Saudi MOH Statement On The Riyadh MERS Outbreak – Aug 23rd

Saudi Arabia

 

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The Saudi Health Ministry has posted an English language press release this evening regarding their ongoing MERS outbreak in the nation’s capital city – a glass-half-full style account – one that emphasizes their response to the outbreak rather than dwelling on the factors that have led to this large (and growing) outbreak.

The numbers cited (53 cases, 17 deaths) refers only to Riyadh’s National Guard Hospital, and doesn’t reflect all of the cases reported over the past month (more than 80 from Riyadh alone). 

While obviously crafted to reassure the public, that goal hinges far more on how many additional cases are announced over the next few days, than on any of the statements you’ll read below.

 

MOH press release about MERS-CoV in Riyadh rejoin

23 August 2015

The Saudi Arabia Ministry of Health today conducted the first of a series of detailed background briefings designed to provide specific and up-to-date information regarding MERS-CoV as part of its commitment to transparency and cooperation. Today’s briefing was focused on the recent outbreak in Riyadh’s National Guard hospital and the related containment actions to date.

The Ministry detailed both the specific actions taken to address the MERS-CoV cluster at the National Guard hospital, as well as actions taken to prevent flare-ups in other areas.

This outbreak tested several of the new procedures put in place recently by the Ministry to respond to such outbreaks and those systems have worked extremely well to date in containing the situation.

53 cases have been traced to the National Guard hospital infection. Of those, 32 patients remain hospitalized, 3 are in at-home isolation, 17 deaths, and 1 patient has already been discharged. More than 5,700 samples have been screened as part the tracking and tracing activity to monitor all potentially impacted persons.

There were 7 new cases confirmed yesterday.  All of these patients are in stable condition.

Specific steps taken to respond to the outbreak include:

• Rapid Response team sent to National Guard hospital immediately after the infections were identified as a MERS-CoV outbreak. This team is comprised of leading experts in infections disease who supported the local medical teams in effective containment procedures.
• Field Epidemiology team deployed to the site to support on-site analysis and transmission specifics.
• Public Health Team is on-site supporting comprehensive tracking, tracing and testing of all persons in the contact circle of suspected and at-risk cases. The Ministry has sampled and tested more than 5,700 samples to support early identification among all at risk individuals and give them the “all clear” when they are identified as having no infection.

In addition, the Ministry worked with the National Guard staff to reduce streamline the facilities to better address the MERS-CoV issue specifically by deferring all elective admissions and procedures.

The Ministry of Health also detailed steps taken to bolster the preparedness of medical facilities across the country to prevent another outbreak, including:

• Deployed Infectious Disease Specialist teams to all Riyadh hospitals. This is meant to increase coverage surrounding the infection area and ensure our facilities are running all necessary safety protocols. The Minister of Health personally met with the directors of all Riyadh hospitals to lead the coordination.
• Established an open network connecting the medial teams throughout our national hospital network. This enables them to be fully connected in real time and able to monitor, communicate and learn from their colleagues about MERS-CoV activity.

Collectively, these containment steps have been highly effective. MERS-CoV is a tricky disease. It can crop up in unlikely places but these rapid response capabilities, built in coordination with global health partners such as the WHO, are essential tools in helping us to beat this challenge.

Responsibility for stopping the spread of MERS-CoV doesn’t end with healthcare workers. It is a responsibility shared by everyone to be aware and informed about the very basic preventative hygiene steps that can stop the spread of infection and save a life:

• Wash your hands with warm soapy water for 30 seconds
• Cough into your arm
• and  Limit visitors to sick family members in the hospital.

Statistics and news regarding MERS-CoV are updated daily on the Ministry of Health website, www.moh.gov.sa and the latest prevention information can be accessed at www.wecanstopthis.com, where you can donate your own personal Twitter feed to broadcast MERS health bulletins to your circle of friends and loved ones.

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Saudi MOH: Riyadh MERS Cluster Adds 6 More Cases

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The Saudi MERS cluster continues to grow, and with today’s addition of 6 new cases in Riyadh the August total reaches 90.  All but a small handful are linked to a multi-hospital nosocomial outbreak in the capital city, which appears to have begun in mid-July.

