1 Sep 2015

#Social #Vulnerability and #Ebola #Virus #Disease in Rural #Liberia (PLoS One, abstract, edited)

[Source: PLoS One, full page: (LINK). Abstract, edited.]

Open Access / Peer-reviewed / Research Article

Social Vulnerability and Ebola Virus Disease in Rural Liberia [      ]

John A. Stanturf,  Scott L. Goodrick,  Melvin L. Warren Jr.,  Susan Charnley,  Christie M. Stegall

Published: September 1, 2015 / DOI: 10.1371/journal.pone.0137208



The Ebola virus disease (EVD) epidemic that has stricken thousands of people in the three West African countries of Liberia, Sierra Leone, and Guinea highlights the lack of adaptive capacity in post-conflict countries. The scarcity of health services in particular renders these populations vulnerable to multiple interacting stressors including food insecurity, climate change, and the cascading effects of disease epidemics such as EVD. However, the spatial distribution of vulnerable rural populations and the individual stressors contributing to their vulnerability are unknown. We developed a Social Vulnerability Classification using census indicators and mapped it at the district scale for Liberia. According to the Classification, we estimate that districts having the highest social vulnerability lie in the north and west of Liberia in Lofa, Bong, Grand Cape Mount, and Bomi Counties. Three of these counties together with the capital Monrovia and surrounding Montserrado and Margibi counties experienced the highest levels of EVD infections in Liberia. Vulnerability has multiple dimensions and a classification developed from multiple variables provides a more holistic view of vulnerability than single indicators such as food insecurity or scarcity of health care facilities. Few rural Liberians are food secure and many cannot reach a medical clinic in <80 minutes. Our results illustrate how census and household survey data, when displayed spatially at a sub-county level, may help highlight the location of the most vulnerable households and populations. Our results can be used to identify vulnerability hotspots where development strategies and allocation of resources to address the underlying causes of vulnerability in Liberia may be warranted. We demonstrate how social vulnerability index approaches can be applied in the context of disease outbreaks, and our methods are relevant elsewhere.


Citation: Stanturf JA, Goodrick SL, Warren ML Jr, Charnley S, Stegall CM (2015) Social Vulnerability and Ebola Virus Disease in Rural Liberia. PLoS ONE 10(9): e0137208. doi:10.1371/journal.pone.0137208

Editor: Osman Alimamy Sankoh, INDEPTH Network, GHANA

Received: February 6, 2015; Accepted: August 14, 2015; Published: September 1, 2015

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication

Data Availability: The authors do not own the data underlying this study. The census data underlying the social vulnerability classification may be available to other interested researchers by applying to the Director General, Liberia Institute of Statistics and Geo-Information Services (LISGIS) in Monrovia, Liberia (Mr. Johnson Q. Kei, email: The Ebola virus disease data are freely available to all interested parties from the World Health Organizations website,​uation-reports/en/.

Funding: Funding for travel was provided to JAS, SLG, and MLW by the Liberia Mission, US Agency, for International Development through the US Forest Service Office of International Programs. All other funding was internal Forest Service appropriated funding from the US Congress. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.



#Thailand, #Dengue #fever #outbreak in Ratchaburi province (The Nation, September 1 2015)

[Source: The Nation, full page: (LINK).]

Dengue fever outbreak in Ratchaburi province [      ]

A dengue fever outbreak in Ratchaburi province has already claimed six lives, deputy provincial public health chief Dr Pajaree Areerop said yesterday.




#USA, #Illinois: #Legionnaires’ #Disease #Outbreak at Illinois #Veterans’ #Home-Quincy #Update (DoH, September 1 2015)

[Source: US State of Illinois Department of Health, full page: (LINK).]

Legionnaires’ Disease Outbreak at Illinois Veterans’ Home-Quincy Update [      ]

1st Sep, 2015

Quincy, IL - The Illinois Department of Veterans’ Affairs (IDVA) and the Illinois Department of Public Health (IDPH) today announced the deaths of a total of seven residents at the Illinois Veterans’ Home-Quincy

The seven residents, all of whom had underlying medical conditions, were among the 39 individuals who had been diagnosed with Legionnaires’ disease to date.  Test results are currently pending for other residents.

“While saddened by the loss of our residents, having been at the Home and talking with the staff and our residents, I am impressed with their resilience and spirit,” said IDVA Director Erica Jeffries.  “We remain vigilant in monitoring our residents and we continue to follow the guidance of our interagency partners to implement remediation efforts across our Home.  The safety and quality of care for our residents and staff are our primary concerns.”

