24 Apr 2014

Jiangsu Province reported a new human case of H7N9 avian influenza infection (DoH, April 24 2014, edited)

[Source: Jiangsu Province Department of Health, full page: (LINK). Automatic translation from Chinese.]

Jiangsu Province reported a new human case of H7N9 avian influenza infection

Published :2014-04-24

Provincial Health Department, the province added a case of human infection of H7N9 avian influenza confirmed case.

The case is a male, 51 years old, [Ryu]. Confirmed on April 23, currently in a Zhenjiang City hospital in critical condition.

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23 Apr 2014

Saudi Arabia Ministry of Health reported thirteen new MERS-CoV cases (April 23 2014, edited)

[Source: Saudi Arabia Ministry of Health, full page: (LINK). Automatic translation from Arabic.]

Saudi Arabia Ministry of Health reported thirteen new MERS-CoV cases

(April 23 2014)

  • The total number of confirmed cases recently: 13 cases
    • distribution of cases on the cities of the Kingdom:
      • 5 cases in the city of Riyadh
      • 2 two cases in the province of Jeddah
      • 4 cases in Mecca
      • one case in Medina
      • one case reported by Jordan ex Saudi
    • distribution of cases to hospitals Kingdom
      • 5 cases at the military hospital in Riyadh
      • one case in the King Faisal Specialist Hospital in Jeddah
      • one case in one hospital in Medina
      • one case at a hospital security forces in the capital of Mecca
      • 3 cases in a hospital in the capital of the Holy Light
    • health status of the cases: 
      • one case without symptoms
      • 3 cases of stable
      • one case a stable – Jordan
      • 6 cases in intensive care
      • 2 deaths
  • Details of the cases
    • 1 / 80 years old, w/ diabetes, high blood pressure and chronic kidney failure and cancer in the blood, he entered the military hospital in Riyadh on the date 28/03/2014, died in the history of God's mercy 04/22/2014 AD.
    • 2 / 69 years old, w/ diabetes, high blood pressure, entered a military hospital in Riyadh on 18/04/2014 AD complaining of symptoms of diabetic foot, then was hit by pneumonia, sleeping in the hospital on an artificial respiratory system.
    • 3 / 70 years, w/ heart disease and chronic lung disease entered the military hospital in Riyadh on 04/04/2014 AD pneumonia, hypnotic in the hospital on an artificial respiratory system.
    • 4 / 72 years old, w/ diabetes and high blood pressure, entered a military hospital in Riyadh on 05/04/2014 AD and then was hit by pneumonia sleeping in the hospital on an artificial respiratory system.
    • 5 / 88 years, w/ diabetes and high blood pressure, stroke, he entered the military hospital in Riyadh on 27/03/2014. Then suffered pneumonia and his health condition is stable.
    • 6 / 41 years, contact of a confirmed cases in Jeddah, no symptoms.
    • 7 / 74 years, entered the King Faisal Specialist Hospital in Jeddah on 14.04.2014 AD suffer from the symptoms of anemia, showed symptoms of pneumonia on 4/20/2014 m sleeping in intensive care.
    • 8 / 46 years old, entered the hospital security forces in the capital of the Holy m on 21/04/2014 respiratory symptoms in intensive care.
    • 9 /  68 years old. entered the hospital in the capital of the Holy Light on 04/12/2014 AD, as a result of a negative sample on 04/14/2014 AD, became positive on 04.22.2014 AD in intensive care.
    • 10 / pilgrims Turkish national, 65 years, Al Noor Hospital in the capital of the Holy respiratory symptoms, his health condition is stable.
    • 11 / resident Barmawi citizenship, 52 years old, entered the hospital in the capital of the Holy Light on 04/18/2014 AD, died on 22.04.2014 AD.
    • 12 / 13 years, W/ asthma, it appeared respiratory symptoms on 09/04/2014 AD, entered the hospital one of Medina on 21/04/2014 AD stable condition.
    • 13 / reported by Jordan, 25 years old, of conservative Qurayyat, has been reported to the ministry the outcome examined positive, still in Jordan and his health condition is stable.
  • two deaths of two patients had their condition suspected and confirmed are as follows:
    • resident works in the health field in Al-Kharj is 45 years old and suffering from chronic diseases, and he passed away on 4/21/2014 m
    • citizen at the age of 29 years suffered infections from the community and died in King Fahd Hospital in Jeddah on 22/4 / 2014

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Bird Flu Found on California Quail Farm Spurs Export Bans (Bloomberg, April 23 2014)

[Source: Bloomberg, full page: (LINK).]

