Coronavirus – Credit CDC PHIL
# 7221
Maryn McKenna, writing on her Superbug Blog this evening, takes a hard look at the delays in reporting, and absence of details, in Saudi Arabia’s announcement today of 7 new novel coronavirus cases (see hCoV-EMC: Saudi Arabia Reports 7 Cases, 5 Fatal).
Since Maryn needs no prefacing from me, I’ll simply invite you to follow the link and read:
New Diseases And National Transparency: Who Is Measuring Up?
- By Maryn McKenna
- 05.02.13
- 6:33 PM
Photo Credit NIAID
# 7220
It’s been roughly 12 hours since the news of 7 new nCoV (aka hCoV-EMC) coronavirus cases in Saudi Arabia broke (see hCoV-EMC: Saudi Arabia Reports 7 Cases, 5 Fatal).
The World Health Organization has recently posted an update on their Global Alert & Response page, and its glaring lack of detail reinforces how difficult it has been to get information out of Saudi Arabia on these cases over the past year.
We have no onset dates, ages, epidemiological links, or anything else of value beyond the case count and the fact that these patients are `not from the same family’ and none had history of recent travel of exposure to farm animals.
As noted in the past, the WHO is pretty much reliant upon the thoroughness and cooperation of each member state’s Health Ministry to gather and dispense outbreak information.
Hopefully KSA’s MOH will release more detailed information, and that they do it sooner rather than later.
Novel coronavirus infection - update
2 May 2013 - The Ministry of Health in Saudi Arabia has informed WHO of seven new laboratory confirmed cases of infection with the novel coronavirus (nCoV), including five deaths.
Two patients are currently in critical condition.
The government is conducting ongoing investigation into this outbreak.
Preliminary investigation show no indication of recent travel or animal contact of any of the confirmed cases. The confirmed cases are not from the same family.
From September 2012 to date, WHO has been informed of a global total of 24 laboratory confirmed cases of human infection with nCoV, including 16 deaths.
Based on the current situation and available information, WHO encourages all Member States (MS) to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns. WHO is currently working with international experts and countries where cases have been reported to assess the situation and review recommendations for surveillance and monitoring.
All MS are reminded to promptly assess and notify WHO of any new case of infection with nCoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course.
WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied.
WHO continues to closely monitor the situation.
BSL-4 Lab Worker - Photo Credit –USAMRIID
# 7219
Ed Yong, writing for Nature News, has the details on a new H5N1 study that – like the Fouchier and Kawaoka studies from 2012 – involved the creation of a more transmissible bird flu virus.
A voluntary moratorium on`gain of function’ studies – those seeking to enhance the transmissibility and/or virulence of the H5N1 virus – went into effect in January of 2012 after biosecurity concerns were raised by a number of experts. (see Scientists Announced a 60 Day Moratorium On Some Types of H5N1 Research).
Objections were raised initially after the 2011 ESWI Influenza Conference in Malta, where Dutch researcher Ron Fouchier revealed that he’d created a more `transmissible’ form of the H5N1 virus (see Debra MacKenzie’s New Scientist: Five Easy Mutations).
That discovery, along with similar news coming from Yoshihiro Kawaoka, a highly respected virologist at the University of Wisconsin-Madison School of Veterinary Medicine, set alarm bells ringing in the biosecurity community.
The voluntary moratorium was later extended beyond two months to give time for international debate, and the formulation of safety rules.
The research papers by Fouchier and Kawaoka on the genetic changes needed to provide H5N1 with enhanced transmissibility have now been published, and the moratorium was lifted earlier this year.
As the following 3 minute NIAID Video explains, pandemic viruses can emerge when two (or more) flu viruses swap genetic material and create a new, hybrid strain.
The stated goal of these controversial experiments is to figure out in the lab which reassortments are likely to produce a human transmissible strain, before nature figures it out in the wild.
Today the Journal Science has published a new study where researchers in China reassorted the genes from the H5N1 and 2009 H1N1 flu viruses, creating 127 new `hybrids’.
Of these, five showed an increased ability to transmit between guinea pigs, suggesting that they would transmit well among humans as well.
Lead author Professor Chen Hualan of the Harbin Veterinary Research Institute has been heavily involved over the past few weeks into the investigation of the H7N9 outbreak (see Study: Source Identification Of H7N9), and was the author of an EID Journal study from 2001 on H5N1 in wild birds (see EID Journal: H5N1 Branching Out).
First a link to the paper and abstract, then a jump to Ed Yong’s article.
