Gregory Hartl & WHO On UAE MERS Cluster

UAE’s Proximity to Saudi Arabia

 

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While we expect a DON (Disease Outbreak News) update later today from the World Health Organization on the UAE MERS family cluster first reported on Friday (see Following The UAE MERS Cluster), Gregory Hartl – spokesperson for the WHO, and @WHO have been providing us with an advance look via their respective twitter accounts.

This cluster consists of a 38 year old husband, his 8-months pregnant wife, and 9-year old child.  We now learn that the mother has given birth, and the newborn has tested negative for the virus.  

A reverse order list of recent activity from Gregory Hartl and the WHO’s twitter account follows:

 

 

Updated: 0900 HRS EST -  While I was working on this post, @WHO tweeted the following information regarding the deaths of the two MERS Cases in Qatar.

 

Qatar Officials Reassure On MERS Threat

 

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The past week has seen a good deal of coverage in the Arabic press of the detectopm of the MERS coronavirus in three Qatari camels that had contact with two human infections (see Qatar, Camels, And the Coronavirus).  While no evidence directly links these human infections to camel exposure, this media attention led to a press conference over the weekend by Qatari health officials, which appears to be mostly aimed at minimizing the publics fears.

 

While most of the points made were valid (if perhaps, overstated), the expression of hope by Dr al-Romaihi  that a vaccine would be available `in the near future’   does seem a bit of an overreach.

 

Those with chronic health conditions are warned to avoid exposure to farm animals, while the general public is advised to maintain good hygiene after contact with camels and other animals, and is urged to only consume camel milk that has been pasteurized, and meat that has been well cooked.  Follow the link to read the entire story from the Gulf Times.  

 

 

Health officials allay fears over Mers outbreak

 Senior health officials yesterday reassured Qatar residents that there is ‘no outbreak of the deadly Middle East Respiratory Syndrome-Coronavirus (Mers-CoV) in the country following the recent detection of two human cases and three camels infected with the virus on a local farm at Shahaniya.

“The current situation is reassuring because since the virus was first detected here in 2012, a lot of people have come in contacts with camels and other animals but no single case among those reported had had a link to animals,” Supreme Council of Health’s Communicable Diseases Control section manager Dr Mohamed al-Hajri told a press conference.

The Mers-CoV has claimed four lives in Qatar since 2012 and the virus was also suspected in a total of 4,323 persons, whose samples were checked at the Hamad Medical Corporation’s Virology laboratory, explained SCH Surveillance and Outbreak section head Dr Hamad Eid al-Romaihi.

“It was the first time in Qatar that camels were linked to Mers-CoV infections and no new cases have so far been reported because we conducted a comprehensive epidemiological investigation into potential sources of exposure of human cases involved, with the support of an international team constituted by World Health Organisation (WHO) and Food and Agriculture Organisation (FAO),” he said.

(Continue . . . )

WHO To Convene 4th Meeting Of IHR Emergency Committee On MERS-CoV

Coronavirus - Photo Credit WHO

 

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On December 4th, members and advisors to  World Health Organization’s International Health Regulations (IHR) Emergency Committee will teleconference once again to review what has been learned about the MERS coronavirus, and to to decide whether the threat posed by MERS-CoV rises to the level of a "public health emergency of international concern" or PHEIC.

 

According to the WHO IHR FAQ, the term public health emergency of international concern (PHEIC ) is defined in the International Health Regulations as “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”.

 

The three previous meetings – all held since last July – have all concluded that such an emergency did not currently exist.

 

WHO statements on MERS-CoV

• Third meeting of the IHR Emergency Committee concerning MERS-CoV
  25 September 2013
• Second meeting of the IHR Emergency Committee concerning MERS-CoV
  17 July 2013
• First meeting of the IHR Emergency Committee concerning MERS-CoV
  9 July 2013

 

The results of this week’s meeting will be posted on the WHO website at the following address:

http://www.who.int/ihr/ihr_ec_2013/en/index.html

 

While I’m not expecting a change in status, I will post an update when we get more information.

Shanghai To Close Poultry Markets Over Lunar New Years To Curtail H7N9

Photo Credit – FAO

 

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Each winter the largest annual migration of human beings commences when millions of  people return home to attend a reunion dinner with their families on the eve of the lunar New Year.  As you might imagine, these mass migrations (along with mass gatherings) are of considerable interest to public health officials and epidemiologists.

 

Chunyun, or the Spring Festival travel season, begins about 15 days before the Lunar New Year and runs for about 40 days total, during which time more than 2 billion passenger journeys will be made (mostly via crowded rail and bus) across Asia.

 

During this time poultry sales in China often reach record levels, as duck and chicken are popular dishes served during these reunion dinners.  It is probably no coincidence that the first outbreak of the H7N9 virus emerged during and just after the last (2013) Spring Festival.

