Saudi MOH Announces 6 More MERS Cases In Riyadh

 

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The Saudi MOH has released, albeit several hours later than usual, their latest MERS update which cites 6 new cases in the Capital City, Riyadh (along with 1 death).

 

Today’s announcement brings to 43 the number of cases reported over the past 7 days, and the month-to-date total to 77.

Given the Saudi MOH’s erratic history case reporting (sometimes a week or longer after they test positive), day-to-day fluctuations in the numbers reported are difficult to interpret.  

Of today’s cases, 1 is listed as a healthcare worker with all but one of the rest (a 58 y.o. Female)  listed as having contact with a previously identified case.  We’ll have to wait for a future WHO update to get any meaningful details, but the vast majority of infections described recently by the WHO were hospital acquired.

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PLoS One: Concentration, Size Distribution, and Infectivity of Airborne Particles Carrying Swine Viruses

Photo Credit CDC EID Journal

 

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We’ve a research article appearing this week in the journal PLoS One that while conducted on swine – and with swine viruses (IAV, PEDV, PRRSV)  – may also help explain the lateral spread of avian flu viruses to neighboring poultry farms, such as we witnessed last spring in the American Midwest with HPAI H5.

The idea that some types of viruses might be carried by dust particles, remain viable for hours, and be spread (often for miles) by prevailing winds isn’t exactly new.  The science even has a name; aerobiology – the study of how bacteria, fungal spores, pollen and even viruses can be passively transported in the air.

 

And for some viruses, this pattern of windborne dispersal has been fairly well documented. The USDA/APHIS Overview of the FMD Response Plan: The Red Book lists Foot & Mouth Disease (FMD) as being windborne, stating:

 

FMDV has also been known to spread through windborne transmission, where the virus infects naïve animals located some miles from known infected animals without any history of contact. The distance of windborne transmission over land surfaces depends on the atmospheric conditions and the amount of virus emitted into the air by the infected animals. Sources suggest FMDV may spread to distances of approximately 60 kilometers over land in favorable conditions and potentially even greater distances over water.

 

Last year, in Evidence of infectivity of airborne porcine epidemic diarrhea virus and detection of airborne viral RNA at long distances from infected herds authors Carmen Alonso, Dane P Goede, Robert B Morrison, Peter R Davies, Albert Rovira, Douglas G Marthaler and Montserrat Torremorell wrote:

 

Results indicated presence of infectious PEDV in the air from experimentally infected pigs and genetic material of PEDV was detected up to 10 miles downwind from naturally infected farms. Airborne transmission should be considered as a potential route for PEDV dissemination.

 

Several of these same authors (Alonso, Davies, and Torremorell) from the University of Minnesota are back with today’s study, one that looks at the virus carrying capacity of aerosols from experimentally infected pigs. First, the abstract (reformatted for readability) and a link to this new study, after which I’ll return with more.

 

Concentration, Size Distribution, and Infectivity of Airborne Particles Carrying Swine Viruses

Carmen Alonso, Peter C. Raynor, Peter R. Davies, Montserrat Torremorell

Published: August 19, 2015  DOI: 10.1371/journal.pone.0135675

Abstract

When pathogens become airborne, they travel associated with particles of different size and composition. Particle size determines the distance across which pathogens can be transported, as well as the site of deposition and the survivability of the pathogen. Despite the importance of this information, the size distribution of particles bearing viruses emitted by infectious animals remains unknown.

In this study we characterized the concentration and size distribution of inhalable particles that transport influenza A virus (IAV), porcine reproductive and respiratory syndrome virus (PRRSV), and porcine epidemic diarrhea virus (PEDV) generated by acutely infected pigs and assessed virus viability for each particle size range. Aerosols from experimentally infected pigs were sampled for 24 days using an Andersen cascade impactor able to separate particles by size (ranging from 0.4 to 10 micrometer (μm) in diameter).

