Watching Indonesia Again

 

 

 

# 8005

 

We’ve a pair of local media reports this morning out of Indonesia indicating that a veterinarian who recently conducted inspection of poultry in the Klaten Regency of Central Java, Indonesia has been hospitalized (in isolation) with a suspected H5N1 infection.

  

At this point all this appears precautionary, as their  suspicion of H5N1 is driven by the patient’s clinical symptoms (which could also match seasonal flu, and many other viral infections) and his recent exposure to poultry. 

 

A positive H5N1 test has not been announced.

 

While the number of H5N1 cases reported out of Indonesia has dropped markedly over the past couple of years, ten days ago we were informed of Indonesia’s third bird flu fatality of 2013 (see Indonesia: MOH Reports H5N1 Fatality), and reports of poultry die offs and poultry culling remain common.

 

 

Veterinarian Allegedly Infected with H5N1 after Check Poultry

Solopos.com, KLATEN - A veterinarian initials DA suspected bird flu after checking poultry in a number of areas in the region of Klaten. Currently victims undergoing treatment in the isolation room dr. Moewardi, Solo, DA to ensure the correctness of contracting the H5N1 strain of virus.

 

The vet suspected of contracting the virus that causes the disease avian influenza (AI) was served in the Division of Animal Husbandry Agriculture (Dispertan) Klaten. Head of Division (Head) Ranch Dispertan Klaten DA Sri Muryani exposing alleged H5N1 was mid last week.

 

When contacted Solopos.com, Sunday (11/24/2013), he explained earlier this week with a team of health Dispertan DA checks Klaten Klaten in some areas. Among areas examined in the region and Manisrenggo Gantiwarno.

 

Initially, Wednesday (20/11/2013), the DA had a high fever accompanied by shortness of breath, cough, and headache. Because not heal, DA health check to one of the private physician who is not far from where he lives.

 

Based on the symptoms experienced DA, known indications of bird flu infection. "Because we do not want to missed, DA finally taken to the hospital. Moewardi to ensure the disease on Thursday (21/11/2013) afternoon, "he told Solopos.com Sunday.

A second report, also from Solopos.com, repeats that this is just a suspected infection, but also carries a warning from the Klaten Head of Livestock Dispertan - Sri Muryani – for people to be wary of the signs of infection in their poultry, stating:

 

"We are not sure which area of ​​bird flu. Hopefully, when people know the symptoms of bird flu may provide information to us and direct culling poultry suspected of AI, "he said.

 

We’ll have to wait for lab results before we know if this veterinarian is actually infected with the bird flu virus.  This is, however, another reminder that while we are more focused on H7N9 and MERS-CoV at the present, the H5N1 virus remains a threat and must be closely monitored as well.

CDC Research On Benefits Of Antivirals For Uncomplicated Influenza

Photo Credit – Wikipedia

 

# 8004

 

In clinical medicine there are a lot of things that we think we know – based on observational studies – but for which rigorous randomized controlled trials (RCTs) have not been conducted. Sometimes it is impractical (or even unethical) to subject patients to an RCT, especially if it involves withholding a potentially lifesaving drug from a `control’ cohort.

 

So we are often left to rely on less desirable, but still useful, observational studies to gauge the value of treatments or therapies.

 

Over the past decade one of the drugs that has fallen into this pharmaceutical limbo is oseltamivir (Tamiflu ®), a product of Roche laboratories, which has been stockpiled by many nations to combat a flu pandemic.  Observational studies have shown that this drug can significantly reduce morbidity and  mortality in severe cases of flu, and modestly reduce the duration of symptoms in uncomplicated seasonal flu.

But robust RCTs have not been conducted to quantify these benefits, and `RCT purists’ like this Cochrane group analysis – that do not consider `observational studies’ to be solid evidence - have found insufficient evidence to show whether the drug reduces influenza complications and transmission (see 2012 CIDRAP article Review renews questions about oseltamivir benefits).

