Anne Goffard, Sylvie Behillil, Vincent Enouf, Valérie Caro, Alexandra Mailles, Didier Che, Jean-Claude Manuguerra, Daniel Mathieu, Arnaud Fontanet, Sylvie van der Werf, and the MERS-CoV study group*

Interpretation

Patients with respiratory symptoms returning from the Middle East or exposed to a confirmed case should be isolated and investigated for MERS-CoV with lower respiratory tract sample analysis and an assumed incubation period of 12 days. Immunosuppression should also be taken into account as a risk factor.

 

 

This first report served to increase the supposed incubation period from 10 days to 12, and warned that lower respiratory samples are more likely to return a positive PCR result than samples retrieved from the upper respiratory system.

 

The second report, available online (free registration req.) can be accessed at the link below:

 

Middle East respiratory syndrome: new disease, old lessons

Charles D Gomersall, Gavin M Joynt

In 2003, severe acute respiratory syndrome coronavirus caused an epidemic of severe viral pneumonia. The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) has raised concerns of a similar epidemic. Although 55 laboratory-confirmed cases have been reported to WHO,1 published clinical details are sparse. In The Lancet, Benoit Guery and colleagues2 give a detailed description of two cases, occurring without co-infection.

This report is important not only because it provides information about the clinical features of the disease, but also because it confirms human-to-human transmission, shows the importance of travel and contact history-taking, draws attention to the need for analysis of lower respiratory tract specimens to exclude disease, and suggests that previous estimates of the incubation period might be too short.

(Continue . . .)

 

While you’ll want to read the entire article, some of the points made include:

 

• Some patients with MERS-CoV infection might present with atypical, or mild symptoms.
• Patients with mild symptoms are less likely to be thoroughly investigated and current case counts might not reflect the true burden of the disease.
• Testing is difficult, and samples taken from the upper respiratory system may be unreliable.
• Repeated negative test results of of lower respiratory tract specimens are required to rule out infection.
• While many exposed HCWs have not fallen ill, it is prudent to take precautions against airborne transmission.
• Further investigations are needed into the presence or absence of MERS viral shedding via the stool.
• The authors stress the importance of travel and contact history-taking

 

 

The most recent MERS-CoV update (June 26th) from the World Health Organization puts the case count at:

 

Globally, from September 2012 to date, WHO has been informed of a total of 77 laboratory-confirmed cases of infection with MERS-CoV, including 40 deaths.

 

There are a number of other exposed individuals for whom serological testing is not completed, and so these numbers are subject to revision.

When The Morning News Goes Viral

Villeneuve-sur-Lot -Wikipedia

 

 

# 7352

 

On an otherwise quiet Sunday morning, we’ve several  unusual virus-and-or-disease-related stories crossing the transom. With a heightened media interest in MERS and H7N9, I believe we can expect to see more these types of news reports over the coming months.

 

Caveat: Most are carried by non-English language media sources and we are forced to make do with somewhat murky machine translations.

 

Our first stop is France, where about a week ago – eight middle-aged women – all of whom helped prepare raw poultry for a catered affair, were hospitalized with an unknown respiratory infection.

Two reports, first this one from May 31st, followed by an update from late yesterday.

 

Villeneuve-sur-Lot (47): eight cases monitored in hospital

Eight women of fifty years were hospitalized with the same symptoms after preparing poultry.

Published on 31/05/2013 at 16:36

Since last week, eight women of fifty years are admitted and monitored at Saint-Cyr hospital with symptoms of fever and cough. Working for a caterer they all prepared poultry for two weddings last weekend.

 

"In a time of emerging viruses, it is probably best to learn," explains Patrick Rolland, the regional branch of the Institute of Health Surveillance (IVS). IVS continues his research, although none of the patients show evidence conclusive coronavirus, H5N1 and H7N9. Further results are expected before making different assumptions.