Air samples collected for the first 9, 20 and the last 3 days of the study were analyzed for IAV, PRRSV and PEDV, respectively, using quantitative reverse transcription polymerase chain reaction (RT-PCR) and quantified as geometric mean copies/m³ within each size range.

• IAV was detected in all particle size ranges in quantities ranging from 5.5x10² (in particles ranging from 1.1 to 2.1μm) to 4.3x10⁵ RNA copies/m³ in the largest particles (9.0–10.0μm).
• PRRSV was detected in all size ranges except particles between 0.7 and 2.1μm in quantities ranging from 6x10² (0.4–0.7μm) to 5.1x10⁴ RNA copies/m³ (9.0–10.0μm).
• PEDV, an enteric virus, was detected in all particle sizes and in higher quantities than IAV and PRRSV (p < 0.0001) ranging from 1.3x10⁶ (0.4–0.7μm) to 3.5x10⁸ RNA copies/m³ (9.0–10.0μm).

Infectious status was demonstrated for the 3 viruses, and in the case of IAV and PRRSV, viruses were isolated from particles larger than 2.1μm. In summary, our results indicated that airborne PEDV, IAV and PRRSV can be found in a wide range of particle sizes. However, virus viability is particle size dependent.

(Continue . . . )

The entire research article is well worth reading, as the methods and materials used were quite complex. The authors recommend, based on their findings:

 

. . . comprehensive personal protective equipment including respiratory protection should be considered for potential exposures to both respiratory and enteric viruses, in particular in settings where animals and people interact. In addition, other biosecurity measurements such as air filtration could be considered to protect nearby at risk populations as previously demonstrated.

The information generated in this study is especially important to design effective airborne disease control programs for both enteric and respiratory viruses, including mitigation of occupational exposure of zoonotic pathogens. Changes in recommendations to protect from airborne viruses should be considered based on exposure to particles of different sizes.

 

While obviously a big concern to the swine industry, this research should also apply to other agricultural industries. 

 

When we began to see clustering of HPAI H5 poultry outbreaks last spring, the idea that some of this spread might be due to wind propelled `dust’ (feathers, dried feces, water vapor, etc. emitted from poultry barn exhaust systems) emerged as a real possibility.

 

We looked at this topic in some depth last April (see Bird Flu’s Airborne `Division’) and again in May (see CIDRAP: H5N2 Roundup & Detection In Environmental Air Samples).

 

Over the summer APHIS  released a 38-page partial epidemiology report on the spread of HPAI H5 across the United States (see APHIS: Partial Epidemiology Report On HPAI H5 In The US) that cited a number of plausible factors behind the spread of AI.  While they were unable to pinpoint one or even a group of factors that satisfactorily explained this AI spread, they acknowledged the possibility that prevailing winds may have carried contaminated dust particles from farm to farm.   

 

They wrote:  

Environmental factors may also play a part in transmitting HPAI. APHIS found that genetic material from the HPAI virus could be detected in air samples taken inside and outside infected poultry houses, supporting the idea that the virus can be transmitted through air. Further reinforcing this concept is preliminary analysis of wind data that shows a relationship between sustained high winds (25 mph or greater for 2 days or longer) and an increase in the number of infected farms 5 to 7 days later.

 

Over the years we’ve seen a growing body of anecdotal evidence suggesting that some pathogens – including swine and avian viruses – may be be carried substantial distances by contaminated dust particles.

 

Increasingly – as with today’s study - we are seeing scientific research that lends credence to the idea.

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RESEP KUE PANCONG TERIGU DAN TEPUNG BERAS

Resep Kue Pancong - Kue basah yang gurih pakai tepung beras dan lembut dengan tepung terigu. Kue basah tradisional ini umumya berbentuk mirip dengan kue pukis karena dimasak melalui cetakan yang sama tetapi berbeda tekstur dan cita rasa. Kue pancong sangat populer sebagai jajanan kuliner khas Betawi, bahkan sekarang kreasi dan penyajiannya sudah sangat lebih kreatif dan inovatif.

