H5N1

Importation and human-to-human transmission of a novel coronavirus in Vietnam

A letter to NEJM by a team of Vietnamese doctors: Importation and Human-to-Human Transmission of a Novel Coronavirus in Vietnam.

The emergence and spread of a novel coronavirus (2019-nCoV) from Wuhan, China, has become a global health concern. Since the detection of the coronavirus in late December 2019, several countries have reported sporadic imported cases among travelers returning from China. We report one family cluster of 2019-nCoV originating from a Chinese man.  

On January 22, 2020, a 65-year-old man with a history of hypertension, type 2 diabetes, coronary heart disease for which a stent had been implanted, and lung cancer was admitted to the emergency department of Cho Ray Hospital, the referral hospital in Ho Chi Minh City, for low-grade fever and fatigue. He had become ill with fever on January 17, a total of 4 days after he and his wife had flown to Hanoi from the Wuchang district in Wuhan, where outbreaks of 2019-nCoV were occurring. He reported that he had not been exposed to a “wet market”(a market where dead and live animals are sold) in Wuhan. 

Throat swabs obtained from the patient tested positive for 2019-nCoV on real-time reverse-transcription–polymerase-chain-reaction (RT-PCR) assays. On admission to the hospital, the man was isolated and treated empirically with antiviral agents, broad-spectrum antibiotics, and supportive therapies. Chest radiographs obtained on admission showed an infiltrate in the upper lobe of the left lung. 

On January 25, he received supplemental oxygen through a nasal cannula at a rate of 5 liters per minute because of increasing dyspnea with hypoxemia. The partial pressure of oxygen was 57.2 mm Hg while he was breathing ambient air, and a progressive infiltrate and consolidation were observed on chest radiographs. His fever disappeared on January 25, and his clinical condition has improved since January 26. His wife had no symptoms of illness while they were traveling. She was healthy as of January 28.  

The couple’s healthy 27-year-old son had lived in Long An, a province 40 km southwest of Ho Chi Minh City, since October 2019. He had not traveled to a region where 2019-nCoV was spreading, and he had not had any known contact with any person returning from such a region. On January 17, he met his father in Nha Trang in central Vietnam and shared a bedroom with his parents for 3 days in a hotel room that had an air conditioner. 

On January 20, a dry cough and fever developed in the son. He also reported having had vomiting and loose stools one time before the admission. This suggests that the incubation period for 2019-nCoV may have been 3 days or less in this case. When the son presented at Cho Ray Hospital with his father on January 22, his illness, characterized by a fever (39°C), was recognized and he was immediately isolated. Chest radiographs and other laboratory examinations in this patient showed no abnormalities except for an increased level of C-reactive protein (13.9 mg per liter). 

Real-time RT-PCR assays for influenza A and B viruses and nonstructural protein 1 antigen rapid tests for dengue viruses were negative in both the father and son. A throat swab in the son was positive for 2019-nCoV. 

His father was thought to be the source of infection. However, sequencing of strains from the two patients to ascertain the transmission of 2019-nCoV from the father to son has not been performed. The son’s condition was stable after January 23. 

This family had traveled to four cities across Vietnam using various forms of transportation, including planes, trains, and taxis. A total of 28 close contacts have been identified, and symptoms of an upper respiratory infection have not developed in any of them. This family cluster of 2019-nCoV infection that occurred outside China arouses concern regarding human-to-human transmission.

Canada: Health officials 'confident' first case of coronavirus has been found in BC

Via CBC News: Health officials 'confident' first case of coronavirus has been found in B.C.

Health officials are "confident" the first case of novel coronavirus has been found in B.C. 

Provincial health officer Dr. Bonnie Henry said Tuesday a man in his 40s who regularly travels to China has tested positive for the virus. The man lives in the Vancouver Coastal Health region and is recovering at home in isolation, Henry said.  

The case is officially considered "presumptive" until Winnipeg's National Microbiology Lab confirms the results from B.C. That process can take up to 48 hours, but Henry said officials on the West Coast are certain about the case. 

