CDC: Contact Of Indiana MERS Case Tests Positive For The Virus

Coronavirus – Credit CDC PHIL

 

# 8635

 

The CDC is about to start a hastily called press conference, which I am listening in on - and we should have some more details shortly - but for the time being we have a press release (embargoed till 3:30pm EST) providing the gist of today’s announcement.

The contact is reportedly well, and has seroconverted – developed antibodies to the virus – indicating prior infection.

 

Documentation of secondary transmission outside of the Middle East has been rare, but with better (and more extensive )testing being done on contacts of the recent US cases, we should learn a good deal more about how this virus transmits between people.

 

 

Embargoed until 3:30 p.m. ET                                           

Saturday, May 17, 2014

Illinois resident who had contact with Indiana MERS patient tests positive for MERS coronavirus

Ongoing investigation of the first imported case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection in the United States has identified evidence of apparent past MERS-CoV infection in an Illinois man who had close contact with the Indiana MERS patient.  The Illinois resident did not seek or require medical care. However, local health officials have monitored his health daily since May 3 as part of the investigation. At this time, the Illinois resident is reported to be feeling well. 

The previously reported Indiana MERS patient is a U.S. resident who had traveled from Saudi Arabia and was admitted to an Indiana hospital on April 28; the patient was confirmed to have MERS on May 2, and has since been released from the hospital. 

For the Illinois resident, laboratory test results showing apparent past MERS-CoV infection were reported late night on May 16. CDC officials explained that these laboratory test results are preliminary and suggest that the Illinois resident probably got the virus from the Indiana patient and the person’s body developed antibodies to fight the virus.  There are two main ways to determine if a person is or has been infected with MERS-CoV. We can collect a respiratory sample and use a test called PCR to determine if a person has active infection with the virus. Or we can do a blood test that looks for antibodies to MERS-CoV that would indicate a person had previously been infected with MERS-CoV.

“This latest development does not change CDC’s current recommendations to prevent the spread of MERS,” said David Swerdlow, M.D., who is leading CDC’s MERS-CoV response. “It’s possible that as the investigation continues others may also test positive for MERS-CoV infection but not get sick.  Along with state and local health experts, CDC will investigate those initial cases and if new information is learned that requires us to change our prevention recommendations, we can do so.”  

The Illinois resident has no recent history of travel outside the United States. He met with the Indiana patient on two occasions shortly before the patient was identified as having MERS-CoV infection.  As part of the MERS follow-up investigation, the local health department in Illinois contacted the Illinois resident on May 3. The health department first tested this person for active MERS-CoV infection on May 5. Those test results were negative. Public health officials are collecting blood samples from people who were identified as close contacts of the Indiana patient. On May 16, the test result was positive for the Illinois resident, showing that he has antibodies to MERS-CoV.

Reports of the first two confirmed imported cases of MERS in the United States – the first in Indiana on May 2, and the second in Florida on May 11 – have resulted in large-scale multistate investigations and responses aimed at minimizing the risk of spread of the virus.  As part of this effort, public health officials are reaching out to healthcare professionals, family members, and others who had close contact with the patients to provide guidance about monitoring their health and recommendations about when to see a healthcare provider for an evaluation. Public health officials also are working with airlines to identify and notify U.S. travelers who may have been exposed to the patient on any of the flights.  Efforts are now under way to identify, notify, test, and monitor close contacts of the Illinois resident.

All reported cases of MERS have been linked to countries in and near the Arabian Peninsula. In some instances, the virus has spread from person to person through close contact. However, there is currently no evidence of sustained spread of MERS-CoV in community settings.

At this time, CDC’s recommendations to the public, travelers, and healthcare providers have not changed on the basis of this new information.

• For the general public: While experts do not yet know exactly how this virus is spread, CDC routinely advises that people help protect themselves from respiratory illnesses by taking everyday preventive actions like washing their hands often; avoiding touching their face with unwashed hands; avoiding contact with people who appear sick; and disinfecting frequently touched surfaces.
• For travelers: CDC currently does not recommend that anyone change their travel plans.  If you are traveling to countries in or near the Arabian Peninsula, CDC recommends that you pay attention to your health during and after your trip.  The CDC travel notice for MERS-CoV was upgraded to a level 2 alert. The travel notice advises people traveling to the Arabian Peninsula for health care work to follow CDC’s recommendations for infection control, and other travelers to the Arabian Peninsula to take general steps to protect their health.
• Healthcare professionals should evaluate patients for MERS-CoV infection who have

• (A) fever and pneumonia or acute respiratory distress syndrome, and either

• a history of travel from countries in or near the Arabian Peninsula within 14 days before symptom onset, or
• have had close contact with a symptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in or near the Arabian Peninsula, or
• are part of a cluster of patients with severe acute respiratory illness of unknown etiology in which MERS-CoV is being evaluated;

• (B) or anyone who has had close contact with a confirmed or probable case of MERS while the person was ill, in consultation with state and local health departments. 

