H5N1

Kenya: War against malaria must be top priority

Via Standard Digital News, an editorial: War against malaria must be top priority. Excerpt:

This was a bad week for malaria in this country following the announcement by the Global Fund that it was freezing its support for malaria projects in the country. 

But much as the programme was already experiencing problems with few outlets still stocking the Artemisinin Combination Therapies, news that the programme was nearing its end could not have come at a worse time when the country was almost winning the war against malaria. Notably, the project helped bring down the cost such medicines by more than 200 per cent, making them affordable even to the poorest of households. 

Tomorrow, as we report elsewhere, more than 3,000 people will march in the streets of Nairobi to launch an ambitious project which aims to raise Sh100 million worth of bed nets to fight malaria. 

The fact that the President and Prime Minister are involved means that the project has the blessings of the Executive and has a greater chance of succeeding. 

Grand Mothers Against Malaria Initiative as the project is known, aims to make long lasting insecticide-treated mosquito nets available to households in malaria endemic areas. But not only that; it intends to sensitise the people to use the nets appropriately. This, it hopes, will push coverage of such nets to 80 per cent from the current 41 per cent and help meet Millennium Development Goal number six by 2015.

McKenna on the novel coronavirus

Events have moved fast since this morning, and Maryn McKenna is lapping the rest of us in her latest post on Superbug: WHO Announces Family Cluster Of Cases Of New Coronavirus. After an excellent summary what we know so far about the novel coronavirus, McKenna says:

So where does that leave us today? 

The WHO statement is notable for what it does not say: It does not give ages, genders or places of residence for the new cases, and it has nothing to say about how they may have become infected — including whether person-to-person transmission of the virus has occurred, which would be one reasonable hypothesis given the family relationships. 

But it does say that the agency assumes the virus to be more widely distributed than these cases suggest, and urges countries to be on the look-out for additional cases. Notably, it suggests testing patients with severe pneumonia even if they have no travel history to Saudi Arabia or Qatar, which is a lowering of the screening threshold from what the agency recommended earlier: 

WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and is currently reviewing the case definition and other guidance related to the novel coronavirus. Until more information is available, it is prudent to consider that the virus is likely more widely distributed than just the two countries which have identified cases. Member States should consider testing of patients with unexplained pneumonias for the new coronavirus even in the absence of travel or other associations with the two affected countries. In addition, any clusters of SARI or SARI in health care workers should be thoroughly investigated regardless of where in the world they occur. 

Much more to come on this, I am sure. Over the weekend, consider following Helen Branswell of Canadian Press and Declan Butler of Nature, who got stories about this posted this afternoon; and also indefatigable emerging-diseases blogger Crawford Kilian, who has picked up indications that the new Qatar case may actually be in Germany.

(She also mentions Mike Coston, who has been on the case too. While it's nice to receive praise, especially from the likes of Maryn McKenna, I am indeed all too defatigable. It's Mike who's tireless.)

What strikes me about the Spiegel Online report just below this post is the astounding lapse in communications among the Qataris, the British, and the Germans. If I understood and translated the report accurately, the Qataris shipped this very ill man off to Germany and his samples off to the UK. But they don't seem to have told the Germans what their suspicions were, or what they'd done about those suspicions. So the Germans treated the man as just another very sick man until the news arrived that they were dealing with London1 coronavirus.

I can well imagine the very unhappy meetings in the Ruhrlandsklinik, not to mention some tense international conference calls.

Both McKenna and Helen Branswell have pointed out how, um, concise the WHO update is. The sheer absence of detail implies that the details would only make the situation look worse.

More on the coronavirus patient in Germany

Via Spiegel Online: Patient with coronavirus treated in Essen Clinic. Excerpt from a Google translation, with my editing, so don't take this as absolutely accurate:

Health authorities are tense: A man from Qatar had been infected with the novel coronavirus that causes SARS-like symptoms. But doctors at the University Hospital Essen have treated the patient for four weeks, with no idea that he was suffering from a dangerous pathogen.

When the man from Qatar was admitted to the Ruhrlandklinik Lung Centre at the Universityof Essen, he had already been sick for 19daysm and the doctors in Qatar could no longer treat him because his lung tissue was severely damaged. Only one treatment at a specialist clinic was available, so he was flown to Germany.

The Qatari doctors had not told their German colleagues about their suspicions, that the patient might be infected with the new coronavirus. The virus had first been detected in September in another patient from Qatar who was treated in London for acute lung and kidney failure. As it turned out, a Saudi citizen, previously in the Netherlands, had died of this pathogen.