 

Add to this a prolonged reluctance on the part of Roche laboratories to release all of their clinical trial data, and a not totally undeserved reputation of `Big Pharma’ to massage test results, and the result has been a vociferous backlash against the government stockpiling of Tamiflu in some quarters (see Dr. Ben Goldacre Opinion Piece).

 

While academics and activists tend to have a dim view of Roche and their antiviral drug, clinicians obviously see value in oseltamivir,  and continue to prescribe it.  The CDC continues to recommend its use – particularly for high-risk influenza patients - or for the treatment of novel flu (see 2012 blog The CDC Responds To The Cochrane Group’s Tamiflu Study). 

 

With a new avian (H7N9) virus in the wings and H5N1 still simmering in Asia and the Middle East, the CDC recently reiterated their support for the use of oseltamivir in the treatment of severe, or novel, influenza infection (See H7N9: Updated CDC Guidance For Antiviral Treatment).

 

Yesterday, the CDC published a news release on an RCT conducted in Bangladesh on the benefits of Oseltamivir in uncomplicated seasonal flu.  A category of illness where one would expect the least amount of benefit to taking an antiviral. A few excerpts, and a link to The Lancet Study, then I’ll return with a bit more.

 

CDC Research Confirms Benefits of Flu Antiviral Drugs, Even Beyond 2 Days After Symptoms Start

New research confirms benefits of the influenza antiviral medication oseltamivir in treating children with uncomplicated flu illness and shows that treatment can be beneficial even beyond the two-day window recommended as a cut-off for treatment in the drug’s package insert.

A new study on influenza (flu) antiviral drugs by CDC authors was released today in The Lancet Infectious Diseases. This study is the first clinical trial to note a significant reduction in the duration of illness and virus shedding in children when influenza antiviral treatment was initiated more than 2 days after the onset of influenza (flu) symptoms. These findings confirm the benefits of using the antiviral drug oseltamivir to treat flu illness and suggest that some children will benefit when treatment is initiated beyond 2 days, which is the recommended cut-off for treatment in the current package insert.

 

The patients in this double-blind, randomized, placebo-controlled study were mostly children (average age: 5 years) in an urban setting in Bangladesh with laboratory-confirmed influenza infection and no additional flu-related complications. Patients were treated with either oseltamivir (a type of flu antiviral drug known as a “neuraminidase inhibitor”) or a placebo (e.g., a shot of saline). Researchers observed when patients began oseltamivir treatment — either less than 48 hours or 48 hours or more after illness onset — and collected information about the duration of flu symptoms using standardized forms collected from daily household visits. In addition to documenting the duration of flu symptoms, researchers also measured viral shedding, which is virus detection at various times after the patients were enrolled. The detection of live virus in respiratory secretions is thought to be associated with how contagious a person is to others.

 

Among all children receiving oseltamivir within 5 days of illness onset, researchers found that overall flu symptoms were reduced by one day compared with those treated with placebo (3 days versus 4 days). This finding is consistent with results from other flu antiviral studies that started treatment within 2 days of illness onset. The results also show that oseltamivir treatment reduced the amount of live virus that was isolated from respiratory specimens by 12% to 50% compared with placebo regardless of whether treatment was started before or after 2 days since illness onset. This finding is especially important because no other study has shown reduced viral shedding in similar proportions regardless of whether treatment is started less than or more than 48 hours after flu symptoms begin.

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The article is available in The Lancet Infectious Diseases: “Efficacy of oseltamivir treatment started within 5 days of symptom onset to reduce influenza illness duration and virus shedding in an urban setting in Bangladesh: a randomised placebo-controlled trial.”

 

 

Of course, governments aren’t stockpiling Tamiflu for uncomplicated seasonal flu.  They have purchased millions of doses in anticipation of a severe pandemic.  And while RCTs on treating severe influenza with the drug are scant, we have seen some pretty compelling observational and anecdotal data.

