Jordan Reports An Imported MERS Case From Saudi Arabia

 

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Overnight the Arabic press lit up with reports of an imported case of MERS in Jordan’s capital city, Amman.  The patient – a male in his 60s – recently returned from working in Saudi Arabia.   A couple of reports.  

 

First, an English language report from PETRA, Jordan’s official news agency.

 

Jordan records coronavirus case of national coming from Saudi Arabia

Amman, August 25 (Petra) -- A new Middle East respiratory syndrome coronavirus (MERS-CoV) case has been recorded for a man who has recently come from Saudi Arabia, the country where most cases of this disease are reported.

The man, who is in his 60s, was admitted to a private hospital suffering from breathing difficulty, coughing and fever, the ministry of health said. He was diagnosed to have the Middle East respiratory syndrome coronavirus (MERS-CoV) and he is now in critical condition, the ministry added.

Since 2012, 13 MERS cases have been recorded in Jordan, according to official data.
//Petra// AA  25/8/2015 - 08:54:08 PM

 

A few additional details can be gleaned from one of the (many) Arabic language reports, although they don’t translate as cleanly as we might like.

 

Recording the first infection "Corona" in Jordan during 2015

By Egypt and the Arab

Announced the Jordanian Ministry of Health, on Tuesday, recording the first case of infection with "Corona" to a citizen in the sixty years of age, Jordan recently entered coming from his work in Saudi Arabia.

The ministry said, in an official statement, "The injured are undergoing treatment in a private hospital in the capital Amman", describing his condition as "critical".

It had "diagnosed the injury through the active monitoring of acute respiratory infections, where the victim suffers from shortness of breath and severe cough with a fluid to accumulate in the membrane surrounding the lungs and high temperature."

She added that she "monitor acute respiratory diseases through four accredited health centers, and the circular to all hospitals to report cases of pneumonia, and take the necessary samples to check for the virus."

The case is the first such infection in Jordan during 2015, while the total number of cases to 13 cases, of which two were in 2012, and 10 in 2014

 

 

The assertion in both reports that up until now, Jordan has only seen 12 MERS cases, runs contrary to the `official counts’ being maintained by outside agencies.   As the chart below shows, the ECDC lists 19 cases in Jordan.  .

Discrepancies such as these typically occur when someone falls ill in one country, but travels to and gets diagnosed in another.  While `country where contracted’ is the preferred standard, sometimes that can be hard to pinpoint. 

 

This case serves as a reminder that – with an incubation period of up to 14 days – a MERS infected individual can easily travel anywhere in the world, and that hospitals everywhere need to be prepared to identify, isolate, and treat them. 

 

A point that becomes even more pertinent as we approach this year’s Hajj.

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Next intake for Nursing program: 1st October 2015

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RESEP CAPCAY GORENG ENAK GURIH SAUS TIRAM

Resep Capcay Goreng bumbu saus tiram yang enak dan gurih. Masakan dari aneka ragam sayur tentunya sangat direkomendasikan sebagai menu makanan sehat sehari-sehari yang sederhana. Capcay yang kita kenal sebagai menu chinese food termasuk ke dalam salah satu menu favorit keluarga karena dimasak dari banyak macam sayuran.

Aneka jenis sayuran bisa kita gunakan sehingga capcay terdapat banyak sekali kreasinya, bahkan untuk cita rasa yang lebih spesial biasa dipadukan dengan unsur hewani seperti telur, ayam, daging, seafood atau variasi bahan lainnya.

Kuah sedikit yang kental atau kering lebih akrab dengan sebutan capcay goreng, sedangkan untuk capcay dengan kuah enak dan praktis dapat dilihat dalam Resep Capcay kuah Enak Sederhana. Saus tiram biasa dipakai dalam bumbu capcay goreng kali ini untuk menambah rasa gurih khas oriental dalam masakan khas tionghoa ini.

