WHO Update On Germany’s Imported MERS Case

Coronavirus – Credit CDC PHIL

# 9799

The World Health Organization has posted an update on the imported MERS case we learned about on Saturday (see Germany Reports Imported MERS Case - ex UAE).  While we are just hearing about this now, this patient has been hospitalized since the middle of February. 

A bit surprisingly, the timeline provided suggests the patient was hospitalized for nearly a week before his MERS diagnosis was made, and full isolation and infection control measures were taken. 

 

 

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

Disease outbreak news
9 March 2015

On 7 March 2015, the National IHR Focal Point for Germany notified WHO of 1 case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

Details of the case:

The case is a 65-year-old, male, German citizen who returned on 8 February to Germany from Abu Dhabi, United Arab Emirates. He developed symptoms on 10 February and was hospitalized in an intensive care unit one week later. The MERS-CoV infection was laboratory confirmed on two samples; the latest sample was taken on 5 March. Currently, the patient is in a severe but stable condition.

All necessary, recommended, preventive and control measures have been applied since 23 February at the hospital where the patient is being treated. Contact tracing of all possible contacts is ongoing for this case. So far, no additional cases have been identified.

Globally, WHO has been notified of 1041 laboratory-confirmed cases of infection with MERS-CoV, including at least 383 related deaths.

(Continue . . . )

Germany Reports Imported MERS Case - ex UAE

 

Credit Wikipedia

 

# 9792

 

 

While we are waiting for confirmation on this morning’s report of 3 suspected cases of MERS in Turkey, Germany’s RKI (Robert Koch Institute) has announced a recently returned traveler from Abu Dhabi is in isolation, being treated for MERS in Lower Saxony.

 

Given this patient returned from the UAE in early February, and the RKI report indicates that his contacts were `were determined and monitored by the relevant health authorities’, it seems likely we are hearing about this case somewhat belatedly.

Although the UAE has been pretty quiet regarding MERS since last summer, there was one case recently reported  to the WHO and posted on February 11th, who fell ill on January 29th, and died on the 6th.  At this point we don’t have any information on how this latest case was exposed.

 

Two reports, a brief (translated) press account, followed the the RKI statement.

 

Infected man from Osnabrück region with fatal Mers-Virus

Osnabrück - When a man from the region of Osnabrück deadly Mers coronavirus was detected. The patient had returned early February from a vacation trip from Abu Dhabi to Germany, said the Lower Saxony Ministry of Health on Saturday in Hanover. He will now be treated in an isolation hospital in Osnabrück. How is the man who was not initially know. Even people from his environment stood now under medical observation. It is the first case of illness of its kind in Lower Saxony. A threat to the population but not there. Mers can lead to kidney failure among others and severe pneumonia. A vaccine does not exist.

 

 

Information of the RKI disease cases by the MERS -Coronavirus

Stand: 07.03.2015

Situation in Germany (change)

In Germany, for the third time occurred a MERS-CoV case, as in the two previous cases, the disease was brought by a-arrived from the Arabian Peninsula patients. It is a 65-year-old German who had traveled to the United Arab Emirates, and is currently being treated at a hospital in Lower Saxony. In the Lower Saxony Minsterium of Health has informed in a press release on 7 March 2015 (see link below, all links mentioned here can be found at the end of the text). People with close contact with the patient were determined and monitored by the relevant health authorities, the authorities are at the local and state level in close contact with the Robert Koch Institute. Generally MERS-CoV is not easily transferable, so that even in the case of secondary cases can not be expected that longer chains of infection occur. In Germany, therefore, there is no increased risk of disease in the general population.

Previously, one patient each in 2012 and 2013 were treated, Qatar and the United Arab Emirates in Germany, one of the two patients could be discharged recovered, the other died. The investigation of contacts in both cases had no evidence of secondary infections result (Buchholz et al., Euro Surveillance 02/21/2013;. Epidemiological Bulletin No. 31/2013, see link below).

The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is known since April 2012. Clinically proven cases present at the beginning with an acute beginning, flu-like illness. The incubation period is usually one to two weeks. In severe cases, a pneumonia may develop, which may turn into an acute respiratory distress syndrome. A common accompaniment is diarrhea; in severe cases even kidney failure may occur. Severe reactions mainly occur in persons with chronic underlying medical conditions such as diabetes, cancer or immunosuppression.

Since the first appearance of MERS 2012 were WHO reported laboratory confirmed cases over a thousand, especially in the Arabian Peninsula, about 40% of them died. The current state of affairs on diseases at the World Health Organization (WHO) available (see link below).

(Continue . . .)

Germany: H5N8 Detected At Rostock Zoo

Credit Wikipedia

# 9544

 

We’ve another report today illustrating the recent spread of HPAI H5N8 across Europe, with the Rostock Zoo reporting the infection of a white stork, and the immediate culling of others in the zoo.  Yesterday Germany reported two wild mallard ducks – shot on New Year’s Eve – tested positive for the virus.

Virtually unknown until its abrupt emergence in South Korea a year ago, H5N8 has – over the past few months – shown up either in wild birds or poultry in China, Russia, Japan, Germany, Italy, the Netherlands, the UK  and the Pacific Northwest of the United States.  

Two reports on today’s discovery.  First a brief announcement on the Mecklenberg-Vorpommern Ministry of Agriculture Governement Portal website followed by a more detailed report on the http://www.mecklenburg-vorpommern.eu website :

 

H5N8: New Strategy for avian influenza in Rostock Zoo

No 006/15. - 08/01/2015 - LU - Ministry of Agriculture, Environment and Consumer Protection

At the zoo of Rostock highly pathogenic avian influenza virus H5N8 was detected.

Minister Dr. Till Backhaus, the backgrounds and other measures today to 16 clock pose at a press conference.

