H5N1

Hong Kong: Government launches Preparedness and Response Plan for Novel Infectious Disease of Public Health Significance

Via the Centre for Health Protection: Government launches Preparedness and Response Plan for Novel Infectious Disease of Public Health Significance. The full statement and then a comment:

The Government today (January 4) launched the Preparedness and Response Plan for Novel Infectious Disease of Public Health Significance (The Plan). In parallel, the Serious Response Level was activated with immediate effect.        

The Plan sets out the Government's preparedness and response plan in case of an outbreak of Novel Infectious Disease of Public Health Significance. A three-tier response level is adopted in the plan. Three response levels, namely Alert, Serious and Emergency, will be activated based on the risk assessment of the Novel Infectious Disease of Public Health Significance that may affect Hong Kong and its health impact on the community.        

Upon the risk assessment of the cluster of cases of viral pneumonia with unknown cause in Wuhan reported by the National Health Commission, the Serious Response Level was activated. Under the Serious Response Level, the immediate health impact caused by Novel Infectious Disease of Public Health Significance on local population is moderate.        

"'Novel Infectious Disease of Public Health Significance' refers to any infectious disease caused by a pathogen unknown to cause human disease before, but may have changed its property to cause human infection with or without the ability of efficient human-to-human transmission. The disease has the potential to lead to international spread and public health emergency. The current cluster of viral pneumonia cases in Wuhan can be regarded as a Novel Infectious Disease of Public Health Significance," a spokesman for the Centre for Health Protection (CHP) of the Department of Health said.        

"The Government will assess the risk from time to time in view of the latest scientific evidence and situation, activate or deactivate the response level and implement corresponding measures," the spokesman said.        

For more information, please refer to the Plan which has been uploaded to the CHP's website (www.chp.gov.hk/files/pdf/govt_preparedness_and_response_plan_for_novel_infectious_disease_of_public_health_significance_eng.pdf).

Hong Kong's CHP was established after the shock of the 1997 H5N1 outbreak, and ever since it's been an exemplar of a public health agency. If sniffles break out in a kindergarten, or someone comes home from Dubai a bit feverish, CHP will be on the scene and prepared to tell the world what's infected the kids and whether the traveller has MERS (so far, not a single person).

H5N1 may have fizzled out, but the Hong Kong Centre for Health Protection has not.

Saudi Arabia: The direct medical costs of MERS

Via Infection and Drug Resistance, the best research report I have yet seen on the MERS epidemic: Estimation Of Direct Medical Costs Of Middle East Respiratory Syndrome. The abstract:

Background: Among the countries affected by Middle East respiratory syndrome (MERS), Saudi Arabia was impacted the most, with 2,058 cases reported as of June 2019. However, the impact of the MERS epidemic on the Saudi economy is unknown. 

Purpose: The present study aimed to evaluate the direct medical costs associated with the management of MERS cases at a tertiary referral hospital in Riyadh, Saudi Arabia. 

Methods: The study involved a retrospective chart review of confirmed cases of MERS coronavirus (MERS-CoV) infections in a tertiary care referral center in Riyadh, Saudi Arabia, from January 2015 to October 2018. The collected data included sociodemographic characteristics, medical information, and the cost of hospitalization of each patient as estimated by micro-costing. 

Results: A complete set of relevant information was available only for 24 of 44 identified MERS-CoV cases. Patients were mostly females, and the mean age was 52 years. Diabetes, hypertension, and chronic kidney disease were the most frequent comorbidities. The length of hospital stay varied from 1 to 31 days, averaging 4.96 ± 7.29 days. Two of the 24 patients died. The total cost of managing a MERS case at the hospital ranged from $1278.41 to $75,987.95 with a mean cost of $12,947.03 ± $19,923.14. 

Conclusion: The findings of this study highlight the enormous expenses incurred by the Saudi health care system due to the MERS-CoV outbreak and the importance of developing an enforceable nationwide policy to control MERS-CoV transmission and infection.

Transmissibility of MERS-CoV infection in closed setting, Riyadh, Saudi Arabia, 2015

Via Emerging Infectious Diseases: Transmissibility of MERS-CoV Infection in Closed Setting, Riyadh, Saudi Arabia, 2015. The abstract:

To investigate a cluster of Middle East respiratory syndrome (MERS) cases in a women-only dormitory in Riyadh, Saudi Arabia, in October 2015, we collected epidemiologic information, nasopharyngeal/oropharyngeal swab samples, and blood samples from 828 residents during November 2015 and December 2015–January 2016. 

We found confirmed infection for 19 (8 by reverse transcription PCR and 11 by serologic testing). Infection attack rates varied (2.7%–32.3%) by dormitory building. No deaths occurred. Independent risk factors for infection were direct contact with a confirmed case-patient and sharing a room with a confirmed case-patient; a protective factor was having an air conditioner in the bedroom. 