RESEP CAPCAY GORENG SAUS TIRAM

Berikut adalah salah satu kreasi cara membuat capcay goreng enak dan gurih saus tiram yang bisa kita coba untuk melengkapi menu makan harian keluarga dengan mempersiapkan bahan-bahan dan bumbu-bumbu di bawah ini :

• 200 gram kembang kol dipotong-potong sesuai selera
• 150 gram jagung muda (putren) dipotong serong
• 100 gram jamur kancing
• 100 gram buncis dipotong-potong 3 cm
• 100 gram wortel dipotong serong
• 50 gram kacang kapri dibuang ujungnya
• 1 lembar (15 gram) kembang tahu dipotong-potong
• 100 gram daging ayam rebus lalu dipotong dadu
• 2 buah sosis ayam dipotong-potong
• 100 ml air
• 2 sdm saus tiram
• 3 sdm saus tomat
• 1 sdm kecap manis
• 1/2 sdt garam
• 1/2 sdt kaldu bubuk atau penyedap
• 1/2 sdt merica
• 1 sdm tepung maizena dilarutkan dengan sedikit air
• 4 butir bawang merah dicincang kasar
• 3 siung bawang putih dicincang kasar
• 1 buah bawang bombay dipotong dadu
• minyak tumis secukupnya

CARA MEMBUAT CAPCAY GORENG :

1. Panaskan sedikit minyak lalu tumis bawang merah, bawang bombay dan bawang putih hingga harum. Masukkan wortel, sosis dan daging ayam, aduk rata.
2. Tuang air, garam, merica dan kaldu bubuk kemudian masukkan juga saus tiram, saus tomat dan kecap manis. Masukkan sayuran yang lainnya, aduk rata dan masak hingga mendidih lalu masukkan kembang tahu.
3. Setelah semua layu dan matang maka terakhir masukkan larutan tepung maizena, aduk-aduk hingga kuah mengental dan hampir kering. Matikan api, angkat dan tuang capcay dalam piring saji lalu siap untuk dihidangkan.

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APHIS/USDA HPAI FAD PReP Updates

 

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In the land of government agencies, the convoluted acronym is king.  And at the USDA,  FAD PReP stands for Foreign Animal Disease Preparedness and Response Plan.   While currently invoked for HPAI H5, FAD PReP is designed to deal with a variety of imported animal diseases, including:

• Foot-and-Mouth Disease
• Classical Swine Fever
• Newcastle Disease
• African Swine Fever

All summer the USDA and APHIS, along with their partners, have been churning out guidance for the expected return of avian flu this fall and winter.  Everything from biosecurity advice, to carcass disposal, to the handling of reimbursements for culled flocks.

A week ago we looked at APHIS: Preparatory Steps For Stockpiling & Using An HPAI H5 Vaccine, and in July we saw an Updated HPAI Epidemiology Report from APHIS.  Prior to that, we looked at biosecurity advice in HPAI: Battening Down The Biosecurity Hatches.

 

While interested parties can always access the most recent updates on the USDA/APHIS HPAI Website, I’ve listed some of the recently updated documents below:

 

FAD PReP Materials and References

Last Modified: Aug 21, 2015

 

HPAI Response & Policy Information: 2014-2015 Outbreak

Note on August 19, 2015: These materials are currently under review, update, and re-posting. Some materials may be briefly removed while new versions are posted. Thanks for your patience!

Initial Response

• First HPAI Confirmation in a New State
• Appraisal and Indemnity Procedures (Aug 19, 2015)

Critical Response Activities

• Surveillance Activities around HPAI Infected Backyard Flocks
• Surveillance Sampling for Commercial Premises in Control Area (Aug 21, 2015)
• HPAI Zones and Premises (Aug 19, 2015)
• Movement Control (Aug 19, 2015)
• Contact Premises

Recovery and Restocking

• Control Area Release
• Timeline, Eligibility, and Approval for Restocking (Aug 19, 2015)
• Post C&D Environmental Sampling Guide (Aug 19, 2015)

Health & Safety Information

• Quick Response Card
• PPE Recommendations for HPAI Responders
• Responder Health Alert--Influenza Like Illness

For More Information on HPAI & Response

• General Resources and Information (Aug 19, 2015)
• H5/H7 Avian Influenza Case Definition

 

 

You can also read two in-depth PDF files regarding recent meetings and conferences on Avian Flu in:

 

• International Conference on Avian Influenza
• Fall Planning Workshop

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Saudi MOH Reports 8 New MERS Cases, 6 Deaths & 6 Recoveries

 

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A busy report from the Saudi MOH today with 8 new MERS cases in Riyadh, and six deaths. Two of the new cases are listed as Health Care workers, but only one is listed as a definite contact with a confirmed case.  For the 7 other cases reported today, their possible exposure is `under review’

That said, most of the 100+ cases reported over the past month have been linked to nosocomial spread of the virus in one or more Riyadh hospitals.

Since onset dates, or dates of positive MERS testing, are not provided in these daily updates we have no good idea how `current’ these reports really are.  In the past we’ve seen delays of a week or more between the time a patient tests positive and their case is reported (see WHO Update On Saudi MERS Cases – August 21st).