For more on the reasons behind this outbreak, see this morning’s Mackay On The Spread Of MERS.

 

As for today’s cases, all are listed as contacts of known cases, and two are Health Care workers.  Half are listed in stable condition, while the other half are critical.

 

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Referral: Mackay On The Spread Of MERS

Coronavirus – Credit CDC PHIL

 

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Since early May we’ve seen three major outbreaks of MERS around the world - and while all three undoubtedly began with a community exposure (likely via camel, camel product, or an infected human) – almost all of the (hundreds) of cases that followed came about due to nosocomial transmission of the virus.  

• Between May and July (see WHO: A Saudi MERS Infographic) the city of Hofuf saw more than 40 cases spread across at least two healthcare facilities. The first case - reported on April 20th - involved a case with camel contact (see here), which then evolved into a family cluster, and then a full hospital outbreak.
• In mid-May, a MERS-infected traveler returning from the Middle East visited four South Korean clinics/hospitals before being diagnosed and isolated, sparking the largest MERS outbreak (186 cases) outside of the Middle East. While 16 hospitals admitted patients, two hospitals (St. Mary’s in Pyeongtaek =36 and Samsung Seoul =90) accounted for roughly 70% of all cases (see Mackay On The Lessons Of MERS).
• Starting in mid-July, the Saudi capital city of Riyadh has seen a growing cluster of MERS cases, one that appears to have involved a large family cluster to start, but has exploded into a multi-hospital cluster of more than 90 patients.

We’re it not for the uncontrolled spread of the virus through healthcare facilities in both Saudi Arabia and South Korea - instead of looking at 300 MERS cases over the past four months - we’d probably be looking at fewer than 30  `community acquired’ cases this summer.

Remarkably, many of those infected in hospitals had no known direct contact with infected patients.  Just being seen in the same busy Emergency department, being admitted to the same crowded ward, or receiving treatment from an exposed (but not necessarily sickened) HCW, was enough to enable their infection. 

If a single community or camel exposure was the spark for these outbreaks, poor hospital infection control practices provided the gasoline.

 
Yet despite these high-profile failures, we’ve seen other medical facilities where MERS cases have been successfully treated without further transmission of the virus (see Eurosurveillance: Estimating The Odds Of Secondary/Tertiary Cases From An Imported MERS Case). 

 

So we know that good infection control practices can stop the virus if uniformly applied.

 

Today Dr. Ian Mackay weighs in on how some hospital practices are enabling the spread of MERS  in his VDU blog.  Follow the link to read:

 

Sunday, 23 August 2015

Whether MERS-CoV spreads or stops is entirely up to the hospitals...

The very steep rises in Middle East respiratory syndrome coronavirus (MERS-CoV) cases seen in the graph below are not due to overwhelming and constant exposures to infected camels resulting in human cases of MERS.

Those upwards inclines are mostly because humans are just numbskulls.

MERS-CoV cases worldwide up to 22-AUG-2015.
Click on image to enlarge.

We propagate epidemics. We create our own headaches in this arena. Many viruses wouldn't break out if we didn't create the circumstances for an outbreak. The biggest headache? Infected patients who spread virus to uninfected patients and health workers when they are in unprotected close contact in a healthcare setting.

(Continue . . . )

 

 

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JM Overseas Pre-University Fair 2015

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15 Aug 2015 - Penang

16 Aug 2015 - Petaling Jaya

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23 Aug 2015 - Kota Kinabalu

Please bring along your original / forecast academic result.

UP to 50% scholarship available*

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

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WHO Update On Saudi MERS Cases – August 21st

Credit WHO

 

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The World Health Organization has published a new batch of Saudi MERS cases, with 18 of 19 cases hailing from Riyadh.  As the current cluster increases in size, the size of these updates becomes a bit unwieldy as well, and so I’ve only published the header and a link to the details.

But to make things a bit easier, I have charted the 19 cases (see below), and from it we can glean some pertinent information (click the chart to enlarge).

