Jordan Reports 5th MERS Case In A Week

#10,468

 

After going 8 months without reporting any coronavirus cases, on Wednesday of last week we learned of a Jordanian MERS case – described as a man in his 60s –  who reportedly has since died. The following day another case - a 38 y.o. male – was announced.

 

While details are scant, both reportedly had recent travel out of the country.  Their relationship, if any, has not been disclosed. 

 

On Friday, we saw Media Reports Of Two Additional MERS Cases In Jordan (Updated), both listed as contacts of one of the first two cases.  The Jordanian MOH website has remained silent on these cases, but over the weekend posted two long statements (in Arabic) on the control of MERS.

 

Committee Epidemiology confirms the safety measures to deal with Koruna

Health stresses the need to follow health guidelines to reduce the respiratory disease

 

Overnight we’ve a report from PETRA, the Jordanian News Agency, of a 5th case – which while not expressly stated, appears to be the result of nosocomial transmission.

 

New MERS case recorded in Jordan

By Petra - Aug 30,2015 - Last updated at Aug 30,2015

AMMAN — A new case of Middle East Respiratory Syndrome (MERS) coronavirus-related infection has been registered in the Kingdom, the Health Ministry said Sunday.

The diagnosed 56-year-old patient suffers from diabetes, blood pressure-related diseases and kidney failure, said Mohammad Abdullat, director of the ministry’s communicable diseases control department.

The patient also recently underwent open-heart surgery, Abdullat added. A team from the directorate is supervising the private hospital’s measures to prevent the spread of the infection and is also following up on the situation of the patient’s relatives and the medical staff who examined him. Since the MERS virus was first registered in Jordan in 2012, 17 cases have been recorded.

 

You’ll note that the claim that 17 cases have been recorded in Jordan differs from the count offered by the ECDC, which sat at 19 before this latest cluster began. 

This difference of 7 cases appears to be due the Jordanians not including 7 cases retrospectively identified in 2014 as infected from the first known hospital cluster of April 2012 (see Serological Testing Of 2012 Jordanian MERS Outbreak).

 
Curious, as this study was conducted in cooperation with Jordanian MOH, and Jordan’s MERS investigation team.
 

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RESEP OREO GORENG PANCAKE ENAK DAN RENYAH

Resep Oreo Goreng pancake untuk menu cemilan yang enak dan renyah. Salah satu pilihan menu yang bisa dicoba di rumah dari kreasi oreo adalah digoreng dengan balutan tepung. Menu ini sangat enak disajikan sebagai cemilan atau juga menu sarapan hingga hidangan makanan ringan menyambut tamu. Adonan tepung yang membalutnya juga memiliki banyak variasi seperti halnya adonan roti dan pancake begitu pula dengan aneka topping yang menghiasinya untuk memperkaya cita rasa.

Froreo (fried oreo) atau oreo goreng yang enak dan renyah krenyes bisa kita praktekkan dalam resep oreo goreng kali ini dengan balutan adonan pancake sederhana.

RESEP OREO GORENG PANCAKE

• 100 gram tepung terigu
• 30 gram gula pasir
• 1 sdm tepung maizena
• 1 sdt baking powder
• 1/4 sdt garam
• 1 butir telur
• 100 ml susu cair
• 18 buah oreo biskuit
• minyak untuk menggoreng
• keju parut atau aneka topping sesuai selera

CARA MEMBUAT OREO GORENG PANCAKE :

1. Sebelumnya simpan dahulu biskuit oreo dalam freezer agar creamnya beku, minimal 2-3 jam atau lebih lama juga tak masalah.
2. Dalam satu wadah campur dan aduk rata tepung terigu, gula pasir, tepung maizena, garam dan baking powder.
3. Kocok lepas telur menggunakan kocokan telur (whisk), kocok biasa saja hingga kuning dan putih tercampur rata hanya sedikit buih. Masukkan susu, aduk rata lalu masukkan tepung terigu secara bertahap sambil aduk rata.
4. Panaskan minyak secukupnya dalam wajan datar, celupkan oreo satu per satu pada adonan tepung hingga rata. Goreng dalam minyak panas di atas api sedang hingga matang kecoklatan bagaian bawah lalu balik agar matang merata. Sajikan oreo goreng dengan parutan kejua atau aneka topping sesuai selera.

Cara membuat oreo goreng yang lebih praktis bisa juga mencoba resep oreo goreng tepung sederhana di bawah ini, akan tetapi untuk kerenyahannya tentu tidak seperti resep pertama di atas.

