Saudi MOH Statement On MERS Family Cluster

 

#10,392

 

For the past couple of weeks we’ve been following an extended outbreak of MERS in and around the Capital city of Riyadh. As of today, at least 13 cases have been confirmed by the Saudi Ministry of Health. 

 

Although the information provided on the MOH website is fairly cryptic, it has been apparent that contacts of family members, and nosocomial contacts, have been infected.  Additionally, some cases have no known risk exposures listed.

 

Today the Ministry of Health has posted a long statement regarding a family cluster, apparently in response to criticisms lodged by family members to the media.   First, a (translated) excerpt from one of the media sources of the accusations, then the MOH response.

 

Health" Saudi Arabia responded to the accusations of family infected with Corona

Riyadh Khalid Al Shaya

August 6, 2015

 

Saudi Ministry of Health and health affairs at the Ministry of National Guard issued a joint statement on Thursday, made it clear the recording of cases of HIV Middle East respiratory syndrome Coruna central Saudi family in Riyadh region. The family has accused the Ministry of Health of causing the injury of six members with the virus, the lack of follow-up to one of its members who was formerly the disease and neglect checking the rest.

The tired-Harbi, a family member, said on Wednesday that four of his family contracted the disease, including his mother, who died, and three of his uncles. He said, adding: "My father virus wounded first, but in spite of it remains in intensive care for five days, but the hospital is directed, declaring that he is no longer suffering from it, which is what caused the transmission of the virus to my mother, who died outcome, and after the virus has moved to my brother, who is currently lying in Prince Mohammad Bin Abdulaziz Hospital with three of my uncles because of the virus. "

He continued, "I attended a medical committee of the Ministry of Health to our house after Thbot injury and my father HIV and conducted tests for a limited number of the family, and they told us that the results were negative. and asked them to check the rest, but they refused, knowing that the effects of the disease were visible on my mother. "

(Continue . . . )

 

The index case (the father) who remains hospitalized, appears to have had recent camel (“beauty”) contact. Subsequently his wife has succumbed, and two sons have been hospitalized.  At least one other family member is isolated at home.

 

Apparently these charges have induced the MOH to take the unusual step of publishing a formal response (see below), where they acknowledge the family cluster, but do not directly address the family’s allegations.

 

As machine translations often lose some context and flavor along the way, if and when an English language statement is published, we may be able to glean more from it.   

 

Health and the Ministry of National Guard issue joint registration virus cases (Corona) to the family of Saudi Arabia in Riyadh

21 October 1436

A desire to shed light on more information on registered cases of HIV (La Coruna), Ministry of Health and Health Affairs at the Ministry of National Guard has issued a joint statement, which made clear recording cases of HIV Middle East respiratory syndrome (Corona) amid a Saudi family in the Riyadh region, including two cases Mnomtan Hospital King Abdulaziz Medical City, National Guard, and the state of hypnotic Hospital, Prince Mohammed bin Abdul Aziz, and the case moved to the mercy of God.

Symptoms and signs have emerged the first case (the father) and who suffer from chronic diseases, and underwent the process of eradication of college previously, and hypnotic currently at King Abdulaziz Medical City, National Guard, and receive the necessary medical care, ask God cure him.

And it has been shown through epidemiological investigation of the case that the patient Mkhalt to beauty, was immediately conduct epidemiological investigation and debate all contacts, and a sampling of those who showed symptoms of the disease, and in accordance with the directives issued by the command and control center at the Ministry of Health and the World Health Organization Scientific Committee.  

As for the second case (mother), the wife of the first patient case; it has been discovered through follow-up to household contacts of the first case, he has died, ask God have mercy and forgiveness.

The third case, the son of the first and the second case, he is hypnotized Hospital, Prince Mohammed bin Abdulaziz, and receive necessary medical care, God's lips.

For the fourth case is the brother of the first case, and hypnotized at King Abdulaziz Medical City, National Guard, and receive necessary medical care, God's lips.