 

The outbreak was finally brought under control by the mass closing of live poultry markets in April and May.  But since then, those markets have reopened, and the concerns run high that we could see a recurrence of this outbreak this winter. 

Today, Shanghai authorities have announced that live poultry  markets will be closed on January 31st (the Lunar New Year) and will remain closed until the end of April. I would imagine that the trade in poultry will be very brisk those last few days of January.  For now, this policy only appears to be enacted in Shanghai.  

 

Poultry market to shut over bird flu fears

By Cai Wenjun and Zhao Wen | December 2, 2013, Monday |

Shanghai will suspend live poultry trading from January 31, the first day of the Chinese Lunar New Year, until April 30 to prevent a recurrence of the bird flu.

The suspension will be an annual feature for the next five years, dependent on the evaluation and warning of the bird flu and the seasonal onset, according to a joint statement issued by the Shanghai Agricultural Commission and the Shanghai Commerce Commission.

All the designated wholesale and retail markets will be banned from trading in poultry and violators face hefty fines between 10,000 yuan (US$1,641) and 30,000 yuan under a new rule that took effect in June.

Unlicensed street vendors who sell live poultry during the period will be punished by urban management teams.

Poultry from other cities and provinces must be sent to designated slaughterhouses and cannot enter the local market directly, it said.

(Continue . . . )

 

Mass gatherings and migrations always raise concerns over infectious disease transmission, something we watched carefully during this year’s Hajj.   Luckily, there appears to have been only a small handful of MERS cases reported during that time. 

 

Still, events like Carnival in Rio, The Super Bowl, Chunyung, and Mardi Gras all keep public health officials on their toes.

 

In 2010, in The Impact Of Mass Gatherings & Travel On Flu Epidemics , we looked at a study  published in BMC Public Health, that looked at and attempted to quantify the impacts of mass gatherings and holiday travel on the spread of an influenza epidemic.

And in 2011, in Viruses With A Ticket To Ride, we looked at a study that  appeared in BMC Infectious Diseases, that looked at the incidence of ARI (Acute Respiratory Infection) presenting within 5 days of train or tram travel in the UK. They found that recent  bus  or  tram  use  within  five  days  of  symptom  onset  was  associated  with  an  almost  six-fold  increased  risk  of  consulting  for  ARI.

While seemingly a strong finding, this observational study was limited by its small size, the fact that it was only conducted in a single location (Nottingham, UK), and that it was conducted during a normal flu season, not a pandemic.

 

It will be interesting to see if other cities and provinces in Easter China follow suit, and what – if any – effect this step will have in mitigating the spread of the H7N9  (or any other avian virus) this winter.

Updating The UAE MERS-CoV Family Cluster

 

UAE’s Proximity to Saudi Arabia

 

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Arabic media sources are carrying brief updates on the family cluster (husband, wife, and child) diagnosed with the MERS coronavirus this afternoon, and from the reading it appears the child is experiencing mild symptoms and was discovered during `contact testing’. 

 

The parents both appear to be suffering acute respiratory infections, and are isolated in intensive care.

 

A quick check of the  Abu Dhabi Health Authority and UAE Health Ministry websites turn up nothing `official’ on these cases.  But we’ve two translated media reports to choose from. The first from http://www.al-sharq.com.

 

UAE recorded were newly infected with "Corona" to a child Jordanian

Abu Dhabi - Agencies

UAE health authorities announced the diagnosis of new cases of HIV, "Corona" that causes respiratory syndrome Middle East for Jordanian children at the age of eight years.

According to the Health Authority in Abu Dhabi, said in a statement on Sunday, "appeared on the child's symptoms and was hospitalized simple to isolate and follow-up of the health situation."

She said that the child's parents were wounded disease was discovered a few days ago and injuries to the child tests conducted precautionary Mkhaltth virtue of his parents turned out to viral infections.

She said the Health Authority that they coordinate with the Ministry of Health and health authorities and the concerned authorities in the UAE in this regard and has taken the necessary measures and precautions in accordance with the recommendations of the scientific and conditions and criteria adopted by the World Health Organization, including epidemiological investigation of Mkhaltin.

The Health Authority of Abu Dhabi announced on Thursday the diagnosis of new cases of infection of the virus to a patient Jordanian Corona and his wife Almqaman Emirates.

 

This second report from http://www.ammonnews.net/

 

Emirates recorded new infections "Corona" to a child Jordanian

 

[12/1/2013 

Ammon - (dpa) - The health authorities of the UAE diagnosis of new cases of HIV, "Corona" that causes respiratory syndrome Middle East for Jordanian children at the age of eight years.