Umumnya adonan kue pancong tidak memakai gula, sedangkan bahan adonan dasar bisa menggunakan tepung terigu ataupun tepung beras yang dikombinasikan dengan kelapa parut dan santan sehingga terasa sangat enak, sedikit asin dan gurih.

Secara sederhana kue pancong sering ditemui dengan disajikan bersama taburan gula pasir untuk perpaduan cita rasa manis atau enak juga dengan cocolan saus baik tomat maupun saus sambal untuk perpaduan cita rasa pedas. Tidak hanya itu, topping aneka rasa seperti keju, coklat meises atau aneka topping lainnya juga cocok untuk memperkaya cita rasanya.

RESEP KUE PANCONG TERIGU

Untuk membuatnya sendiri sebagai variasi menu cemilan sederhana keluarga di rumah, berikut adalah pilihan cara membuat kue pancong enak, baik yang menggunakan tepung terigu atau dengan tepung beras.

Bahan-bahan :

• 125 gram tepung terigu
• 100 gram kelapa parut
• 200 ml santan dari 400 gram kelapa parut, didihkan lalu biarkan dingin
• 1 butir telur dikocok lepas
• 1 sdt ragi instan diaduk dengan 2 sdm air hangat
• 1/2 sdt garam

CARA MEMBUAT KUE PANCONG TERIGU

1. Campurkan tepung terigu, kelapa parut, garam, telur, ragi dan aduk rata. Tuang santan kemudian aduk hingga rata dan biarkan selama 25 menit.
2. Panaskan cetakan lalu olesi dengan minyak, setelah panas tuang adonan dalam cetakan hingga penuh. Tutup cetakan lalu masak dengan api kecil supaya tidak cepat gosong.
3. Setelah matang, kulit bawah sudah terlihat kecoklatan kemudian angkat dan siap untuk disajikan dengan aneka toping sesuai selera. Takaran resep bisa menghasilkan 17 buah kue pancong.

RESEP KUE PANCONG TEPUNG BERAS
Kue pancong dari tepung terigu memang memiliki tekstur yang lebih lembut dan empuk, sedangkan dari bahan tepung beras untuk rasa lebih gurih dan kali ini dibuat dengan cara yang mudah dan lebih sederhana. Dari segi cita rasa keduanya sama-sama enak dan tentunya pilihan sangat tergantung dengan selera.

Bahan-bahan :

• 125 gram tepung beras
• 125 gram kelapa parut
• 1/2 sdt garam
• 300 ml santan dari 1/2 butir kelapa, didihkan lalu biarkan dingin

CARA MEMBUAT KUE PANCONG BERAS

1. Campur rata tepung beras, garam dan kelapa parut lalu tuang santan sedikit demi sedikit sambil diaduk rata.
2. Panaskan cetakan lalu olesi dengan minyak, setelah panas tuang adonan hingga penuh ke dalam cetakan. Gunakan api kecil dan tutup cetakan hingga kulit bawah berwarna kecoklatan. Angkat setelah matang dan siap untuk disajikan.

Setelah mencoba membuat kue pancong di rumah, coba juga Resep Kue Pukis Enak dengan topping pisang sebagai variasi menu hidangan keluarga lainnya.

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Saudi MOH: 10 More MERS Cases In Riyadh

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Riyadh’s MERS outbreak continues with 10 more cases announced today.  This brings to 71 the number of cases reported since August third, with all but a handful hailing from the capital city.

While today’s announcement lists all of today’s cases exposure as `under review’, we’ve seen dozens of nosocomial infections – often among those simply hospitalized or treated in facilities with MERS cases – over the past couple of weeks.

We’ve also seen delays in case announcements – often as much as a week after they tested positive – so the daily release numbers may not tell us as much about the trajectory of the outbreak as we’d like.

