Welcome to A Time's Memory Blog

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A TIME'S MEMORY - Flu, Bugs & Other Accidents Blog - Year: XIII - Here, Reader, you will find many items if your interests are in the field of emerging threats to global or public health, with a perspective that is not mainstream. Thank to You for the interest!

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15 Nov 2018

#Ebola virus disease #Outbreak in #DRC (@WHO, Nov. 15 ‘18)

          

Title:

#Ebola virus disease #Outbreak in #DRC.

Subject:

Ebola Virus Disease Outbreak in the Dem. Rep. of Congo, current situation.

Source:

World Health Organization (WHO), full page: (LINK).

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Disease outbreak news: Update | 15 November 2018


New measures to overcome obstacles in responding to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo are having a positive impact. The Ministry of Health (MoH), WHO and partners continue to be confident that, despite challenges, the outbreak can be contained.

Over the past week (7 – 13 November), transmission continued in several areas of North Kivu Province, while a geographical expansion of the outbreak to two new health zones (Kyondo and Mutwanga) was observed (Figure 1). The first cases reported from these health zones were exposed through contact with cases in Butembo and Beni, respectively.

During the reporting period, 31 new confirmed EVD cases were reported from Beni, Mutwanga, Kalunguta, Butembo, Vuhovi, Kyondo and Musienene.

Four of the new cases were newborn babies and infants aged less than two years, three were children aged between 2 – 17 years and three were women who were pregnant or breastfeeding.

Three health workers from Beni and Butembo were among the newly infected; 31 health workers have been infected to date.

Twelve additional survivors were discharged from Beni (nine), Butembo (two) and Mabalako (one) Ebola treatment centres (ETCs) and reintegrated into their communities; 103 patients have recovered to date.

During the past week, a review and reconciliation of case records was conducted. This review resulted in the addition of 14 probable cases, invalidation of 11 past deaths previously reported as probable cases and exclusion of duplicate cases. In addition, some confirmed and probable cases were recategorized to health zones where their infection most likely occurred, as opposed to the location of the ETC where they were admitted.

As of 13 November, 341 EVD cases (303 confirmed and 38 probable), including 215 deaths (177 confirmed and 38 probable)1, have been reported in 11 health zones in North Kivu Province and three health zones in Ituri Province (Figure 1).

The overall trends in weekly case incidence reflect the continuation of community transmission in several cities and villages in North Kivu (Figure 2). Given the expected delays in case detection and ongoing data reconciliation activities, trends, especially in the most recent weeks, must be interpreted cautiously.

The risk of the outbreak spreading to other provinces in the Democratic Republic of the Congo, as well as to neighbouring countries, remains very high. Over the course of the past week, alerts have been reported from South Sudan and Uganda; EVD has been ruled out for all alerts to date. The vaccination of health and frontline workers at priority sites in Uganda began on 7 November, and preparations are ongoing for the vaccination of health and frontline workers in Rwanda and South Sudan.

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Figure 1: Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 13 November 2018 (n=341)

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Figure 2: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 13 November 2018 (n=341)*

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{*} Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning – trends during this period should be interpreted cautiously.


Public health response

The MoH continues to strengthen response measures, with support from WHO and partners. Priorities include coordinating the response, surveillance, contact tracing, laboratory capacity, infection prevention and control (IPC), clinical management of patients, vaccination, risk communication and community engagement, psychosocial support, safe and dignified burials (SDB), cross-border surveillance and preparedness activities in neighbouring provinces and countries.

To support the MoH, WHO is working intensively with a wide range of multisectoral and multidisciplinary regional and global partners and stakeholders for EVD response, research and urgent preparedness, including in neighbouring countries.

For detailed information about the public health response actions by WHO and partners, see the latest situation reports published by the WHO Regional Office for Africa:


WHO risk assessment

This outbreak of EVD is affecting north-eastern provinces of the country, which border Uganda, Rwanda and South Sudan.

Potential risk factors for transmission of EVD at the national and regional levels include: transportation links between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations; and the displacement of Congolese refugees to neighbouring countries.

The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria), and a long-term humanitarian crisis.

Additionally, the security situation in North Kivu and Ituri at times limits the implementation of response activities.

WHO’s risk assessment for the outbreak is currently very high at the national and regional levels; the global risk level remains low.

WHO continues to advise against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on currently available information.

As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. The IHR Emergency Committee has advised that failing to intensify these preparedness and surveillance activities would lead to worsening conditions and further spread. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.


WHO advice

  • International traffic:
    • WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information.
    • There is currently no licensed vaccine to protect people from the Ebola virus.
    • Therefore, any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for passengers leaving the Democratic Republic of the Congo.
    • WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event.
    • Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo.
    • Travellers should seek medical advice before travel and should practice good hygiene.

For more information, see:

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{1} The number of cases is subject to change due to ongoing reclassification, retrospective investigation, and the availability of laboratory results.

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Keywords: WHO; Updates; Ebola; DRC.

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#Surveillance of #antimicrobial #resistance in #Europe 2017 (@ECDC_EU, summary)

          

Title:

#Surveillance of #antimicrobial #resistance in #Europe 2017.

Subject:

Antimicrobial resistance, current epidemiological situation in the European Region.

Source:

European Centre for Disease Prevention and Control (ECDC), full page: (LINK). Summary, edited.