It should be noted that a family member was found positivity when the virus check, which is isolated now at home, and is a carrier of the virus only, and does not apply it your disease virus case definition (Corona) in accordance with the Guidelines approved by the Scientific Committee and the center of command and control at the Ministry of Health and the World Health Organization and the control center and control diseases in the United States of America, and place a stable home, thankfully.

For its part, the Ministry of Health made it clear that this is not the first time that an outbreak occur amid members of one family, there have been outbreaks earlier, also in Al-Ahsa province to the family of one of the seven members, also occurred in the province of Taif and Riyadh region, all outbreaks of the center of a Saudi family link among them is communion friction and beauty products.

The Ministry of Health also confirmed that it already noted for all in more than one occasion through the media channels and various means of social communication through the campaign (appreciate plugged) health awareness, and calls upon the ministry now valued citizens need to take the necessary precautions when dealing with beauty, from the coverage of the mouth, face and follow health habits for example, washing of hands.

The ministry also Taml the integrative role with our partners from government agencies in the Ministry of Agriculture and the Ministry of Municipal and Rural Affairs and valued citizens who trust in the health and awareness.

We ask God for this family urgently healing, and that the ruthless dead

 

While large family clusters of MERS have been reported before, they are uncommon enough to warrant additional investigation and scientific scrutiny.   Hopefully whatever is learned will be shared – sooner rather than later – by  the Saudi Authorities.

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Eurosurveillance: Parotitis Associated With A Drifted A/H3N2 Infection

Credit Wikipedia

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Last February, amid concerns that the dominant seasonal H3N2 virus had drifted away from last winter’s vaccine (see CDC HAN Advisory On `Drifted’ H3N2 Seasonal Flu Virus), we began to hear of cases of Unusual Presentation Of Parotitis With Seasonal Influenza.

 

The classic cause of parotid swelling is the mumps virus, but other viruses (EBV & HIV), along with acute bacterial parotitis or Extrapulmonary Tuberculosis can cause inflammation of these glands, as well as some autoimmune diseases. And sometimes, the etiology is unknown.

 

In January, the Chicago Department of Public Health issued an alert to local doctors to test for both influenza, and mumps, when diagnosing parotitis, as several unusual influenza-related cases had surfaced.

 

The following month,  the CDC published an overview of the 2014-15 flu season, with the following comment on these parotitis cases.

What You Should Know for the 2014-2015 Influenza Season

(excerpt)

Is there any unusual disease activity going on this season?

Since December 2014, multiple states have notified CDC of laboratory-confirmed influenza infections in persons who have swelling of their salivary glands (a condition called ‘parotitis’). Of the cases of influenza infection with parotitis that have been reported to CDC, the majority have occurred in children with influenza A (H3) infection, and have resulted in mild illness. No deaths have been reported. CDC is currently investigating  the situation in order to understand the characteristics of patients and the occurrence of parotitis.

Parotitis is not a common symptom of influenza infection, although cases of parotitis with influenza infection have been reported in the past. Parotitis is much more commonly seen following infection with other pathogens such as the mumps virus. Symptoms of influenza infection include fever, chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headache, fatigue (tiredness), and sometimes vomiting and  diarrhea (more common in children than adults).

 

Fast forward to today, and we have a report in today’s Eurosurveillance Journal of A/H3N2 detected last winter in children being tested for mumps in the England.

 

Eurosurveillance, Volume 20, Issue 31, 06 August 2015

Rapid communications

Detection of influenza A(H3N2) virus in children with suspected mumps during winter 2014/15 in England

C I Thompson ()¹, J Ellis¹, M Galiano¹, M Ramsay², K E Brown¹, M Zambon¹

Influenza A(H3N2) virus was detected in oral fluid from 16/107 children (aged 2 to 12 years) with a clinical diagnosis of mumps, who were sampled between December 2014 and February 2015 in England, during the peak of the 2014/15 influenza season. Sequence analysis of an A(H3N2) virus from a child with suspected mumps showed the virus was similar to other circulating A(H3N2) viruses detected in winter 2014/15, which were antigenically drifted from the A(H3N2) vaccine strain.