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Hajj: Camel Sacrifice Prohibited To Help Prevent MERS

Credit FAO

 

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Camels are not only a beloved national symbol of Saudi Arabia, they are also a mainstay of the local economy (milk, meat, camel racing, camel rides for tourists, etc.), and their sacrifice (and the distribution of their meat to the poor) during the Hajj or Umrah plays an important part in their religion. 

All of which has made the fact that camels are carriers of the MERS coronavirus, and are likely a source of human infection, difficult for many Saudis to accept.

Eight months after this camel-MERS connection first came to light (see Aug 2103 Lancet: Camels Found With Antibodies To MERS-CoV-Like Virus), there was still resistance from the Ministry of Health and the Ministry of Agriculture to admit any link (see 2014 Saudi MOA Spokesman: Camel Link Unproven, MERS-CoV Is MOH Problem and Saudi Health Minister denies relation between camels, Mers).  

 

So deep was the denial that public `camel kissing’ briefly surged as an act of defiance. 

In the face of mounting evidence (see EID Journal: MERS Coronaviruses in Dromedary Camels, Egypt & The Lancet: Identification Of MERS Virus In Camels), in May of 2014 the Saudi Ministry Of Agriculture Issued Warnings On Camels, urging breeders and owners to limit their contact with camels, and to use PPEs (masks, gloves, protective clothing) when in close contact with their animals.

 

Compliance, however, has been spotty and camel products continue to be used by the public.  And while most human MERS infection are due to human-to-human transmission, we continue to see suspected camel-to-human cases.

As mentioned above, camel sacrifice is a big part of the annual Hajj, and based on the small sampling of Youtube videos I’ve viewed of animal sacrifices during the Hajj (not for the squeamish), opportunities for transmission of blood-borne pathogens to the participants (who wear no protective gear) would seem to be fairly high.

As part of their Hajj, each pilgrim must participate in (often just pay for) the sacrifice of an animal; a sheep or goat can be sacrificed on behalf of only one person; whereas, a cow or camel can be shared by seven people. The cooked  meat is then distributed to the poor.

 

Animals are  sacrificed during Eid al Adha -- the feast of sacrifice --  which commemorates the willingness of Ibrahim to sacrifice his son. This year it will take place the last week of September.

The big story in the Arabic press overnight, however, indicates that things will be different  this year. The Minister of Health yesterday announced – in response to the growing concerns of the Riyadh MERS outbreak - that camel sacrifice will not be allowed during the upcoming Hajj.

 

(translation)

Saudi Arabia prohibits sacrificial camels in Hajj

Riyadh / PNN- revealed Saudi Health Minister Khalid Al-Falih, the direction for dispensing camels in the pilgrimage this year and do not receive the slaughter Khda or sacrifice even infected with Corona does not occur, pointing out that there is coordination with Mecca Secretariat for concerted efforts to curb the spread of the virus through Hajj season.

The minister spoke of the utmost measures to contain the virus and prevent his release from Riyadh to ensure regular meetings and work awareness campaigns for pilgrims and conduct medical examinations and necessary immunizations to limit private spread arrivals from Riyadh, saying they are ready to deal with any emergency situation.

(Continue . . . )

 

While the suspension of camel sacrifice during Eid al Adha due to MERS concerns has been discussed before, this appears to be the first time this practice will be prohibited.

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RESEP SAMBAL DABU DABU KHAS MANADO

Resep Sambal Dabu Dabu lilang sambal iris ala Manado. Indonesia kaya akan berbagai jenis sambal yang membuat menu utama menjadi terasa semakin enak dan lezat. Ikan bakar, ikan goreng dan aneka menu makanan lainnya kurang lengkap apabila tidak disajikan bersama dengan sambal. Selain diolah dengan cara diulek atau halus juga terdapat sambal iris yang memiliki bermacam variasi racikan yang berbeda pula, salah satunya adalah sambal dabu-dabu.