H5N1 Hybrid Viruses Bearing 2009/H1N1 Virus Genes Transmit in Guinea Pigs by Respiratory Droplet
Ying Zhang,Qianyi Zhang, Huihui Kong, Yongping Jiang, Yuwei Gao, Guohua Deng, Jianzhong Shi, Guobin Tian, Liling Liu, Jinxiong Liu, Yuntao Guan, Zhigao Bu, Hualan Chen
Nature | News
Scientists create hybrid flu that can go airborne
H5N1 virus with genes from H1N1 can spread through the air between mammals.
02 May 2013
As the world is transfixed by a new H7N9 bird flu virus spreading through China, a study reminds us that a different avian influenza — H5N1 — still poses a pandemic threat.
A team of scientists in China has created hybrid viruses by mixing genes from H5N1 and the H1N1 strain behind the 2009 swine flu pandemic, and showed that some of the hybrids can spread through the air between guinea pigs. The results are published in Science1.
Despite the lifting of the research moratorium, these types of experiments are still viewed as controversial – and potentially dangerous - by a number of experts.
For more on this debate, you may wish to revisit:
The Furor Over H5N1 Research Continues
The Biosecurity Debate On H5N1 Research
Referral: Laurie Garrett On The Bird Flu Research Controversy
The Bird Flu Research Debate Continues
FIGURE 1. Location of confirmed cases of human infection (n = 126) with avian influenza A(H7N9) virus and deaths (n = 24) — China, February 19–April 29, 2013
# 7218
Playing a little catch-up after having been away from my desk for much of yesterday, we’ve an Early Release MMWR on the avian H7N8 virus outbreak in China.
It’s a fairly lengthy report, so I’ll just include a few excerpts (reparagraphed for readability) and invite you to follow the link to read it in its entirety.
Emergence of Avian Influenza A(H7N9) Virus Causing Severe Human Illness — China, February–April 2013
Early Release
May 1, 2013 / 62(Early Release);1-6On March 29, 2013, the Chinese Center for Disease Control and Prevention completed laboratory confirmation of three human infections with an avian influenza A(H7N9) virus not previously reported in humans (1). These infections were reported to the World Health Organization (WHO) on March 31, 2013, in accordance with International Health Regulations.
The cases involved two adults in Shanghai and one in Anhui Province. All three patients had severe pneumonia, developed acute respiratory distress syndrome (ARDS), and died from their illness (2). The cases were not epidemiologically linked. The detection of these cases initiated a cascade of activities in China, including diagnostic test development, enhanced surveillance for new cases, and investigations to identify the source(s) of infection.
No evidence of sustained human-to-human transmission has been found, and no human cases of H7N9 virus infection have been detected outside China, including the United States. This report summarizes recent findings and recommendations for preparing and responding to potential H7N9 cases in the United States. Clinicians should consider the diagnosis of avian influenza A(H7N9) virus infection in persons with acute respiratory illness and relevant exposure history and should contact their state health departments regarding specimen collection and facilitation of confirmatory testing.
Epidemiologic Investigation
As of April 29, 2013, China had reported 126 confirmed H7N9 infections in humans, among whom 24 (19%) died (1). Cases have been confirmed in eight contiguous provinces in eastern China (Anhui, Fujian, Henan, Hunan, Jiangsu, Jiangxi, Shandong, and Zhejiang), two municipalities (Beijing and Shanghai), and Taiwan (Figure 1). Illness onset of confirmed cases occurred during February 19–April 29 (Figure 2). The source of the human infections remains under investigation.
Almost all confirmed cases have been sporadic, with no epidemiologic link to other human cases, and are presumed to have resulted from exposure to infected birds (3,4). Among 82 confirmed cases for which exposure information is available, 63 (77%) involved reported exposure to live animals, primarily chickens (76%) and ducks (20%) (3). However, at least three family clusters of two or three confirmed cases have been reported where limited human-to-human transmission might have occurred (3).
The MMWR summarizes their findings thusly:
What is already known on this topic?
Human infections with a new avian influenza A(H7N9) virus were first reported to the World Health Organization on March 31, 2013. Available information suggests that poultry is the source of infection in most cases. Although no evidence of sustained (ongoing) human-to-human spread of this virus has been identified; small family clusters have occurred where human-to-human spread cannot be conclusively ruled out.
What is added by this report?