 

Fast forward to last night, and we learn that MERS and H7N9 have apparently been excluded and the focus now seems to be on determining a bacterial cause.

 

Villeneuve-sur-Lot (47): eight women always kept under observation in hospital

We still do not know what the eight admitted to suffering from last Friday with fever and cough patients.

If influenza H5N1 and H7N9 type virus and corona are now apart, we still do not know what's with the eight women of fifty years under observation in the pulmonology department of the hospital in Saint-Cyr-sur Villeneuve -Lot.

 

Recall that is all knowing and working for a caterer, they had participated in the evisceration of nearly 150 birds in the previous days, for the preparation of two marriages.

 

Although their status has improved thanks to venous antibiotics, the first samples have failed to establish a diagnosis. It was not until the following samples for antibodies can be detected and thus identify bacteria. The eight women are still pending, hospitalized.

 

This is a curious enough report that I’ll try to follow up on it when a cause is determined.

 

Next stop, a genuine MERS-related story out of Saudi Arabia, where a public health official appears to have tried to board a plane carrying a sample of the novel coronavirus (in exactly what kind of container is not stated), to fly to Jeddah.

Apparently the plane was not BSL-3 certified, and airport security thought better of the idea.

 

My thanks to Sharon Sanders of FluTrackers for finding this report from Alwafd.org.

 

King Fahd International Airport ..

Saudi prevent carries sample "Corona" of travel

King Fahd Airport
Gateway delegation - rebounds: Saturday, June 1, 2013 11:50

Saudi security authorities prevented in the King Fahd International Airport in Dammam employees in the Ministry of Health of the rise of the plane that he planned to travel to Jeddah on board, because of him pulled from the sample is infected with "Corona".

The general director of the King Fahd International Airport in Dammam Khaled المزعل, in a statement published Saturday, that the traveler was forced to transfer the sample via the shipping company, and did not allow him to carry on the plane, his trip was postponed so check it and boarded the plane without "Corona."

 

 

And we finish our morning tour with report out of the island nation of Bahrain (which is connected to Saudi Arabia by a causeway), that tells of a Pakistani – who was being tested for the MERS virus – escaping from a local hospital.

 

Once again, Sharon Sanders has the original Arabic story here, which suggests the patient initially tested positive for the virus.  But in short order, Bahrain’s MOH came out with a flat denial (h/t Tetano).

 

Bahrain denies coronavirus case report

Health ministry says test results were negative

By Habib Toumi Bureau Chief

Published: 16:23 June 2, 2013

Manama: Bahrain’s health ministry has denied reports that a Pakistani national who had the coronavirus had fled the country’s main public hospital.

 

The report said that the Pakistani driver was taken to Salmaniya Medical Complex after officials at the King Fahd Causeway linking Bahrain with Saudi Arabia suspected he had the respiratory virus. However, the report added, he managed to leave the hospital while the medics were waiting for the test results.

 

The health ministry on Sunday issued a statement in which it said that exhaustive tests proved that the driver had not contracted the coronavirus and that he left the hospital normally.

(Continue. . . )

 

 

If nothing else, today’s stories will give you an idea of the kind of stories that the combined volunteer newshounds of flublogia wade through (in English, Arabic, Chinese, Vietnamese, Indonesian, French, etc) each and every day.

 

Not every report is `breaking news’, of course.  But each must be identified, translated, and analyzed before they can be cataloged on the flu forums, and put into some kind of context. 

 

Often we don’t know until days, or weeks later, the true significance of these reports. But having the library of these reports can be invaluable.

 

For more on the work done by the newshounds on the Flu Forums, you may wish to revisit:

 

Newshounds On The Trail Of The Latest Beijing H7N9 Report

France: Hospital Statement On MERS-CoV Fatality, Surviving Patient

 

Lille France – Credit Wikipedia

 

# 7334

 

In their first update in more than a week, yesterday the Centre Hospitalier Regionale et Universitaire de Lille  announced the death of one of their two MERS-CoV patients (see Media: France’s 1st MERS-CoV Patient Dies), and provided a brief update on the condition of the surviving patient.