During winter 2014/15, clinical parotitis in children with confirmed influenza A(H3) infection was reported in North America [1]. In contrast, however, neither clinical nor virological surveillance for influenza-like illness (ILI) through sentinel general practitioners (GPs) in England detected an association between parotitis and influenza virus infection in the 2014/15 winter. In light of the observations from North America, gingival crevicular fluid (oral fluids) submitted for mumps surveillance in England were examined for influenza virus. Analysis of samples from 107 children (aged 2 to 12 years) with a clinical diagnosis of mumps but negative for mumps virus, sampled between December 2014 and February 2015, during the peak of the 2014/15 influenza season, showed that 16 (15%) were infected with influenza A(H3N2) virus.

(SNIP)

Influenza virus as an atypical cause of acute viral parotitis should be considered especially during epidemic seasons with drifted A(H3N2) strains, such as in 2014/15, or when zoonotic exposure has occurred.

Influenza A(H3N2) viruses from the 3C.2a clade that have predominantly circulated in the UK during winter 2014/15 show reduced agglutination of red blood cells used in laboratory tests suggestive of a change in binding specificity or avidity for sialic acid receptors [20]. Both mumps and influenza viruses bind sialic acid receptors on cells in the upper respiratory tract [21]. The unusual clinical presentation of parotitis during the 2014/15 season in conjunction with a change in virus receptor binding properties warrants further investigation.

(Continue . . . )

 

The idea that a sufficiently `drifted’ or zoonotic H3N2 virus might cause an atypical presentation like parotitis isn’t without precedent.  While rare, it has been documented before, as in this April of 2009 edition of the Journal of Clinical Microbiology.

 

Parotitis in a Child Infected with Triple-Reassortant Influenza A Virus in Canada in 2007

Nathalie Bastien1,Donalda Bowness1,  Laura Burton2, Erika Bontovics2,  Anne-Luise Winter2,  Graham Tipples1, Debby Minielly2,  Betty Gregg2,  Christine Cramer2,  Christine Schincariol2 and  Yan Li1,*

ABSTRACT

Swine H3N2 influenza virus designated A/Ontario/1252/2007 was isolated from a child with parotitis. Diagnosis was confirmed by viral isolation and serological assays. A/Ontario/1252/2007 was related to H3N2 triple reassortants that emerged in swine in the United States in 1998. Three of five tested household members were also seropositive for A/Ontario/1252/2007.

(Continue . . . )

 

Going even further back in the literature, in 1977 the NEJM reported on Acute Parotitis Associated with Influenza Type a — A Report of Twelve Cases, which occurred during the last year that A/H3N2 ruled the influenza court alone (H1N1 reemerged in May of 1977 after a 20 year absence).

Although there is always a degree of diversity in the flu strains circulating around the globe, the most recent ECDC  Influenza Virus Characterization Report describes an increasingly complex H3N2 viral field.

Since 2009, seven genetic groups based on the HA gene have been defined for A(H3N2) viruses.

The HA genes fall within genetic group 3C. This group has three subdivisions: 3C.1 (to which the recommended vaccine virus for the 2014–15 northern hemisphere season, A/Texas/50/2012, belongs), 3C.2 and 3C.3. Viruses in these three subdivisions have been antigenically similar.

However, in 2014 three new genetic subgroups emerged, one in subdivision 3C.2, 3C.2a, and two in 3C.3, 3C.3a and 3C.3b (Figure 2). While viruses in genetic subgroups 3C.2a and 3C.3a are antigenic drift variants, those in 3C.3b have remained antigenically similar to previously circulating viruses in the 3C.3 subdivision. Amino acid substitutions that define these subdivisions and subgroups compared with A/Texas/50/2012 are:

• (3C.2) N145S and V186G5 in HA1, and D160N in HA2, e.g. A/Hong Kong/146/2013
• (3C.2a) Those in 3C.2 plus L3I, N144S (resulting in the loss of a potential glycosylation site), F159Y, K160T (in the majority of viruses, resulting in the gain of a potential glycosylation site), N225D and Q311H in HA1, e.g. A/Hong Kong/5738/2014
• (3C.3) T128A (resulting in the loss of a potential glycosylation site), R142G, N145S and V186G in HA1, e.g. A/Samara/73/2013
• (3C.3a) those in 3C.3 plus A138S, F159S and N225D in HA1, many with K326R, e.g. A/Switzerland/9715293/2013
• (3C.3b) those in 3C.3 plus E62K, K83R, N122D (resulting in the loss of a potential glycosylation site), L157S and R261Q in HA1 with M18K in HA2, e.g. A/Newcastle/22/2014.

 

Whether this growing diversity portends more atypical flu presentations is far from certain.  It does, however, make selecting the right vaccine strain for future flu seasons a lot more complicated.

 

The authors of today’s Eurosurveillance Journal report conclude by saying:

 

The specific detection of influenza A(H3N2), and not influenza B or A(H1N1)pdm09 in this sample set, in combination with the clinical syndrome reporting from North America, suggests that influenza should be considered as part of the differential diagnosis for parotitis at the time when influenza virus is circulating, but this conclusion requires evaluation with different circulating influenza virus strains.

The question of whether 3C.2a A(H3N2) influenza virus strains have an unusual tissue distribution compared with other A(H3N2) viruses or whether a subset of children infected with any influenza strain experience parotitis remains to be determined. Our conclusions would be strengthened by evaluation of further studies during future influenza seasons where oral fluids are taken in parallel with nasal swabs from children with influenza, with and without parotitis.

Nevertheless, greater awareness of influenza virus as a potential cause of parotitis especially during epidemic periods associated with a drifted A(H3N2) strain is an important clinical and public health message.

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August Tropical Climatology & The Latest CSU Hurricane Forecast

 

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As a resident of Florida for nearly 50 of my 61 years, I’m pretty used to casting a weather eye towards the tropics six months out of every year.  But while hurricane season runs from June 1st through the end of November, as the chart above illustrates, most of our tropical activity takes place between August 20th and October 20th.

 

As the summer progresses the spawning grounds for Hurricanes expands greatly, moving further east into the warming Atlantic ocean.  It is usually  August and September when the Cape Verde basin begins to produce what often turn into the largest and most persistent storms.

 

July & August Tropical Climatology

You can find much more on Hurricane Climatology at NOAA’s  Tropical Cyclone Climatology page.

This being a strong El Niño year, we would expect tropical activity in the Eastern Pacific to be enhanced, while tropical development in the Atlantic is suppressed. 

 

But there is a great deal more to long range tropical forecasting, which is why we eagerly await the forecasts each spring and summer by Philip J. Klotzbach and William M. Gray who run Colorado State University’s Tropical Meteorology Project.

 

Starting in April, they begin producing regular forecasts for the upcoming season, adjusting and fine tuning their projections throughout the season.  Their initial forecast (April 9th) anticipated that `the 2015 Atlantic basin hurricane season will be one of the least active seasons since the middle of the 20th century’.

Their latest update (August 4th) continues to predict a below-average Atlantic tropical season.

 

FORECAST OF ATLANTIC SEASONAL HURRICANE ACTIVITY AND LANDFALL STRIKE PROBABILITY FOR 2015

We continue to foresee a well below-average 2015 Atlantic hurricane season. A strong El Niño event is already underway. Conditions in the tropical Atlantic remain unfavorable for hurricane formation. We continue to call for a below-average probability of United States and Caribbean major hurricane landfall.

(Continue . .. )

 

Of course, even a slow hurricane season doesn’t preclude seeing one or more potentially deadly storms affect the United States coastline.   The chart below from the latest forecast still gives Florida 1 in 5 chance of seeing a hurricane yet this year, and a 13% probability for Texas.

 

So, if you haven’t already downloaded the updated Tropical Cyclone Preparedness Guide, now would be an excellent time to do so.