"We are confident that this is truly a case of this novel coronavirus," Henry said. 

The health officer said the man arrived in Vancouver last week. His symptoms did not begin until more than 24 hours after he arrived home.  

"He did not go out because he was concerned," Henry said. "When he had his onset of symptoms, he called ahead and went to a clinic for assessment."

Cambodia: First case of coronavirus reported in the Kingdom

Via the Phnom Penh Post: First case of coronavirus reported in the Kingdom.

Cambodia reported its first case of the deadly 2019 Novel Coronavirus (2019-nCoV) on Monday, Minister of Health Mam Bun Heng announced. 

He said medical specialists detected the virus in a Chinese tourist in Sihanoukville.  

The minister said Jia Jianhua, 60, travelled from Wuhan city, where the outbreak originated, to Sihanoukville with three family members – Wang Lingzhen, 57; Xiao Yan, 38; and Jia Ruixuan, 33. Their aeroplane landed at Sihanoukville International Airport on January 23.  

On January 25, Jia developed a high fever, runny nose, and other flu-like symptoms, and on Monday, Cambodian experts confirmed he had contracted the virus. His other family members tested negative. 

“They travelled from Wuhan city to Sihanoukville and then took a taxi to the Independence Hotel where they stayed for two nights. They later moved to Queenco Hotel.  

“In the afternoon of January 25, Jia Jianhua said he had a fever after swimming in the pool for two hours. That same day, his wife called relatives in China to tell them Jia was feeling ill,” Bun Heng said. 

He said the following day, provincial authorities – including the director of the provincial department of health as well as emergency response officials of the Ministry of Health –investigated the case after being informed by Preah Sihanouk provincial governor Kuoch Chamroeun. 

Jia is in a stable condition and has only minor symptoms like sneezing, Bun Heng said. He and his family have been placed under quarantine.  

The authorities are now on the lookout for individuals that may have come into contact with Jia to test them for the virus. They will also disinfect places where the family stayed to eliminate any trace of it. 

Meanwhile, Cambodian aviation authorities on Monday announced that all flights between Cambodia and Wuhan city have been cancelled.

Update on pneumonia of new coronavirus infection as of 24:00 on January 27

Thanks to FluTrackers for sending the link to this report from China's National Health Commission: Update on pneumonia of new coronavirus infection as of 24:00 on January 27. The Google translation, with my bolding:

At 04:00 on January 27, 30 provinces (autonomous regions and municipalities) reported 1771 newly confirmed cases, 515 severe cases, and 26 new deaths (24 in Hubei Province, 1 in Beijing, Hainan). 1 case in the province), 9 new cases were cured and discharged, and 2077 new cases were suspected. 　　

As of 24:00 on January 27, the National Health and Health Commission had received a total of 4,515 confirmed cases, 30 of which were 976 cases of severe cases, 106 cases of deaths, and 60 cases of discharged patients. There are 6973 suspected cases. 　　

At present, 47,833 close contacts have been tracked. Of the 914 people who were released from medical observation on the same day, 44,132 people are currently receiving medical observation. 　　

Accumulated notifications were received from Hong Kong, Macao and Taiwan: 8 cases from Hong Kong Special Administrative Region, 7 cases from Macao Special Administrative Region, and 5 cases from Taiwan.

WHO: Reporting coronavirus

On WHO's Situation reports page for coronavirus, sitrep #7 consists of a new "Interim case reporting form for 2019 Novel Coronavirus." Presumably future sitreps will be much more detailed as a result. Here it is if you want to download it:

Download 20200121-2019-ncov-reporting-form

China bans wildlife trade as Wuhan coronavirus death toll reaches 80

Via the South China Morning Post: China bans wildlife trade as killer Wuhan coronavirus spreads. Excerpt and then a comment:

China issued a blanket ban on the wildlife trade on Sunday, as the country struggles to contain a deadly virus thought to have jumped from animals to humans. 

Health authorities have linked exotic animals sold at a seafood market in the central city of Wuhan to the new coronavirus, which has killed 80 people and infected more than 2,400 others within China, and spread around the world. 