There was no association between the two cases. However, the authorities were alerted immediately. In 2003, another coronavirus had spread like wildfire around the world—the agent of the lung disease SARS. Before it disappeared, it had claimed more than 700 victims.

Doctors in Qatar had therefore sent a sample of body fluids to London for analysis at the Health Protection Agency, which is currently doing regular tests for the new coronavirus on samples from Qatar and Saudi Arabia. In fact, the result was positive. But the doctors in the Ruhrlandklinik learned this only on Thursday from the Robert Koch Institute. The patient is back in Qatar, largely recovered, and one day previously was transferred to a rehabilitation hospital.

WHO: Update on Ebola in Uganda

WHO has published Ebola in Uganda. 

As of 23 November 2012, the Ministry of Health (MoH) of Uganda has reported 10 cases (6 confirmed and 4 probable), including 5 deaths in Luweero and Kampala. 

The last confirmed case was hospitalised on 17 November 2012. Close contacts of the Ebola cases are being identified and followed up for a period of 21 days. All the cases alerted to the field teams are being investigated. 

WHO and partners, including the US Centers for Disease Control and Prevention (CDC), Médecins Sans Frontières (MSF), the Uganda Red Cross (URCS), African Field Epidemiology Network (AFENET) and Plan Uganda are supporting the national authorities in the investigation and response to the outbreak. 

Experts in the area of field epidemiology, health promotion, logistics management, and infection prevention and control , have been mobilized by WHO through the Global Outbreak Alert and Response Network (GOARN), to provide support to the response. 

With respect to this event, WHO does not recommend that any travel or trade restriction be applied to Uganda.

Haiti: 7,721 cholera deaths as of November 19

MSPP's last posting of cholera statistics brought us up to November 12 with 614,196 cases since the outbreak began in October 2010, and 7,691 deaths. Now the Documentation page has another week's worth of numbers, ending with November 19.

As usual, the daily and cumulative numbers don't match. The daily cases for November 13-19 total 2,496; the cumulative total is 618,383—4,087 more than the total for November 12.

The daily numbers are still bad, especially the three days between the 15th and 17th: 413 cases, 470, and 411. Then the numbers fell slightly, to 353 on the 18th and 317 on the 19th.

Twenty-nine persons died of cholera during this latest period, but the cumulative deaths rose by 30, to 7,721. On two days, November 13 and 18, 7 persons died; that's higher than I can recall for a long time. 

On October 19, MSPP reported 604,045 cumulative cases and 7,588 deaths. So that means 14,238 cases in one month, and 133 deaths.

I also see bad case fatality ratios in some departments: On October 19 they included 4.8 per cent in Sud Est, 4.2% in Grande Anse, 2.7 per cent in Nippes. On November 19, CFRs were 4.7 per cent in Sud Est, 4.1 per cent in Grande Anse, 2.7 per cent in Nippes. Port-au-Prince has a current CFR of 0.7 per cent, the only one below 1 per cent.

As always, the true cases and deaths numbers are probably somewhere higher than MSPP's.

Butler: Family cluster of novel coronavirus cases reported in Saudi Arabia

Via Nature News Blog, a post by Declan Butler: Family cluster of novel coronavirus cases reported in Saudi Arabia. Excerpt:

The World Health Organization (WHO) this afternoon reported four new lab-confirmed cases of a novel coronavirus infection bringing the total number of cases identified since June to six. Two of the cases are from the same household, raising the possibility of human-to-human transmission of the virus, although it’s also possible that they both contracted it independently from an animal source in the area. 

Three of the new cases occurred in Saudi Arabia, including one who died, while a fourth case was reported in Qatar. The WHO gave few further details of the cases, such as their age or sex, or their current medical condition. 

That the new cases have been found likely reflects increased surveillance for the virus since it’s identification as a novel virus. They follow two cases reported earlier — a 60 year old man from Saudi Arabia who fell ill, and died in June, and a 49-year-old man from Qatar who fell ill in September and has since recovered — see SARS veterans tackle coronavirus. 

None of the contacts of those two men are known to have contracted the virus, which suggests that the virus likely doesn’t transmit, or doesn’t transmit easily, between humans. The coronavirus, identified in September is genetically most-closely related to bat coronavirus, and bats and possibly intermediate animal hosts, are likely to be the virus’ reservoirs. 

Among this new batch of cases, two of the four cases in Saudi Arabia were from the same family, living in the same household — one died and the other recovered. Moreover, two other family members showed similar symptoms, and one has died; the WHO is waiting on the results as to whether the fatal case tests positive for the coronavirus too; the recovered case tested negative. 