Location: Ministry of Agriculture, Environment and Consumer Protection MV

 

 

 

White Stork in Rostock Zoo infected with avian influenza virus H5N8

08.01.2015

Rostock (AP) - In Rostock Zoo there is a case of avian flu. As the city administration Rostock on Thursday reported a white stork has infected. According to information from the Ministry of Agriculture in Schwerin highly pathogenic H5N8 virus was detected. As the dpa learned the affected animal and the other eight white storks of the zoo have been killed.

More information about the case or the possible consequences for other zoo animals were not available initially. Minister for Agriculture Till Backhaus (SPD) wanted to inform the public in the afternoon. As reported by the Veterinary Zoos of the city has instructed to close the zoo for this Thursday.

Only on Wednesday bird flu was detected in northern Saxony-Anhalt in two wild ducks. The animals had been shot during the game monitoring on 31 December. In both animals, the Friedrich-Loeffler-Institut was detected on Riems the H5N8 virus.

In Mecklenburg-Vorpommern bird flu was (district of Vorpommern-Greifswald) erupted with the same pathogen in early November in an operation in Heinrichswalde with around 31 000 turkeys. About 2,000 animals died, the others were killed. Two weeks later the virus H5N8 was first in Europe in a wild bird on the island of Rügen in Ummanz - proven - a teal.

 

Germany Reports H5N8 Again In Wild Mallards

Major Global Migratory Flyways – Credit FAO

 

# 9540

 

Although it has been nearly 3 weeks since the last report of H5N8 in Germany’s poultry population (see Germany: 2nd H5N8 Outbreak In Lower Saxony), surveillance is still ongoing across much of Europe – both in commercial flocks and in wild birds.  

 

Today German authorities in the District of Stendal in  Saxony-Anhalt announced the detection of H5N8 in two mallards shot by hunters on New Year’s Eve.

 

The sudden expansion of the range of HPAI H5N8 via wild and migratory birds has become a big story these past couple of months, with this recently emerged virus spreading from Korea to China, Japan, Russia, and Europe – and recently turning up in North America as well (see Avian Flu Suspected In 2nd Washington State Backyard Flock).

.

This report from MDR Sachsen-Anhalt

 

H5N8 confirmed in mallards New bird flu case in Saxony-Anhalt

In the district of Stendal the highly contagious bird flu virus H5N8 has been detected in two mallards. This was announced by the District Office Stendal on Wednesday afternoon. The reference laboratory for avian influenza, the Friedrich Loeffler Institute on Riems, pointed at the already 31 December 2014 shot in hunting district of Great Schwechten animals, the infection after. In the vicinity are now immediately Clinical and virological investigations carried out in poultry. The results to be expected in the next week. The county stressed that the stable duty would continue to be made.

Last December, the initial virus was detected at a dead mallard in Aken. An influenza type H5N8 was detected since November in Germany, the Netherlands, Great Britain and Italy both in domestic poultry and wild birds.

MDR SAXONY-ANHALT

Detected avian influenza in mallard ducks

In Saxony-Anhalt, a new case of bird flu has been confirmed. Two hunters shot on New Year's Eve at major Schwechten the wild ducks. Now, more animals are examined.

01.07.2015, 17:00 clock | 1:00 min

Germany Adopts New Stringent Bird Flu Protection Regulations

Lower Saxony – Near Dutch Border – Credit Wikipedia

 

# 9473

 

After the announcement on Saturday (see Germany: 2nd H5N8 Outbreak In Lower Saxony) of Germany’s 3rd farm to be impacted by the H5N8 virus, followed closely by a report of a wild duck in the eastern state of Saxony-Anhalt likewise infected, the Federal Ministry of Agriculture (BMEL) has announced new stringent regulations on the raising, sale, and transport of ducks and geese within the country.

Unlike chickens and turkeys, ducks and geese (and waterfowl in general) are less apt to show outward signs of infection with avian flu viruses, and so recent testing is now required prior to transport and slaughter.

 

The concern at this time is over the potential to spread the H5N8 virus to other poultry holdings via the transporting of asymptomatic ducks and geese, rather than any serious human health threat. 

 

This (machine translated) press release from the BMEL.

 

Press release no. 336, 22/12/14

Federal Agriculture Minister Schmidt shall express regulation for protection against avian influenza

Federal Agriculture Minister Christian Schmidt has signed a rush Regulation on Monday, with all the ducks and geese holders are obliged to examine your animal populations for the presence of avian influenza prior to transport. Only with a negative test result, the animals can be transported and slaughtered.

At the time of shipment, the sampling must not be older than seven days. The Regulation shall enter into force on Tuesday at 0.00 clock and applies nationwide by 31st March 2015th The associations of the poultry industry had promised to the Federal Ministry of Agriculture at the weekend to implement the proposed investigation obligation immediately.

"Ducks and geese, in contrast to turkeys and chickens no signs of illness, if they have been infected with the highly infectious virus H5N8. The risk of undetected infected animals are transported and the spread of disease vehicle and personal contacts may be reproduced, is therefore high, "said Minister Schmidt. "This measure is intended to protect our livestock", as Schmidt added.

In the last week of Avian Influenza Virus was first detected in a Lower Saxony turkey fattening farm and then ducks in a pig farm, also in Lower Saxony. Between the two companies was no contact. Experts have previously assumed that the most likely causes of the spread of the pathogen are migratory. As the pathogen has entered the livestock numbers, is still the subject of ongoing investigations.

There is no evidence that the H5N8 virus is transmitted to humans worldwide. Consumers should generally comply with strict kitchen hygiene rules when preparing poultry and poultry eat only cooked through. To protect against animal diseases are beyond raw meat scraps principle in your household trash and not in the organic waste still on the compost heap.