The ban goes into effect immediately and will continue until the end of the “national epidemic”. 

In addition, wildlife breeding centres will be quarantined, regulations strictly enforced, and the public warned not to eat wild game products, according to the orders backed by three government agencies. 

“Consumers should fully understand the health risks of eating wild animals, avoid ‘game meat’, and eat healthily,” the agencies – the State Administration for Market Regulation, the Ministry of Agriculture and Rural Affairs, and National Forestry and Grassland Administration – said in a statement on Sunday.  

The move follows a call from 19 leading scientists for the “elimination of the consumption and trade of wild animals”, published on the Twitter-like platform Weibo on Friday. 

The group said various emerging infectious diseases had been linked to animals in recent years, including severe acute respiratory syndrome (Sars), H7N9 bird flu, and Middle East respiratory syndrome.

“Controlling or even eliminating wild animal food and its related trade is not only necessary for ecological protection, but also of great significance in controlling risks to public health,” the group said, adding that the risk of disease transmission grew with increased contact between wild animals and humans.

Links between game meat or the handling of wildlife and the Wuhan coronavirus have been suspected since the early days of the outbreak, when many of the initial patients with pneumonia-like symptoms were found to have worked or lived near the city’s Huanan Wholesale Seafood Market. 

The market, which reportedly sold exotic game meats in addition to seafood, was closed on January 1. 

The link between the virus and wild animals sold at a seafood market was confirmed on Wednesday by Gao Fu, director general of the Chinese Centre for Disease Control and Prevention. 

The outbreak has similarities with Sars in 2002-03, which was linked to civets sold at a wet market in Guangdong province near Hong Kong.

I can foresee two outcomes from this measure: A drop-off in diseases contracted from wild game, and the rapid growth of an illicit market in wild game. That will ensure that at least some outbreaks continue.

DRC Ebola: CMRE update, January 25

Ebola continues its long, hard slog—not as exciting as coronavirus, but just as serious. CMRE has published Situation épidémiologique du 25 Janvier 2020. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI ON JANUARY 24, 2020    

Saturday, January 25, 2020   

• Since the start of the epidemic, the cumulative number of cases is 3,416, of which 3,297 are confirmed and 119 probable. In total, there were 2,240 deaths (2,121 confirmed and 119 probable) and 1,148 people healed; 

• 585 suspected cases under investigation; 

• No new confirmed cases; 

• No new deaths from confirmed cases, including: 

o No community deaths have been recorded; 

o No deaths among the confirmed cases have been recorded; 

• 6 healed people out of CTE in North Kivu, including 5 in Mabalako and 1 in Butembo;  

• No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 167 (approximately 5% of all confirmed / probable cases), including 41 deaths.

The data presented in this table are likely to change later, after in-depth investigations and after redistribution of cases and deaths in their respective health zones.

NEWS  

NOTHING TO REPORT 

VACCINATION  

• 7,611 people were vaccinated, until January 22, 2020, with the 2nd vaccine Ad26.ZEBOV / MVA-BN-Filo (Johnson & Johnson) in the two health areas from Karisimbi to Goma; • Since the start of vaccination on August 8, 2018 with the rVSV-ZEBOV vaccine, until January 23, 2020, 273,837 people have been vaccinated; 

• Approved on October 22, 2019 by the Ethics Committee of the School of Public Health of the University of Kinshasa and on October 23, 2019 by the National Ethics Committee, the second vaccine, called Ad26.ZEBOV / MVA-BN -Filo, is produced by Janssen Pharmaceuticals for Johnson & Johnson; 

• This new vaccine complements the first, rVSV-ZEBOV, a vaccine used until then (since August 08, 2018) in this epidemic manufactured by the pharmaceutical group Merck, after approval by the Ethics Committee on May 20, 2018. It was recently pre-qualified for certification. 

SURVEILLANCE AT POINTS  OF ENTRY 

• Since the start of the epidemic, the cumulative number of travelers checked (temperature taken) at health checkpoints is 143,003,676 ;  

• To date, a total of 109 entry points (PoE) and health control points (PoC) have been established in the provinces of North Kivu and Ituri in order to protect the country's major cities and avoid the spread of the epidemic in neighboring countries.