“We continue to work diligently with our public health and Veterans’ Affairs partners to get immediate medical care to residents or staff at the Home who are experiencing respiratory illness,” said IDPH Director Nirav D. Shah, M.D., J.D.  

“Unfortunately, we expect to see additional cases and possibly additional deaths because the incubation period for Legionnaires’ disease can be up to two weeks, and because patients with underlying medical conditions are at increased risk of more severe illness.”

On August 30, 2015, IDPH requested aid from the U.S. Centers for Disease Control and Prevention (CDC) for epidemiology and environmental health assistance. 

Yesterday, three CDC Epidemic Intelligence Service Officers and one environmental health specialist arrived at the Illinois Veterans’ Home – Quincy to work with IDVA and IDPH in investigating the Legionnaires’ disease outbreak.  CDC will also provide laboratory support from its headquarters in Atlanta, GA.

IDVA and IDPH continue to work closely with the Adams County Health Department to identify and mitigate possible sources of the Legionella bacteria. 

Due to the nature of the bacteria, test results can take up to two weeks. 

Public and environmental health officials are working closely with home staff to implement control measures at the home in order to prevent additional individuals from being infected.

Most cases of Legionnaires’ disease can be traced to plumbing systems where conditions are favorable for Legionella growth, such as hot water tanks, cooling towers, and evaporative condensers of large air-conditioning systems. 

In order to be infected with the bacteria, a person must inhale contaminated water vapor.  Legionnaires’ disease cannot be transmitted person-to-person. 

For more information about Legionnaires’ disease, visit the IDPH website.

For media seeking additional information, please contact:

IDVA / IVH-Q:  Ryan Yantis, IDVA PIO (d) 312-814-0778 (c) 312-520-6958 / IDPH: Melaney Arnold, IDPH PIO (d) 217-558-0500 (c) 217-836-6438 / Adams Co. Health Dept.: Shay Drummond, (d)217-222-8440 x148 (c)217-316-2795




Seven dead in #Legionnaires' #outbreak at #Illinois #veterans #home (Channel News Asia, September 1 2015)

[Source: Channel News Asia, full page: (LINK).]

Seven dead in Legionnaires' outbreak at Illinois veterans home [      ]

Seven people have died and 32 sickened in a Legionnaires' disease outbreak at a veterans home in Quincy, Illinois, state veterans and health officials said in a statement on Tuesday.




Middle East Respiratory Syndrome #coronavirus (#MERS-CoV) – #Jordan (@WHO, September 1 2015)

[Source: World Health Organization, full page: (LINK).]

Middle East Respiratory Syndrome coronavirus (MERS-CoV) – Jordan [      ]

Disease outbreak news / 1 September 2015

Between 26 and 28 August 2015, the National IHR Focal Point of Jordan notified WHO of 4 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 1 death. All these cases are associated with a MERS-CoV outbreak currently occurring in a hospital in Amman city.


Details of the cases

  1. A 60-year-old male living in Jeddah city, Saudi Arabia travelled to Amman city, Jordan on 28 July.
    • He developed symptoms on 31 July and, on 10 August, was admitted to hospital.
    • The patient, who had comorbidities, was treated symptomatically and discharged on 18 August.
    • As symptoms relapsed, on 20 August, the patient was admitted to another hospital in Amman on 23 August.
    • He tested positive for MERS-CoV on 25 August and passed away on 27 August.
    • Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.
  2. A 38-year-old male from Kuwait city, Kuwait travelled to Amman city, Jordan on 7 August.
    • He developed symptoms on 12 August and, on 17 August, was admitted to the hospital where a laboratory-confirmed MERS-CoV case was hospitalized (case no. 1 – see above).
    • Since his arrival in Amman city, he frequently visited a family member at the same hospital.
    • The patient, who has no comorbidities, has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.
    • He tested positive for MERS-CoV on 26 August.
    • Currently, the patient is in critical condition in ICU.
    • Investigation of possible epidemiological links with the index case or with shared health care workers is ongoing.
  3. A 76-year-old male from Amman city developed symptoms.
    • On 16 August, due to his chronic condition, the patient was admitted to the hospital where a laboratory-confirmed MERS-CoV case was hospitalized (case no. 1 – see above).
    • He was discharged on the same day.
    • On 20 August, the patient was admitted to the same hospital for a medical procedure for his chronic condition and, on 24 August, was discharged.
    • On 25 August, he developed symptoms and was admitted to the same hospital.
    • The patient tested positive for MERS-CoV on 25 August.
    • Currently, he is in critical condition in ICU.
    • Investigation of possible epidemiological links with MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing.
  4. A 47-year-old female from Kuwait city, Kuwait travelled to Amman city, Jordan on 15 July.
    • She was identified through the screening of contacts of a laboratory-confirmed MERS-CoV case (case no. 2 – see above).
    • The patient, who has no comorbidities, tested positive for MERS-CoV on 27 August.
    • Currently, she is asymptomatic in home isolation.
    • The patient visited her family members at the hospital where a laboratory-confirmed MERS-CoV case was hospitalized (case no. 1 – see above).
    • She has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.

