H5N1

Dr. Mackay on MERS's biggest day

On his VDU's blog, Dr. Ian Mackay has a new post well worth reading and pondering: And then that happened.... He points out that this month alone has seen almost as many MERS cases as all of 2013. And April 23 "is the biggest single day of MERS-CoV case reporting ever." Then he goes on to say:

So let's all agree that the pattern of MERS-CoV detections has changed this month compared to any other month you want to point at. 

But why?  

I have two main thoughts on that. 

Option 1: MERS-CoV v2.0 spreads better than v1.0. We need sequences to address this. If the virus has changed then this may be the percolation of a virus with pandemic potential, and a sizable clinical impact among a particular portion of the community, happening in  real-time. Or not. Suffice to say we need those sequences yesterday to stay in front of that possibility and its global implications. 

Option 2. Massive breakdown in infection prevention and control in some healthcare facilities, which has spread. The question I have about this option is why has it occurred in 2 geographically distinct places at once (Jeddah, Kingdom of Saudi Arabia [KSA] & Abu Dhabi, United Arab Emirates)? The fact that healthcare workers were intimately involved at both sites adds weight to close-contact, but also to their role as sentinels for emerging viruses, including v2.0 variants. And this much close contact?  

It's impossible to say which option, or if both, have contributed to the uncharacteristic and ongoing spike in cases. But we need to keep watching this closely for some answers since this is the most rapid development for MERS epidemiology since its discovery. 

If the KSA Ministry of Health experts are serious about accepting ideas from outside, I have a few quickies: 

1. Please tell us what you're doing to control the cluster in Jeddah.

2. Please  tell us if testing methods or approaches have changed lately (more testing overall, different tests, testing instead of simply observing contacts..). 

3. Please tell us what you're doing to understand MERS-CoV, the virus, in 2014 (hint: sequence the Spike gene of as many viruses as you can get you hands on, do genomes later and release those data quickly; social media, WHO, Eurosurveillance or some other super-rapid journal, for example) 

4. Please give us a reason, or a best guess, for why April is different from every other month since MERS-CoV was identified in 2012. 

5. Please provide the WHO scrubbed case data more quickly and include sex/age/date of illness/animal contact[Y/N]/comorbidity[Y/N]/date of hospitalisation/region of KSA. 

6. Please screen samples by PCR from the community, looking at asymptomatic, mild and moderate acute respiratory disease. 

7. Please publish some data on what other respiratory viruses do among older males with comorbidities (e.g. diabetes) in the KSA so we have a comparator for MERS-CoV.

Saudi Arabia: King in Jeddah to reassure people about MERS

Via Saudi Gazette, a report that confirms what I heard from an expat a few days ago: King in Jeddah to reassure people about coronavirus.

Custodian of the Two Holy Mosques King Abdullah has arrived in Jeddah to reassure the public and to prove that the exaggerated and false rumors about coronavirus are not true, said Prince Miteb Bin Abdullah,  Minister of National Guard, in an address to the students of King Abdulaziz University here on Wednesday. 

He said the MERS situation is reassuring and it has not reached the level of an epidemic. 

The King made an unscheduled arrival in Jeddah to be near the citizens the way he did in Jazan some two years ago at the time of the Rift Valley Fever there, Prince Miteb said.

My source tells me the king usually goes into residence in Jeddah closer to Ramadan, which this year will begin late in June. Arriving early is purely for reassuring the city's anxious residents.

Saudi Arabia: Umrah won't be cancelled over MERS

Via Arab News: Umrah cancellation rumors scotched. 

The Haj Ministry has not received cancellations for Umrah reservations in the wake of the coronavirus, said Abdullah Marghalani, undersecretary at the Haj Ministry and general director of the ministry’s Jeddah branch. 

“We take directives solely from the Saudi Health Ministry, the only official body responsible for issuing health advice for the pilgrimage,” he said. “We do not take into account rumors circulating on social networking sites.” 