Bird Flu Found on California Quail Farm Spurs Export Bans

The disease known as bird flu has been found on a quail farm in California, prompting countries including Russia to ban poultry shipments from the state.

(…)

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MERS–Related Betacoronavirus in Vespertilio superans Bats, China (Emerg Infect Dis., abstract, edited)

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

Volume 20, Number 7—July 2014  / Letter

MERS–Related Betacoronavirus in Vespertilio superans Bats, China

To the Editor:

Middle East respiratory syndrome coronavirus (MERS-CoV), a novel lineage C betacoronavirus, was first described in September 2012, and by April 16, 2014, the virus had caused 238 infections and 92 deaths in humans worldwide (1). Antibodies against MERS-CoV in dromedary camels were recently reported (2), as was the full genome of MERS-CoV from dromedary camels (3). Finding the natural reservoir of MERS-CoV is fundamental to our ability to control transmission of this virus to humans (4).

We report a novel lineage C betacoronavirus identified from Vespertilio superans bats in China. The full-length genome of this betacoronavirus showed close genetic relationship with MERS-CoV. Together with other evidence of MERS-CoV–related viruses in bats (58), our findings suggest that bats might be the natural reservoirs of MERS-related CoVs.

In June 2013, we collected anal swab samples from 32 V. superans bats from southwestern China. A small proportion of each sample was pooled (without barcoding) and processed by using virus particle–protected nucleic acid purification and sequence-independent PCR for next-generation sequencing analysis with the Illumina (Solexa) Genome Analyzer II (Illumina, San Diego, CA, USA). Redundant reads were filtered, as described (9), from the raw sequencing reads generated by the genome analyzer and then aligned with the nonredundant protein database of the National Center for Biotechnology Information (ftp://ftp.ncbi.nlm.nih.gov/blast/db/) by using BLAST (http://blast.ncbi.nlm.nih.gov ). The taxonomy of these aligned reads was parsed by using MEGAN 4 (http://ab.inf.uni-tuebingen.de/software/megan/ ).

On the basis of the BLAST results, 8,751,354 sequence reads 81 nt in length were aligned with the protein sequences of the nonredundant protein database: 72,084 of the reads were uniquely matched with virus proteins. Of these 72,084 reads, 32,365 were assigned to the family Coronaviridae, primarily to lineage C of the genus Betacoronavirus, and found to share 60%–97% aa identity with MERS-CoV.

The MERS-CoV–related reads were extracted and assembled by using SeqMan software from the Lasergene 7.1.0 program (DNASTAR, Madison, WI, USA), resulting in a draft CoV genome. Reverse transcription PCR selective for the partial RNA-dependent RNA polymerase (RdRp) gene of this novel lineage C betacoronavirus suggested that 5 of the 32 samples (≈16%) were positive for the novel betacoronavirus, and the PCR amplicons shared >98% nt identity with each other. Using a set of overlapped nested PCRs and the rapid amplification of cDNA ends method, we determined the full-length genome of 1 strain of this V. superans bat–derived betacoronavirus (referred to as BtVs-BetaCoV/SC2013, GenBank accession no. KJ473821).

The betacoronavirus strain had a genome length of 30,413 nt, excluding the 3′ poly (A) tails, and a G+C content of 43.1%. Pairwise genome sequence alignment, conducted by the EMBOSS Needle software (www.ebi.ac.uk/Tools/psa/emboss_needle/) with default parameters, suggested that the genome sequence of BtVs-BetaCoV/SC2013 showed 75.7% nt identity with that of human MERS-CoV (hCoV-MERS); this shared identity is higher than that for other lineage C betacoronaviruses (from bats and hedgehogs) with full genomes available. hCoV-MERS showed 69.9% nt identity with bat CoV (BtCoV) HKU4-1, 70.1% nt identity with BtCoV-HKU5-1, and 69.6% nt identity with hedgehog CoV EriCoV-2012–174.