Contact tracing of household contacts and healthcare contacts is ongoing for these cases. The National IHR Focal Point of Jordan informed the National IHR Focal Point for the Kingdom of Saudi Arabia about the index case to trace contacts in Saudi Arabia.

Globally, the WHO has been notified of 1,478 laboratory-confirmed cases of infection with MERS-CoV, including at least 516 related deaths.


WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

WHO remains vigilant and is monitoring the situation. Given the lack of evidence of sustained human-to-human transmission in the community, WHO does not recommend travel or trade restrictions with regard to this event. Raising awareness about MERS-CoV among travellers to and from affected countries is good public health practice.

Public health authorities in host countries preparing for mass gatherings should ensure that all recommendations and guidance issued by WHO with respect to MERS-CoV have been appropriately taken into consideration and made accessible to all concerned officials. Public health authorities should plan for surge capacity to ensure that visitors during the mass gathering can be accommodated by health systems.



Circulating #vaccine-derived #poliovirus – #Ukraine (@WHO, DON, September 1 2015)

[Source: World Health Organization, full page: (LINK).]

Circulating vaccine-derived poliovirus – Ukraine [      ]

Disease outbreak news  / 1 September 2015

In Ukraine, 2 cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) have been confirmed, with dates of onset of paralysis on 30 June and 7 July 2015. Both are from the Zakarpatskaya oblast, in south-western Ukraine, bordering Romania, Hungary, Slovakia and Poland. One child was 4 years old and the other 10 months old at the time of onset of paralysis.

Ukraine had been at particular risk of emergence of a cVDPV, due to inadequate vaccination coverage.

In 2014, only 50% of children were fully immunized against polio and other vaccine-preventable diseases.


Public health response

Discussions are currently ongoing with national health authorities to plan and implement an urgent outbreak response.

An outbreak response of internationally-agreed standard, as adopted by the World Health Assembly in May 2015, requires a minimum of three large-scale supplementary immunization activities with an appropriate oral polio vaccine, to begin within two weeks of confirmation of the outbreak and covering a target population of 2 million children aged less than five years, and the public declaration of the outbreak as a national public health emergency.


WHO risk assessment

Circulating VDPVs are rare but well-documented strains of poliovirus that can emerge in some populations which are inadequately immunized.

A robust outbreak response can rapidly stop such events.

Given substantial vaccination coverage gaps across the country and subnational surveillance deficits, the risk of further spread of this strain within the country is deemed to be high.

The emergence of cVDPV strains underscores the importance of maintaining high levels of routine vaccination coverage.

WHO currently assesses the risk of international spread from Ukraine to be low, but notes that the infected oblast shares borders with four countries (Romania, Hungary, Slovakia and Poland).

WHO emphasises the need for a full and complete implementation of an outbreak response of the internationally-agreed standard. WHO will continue to evaluate the epidemiological situation and outbreak response measures being implemented.


WHO advice

It is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for cases of acute flaccid paralysis (AFP) in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.

WHO recommends that all travelers to polio-affected areas be fully vaccinated against polio. Residents (and visitors for more than 4 weeks) from infected areas should receive an additional dose of oral polio vaccine (OPV) or inactivated polio vaccine (IPV) within 4 weeks to 12 months of travel.




[Source: IAEA, full PDF file: (LINK). Summary.]