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Surveillance Report  | 15 Nov 2018 | Publication series: Antimicrobial resistance surveillance in Europe | Time period covered: 2014 - 2017


Abstract

  • EARS-Net data for 2017 show that antimicrobial resistance remains a serious threat in Europe.
  • For invasive bacterial infections, prompt treatment with effective antimicrobial agents is especially important and is one of the single most effective interventions to reduce the risk of fatal outcome.
  • The high percentages of resistance to key antimicrobial groups reported from many countries are therefore of great concern and represent a serious threat to patient safety in Europe.
  • Prudent antimicrobial use and comprehensive infection prevention and control strategies targeting all healthcare sectors are the cornerstones of effective interventions aiming to prevent selection and transmission of bacteria resistant to antimicrobial agents.


Executive summary

  • The results presented in this report are based on antimicrobial resistance data from invasive isolates reported to the European Antimicrobial Resistance Surveillance Network (EARS-Net) by 30 European Union (EU) and European Economic Area (EEA) countries in 2018 (data referring to 2017), and on trend analyses of data reported by the participating countries for the period 2014 to 2017.
  • Despite the political prioritisation of antimicrobial resistance as a threat to public health and the availability of evidence-based guidance for antimicrobial stewardship and infection prevention and control, high levels of resistance remain in the EU/EEA for several bacterial species–antimicrobial group combinations. Intercountry variations also indicate that that there is scope for significant reductions in antimicrobial resistance in many countries through strengthening of current best practice.
  • The antimicrobial resistance situation in Europe displays wide variations depending on the bacterial species, antimicrobial group and geographical region. For several bacterial species–antimicrobial group combinations, a north-to-south and west-to-east gradient is evident. In general, lower resistance percentages were reported by countries in the north while higher percentages were reported in the south and east of Europe.
  • For Escherichia coli and Klebsiella pneumoniae, combined resistance to several antimicrobial groups was frequent, and extended-spectrum beta-lactamase (ESBL) production was common.
    • Resistance percentages were generally higher in K. pneumoniae than in E. coli.
    • For E. coli, there was a small but significant increase in the trend of the EU/EEA population-weighted mean percentage for third-generation cephalosporin resistance from 14.2% in 2014 to 14.9% in 2017, a trend that remained significant when only laboratories reporting consistently during all four years were included.
    • By contrast, no significant trends were noted for the K. pneumoniae EU/ EEA population-weighted mean resistance percentages when restricting analyses to the laboratories that consistently reported data during the four-year period.
  • While carbapenem resistance remained rare in E. coli, several countries reported carbapenem resistance percentages above 10% for K. pneumoniae.
    • Carbapenem resistance was also common in Pseudomonas aeruginosa and Acinetobacter species, and at higher percentages compared with K. pneumoniae.
    • For all four gram-negative bacteria, the countries reporting the highest carbapenem resistance percentages were also among the countries reporting the highest resistance percentages for other antimicrobial groups.
  • For Streptococcus pneumoniae, the resistance situation appeared stable between 2014 and 2017, but with large inter-country variations. Macrolide non-susceptibility was, for most countries, more frequent than penicillin non-susceptibility.
  • For Staphylococcus aureus, the decline in the percentage of meticillin-resistant, i.e. MRSA, isolates reported in previous years continued in 2017.
    • The EU/EEA population-weighted mean MRSA percentage decreased significantly from 19.6% in 2014 to 16.9% in 2017, with similar decreasing trends reported from more than one fourth of the countries.
    • Nevertheless, MRSA remains an important pathogen in the EU/EEA, as the levels of MRSA were still high in several countries, and combined resistance to other antimicrobial groups was common.
  • Among enterococci, the increasing trend of Enterococcus faecium resistant to vancomycin is a cause of concern. The EU/EEA population-weighted mean percentage increased significantly from 10.4% in 2014 to 14.9% in 2017, and corresponding increasing trends were noted in around one third of the countries.

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Download: |-- Surveillance of antimicrobial resistance in Europe 2017 - EN - [PDF-23.7 MB] –|

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Keywords: ECDC; Updates; European Region; Antibiotics; Drugs Resistance.

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14 Nov 2018

Highly pathogenic #avian #influenza #H5N2, #Taiwan [a #poultry #outbreak] (#OIE, Nov. 14 ‘18)

          

Title:

Highly pathogenic #avian #influenza #H5N2, #Taiwan [a #poultry #outbreak].

Subject:

Avian Influenza, H5N2 subtype, poultry epizootics in Taiwan.

Source:

OIE, full page: (LINK).

Code:

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Information received on 14/11/2018 from Dr Chun-Ping Cheng, Secretary General , Bureau of Animal and Plant Health Inspection and Quarantine, Council of Agriculture Executive Yuan, Taipei, Chinese Taipei

  • Summary
    • Report type    Follow-up report No. 115
    • Date of start of the event    07/01/2015
    • Date of confirmation of the event    11/01/2015
    • Report date    13/11/2018
    • Date submitted to OIE    14/11/2018
    • Reason for notification    Recurrence of a listed disease
    • Date of previous occurrence    23/07/2014
    • Manifestation of disease    Clinical disease
    • Causal agent    Highly pathogenic avian influenza virus
    • Serotype    H5N2
    • Nature of diagnosis    Clinical, Laboratory (advanced)
    • This event pertains to    a defined zone within the country 
  • Summary of outbreaks   
    • Total outbreaks: 1
      • Total animals affected: Species    - Susceptible    - Cases    - Deaths    - Killed and disposed of    - Slaughtered
        • Birds    - 640    - 626    - 626    - 14    - 0
      • Outbreak statistics: Species    - Apparent morbidity rate    - Apparent mortality rate    - Apparent case fatality rate    - Proportion susceptible animals lost*
        • Birds    - 97.81%    - 97.81%    - 100.00%    - 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   
    • Samples from Yunlin County were sent to the National Laboratory, Animal Health Research Institute (AHRI) for diagnosis.
    • Highly pathogenic avian influenza H5N2 subtype was confirmed by AHRI.
    • The infected farm has been placed under movement restriction.
    • All animals on the infected farm have been culled.
    • Thorough cleaning and disinfection have been conducted after stamping out operation.
    • Surrounding poultry farms within 3 km radius of the infected farm are under intensified surveillance for three months.