When it comes to getting the latest information on hurricanes, your first stop should always be the National Hurricane Center in Miami, Florida. These are the real experts, and the only ones you should rely on to track and forecast the storm.

 

And if you are on Twitter, you should also follow @FEMA, @CraigatFEMA, @NHC_Atlantic, @NHC_Pacific and @ReadyGov.

 

For more on preparedness, you may wish to revisit some of these recent blogs:

•  Appreciating The Nature Of The Threat
• When Evacuation Is The Better Part Of Valor
• When 72 Hours Isn’t Enough

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Updating NYC’s Legionnaire’s Outbreak

Legionella Bacteria - Photo Credit CDC PHIL

 

# 10,389

 

In a story we’ve been following for more than a week (see Monday’s Updating The NYC Legionella Outbreak), the number of Legionella infections reported in the South Bronx continues to rise, with the total nearing 100. As many people who contract this type of bacterial infection experience only minor symptoms, this is likely an undercount.

 

Those who are susceptible (often smokers, the elderly, immunocompromised, etc.) can develop serious – even life threatening – pneumonia.

 

The Legionella bacteria thrives in warm water, such as is commonly found in air-conditioning cooling towers, hot tubs, and even ornamental water fountains. When water is sprayed into the air the bacteria can become aerosolized and inhaled.

 

The CDC estimates that between 8,000 and 18,000 Americans are hospitalized with Legionnaire's Disease each year. While large outbreaks of Legionella are often traced to specific causes, quite often the source of the infection for individual cases remains unknown.  

 

Overnight NYC.gov posted the following update.

 

NYC.gov

Bronx Legionnaires' Disease Cluster Updated Fact-Sheet 8/5/15

Cases

• Individuals with Legionnaires' deceased: 8
• All deceased individuals were older adults and had additional underlying medical problems.
• These patients are connected to the current cluster.
• Reported individuals with Legionnaires': 97
• Individuals with Legionnaires' hospitalized: 92
• Of the 92, the number of individuals with Legionnaires' treated and discharged: 48

FAQ

• New York City's drinking water supply and other water features, like fountains, shower heads and pools, are safe throughout New York City and are unaffected by legionella
• Water towers are unaffected by legionella
• Home air conditioner units are unaffected and walking into air conditioned environments is safe, as well.

Locations and Remediation

• 17 cooling towers were tested
• 5 locations tested positive, and all have been remediated. Health officials are confident that one or more of the five locations that tested positive was the source of the outbreak, and the risk has been removed through disinfection.
• All sites will submit long-term plans as to how they will maintain the cooling towers to protect against any future growth of legionella – those plans are due Friday.
• The Health Department convened a panel of experts in the field of infectious disease to discuss the work the City has done so far and to ensure that all the appropriate steps are being taken to find and eliminate the source of the outbreak.

Ongoing DOHMH Actions

• Continued monitoring for new cases
• Close collaboration with area hospitals
• Disease detectives conducting epidemiological investigation
• Interviews with all individuals reported with Legionnaires' to support source identification
• Providing updates to elected officials and Bronx residents
• Outreach to vulnerable populations – senior centers, homeless shelters, and other locations
• Monitoring of disinfection of affected cooling towers

 

For more information on the disease, the CDC maintains a fact sheet at Patient Facts: Learn More about Legionnaires' disease.

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Media Reports: H5N2 Poultry Outbreak – Sinaloa, Mexico

Sinaloa, MX

 

#10,388

 

This story has been percolating through the Spanish language press since yesterday afternoon, but thus far Mexico’s Agricultural Ministry (Secretaría de Agricultura, Ganadería, Desarrollo Rural, Pesca y Alimentación; SAGARPA)  and National Health Service, Food Safety and Food Quality (SENASICA ) websites remain silent on the reports.

 

Additionally, a quick check of both the FAO and OIE reporting systems shows no notification as of this writing.

 

While official confirmation is still lacking, the following (translated) report - issued this morning by El Siglo de Torreon - is not only the latest, but one of most detailed account that I’ve run across.