Dabu dabu adalah salah satu varian sambal khas nusantara yang sangat dikenal sebagai masakan asli Manado atau disebut juga dengan dabu-dabu lilang karena bahan-bahannya diolah dengan cara dipotong-potong.

Sambal praktis ini mempunyai cita rasa yang sangat enak dari kombinasi pedas dan asam yang segar, bahan-bahan yang dipotong atau iris secara tak beraturan tersebut biasanya dilengkapi dengan siraman air jeruk nipis sebelum disajikan.

RESEP SAMBAL DABU DABU MANADO

Penambahan variasi bahan dabu-dabu sendiri tentu bisa kita sesuaikan dengan selera, pada kreasi cara membuat sambal dabu dabu kali ini menggunakan belimbing sayur untuk variasi rasa asamnya yang segar.

Bahan dan bumbu :

• 15 butir bawang merah diiris tipis
• 4 buah cabe merah keriting dipotong kecil-kecil
• 1 buah tomat merah diiris dadu
• 10 buah cabe rawit merah atau hijau dipotong kecil-kecil
• 3 buah belimbing sayur (wuluh) diiris tipis
• 1/4 sendok teh garam
• 1/2 sendok teh gula pasir
• 5 sendok makan minyak goreng panas

CARA MEMBUAT SAMBAL DABU DABU

1. Cara membuatnya sangat mudah, kita tinggak mencampurkan semua bahan-bahan di atas, jagan lupa beri garam dan gula pasir kemudian aduk rata.
2. Setelah rata, sirami dengan minyak panas serta aduk-aduk lagi supaya lebih merata lalu siap untuk disajikan.

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Saudi MOH Statement On The Riyadh MERS Outbreak

Credit Saudi MOH

 

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The recent spike in Saudi MERS cases (61 cases in the past 16 days) – during what is normally a quiet time of the year for coronavirus reports, and just a little over a month before the Hajj – has caused a good deal of consternation both in the public, and the Saudi Ministry of Health.  

 

Roughly 2 weeks ago, in response to public criticism over their handling and isolation of patient contacts, the MOH issued a rare statement on a large family cluster of cases.

 

At the time, the `Riyadh Cluster’  sat a only 7 cases.  Since then, they have reported another 50 local cases, and there are no signs that the outbreak is slowing.

In recent days we’ve seen Saudi social media (twitter hashtag ` كورونا‘) grow increasingly critical of the Health Ministry’s handling of the situation, and even some Arabic news media outlets have been less than complementary. 

One of the most popular tweets appears to be this poster of the 6 Ministers of Health who have reigned since MERS first appeared in 2012, with the caption `Six Ministers and still #كورونا remain and expand ‘.

 

Today the Ministry of Health has posted a very long (1300 words+) statement that that it obviously hopes will help minimize the public’s concerns.  An early look at its reception in Arabic twitterverse suggests it isn’t entirely successful.

 

(Note: I’ve switched to the Bing Translation for this statement, as the Google version introduced some `ambiguities’.  Alas, none are perfect, as each machine translator adds its own quirks.   My thanks to Dr Ilham Abuljadayel  for the assist.)

 

 

(Translated)

Minister of Health: Corona virus is relatively limited and cases of Riyadh single source and seek to control it

04 November 1436

His Excellency Minister of health Mr. Khalid Bin Abdulaziz Al-Falih, the current proliferation of HIV/AIDS Middle East respiratory "SK" relatively limited and that all cases have been recorded recently in Riyadh is a mono source and strive to rapidly and professionally to control adding dependants in letters addressed to the community while meeting with executives of hospitals and health facility in Riyadh, the Ministry said that his Ministry will continue to approach to transparency in dealing with community and media through health status statement and Declaration of the confirmed cases after proving positive will There are many scheduled meetings with health sectors and our partners in the media through press releases and conferences and meetings.