 

In 2010 an observational study appearing in JAMA  (see Study: Antivirals Saved Lives Of Pregnant Women) strongly suggested that Tamiflu was life saving for some patients with pandemic flu. And again in 2010, in BMJ: Efficacy of Oseltamivir In Mild H1N1, we saw a study which suggested that the administration of oseltamivir may have significantly reduced the incidence of pneumonia among otherwise healthy pandemic H1N1 patients.

 

In December of 2012, in Study: The Benefits Of Antiviral Therapy During the 2009 Pandemic we looked at a meta-analysis of 90 observational studies that appeared in the Journal of Infectious Diseases that spanned nearly 35,000 patients, 85% of whom has laboratory confirmed H1N1.

 

Their main finding was antiviral therapy - principally oseltamivir - initiated within 48 hours of onset, reduced the likelihood of severe outcomes, namely admission to a critical care unit or death, by 49 to 65%.

 

And lastly, for those who question the value of Tamiflu in an avian flu pandemic, in Study: Antiviral Therapy For H5N1, we saw the largest study to date on outcomes of H5N1 patients who either received, or did not receive, antiviral treatment. The research appears in the IDSA’s  Journal of Infectious Diseases. The bottom line is essentially out of 308 cases studied, the overall survival rate was a dismal 43.5%.

 

But . . . of those who received at least one dose of Tamiflu . . .  60% survived . . .  as opposed to only 24% who received no antivirals.

While today’s study may not completely mollify the critics, the preponderance of evidence continues to show that antivirals – including Tamiflu – can have a substantial positive therapeutic effect on influenza, particularly in high risk patients.

CIDRAP On Today’s WHO Summary On MERS-CoV

Coronavirus – Credit CDC PHIL

 

 

# 8003

 

 

Robert Roos writing for CIDRAP News this evening has the story on today’s MERS-CoV summary from the World Health Organization that indicates they believe that zoonotic spillover of the virus – and human-to-human transmission – are likely contributing to the ongoing spread of the MERS Coronavirus.

 

Follow the link to read:

 

WHO: Humans, animals both likely fueling MERS spread

Nov 22, 2013

The World Health Organization (WHO) said in a report today that the continuing outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) cases is probably being sustained, as some researchers have suggested, by a combination of human-to-human transmission and spillover from animals or other non-human sources—not one or the other.

In its latest summary and literature update, the WHO also agreed that many MERS-CoV cases are probably going undetected and warned that this poses a risk of further outbreaks in hospitals.

(Continue . . . )

 

Nov 22 WHO MERS summary and literature update

FDA Approves Adjuvanted H5N1 Vaccine For National Stockpile

Since the H5N1 virus was first identified in 1996 it has expanded into more than 20 different clades and subclades, and new clades and variants continue to evolve. Credit - WHO

# 8002

 

With the recent emergence of H7N9 and MERS-CoV,  some may think of avian H5N1 influenza as `yesterday’s threat’,  but that virus continues to circulate – and mutate into new clades – in many places around the world.  Earlier this month in The Expanding Variants Of H5N1 we looked at an EID report on the emergence of three new variations of the H5N1 virus in Vietnam between 2009 and 2012.

 

And while the number of human H5N1 infections being reported in Indonesia, China, and Egypt have been much reduced over the past couple of years, Cambodia has seen more cases this year than their total over the 8 years before 2013 (see Nov 14th report Cambodian MOH Announces Two New H5N1 Cases.

 

Although some early experimental H5N1 vaccines were produced and stockpiled by the United States government in 2006 and 2007, the clades those shots were based on are no longer dominant.  Additionally, early human testing revealed a very poor immune response when using the standard antigen load of 15 ug.  In fact, it was discovered that it might take a whopping 12x’s the antigen (2 - 90 ug shots, 21 days apart) to produce a reasonable level of protection.

 

With a limited ability to produce H5N1 antigen in bulk, a requirement for 2-90 ug shots would dramatically reduce the number of vaccines that could be delivered in the first 6 to 12 months of a pandemic.