Compared with those lineage C betacoronaviruses, which had an 816-bp partial RdRp sequence fragment available, BtVs-BetaCoV/SC2013 shared 96.7 % aa identity with hCoV-MERS. Pipistrellus BtCoVs found in Europe (BtCoV-8-724, BtCoV-8-691, BtCoV-UKR-G17) shared 98.2 % aa identity with hCoV-MERS, and Eptesicus BtCoV found in Italy (BtCoV-ITA26/384/2012) and other lineage C betacoronaviruses shared 96.3 % aa and <95% aa identity, respectively, with hCoV-MERS.

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Figure

Thumbnail of Phylogenetic trees based on the deduced amino acid sequences of the partial RNA-dependent RNA polymerase (RdRp; an 816-nt sequence fragment corresponding to positions 14817–15632 in human Middle East respiratory syndrome coronavirus [hCoV-MERS; KF192507]) and complete spike (S) protein. The novel virus is shown in gray, and hCoV-MERS is shown in bold. The following coronaviruses were used (GenBank accession numbers are shown in parentheses): severe acute respiratory syndrome coronav

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Figure. Phylogenetic trees based on the deduced amino acid sequences of the partial RNA-dependent RNA polymerase (RdRp; an 816-nt sequence fragment corresponding to positions 14817–15632 in human Middle East respiratory syndrome coronavirus...

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To clarify the evolutionary relationship between BtVs-BetaCoV/SC2013 and other lineage C betacoronaviruses, we performed phylogenetic analyses based on the deduced RdRp and the spike, envelope, membrane, and nucleocapsid proteins by using MEGA5 (www.megasoftware.net) (Figure; Technical Appendix  [PDF - 247 KB - 1 page]). For RdRp and the envelope, membrane, and nucleocapsid proteins, BtVs-BetaCoV/SC2013 always clustered with hCoV-MERS with short branch lengths, reflecting their high sequence similarities.

In the spike protein phylogenetic tree, BtVs-BetaCoV/SC2013 clustered with a clade defined by BtCoV-HKU5, with which it shares 74.8% aa identity. The spike proteins of hCoV-MERS form a sister clade of the clade defined by HKU5 BtCoVs and BtVs-betaCoV/SC2013, and the spike proteins share 69.0% aa identity with BtVs-betaCoV/SC2013. Spike proteins of BtVs-BetaCoV/SC2013, HKU5 BtCoVs, HKU4 BtCoVs, and hCoV-MERS, rather than EriCoV-2012-174, EriCoV-2012-216, and BtCoV-KW2E-F93, form a super clade. Spike protein is the critical factor for receptor recognition, binding, and cellular entry of CoVs in different host species (10), which may explain why the spike proteins in our study were relatively conserved within the same host species.

We identified a novel lineage C betacoronavirus from a V. superans bat and determined its full-length genome sequence. This novel betacoronavirus represents one of the most MERS-like CoVs that have been identified in bats as of the end of March 2014. The full-length genome sequence of the novel virus showed a closer genetic relationship with hCoV-MERS and camel MERS-CoV than with any other fully sequenced lineage C betacoronaviruses previously identified in bats or hedgehogs. Further studies of CoVs from more bat species worldwide may, therefore, help provide additional clues to the origins of pathogenic hCoV-MERS.

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Li Yang1, Zhiqiang Wu1, Xianwen Ren1, Fan Yang1, Junpeng Zhang, Guimei He, Jie Dong, Lilian Sun, Yafang Zhu, Shuyi Zhang, and Qi Jin

Author affiliations: Ministry of Health Key Laboratory of Systems Biology of Pathogens, Beijing, China (L. Yang, Z. Wu, X. Ren, F. Yang, J. Dong, L. Sun, Y. Zhu, Q. Jin); Institute of Pathogen Biology, Beijing (L. Yang, Z. Wu, X. Ren, F. Yang, J. Dong, L. Sun, Y. Zhu, Q. Jin); East China Normal University, Shanghai, China (J. Zhang, G. He, S. Zhang)

 

Acknowledgment

This work was supported by the National S&T Major Project, “China Mega-Project for Infectious Disease” (grant nos. 2011ZX10004-001 and 2014ZX10004001) from the Chinese government.