 

The second patient, who became infected while sharing a room with their index case (before his infection was diagnosed), remains in very serious condition and on ECMO.

 

The index patient returned from a visit to Dubai (spanning Apr. 9th-17th) and was hospitalized on April 23rd in Valenciennes in the north of France. He was subsequently transferred to Douai on the 28th, and then a week later, on to the hospital in Lille.

 

The following is a machine translation.

 

The University Hospital of Lille mourns First patient coronavirus

The University Hospital of Lille mourns death this afternoon of the first patient coronavirus hospitalized in the intensive care unit of the University Hospital Centre of Lille since May 9, 2013, the following a multi-organ failure.

 

The patient was placed in a chamber designed to allow its isolation since his admission to the University Hospital of Lille, and had benefited from taking supported by a dedicated team.

 

Teams Centre resuscitation SAMU 59, and cardiac surgery (unit Circulatory Support) of the University Hospital of Lille, have implemented all the material means and human resources to support the patient in the best conditions.

 

He had especially placed under extracorporeal support (ECMO: Oxygenation by extracorporeal member), to take over his lung function. Branch and all the teams present their sincere University Hospital condolences to the family.

 

The second patient coronavirus is meanwhile still hospitalized in Resuscitation of the University Hospital Centre, under cardiopulmonary bypass (ECMO). His condition remains stable but still very serious

 

Media: France’s 1st MERS-CoV Patient Dies

Extracorporeal membrane oxygenation (ECMO) machine in a ICU patient in Santa Cruz Hospital, Lisbon, Portugalj - Wikipedia

 

 

# 7327

 

It’s being widely reported this morning that France’s first MERS-CoV case (see France: More Details On Imported nCoV Case) - the 65-year old man who returned form Dubai in Mid-April - has died after more than a month of hospitalization.

 

He, and another patient who shared a hospital room with him before he was diagnosed, were both reported to be in grave condition more than a week ago (see France: 2nd nCoV Patient Deteriorates, Placed On ECMO).

 

Although I’ve not found an official statement on the French Ministry of Health website, Reuters and AFP are both reporting the fatality.

 

French victim of coronavirus dies

Last updated: Tuesday, May 28, 2013 3:46 PM

Coronavirus sufferer dies in France - hospital source

Source: Reuters - Tue, 28 May 2013 12:50 PM

France: 2nd nCoV Patient Deteriorates, Placed On ECMO

 

Extracorporeal membrane oxygenation (ECMO) machine in a ICU patient in Santa Cruz

 

# 7280

 

While I’ve yet to find the official release, it is being widely reported this morning that the Centre Hospitalier Regionale et Universitaire de Lille has announced the condition of their second novel coronavirus patient has deteriorated since our last update (see France: Both Coronavirus Patients Remain In `Poor’ Condition) and he has now been placed on ECMO.

 

This from AFP.

 

Coronavirus: the health of the French second patient deteriorated

(AFP)

LILLE - The health of the roommate of the first confirmed case of novel coronavirus in France deteriorated Wednesday, Thursday announced the Lille University Hospital where both hospitalized patients.

 

"The health status of the second patient deteriorated in the last day. He was placed on ECMO (extracorporeal membrane oxygenation) to take over from his lung function," said the University Hospital in a statement

 

"His condition has stabilized but remains a serious concern," the statement said.

(Continue . . .)

 

 

France’s index case, a 65-year-old man who had recently traveled to the UAE, was hospitalized on April 23rd, and was placed on ECMO support on May 8th.

 

Both cases illustrate just how devastatingly virulent this infection can be.  Of 40 known cases, 20 have died, and many of the survivors have required significant and prolonged medical intervention.

 

For more on ECMO, and how it has been used for severe respiratory disease, you may wish to revisit.