Household clusters of cases of a novel virus raise the possibility of human-to-human transmission, and so immediately catch the attention of epidemiologists, who along with clinicians and virologists, will be urgently seeking to tease out the likely source of infection, how the people contracted the virus, and whether they each caught it independently from an animal reservoir, or is there any human-to-human transmission going on. 

The WHO gave no description of the symptoms, but the cases in June and September had severe pneumonia and acute renal failure. What’s also striking so far is the very high case mortality rate – so far two out of six cases, and three out of seven if the unconfirmed fatal case tests positive. 

Now, one can’t put a firm figure on case mortality rates until one knows the true number of deaths and cases, in particular as more asymptomatic or recovered cases may be going unnoticed — pinning that down will require more surveillance and epidemiology data, including seroprevalence surveys to tests if people not showing infection have antibodies to the virus, and so have been exposed to it. 

But the symptoms are serious, and the death rate in this particular cluster suggests the mortality rate could be high.

WHO: Novel coronavirus infection - update

Via WHO, a major development: Novel coronavirus infection - update.

WHO has been notified of four additional cases, including one death, due to infection with the novel coronavirus. The additional cases have been identified as part of the enhanced surveillance in Saudi Arabia (3 cases, including 1 death) and Qatar (1 case). This brings the total of laboratory confirmed cases to 6. 

Investigations are ongoing in areas of epidemiology, clinical management, and virology, to look into the likely source of infection, the route of exposure, and the possibility of human-to-human transmission of the virus. Close contacts of the recently confirmed cases are being identified and followed-up. 

So far, only the two most recently confirmed cases in Saudi Arabia are epidemiologically linked - they are from the same family, living in the same household. Preliminary investigations indicate that these 2 cases presented with similar symptoms of illness. One died and the other recovered. 

Additionally, 2 other members of this family presented with similar symptoms of illness, where one died and the other is recovering. Laboratory results of the fatal case is pending, while the case that is recovering tested negative for the novel coronavirus. 

WHO continues to work with the governments of Saudi Arabia, Qatar and other international health partners to gain a better understanding of the novel coronavirus and the disease in humans. Further epidemiological and scientific studies are needed to better understand the virus. 

WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and is currently reviewing the case definition and other guidance related to the novel coronavirus. 

Until more information is available, it is prudent to consider that the virus is likely more widely distributed than just the two countries which have identified cases. Member States should consider testing of patients with unexplained pneumonias for the new coronavirus even in the absence of travel or other associations with the two affected countries. 

In addition, any clusters of SARI or SARI in health care workers should be thoroughly investigated regardless of where in the world they occur. 

Of the 6 laboratory confirmed cases reported to WHO, 4 cases (including 2 deaths) are from Saudi Arabia and 2 cases are from Qatar.

ECDC: West Nile transmission season coming to its end

Via ECDC: West Nile transmission season coming to its end. Click through for a great many links. Excerpt:

The West Nile transmission season has come to its end; no new recent cases have been reported in the EU for three consecutive weeks, since week 43 (22-28 October). 

This week in the EU and its neighbouring countries, new West Nile cases have been identified retrospectively: Hungary confirmed two new cases, which occurred in September and August 2012, and Russia, 13 new cases from the period January - October 2012. 

Today’s maps are the last weekly update in 2012, next Friday ECDC will publish an overview of the West Nile season 2012.

Peru declares state of emergency in dengue-affected region

Via Xinhua: Peru declares state of emergency in dengue-affected region. Excerpt:

Peru formally declared a state of emergency in its Amazonian region of Ucayali on Thursday after an outbreak of dengue fever that has so far claimed 10 lives. 

Under the state of emergency, signed by Peruvian President Ollanta Humala, immediate medical treatment should be provided to affected residents at local hospitals and healthcare centers, and all possible measures should be adopted to safeguard affected areas. 

The measure is to last 60 days in the Ucayali communities of Coronel Portillo, Padre Abad and Atalaya, 840 km east of the capital Lima. 

According to Peru's Health Ministry, more than 2,000 people have so far shown symptoms of dengue, which include high fever, headaches and eye aches, muscle pain, loss of appetite, rash, nausea, vomiting and hemorrhage in the most severe cases.

Another novel coronavirus case

Mike Coston at Avian Flu Diary has the story: RKI: Another Coronavirus Case Treated In Germany. This patient is a Qatari who's been under treatment in Germany since last month. I'll look for more information on this case.