 

They slaughtered 500 thousand chickens by virus

CULIACÁN, Sinaloa.- Over half a million laying hens be sacrificed in southern Sinaloa due to infection of H5N2 avian flu that has spread in the area, announced Juan Guerra Ochoa, Secretary of Agriculture of the State.

The official said the company Sinaloa name El Rosario SPR "Egg Champion" is quarantined due to illness.

"The outbreak was detected on 21 July and 24 July, the company was in quarantine, unable to leave or enter any bird, nor products, be slaughtered 512 000 birds.

He explained that the borders of Sinaloa were closed to the import and export of products to prevent the virus from spreading, but said that there is no risk of being transferred to other farms.

"It is given a final quarantine, that the next step is the slaughter of all animals and not let anything in or out so that it will not spread to other places," he said.

Guerra Ochoa explained that the virus apparently came from the State of Jalisco, while Wednesday held a meeting with the head of Senasica, Enrique Sanchez Cruz, to address the issue.

 

Other media reports overnight include Detect bird flu outbreak in the municipality of Rosario, Sinaloa and 512 000 birds slaughtered bird flu outbreak in Sinaloa farm.  

 

While one might be tempted to assume this is a spillover of HPAI H5N2 from migratory birds, such as we’ve seen recently in the United States and Canada, these reports don’t indicate the pathogenicity (LP or HP) of the virus.

 

As Mexico has a long history of LPAI (low pathogenic) H5N2 outbreaks going back more than 20 years, this may simply be a reoccurrence of their native LPAI H5N2 virus.  We’ll have to await further details to know one way or the other.

So far this year, only two other outbreaks of avian flu have been reported by Mexican authorities to the OIE, and both of those were H7N3 (see OIE Notification On H7N3 In Chiapas Wild Birds).

 

There are references in the media reports to this H5N2 virus having been imported from a farm in Jalisco, but the last outbreak reported from that state (2012-2014) was the H7N3 virus.

 

Hopefully we’ll get clarification on this from the OIE, FAO, or SAGARPA soon.

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KDU University College - Malaysia

Last Call for September 2015 Intake

Foundation in Arts

• Starting from 2016, the intakes are Jan, April & July
• Sept only for 2015 intake
• Full time program

• Duration - 3 Semester, minimum 1 year
• Course location: KDU College, Damansara Jaya
• Enrty requirement: SPM/O levels - Min 5 credits, UEC - Min 3 Credits

Bachelor of Software Engineering (Hons)

• Effective from Sept 2015
• Full time program

• Duration: 3 years
• Course location: KDU University College, Utropolis, Glenmarie
• Entry requirement: Matriculation/Foundation - A pass with CGPA 2.0 & a credit in A.Maths in SPM or equivalent, STPM - A pass with min Grade C in any 2 subjects & a credit in A.Maths in SPM or equivalent, UEC - Min 5 credits inclusive Maths

Master of Design (Innovation)

• New programs starting from Sept 2015 intake
• Can be full time or part time (optional)

• Duration: Min 1 year and 4 months
• Course location: KDU University College, Utropolis, Glenmarie
• Entry requirement: Bachelor Degree in relevant field - Min. CGPA 2.67 (Min CGPA 2.0 with min 3 years of working experience can be accepted), Portfolio presentation and Interview

For more information, please feel free to contact your nearest JM Office. 

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Queen's University Belfast, United Kingdom

International Scholarship for 2015/16

• For both undergraduate & postgraduate international students who hold offer plan to enroll in 2015/16 are eligible to apply

Full Fee Postgraduate Research Scholar

• For those student who will starting in September 2015

10% Early Bird Reward

• For those hold unconditional offer and paid tuition fee before 17 July are subject to entitled

Further information on International Scholarship 2015/16, please refer to the link:

• International Undergraduate Scholarship 2015
• International Postgraduate Taught Scholarships 2015
• International Postgraduate Research Scholarships 2015

APPLICATION DEADLINE: 20 AUGUST 2015

For more information, please feel free to contact your nearest JM Office. 

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