All IAEA scientific and technical publications are protected by the terms of the Universal Copyright Convention as adopted in 1952 (Berne) and as revised in 1972 (Paris). The copyright has since been extended by the World Intellectual Property Organization (Geneva) to include electronic and virtual intellectual property. Permission to use whole or parts of texts contained in IAEA publications in printed or electronic form must be obtained and is usually subject to royalty agreements. Proposals for noncommercial reproductions and translations are welcomed and considered on a case-by-case basis. Enquiries should be addressed to the IAEA Publishing Section at: Marketing and Sales Unit, Publishing Section International Atomic Energy Agency Vienna International Centre PO Box 100 1400 Vienna, Austria Fax: +43 1 2600 29302 Tel.: +43 1 2600 22417 Email:

©IAEA, 2015 Printed by the IAEA in Austria August 2015 STI/PUB/1710



By Yukiya Amano, Director General

This report presents an assessment of the causes and consequences of the accident at the Fukushima Daiichi nuclear power plant in Japan, which began on 11 March 2011. Caused by a huge tsunami that followed a massive earthquake, it was the worst accident at a nuclear power plant since the Chernobyl disaster in 1986. The report considers human, organizational and technical factors, and aims to provide an understanding of what happened, and why, so that the necessary lessons learned can be acted upon by governments, regulators and nuclear power plant operators throughout the world. Measures taken in response to the accident, both in Japan and internationally, are also examined. The immense human impact of the Fukushima Daiichi accident should not be forgotten. More than 100 000 people were evacuated because of the release of radionuclides to the environment. At the time of writing, in 2015, many of them were still unable to return to their homes. I visited the Fukushima Daiichi plant a few months after the accident and saw for myself the powerful and destructive impact of the tsunami. It was a shocking and sobering experience. But I was deeply impressed by the courage and dedication of those workers and managers who remained at their posts after the tsunami struck and who struggled, in appalling conditions, to bring the stricken reactors under control. They had to improvise a response in circumstances for which they had not been trained, often lacking appropriate equipment. They deserve our respect and admiration. A major factor that contributed to the accident was the widespread assumption in Japan that its nuclear power plants were so safe that an accident of this magnitude was simply unthinkable. This assumption was accepted by nuclear power plant operators and was not challenged by regulators or by the Government. As a result, Japan was not sufficiently prepared for a severe nuclear accident in March 2011. The Fukushima Daiichi accident exposed certain weaknesses in Japan’s regulatory framework. Responsibilities were divided among a number of bodies, and it was not always clear where authority lay. There were also certain weaknesses in plant design, in emergency preparedness and response arrangements and in planning for the management of a severe accident. There was an assumption that there would never be a loss of all electrical power at a nuclear power plant for more than a short period. The possibility of several reactors at the same facility suffering a crisis at the same time was not considered. And insufficient provision was made for the possibility of a nuclear accident occurring at the same time as a major natural disaster. Since the accident, Japan has reformed its regulatory system to better meet international standards. It gave regulators clearer responsibilities and greater authority. The new regulatory framework will be reviewed by international experts through an IAEA Integrated Regulatory Review Service mission. Emergency preparedness and response arrangements have also been strengthened. Other countries responded to the accident with measures that included carrying out ‘stress tests’ to reassess the design of nuclear power plants against site specific extreme natural hazards, installing additional backup sources of electrical power and supplies of water, and strengthening the protection of plants against extreme external events.

Although nuclear safety remains the responsibility of each individual country, nuclear accidents can transcend national borders. The Fukushima Daiichi accident underlined the vital importance of effective international cooperation. The IAEA is where most of that cooperation takes place. Our Member States adopted the IAEA Action Plan on Nuclear Safety a few months after the accident and have been implementing its far-reaching provisions to improve global nuclear safety. The IAEA, which provided technical support and expertise to Japan after the accident and shared information about the unfolding crisis with the world, has reviewed and improved its own arrangements for responding to a nuclear emergency. Our role during a nuclear emergency has been expanded to include providing analysis of its potential consequences and presenting possible scenarios on how a crisis could develop. IAEA safety standards embody an international consensus on what constitutes a high level of safety. They were reviewed after the accident by the Commission on Safety Standards. A few amendments were proposed and adopted. I encourage all countries to fully implement IAEA safety standards. IAEA peer reviews have a key role to play in global nuclear safety, enabling countries to benefit from the independent insights of leading international experts, based on the common reference frame of the IAEA safety standards. They address issues such as operational safety at nuclear power plants, the effectiveness of nuclear regulators and the design of nuclear power plant sites against specific hazards. We have strengthened our peer review programme since the accident and will continue to do so. I am confident that the legacy of the Fukushima Daiichi accident will be a sharper focus on nuclear safety everywhere. I have seen improvements in safety measures and procedures in every nuclear power plant that I have visited. There is widespread recognition that everything humanly possible must be done to ensure that no such accident ever happens again. This is all the more essential as global use of nuclear power is likely to continue to grow in the coming decades. There can be no grounds for complacency about nuclear safety in any country. Some of the factors that contributed to the Fukushima Daiichi accident were not unique to Japan. Continuous questioning and openness to learning from experience are key to safety culture and are essential for everyone involved in nuclear power. Safety must always come first. I express my gratitude to the experts from many countries and international organizations who contributed to this report, and to my colleagues at the IAEA who drafted and reviewed it. I hope that the report, and the accompanying technical volumes, will prove valuable to all countries that use, or plan to use, nuclear power in their continuous efforts to improve safety.