 

The solution offered was the inclusion of an adjuvant -  proprietary chemicals that are added to vaccines to increase the recipient’s immune response, and that can dramatically lower the amount of antigen needed in a vaccine. Since they are viewed by some as somewhat controversial, adjuvants were not used in flu vaccines in the United States during the 2009 H1N1 pandemic, but they were widely used in Canada and Europe.

 

While millions received adjuvanted vaccines during the 2009 pandemic without incident, a small number of children in Europe developed a rare neurological illness (narcolepsy) in the months after receiving the adjuvanted Pandemrix vaccine.

 

Although the adjuvant is being looked at, the actual cause of this illness has not been established.  The exact mechanism behind this Pandemrix-Narcolepsy link remains a medical mystery. Our understanding of this neurological disorder is very limited, as well.

 

In February of this year the UK’s HPA published a statement ( see Pandemrix Vaccine Linked To Childhood Narcolepsy In England) that found the absolute risk of a child developing narcolepsy from the adjuvanted Pandemrix flu shot appeared to be about 1 in 55,000. 

Over the past several years GSK has been moving through the approval process on their candidate monovalent, adjuvanted pandemic H5N1 influenza vaccine. Data published in November of 2012 indicated that they’d found a good immune response with their adjuvanted vaccine with just two doses of 3.75 ug, given 21 days apart. 

 

The adjuvant is provided in a separate vial, and is pre-mixed prior to injection.  You can view a Power Point Presentation on the FDA Website with the details of those trials at this link.

 

All of which brings us to a late Friday afternoon announcement from the FDA, that they have approved the first adjuvanted flu vaccine for the prevention of H5N1 influenza . This approval is for inclusion in the National Strategic Stockpile, not for commercial use, and is approved only for those over the age of 18.

 

 

FDA NEWS RELEASE

For Immediate Release: Nov. 22, 2013

Media Inquiries: Jennifer Rodriguez, 301-796-8232, jennifer.rodriguez@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA,OCOD@fda.hhs.gov

FDA approves first adjuvanted vaccine for prevention of H5N1 avian influenza

Vaccine to supplement National Stockpile, not intended for commercial availability

The U.S. Food and Drug Administration today approved the first adjuvanted vaccine for the prevention of H5N1 influenza, commonly known as avian or bird flu. The vaccine, Influenza A (H5N1) Virus Monovalent Vaccine, Adjuvanted, is for use in people 18 years of age and older who are at increased risk of exposure to the H5N1 influenza virus.

Avian influenza is an infectious disease of birds caused by certain influenza A viruses. Most avian influenza A viruses do not infect people. However some viruses, such as H5N1, have caused serious illness and death in people outside of the U.S., mostly among people who have been in close contact with infected and ill poultry. When people do become infected with H5N1, about 60 percent die, according to the World Health Organization. H5N1 is an influenza virus with pandemic potential because it continues to infect wild birds with occasional outbreaks of influenza disease in poultry populations, and most humans have no immunity to it.

 

“This vaccine could be used in the event that the H5N1 avian influenza virus develops the capability to spread efficiently from human to human, resulting in the rapid spread of disease across the globe,” said Karen Midthun, M.D., director of the FDA’s Center for Biologics Evaluation and Research. “Vaccines are critical to protecting public health by helping to counter the transmission of influenza disease during a pandemic.”

 

The H5N1 avian influenza vaccine is not intended for commercial availability. The U.S. Department of Health and Human Services has purchased the vaccine from the manufacturer, ID Biomedical Corporation of Quebec, Quebec City, Canada (a subsidiary of GlaxoSmithKline Biologicals), for inclusion within the National Stockpile for distribution by public health officials if needed.

 

The vaccine is made using an egg-based manufacturing process, which is also used for ID Biomedical Corporation’s seasonal influenza vaccine, FluLaval. It contains the adjuvant AS03, an oil-in-water emulsion. An adjuvant is a substance incorporated into some vaccines to enhance or direct the immune response of the vaccinated individual. The adjuvant makes it possible to use a small amount of influenza protein per dose of vaccine to elicit the desired immune response in an individual to prevent influenza disease. Reducing the amount of influenza protein per dose helps to increase the total number of doses of a safe and effective vaccine available for the public during a pandemic.