(...)
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Keywords: OIE; Updates; Avian Influenza; H5N2 ; Poultry; Taiwan.

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#Ebola Virus Disease #Outbreak in #DRC – #Situation #Report No. 15 (@WHO, Nov. 14 ‘18)

          

Title:

#Ebola Virus Disease #Outbreak in #DRC – #Situation #Report No. 15.

Subject:

Ebola Virus Disease Outbreak in the Dem. Rep. of Congo, current situation.

Source:

World Health Organization (WHO), via ReliefWeb, full PDF file: (LINK).

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Keywords: WHO; Updates; Ebola; DRC.

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13 Nov 2018

#USA, [Acute Flaccid #Myelitis] #AFM #Investigation (@CDCgov, Nov. 13 ‘18)

          

Title:

#USA, [Acute Flaccid #Myelitis] #AFM #Investigation.

Subject:

Unexplained neurological illness, acute flaccid myelitis (AFM) & paralysis (AFP), post-infectious, current situation in the US.

Source:

US Centers for Disease Control and Prevention (CDC), full page: (LINK).

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Language: [ English (US) | EspaƱol (Spanish) ]

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Summary

  • Acute flaccid myelitis (AFM) is a rare but serious condition.
  • It affects the nervous system, specifically the area of the spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak.
  • CDC has been thoroughly investigating the AFM cases that have occurred since 2014, when we first noted a large number of cases being reported.


What CDC has learned since 2014

  • Most of the patients with AFM (more than 90%) had a mild respiratory illness or fever consistent with a viral infection before they developed AFM.
    • Viral infections such as from enteroviruses are common, especially in children, and most people recover. We don’t know why a small number of people develop AFM, while most others recover. We are continuing to investigate this.
  • These AFM cases are not caused by poliovirus; all patients tested negative for poliovirus.
  • We detected coxsackievirus A16, EV-A71, and EV-D68 in the spinal fluid of four of 414 confirmed cases of AFM since 2014, which points to the cause of their AFM. For all other patients, no pathogen (germ) has been detected in their spinal fluid to confirm a cause.
  • Most patients had onset of AFM between August and October, with increases in AFM cases every two years since 2014. At this same time of year, many viruses commonly circulate, including enteroviruses, and will be temporally associated with AFM.
  • Most AFM cases are children (over 90%) and have occurred in 44 states.


What CDC Is Doing

  • We work closely with national experts, healthcare providers, and state and local health departments to thoroughly investigate AFM by looking for possible risk factors and causes, figuring out why some people develop this condition, monitoring AFM activity nationwide, and updating possible treatment options.
  • Specific activities include:
  • Obtaining National Data and Monitoring AFM Activity
    • Encouraging healthcare providers to recognize and report to their health departments all patients who they suspect may have AFM, then for health departments to send this information to CDC to help us understand AFM activity nationwide
    • Conducting enhanced surveillance for AFM by initiating a study at seven pediatric hospitals across a geographically diverse area of the United States. These hospitals are also conducting surveillance for acute respiratory and gastrointestinal illness and collecting samples for viral testing. Enhancing AFM surveillance at these hospitals will allow a comparison of AFM case counts with current circulating respiratory and gastrointestinal viruses in these locations
    • Supporting states that want to confirm their own cases, by providing standard operating procedures, a medical chart abstraction tool, and training on how to interpret the information. We also created a secure database to collect medical information including symptoms, findings from their clinical exam, treatment, and laboratory test results
    • Collaborating with experts to review MRI scans of people from the past 10 years to estimate how many AFM cases occurred before 2014
  • Confirming Cases of AFM
    • Verifying clinical information of patients under investigation (PUIs) for AFM submitted by health departments, and working with health departments and neurologists to classify cases using a standard case definition adopted by the Council of State and Territorial Epidemiologists (CSTE)
  • Exploring Treatment Options
    • Providing “Interim Considerations for Clinical Management of Patients with AFMin November 2014, in consultation with national experts in infectious diseases, neurology, pediatrics, critical care medicine, public health epidemiology, and virology in response to the rapid emergence of AFM. We are currently updating this document after four years of best practices in patient care and treatment experience.
  • Laboratory Testing of Specimens from PUIs for AFM
    • Testing specimens, including stool, blood, and spinal fluid, from PUIs for enteroviruses and other viruses
    • Collecting data from laboratories outside of CDC about their testing results to complete records of laboratory test results for all PUIs
    • Using metagenomic sequencing approaches to identify known and unknown pathogens (germs) not currently considered in the EV-D68 specifically targeted approaches
    • Developing assays to look for biomarkers associated with AFM for earlier identification of children at risk of becoming paralyzed
    • Investigating how damage to the spinal cord in AFM patients could occur days or weeks after an infection to understand how viruses may be causing this disease
  • Consulting with experts to better understand AFM
    • Establishing an AFM working group to foster collaborations between CDC and the scientific community to better understand what’s causing AFM, how to prevent it, and how to treat it
    • Hosted a one-day technical consultation in September 2017 with 12 nationally-recognized experts in AFM and 20 CDC medical officers, epidemiologists, and laboratory scientists to discuss how viruses could cause AFM and what viruses were most likely responsible
  • Educating healthcare providers and the public
    • Working with health departments to educate healthcare providers in every state so they are aware of the symptoms of AFM, how to report PUIs, what specimens to collect, and the clinical management considerations for patients with AFM. Some educational activities and materials include health alerts, job aids, toolkits, webinars, and scientific publications and presentations.
    • Updating our AFM website regularly with new information about AFM, and current counts of confirmed AFM cases. This website has information about AFM and CDC’s investigation, and a section for healthcare providers with information about the AFM case definitions, data collection and reporting of PUIs, specimen collection and shipping, and clinical management of patients
    • Publishing data and findings of our AFM investigation in scientific journals, and presenting at scientific conferences
  • Understanding Why Patients Developed AFM 
    • AFM is a complex condition, and it is difficult to determine why only some people go from having a mild respiratory illness or fever to developing AFM.
    • Since AFM affects the spinal cord, finding a pathogen (germ) in the fluid that surrounds the spinal cord would be good evidence for a cause. CDC has tested many different specimens from AFM patients for a wide range of pathogens that can cause AFM. We detected coxsackievirus A16, EV-A71, and EV-D68 in the spinal fluid of four AFM cases out of 404 confirmed cases since 2014, which points to the cause of their AFM. For all other patients, no pathogen (germ) has been detected in their spinal fluid. The absence of a pathogen in most AFM cases means we haven’t found the definitive cause yet.  There could also be something else triggering the patient’s AFM, such as their immune response to an infection or a genetic factor that may make them more susceptible.
    • Respiratory illnesses and fever from viral infections such as enteroviruses are common, especially in children, and most people recover. We don’t know why a small number of patients develop AFM, while most others recover. We are investigating possible:
      • A direct infection of a virus on the motor neurons (nerves that make the muscles move)
      • An indirect infection where a virus may lead to an inflammatory or immune response directed toward motor neurons
      • Host genetic factors in which certain children may be more susceptible than others
    • Most patients had onset of AFM between August and October, with increases in AFM cases every two years since 2014. At this same time of year, many viruses commonly circulate, including enteroviruses, and what association it may have with AFM.
      • The large number of AFM cases identified in 2014 coincided with a national outbreak of severe respiratory illness among people caused by EV-D68. CDC is working with national partners to understand the annual circulation of enteroviruses, including EV-D68, and what association it may have with AFM.
      • Enteroviruses most commonly cause mild illness. They can also cause neurologic illness, such as meningitis, encephalitis, and acute flaccid limb weakness, but these are rare.