 

JAMA: H1N1, ECMO, and Survivability

The ECMO Option

France: Both Coronavirus Patients Remain In `Poor’ Condition

 

Extracorporeal membrane oxygenation (ECMO) machine in a ICU patient in Santa Cruz Hospital, Lisbon, Portugalj - Wikipedia

# 7270

 

 

An update from the Centre Hospitalier Regionale et Universitaire de Lille, in France where two nCoV patients remain in their ICU; the index case who traveled to the UAE during the middle of April, and a second patient who shared a hospital room with him before he was diagnosed.

 

 

Checkup of the two patients coronavirus

14 May 2013 - 12

Both patients coronavirus ICU at University Hospital of Lille are still in a poor state of health.

 

The first patient remains in stable condition. No improvement is recognized by doctors for the moment.

 

The second patient is still under ventilatory support by ventilator.

 

His condition is not completely stabilized.

 

 

The index case – a 65 y.o. man who was hospitalized on April 23rd -  reportedly remains on an ECMO (Extracorporeal Membrane Oxygenation) machine.  Increasingly, we’ve seen ECMO support used for severe respiratory distress due to pneumonia, avian flu, and the novel coronavirus.

 

Normally patients with Acute Respiratory Distress Syndrome (ARDS) are placed on a mechanical ventilator and treated with a variety of drugs to reduce infection (antibiotics) and lung inflammation (corticosteroids, Nitric Oxide, etc.).

 

Despite these measures, ARDS is generally fatal in 50% of patients.

 

 

Which is why in 2009 some hospitals tried an expensive and controversial treatment called ECMO on some adult and adolescent patients with H1N1 related pneumonia, and early reports were encouraging.

 

ECMO is a specialized heart-lung bypass machine used to take over the body’s heart and lung function – for days or weeks if necessary – while the body heals from injury or illness.

 

ECMO is most commonly used in neonatal intensive care units for newborns in respiratory distress, although it is also used for pediatric and adult patients with severe heart or respiratory deficits.

 

In the fall of 2009 we saw a report in The Lancet  where UK researchers determined that ARF (Adult Respiratory Failure) patients that received ECMO support as opposed to conventional ventilation had a greater survivability without disability.

 

While often lifesaving, ECMO resources are extremely limited, and are simply not available in many regions of the world.  

 

For more on ECMO, and how it has been used for ARDS, you may wish to revisit.

 

JAMA: H1N1, ECMO, and Survivability

The ECMO Option

France: Second Coronavirus Case Confirmed

 

# 7262

 

Overnight the Health Ministry in France confirmed that country’s second novel coronavirus (nCoV) infection – that of a patient who shared a hospital room with their index case – a traveler recently returned from the UAE.

 

This confirmation marks the third known hospital-linked transmission of the virus. Although nCoV is not SARS, this is a  scenario similar to what we saw with the SARS virus a decade ago.

 

While several other close contacts have tested negative for the virus (see France: Update On Coronavirus Suspect Cases), roughly 120 patient contacts are reportedly being watched for signs of infection. 

 

This report from Reuters:

 

Second French coronavirus case confirmed

ARIS | Sun May 12, 2013 5:38am EDT

(Reuters) - A second case of a new SARS-like coronavirus has been diagnosed in France, the Health Ministry said on Sunday, in what appeared to be a case of human-to-human transmission.

 

The new infection was found in a patient who had shared a hospital room with the only other confirmed sufferer in France, the ministry said in a statement.

 

Health experts are concerned about clusters of cases of the new coronavirus strain, nCoV, which started in the Gulf and has spread to France, Britain and Germany. But there has so far been little evidence of sustained human-to-human transmission.

(Continue . . .)

 

 

At least one news agency is reporting that this second case was moved into ICU on Sunday Afternoon (local time).

 

Coronavirus: the second patient transferred to ICU

The second patient's clinical condition worsened by the Lille University Hospital. The patient has difficulty breathing.