Financial assistance was provided by Canada, Japan, the Russian Federation, the United Kingdom and the United States of America. In-kind contributions were received from Argentina, Australia, Belarus, Brazil, Canada, China, Cuba, the Czech Republic, Finland, France, Germany, Ghana, Iceland, India, Indonesia, Israel, Italy, Japan, the Republic of Korea, Malaysia, Mexico, Morocco, the Netherlands, New Zealand, Norway, Pakistan, the Philippines, Poland, the Russian Federation, Slovakia, South Africa, Spain, Sweden, Switzerland, the Syrian Arab Republic, Turkey, Ukraine, the United Arab Emirates, the United Kingdom, the United Republic of Tanzania and the United States of America. In-kind contributions were also received from the European Commission, the Food and Agriculture Organization of the United Nations, the International Commission on Radiological Protection, the International Labour Organization, the International Nuclear Safety Group, the OECD Nuclear Energy Agency, the United Nations Scientific Committee on the Effects of Atomic Radiation, the World Association of Nuclear Operators and the World Meteorological Organization. The Government of Japan provided invaluable support by making available a considerable amount of information, arranging for Japanese experts to support the work on the report and ensuring logistical assistance for bilateral meetings in Japan. The United Nations Scientific Committee on the Effects of Atomic Radiation supported the IAEA by sharing the relevant database of references from its 2013 report and allowing information and figures from the report to be reproduced. The IAEA thanks the large number of experts who were involved in this report. It is the result of the dedicated efforts of many people. All participants listed at the end of this report made valuable contributions, but a particularly heavy load was borne by the Co-Chairs and coordinators of the working groups. The efforts of many expert reviewers, including members of the International Technical Advisory Group, are also gratefully acknowledged.




Circulating #vaccine-derived #poliovirus type 1 confirmed in #Ukraine (@WHO EURO, September 1 2015)

[Source: World Health Organization, Regional Office for Europe, full page: (LINK).]

Circulating vaccine-derived poliovirus type 1 confirmed in Ukraine [      ]


On 28 August 2015, the WHO Regional Office for Europe was notified of two confirmed cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) in Ukraine. There is a genetic similarity between the two cases, which indicates that active transmission of cVDPV1 is ongoing. WHO and UNICEF are supporting the Ministry of Health of Ukraine to conduct an urgent and robust response.

The strain was isolated from two children from the Zakarpatskaya oblast, in south-western Ukraine.

One child was four years old and the second child 10 months old at the time of onset of paralysis; both were not vaccinated against polio.

The circulation of cVDPV occurred due to the low immunization coverage since 2008 in Ukraine.

In 2014, only 49% of children were fully immunized against polio, and currently, in 2015, the level of immunization against polio among children under 1 year old is 14,1% due to vaccine shortage.

The World Health Organization and UNICEF are providing the Ministry of Health with both technical and on-site support in planning and implementing large-scale supplementary immunization activities with oral polio vaccine (OPV) that can rapidly stop the virus circulation. OPV is the most effective vaccine to stop the spread of polio virus and ensure collective immunity.

WHO recommends that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for acute flaccid paralysis (AFP) cases and maintain high routine immunization coverage. All travellers to polio-affected areas should be fully vaccinated against polio.





Middle East Respiratory Syndrome [#MERS] in 3 #Persons, South #Korea, 2015 (@CDC_EIDjournal, edited)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Edited.]