 

References

  1. MERS-CoV—Eastern Mediterranean. ProMED-mail 2014 Apr 16 [cited 2014 Apr 16]. http://www.promedmail.org/, archive no. 20140416.2406647.
  2. Meyer B, Muller MA, Corman VM, Reusken CB, Ritz D, Godeke GJ, Antibodies against MERS coronavirus in dromedary camels, United Arab Emirates, 2003 and 2013. Emerg Infect Dis. 2014;20:552–9. DOIPubMed
  3. Hemida MG, Chu DKW, Poon LLM, Perera RAPM, Alhammadi MA, Ng HY, MERS coronavirus in dromedary camel herd, Saudi Arabia. Emerg Infect Dis. [Epub ahead of print]. 2014 Jul [cited 2014 Apr 19].
  4. Corman VM, Kallies R, Philipps H, Gopner G, Muller MA, Eckerle I, Characterization of a novel betacoronavirus related to middle East respiratory syndrome coronavirus in European hedgehogs. J Virol. 2014;88:717–24. DOIPubMed
  5. De Benedictis P, Marciano S, Scaravelli D, Priori P, Zecchin B, Capua I, Alpha and lineage C betaCoV infections in Italian bats. Virus Genes. 2014;48:366–71. DOIPubMed
  6. Annan A, Baldwin HJ, Corman VM, Klose SM, Owusu M, Nkrumah EE, Human betacoronavirus 2c EMC/2012-related viruses in bats, Ghana and Europe. Emerg Infect Dis. 2013;19:456–9. DOIPubMed
  7. Memish ZA, Mishra N, Olival KJ, Fagbo SF, Kapoor V, Epstein JH, Middle East respiratory syndrome coronavirus in bats, Saudi Arabia. Emerg Infect Dis. 2013;19:1819–23. DOIPubMed
  8. Wacharapluesadee S, Sintunawa C, Kaewpom T, Khongnomnan K, Olival KJ, Epstein JH, Group C betacoronavirus in bat guano fertilizer, Thailand. Emerg Infect Dis. 2013;19:1349–51.PubMed
  9. Wu Z, Ren X, Yang L, Hu Y, Yang J, He G, Virome analysis for identification of novel mammalian viruses in bat species from Chinese provinces. J Virol. 2012;86:10999–1012. DOIPubMed
  10. Perlman S, Netland J. Coronaviruses post-SARS: update on replication and pathogenesis. Nat Rev Microbiol. 2009;7:439–50. DOIPubMed

 

Figure

Figure. Phylogenetic trees based on the deduced amino acid sequences of the partial RNA-dependent RNA polymerase (RdRp; an 816-nt sequence fragment corresponding to positions 14817–15632 in human Middle East respiratory syndrome...

 

Technical Appendix

Technical Appendix. Phylogenetic trees of a novel Middle East respiratory syndrome–related coronavirus, human Middle East respiratory syndrome coronaviruses, severe acute respiratory syndrome virus, and various other coronaviruses.  247 KB

____

Suggested citation for this article: Yang L, Wu Z, Ren X, Yang F, Zhang J, He G, et al. MERS–related betacoronavirus in Vespertilio superans bats, China [letter]. Emerg Infect Dis. 2014 July [date cited]. http://dx.doi.org/10.3201/eid2007.140318

DOI: 10.3201/eid2007.140318

1These authors contributed equally to this article.

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Coronavirus MERS: 11 nouvelles contaminations en Arabie saoudite (Le Temps d'Algérie, April 23 2014)

[Source: Le Temps d’Algérie, full page: (LINK).]

Coronavirus MERS: 11 nouvelles contaminations en Arabie saoudite

Santé-Coronavirus MERS: 11 nouvelles contaminations en Arabie saoudite. Onze nouveaux cas de contamination par le coronavirus MERS ont été enregistrés en Arabie saoudite, a annoncé mercredi le nouveau ministre saoudien de la Santé, tout en affirmant que la maladie qui a provoqué 81 décès dans le royaume n'avait pas atteint le stade d'épidémie.

(…)

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Hong Kong, Patient with respiratory symptoms and travel history under CHP investigation (April 23 2014)

[Source: Centre for Health Protection, Hong Kong PRC SAR, full page: (LINK).]

Patient with respiratory symptoms and travel history under CHP investigation

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (April 23) investigating a suspected case of Middle East Respiratory Syndrome (MERS) affecting a woman aged 30 in Queen Mary Hospital (QMH).

The patient, with good past health, has presented with fever, cough, runny nose, sore throat and malaise since yesterday (April 22). She attended QMH's Accident and Emergency Department today and was admitted for management under isolation. She is now in stable condition.