According to the Health Authority in Abu Dhabi, said in a statement on Sunday, "appeared on the child's symptoms and was hospitalized simple to isolate and follow-up of the health situation."

She said that the child's parents were wounded disease was discovered a few days ago and injuries to the child tests conducted precautionary Mkhaltth by virtue of his parents turned out having the virus.

She said the Health Authority that they coordinate with the Ministry of Health and health authorities and stakeholders the UAE in this regard and has taken the necessary measures and precautions in accordance with the recommendations of the scientific and conditions and criteria adopted by the World Health Organization, including epidemiological investigation of Mkhaltin.

The Health Authority of Abu Dhabi announced on Thursday new cases diagnosed cases of HIV in a patient Jordanian Corona and his wife Almqaman Emirates.

The patient's age 38 years and is currently receiving treatment in intensive care and his wife, eight months pregnant and infected with acute respiratory symptoms and receiving treatment in intensive care at a hospital in the UAE.

 

World AIDS Day - 2013

Credit AIDS.gov

 

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Like so many others, I’ve lost friends and family members to the AIDS pandemic over the past three decades. AIDS has claimed more than 36 million lives since it was first reported 32 years ago, and today there are an estimated 33 million people around the world living with HIV.

 

The availability of antiretroviral therapy (ART) means that HIV infection isn’t the automatic death sentence it once was, but not everyone is able to receive this vital treatment.

 

Despite progress in treatments and ongoing work on candidate vaccines, new challenges continue to emerge with this rapidly mutating retrovirus. Just this week Lund University in Sweden announced their discovery of a new, highly aggressive strain of HIV that leads to the development of AIDS much quicker than HIV normally does. 

 

From their press release:

 

There are over 60 different epidemic strains of HIV-1 in the world, and geographic regions are often dominated by one or two of these. If a person becomes infected with two different strains, they can fuse and a recombined form can occur.

"Recombinants seem to be more vigorous and more aggressive than the strains from which they developed", explained Angelica Palm, a doctoral student at Lund University.

The recombinant studied is called A3/02 and is a cross between the two most common strains in Guinea-Bissau, West Africa - 02AG and A3. It has previously been described by Joakim Esbjörnsson, a postdoctoral fellow at the University of Oxford, who is a co-author of the study.

So far, the new strain has only been identified in West Africa, but other studies have shown that the global spread of different recombinants is increasing. In countries and regions with high levels of immigration, such as the US and Europe, the trend is towards an increasingly mixed and complex HIV flora, unlike in the beginning of the epidemic when a small number of non-recombinant variants of the virus dominated. There is therefore reason to be wary of HIV recombinants in general.

 

In October, Russian media reported on a rapidly emerging strain of HIV in Siberia, which is now responsible for half of all new infections in that region.  And this week the ECDC and WHO, in joint press release, announced that 131,000 new HIV infections were reported in the WHO European region, an increase of 8% over the previous year.  They write:

 

This confirms a steady increase across Europe over the last year: a 9% rise in eastern Europe and central Asia (EECA) countries and a less than 1% rise in the countries of the European Union and European and Economic Area (EU/EEA).

Of the new HIV infections in the Region, almost 102 000 were reported in the EECA and over  29 000 in the EU/EEA. The total number includes more than 55 000 newly diagnosed HIV infections in 2012 reported to ECDC and the WHO, and nearly 76 000 new cases recorded by the Federal Statistics Agency of the Russian Federation through its database.

 

Each year December 1s is designated World AIDS Day, and this year the theme is  "Shared Responsibility: Strengthening Results for an AIDS-Free Generation

 

A few web resources for you include:

 

This week’s MMWR from the CDC.

 

World AIDS Day — December 1, 2013

Weekly

November 29, 2013 / 62(47);946-946

World AIDS Day draws attention to the current status of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic worldwide. The theme for this year's December 1 observance is "Shared Responsibility: Strengthening Results for an AIDS-Free Generation."

The first cases of AIDS were reported more than 32 years ago in the June 5, 1981, issue of MMWR. Since then, an estimated 36 million persons worldwide have died from HIV/AIDS; an estimated 35.3 million persons continue to live with HIV infection (1).

In the United States, approximately 636,000 persons with AIDS diagnoses have died since the first cases were reported (2); an estimated 1.1 million persons continue to live with HIV infection (3).

Global efforts, including the U.S. President's Emergency Plan for AIDS Relief (for which CDC is an implementing partner), provided antiretroviral therapy to approximately 9.7 million persons in low-income and middle-income countries in 2012, an increase of 1.6 million persons from 2011 (4).

The United State’s government web portal for AIDS/HIV information  AIDS.GOV.

And last stop is the WORLD AIDS DAY website, where you can find out more about this ongoing pandemic, and how you can help.