Volume 21, Number 11—November 2015 / Dispatch

Middle East Respiratory Syndrome in 3 Persons, South Korea, 2015 [      ]

Jeong-Sun Yang, SungHan Park, You-Jin Kim, Hae Ji Kang, Hak Kim, Young Woo Han, Han Saem Lee, Dae-Won Kim, A-Reum Kim, Deok Rim Heo, Joo Ae Kim, Su Jin Kim, Jeong-Gu Nam, Hee-Dong Jung, Hyang-Min Cheong, Kisoon Kim, Joo-Shil Lee, and Sung Soon Kim

Author affiliations: Korea Centers for Disease Control and Prevention, Cheongju, South Korea



In May 2015, Middle East respiratory syndrome coronavirus infection was laboratory confirmed in South Korea. Patients were a man who had visited the Middle East, his wife, and a man who shared a hospital room with the index patient. Rapid laboratory confirmation will facilitate subsequent prevention and control for imported cases.


Middle East respiratory syndrome (MERS) is characterized by mild-to-severe respiratory distress and is caused by a novel coronavirus (MERS-CoV) (1). Since its first identification in 2012, MERS-CoV infection has been reported for 1,413 persons from 26 countries; case-fatality rate is 40.92% (2). We describe an outbreak comprising 3 laboratory-confirmed cases of MERS-CoV infection in South Korea (35).


The Study


Figure 1

Thumbnail of Timeline of events for patients infected with Middle East respiratory syndrome coronavirus (MERS-CoV). The laboratory diagnostic methods used for molecular detection of MERS-CoV RNA were multiplex MERS-CoV real-time reverse transcription PCRs targeting an upstream MERS-CoV envelope protein gene and an open reading frame 1a gene (8,9). KSA, Kingdom of Saudi Arabia; UAE, United Arab Emirates.


Figure 1. Timeline of events for patients infected with Middle East respiratory syndrome coronavirus (MERS-CoV). The laboratory diagnostic methods used for molecular detection of MERS-CoV RNA were multiplex MERS-CoV real-time reverse transcription PCRs...


In accordance with national MERS control guidelines in South Korea (6), specimens are collected from hospitalized patients suspected of having MERS on the basis of epidemiologic history linked to the Middle East; these specimens are then transferred to the Korea National Institute of Health for examination. The index patient, a 68-year-old man engaged in farming-related business, reported that he had traveled to Bahrain on April 18, 2015, the United Arab Emirates on April 29–30, Saudi Arabia on May 1–2, and Qatar on May 2–3 before returning to South Korea on May 4 (Figure 1). While in these countries, he was not exposed to any patients, health care facilities, or animals (including camels and bats) or their excreta. On May 11, the patient experienced chills and a fever (>37°C), and an over-the-counter drug was prescribed when he first visited a local clinic. However, his symptoms worsened (temperature 38.3°C, myalgia, cough, and dyspnea), and after he had visited 4 hospitals (hospitals A–D, in or around Seoul), he was admitted to a general hospital (hospital D, Seoul, South Korea) on May 18. A nasopharyngeal aspiration specimen was collected for MERS-CoV laboratory testing on May 19.

Sputum samples from 2 persons who had been in contact with the index patient were also tested for MERS-CoV. Patient 2 was the 63-year-old wife of the index patient; she had had physical contact with him while caring for him during the 3 days of hospitalization. Fever (38°C) and slight oliguria developed in patient 2 on May 19. The other contact, patient 3, was a 78-year-old man who had chronic obstructive pulmonary disease, asthma, and cholangiocarcinoma and who had shared a hospital room with the index patient and had been within 2 meters from him for 4 hours on May 16. Fever (37.8°C) and respiratory symptoms developed in patient 3 on May 20. In the hospital room, the index patient did not undergo any aerosol-generating procedures, but a severe cough developed. The same health care workers cared for the index patient and patient 3.

Laboratory diagnostic methods were performed according to World Health Organization guidelines for molecular detection of MERS-CoV (79). To check for contamination derived from the positive control, we designed and synthesized the MERS-CoV real-time reverse transcription PCR (rRT-PCR)–positive transcripts for an upstream MERS-CoV envelope protein gene (upE) and the open reading frame 1a (ORF1a) gene containing 50 bp of a foreign gene (centipede).

Initially, nasopharyngeal samples from the index patient were positive for MERS-CoV by multiplex rRT-PCR. Sputum samples from patients 2 and 3 were also positive, supporting a diagnosis of MERS-CoV infection. Multiplex rRT-PCR results for upE and ORF1a were positive (Table 1). According to rRT-PCR, the respiratory samples from the 3 patients were negative for 5 other human coronaviruses (SARS-CoV and human CoV-229E, -OC43, -NL63, and -HKU1) and 7 viruses that cause acute respiratory infection (influenza virus A and B; human adenovirus; bocavirus; human parainfluenza virus types 1, 2, and 3; respiratory syncytial virus A and B; human rhinovirus; human metapneumovirus).