Germany: 2nd H5N8 Outbreak In Lower Saxony

Emmsland – Lower Saxony – Near Dutch Border – Credit Wikipedia

 

# 9469

Detections of highly pathogenic H5N8 – an avian flu subtype practically unknown a year ago – continue with another farm in Germany reporting the virus.  This is the third German farm in just over a month to report an outbreak.

 

We’ve also seen this highly mobile avian flu virus abruptly show up in North America, Japan, and Italy this week, likely spreading via migratory birds.   

 

While H5N8 is not currently believed to pose a serious human health threat, and is primarily a concern for poultry producers, H5 avian viruses are notoriously unstable and difficult to control. So this rapid geographic expansion of H5N8 bears watching.

 

This report from NRC.NL

 

Bird flu in Germany, again near Dutch border

News

In the German Meppen, that near the Dutch border is, is a second case of bird flu at a duck farm discovered. It comes to the dangerous variant H5N8.

Meppen is located in Lower Saxony, Germany, about 35 kilometres from Emmen.

Control in other companies

The Ministry of agriculture in Hannover reports that all 10,000 birds are culled. In a radius of 3 km are checked poultry farms. In that area are still 18 poultry farms with a total of 180,000 animals. For the time being applies a transport ban at this time.

(Continue . . .)

Germany & Japan Both Report H5N8 In Wild Birds

International Migratory Flyways

 

# 9361

 

On Tuesday, in H5N8: A Case Of Deja Flu?, I recounted the history of great H5N1 bird flu expansion of 2005-2007, where that virus jumped from only 9 Southeast Asia countries to 60+ nations across Europe and Asia.  While it is far from clear whether H5N8 will follow H5N1’s flight path, we continue to see evidence of its encroachment to other regions of the world.

Since Tuesday, the Netherlands has reported several additional farms infected (see Netherlands: 2nd Farm At Kamperveen Showing Signs Of Bird Flu), and both Japan and Germany have found evidence of the virus in wild or migratory birds.

First stop, a report today from Reuters of a 2nd detection of H5N8 in Germany, this time in wild birds.

Germany reports second case of bird flu - H5N8 found in wild bird

BERLIN Sat Nov 22, 2014 10:51am EST

Nov 22 (Reuters) - German authorities on Saturday confirmed a second case of the H5N8 strain of bird flu in the eastern state of Mecklenburg-Vorpommern, with the virus found in a wild bird.

The strain is highly contagious among birds but has never been detected in humans.

"For the first time, the H5N8 virus has been confirmed in a wild bird in Mecklenburg-Vorpommern," Agriculture Minister Christian Schmidt said in a statement.

(Continue . . .)

 

Japan, which saw a brief incursion of the H5N8 virus last April while South Korea was battling against multiple outbreaks (see Japan’s Avian Flu Outbreak Identified As H5N8 ), and which reported a little more than a week ago H5N8 In Migratory Bird Droppings, has now reported to the OIE another detection of H5N8 in Chiba prefecture.

 

According to a Japan News article earlier today (Bird flu detected in Chiba Prefecture), with this second detection, Japan will now raise its nationwide bird flu alert from 2 to 3, and dispatch an emergency wild bird survey team.

While none of this is absolute confirmation that the H5N8 virus arrived in Western Europe on the wings of migratory birds, when you combine these recent detections in birds, and the statement from the OIE: European H5N8 Strain `Closely Related’ To Korean Strain, the preponderance of evidence swings in that direction.

 

For more on this you may wish to revisit these recent related blogs:

FAO On The Potential Threat Of HPAI Spread Via Migratory Birds

Bird Flu Spread: The Flyway Or The Highway?

EID Journal: Subclinical HPAI In Vaccinated Poultry – China

Bird Flu Spread: The Flyway Or The Highway?

Major Global Migratory Flyways – Credit FAO

 

# 9303

 

The announcement last week that a highly pathogenic avian influenza, only previously seen in Eastern Asia, had turned up at a turkey farm thousands of miles away in central Europe (see Germany Reports H5N8 Outbreak in Turkeys), raises serious questions about how far this emergent virus has already spread in the wild, and elevates concerns over the spread of other novel influenza sub-types as well.

 

The H5N8 virus first made headlines 10 months ago, when on January 19th of this year we learned of an outbreak in South Korea.   Within weeks, dozens of farms across that country had been affected, and millions of birds were culled. (see South Korea: 30 Days Into Their H5N8 Outbreak).

 

The virus made a brief appearance in Japan in April, but forewarned authorities quickly quashed that outbreak.  Japan’s MAFF (Ministry of Agriculture, Forestry & Fisheries) maintains a large web portal where they follow this virus closely, knowing that migratory birds could easily deliver it back to their shores at any time.

 

The news thus far out of Germany is that no other farms in region have tested positive for the virus (see H5N8 virus: search for the origin).

 

While we don’t know the precise mechanism by which the virus arrived in Germany, migratory birds are viewed as as `highly plausible’ explanation (see UK: Defra Preliminary Assessment On Germany’s H5N8 Outbreak In Poultry).

 

The debate over the role of migratory birds in the spread of avian flu has been a contentious one, with bird enthusiasts pointing to the poorly managed poultry trade as being the root cause, while those in the poultry industry are often quick to blame migratory birds (see Study: The Role Of Migratory Birds In Spreading Bird Flu).

.

Since I don’t have a bird in this fight, I readily concede that both are probably significant contributing factors in the spread of the virus. I see no reason why they should be mutually exclusive.

 

The way that HPAI H5N1 virus spread out of South East Asia to Europe and the Middle East in the middle of the last decade certainly suggests that migratory birds played a major role in its dissemination. We’ve seen that some birds can carry avian influenza viruses without ill effect, and when they encounter other birds, can `share’ their viral cargo along their migratory flyway.

 

Where flyways overlap, there is a greater chance of spreading a virus from one region to another. And as you can see by the map above, they overlap a lot.