For 9 women from whom a second serum sample was collected, antibodies remained detectable at titers >1:20 by pseudoparticle neutralization tests (n = 8) and 90% plaque-reduction neutralization tests (n = 2). 

In closed high-contact settings, MERS coronavirus was highly infectious and pathogenicity was relatively low.

ECDC: CDTR, July 28-August 3, week 31

ECDC has published Communicable disease threats report, 28 July-3 August 2019, week 31.

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period from 28 July to 3 August 2019 and includes updates on Middle East respiratory syndrome coronavirus (MERS-CoV), Ebola virus disease, monitoring environmental sustainability of Vibrio growth in the Baltic Sea and West Nile virus infection.

ECDC rapid risk assessment: Public health risks related to communicable diseases during the hajj 2019, Saudi Arabia, 9–14 August

ECDC has published Rapid risk assessment: Public health risks related to communicable diseases during the hajj 2019, Saudi Arabia, 9–14 August 2019. The executive summary: 

Main conclusions and options for response 

In 2019, the hajj will take place between 9 and 14 August. 

The risk for EU/EEA citizens to become infected with communicable diseases during the 2019 hajj is considered low, thanks to the vaccination requirements for travelling to Makkah (Mecca) and the Saudi Arabian preparedness plans that address the management of health hazards during and after hajj.   

As with other mass gathering events, the risk of communicable disease outbreaks is greatest for food- and waterborne diseases and respiratory diseases. Outbreaks of MERS-CoV continue to be reported from the Arabian Peninsula, specifically from Saudi Arabia, which implies that there is a risk of importation of cases to Europe after the hajj.  

The risk of vaccine-preventable and vector-borne diseases is considered low if preventive measures are applied.   

Advice for those making the hajj 

Prior to travelling 

It is important that travellers seek advice from healthcare providers on the health requirements and recommendations for Saudi Arabia. Travellers should be advised to follow recommendations issued by the Saudi Arabian Ministry of Health and WHO. Advice issued by ECDC should also be taken into account.  

According to the Saudi authorities, pilgrims are required to provide proof of vaccination with the conjugated meningococcal ACW135Y vaccine administered no less than ten days prior to arrival in Saudi Arabia in order to obtain an entry visa. Travellers making the hajj should be up to date with immunisations routinely administered in their EU country of residence, including vaccinations for measles, mumps and rubella (MMR) and diphtheria-tetanus-polio. Additional vaccinations such as hepatitis A, hepatitis B, influenza, and rabies may be indicated.  

During the hajj 

Travellers making the hajj should take the following into account:  

• Pay attention to personal hygiene and adhere to food and water hygiene regulations in order to decrease the risk of gastrointestinal illnesses. 

• Practise respiratory hygiene and cough etiquette to reduce the risk of respiratory infections. 

• Practise insect and tick bite avoidance measures day and night. 

• Visit only licensed barbers for shaving. 

• Due to the expected high temperatures, avoid direct sun exposure and drink sufficient amounts of liquid. 

After the hajj 

Travellers returning from the hajj should seek medical attention immediately if they experience symptoms suggestive of any type of infection, e.g. gastrointestinal or respiratory. They should also mention their travel history to their healthcare provider. 

Due to continuing reports of MERS-CoV disease in Saudi Arabia, people returning from the hajj should be made aware of the need to seek immediate medical advice if they have a fever (38 ºC and over), cough or difficulties breathing within 14 days of their return. 

Travel history and previous hospitalisation should be reported to the healthcare provider if a person returning from the hajj requires hospitalisation within one year after returning from the hajj. This is to ensure that the possible acquisition of antimicrobial-resistant (AMR) bacteria will be considered and that appropriate measures can be implemented in accordance with national guidelines for the prevention of AMR. 

ECDC: CDTR, week 23

ECDC has published Communicable Disease Threats Report, 2 - 8 June 2019, Week 23.

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period from 2-8 June 2019 and includes updates on poliomyelitis, Middle East respiratory syndrome coronavirus (MERS-CoV), dengue, Ebola virus disease, Legionnaires' disease and West Nile virus infection.

An experimental Ebola cure may also protect against Nipah virus

Via The New York Times, news of a veritable panacea: An Experimental Ebola Cure May Also Protect Against Nipah Virus. Excerpt:

An experimental drug has protected monkeys against infection with Nipah virus, a lethal disease and emerging pandemic threat for which there is no approved vaccine or cure, scientists reported on Wednesday.  

The antiviral drug, remdesivir, is also being tested against the Ebola virus in the outbreak now underway in the Democratic Republic of Congo.  

The only current treatment for Nipah virus infection is a monoclonal antibody that is still experimental; it was tested during an outbreak in India last year. 

In the new trial, eight African green monkeys were given lethal doses of Nipah virus. Half of them later got intravenous remdesivir. All four monkeys that got the drug survived; the four that did not died within eight days.