AFM Cases in the U.S.

So far in 2018, there are 90 confirmed cases of AFM in 27 states. These 90 confirmed cases are among the total of 252 reports that CDC received of patients under investigation (PUIs).

  • In 2017, CDC received information for 33 confirmed cases of AFM in 16 states.
  • In 2016, CDC received information for 149 confirmed cases of AFM in 39 states and DC.
  • In 2015, CDC received information for 22 confirmed cases of AFM in 17 states.
  • From August to December 2014, CDC received information for 120 people confirmed cases of AFM in 34 states.

The case counts represent only those cases for which information has been sent to and confirmed by CDC.

See graph that shows AFM cases by year.

For more information, see

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Keywords: US CDC; USA; Updates; AFM; AFP; Enterovirus; Undiagnosed Illness.

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#Increase in Acute Flaccid #Myelitis [#AFM] — #USA, 2018 (@CDCgov, MMWR, edited)

          

Title:

#Increase in Acute Flaccid #Myelitis [#AFM] — #USA, 2018.

Subject:

Unexplained neurological illness, Acute Flaccid Paralysis (AFP) & Myelitis (AFM), post-infectious, current situation in the US.

Source:

US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK).

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Early Release / November 13, 2018 / 67

Format: [ PDF [205K] ]

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Susannah L. McKay, PhD1,2; Adria D. Lee, MSPH2; Adriana S. Lopez, MHS2; W. Allan Nix, PhD2; Kathleen L. Dooling, MD2; Amelia A. Keaton, MD3; Emily Spence-Davizon, MPH4; Rachel Herlihy, MD4; Thomas A. Clark, MD5; Sarah E. Hopkins, MD6; Daniel M. Pastula, MD2,7; James Sejvar, MD8; M. Steven Oberste, PhD2; Mark A. Pallansch, PhD2; Manisha Patel, MD2; Janell A. Routh, MD2

1Epidemic Intelligence Service, CDC; 2Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC; 3Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 4Colorado Department of Public Health and the Environment; 5National Center for Immunization and Respiratory Diseases, CDC; 6Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania; 7University of Colorado School of Medicine, Aurora, Colorado; 8Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC.

Corresponding author: Susannah L. McKay, smckay@cdc.gov, 404-718-6806.

Suggested citation for this article: McKay SL, Lee AD, Lopez AS, et al. Increase in Acute Flaccid Myelitis — United States, 2018. MMWR Morb Mortal Wkly Rep. ePub: 13 November 2018. DOI: http://dx.doi.org/10.15585/mmwr.mm6745e1


Abstract

In August 2018, CDC noted an increased number of reports of patients having symptoms clinically compatible with acute flaccid myelitis (AFM), a rare condition characterized by rapid onset of flaccid weakness in one or more limbs and spinal cord gray matter lesions, compared with August 2017. Since 2014, CDC has conducted surveillance for AFM using a standardized case definition (1,2). An Epi-X* notice was issued on August 23, 2018, to increase clinician awareness and provide guidance for case reporting.

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Patients who meet the clinical case criteria for AFM, defined as acute flaccid limb weakness, are classified using the Council of State and Territorial Epidemiologists case definitions of “confirmed” (magnetic resonance imaging [MRI] with spinal cord lesion largely restricted to gray matter and spanning ≥1 spinal segments), “probable” (cerebrospinal fluid [CSF] pleocytosis [>5 white blood cells per mm3]), or “not a case.”