 

The H5N1 component and the AS03 adjuvant component are supplied in two separate vials, which must be combined prior to use. The vaccine is administered via intramuscular injection in two doses, 21 days apart.

 

The evaluation of safety compared approximately 3,400 adults 18 years of age and older who received the vaccine to about 1,100 adults who received placebo in a multi-center study. The most common side effect reported during the clinical studies among the vaccine recipients was injection site pain. Muscle aches, headache, fatigue and injection site redness and swelling were also common. To determine how well the vaccine works, the immune response was evaluated in about 2,000 of the vaccinated adults. The results showed that 91 percent of individuals between the ages of 18 and 64 years and 74 percent of individuals 65 years and older who received the two-dose regimen developed antibodies at a level that is expected to reduce the risk of getting influenza.

 

The manufacturer will collaborate with the FDA and other U.S. governmental agencies on plans to collect additional safety and effectiveness data through U.S. government-sponsored studies of the vaccine, in the event that it is used during an H5N1 influenza virus pandemic.

Synthetic Cannabinoids Associated With Severe Illness, Stroke & Psychosis

 


# 8001

 

 

In the 1970s, when I was a paramedic in Phoenix, AZ and in Florida, the street drug of choice was Heroin, and Naloxone (a narcotic antagonist used for treating opiate overdoses) was one of our most utilized meds.  There were a lot of pot smokers as well, but the weed available back then was comparatively mild, and unlikely to put a user in the back of my ambulance.

 

Today, the drug scene is much different.  Powder Cocaine arrived in the 1980s with a vengeance, and largely supplanted heroin, particularly among upscale users.  Crack cocaine was the option on the street.  Home brew crystal meth took off in the 1990s, and continues today.   And Heroin is back as well, and unlike the `black tar’ of the old days, is pure enough to snort.

 

Bad stuff, all.  But in recent years another drug has emerged, one that plays on people’s perception that marijuana is relatively harmless (and indeed, legal in some states); synthetic pot. 

 

Cheap, and often readily available – usually sold as "herbal incense" or sometimes as  "herbal smoking blends"  with names like `Spice’, `K2’, or `Aroma’  – these synthetics have a growing reputation among ER doctors, and mental health professionals, as extremely dangerous drugs.

 

Over the summer, authorities in Denver reported at least 75 people treated in local emergency rooms due to bad reactions to `spice’, as reported in this CNN article 3 deaths may be tied to synthetic marijuana in Colorado.

 

Three reports today, one from yesterday’s MMWR, another on a recent study from the University of South Florida that links smoking  synthetic marijuana to a  risk of stroke in young people, and lastly an older report linking `spice’ and psychosis. 

 

Notes from the Field: Severe Illness Associated with Synthetic Cannabinoid Use — Brunswick, Georgia, 2013

Weekly

November 22, 2013 / 62(46);939-939

On August 23, 2013, the Georgia Poison Center was notified of eight persons examined in an emergency department in Brunswick, Georgia, after smoking or inhaling fumes from synthetic cannabinoids. The Georgia Poison Center notified the Georgia Drug and Narcotics Agency, which informed the Georgia Department of Public Health (DPH). The Brunswick emergency department was asked to report any additional patients who reported use of synthetic cannabinoid to the Coastal District Health Department. DPH investigators reviewed recent medical records of patients who had gone to the emergency department and found that 22 patients had been examined after using synthetic cannabinoids during August 22–September 9, 2013.