If the drug wins approval for use against Nipah, “it will give us an extra treatment that could be used relatively quickly,” said Emmie de Wit, a virologist at the National Institute of Allergy and Infectious Diseases and one of the study’s lead authors. “The average person who reaches a hospital dies within two days, so it’s hard to protect them once they’re infected.” 

Ebola and Nipah belong to different viral families, but remdesivir — made by Gilead Sciences and also known as GS-5734 — appears effective against both.

In mice or cells cultivated in the laboratory, the drug has also shown some effectiveness against two other pandemic threats: Lassa fever and MERS coronavirus. It is also effective against respiratory syncytial virus, which infects children all over the world.  

Although the outer shells of all these viruses are very different, their polymerases — the genome-copying enzyme that remdesivir targets — are similar, Dr. de Wit explained.  

The new study, done jointly by the N.I.A.I.D. and the Centers for Disease Control and Prevention, was published in Science Translational Medicine.

WHO: Middle East respiratory syndrome coronavirus (MERS-CoV) – The Kingdom of Saudi Arabia

WHO has published Middle East respiratory syndrome coronavirus (MERS-CoV) – The Kingdom of Saudi Arabia. Click or tap through to download the spreadsheet with case details. Excerpt:

From 9 through 30 April 2019, the National International Health Regulations (IHR) Focal Point of Saudi Arabia reported nine additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including three deaths. Of the nine cases reported, five were associated with ongoing clusters in three cities. Three cases (including one death) were reported in Alkhafji city in the Eastern region of Saudi Arabia, one case in Alderb city in Jazan region and one case in Alkharji city in Riyadh region of Saudi Arabia. Details of the ongoing clusters are available in the Disease Outbreak News published on 9 May 2019.

From 2012 through 30 April 2019, a total of 2428 laboratory-confirmed cases of MERS-CoV infection and 839 associated deaths were reported globally to WHO under the IHR. The associated deaths reported to WHO were identified through follow-up with affected member states.  

WHO risk assessment 

Infection with MERS-CoV can cause severe disease resulting in high morbidity and mortality. Humans are infected with MERS-CoV from direct or indirect contact with infected dromedary camels. MERS-CoV has demonstrated the ability to transmit between humans, especially from close unprotected contact with infected patients. So far, the observed non-sustained human-to-human transmission has occurred mainly in health care settings.  

The notification of these additional cases does not change WHO’s overall risk assessment of MERS. WHO expects that additional cases of MERS will be reported from the Middle East, and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to dromedary camels, animal products (e.g. consumption of camel’s raw milk), or humans (e.g. in a health care setting).  

WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.

WHO: Middle East respiratory syndrome coronavirus (MERS-CoV) – The Kingdom of Saudi Arabia

WHO has published Middle East respiratory syndrome coronavirus (MERS-CoV) – The Kingdom of Saudi Arabia. Excerpt:

From 14 February through 31 March 2019, the National IHR Focal Point of Saudi Arabia reported 22 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including four deaths, associated with the outbreak in Wadi Aldwasir. Of the 22 cases, 19 were reported from Wadi Aldwasir city including two healthcare workers. The remaining three cases, which are epidemiologically linked to the outbreak, were healthcare workers from a hospital in Khamees Mushait city, Asir region. 

Since the beginning of this outbreak in January 2019, a total of 61 MERS-CoV cases, with a case fatality ratio of 13.1% (8/61), have been reported in Wadi Aldwasir city. The median age of reported cases was 46 years (range 16 to 85 years). Of the 61 cases, 65% (n=46) were male, and 23% (n = 14) were health care workers. 

Investigations into the source of infection of the 61 cases found that 37 were health-care acquired infections, 14 were primary cases presumed to be infected from contact with dromedary camels and the remaining (10) infections occurred among close contacts outside of health care settings. As previously reported, two human to human transmission amplification events took place at a hospital during this outbreak.

Hong Kong: Update on latest MERS situation in Saudi Arabia

Via the Centre for Health Protection: Update on latest MERS situation in Saudi Arabia. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health is today (April 1) closely monitoring 19 additional cases of Middle East Respiratory Syndrome (MERS), reported to the World Health Organization (WHO) by the Kingdom of Saudi Arabia (KSA) from February 1 to 28. The CHP again urged the public to pay special attention to safety during travel, taking due consideration of the health risks in the places they visit.        

According to the WHO, among the 17 male patients and two female patients, aged 24 to 94, 13 had underlying illnesses, nine had exposure to camels and consumed camel milk, two had contact with previously confirmed patients, and three had passed away.      

"We will maintain close communication with the WHO and relevant health authorities," a spokesman for the CHP said.      

"As countries in the Middle East, particularly the KSA, continue to report MERS cases from time to time, travellers should refrain from going to farms, barns or markets with camels and avoid contact with sick persons and animals, especially camels, birds or poultry. Most of the cases reported in the Middle East had history of exposure to camels, consumption of camel milk or contact with other MERS patients," the spokesman said.