Among 106 patients with acute flaccid limb weakness classified during January 1–November 2, 2018, 80 cases of AFM were classified as confirmed (from 25 states) (Figure), 6 as probable, and 20 as noncases. This represents a threefold increase in confirmed cases compared with the same period in 2017. Among confirmed cases, the median patient age was 4 years (range = 7 months–32 years; interquartile range [IQR] = 2.4–7.6 years), 47 (59%) were male, and, among 65 patients with information on race available, 56 (86%) were white. During the 4 weeks preceding the onset of limb weakness, signs and symptoms consistent with a viral illness were reported for 79 (99%), including fever for 65 (81%), respiratory symptoms (e.g., cough, rhinorrhea, and congestion) for 62 (78%), and gastrointestinal symptoms (e.g., vomiting and diarrhea) for 30 (38%) patients with confirmed AFM. Upper limb only involvement was reported by 38 (47.5%) patients, lower limb only by 7 (8.8%), two to three upper and lower limbs by 12 (15.0%), and all four limbs by 23 (28.8%). All patients with confirmed AFM were hospitalized, and 47 (59%) were admitted to intensive care units; no deaths have been reported.

Among 78 (98%) confirmed cases with available CSF results, 65 (83%) had pleocytosis, with a median cell count of 103 cells per mm3 (range = 6–814; IQR = 56–194); most had a lymphocyte predominance. Median CSF protein and glucose were 47 mg per dL (range = 8–289; IQR = 37–62; normal <45) and 59 mg per dL (range = 40–138; IQR = 52–65; normal ≥40), respectively. The median interval from limb weakness to CSF collection was 1 day (range = 0–16; IQR = 1–3). The median interval from sign or symptom onset to CSF collection was 7 days (range = 0–23; IQR = 5–8) for respiratory illness, 4 days (range = 0–22; IQR = 3–7) for gastrointestinal symptoms, and 3 days (range = 0–17; IQR = 2–6) for fever.

CDC conducts enterovirus/rhinovirus (EV/RV) testing for all patients meeting the clinical criteria for AFM, when specimens are available. Of the 80 confirmed cases in 2018, testing was performed on a total of 125 clinical specimens from 71 (89%) patients, including 21 CSF, 59 upper respiratory, and 45 stool/rectal swab specimens (Table). Among these, specimens from 38 (54%) patients were positive by EV/RV real-time reverse transcription–polymerase chain reaction testing, including 11 (29%) for EV-A71, 14 (37%) for EV-D68, and 13 (34%) for other viruses, primarily from nonsterile sites. CSF specimens from two patients were positive. One CSF specimen was positive for EV-A71; this patient also had a stool specimen positive for EV-A71. The second patient had a CSF specimen positive for EV-D68; this patient also had EV-D68 and parechovirus-A6 identified in a respiratory specimen. Two additional patients had more than one virus detected in a single respiratory specimen, including one with EV-D68 and echovirus 6 and one with RV-A24 and parechovirus-A6. All stool specimens tested negative for poliovirus. Among the 20 patients who did not meet the AFM case definition and were classified as non­cases, 1 (5%) had a positive CSF specimen (echovirus 25), 7 (35%) had positive respiratory specimens (EV-A71, RV-A24, RV-A56, RV-A90, EV/RV not typed), and 6 (30%) had positive stool or rectal swab specimens (EV-D68, EV-A71, RV-A90, echovirus 9, echovirus 11, echovirus 25).

Because some enteroviruses can cause acute flaccid limb weakness, and there was a temporal association with AFM and a nationwide severe respiratory outbreak of EV-D68 in 2014 (2), CDC performs EV/RV testing in an effort to identify etiologies for AFM cases. Despite a subsequent peak of AFM in 2016 (https://www.cdc.gov/acute-flaccid-myelitis/afm-surveillance.html), CDC did not receive reports of large outbreaks of severe respiratory illness in 2016. Further, there has been limited detection of pathogens in CSF in these cases; virus identified in CSF would be considered etiologic. Almost all patients with AFM have reported signs and symptoms consistent with viral illness in the weeks preceding limb weakness. Clinical, laboratory, and epidemiologic evidence to date suggest a viral association. CDC and collaborators continue to investigate risk factors for AFM and to study the causes and mechanisms of AFM.

Parents and caregivers are urged to seek immediate medical care for a child who develops sudden weakness of the arms or legs. In the evaluation of a child with acute flaccid limb weakness, clinicians are advised to inquire about recent fever with or without antecedent respiratory or gastrointestinal symptoms and to collect timely specimens for viral testing, including CSF, serum, respiratory, and stool specimens. Additional information for clinicians is available at https://www.cdc.gov/acute-flaccid-myelitis/hcp/index.html. Patients with acute flaccid limb weakness should be reported to their health departments as soon as possible regardless of laboratory or MRI findings.

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All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. W. Allan Nix reports U.S. Patent Numbers 7,714,122 and 8,048,630, and U.S. Provisional Patent Application Serial Number 62/171,657. No other potential conflicts of interest were disclosed.

{*} https://www.cdc.gov/mmwr/epix/epix.html.


References

  1. Pastula DM, Aliabadi N, Haynes AK, et al. Acute neurologic illness of unknown etiology in children—Colorado, August–September 2014. MMWR Morb Mortal Wkly Rep 2014;63:901–2. PubMed
  2. Sejvar JJ, Lopez AS, Cortese MM, et al. Acute flaccid myelitis in the United States, August–December 2014: results of nationwide surveillance. Clin Infect Dis 2016;63:737–45. CrossRef PubMed

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FIGURE. Number of confirmed cases of acute flaccid myelitis (AFM) reported to CDC, by month of onset — United States, January–October 2018*

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{*} Confirmed AFM cases that CDC was made aware of as of November 2, 2018. Patients under investigation are still being classified, and the case counts are subject to change.