Initial investigations by the CHP revealed that the patient had travelled to the Kingdom of Saudi Arabia with her family from April 15 to 21, during which she had no contact with animals or patients. Her son has had fever and cough since April 15 and his fever has already subsided. The other travel collateral has remained asymptomatic.

Her respiratory specimen will be taken for preliminary laboratory testing by the CHP's Public Health Laboratory Services Branch (PHLSB).

Locally, the DH's surveillance mechanism with public and private hospitals, practising doctors and at the airport is well in place. Suspected cases identified will be sent to public hospitals for isolation and management until their specimens test negative for MERS Coronavirus (MERS-CoV).

"As pre-existing major illnesses can increase the likelihood of medical problems, including MERS, during travel, in view of recent pilgrimage activities, pilgrims should consult a health-care provider before travelling to assess whether it is medically advisable," a spokesman for the DH said.

"MERS is a statutorily notifiable infectious disease and the PHLSB is capable of detecting the virus. No human cases have been recorded so far in Hong Kong," the spokesman stressed.

"The Government will be as transparent as possible in the dissemination of information. Whenever there is a suspected case, particularly involving patients with travel history to the Middle East, the CHP will release information to the public as soon as possible," the spokesman remarked.

Early identification of MERS-CoV is important, but not all cases can be detected in a timely manner, especially mild or atypical cases. Health-care workers (HCWs) should maintain vigilance and adhere to strict infection control measures while handling suspected or confirmed cases to reduce the risk of transmission to other patients, HCWs or visitors. Regular education should be provided.

Travellers returning from the Middle East who develop respiratory symptoms should wear face masks, seek medical attention and reveal their travel history. MERS-CoV should be tested for. Patients' lower respiratory tract specimens should also be diagnosed when possible and repeat testing should be done when clinical and epidemiological clues strongly suggest MERS.

Members of the public are reminded to take heed of personal, food and environmental hygiene:

  • Avoid going to farms and barns;
  • Avoid contact with animals (especially camels), birds, poultry or sick people during travel;
  • Wash hands regularly before and after touching animals in case of visits to farms or barns;
  • Seek medical consultation immediately if feeling unwell;
  • Avoid visits to health-care settings with MERS patients;
  • Wash hands before touching the eyes, nose and mouth, and after sneezing, coughing or cleaning the nose;
  • Wash hands before eating or handling food, and after using the toilet; and
  • Avoid undercooked meats, raw fruits, vegetables (unless peeled) and unsafe water.

The public may visit the CHP's MERS page (www.chp.gov.hk/en/view_content/26511.html), the DH's Travel Health Service (www.travelhealth.gov.hk/english/popup/popup.html ) or the World Health Organization's latest news (www.who.int/csr/don/archive/disease/coronavirus_infections/en/ ) for more information and health advice.

 

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Saudi Arabia reports 11 new cases of MERS virus, first in Mecca (Reuters, April 23 2014)

[Source: Reuters, full page: (LINK).]

Saudi Arabia reports 11 new cases of MERS virus, first in Mecca

Source: Reuters - Wed, 23 Apr 2014 09:34 AM / Author: Reuters

ABU DHABI, April 23 (Reuters) - Saudi Arabia said on Wednesday it had discovered 11 more cases of the potentially deadly Middle East Respiratory Syndrome (MERS), including what appeared to be the first case in the Muslim holy city of Mecca.

(…)

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Saudi Arabia, Statement of the newly appointed Minister of Health (April 23 2014, edited)

[Source: Saudi Arabia Ministry of Health, full page in Arabic: (LINK). Automatic translation.]

Saudi Arabia, Statement of the newly appointed Minister of Health 

(April 23 2014)

With interest in the health of the citizens of our wise leadership as a high priority, had the privilege of receipt of the Royal Order of the Custodian of the Two Holy Mosques King Abdullah bin Abdulaziz Al-Saud "may God protect him," which eliminates entrusted me to serve as the Minister of Health. Thankful for substitute Karim confidence that Olaneha expensive, and confirming my desire to do everything I can to be the subject of this trust and Welcome to Hassan thinks.

The promised shortly before a visit to the King Fahd Hospital in Jeddah to inspect the cases of infection with Corona included a number of patients, including colleagues from the Ministry of Health employees and citizens. And heard a briefing from the medical team treating the cases of those who visited them injured. I was pleased that some of the patients recovered, and thankfully, although there were several other cases are still under critical for treatment and follow-up continuously.