 

For the most of the past decade, we’ve basically had only one avian influenza virus to worry about; H5N1.  But a little less than two years ago another avian virus with a disturbing penchant for jumping to humans appeared in Eastern China – H7N9 – and that has sparked two seasonal epidemics.  

 

The second wave was notably 2.5 times bigger than the first, and a third wave is expected later this winter.

Credit BCCDC

 

Also of note, in the past few months, we’ve seen cases reported in the far western province of China – thousands of kilometers away from where it emerged. Not only does this raise questions regarding the provinces in-between that haven’t reported cases, it begs the question – how did it jump thousands of kilometers to Xinjiang Province?

 

Credit BCCDC

 

Tracking H7N9 in birds is considerably more difficult than H5N1 or even H5N8, as this H7 subtype doesn’t make birds sick at all –  it is a stealth virus.  But in humans, it is highly pathogenic. 

 

It is literally the first avian flu virus for which humans are the sentinel species.

 

Another recent arrival – H5N6 – appeared on our radar screen last April in Southern China, where it infected local poultry and killed one person (see Sichuan China: 1st Known Human Infection With H5N6 Avian Flu).  After a quiet summer, in August reports of the virus began to turn up as far south as Central Vietnam and as far north as China's Heilongjiang Province -  more than 2000 miles apart.

 

The latest FAO report (see China: H5 AI Rising) showed 24 detections of H5N6 over the past 6 weeks across thousands of miles of China.

Whether spread by migratory birds, or facilitated in their travels by commerce or trade – or most likely, as a combination of the two - these emerging avian viruses are moving inexorably westward, and are covering a lot of ground very quickly. 

 

All of which should have agricultural and public health interests in India, Pakistan, Kazakhstan, the Middle East, and Eastern Europe on alert for any signs of their arrival this fall and winter – and probably for years to come.

Germany Reports H5N8 Outbreak in Turkeys

 

# 9291

 

We’ve a surprising announcement overnight from German authorities that they’ve detected the recently emerged H5N8 virus at a turkey farm in the northern state of Mecklenburg-Vorpommern.   Although H5N8 is not currently known to infect humans, its emergence among European poultry could prove very costly to the poultry industry.

 

Detected avian influenza virus in Mecklenburg-Vorpommern: H5N8
A known previously only from Asia avian-type is now also occurred in Germany. The affected turkeys operating in Mecklenburg-Vorpommern has been banned, such as the Ministry of Agriculture in Schwerin said. Around 31 000 animals are killed, more are at risk

 

Last January, a highly pathogenic version of H5N8 avian influenza appeared for the first time in South Korea which proceeded to infect scores of farms, and resulted in the culling of more than 13 million birds (see South Korea: 30 Days Into Their H5N8 Outbreak).

 

In mid-April, the same strain showed up in Japan - presumably carried there by migratory birds – but was quickly quashed.  Other than that, last month we saw a report of H5N8 in Northern China.

 

Low path H5N8 had previously been seen in other parts of the world (see CIDRAP 2008 Low-pathogenic avian flu hits Idaho game farm), but only one detection of H5N8 in an HPAI form had previously been recorded back in 2009-10 (see Characterization of three H5N5 and one H5N8 highly pathogenic avian influenza viruses in China).

 

We’ll need to wait for further genetic analysis to find out just how closely this H5N8 matches the Asian strain. There are also are a lot of open questions regarding how the virus could suddenly show up in Northern Europe - 8,000 miles from where it first appeared just 10 months ago.

For now, authorities have imposed a 3km security zone around the affected poultry farm, are culling thousands of birds, and are expected to test neighboring poultry farms.  We’ve further details on the response from this RP Online report:

 

6. November 2014| 06.26 clock

H5N8 known only from Asia 2 0

Appeared dangerous avian influenza virus in Germany

<EXCERPT>

Therefore particularly dangerous - - The turkey is a highly pathogenic influenza virus subtype H5N8 has been detected by said spokesman Constantin Marquardt. "This so far only from Asia, especially South Korea, known subtype was thus first detected in poultry stock in Europe." Even in the wild bird population of subtype had not been previously detected.

Authorities any details to operate

As announced in the morning, around 31,000 affected animals are killed. "This is the first Glutnest of this virus and must be withdrawn quickly," district veterinary officer Holger Vogel said Thursday in Anklam news agency dpa.

Poultry shall within 50 kilometers no longer be kept out - and not in high-risk areas in Mecklenburg-Western Pomerania and the Baltic Sea coast and on inland lakes.

 

This morning the big question has to be whether this outbreak is the result of an unlucky chance meeting of an infected migratory bird with a flock of free range turkeys, or a sign of a much bigger incursion by the virus into Europe? 

 

Between 2006 and 2007, after years of watching H5N1 stay pretty much a Southeast Asian problem, that virus suddenly expanded its range, spreading into Europe and the Middle East at great cost to the poultry industry (see Germany Reports H5N1 In Wild Birds & Bavarian Farm Positive for High Path H5N1).

 

The H5N8 virus is just one of several newly arrived avian flu viruses of concern.  Last spring, the H5N6 virus also appeared in China – and has spread into Vietnam – infecting poultry and in at least one case,  infecting and killing a human (see FAO Warns on H5N6).

 

Like H5N6, the Korean H5N8 virus is a reassortant of the highly pathogenic H5N1 virus, which has sparked pandemic concerns globally for well over a decade.

 

Beyond the threat to agricultural interests and food security and the local economy, these viruses are all evolving and playing `mix and match’ with their genes,  and continue to produce new clades and subtypes.  Luckily, most of these will be evolutionary failures, and fail to thrive. 

 

A few will become a serious threat to poultry, while even fewer will pose a public health threat.

 

But its a numbers game.

 

The more rolls nature gets with the genetic dice – the greater the chances of rolling a natural.