The 22 patients were aged 16–57 years (median: 25 years); 18 (82%) were male. Patients experienced hyperglycemia (13 [59%]), hypokalemia (nine [41%]), acidosis (seven [32%]), tachycardia (13 [59%]), nausea/vomiting (eight [36%]), confusion/disorientation (seven [32%]), aggression (seven [32%]), somnolence/unresponsiveness (seven [32%]), and seizures (three [14%]). Complications included pneumonia (two patients), rhabdomyolysis (one), and myocardial infarction (one). Six (27%) patients were admitted to the intensive care unit; five (23%) required assisted ventilation; none died. Serum from seven of the initial eight patients was tested for synthetic cannabinoid by the Clinical and Environmental Toxicology Laboratory at the University of California, San Francisco. Five tested positive for ADB-PINACA (N-(1-amino-3,3-dimethy-1-oxobutan-2-yl)-1-pentyl-1H-indazole-3-carboxamide), a previously unrecognized synthetic cannabinoid related to indole compounds recently identified in Europe and Japan (1).

 

Law enforcement authorities removed the synthetic cannabinoid from the implicated Brunswick smoke shop,* which sold all types of tobacco products and smoking paraphernalia. The product, "Crazy Clown," was tested by the Georgia Bureau of Investigation Crime Laboratory, which identified ADB-PINACA, an indazole classified under Georgia law as Schedule 1 on the basis of its close relationship to Schedule 1 compounds already specified. The smoke shop owners were charged on September 10, 2013, with possession of a Schedule 1 controlled substance with intent to distribute; no additional patients who used synthetic cannabinoids have been reported by the ED.

Synthetic cannabinoids are designer drugs often smoked as a marijuana alternative. Despite laws prohibiting synthetic cannabinoid sales, they are still widely available, and recent increases in reports of synthetic cannabinoid use and adverse health effects have occurred (2,3). Common adverse effects include altered mental status and tachycardia. Clinicians examining patients with suspected drug abuse and these symptoms should consider synthetic cannabinoid intoxication (4). Public health authorities can raise awareness of adverse events associated with synthetic cannabinoids and establish mechanisms for surveillance by partnering with poison centers, health-care providers, and law enforcement.

 

 

A second `Spice’ story comes this week from researches at USF, who studied a pair of siblings who both suffered ischemic strokes after smoking synthetic pot.

 

 

Case studies by USF Health neurologists link smoking “spice” with stroke in healthy, young adults

Written by Anne DeLotto Baier · November 19, 2013 @ 10:33 am · Filed under Hot News, Morsani College of Medicine, Neurosciences & Brain Repair, News Releases, Research

Tampa, FL (Nov. 19, 2013) – Add stroke to the list of severe health hazards that may be associated with smoking synthetic marijuana,  popularly known as spice or K2, a University of South Florida neurology team reports.

An advance online article in the journal Neurology  details case studies by the USF neurologists of two healthy, young siblings who experienced acute ischemic strokes soon after smoking the street drug spice.  Ischemic strokes occur when an artery to the brain is blocked.

Seizures, abnormal heart rhythms, heart attacks, psychosis, hallucinations and other serious adverse effects have been associated with smoking synthetic pot.  Medical journals have also begun to report a growing number of strokes potentially related to the use of natural (non-synthetic) marijuana.

“Since the two patients were siblings, we wondered whether they might have any undiagnosed genetic conditions that predisposed them to strokes at a young age. We rigorously looked for those and didn’t come up with anything,” said senior author W. Scott Burgin, MD, professor of neurology at the USF Health Morsani College of Medicine and director of the Comprehensive Stroke Center at Tampa General Hospital.

“To the best of our knowledge, what appeared to be heart-derived strokes occurred in two people with otherwise healthy hearts.  So more study is needed.”

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Citation:
Ischemic stroke after use of the synthetic marijuana “spice,” Melissa J. Freeman, MD; David Z. Rose, MD; Martin A. Myers, MD; Clifton L. Gooch, MD; Andrea C. Bozeman, MS, ARNP-C; and W. Scott Burgin, MD; Neurology; published online before print November 8, 2013, doi: 10.1212/01.wnl.0000437297.05570.a2

 

 

And finally, a trend that has been confirmed to me by mental health professionals, is they are increasingly seeing a link between synthetic marijuana use and the admission of patients for psychotic behavior.   This from Medscape in 2011.