For the index patient, MERS-CoV RNA was detectable in sputum, throat swab, and serum samples but not in a urine sample collected 9 days after symptom onset (Table 1). The viral load, indicated by cycle threshold values, was high in the lower respiratory tract sample but almost undetectable in the throat swab and serum samples. After sequential sampling repeated every 2–5 days, MERS-CoV RNA was detected in sputum until 44 days after symptom onset, although viral RNA was inconsistently detected and patterns of viral load fluctuated (Table 2). Other than initial fever (>37°C), clinical features differed for all 3 patients. The index patient had respiratory symptoms with cough, dyspnea, and myalgia. Patient 2 did not have a relevant medical history and showed mild symptoms. Patient 3 had underlying concurrent conditions and died 16 days after confirmation of MERS-CoV infection (Figure 1).


Figure 2

Thumbnail of Phylogenetic tree comparing complete genome nucleotide sequences of Middle East respiratory syndrome coronavirus (MERS-CoV) isolate from South Korea (KOR/KNIH/002_05_2015) with those of 67 reference MERS-CoVs (GenBank database). The tree was constructed by using the general time reversible plus gamma model of RAxML version 8.8.0 software (10) and visualized by using FigTree version 1.4.2 ( RAxML bootstrap values (1,000 replicates) are shown


Figure 2. Phylogenetic tree comparing complete genome nucleotide sequences of Middle East respiratory syndrome coronavirus (MERS-CoV) isolate from South Korea (KOR/KNIH/002_05_2015) with those of 67 reference MERS-CoVs (GenBank database). The tree was constructed...


Virus isolation on Vero cells was attempted for each respiratory specimen from the 3 patients. The culture supernatant after inoculation was serially assessed for virus growth by using rRT-PCR and was used for blind passages every 3–7 days after inoculation. After 3 blind passages, cytopathic effect was observed, and we isolated the MERS-CoV strain from South Korea (KOR/KNIH/002_05_2015) from the Vero cells after inoculation by using the sputum from patient 2. We constructed a phylogenetic tree by using the general time reversible plus gamma model of the RAxML version 8.8.0 software (10) and FigTree version 1.4.2 ( and by using complete genomes of the MERS-CoV isolate from South Korea (GenBank accession no. KT029139) and 67 reference MERS-CoVs (Figure 2).



Because, to our knowledge, cases of MERS-CoV infection in South Korea have not been reported, we had to establish laboratory testing protocols to overcome vulnerabilities in the absence of appropriate epidemiologic support (i.e., generate positive controls to check for contamination and repeat testing). Positive controls containing foreign genes have been generated to check for laboratory contamination. For patients with an unclear exposure history (such as the index patient) and for patients with short exposure durations and unusual clinical symptoms (such as patients 2 and 3), it would be useful if the positive results of rRT-PCR could be confirmed through agarose gel electrophoresis to exclude contamination from the positive control (3,4).

The index patient had no history of potential exposure to camels, bats, or their excreta; to symptomatic persons; or to health care workers during his trip to the Middle East, including Saudi Arabia. Although the source of infection for the index patient is unclear, phylogenetic analysis of the whole viral genome showed that the isolate from South Korea was closely related to the MERS-CoV strains isolated in Saudi Arabia in 2015.

Because the index patient initially concealed his travel history to Saudi Arabia and Qatar, MERS-CoV infection was not considered and the patient was not isolated until MERS-CoV infection was confirmed 9 days after symptom onset. Meanwhile, other patients and health care workers had multiple opportunities for exposure to the index patient (35). The 2 contacts reported here had each been exposed to the index patient. Patient 3 was probably infected via droplet transmission in the hospital room. The hospital room, originally built for 6 persons, had been divided into 2 rooms and lacked ventilation. Furthermore, an air conditioning unit cycled the air in the room with the door and window closed. Thus, poor ventilation might have played a major role in droplet transmission. Detection of MERS-CoV RNA in the respiratory tract varies up to day 33 (1113). In this study, virus was detected in the respiratory tract, inconsistently, for up to 44 days.

Development of effective preventive measures for the MERS-CoV prevention will require systemic and prospective studies associated with viral shedding and use of specimens in addition to those obtained from the respiratory tract to define the kinetics of MERS-CoV. Rapid detection of MERS-CoV, using multiplex rRT-PCR to detect upE and ORF1a genes, would be helpful for countries outside the Arabian Peninsula.