Munich Hospital: NCoV Patient Dies

 

Photo Credit NIAID

# 7030

 

 

The Munich Municipal Hospital that was treating a novel coronavirus (NCoV) case recently transferred from the UAE (see Germany Reporting 17th NCoV Case), has posted the following announcement of his death.

 

 

With the novel coronavirus (HCoV-EMC) infected patient is tonight at its severe disease died

Munich 26, March 2013. The novel from an infection with the Beta coronavirus (HCoV-EMC) ill 73-year-old male from the United Arab Emirates (UAE), in the Schwabing Clinic in the medical Care was, tonight died of his serious illness.

 

The patient died one underlying circulatory shock in the infection and underlying serious medical conditions. "Due to an advanced stage, Infection with HCoV-EMC and septic disease was the forecast for the Patients unfortunately very unfavorable, so that the patient despite maximum intensive care could not be saved, "lamented Wendtner Professor, Head of the Department of Infectious Diseases at the Schwabing Hospital, the tragic course in this patient. The body of the patient in a timely manner his homeland are transferred. This is done in close coordination with the obert Koch Institute and the Department of Health and Environment (RGU).

 

Contact persons and relatives of the patients are still in tighter coordination between the hospital and the RGU and advise medically monitored.

 

Based on previous reporting by the World Health Organization, this should represent the 17th lab confirmed case of NCoV, and the 11th known death.  

As of this posting, there is no update on the WHO coronavirus site.

 

Germany Reporting 17th NCoV Case

 

Coronavirus – Credit CDC PHIL

 

# 7029

 

 

The eagle-eyed newshounds at FluTrackers this afternoon have picked up several German news stories indicating that a hospital there is treating another novel coronavirus case.

The FT thread with these stories (hat tips to Curiosity & Alert) may be accessed here.

 

(Note: FluTrackers has been the subject of repeated DOS – Denial of Service – attacks in recent weeks and has been intermittently down this afternoon.

 

 

In the meantime, the hospital in Munich has just posted the following announcement (h/t RoRo at FT).

 

Press release

Coronavirus in patients diagnosed

(25/03/2013) In a house the Municipal Hospital Munich GmbH is currently a patient treated, wherein the 23 March an infection has been diagnosed with the corona virus. The Patient came specially to transport to a medical intensive care in a specialized care Munich. The disease was the Department of Health and Environment on the same Days reported. Of the Arab region dating and living there is in man Hospital in strict isolation in a single room in the ICU treated. For Population was never a danger of contagion.

 

Worldwide, according to the current Knowledge, only 16 cases of coronavirus (novel human Betacoronavirus2c EMC/2012) occurred, while in Germany it is the second became known infection. In both cases, These it is imported cases of disease.

 

For the first time the virus was in June 2012 at a man from Saudi Arabia demonstrated.

Coronaviruses  cause respiratory infections in Respiratory to mammals and also in birds, ie, it is the primary or flu-like symptoms. According to current knowledge, from a very small Infectivity of human assumed to person. According to present knowledge goes The disease associated with pneumonia and can be transferred to other organs.

 

Especially in debilitated patients or people with pre-existing conditions one can severe course take. The contact persons and relatives of the patients are in Munich advised and monitored medically.

 

Perhaps the most detailed media report (machine translated) is available at TZ-Online :

50 Munich under observation

Eerie Death virus in Schwabing Clinic

Munich - In the Schwabing isolation ward doctors fight for the life of an Arab, who is ill with dangerous coronavirus. 50 Munich, who had contact with him are now being observed.

 

The virus appears not to be extremely contagious - but it is extremely deadly: Worldwide only 16 infections with the new coronavirus are known, nine patients died. Now a man in Munich is in danger! Health officials monitor about 50 people in the city, which had to do with the patient. For the population have no risk of infection existed.

(Continue . . . )

 

 

The story goes on to provide details on this case; a 73 year old man from the UAE who was treated at a hospital in Abu Dhabi last Tuesday, and was transferred by air ambulance to Germany last week.

On Saturday, lab results reportedly confirmed NCoV, after which the patient was placed in isolation, and contact tracking was begun on up to 50 people.

 

A second report, this time from Abendzeitung-muenchen.de,

 

Munich

Coronavirus killer virus in Munich: patient in hospital

Julia Lenders, 25.03.2013 17:32 clock

Hospital in the city infected is treated, has the dangerous Coronavirus - this is only the second time in Germany.

Munich - It's brand new. And highly dangerous. Last year, the "Human coronavirus Beta 2c EMC/2012" was first identified. It can cause severe human respiratory infection, pneumonia, and kidney failure. Existing diseases ran hard and often fatal.

 

Now Munich Municipal Hospital, a patient is treated, in which recent infection with the coronavirus been diagnosed. In Germany, it is only the second reported case.

(Continue . . .)

 

Once confirmed by the World Health Organization, this will become the 17th lab confirmed novel coronavirus case in the past year, and the second announced in the past 3 days.

Sunday Morning Avian Flu Roundup

Source WHO Influenza At The Human-Animal Interface

 

 

# 6945

 

Avian flu infections in humans, and outbreaks among poultry, generally reach their peak during the winter and spring months. This is a pattern we see nicely illustrated by the chart above.

 

So it is of little surprise that we have multiple reports of H5N1 and H7 avian flu activity from around the globe this weekend.

 

Rather than devote separate blogs to each of these reports, this morning we’ll roll them all up into one.

 

On Friday (Feb 15th), the World Health Organization  released their monthly H5N1 update, indicating 10 new human infections (Cambodia = 7, Egypt= 1, China = 2) since their last report on January 15th.

 

(EXCERPT)

 

Since 16 January, Cambodia reported seven new human cases with influenza A(H5N1) virus infection
including six fatal cases. These cases come from four provinces all located in southern Cambodia. These cases do not seem to be linked epidemiologically, and most had contact with sick poultry in the village.