California: Novel coronavirus case confirmed in Orange County

Via Outbreak News Today: California: Novel coronavirus case confirmed in Orange County.

Officials with the Orange County (CA) Health Care Agency’s (HCA) Communicable Disease Control Division received confirmation from the Centers for Disease Control and Prevention (CDC) that an Orange County, California case has tested positive for the novel coronavirus. 

The case, a traveler from Wuhan, China, has been in contact with the HCA and was provided guidance in order to reduce exposure to the public while awaiting laboratory confirmation from the CDC. The individual has now been transported to a local hospital and is in isolation in good condition.  

This is the third confirmed case reported in the United States, following cases reported in Seattle and Chicago.

China coronavirus: 1,700+ cases, 55 deaths; anti-HIV drugs in use

Via the South China Morning Post: China coronavirus: Beijing confirms use of anti-HIV drugs at some hospitals. The case and death numbers in the headline haven't yet been confirmed on the case-count dashboards. Excerpt:

Beijing’s government announced on Sunday that some of the city’s hospitals are giving patients infected with the Wuhan coronavirus medication used to treat HIV, part of efforts to stop the spread of the deadly illness. 

“Online rumors say that an anti-Aids drug has been used and proved to be effective in treating the coronavirus,” according to a statement by Beijing Municipal Health Commission. “The National Health Commission has recommended the rumored names to treat the coronavirus before and we have Lopinavir/Ritonavir in stock in Beijing,”

Three Beijing hospitals designated to treat confirmed coronavirus cases – Beijing Ditan Hospital, Beijing Youan Hospital, and No. 5 Medical Center of PLA General Hospital – have begun using this therapy for treatment, the statement added. 

The two drugs are antiretrovirals, which block the ability of HIV to bind with healthy cells and reproduce, and are often used in combination to treat the illness.

New research on 41 Wuhan coronavirus cases in China published in Friday’s edition of The Lancet medical journal noted “substantial clinical benefit” from use of the medication in treatment of SARS, a coronavirus epidemic that swept through China in 2002 and 2003. 

However, the authors – experts from numerous medical research institutes in mainland China – also said no such treatment method had been proven. 

“No antiviral treatment for coronavirus infection has been proven to be effective,” according to the article published in The Lancet. “In a historical control study, the combination of lopinavir and ritonavir among SARS-CoV patients was associated with substantial clinical benefit (fewer adverse clinical outcomes).” LUNAR NEWSLETTER Get updates direct to your inbox SUBSCRIBE By registering, you agree to our T&C and Privacy Policy 

By Saturday, 51 cases of the Wuhan coronavirus have been confirmed in Beijing. Of these, two have been cured, and the other 49 remain hospitalised, with one in critical condition.

Deaths caused by the rapidly spreading coronavirus infection that began in China’s Hubei province have risen to 55, while the number of confirmed cases nationwide surpassed 1,700, authorities said on Sunday.

No link with seafood market in first case of China coronavirus, Chinese scientists revealed

Via the South China Morning Post: No link with seafood market in first case of China coronavirus, Chinese scientists revealed. Excerpt:

The first person known to have been infected by the Wuhan coronavirus had never visited the city’s seafood market – regarded as the epicentre of the outbreak – according to Chinese researchers, who also called for extra precautions against airborne transmission of the disease between humans. 

The researchers, seven of whom work at Wuhan’s Jinyintan hospital, designated for patients with the illness, revealed on Friday in The Lancet medical journal that symptoms of the new disease were first reported on December 1 – much earlier than the Wuhan government’s initial announcement on December 31 of 27 cases of the pneumonia-like infection. 

According to the report, the first patient had no exposure to the Huanan seafood market which was shut down on January 1 over fears – later confirmed – that the new virus was linked to its trade in wild animals. The researchers added that none of the patient’s family had developed fever or any respiratory symptoms. There was also no epidemiological link between the first patient and the later cases, they found.