Oreo Goreng Tepung Sederhana

Bahan-bahan :

• 12 buah oreo aneka rasa
• 150 gram tepung terigu
• 150 ml susu cair
• 1 butir telur
• 15 gram gula halus
• minyak goreng secukupnya
• gula halus atau aneka topping sesuai selera

CARA MEMBUAT OREO GORENG TEPUNG :

1. Campurkan terigu, susu cair, telur dan gula halus lalu aduk rata hingga adonan tidak ada gumpalan.
2. Panaskan minyak, celupkan biskuit oreo ke dalam adonan tepung kemudian goreng hingga matang berwarna kuning kecoklatan. Angkat dan tiriskan bisa memakai tisu sebagai alasnya supaya minyak menyerap.
3. Tata dalam piring saji, taburi dengan gula halus atau sajikan selagi hangat dengan aneka topping sesuai selera.

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J. Virol: Novel Reassortant Human-like H3N2 & H3N1 Influenza A Viruses In Pigs

 

 

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Swine are highly susceptible to a variety of flu viruses (human, swine, avian) - and are viewed as excellent `mixing vessels’, allowing viruses to reassort into new hybrid strains.  Swine Influenza Viruses (SIVs) are not a reportable or regulated animal disease in the United States, but the USDA does conduct limited voluntary surveillance for SIV in the US.

 

The USDA describes this program thusly: `This surveillance is not conducted to define prevalence - the goal is to identify viruses that may be circulating in swine, and gain knowledge to contribute to improved animal health diagnostics and vaccines.’

 

Just shy of a year ago, in  USDA IAV-S Surveillance Program Detects Novel H3N1 In US Swine, we learned that a new reassortant SIV had been detected in two states.  While swine H3N1 has been known to circulate in pigs for nearly a decade (see EID Journal 2006 article Novel Swine Influenza Virus Subtype H3N1, United States) this latest variant was a combination of both human and swine influenza viruses.

 

The USDA sent out an email to all SIV (swine influenza virus) approved NAHLN (National Animal Health Laboratory Network) labs on September 14th  (see H3N1 Identified in Swine in Two States), which described the virus as carrying `a novel human seasonal HA gene from contemporary human viruses and are distinct from our current swine H3 viruses.’

 

They warned:

A review of Genbank data indicates there may be more human-like H3 genes (in either H3N1 or H3N2) circulating in U.S. swine subtypes than what the USDA surveillance data has captured. Potential spread of H3N1 or H3N2 that carries the human-like H3 could have significant impact in swine herds due to poor herd immunity as well as potential public health ramifications. Preliminary findings by the USDA-ARS from testing of one of these H3N1 isolates with the human-like H3 gene in swine indicate the virus is fully virulent, causing typical influenza disease.

 

As we saw with the 2009 H1N1 pandemic virus, reassortant influenza viruses can kick around swine herds for years or even decades – picking up mutations or mixing with other viruses –  without posing a threat to humans. Most end up evolutionary failures, but every once in awhile, a genetic winner emerges.

 

Over the past decade we’ve been watching a variety of swine variant viruses (H1N1v, H1N2v,H3N2v) making tentative leaps into human hosts, with a new case reported just last Friday.  So far, these cases remain sporadic, and human-to-human transmission appears rare.

 

All of which brings us to a new study, published last week in the Journal of Virology (alas, behind a pay wall), that describes two distinct novel reassortants (H3N1 and H3N2) that possess human-like H3, and the internal genes from the 2009 H1N1 pandemic virus.

 

They describe both of these novel subtypes as “. . . virulent and can sustain onward transmission in pigs, and the naturally occurring mutations in the HA were associated with antigenic divergence from H3 IAV from human and swine’” and goes on to warn that  ``. . . the potential risk of these emerging swine IAV to humans should be considered”.

 

The Abstract from PubMed.gov follows:

 

J Virol. 2015 Aug 26. pii: JVI.01675-15. [Epub ahead of print]

Novel reassortant human-like H3N2 and H3N1 influenza A viruses detected in pigs are virulent and antigenically distinct from endemic viruses.

Rajão DS¹, Gauger PC², Anderson TK¹, Lewis NS³, Abente EJ¹, Killian ML⁴, Perez DR⁵, Sutton TC⁶, Zhang J², Vincent AL⁷.

Author information

Abstract

Human-like swine H3 influenza A viruses (IAV) were detected by the USDA surveillance system. We characterized two novel swine human-like H3N2 and H3N1 viruses with HA genes similar to human seasonal H3 strains and the internal genes closely related to 2009 H1N1 pandemic viruses. The H3N2 NA was of the contemporary human N2 lineage, while the H3N1 NA was of the classical swine N1 lineage.

Both viruses were antigenically distant from swine H3 viruses that circulate in the U.S. and from swine vaccine strains, and also showed antigenic drift from human seasonal H3N2. Their pathogenicity and transmission in pigs were compared to a human H3N2 with common HA ancestry. Both swine human-like H3 viruses efficiently infected pigs and transmitted to indirect contacts, whereas the human H3N2 was much less efficient.

To evaluate the role of genes from the swine isolates on their pathogenesis, reverse genetics-generated reassortants between the swine human-like H3N1 and the seasonal human H3N2 were tested in pigs. Gene segment contribution to virulence was complex with the swine HA and internal genes showing effect in vivo. The experimental infections indicate that these novel H3 viruses are virulent and can sustain onward transmission in pigs, and the naturally occurring mutations in the HA were associated with antigenic divergence from H3 IAV from human and swine.