 

Of note, we have a rare pediatric case (age 2), a direct contact of a previously identified case.  While making up roughly 40% of the Saudi population, less than 2% of MERS cases are under the age of 20. 

 

Males outnumber females nearly 2:1, with an average age of 58.  Two are HCWs, while the vast majority appear to have acquired the infection while hospitalized for being treated for something else.

 

When it comes to the time between the patient testing positive for MERS, and the time the case is revealed by the MOH daily reports, we see everything from notification the same day, to as much as a week later. While 5 of the 19 cases were announced within 48 hours of testing positive, the delay for 6 cases was five days or longer (max=7). 

 

The average delay is nearly 4 days.

 

Follow the link below for the lengthy WHO update.

 

 

Middle East Respiratory Syndrome coronavirus (MERS-CoV) – Saudi Arabia

Disease outbreak news
21 August 2015

Between 13 and 17 August 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 19 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 1 death. Fifteen (15) of these reported cases are associated with a MERS-CoV outbreak currently occurring in a hospital in Riyadh.

(Continue . . . )

 

 

 

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Saudi MOH Reports 7 New MERS Cases In Riyadh

 

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The number of MERS cases in Riyadh continues to grow with 7 more cases announced today, 1 of whom is listed as a healthcare worker, and one is listed as not having known contact with previously identified cases.

 

This brings the number of cases reported during the month of August to 84, with all but a small handful coming out of Riyadh.  Most appear linked to nosocomial transmission, although in some cases no direct links with an infected patient have been established.

 

According to media sources this morning, the World Health Organization will be sending a representative to Saudi Arabia next week to assess the situation.

 

WHO official coming to assess MERS outbreak

ARAB NEWS

Published — Saturday 22 August 2015

JEDDAH: An expert from the World Health Organization (WHO) will arrive in Riyadh next week to assess the latest spike in infections and deaths from the deadly Middle East Respiratory Syndrome coronavirus (MERS-CoV).

This is according to Izz Al-Din Muhseini, the Kingdom’s WHO representative, who also issued assurances that the Ministry of Health has made every effort to contain the virus inside the National Guard Hospital in Riyadh, the health facility at the center of the surge in cases over the past week.

The WHO expert would evaluate the measures taken by the ministry, and participate in meetings held by ministry officials, Muhseini was quoted as saying by a local publication on Friday.

(Continue . . . )

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Revisiting Egypt’s Murky H5N1 Battle

 

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We’ve some interesting numbers, released today from Egypt’s Central Agency for Public Mobilization and Statistics  on their growing avian influenza problem, but first some background and catch-up.

 

Since late January, getting credible information out of Egypt on their AI (Avian Influenza) problem has become increasingly difficult.  During the first three weeks of the year – when human H5N1 cases were climbing rapidly – we saw daily status reports issued. 

 

But after January 22nd, that practice abruptly stopped (see Egypt’s MOH Confirms 21st H5N1 Case).

 

Since then, as I’ve noted before (see The Silence Of The Egyptian MOH &  Media: WHO H5N1 Mission To Egypt), the Egyptian MOH has ceased to report most cases on their website and the YTD numbers attributed to MOH spokesmen in the Egyptian media have been `fanciful’ at best.

 

Although I wouldn’t wager anything I’d care to lose on its accuracy (it is, after all, based on Egypt’s self reporting), the World Health Organization  reports 134 human H5N1 cases (and 37 deaths) in Egypt during the first half of the year. 

 

To put this into perspective, prior to 2015, all of the world’s countries combined had never reported more than 115 cases in a single year.

 

More than five months ago World Health Organization, along with the FAO, OIE,  NAMRU-3, CDC & UNICEF were invited to Egypt as a joint mission to investigate and to make recommendations on containing that outbreak. In early May we aw the  WHO Statement On Joint H5N1 Mission To Egypt,  with specific recommendations for addressing the crisis.

The 7-page executive summary, warns:

` . . .  the presence of H5N1 viruses in Egypt with the ability to jump more readily from birds to humans than viruses in other enzootic countries is of concern and requires a high level of vigilance from the Ministries of Health and Agriculture.’