By April 29, a total of 126 H7N9 human infections (including 24 deaths) had been confirmed. Although a number of travelers returning to the United States from affected areas of China have developed influenza-like symptoms and been tested for H7N9 infection, no cases have been detected in the United States. Laboratory and epidemiologic evidence suggest that this H7N9 virus is more easily transmitted from birds to humans than other avian influenza viruses. Candidate vaccine viruses are being evaluated and human clinical vaccine trials are forthcoming, but no decision has been made regarding a U.S. H7N9 vaccination program.
What are the implications for public health practice?
State and local health authorities are encouraged to review pandemic influenza preparedness plans to ensure response readiness. Clinicians in the United States should consider H7N9 virus infection in recent travelers from China who exhibit signs and symptoms consistent with influenza. Patients with H7N9 virus infection (laboratory-confirmed, probable, or under investigation) should receive antiviral treatment with oral oseltamivir or inhaled zanamivir as early as possible.
The entire release is well worthreading, but I'll call particular attention to the conclusions presented at the end the Editorial notes section, pertaining to preparedness.
Given the number and severity of human H7N9 illnesses in China, CDC and its partners are taking steps to develop a H7N9 candidate vaccine virus. Past serologic studies evaluating immune response to H7 subtypes of influenza viruses have shown no existing cross-reactive antibodies in human sera.
In addition, CDC has activated its Emergency Operations Center to coordinate efforts. In the United States, planning for H7N9 vaccine clinical trials is under way. Although no decision has been made to initiate an H7N9 vaccination program in the United States, CDC recommends that local authorities and preparedness programs take time to review and update their pandemic influenza vaccine preparedness plans because it could take several months to ready a vaccination program, if one becomes necessary.
CDC also recommends that public health agencies review their overall pandemic influenza plans to identify operational gaps and to ensure administrative readiness for an influenza pandemic. Continued collaboration between the human and animal health sectors is essential to better understand the epidemiology and ecology of H7N9 infections among humans and animals and target control measures for preventing further transmission.
With the opening of hurricane season just 30 days away, the spring flood and storm season upon us, and the fact that earthquakes know no season, there are plenty of good reasons – beyond worrying about a possible pandemic - for all of us to be looking at and updating our emergency plans.
The best disaster and preparedness plans are designed around dealing with `all hazards’, as opposed to focusing on any one particular threat.
For information on preparedness, I would invite you to visit:
FEMA http://www.fema.gov/index.shtm
READY.GOV http://www.ready.gov/
AMERICAN RED CROSS http://www.redcross.org/
And lastly, you may wish to revisit some of my earlier preparedness essays, including:
In An Emergency, Who Has Your Back?
Heat map – Credit Laidback Al FluTrackers
# 7217
Three days ago, in Chinese Science Bulletin: Early H7N9 Risk Analysis, we looked a a sobering threat analysis of the H7N9 virus by a group of researchers from the China National Avian Influenza Professional Laboratory in Qingdao, China.
Crof has managed to contact the corresponding author of the study, Professor Ji-Ming Chen, and has posted (with permission) their illuminating exchange on his blog.
By all means, if you haven’t done so already, surf on over and read:
H7N9: From the authors of the CSB risk analysis
May 01, 2013
The risk analysis published in Chinese Science Bulletin is so far the most detailed we have, and I've commented on it here and here. The article drew criticism and speculation—criticism about its methods, and speculation about the political implications of its publication in China.
Coronavirus – Credit CDC PHIL
# 7216
My thanks to Gregory Hartl, spokesperson for the World Health Organization, for the link to the Saudi Press release on the seven new novel coronavirus cases (see hCoV-EMC: Saudi Arabia Reports 7 Cases, 5 Fatal).
What follows is a machine translation from the original Arabic.
“Health" monitor seven cases of HIV Coruna five people have died
Riyadh 21 Jumada II 1434 H corresponding to May 1, 2013, SPA
Announced the Ministry of Health Monitoring (7) cases of infection Corona new during the past few days in the province of Al-Ahsa, died, including five people, two in intensive care.
The ministry said in a statement released by the evening that The Ministry of Health is doing all the precautionary measures for Mkhaltin for people by routers scientific local and global sampling of them to see if there are cases among them, indicating that it recorded so far 17 confirmed cases of the disease worldwide.
Showed that the virus Corona is one of the viruses that infect the respiratory tract, accounting for 15% of the viruses that cause influenza in humans, while the longer this pattern a new not yet exist at the level of the world accurate information about the source of this virus and its modes of transmission, as there is no vaccination and preventive or antibiotic treatment for the virus.