Background
Middle East Respiratory Syndrome Coronavirus is a virus that is new to humans and was first reported in Saudi Arabia in 2012. As of May 16, there have been 572 laboratory-confirmed cases of MERS in 15 countries. Most of these people developed severe acute respiratory illness, with fever, cough, and shortness of breath; 173 people died. Officials do not know where the virus came from or exactly how it spreads. There is no available vaccine or specific treatment recommended for the virus.

For more information about MERS-CoV, please visit:

• Middle East Respiratory Syndrome: http://www.cdc.gov/coronavirus/mers/index.html
• Frequently Asked MERS Questions and Answers:   http://www.cdc.gov/coronavirus/mers/faq.html

• Indiana State Department of Health:  http://www.state.in.us/isdh/
• Illinois Department of Public Health:  http://www.idph.state.il.us/

CDC Press Conference Today: 2nd MERS Case Imported To US

Coronavirus – Credit CDC PHIL

 

# 8609

 

The CDC has informed the media that they will hold a press conference at 2pm this afternoon to announce the 2nd imported MERS case to the United States .

I’ll have updates and details as they become available.

 

 

 

CDC announces second imported case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection in the United States

Date: May 12, 2014 11:22 AM
Media Advisory

For Immediate Release

Monday, May 12, 2014
Contact: CDC Media Relations
(404) 639-3286

CDC announces second imported case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection in the United States

WHAT: CDC and Florida Department of Health officials are investigating the second case of MERS-CoV infection in the United States. MERS-CoV, a virus relatively new to humans, was first reported in Saudi Arabia in 2012. On May 2, 2014 CDC reported the first case of MERS in the United States.

WHO: Tom Frieden, M.D., M.P.H., Director, U.S. Centers for Disease Control and Prevention
Anne Schuchat, M.D. (RADM, USPHS) Assistant Surgeon General, United States Public Health Service; Director, National Center for Immunization and Respiratory Diseases
John H. Armstrong, MD, FACS, FCCP
Florida’s State Surgeon General and Secretary of Health

Updates From The United States Embassy In Japan

 

 

 

# 5410

 

When Americans are living or travelling abroad, U.S. Embassies, Consulates, and Diplomatic Missions are often the best source of information for our citizens.

 

As you might imagine, in the wake of the Tohoku Earthquake, Tsunami, and ongoing nuclear crisis in Japan, our Embassy in Tokyo is extremely busy.

 

Today, March 17th, has seen the issuance of several statements, including a travel warning to U.S. citizens  that states:

The State Department strongly urges U.S. citizens to defer travel to Japan at this time and those in Japan should consider departing. 

 

Below you’ll find limited excerpts, follow the link to read the warning in its entirety.

 

 

Travel Warning

• The U.S. Department of State warns U.S citizens of the deteriorating situation at the Fukushima Daiichi Nuclear Power Plant. The United States Nuclear Regulatory Commission (NRC) recommends that U.S. citizens who live within 50 miles (80 km) of the Fukushima Daiichi Nuclear Power Plant evacuate the area or take shelter indoors if safe evacuation is not practical. The State Department strongly urges U.S. citizens to defer travel to Japan at this time and those in Japan should consider departing. On March 16, 2011, the Department of State authorized the voluntary departure from Japan of eligible family members of U.S. government personnel in Tokyo, Nagoya, and Yokohama. This Travel Warning replaces the Travel Alert dated March 13, 2011.
• In response to the deteriorating situation at the Fukushima Daiichi Nuclear Power Plant, the United States Nuclear Regulatory Commission (NRC), the Department of Energy, and other technical experts in the U.S. Government have reviewed the scientific and technical information they have collected from assets in country, as well as what the Government of Japan has disseminated. Consistent with the NRC guidelines that would apply to such a situation in the United States, we are recommending, as a precaution, that U.S. citizens who live within 50 miles (80 km) of the Fukushima Daiichi Nuclear Power Plant evacuate the area or to take shelter indoors if safe evacuation is not practical.
• <SNIP>
• As a result of this assessment, the State Department has authorized the voluntary departure from Japan of eligible family members of U.S. government personnel assigned to the U.S. Embassy in Tokyo, the U.S. Consulate in Nagoya, and the Foreign Service Institute Field School in Yokohama. U.S. citizens should defer all travel to the evacuation zone around Fukushima Daiichi Nuclear Power Plant, areas affected by the earthquake and tsunami and tourism and non-essential travel to the rest of Japan at this time.
• <SNIP>
• Hardships caused by the March 11 earthquake and tsunami continue to cause severe difficulties for people in the areas affected by the disaster. Temporary shortages of water and food supplies may occur in affected areas of Japan due to power and transportation disruptions. Telephone services have also been disrupted in affected areas; where possible, you may be able to contact family members using text message or social media such as Facebook or Twitter.
• (Continue . . . )