On the basis of the size of this responsibility, I assure my commitment to complete the following:

  • First, we pledge - my colleagues and I - in communion with permanent community, and his results of the follow-up and audit work by the Ministry of Health at the moment.
  • Secondly, I emphasize my desire to adhere to the principle of transparency and disclosure, with the media and all members of the community, and provide access to timely information easily and smoothly, and that's not just because of your right we get this information, but also for being shareholders us to overcome this difficult challenge, as the combined efforts of interested parties and all members of society with the ministry will not be achieved unless the availability of the right information to have.
  • Finally, to assure that the health and safety of this community a top priority for the Custodian of the Two Holy Mosques (may Allah protect him), who directed me not to spare the Ministry of Health effort to provide investigating citizens 'health and safety, stressing to me (may Allah protect him) that the citizens' health and safety are the most expensive and the most precious thing at home.

Again, I would like to thank the Custodian of the Two Holy Mosques (may Allah protect him) on the confidence expensive, and underline my commitment to work together with you; together to overcome these challenges.

May Allah guide us all to the community health and safety.

Adel bin Mohammed Faqih, Grandmother, 22 Jumada II 1435 AH, April 22, 2014 AD

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Middle East respiratory syndrome coronavirus (MERS-CoV) – update (WHO, April 23 2014, edited)

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

Middle East respiratory syndrome coronavirus (MERS-CoV) – update

Disease Outbreak News / 23 April 2014

On 21 April 2014, 18 April 2014 and 16 April 2014, the Ministry of Health of the United Arab Emirates (UAE) reported an additional 9 laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV).

The following details were provided to WHO on 21 April 2014 by the Ministry of Health UAE:

  • A 52 year-old woman from Abu Dhabi.
    • She became ill and was admitted to a hospital on 16 April.
    • She has underlying medical conditions and is currently in a stable condition.
    • The patient travelled to Jeddah, Saudi Arabia from 5-16 April, where she visited the hospital 3 times.
    • She has no history of contact with animals.
    • All her contacts are being investigated.

The following details were provided to WHO on 18 April by the Ministry of Health UAE:

  • A 63 year-old woman from Abu Dhabi who had close contact with a previously laboratory-confirmed case reported on 14 April.
    • She was screened on 13 April and became ill on 15 April.
    • She is reported to have an underlying medical condition.
    • She is reported to have no exposure to animals or a recent travel history.
  • A 73 year-old woman from Abu Dhabi who has been an in-patient at the hospital since 26 February due to other illnesses.
    • She has underlying medical conditions.
    • The patient was admitted to the intensive care unit (ICU) on 14 April.
    • She is reported to have no exposure to animals or a recent travel history.

Globally, from September 2012 to date, WHO has been informed of a total of 253 laboratory-confirmed cases of infection with MERS-CoV, including 93 deaths.

Case totals published in the Disease Outbreak News on MERS-CoV on 20 April 2014, already included the 6 laboratory-confirmed cases reported from the UAE on 16 April, 2014 below.

The following details were provided to WHO on 16 April 2014 by the Ministry of Health UAE:

All the cases are from Abu Dhabi and have had close contact with a laboratory-confirmed case reported on 10 April.

To date, the cases are kept in isolation in a hospital and are well.

Screening of other health care contacts and family members are ongoing.

  • A 52 year-old woman who had mild illness on 9 April and was screened on 10 April. She is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
  • A 28 year-old who was screened on 10 April. He has no illness and is reported not to have any underling medical condition and does not have exposure to animals or a recent travel history.
  • A 59 year-old man who was screened on 12 April. He has no illness. He is reported to have an underlying medical condition. He is reported not to have exposure to animals or a recent travel history.
  • A 28 year-old man who was screened on 10 April. He developed mild illness on 11 April. He is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
  • A 55 year-old woman who was screened on 12 April. She developed mild illness on 8 April. She is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
  • A 28 year-old woman who was screened on 10 April. She developed mild illness on 8 April. She is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.

 

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) 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. Health-care facilities that provide for patients suspected or confirmed to be infected with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus from an infected patient to other patients, health-care workers and visitors. Health care workers should be educated, trained and refreshed with skills on infection prevention and control.