Faleh drew that vigilance in such situations, and do not want to overstate the reassurance and confidence which have negative effects, but at the same time, I wish to emphasize that this is not the first case of the outbreak of Corona in Saudi Arabia and we are confident that the strict application of infection control systems adopted by the Ministry of health has in the past successfully thanks be to God control and will succeed, God willing now to control the disease.

Increased: current data and status quo and preparations by the Ministry in cooperation with its partners in other health sectors calls for confidence and there is no need to worry, there is no guide to close schools or banned from going to public places and nature life, certain to everyone to exercise caution when mixing those with respiratory illnesses and adherence to infection control practices in health facilities, notably refraining from visiting inpatient infectious diseases in hospitals as possible and follow instructions for personal protection With care and attention during the visit and application awareness messages advocated by the Ministry of health.

He noted that cases of children with HIV have been few and limited, and that the virus is not transmitted in the air often but by direct contact to infected patients, and the most susceptible to complications are chronic diseases also said.

He stressed that the health sector possesses accumulated expertise and has successful experiences and lessons learned from some of the areas where outbreaks were recorded which enabled and enhanced the capacity of the health system to deal with it, and would be able to deal with the current situation quite successfully.

His Excellency assured during the press conference, citizens and residents to register cases remains limited and confined to close contacts of the initial state and there is no evidence of any other outbreaks within Riyadh or outside at the moment. Calling on everyone to remain vigilant and at the same time not excessive concern.

Minister of Health said they expect continued recording the number of cases linked to the current outbreak and may reach other hospitals, stressing his Excellency readiness Ministry of health hospitals and other health sectors in Riyadh to work under a unified system of expected cases with strict application of infection control measures to prevent the spread of disease within and outside health facilities.

His Excellency Minister of health Mr. Khalid Bin Abdulaziz Al-Faleh was confident in overcoming the health sector which operates as one integrated and harmonious system of viral outbreaks of AIDS Middle East respiratory virus "SK" in Riyadh and the resulting emergence of cases in more than one hospital. Pointing out that the city of King Abdulaziz National Guard Department has faced over the past few weeks if an outbreak of the virus began one krone and then spread through contact either direct contacts or health practitioners.

The continuous cooperation of the clock between the command and control center of the Ministry of health and other health sectors to evaluate procedures for infection control within healthcare facilities and developed to curb the spread of the virus inside and outside the facility.

Minister of health attributed the emergence of some outbreaks in health sectors during the past three years to gaps in the application of strict infection control procedures in health facilities. He stressed the continuing need to assess compliance and follow-up of performance and repeat visits to field teams for health facilities in all sectors without exception.

His Excellency announced that in the framework of cooperation and coordination between all the health sectors in the Kingdom to visit King Abdulaziz Medical City in the National Guard to check on inpatients and procedures to control the disease, noting that the Emergency Department was closed the hospital and some clinics and non-emergency procedures as a precaution, while other departments services offered normally for patients and visitors. , Adding that efforts were now focused on limiting contacts and examined according to the approved Protocol in addition to the isolation of suspected and confirmed.

And the Ministry's preparations to prevent the emergence of the virus during the Hajj season confirmed that the Ministry has completed its preparations and prepared a comprehensive prevention plan starting at ports of entry through the regions of pilgrimage until the return of pilgrims to their homes unharmed will God through equipping health facilities scattered throughout the Hajj therapeutic and preventive, adding that the Ministry generally over the past years harness all energies to prevent hospitality to any contagious disease and will continue the same approach this year.

Showing Ma'aleh no cases in previous seasons of Hajj, praise be to Allaah, and that the facilities of the Ministry in the Holy formatted with potential for rapid diagnosis, and isolation of cases.

Noting that the Ministry has to activate the role of Center crowd and the formation of the advisory scientific centre to support experience in dealing with this virus.

In reply to a question on the success of the Republic of South Korea

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