Enhanced surveillance has been put in place and did not detect additional cases linked to these cases.
Current evidence does not support human-to-human transmission. It has been suggested that the A(H5N1) virus is endemic in poultry in Cambodia1, and that there is more poultry and human movement around   the Lunar New Year. As such, additional sporadic human cases might be expected.

 

Egypt has reported one new human case with influenza A(H5N1) virus infection in Behera Governorate. The A(H5N1) virus is also endemic in poultry in some areas of Egypt, and additional sporadic human cases are possible.

 

On 10 February 2013, China reported 2 new human cases of influenza A(H5N1) virus infection. Both
remain in critical condition. The cases come from the same province but do not seem to be
epidemiologically linked. Neither had documented contact with sick or dead poultry. Contact tracing and follow up is on-going but no additional cases have been identified. The last official report of A(H5N1) in poultry in mainland China was from Guangdong Province in September 2012

 

Since the return of H5N1 in 2003, there have been 620 lab confirmed human infections, of which 367 have proved fatal.

 

While these numbers suggest a mortality rate of 59%, the debate over the true number of cases, and the existence of `mild, undiagnosed’ infections, continues (see The Great CFR Divide).

 

This morning, some follow up stories, and reports of fresh outbreaks in poultry around the world. 

 

First stop, a report from China indicating that more than 100 close contacts of the two cases reported above have been released from quarantine after developing no sign of infection. 

 

110 released from bird flu quarantine

February 17, 2013

A total of 110 people who had close contact with two patients contracted avian influenza H5N1 in southwest China's Guizhou Province earlier this month have been released from quarantine, local health authorities announced on Sunday.

 

Two residents of the provincial capital of Guiyang were reported to have contracted the H5N1 virus on Feb. 8. The health authority put 110 people who had close contact with the two patients under quarantine, according to the provincial government's emergency response office.

 

They were released as no abnormal symptoms were discovered.

 

One patient, a 21-year-old woman, died of multiple organ failure on Wednesday. The other patient, a 31-year-old man, is still receiving medical treatment.

(Continue. . . )

 

Next stop Mexico, where authorities and poultry farmers have been engaged in a running battle with highly pathogenic H7N3 avian flu since early last summer (see Mexico Declares National H7N3 Animal Health Emergency).

 

While H7 is not considered as dangerous as H5N1, the OIE requires their notification (and containment steps taken) whenever H5 or H7 strains are identified because these strains have a history of evolving from LPAI into more pathogenic strains.

 

The original outbreak in Jalisco was quelled last fall (after culling 20 million birds), but the virus continues to pop up around the country (see Mexico: Fresh Outbreaks Of Avian H7N3).

 

This weekend, once again poultry farmers are faced with culling hundreds of thousands of birds, as reported from this New Zealand news story.

 

Mexican bird flu outbreak hits 582,000 chickens

 

Sat, 16 Feb 2013 2:30p.m.

 

Mexico's animal health agency says a bird flu outbreak at seven farms in central Mexico has affected as many as 582,000 chickens.

(Continue . . .)

 

Germany, too, is reporting an outbreak of avian flu in poultry, although there are conflicting reports on the test results. Assuming it is confirmed, this would make the first appearance of H5N1 in Germany in three years.

 

Bird flu found at German farm

February 16 2013 at 04:08pm 

Berlin - About 14 000 ducks at a German farm are being slaughtered following a bird flu outbreak.

 

(Continue . . . )

 

Along with these outbreaks, we continue to see reports of multiple outbreaks in poultry from countries where the virus is well entrenched, particularly Egypt, Indonesia, Nepal, and Bangladesh.

 

We are now a decade since the H5N1 virus reappeared in Vietnam, and subsequently spread out of Asia to parts of Europe and the Middle East. 

 

Despite many opportunities to do so, the virus has not managed to adapt well enough to humans to pose a pandemic threat.  Nevertheless, the potential for this status quo to change exists, and so the WHO provides this risk assessment:

 

Public health risk assessment of avian influenza A(H5N1) viruses:

Any time influenza viruses are circulating in poultry, sporadic infections or small clusters of human cases are possible especially in people exposed to infected poultry kept in households.

However, currently, this H5N1 virus does not appear to transmit easily among people and therefore the risk of community level spread of this virus remains low. Therefore, the public health risk associated with this virus remains unchanged.

ECDC: Lessons Learned On EHEC Outbreak

 

# 5677

 

 

At an informal health council meeting in Sopot, Poland over July 5th-6th, ECDC director Dr. Marc Sprenger delivered a speech on the lessons learned from the recent EHEC/STEC outbreak that began in Germany in mid-May.

 

The presentation was called "Outbreak of EHEC/STEC in Germany: Lessons Learned.", and the director cited the most obvious lesson as being `the EU is still vulnerable to epidemics’.

 

 

The entire presentation is available in the 2-page PDF file above, but a few excerpts include:

 

Lessons learned on how to further strengthen EU
cooperation against epidemics

Now for some lessons learned on how to further strengthen cooperation against epidemics

During this outbreak, it was very useful having an ECDC liaison officer embedded in the German outbreak investigation team – both for ECDC, and our German partners. It made information sharing much easier. ECDC is now developing some standard terms of reference for this liaison officer role, which we would like to agree with our national partners. If we can do this ahead of the next outbreak, then we can deploy a liaison officer even more quickly and efficiently. 

Let me leave you with my top four lessons learned on further strengthening our defences.

• Firstly, investment in microbiology is key. We need good labs in Europe to tackle outbreaks.

• Secondly, we should use temporary platforms to exchange clinical information during outbreaks.

• Thirdly, cross-sectoral cooperation is essential in all outbreaks, but particularly food borne outbreaks. Remember that “one voice” information to policy makers and citizens is key.