 

 

 

This makes the third hospital-associated cluster of nCoV cases, and reinforces the idea that this virus can – at least through close and prolonged contact – transmit in some limited way among humans.

 

How well this virus is transmitted, and whether there are asymptomatic cases occurring that are not being picked up by current surveillance techniques, are important questions needing answers.

 

Another unknown is the sensitivity of the lab tests being employed. Until serological studies can be done on patients who tested negative by PCR, we really won’t know the answer to that question.

 

Meanwhile, World Health Organization and international health experts are in Saudi Arabia in an attempt to help the Saudi Ministry of Health investigate the outbreak in Al-Ahsa. 

 

We continue to see syntax-mangled (machine translated) Arabic news reports that paint a confusing (and perhaps misleading) picture of what is happening in Saudi Arabia. 

 

Hopefully we’ll get some detailed updates from the World Health Organization on the extent, and status, of the Saudi outbreak over the next day or two.

 

For recent updates on the novel coronavirus from the WHO and CDC, you may wish to revisit:

 

CDC Updates On Novel Coronavirus

WHO: Extensive GAR Update On nCoV

France: Update On Coronavirus Suspect Cases

 

 

# 7261

 

Welcome to the new normal, where we find ourselves waiting for hours, or sometimes even days, for test results on isolated suspected nCoV and H7N9 cases.

 

For veteran H5N1 avian flu watchers, this is familiar territory.

 

This morning the French press is reporting that three of the `contacts’ of France’s nCoV case who had displayed `symptoms’ have initially tested negative for the novel coronavirus, while the status of the fourth requires further testing. 

 

A fifth case, that of a "a man, relatively young"  with mild symptoms who is currently staying at home, is also under investigation.

 

This (machine translated) report from 20Minutes.fr.  

 

Coronavirus: A fifth suspect identified

 

Updated on May 11, 2013 at 11:06.

Health A new suspect has been identified in the entourage of the patient with the novel coronavirus, SARS close, announced Saturday the Minister of Health, Marisol Touraine.

The Minister of Health, Marisol Touraine went Saturday morning at University Hospital of Lille, where four cases of coronavirus had been suspected. The Minister announced the presence of a fifth case in the entourage of the sick patient. "A fifth case contact was identified in the entourage of the sick patient. Samples were made that we know the results at the end of the day," said the minister at a press briefing.

<SNIP>

"One hundred and twenty persons identified, three (one patient who had rubbed the patient, a doctor, a nurse), and a fourth in the 10th of May had symptoms that led to virological sampling and placing them under observation in isolation, infectious diseases service, "says the ministry. "For three people, negative results are to be confirmed by the national reference center of the Pasteur Institute in Paris."

(Continue . . .)

 

 

 

As concerns over the emergence and spread of both H7N9 and nCoV grow, we are sure to see an expanding list of `suspect cases’ isolated and tested around the world.

 

Some will have a recent travel history to Asia or the Arabian peninsula, while others may have had contact with a diagnosed case. Their symptoms may range from severe, to a mild ILI (Influenza-Like-Illness). Some may even be asymptomatic. 

 

And  not surprisingly, many will test negative.

 

Some of these `negative’ findings may be the result of deficits in the procedures; a lack of sensitivity on the part of the test, the method of sample collection, the timing of sample collection, or even problems in the shipping and handling of specimens.

 

But in all likelihood, most of these negative tests will probably be correct.

For now (and hopefully well into the future) infections with more mundane seasonal respiratory viruses (Rhinoviruses, seasonal influenza, Adenovirus, RSV etc.) far exceed the number of human infections with exotic and emerging viruses like nCoV and H7N9.  

 

We get a good example of this in Hong Kong, where from yesterday’s report Update on number of suspected human cases of avian influenza A(H7) notified to CHP we learn:

 

This brings the total number of notifications received by the CHP since March 31 of cases fulfilling reporting criteria of suspected human cases of avian influenza A(H7) to 22, and the total number of notifications not fulfilling reporting criteria to 84.