The Health Ministry has reassured residents that the virus has not reached an epidemic stage, he said. This is why the Haj Ministry has not taken precautionary measures so far. 

“Wearing a face mask is optional and cannot be forced upon pilgrims,” he said. “We have not had any complaints from foreign governments about any of their pilgrims being infected with the virus. The virus itself has not affected Umrah pilgrims so far, nor has it had any effect on applications for the Haj and Umrah pilgrimages.” 

According to official statistics, there have been 3.8 million Umrah pilgrims since the beginning of the season, a 30 percent increase from the 2.5 million pilgrims performing Umrah this time last year,” said Marghalani. Umrah service providers have also indicated a 30 percent increase in the number of applications this year.

I don't know why the Haj Ministry is sticking to its story about no pilgrims with MERS, when a Malaysian pilgrim died of MERS on April 13 after returning from Umrah on March 29.

Canada: BC health worker fired for not getting flu vaccine

Via CBC News: B.C. health worker fired for not getting flu vaccine. 

A B.C. care aide was fired for refusing to get vaccinated against influenza or wear a mask this past winter, B.C.'s Health Minister Terry Lake has confirmed, as part of his assessment of the province's flu season. 

About 80 per cent of health care workers in the province elected to get the vaccine this season, 10 per cent more than last year. With the exception of the care aide who was fired, those who did not get vaccinated all agreed to wear masks at work during the flu season. 

This was the first year either a mask or vaccine was required for all workers and visitors at health care facilities in the province. 

Lake said a record number of 1.4 million B.C. residents were vaccinated, and the vaccine was rated 74 percent effective at protecting them against the predominate H1N1 strain of influenza.

WHO: Busting the myths about Ebola is crucial

WHO has published a news release: Busting the myths about Ebola is crucial to stop the transmission of the virus disease in Guinea. Excerpt:

Will eating raw onions once a day for three days protect me from Ebola? Is it safe to eat mangoes? Is it true that a daily intake of condensed milk can prevent infection with Ebola? 

These are just some of the questions posed to the health workers responding round the clock to calls received through the free Ebola hotline. With so many Ebola deaths to date, fear has allowed the spread of rumours and misinformation.  

The Ministry of Health of Guinea set up Hotline 115 when it announced the country’s Ebola outbreak on 21 March. Its main goal is to respond to people’s concerns and to be able to quickly refer suspect cases to the isolation ward at Donka hospital in Conakry for further investigation. It currently receives between 200 and 300 calls per day. 

“Some of the people who call the hotline are in panic and false rumours make it difficult to calm them down”, says Dr Saran Tata Camara, one of the doctors who takes the calls. “But if we tell them that it is not easy to contract Ebola and that they can protect themselves if they respect some rules, they often understand.”

Dr. Mackay updates Ebola

On his VDU's blog, Dr. Ian Mackay offers an Ebola update: some additional numbers for Guinea & Liberia from 20-April, WHO-AFRO update. Click through for his sources and an excellent chart. Excerpt:

The case curves are flattening which is a good sign that the 2014 West African Zaire ebolavirus outbreak is being brought under control.  

Nothing new is happening in Sierra Leone--no new case onsets have occurred there since 6 Apr. Nothing has tested positive in Mali. 

The previous SitRep [2] seemed to have lowered the Liberia case numbers but they have popped back up again - perhaps part of the "cleaning" of case data there - and that has made it "look" like a jump (contributing to the grey bar), when it may have been a more gradual rise. 

The most recent activity is in Guinea, where the last cases isolated were on 20 Apr.

Saudi Arabia: Campaign planned to raise MERS awareness among Indian expats

Via the Saudi Gazette: Campaign planned to raise MERS awareness.

The Indian Social Forum (ISF) will spearhead an intensive awareness campaign to enlighten the public on ways to protect themselves from a possible outbreak of the Middle East Respiratory Syndrome (MERS). 

The campaign will be organized in Jeddah, Makkah and Madinah in cooperation with the Ministry of Health and with the support of the Consulate General of India and Al Abeer Medical Group. 