• Fourthly, remember that what looks like a local outbreak can quickly become an EU-wide event.

 

 

With remnants of the outbreak still underway, and many questions about the source and evolution of this virulent strain of E. Coli still unanswered, the final after-action report on this outbreak has yet to be written.

 

According to the latest ECDC figures (released July 6th), 50 people have died from this outbreak, and more than 4200 have been sickened.

 

 

Although the number of new cases continues to decline, there remain concerns that contaminated sprout seeds (believed to be behind this outbreak) may still be in the food pipeline.

 

The EFSA continues to advise to people: not to grow sprouts for their own consumption and not to eat sprouts or sprouted seeds unless they have been cooked thoroughly.

EFSA Task Force Report On E. Coli O104:H4

 

 

Photo Credit – ECDC 

 

# 5672

 

 

The European Food Safety Authority (EFSA) has released an updated task force report on the enterohaemorrhagic Escherichia coli (EHEC) outbreak that has affected more than 4000 people (including 47 fatal cases) across 13 nations in Europe since mid-May.

 

Although we’ve seen other E. Coli outbreaks in the past, this one is remarkable both for the total number of victims, and the virulence of this emerging 0104:H4 strain of E. Coli.

 

During the opening weeks of the outbreak suspicions regarding the source of the infection were cast in a variety of directions, causing serious economic harm to produce growers in Spain and elsewhere. 

 

Over the past two weeks, investigators have zeroed in on fenugreek seeds imported from Egypt as being the likely source of the E. Coli contamination.

 

Two links this morning, along with some excerpts from the EFSA’s press release and technical report.  Follow the links to read them in their entirety.

 

 

EFSA publishes report from its Task Force on the E. coli O104:H4 outbreaks in Germany and France in 2011 and makes further recommendations to protect consumers

Press Release
5 July 2011

The EFSA Task Force established to coordinate investigations to track down the possible source of the French and German outbreaks of E. coli O104:H4 has concluded that one lot of fenugreek seeds imported from Egypt and used to produce sprouts is the most likely common link between the two outbreaks.

 

However, it cannot be excluded that other lots of fenugreek imported from Egypt during the period 2009-2011 may be implicated. Based on these findings, EFSA recommends to the European Commission that all efforts be made to prevent any further consumer exposure to the suspect seeds and that forward tracing be carried out in all countries which may have received seeds from the concerned lots.

 

In this context, EFSA continues to advise consumers not to grow sprouts for their own consumption and not to eat sprouts or sprouted seeds unless they have been cooked thoroughly.

<SNIP>

 

The analysis of information from the French and German outbreaks leads to the conclusion that an imported lot of fenugreek seeds which was used to grow sprouts imported from Egypt by a German importer, is the most likely common link but other lots may be implicated. The report highlights that negative results from microbiological tests carried out on seeds cannot be interpreted as proof that a lot is not contaminated with STEC.

(Continue . . . )

 

Details on the trace back investigation that has led the EFSA to conclude that contaminated fenugreek seeds are behind this outbreak are contained in the technical document below.

 

The actual report is a 23-page PDF file.  The link below is to the summary.

 

 

 

Tracing seeds, in particular fenugreek (Trigonella foenum-graecum) seeds, in relation to the Shiga toxin-producing E. coli (STEC) O104:H4 2011 Outbreaks in Germany and France

Question number: EFSA-Q-2011-00817
Issued: 5 July 2011

Report (0.1 Mb)

Summary

On the 21^st of May 2011, Germany reported an ongoing outbreak of Shiga-toxin producing Escherichia coli- bacteria (STEC[1][2]), serotype O104:H4 (Frank et al., 2011). In Germany, between the 1^st of May and the 28^th of June 2011, 838 Haemolytic Uremic Syndrome (HUS) cases and 3 091 STEC cases with diarrhea have been reported, of which 47 persons have died (RKI, 2011).

 

On Friday the 24^th of June, France reported[3] a cluster of patients with bloody diarrhoea, after having participated in an event in the Commune of Bègles near Bordeaux on the 8th of June. As of 28 June, eight cases of bloody diarrhoea and a further eight cases with HUS have been identified. Eleven of these patients, seven women and four men, between 31 and 64 years of age, had attended the same event in Bègles. Infection with E. coli O104:H4 has been confirmed for four patients with HUS.

 

Six of the cases reported having eaten sprouts at the event on the 8^th of June, and leftovers are being analysed. Outbreak investigation revealed that the suspected sprouts of fenugreek, rocket and mustard had been privately produced in small quantities by the organiser of the event from seeds bought at an approved garden centre, and were not imported from the sprout producer implicated in the outbreak in Germany (INVS, 2011). An analytical epidemiological study is ongoing with the persons that attended the event on 8^th of June. Local trace back investigations in France suggested that the seeds for sprouting were distributed to the approved garden centre by a UK based company.

(Continue . . . )

 

After the row last week over the ECDC first printing, then removing the name of the (suspected) supplier of the contaminated seeds (see CIDRAP article), it is interesting to note that none of the links in the supply chain appear to be directly named in this report.

 

The bottom line is that while the number of new cases continues to decline, the potential exists for additional localized outbreaks as potentially contaminated seeds may still be in the pipeline.

 

From the report:

 

The number of Member States that have received parts of the suspected lots is much larger than previously known and it cannot be excluded that other Member States and third countries were supplied. The trace forward operation is becoming complex and widespread and may take weeks.

 

Hence the EFSA’s advise to people: not to grow sprouts for their own consumption and not to eat sprouts or sprouted seeds unless they have been cooked thoroughly.

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.

WHO: EHEC Update

 

# 5654

 

 

From the World Health Organization this morning, an update on the EHEC (E. Coli) in Germany, and a few details on the similar outbreak now reported in Bordeaux, France.