 

 

Other updates from the Embassy today include:

 

• On-the-Record Briefing with Under Secretary of State Kennedy, Deputy Secretary of Energy Poneman - March 17 at 4 p.m.

• Travel to Safehaven Locations in Asia - March 17 at 3 p.m.

• A Message to American Citizens from Ambassador John V. Roos - March 17 at 4 a.m.

North America Influenza Surveillance - Week 4

 

 

 

# 5290

 

While the flu season appears to have peaked in Canada, the numbers in the United States continue to climb in the latest surveillance reports.

 

We’ve also fresh report in this week’s MMWR and CDC FluView  on another novel H3N2 swine flu virus detection in Pennsylvania dating back to last September.

 

As you will recall, last year the US saw 4 other cases, and last month China reported a case as well (see China: Single Novel Swine Flu Infection Reported).

 

First some details on this latest novel virus detection, then a brief look at the latest surveillance numbers from Canada and the United States.

 

The following comes from this week’s FluView report. I’ve bolded some of the highlights.

 

 

Novel Influenza A Virus:

One case of human infection with a novel influenza A virus was reported by the Pennsylvania Department of Health. The patient was infected with a swine origin influenza A (H3N2) virus. The patient reported contact with pigs in the week preceding symptom onset on September 6, 2010, did not require hospitalization, and has since fully recovered.

Initial testing of the specimen indicated a seasonal influenza A (H3N2) virus and the specimen was submitted to CDC as a routine surveillance sample. The delay from onset to detection occurred because attempts to culture the virus were unsuccessful. RT-PCR testing confirmed swine-origin influenza A (H3N2). Six other human infections with swine origin influenza A (H3N2) viruses have been identified in the United States during 2009 through 2010, including one other case from Pennsylvania in week 44 of 2010.

 

No epidemiologic links between this case and any of the other cases of swine-origin H3N2 infection have been identified and the viruses from all seven cases have genetic differences indicating different sources of infection.

 

There is no evidence of human-to-human transmission with this virus; however, early identification and investigation of all human infections with novel influenza A viruses is critical to evaluate the extent of the outbreak and possible human-to-human transmission. Surveillance for human infections with novel influenza A viruses continues year round.

 

For more on the potential threats posed by novel swine viruses, you wish to revisit my recent blog The (Swine) Influenza Reassortment Puzzle.

 

Moving on to Canada’s FluWatch report:

 

Summary of FluWatch Findings for the Week ending January 29, 2011

• Overall influenza detections appear to have peaked, with most regions across the country continuing to show a decline in the percentage of positive influenza detections, with the exception of the Atlantic provinces. Other indicators of influenza activity have either decreased or remained similar to the previous week.
• Since the beginning of the season, 88.9% of the subtyped positive influenza A specimens were influenza A/H3N2.In week 04, detections of pandemic H1N1 2009 decreased slightly as a proportion of subtyped influenza A specimens, while influenza B virus detections increased slightly. The proportion of positive tests for RSV continued to increase.

• 

 

Moving on to the United States FluView report:

 

010-2011 Influenza Season Week 4 ending January 29, 2011

.

Synopsis:

During week 4 (January 23-29, 2011), influenza activity in the United States increased.

• Of the 6,209 specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division, 2,044 (32.9%) were positive for influenza.
• One human infection with a novel influenza A virus was reported.
• The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
• Six influenza-associated pediatric deaths were reported. Four of these deaths were associated with influenza B viruses, one of these deaths was associated with an influenza A (H3) virus, and one was associated with a 2009 influenza A (H1N1) virus.
• The proportion of outpatient visits for influenza-like illness (ILI) was 4.0%, which is above the national baseline of 2.5%. Seven of the 10 regions (Regions 1, 2, 3, 4, 5, 6, and 7) reported ILI at or above region-specific baseline levels. Seventeen states experienced high ILI activity; three states experienced
• moderate ILI activity; New York City and 10 states experienced low ILI activity; the District of Columbia and 19 states experienced minimal ILI activity, and one state had insufficient data.
• The geographic spread of influenza in 30 states was reported as widespread; 15 states reported regional influenza activity; the District of Columbia and one state reported local influenza activity; Puerto Rico, the U.S. Virgin Islands, and four states reported sporadic influenza activity, and Guam reported no influenza activity.