<SNIP>

"Influenza A(H7) is a statutorily notifiable infectious disease in Hong Kong. Locally, no confirmed human cases of avian influenza A(H7N9) have been recorded so far," the spokesman stressed.

 

During the first couple of weeks of the H7N9 outbreak on the mainland, every `suspect’ case tested in Hong Kong was big news. 

 

Now – and until a positive case shows up – it’s the subject of a routine daily update.

 

None of this is meant to minimize the risks of these viruses spreading, or to suggest that it isn’t prudent to isolate and test any and all suspect cases. 

 

While the odds that individual ILI case might be nCoV or avian flu may be small, health officials know it only takes one super-spreader (see Influenza Transmission, PPEs & `Super Emitters’) to jump start an epidemic.

 

But even if nCoV and H7N9 prove themselves not ready for primetime, they are unlikely to fade back into the woodwork anytime soon. Additional human cases are likely, and so limited human-to-human transmission is certainly possible.

 

Which means, concerning as they may be, we might as well start getting used to seeing headlines about the testing of suspected cases around the globe, as this is a situation we are apt to be dealing with for some time.

Two Contacts Of French nCoV Patient Hospitalized For Tests

 

 

#7255

 

 

A story the newshounds at Flutrackers have been following for about an hour – but via this machine translated news report – has now now made the wire services in English.

Two contacts of the French nCoV patient (see France: More Details On Imported nCoV Case) are apparently displaying signs of infection – but with what – is yet to be determined.

 

One is a doctor who treated the French traveler, and another a patient who shared a hospital room with him in in Valenciennes, before he was diagnosed and isolated.

 

Tests are being conducted, and so for now, these are only suspect cases.  

 

This report from Reuters:

 

Two people in France ill after contact with coronavirus victim

LILLE, France | Fri May 10, 2013 2:45am IST

(Reuters) - Two people who had contact with a Frenchman who is seriously ill with the new SARS-like coronavirus have fallen sick and been admitted to hospital, health officials in northern France said on Thursday.

 

One is a patient who shared a ward with the 65-year-old man infected with the virus when he was in a hospital in the town of Valenciennes, northern France, at the end of April, and the other is a doctor who treated him there.

(Continue . . .)

 

With two previously recorded healthcare-related clusters involving this virus, health officials are quick to isolate and test any contacts who display any signs of illness.

We will hopefully get some definitive word on their status in the hours ahead.

France: More Details On Imported nCoV Case

 

 

# 7246

 

Based on details from an AFP report, it appears that France’s first imported coronavirus case returned from a visit to Dubai (spanning Apr. 9th-17th) and was hospitalized on April 23rd in Valenciennes, a town of about 40,000 people in the north of France near the Belgium border.

On April 29th, the 65-year-old man was transferred to a hospital in Douai, a distance of about 41 km.

 

Given this patient’s travel history, It’s not immediately clear why it has taken more than two weeks to diagnose and announce this patient's nCoV infection.

 

 

Coronavirus: the patient is 65 years old and was hospitalized in Douai

PARIS - The first French patient with an acute respiratory infection again close the SARS virus (Severe Acute Respiratory Syndrome) is 65 and is hospitalized in Douai (North), said Wednesday the Ministry of Health.

 

The patient was hospitalized on April 23 in Valenciennes, Douai and then transferred to 29 April, where he is in intensive care and benefits of respite care or respiratory assistance and exchange of blood, said Jean-Yves Grall, Director General of Health at a press conference.

 

The man had stayed in Dubai from April 9 to 17, he said. He was hospitalized with acute respiratory disease.

(Continue  . .)

France: Imported Case Of nCoV From The UAE

 

 

# 7244

 

 

Via a brief and less-than-detailed press release from France’s Health Ministry, we learn of an imported case of novel coronavirus infection, courtesy of a traveler returning from the UAE.