Dr. Yang is a staff scientist in Korea National Institute of Health, Korea Centers for Disease Control and Prevention. Her research encompasses the diagnosis, immune response, viral pathogenesis, epidemiology of respiratory viruses with a particular interest in emerging virus identification.



This study was supported by grants from the Intramural Research Fund no.2014-N47001-00 of the Korea National Institute of Health and the Intramural Fund no.4834-300-210-13 of the Korea Centers for Disease Control and Prevention.



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Suggested citation for this article: Yang JS, Park S, Kim YJ, Kang HJ, Kim H, Han YW, et al. Middle East respiratory syndrome in 3 persons, South Korea, 2015. Emerg Infect Dis. 2015 Nov [date cited].

DOI: 10.3201/eid2111.151016



#Heterosubtypic #immunity to #H7N9 #influenza #virus in isogenic guinea pigs after #infection with #pandemic #H1N1 virus (Vaccine, abstract, edited)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Vaccine. 2015 Aug 25. pii: S0264-410X(15)01165-2. doi: 10.1016/j.vaccine.2015.08.038. [Epub ahead of print]

Heterosubtypic immunity to H7N9 influenza virus in isogenic guinea pigs after infection with pandemic H1N1 virus. [      ]

Wiersma LC1, Vogelzang-van Trierum SE1, Kreijtz JH1, van Amerongen G2, van Run P1, Ladwig M3, Banneke S3, Schaefer H4, Fouchier RA1, Kuiken T1, Osterhaus AD2, Rimmelzwaan GF5.

Author information: 1Department of Viroscience, Erasmus Medical Centre, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands. 2Department of Viroscience, Erasmus Medical Centre, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands; Viroclinics Biosciences B.V., Rotterdam Science Tower, Marconistraat 16, 3029 AK Rotterdam, The Netherlands. 3Department of Experimental Toxicology and Centre for Documentation and Evaluation of Alternatives to Animal Experiments, The Federal Institute for Risk Assessment, Diedersdorfer Weg 1, 12277 Berlin, Germany. 4Experimental Immunology, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany. 5Department of Viroscience, Erasmus Medical Centre, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands; Viroclinics Biosciences B.V., Rotterdam Science Tower, Marconistraat 16, 3029 AK Rotterdam, The Netherlands. Electronic address:



Heterosubtypic immunity is defined as immune-mediated (partial) protection against an influenza virus induced by an influenza virus of another subtype to which the host has not previously been exposed. This cross-protective effect has not yet been demonstrated to the newly emerging avian influenza A viruses of the H7N9 subtype. Here, we assessed the induction of protective immunity to these viruses by infection with A(H1N1)pdm09 virus in a newly developed guinea pig model. To this end, ten female 12-16 week old strain 2 guinea pigs were inoculated intratracheally with either A(H1N1)pdm09 influenza virus or PBS (unprimed controls) followed 4 weeks later with an A/H7N9 influenza virus challenge. Nasal swabs were taken daily and animals from both groups were sacrificed on days 2 and 7 post inoculation (p.i.) with A/H7N9 virus and full necropsies were performed. Nasal virus excretion persisted until day 7 in unprimed control animals, whereas only two out of seven H1N1pdm09-primed animals excreted virus via the nose. Infectious virus was recovered from nasal turbinates, trachea and lung of all animals at day 2 p.i., but titers were lower for H1N1pdm09-primed animals, especially in the nasal turbinates. By day 7 p.i., relatively high virus titers were found in the nasal turbinates of all unprimed control animals but infectious virus was isolated from the nose of only one of four H1N1pdm09-primed animals. Animals of both groups developed inflammation of variable severity in the entire respiratory tract. Viral antigen positive cells were demonstrated in the nasal epithelium of both groups at day 2. The bronchi(oli) and alveoli of unprimed animals showed a moderate to strong positive signal at day 2, whereas H1N1pdm09-primed animals showed only minimal positivity. By day 7, only viral antigen positive cells were found after H7N9 virus infection in the nasal turbinates and the lungs of unprimed controls. Thus infection with H1N1pdm09 virus induced partially protective heterosubtypic immunity to H7N9 virus in (isogenic) guinea pigs that could not be attributed to cross-reactive virus neutralizing antibodies.

Copyright © 2015. Published by Elsevier Ltd.

KEYWORDS: Heterosubtypic immunity; Influenza; Isogenic guinea pig

PMID: 26319067 [PubMed - as supplied by publisher]