 

 

Late yesterday we also gained a bit more insight on how the Saudi MOH regards asymptomatic MERS cases, via a twitter conversation between Dr. Hail Alabdely of the Saudi MOH, FluTrackers, Dr. Ian Mackay, and others.

The argument over whether an asymptomatic infection is a truly a `case’  notwithstanding, there are genuine concerns regarding asymptomatic cases. 

 

First, how do we define `symptomatic’? Are `sniffles’ considered symptomatic?  Malaise?  Is there a specific fever threshold?   

And quite frankly, we don’t know what level of symptomology is required for a carrier to be contagious.  We’ve seen some evidence to suggest that mildly symptomatic - or even asymptomatic cases - may be able to pass on the virus (see Study: Possible Transmission From Asymptomatic MERS-CoV Case).

 

While many infections can be traced back to a known risk exposure, for many community acquired cases, no known exposure is ever identified. This at least suggests the virus may be transmitting silently in the community.

From a public relations standpoint, not counting `asymptomatic’ cases may have some advantages.  But from a scientific and investigatory standpoint, you need to take all of the available evidence into account, if you hope to understand the full picture.

 

And perhaps the Saudis truly are.

 

But we have no way of  knowing that since we’ve yet to see the release of their long-promised case control study, they continue to be parsimonious in their release of both research studies and epidemiological data, and their 3-year track record for controlling the virus has been less than enviable.

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Just In Time For National Preparedness Month

 

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Although hurricane Danny dissipated yesterday before impacting the Leeward Islands, further out to sea Tropical Storm Erika has formed, and is forecast to threaten the Bahamas -  possibly  as a hurricane - by this  weekend.  

 

Computer models grow less reliable beyond 5 days, and while some currently suggest a northward turn,  Florida could be in the crosshairs early next week.

 

You can keep track of Erika’s progress by visiting the National Hurricane Center website. 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.

Whether Erika steams far enough west to impact Florida, or curves back to sea, is too soon to tell.   But this storm does remind us that for the next couple of months we are in the height of hurricane season, and everyone who lives along the Gulf or Altantic coasts – and well inland – needs to be aware and prepared.

But even if you don’t live in a hurricane zone, the odds are you are in a seismically active area, or are subject to blizzards, tornadoes, floods or some other natural calamity.   Preparedness is for everyone.

 

A week from today we begin to observe National Preparedness Month, where every year FEMA, Ready.gov, and thousands of coalition members (like AFD) promote emergency preparedness for individuals, families, businesses, and communities.    

 

While the event doesn’t kick off until next Tuesday, with a potential tropical system knocking on our door, the advice `Don’t Wait.  Communicate’  takes added meaning. Preparedness is a year-round endeavor, and disasters don’t read calendars.

 

While I promote preparedness year-round, twice each year this blog makes a concerted `preparedness push’; first in late May to kick off Hurricane season, and again in September for National Preparedness Month.

 

The goal of NPM2015 is to foster a culture of national preparedness, and to encourage everyone to plan and be prepared to deal with an event where they can go at least three days without electricity, running water, local services, or access to a supermarket.

 

These are, of course, minimum goals.

 

The disruptions following hurricanes, tornado outbreaks, floods, and other natural disasters often run for days or even weeks, and so – if you are able to do so - being prepared for 10 days to 2 weeks makes a good deal of sense (see When 72 Hours Isn’t Enough).

 

As a Floridian, my preparedness plans are somewhat hurricane-centric, as these massive storms provide the most likely disaster scenario for my area.  But my disaster plans are appropriate for other disaster scenarios as well.

 

In addition to being prepared to shelter-in-place for up to two weeks, I have a network of trusted disaster buddies to whom I can turn in an emergency (as can they to me), several pre-arranged evacuation destinations should I need to `get out of Dodge’, and a 72-hour bug-out bag I can grab at a moment’s notice.

My Bug-out-bag, Canteen, & Toiletry kit

 

I also keep an overnight bag, and a fully equipped first aid kit, in the trunk of my car . . .  just in case (see Inside My Auto First Aid Kit).

 

My investment in preparedness is relatively small – only a few hundred dollars – which I consider cheap insurance. But if a hurricane, a pandemic, or some other disaster strikes, I’ll be in a much better position to cope.

 

As I tell people, preparing is easy.  It’s worrying that’s hard.

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