 

 

Synthetic Cannabis May Pose an Even Greater Psychosis Risk

'Spice' Packs a Bigger Punch than Natural Cannabis

Deborah Brauser

December 13, 2011

December 13, 2011 (Scottsdale, Arizona) — The synthetic cannabis product known as Spice may pose a risk for psychosis in users, including those with no prior history of a psychiatric disorder, new research suggests.

A literature review, Internet sites, and even blogs spanning the past decade suggest that because it lacks the antipsychotic protective agents found in natural cannabis, Spice may pose an even greater risk of psychosis when compared with the natural product.

The results were presented here at the American Academy of Addiction Psychiatry (AAAP) 22nd Annual Meeting & Symposium.

"I would tell clinicians that when there are unexplained causes of psychosis and urine tests are coming back negative, to keep in mind that it could be caused by synthetic cannabis such as Spice," lead author Carlos Alverio, MD, a 4-year psychiatry resident from Boston University School of Medicine, Massachusetts, told Medscape Medical News.

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A Confusing MERS-CoV Report From Qatar

 

 

# 8000

 

What ought to be routine announcement – that of another MERS death in the Middle East - is complicated by the fact that this patient appears to be the same one who was reported earlier this week to have fully recovered and been released from the hospital. Tracking of individual cases in the Middle East is admittedly difficult since no identifying information other than age – and usually their gender and location – are generally provided.

 

Based on FluTrackers’  MERS Case List by Country, Qatar has only announced one 48 year-old MERS case thus far, which leaves us with a bit of a mystery.

 

First a link and text from one of the many Arabic media reports this morning (no update on Qatar’s Supreme Council of Health website), and then a flashback to the announcement last Tuesday that their 48 year-old MERS case had recovered and been released.

 

Qatar Health announced the death of a resident infected with Corona

The Supreme Council for the health of the country today for the death of a resident at the age of 48 years are infected with (Corona) that causes respiratory syndrome Middle East.

 

The Supreme Council of Health Qatar in a statement that the deceased, who did not disclose his identity had been suffering from several chronic diseases.

 

With this announcement toll of victims who Hsdhm virus since the beginning of his appearance to more than 67 deaths worldwide, according to statistics from the World Health Organization.

 

Compare this report to this announcement, lifted earlier this week from Qatar’s Supreme Council of Health website, apparently announcing this same patient’s recovery.

 

 

One patient recovered, another one died in MERS coronavirus, SCH says

Doha - Tuesday, 19 Nov 2013

The Supreme Council of Health (SCH) has announced Tuesday the recovery of one resident patient inflicted with MERS coronavirus and another passed away due to the same illness.

The 48-year-old first patient was admitted to hospital for three weeks to receive proper treatment. After a course of treatment, he recovered, the SCH said in a press statement.

In the same context, the SCH announces the death of 61-year old expat patient who was battling several chronic health issues and tested positive for the MERS coronavirus.

 

 

Perhaps this discrepancy comes from an error in reporting (either today, last Tuesday, or in the reported age of one of the previous cases). It’s possible, I suppose, there might be another 48-year-old MERS case we don’t know about. There are a lot of possibilities here.

When there were but a handful of cases, keeping a reasonably accurate line-listing of patients was fairly easy. 

 

But as the number of cases has grown, and given deplorable lack of information (such as onset dates, dates of hospitalization, or dates of death) being provided by the respective Ministries of Health, the task of compiling and tracking cases has grown much harder. 

 

No one truly believes that the (roughly) 160  MERS cases identified to date represents the full burden of the disease (see Referral: Dr. Ian Mackay On `The Slowly Growing Epidemic’ Of MERS-CoV).  But these line lists have provided important information regarding the rate of new cases being detected, and their geographic spread.

 

At some point, if MERS cases continue to accrue, it will become impossible to keep reasonable track of individual cases.  We saw that with the H1N1 Pandemic virus quite early on, and that is to be expected with any emerging disease that find success in the human population.

 
But when that happens we will lose an important tracking tool, one that could have been even more valuable had public health officials in the Middle East been just a little more forthcoming with epidemiological details on these early cases.