 

While we saw an another case originating from the UAE last March (see WHO: Update On NCoV Fatality In Germany), I suspect that no time will be wasted in seeing if this person’s infection is linked – in any possible way – to the outbreak currently ongoing in neighboring Saudi Arabia.

As they say, an epidemiological investigation is ongoing.  Stay tuned.

 

First confirmed case of coronavirus in France

May 8, 2013

An acute respiratory infection linked to the new coronavirus (NCoV) has been reported to the Institut de Veille Sanitaire (VS) by the National Reference Center (NRC) at the Pasteur Institute who carried out the virological analyzes. This is the first and only confirmed case in France to this day.

 

It concerns a person returning from a trip to the United Arab Emirates. She is currently hospitalized in intensive care and placed in isolation.

 

The Ministry of Social Affairs and Health has immediately launched a thorough epidemiological investigation surrounding this case.

 

Marisol Touraine, Minister of Social Affairs and Health, held a press conference today at 24:00

In the presence of:

• Dr. Jean-Yves Grall, Director General of Health
• Dr. Françoise Weber, Director of the Institute of Health

Newsroom 1, Place de Fontenoy 75007 Paris

 

Sweden: First Domestic EHEC Case

 

 

# 5659

 

 

Today, the Smittskyddsinstitutet (Swedish Institute for Communicable Disease Control) announced their first locally acquired case of EHEC due to the same enterohemorrhagic E. coli strain that has recently sickened thousands, and killed dozens, across Germany and parts of Europe.

 

Exactly how this patient – a middle-aged man from Skåne (southern Sweden) with no history of travel to Germany and no known contact with anyone returning from the region – came to acquire the infection is unknown.

 

Of particular concern would be if this virulent strain of E. Coli has managed to get into Sweden’s food supply.  There are other possibilities, of course, including acquiring the bacteria indirectly from contact with another person.

 

Tracking down the source of this infection is now a top priority for local health officials. 

 

This from The Local.se.

 

 

Sweden reports first domestic EHEC case

Published: 28 Jun 11 16:24 CET |

For the first time, a Swede with no connections to Germany has been infected with the virulent enterohaemorrhagic E. coli (EHEC) bacteria that has claimed dozens of lives across Europe, Swedish health authorities reported on Tuesday.

 

“This means that the source of the infection is in Sweden, which is a lot worse, because it might mean that there is some form of infected food product in circulation that we haven’t yet identified, “ said Sofie Ivarsson, epidemiologist at the institute to news agency TT.

(Continue . . . )

 

Meanwhile the latest ECDC update shows roughly 4,000 cases in Germany and 48 related deaths.

 

 

Separately, another much smaller outbreak featuring the same E. coli O104:H4 strain has been detected in Bordeaux, France, hospitalizing at least 9 people. 

 

ECDC update on outbreak in Germany and cluster in France

27 Jun 2011

ECDC

On Friday 24 June, France reported a cluster of eight patients with bloody diarrhoea, after having participated in an event in the commune of Bègles around Bordeaux on 8 June. Of these, seven have developed HUS, a severe complication of E. coli infection. In three of the patients, infection with E. coli O104:H4 has been confirmed.

 

The French authorities are investigating this new cluster of STEC - the suspected vehicle of infection for the cases and whether there is any link between that cluster and the large outbreak reported from Germany.

 

Since 25 June in the EU/EEA, 880 HUS cases, including 31 deaths, and 3 039 non-HUS cases, including 16 deaths have so far been reported. ECDC is continuously monitoring the enterohaemorrhagic E. coli (EHEC) and Shiga toxin-producing E. coli (STEC) oubreak in Germany and other EU Member States.

 

 

While the original outbreak in Germany is winding down, two fresh foci of infection – seemingly unrelated to the main outbreak – leave us with many unanswered questions.

 

And so the epidemiological investigation continues.