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TABLE. Enterovirus/rhinovirus (EV/RV) type testing results* of specimens from patients with confirmed acute flaccid myelitis and specimens positive for EV/RV, by specimen type — United States, January–October 2018

[Enterovirus and rhinovirus testing, by type - CDC laboratory results: CSF specimens (n = 21) - Respiratory specimens (n = 59) - Stool/Rectal swab specimens (n = 45) - Total (N = 125)]

  • EV- or RV-positive no. (%) - 2 (10) - 31 (53) - 17 (38) – 50
  • Subtype, no. (%) positive 
    • EV-A71 - 1 (50) - 10 (32) - 10 (59) - 21 (42)
    • EV-D68 - 1 (50) - 13 (42) - 1 (6) - 15 (30)
    • EV-D68/PeV-A6 - 0 — - 1 (3) - 0 — - 1 (2)
    • RV-A38 - 0 — - 1 (3) - 0 — - 1 (2)
    • RV-A101 - 0 — - 1 (3) - 0 — - 1 (2)
    • RV-A24/PeV-A6 - 0 — - 1 (3) - 0 — - 1 (2)
    • RV-A81 - 0 — - 1 (3) - 0 — 1 (2)
    • RV-A54 - 0 — - 1 (3) 0 — - 1 (2)
    • CVA2 - 0 — - 0 — - 1 (6) - 1 (2)
    • CVA4 - 0 — - 0 — - 1 (6) - 1 (2)
    • CVA9 - 0 — - 0 — - 1 (6) - 1 (2)
    • CVA16 - 0 — - 0 — - 1 (6) - 1 (2)
    • PeV-A1 - 0 — - 0 — - 1 (6) - 1 (2)
    • Nontyped EV/RV - 0 — - 2 (6) - 1 (6) - 3 (6)

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Abbreviations: CSF = cerebrospinal fluid; CVA = Coxsackie A virus; PeV-A6 = parechovirus A6.

{*} Specimens tested at CDC laboratory.

{†} Among EV- or RV-positive specimens.


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Keywords: US CDC; USA; Updates; AFM; AFP; Undiagnosed Illness; EV-D68.

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#HK, Suspected #MERS #Coronavirus case reported (CHP, Nov. 13 ‘18)

          

Title:

#HK, Suspected #MERS #Coronavirus case reported.

Subject:

Middle East Respiratory Syndrome, suspected imported case in Hong Kong.

Source:

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

Code:

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The Centre for Health Protection (CHP) of the Department of Health today (November 13) reported a suspected case of Middle East Respiratory Syndrome (MERS), and again urged the public to pay special attention to safety during travel, taking due consideration of the health risks in the places they visit.

The case is detailed below:

  • Sex – Female
  • Age – 37
  • Affected area involved - Dubai, United Arab Emirates
  • High-risk exposure – Nil
  • Hospital - Prince of Wales Hospital
  • Condition – Stable
  • MERS-Coronavirus preliminary test result – Negative

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(…)

The public may visit:

Tour leaders and tour guides operating overseas tours are advised to refer to the CHP's health advice on MERS.

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Keywords: HK PRC SAR; Updates; MERS-CoV.

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#Zika #Virus #Research #References #Library–November 13 2018 #Update, Issue No. 142

          

Title:

#Zika #Virus #Research #References #Library–November 13 2018 #Update, Issue No. 142.

Subject:

Zika Virus Infection and related complications research, weekly references library update.

Source:

AMEDEO, homepage: https://amedeo.com

Code:

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This Issue:

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  1. LIN KW, Kraemer JD, Piltch-Loeb R, Stoto MA, et al.
    • The Complex Interpretation and Management of Zika Virus Test Results.
      • J Am Board Fam Med. 2018;31:924-930.
  2. CARTAXO MFS, Silva SMD, Silva JGM, Beltrao EIC, et al.
    • Social determinants of health associated with topical repellent use in pregnancy: a cross-sectional study during a Zika outbreak in Brazil.
      • Trans R Soc Trop Med Hyg. 2018 Nov 9. pii: 5167472. doi: 10.1093.
  3. LIAO Y, Fan Z, Deng H, Yang Y, et al.
    • Zika Virus Liquid Biopsy: A Dendritic Ru(bpy)3 (2+)-Polymer-Amplified ECL Diagnosis Strategy Using a Drop of Blood.
      • ACS Cent Sci. 2018;4:1403-1411.
  4. WIRZ CD, Xenos MA, Brossard D, Scheufele D, et al.
    • Rethinking Social Amplification of Risk: Social Media and Zika in Three Languages.
      • Risk Anal. 2018 Nov 8. doi: 10.1111/risa.13228.
  5. HO CY, Castillo N, Encinales L, Porras A, et al.
    • Second-trimester Ultrasound and Neuropathologic Findings in Congenital Zika Virus Infection.
      • Pediatr Infect Dis J. 2018;37:1290-1293.
  6. XIAO P, Han J, Zhang Y, Li C, et al.
    • Metagenomic Analysis of Flaviviridae in Mosquito Viromes Isolated From Yunnan Province in China Reveals Genes From Dengue and Zika Viruses.
      • Front Cell Infect Microbiol. 2018;8:359.
  7. ROCHA AMO, de Mello MJG, Torres JRD, Valenca NO, et al.
    • Palliative Care in Congenital Syndrome of the Zika Virus Associated with Hospitalization and Emergency Consultation: Palliative Care and Congenital Syndrome of Zika.
      • J Trop Med. 2018;2018:1025193.
  8. BALDWIN WR, Livengood JA, Giebler HA, Stovall JL, et al.
    • Purified Inactivated Zika Vaccine Candidates Afford Protection against Lethal Challenge in Mice.
      • Sci Rep. 2018;8:16509.
  9. OLIVEIRA DBL, Durigon GS, Mendes EA, Ladner JT, et al.
    • Persistence and Intra-Host Genetic Evolution of Zika Virus Infection in Symptomatic Adults: A Special View in the Male Reproductive System.
      • Viruses. 2018;10.
  10. WU YH, Cui XY, Yang W, Fan DY, et al.
    • Zika Virus Infection in Hypothalamus Causes Hormone Deficiencies and Leads to Irreversible Growth Delay and Memory Impairment in Mice.
      • Cell Rep. 2018;25:1537-1547.
  11. KEEFFE JR, Van Rompay KKA, Olsen PC, Wang Q, et al.
    • A Combination of Two Human Monoclonal Antibodies Prevents Zika Virus Escape Mutations in Non-human Primates.
      • Cell Rep. 2018;25:1385-1394.
  12. CORDEIRO DE SOUZA L, de Souza AA, de Almeida EEP, Honse Ribeiro L, et al.
    • Inspiratory Muscle Training with Isokinetic Device to Help Ventilatory Weaning in a Patient with Guillain-Barre Syndrome by Zika Virus.
      • Case Rep Crit Care. 2018;2018:9708451.
  13. SOLIMINI AG, Manica M, Rosa R, Della Torre A, et al.
    • Estimating the risk of Dengue, Chikungunya and Zika outbreaks in a large European city.
      • Sci Rep. 2018;8:16435.
  14. FONTAINE KA, Leon KE, Khalid MM, Tomar S, et al.
    • The Cellular NMD Pathway Restricts Zika Virus Infection and Is Targeted by the Viral Capsid Protein.
      • MBio. 2018;9.
  15. YASRI S, Wiwanitkit V.
    • Concurrent Guillain-Barre syndrome, transverse myelitis and encephalitis post-Zika and multiple arboviral immunity.
      • J Neurol Sci. 2018 Nov 2. pii: S0022-510X(18)30451.
  16. MANCERA-PAEZ O, Roman GC, Pardo-Turriago R, Rodriguez Y, et al.
    • Erratum to 'Concurrent Guillain-Barre syndrome, transverse myelitis and encephalitis post-Zika: A case report and review of the pathogenic role of multiple arboviral immunity', Journal of the Neurological Sciences, Volume 395, 15 December 2018, Pages 47-53.
      • J Neurol Sci. 2018;395:207-209.
  17. OLAFUYI O, Badhan RKS.
    • Dose optimisation of chloroquine by pharmacokinetic modelling during pregnancy for the treatment of Zika virus infection.
      • J Pharm Sci. 2018 Nov 3. pii: S0022-3549(18)30689.
  18. FOURIE T, Grard G, Leparc-Goffart I, Briolant S, et al.
    • Variability of Zika Virus Incubation Period in Humans.
      • Open Forum Infect Dis. 2018;5:ofy261.
  19. GOMEZ EJ, Perez FA, Ventura D.
    • What explains the lacklustre response to Zika in Brazil? Exploring institutional, economic and health system context.
      • BMJ Glob Health. 2018;3:e000862.
  20. BOWMAN LR, Rocklov J, Kroeger A, Olliaro P, et al.
    • A comparison of Zika and dengue outbreaks using national surveillance data in the Dominican Republic.
      • PLoS Negl Trop Dis. 2018;12:e0006876.
  21. DEL CARPIO-ORANTES L, Gonzalez-Clemente MC.
    • Zika, afebrile disease?
      • Rev Med Inst Mex Seguro Soc. 2018;56:305-308.
  22. ZHANG Y, Zhang H, Ma W, Liu K, et al.
    • Evaluation of Zika Virus-specific T-cell Responses in Immunoprivileged Organs of Infected Ifnar1-/- Mice.
      • J Vis Exp. 2018;.
  23. CORONADO MA, Eberle RJ, Bleffert N, Feuerstein S, et al.
    • Zika virus NS2B/NS3 proteinase: A new target for an old drug - Suramin a lead compound for NS2B/NS3 proteinase inhibition.
      • Antiviral Res. 2018;160:118-125.
  24. SIMOES ML, Caragata EP, Dimopoulos G.
    • Diverse Host and Restriction Factors Regulate Mosquito-Pathogen Interactions.
      • Trends Parasitol. 2018;34:603-616.
  25. DA CRUZ TE, Souza RP, Pelloso SM, Morelli F, et al.
    • Case Reports: Prolonged Detection of Zika Virus RNA in Vaginal and Endocervical Samples from a Brazilian Woman, 2018.
      • Am J Trop Med Hyg. 2018 Nov 5. doi: 10.4269/ajtmh.18-0623.
  26. BENITES BD, Rocha D, Andrade E, Godoy DT, et al.
    • Zika Virus and the Safety of Blood Supply in Brazil: A Retrospective Epidemiological Evaluation.
      • Am J Trop Med Hyg. 2018 Nov 5. doi: 10.4269/ajtmh.17-0843.
  27. OO A, Teoh BT, Sam SS, Bakar SA, et al.
    • Baicalein and baicalin as Zika virus inhibitors.
      • Arch Virol. 2018 Nov 3. pii: 10.1007/s00705-018-4083.
  28. GRIFONI A, Costa-Ramos P, Pham J, Tian Y, et al.
    • Cutting Edge: Transcriptional Profiling Reveals Multifunctional and Cytotoxic Antiviral Responses of Zika Virus-Specific CD8(+) T Cells.
      • J Immunol. 2018 Nov 9. pii: jimmunol.1801090. doi: 10.4049/jimmunol.1801090.
  29. ADAM A, Woda M, Kounlavouth S, Rothman AL, et al.
    • Multiplexed FluoroSpot for the Analysis of Dengue Virus- and Zika Virus-Specific and Cross-Reactive Memory B Cells.
      • J Immunol. 2018 Nov 9. pii: jimmunol.1800892. doi: 10.4049/jimmunol.1800892.
  30. SAXENA SK, Kumar S, Sharma R, Maurya VK, et al.
    • Zika virus disease in India - Update October 2018.
      • Travel Med Infect Dis. 2018 Nov 3. pii: S1477-8939(18)30358.