 

You can read the full details in my May 15th blog, WHO Statement On Joint H5N1 Mission To Egypt.  The status of the 2-year action plan’ - outlined in the executive summary and supposedly due by now – remains uncertain.

 

Although human infections are of the greatest concern, equally murky have been the number and severity of HPAI outbreaks in Egypt’s poultry population.  

 

Since 2008, H5N1 has been considered endemic in Egyptian poultry, and regular reporting to the OIE ceased (see 07/07/08 Final report (endemic)), . That final report stated, `No more follow-up reports will be made, but instead, information about this disease will be included in the future six-monthly reports.’

 

Although hard numbers have been difficult to obtain, between Arabic media reports, and sporadic reporting to the OIE and FAO, it has been no secret that HPAI continues to ravage Egyptian poultry. 

Like China, Egypt depends heavily upon HPAI poultry vaccines to control their AI problem, and is in fact the world’s second largest consumer of these vaccines (after China). But as we’ve seen elsewhere in the world, the longer they have been in use, the less effective they have become (see A Paltry Poultry Vaccine). 

 

While Egypt’s AI problems never went away, it did seem on the decline after 2010. In mid-2014 we began to see signs that the number of poultry outbreaks was increasing, and in the fall of 2014 Egypt began the largest, and longest running, outbreak of human H5N1 in history. 

The likely explanation for this spike in human cases was that more poultry were falling ill and therefore more human exposures were occurring.

 

In February of this year, in Egypt H5N1: Poultry Losses Climbing, Prices Up 25%, we saw reports of vaccinated poultry flocks succumbing to the H5N1 virus, and and growing panic in the poultry industry.  And in April, a report in the ECDC’s Eurosurveillance journal appeared to shed additional light on this change in AI activity.

 

In Eurosurveillance: Emergence Of A Novel Cluster of H5N1 Clade 2.2.1.2, we learned that the predominant H5N1 virus in Egypt had changed in mid-2014, just months before the human and poultry outbreaks began to rise.  From the Abstract:

 

A distinct cluster of highly pathogenic avian influenza viruses of subtype A(H5N1) has been found to emerge within clade 2.2.1.2 in poultry in Egypt since summer 2014 and appears to have quickly become predominant. Viruses of this cluster may be associated with increased incidence of human influenza A(H5N1) infections in Egypt over the last months.

 

As AI outbreaks always decline during the heat of the summer,  we’re seeing very little in the way of H5N1 reports right now.  In the meantime, we have a very brief report today that sheds some light on last year’s abrupt increase in poultry outbreaks in Egypt.

Note, this is a comparison of poultry outbreaks reported in 2014 vs. 2013, and they attribute the increase to a `mutation of the virus’ .  We don’t have official numbers for the current year.

 

281.6% increase in the incidence of bird flu

Saturday, August 22, 2015 11:46

Cairo - Gate delegation

Central Agency for Public Mobilization and Statistics, revealed that the total incidence of bird flu epicenter was 374 in 2014 compared to 98 the focus in 2013, an increase of 281.6%.

He attributed this surge device for the mutation of the virus that causes the disease which led to the ineffectiveness of fortifications used and thus increase the number of casualties.

The device, in its annual report on animal diseases in Egypt, that the Minya governorate registered the highest percentage of injury where the number of spots reached 47 focus, by 12.6%, followed by Giza province, where the number of foci of 38 focus by 10.2%, followed by Sohag 36 focus by 9.6 % of the total number of outposts

 

These are, of course, only officially reported (and recorded) outbreaks.  As with any type of disease reporting, 100% accuracy and year-to-year consistency in surveillance and reporting is impossible to achieve. 

 

Sill, a nearly 3-fold increase in outbreaks over 2013 is a pretty telling statistic.

The big concern this year is that it won’t just be Egypt and China dealing with the bulk of avian flu this winter.   HPAI H5 is expected to return to plague North America’s poultry industry,  Europe may well find HPAI H5 and H7 making inroads again, Southeast Asia remains vulnerable to H5N6 and H7N9, and Africa continues to report a major surge in bird flu reports.

 

Stay tuned . . . and fasten your seatbelts . . . it’s likely to be a bumpy ride.

 

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