Pneumonia and Influenza (P&I) Mortality Surveillance

During week 4, 8.5% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 7.9% for week 4.

Outpatient Illness Surveillance:

Nationwide during week 4, 4.0% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is above the national baseline of 2.5%.

US: Turkey Farm Reports H1N1

# 4104

 

 

 

It was only last month that that a study in Eurosurveilance sought to reassure us that Turkeys weren’t particularly susceptible to the H1N1 virus.   

 

Below is just an excerpt.

 

Eurosurveillance, Volume 14, Issue 41, 15 October 2009

Rapid communications

Resistance of turkeys to experimental infection with an early 2009 Italian human influenza A(H1N1)v virus isolate

C Terregino¹, R De Nardi¹, R Nisi¹, F Cilloni¹, A Salviato¹, M Fasolato¹, I Capua ()¹

 

Our findings suggest that in its present form, the pandemic H1N1 influenza virus is not likely to be transmitted to meat turkeys and does therefore not represent an animal health or food safety issue for this species.

 

 

Despite this study (which has an excellent pedigree in Ilaria Capuam, noted virologist for the OIE/FAO in Italy), over the past few months we’ve had reports of infected turkeys in Chile (see FAO: Concerns Novel H1N1 May Spread In Poultry  and   Chile: H1N1 Jumps To Turkeys) and Canada  (see Update On Ontario H1N1 Infected Turkeys).

 

Now, a US turkey farm in the the state of Virginia is reporting an H1N1 infection in a flock.   A hat tip goes to Indigo Girl on Allnurses pandemic forum and celvin11 on FluTrackers for the link.

 

This report from Reuters. 

 

U.S. finds pandemic H1N1 virus in turkey flock

 

Mon Nov 30, 2009 5:53pm EST

WASHINGTON (Reuters) - The pandemic H1N1 flu virus was confirmed in a flock of breeder turkeys in Virginia -- the first U.S. case involving turkeys, the U.S. Agriculture Department said on Monday.

 

The virus also has been found in hogs, three house cats, pet ferrets and a cheetah in California. USDA said infections of turkeys have been reported in Canada and Chile.

 

"This is the first detection of 2009 pandemic H1N1 influenza in turkeys in the United States," said a USDA spokesperson.

(Continue . . . )

 

We’ve chronicled a number of species jumps involving the H1N1 virus, and the Reveres at Effect Measure took on the subject of promiscuous flu viruses in their blog today  (see Dogs, cats and swine flu's promiscuity).

 

I confess I’m unaware of the `cheetah story’ alluded to in the above story, and a quick Google search didn’t turn up anything. 

 

We will no doubt be reminded by the USDA that these infections pose no food safety issues, but the ultimate threat of an ever widening host range for the H1N1 virus is less clear. 

There are a couple of trains of thought here.  

 

One is that when the virus broadens its host range, it has more opportunities to mutate or to reassort with other viruses. 

 

One might, after all, reasonably expect that the H1N1 virus has a better chance to meet up and reassort with an H5 or H7 avian virus in a turkey, than in a human host. 

 

There is another theory, however, that states that viruses don’t tend to mutate as long as they have a large number of susceptible hosts.

 

Virologist John Oxford has suggested that mutations in the H1N1 virus are less likely to occur until a certain amount of herd immunity is achieved. There have been studies that indicate that vaccination pressure may actually drive antigenic drift in flu viruses.

 

Avian influenza: genetic evolution under vaccination pressure

Magdalena Escorcia, Lourdes Vázquez, Sara T Méndez, Andrea Rodríguez-Ropón, Eduardo Lucio and Gerardo M Nava

Virology Journal 2008, 5:15doi:10.1186/1743-422X-5-15

 

As a population gains herd immunity (through vaccines or exposure), the virus must either evolve (mutate) away from the established immunity or die off for a lack of suitable hosts.

 

But, if the virus has a wider host range (say humans, pigs, and birds), or a ready natural reservoir, then there is less evolutionary pressure on it to mutate.  

 

Of course this second theory doesn’t help much with relatively rare, but major antigenic shifts (reassortments), but deals mostly with the far more common antigenic drift (minor mutations).

 

Which theory is correct?

 

It’s entirely possible that both are correct, as they are not mutually exclusive. 

 

As to what happens with this promiscuous pandemic H1N1 virus? 

 

That’s the $64 question, and no one has a good answer yet. 

 

Stay tuned.