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Keywords: Research; Abstracts; Zika References Library.

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#Influenza [#H1N1pdm09, #H3N2, B]–#Update No. 328, based on data up to 28 Oct. ‘18 (@WHO, summary)

          

Title:

#Influenza [#H1N1pdm09, #H3N2, B]–#Update No. 328, based on data up to 28 Oct. ‘18.

Subject:

Human Influenza Viruses, A (H1, H3) & B subtypes, current global epidemiological situation.

Source:

World Health Organization (WHO), full page: (LINK). Summary, edited.

Code:

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Information in this report is categorized by influenza transmission zones, which are geographical groups of countries, areas or territories with similar influenza transmission patterns.

For more information on influenza transmission zones, see the link below:

|-- Influenza Transmission Zones pdf, 659kb –|

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|-- Open map in new window jpg, 450kb –|


Summary
  • In the temperate zone of the northern hemisphere influenza activity remained at inter-seasonal levels.
  • Increased influenza detections were reported in some countries of Southern and South-East Asia.
  • In the temperate zones of the southern hemisphere, influenza activity returned to nearly inter-seasonal levels.
  • Worldwide, seasonal influenza subtype A viruses accounted for the majority of detections.
  • National Influenza Centres (NICs) and other national influenza laboratories from 104 countries, areas or territories reported data to FluNet for the time period from 15 October 2018 to 28 October 2018 (data as of 2018-11-09 03:38:30 UTC).
  • The WHO GISRS laboratories tested more than 84313 specimens during that time period.
  • 2145 were positive for influenza viruses, of which 1845 (86%) were typed as influenza A and 300 (14%) as influenza B.
  • Of the sub-typed influenza A viruses, 905 (64.5%) were influenza A(H1N1)pdm09 and 499 (35.5%) were influenza A(H3N2).
  • Of the characterized B viruses, 54 (52.4%) belonged to the B-Yamagata lineage and 49 (47.6%) to the B-Victoria lineage.
  • The WHO Consultation and Information Meeting on the Composition of Influenza Virus Vaccines for Use in the 2019 Southern Hemisphere Influenza Season was held on 24-26 September 2018 in Atlanta, United States of America.
  • It was recommended that trivalent vaccines contain the following:
    • an A/Michigan/45/2015 (H1N1)pdm09-like virus;
    • an A/Switzerland/8060/2017 (H3N2)-like virus; and
    • a B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage).
  • It was also recommended that quadrivalent vaccines containing two influenza B viruses contain the above three viruses and a B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage).
  • The vaccine recommendation for the 2019 Southern Hemisphere Influenza Season can be consulted at this link below:

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Detailed influenza update: |—Download PDF pdf, 739kb –|

Influenza fact sheet: |-- Influenza (Seasonal) fact sheet –|

Seasonal update: |-- Seasonal influenza reviews –|

|—AMRO | EURO | WPRO –|

|-- Influenza at the Human-Animal Interface (HAI) --|

|-- Disease outbreak news –|


Source of data

The Global Influenza Programme monitors influenza activity worldwide and publishes an update every two weeks. The updates are based on available epidemiological and virological data sources, including FluNet (reported by the WHO Global Influenza Surveillance and Response System), FluID (epidemiological data reported by national focal points) and influenza reports from WHO Regional Offices and Member States. Completeness can vary among updates due to availability and quality of data available at the time when the update is developed.

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Keywords: WHO; Updates; Worldwide; Seasonal Influenza.

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One New #MERS #Coronavirus Case reported by #Saudi Arabia (MoH, November 13 '18)

          

Title:

One New MERS Coronavirus Case reported by Saudi Arabia (MoH, November 13 '18).

Subject:

Middle East Respiratory Syndrome in Saudi Arabia, daily update.

Source:

Ministry of Health, full page: (LINK).

Code:

[     ]

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November 13 2018


New Case(s) Reported:

[Date report - Sex, Age, Citizenship, Resident in, Date Onset, Date Hospitalization, Health Status, Note]

  1. 13/11 - Male, 67, ..., Al Asiah (Qasseem region), ..., ..., Hospitalized; *

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{*} Primary, community acquired (no contact with camels).

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Cumulative number of confirmed cases and deaths since 2012:

  • Total No. of Cases: 1882 {§}
  • Total No. of Deaths: 729 {§}
  • Patients currently under treatment: ...
  • Case-Fatality Rate: 39%

{§} WHO data as of October 11 2018, see more: http://www.emro.who.int/pandemic-epidemic-diseases/mers-cov/mers-situation-update-september-2018.html

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Keywords: MERS-CoV; Updates; Saudi Arabia.

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