 

The good news is that the number of new cases has declined significantly over the past couple of weeks in the German outbreak, and so far, the outbreak in France has been limited to just 8 cases.

 

 

 

EHEC outbreaks: Update 24, France reports 8 cases in new outbreak

27-06-2011

Since week 23/2011, the number of reported cases of haemolytic uraemic syndrome (HUS) enterohaemorrhagic Escherichia coli (EHEC) has declined significantly. In Germany, the daily numbers of reported cases have steadily decreased since they peaked on 22 May. Nevertheless, the cumulative numbers of cases from Germany continue to rise, primarily owing to delays in notification.

 

Investigations by the German authorities indicate that the vehicle of the bacterium responsible for the outbreak, enteroaggregative verocytotoxin-producing E. coli (EAggEC VTEC) O104:H4, is bean and seed sprouts, and the Robert Koch Institute has warned people in Germany not to eat raw sprouts of any origin.

 

On 24 June, France reported an outbreak of verocytotoxin-producing E. coli (VTEC)/HUS with 8 cases in adults (6 women and 2 men). E. coli O104:H4 has been confirmed in 3 cases. Investigations are ongoing, but the first findings suggest that locally grown sprouts might be involved. Intensive traceback is under way to identify a possible common source of the German and French sprout seeds. Other potential vehicles are also under investigation.

 

The table shows the reported cases of and deaths from HUS and EHEC infection as of 24 June at 15:00 CET. It does not include the 8 cases reported by France on 24 June, as these are considered a separate outbreak.

 

In Germany, the latest date of onset of diarrhoea is 22 June for HUS cases and 20 June for EHEC cases. All but 5 of the above HUS and EHEC cases were in people who had travelled to or lived in Germany during the incubation period for infection, typically 3–4 days after exposure (range: 2–10 days). The remaining 5 cases can also be linked to the outbreak in Germany.

Note

EHEC and HUS have exclusive notification categories, so case numbers should not overlap. The figures in any rapidly evolving outbreak, however, are provisional and subject to change for a variety of reasons.

 

In providing the above information, WHO wishes to recognize the contribution of its Member States, and technical partners such as the European Commission, the European Centre for Disease Prevention and Control and a number of WHO collaborating centres.

UK: Updated Sprout Safety Statement

 

 

# 5651

 

Even as the sprout-linked  EHEC outbreak in Germany drags on, a new (and similar) outbreak has been reported in Bordeaux, France - with seven people hospitalized.

 

This report from Deutsche Presse-Agentur.

 

French E coli outbreak likened to deadly German drama

Jun 26, 2011, 10:05 GMT

Paris - This week's outbreak of E Coli in the south-western French city of Bordeaux bears the hallmarks of the outbreak that claimed dozens of lives in Germany, French media reports said Sunday.

(Continue . . . )

 

 

As a possible link to a UK supplier of sprout seeds has been mentioned (but not confirmed), the UK’s Food Standards Agency has issued a revised safety statement on the preparing and handling of sprout seeds.

 

 

Updated sprouted beans statement

Saturday 25 June 2011

Following further cases of E. coli in France, the Food Standards Agency is revising its guidance on the consumption of sprouted seeds such as alfalfa, mung beans (usually known as beansprouts) and fenugreek.

 

As a precaution, the Agency is advising that sprouted seeds should only be eaten if they have been cooked thoroughly until steaming hot throughout; they should not be eaten raw.

 

The investigations into the outbreak of E. coli in France have suggested a possible link to sprouting seeds from a company based in the UK. To date, no cases of food poisoning have been reported in the UK linked to the outbreak in France. We are in close contact with the Health Protection Agency who is actively monitoring the situation.

 

The Agency also advises that equipment which has been used for sprouting seeds should be cleaned thoroughly after use. You should always wash your hands after handling seeds intended for planting or sprouting.

Referral: McKenna On E. Coli

 

 

 

# 5649

 

This week we’ve seen a number of new journal articles on Germany’s EHEC outbreak, appearing in The Lancet , Eurosurveillance Journal, and the NEJM.

 

Maryn McKenna gives us an excellent walk-thru of their findings this morning in her SUPERBUG BLOG post:

 

E. coli: Some Answers, Many Questions Still

• By Maryn McKenna
• June 24, 2011  | 

 

Highly Recommended.

 

And for a terrific (ongoing) multi-part series on HUS (Hemolytic Uremic Syndrome) – a devastating complication in some toxic E. Coli infections - I would refer you to Tara C. Smith’s Aetiology Blog.

ECDC: EHEC/STEC Update June 13th

 

 

# 5625

 

Although German authorities are hopeful that the peak of the EHEC or Shiga-Toxin Producing E. Coli outbreak has now passed, the latest ECDC update reports one new fatality since yesterday, and nearly 70 new cases.

 

 

Outbreak of Shiga toxin-producing E. coli in Germany (13 June, 11:00)

13 Jun 2011

 

With an incubation period of up to 2-weeks, it is considered likely that more cases (and perhaps more deaths) will be reported before this outbreak completely burns itself out.

 

Meanwhile, Spiegel Online is reporting that as many as 100 people who developed the life-threatening complication called HUS (Hemolytic Uremic Syndrome) experienced severe enough kidney damage to either need life-long dialysis or a kidney transplant.

 

06/13/2011

Long-Term Impact of E. Coli Outbreak

Expert Warns 100 Patients Will Need New Kidneys or Dialysis

 

 

While the source of the infection has been traced to a specific sprout farm in lower Saxony, exactly how their sprouts came to be contaminated has not been established.    

 

Health authorities warn that sprout seeds may harbor the bacteria, which reproduce rapidly during the sprouting process, and warn that home growers should not consume their produce raw.

 

E.coli warnings over bean sprout seeds