Acting Consul General of India Mohammed Noor Rahman Sheikh will inaugurate the campaign at the Ministry of Health auditorium Friday evening. Dr. Muneera Balahmar, head of preventive medicine at the Ministry of Health, will be the chief guest at the event. 

Balahmar will lead the training program with the help of a multi-media presentation for the male volunteers on Friday and for female volunteers on Saturday at the same venue. 

In the second phase of the campaign, ISF volunteers will visit locations where large numbers of expatriates gather, said Ashraf Morayoor, president of the forum. 

“The volunteers will educate community members on how to protect themselves from the coronavirus. We will focus on door-to-door visits covering bachelor accommodations and family gatherings to ensure that all are well informed about this new virus,” he said, adding that the volunteers will also visit labor camps, schools and public places as part of the campaign.

Branswell: Sharp rise in MERS cases, many human spread, has world health experts concerned

I'm back after another temporary outage. Via the National Post, Helen Branswell of The Canadian Press writes: Sharp rise in MERS cases, many human spread, has world health experts concerned. Excerpt:

The World Health Organization is expressing concern about the recent sharp rise in MERS cases in Saudi Arabia and the United Arab Emirates. 

The organization is particularly worried about what it calls two significant outbreaks in health-care facilities. 

The global case count of infections with MERS virus has skyrocketed this month, with about 140 new cases reported since the beginning of April. 

To put that in context, that represents about 41% of all cases of MERS diagnosed since the first known infections in April of 2012. 

The WHO statement says about three quarters of the recently diagnosed cases involve person-to-person spread of the virus, with most of these cases being infected in hospitals. 

The WHO says it has offered to pull together teams of international experts to help Saudi Arabia and the United Arab Emirates deal with the outbreaks. 

The statement, issued by the WHO’s Eastern Mediterranean Regional Office, says the global health agency believes there are “critical information gaps” related to how the virus is transmitting to and among people.

Majumder: MERS infographics

I highly recommend some highly effective new infographics: MERS by Maia Majumder.

They offer excellent overviews of the situation, both since 2012 and more recently. She promises to update them frequently, so I'm putting a link to them in the MERS Resource list, with thanks.

Saudi Arabia: Thirteen more MERS cases, two deaths

Events are moving fast in Saudi Arabia: Via the KSA MOH Arabic page: (health) record (13) infected with the case of Corona. We are now up to 285 cases and 83 deaths. The Google translation:

Corona virus that causes respiratory syndrome Middle East media data (health) record (13) infected with the case of Corona (Health) record (13) case infected with Corona 06/23/1435    

• 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 the capital of the Holy 

 one case in Medina 

 one case the amount reported by the representative of the World Health hypnotic Jordan to Saudi citizen 

• 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 the Holy 

 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 and sleeping in the wings 

 one case a stable Jordan 

 6 cases in intensive care 

 2 deaths   

• Details of the cases 

1 / citizen 80 years, he has 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 / citizen 69 years old, has 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 / citizen 70 years, he has 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 / citizen 72 years old, has 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 / citizen 88 years has 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 / citizen 41 years Mkhalt of confirmed cases in Jeddah and there are any symptoms of it.   

7 / citizenship 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 / citizen 46 years old entered the hospital security forces in the capital of the Holy m on 21/04/2014 hypnotized respiratory symptoms in intensive care. 

9 / citizen 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 hypnotized in intensive care. 

10 / pilgrims Turkish national income 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 / citizen 13 years has asthma, it appeared respiratory symptoms on 09/04/2014 AD, entered the hospital one of Medina on 21/04/2014 AD stable condition.   

13 / case the amount reported by the WHO representative in Jordan for a citizen 25 years 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: 

o 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  

o citizen at the age of 29 years suffered infections from the community and died in King Fahd Hospital in Jeddah on 22/4 / 2014

Well, serve me bloody well right for all my whining about wanting more information. At least we now have a better class of problem—making sense out of this information carpet-bombing before the next wave of bombers comes overheard.