It is not always possible to identify patients with MERS-CoV early because some have mild or unusual symptoms. For this reason, it is important that health-care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices all the time.

Droplet precautions should be added to the standard precautions when providing care to all 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.

Patients should be managed as potentially infected when the clinical and epidemiological clues strongly suggest MERS-CoV, even if an initial test on a nasopharyngeal swab is negative. Repeat testing should be done when the initial testing is negative, preferably on specimens from the lower respiratory tract.

Health-care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.

People at high risk of severe disease due to MERS-CoV should avoid close contact with animals when visiting farms or barn areas where the virus is known to be potentially circulating. For the general public, when visiting a farm or a barn, general hygiene measures, such as regular hand washing before and after touching animals, avoiding contact with sick animals, and following food hygiene practices, should be adhered to.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

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Highly pathogenic avian influenza H5N1, Korea (Dem. People's Rep.) (OIE World Animal Health Information System, April 23 2014, edited)

[Source: OIE, full page: (LINK). Edited.]

Highly pathogenic avian influenza H5N1, Korea (Dem. People's Rep.)

Information received on 22/04/2014 from Mr Ri Kyong Gun, Director of the Veterinary and, Ministry of Agriculture, Anti-Epizootic Department, PYONGYANG, Korea (Dem. People's Rep.) 

  • Summary
    • Report type Follow-up report No. 1
    • Date of start of the event 21/03/2014
    • Date of pre-confirmation of the event 26/03/2014
    • Report date 22/04/2014
    • Date submitted to OIE 22/04/2014
    • Reason for notification Reoccurrence of a listed disease
    • Date of previous occurrence 09/05/2013
    • Manifestation of disease Clinical disease
    • Causal agent Highly pathogenic avian influenza virus
    • Serotype H5N1
    • Nature of diagnosis Clinical, Laboratory (advanced)
    • This event pertains to the whole country
    • Related reports
      • Immediate notification (16/04/2014)
      • Follow-up report No. 1 (22/04/2014)
  • New outbreaks (1)
    • Outbreak 1  - Ryonggung ri, Hwangju county, HWANGHAE-BUKTO
      • Date of start of the outbreak 10/04/2014
      • Outbreak status Continuing (or date resolved not provided)
      • Epidemiological unit Village
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds  - 501 – 501 – 136 – 365 – 0
        • Affected population Chickens and geese
  • Summary of outbreaks
    • Total outbreaks: 1
      • Total animals affected: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 501 – 501 – 136 – 365 – 0
      • Outbreak statistics: Species - Apparent morbidity rate - Apparent mortality rate - Apparent case fatality rate  - Proportion susceptible animals lost*
        • Birds - 100.00% - 27.15% - 27.15% - 100.00%
        • *Removed from the susceptible population through death, destruction and/or slaughter
  • Epidemiology
    • Source of the outbreak(s) or origin of infection
      • Unknown or inconclusive
  • Epidemiological comments
    • All birds in infected cages were killed by formalin gas of 60g per m3. 
  • Control measures
    • Measures applied
      • Control of wildlife reservoirs
      • Stamping out
      • Quarantine
      • Movement control inside the country
      • Screening
      • Zoning
      • Vaccination in response to the outbreak (s)
        • Administrative division – Species - Total Vaccinated – Details
          • HWANGHAE-BUKTO – Birds – 20000 – 20000 chickens 
          • P'YONGYANG-SI – Birds – 530000 – 240000 chickens in Hadang Chicken Factory and 290000 chickens in Sopo Chicken Factory
      • Disinfection of infected premises/establishment(s)
      • No treatment of affected animals
    • Measures to be applied
      • No other measures
  • Diagnostic test results
    • Laboratory name and type – Species – Test - Test date – Result
      • Central Veterinary Station (National laboratory) – Birds - enzyme-linked immunosorbent assay (ELISA)  - 26/03/2014 – Positive
      • Central Veterinary Station (National laboratory) – Birds - enzyme-linked immunosorbent assay (ELISA)  - 10/04/2014 – Positive
      • Veterinary Research Institute, Academy of Agriculture Science (National laboratory) – Birds - reverse transcription - polymerase chain reaction (RT-PCR) - 26/03/2014 – Positive
  • Future Reporting
    • The event is continuing. Weekly follow-up reports will be submitted.

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