Consequently, these viruses could have a significant impact on the swine industry if they cause more widespread outbreaks, and the potential risk of these emerging swine IAV to humans should be considered.

IMPORTANCE:

Pigs are important hosts in the evolution of influenza A viruses (IAV). Human-to-swine transmissions of IAV have resulted in the circulation of reassortant viruses containing human-origin genes in pigs, greatly contributing to the diversity of IAV in swine worldwide. New human-like H3N2 and H3N1 viruses that contain a mix of human and swine gene segments were recently detected by the USDA surveillance system. The human-like viruses efficiently infected pigs and resulted in onward airborne transmission, likely due to multiple changes identified between human and swine H3 viruses. The human-like swine viruses are distinct from contemporary U.S. H3 swine viruses and from the strains used in swine vaccines, which could have a significant impact on the swine industry due to lack of population immunity. Additionally, public health experts should consider appropriate risk assessment for these emerging swine H3N1 for the human population.

Copyright © 2015, American Society for Microbiology. All Rights Reserved.

 

While avian influenza has been getting the bulk of our attention the past couple of years, swine influenza viruses – while usually less virulent -  are also worrisome because they probably have less of a `leap’ to make in order to adapt to human physiology.  

 

For more on swine as potential `flu factories’, you may wish to revisit:

 

Live Markets & Novel Flu Risks In The United States

Keeping Our Eyes On The Prize Pig

EID Journal: Influenza A Viruses of Human Origin in Swine, Brazil

H5N2: The Other Biosecurity Concern

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Saudi MOH: 3 New MERS Cases, 4 Deaths

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The Saudi MOH update today indicates two more MERS cases in Riyadh, one of whom is a healthcare worker, and both are listed as contacts of previously confirmed cases.   

A third case, listed as a 67 y.o. male from Hail – located some 700 km north of Riyadh – is listed as a contact of a previous case.  A tad curious since this is the first case we’ve seen from Hail in quite some time.

 

The report goes on to list 4 deaths from Riyadh, and 3 recent recoveries.

 

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J.Virol.: Experimental Infectivity Of H3N8 In Swine

Credit ECDC – 125 years of  Pandemic  History

 

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The H3N8 subtype of influenza A is of particular interest to influenza researchers for several reasons. 

• First, as the chart above illustrates, H3N8 is strongly suspected to have sparked human epidemics and a pandemic around the turn of the 20th century.
• Second, avian H3N8 remains endemic in birds.
• Third, about 50 years ago H3N8 jumped unexpectedly to horses in Miami, and since the 1970s appears to have supplanted the old equine H7N7  and is now  the only equine-specific influenza circulating the globe.
• Fourth, in 2004 the equine H3N8 virus mutated enough to jump to canines, and began to spread among greyhounds in Florida (see EID Journal article Influenza A Virus (H3N8) in Dogs with Respiratory Disease, Florida).
• Fifth, in 2011 avian H3N8 was found in marine mammals (harbor seals), and 2012’s  mBio: A Mammalian Adapted H3N8 In Seals,  provided evidence that this virus had recently adapted to bind to alpha 2,6 receptor cells, the type found in the human upper respiratory tract.
• Sixth, the mBio findings were further confirmed last year in when Nature Communications: Respiratory Transmission of Avian H3N8 In Ferrets, confirmed that this `virus has an increased affinity for mammalian receptors, transmits via respiratory droplets in ferrets and replicates in human lung cells.’

 

Add in that in the short history of studying influenza, only H1, H2, and H3 subtypes have taken hold in the human population (see Are Influenza Pandemic Viruses Members Of An Exclusive Club?), and there are many who believe what went around 110 years ago could possibly come around again.

All of which makes the findings of the following study particularly interesting. 

     

Cross-species infectivity of H3N8 influenza virus in an experimental infection in swine

J Virol. 2015 Aug 26. pii: JVI.01509-15. [Epub ahead of print]

Solórzano A¹, Foni E², Córdoba L³, Baratelli M³, Razzuoli E⁴, Bilato D⁵, Martín Del Burgo MÁ⁶, Perlin DS¹, Martínez J⁷, Martínez-Orellana P³, Fraile L⁸, Chiapponi C², Amadori M⁵, Del Real G⁶, Montoya M⁹

Abstract

Avian influenza A viruses have gained increasing attention due to their ability to cross the species barrier and cause severe disease in humans and other mammal species as pigs. H3 and particularly H3N8 viruses, are highly adaptive since they are found in multiple avian and mammal hosts. H3N8 viruses have not been isolated yet from humans; however a recent report showed that equine influenza A viruses (IAV) can be isolated from pigs, although an established infection has not been observed so far in this host.

To gain insight into the possibility of H3N8 avian IAV to cross the species barrier into pigs, in vitro experiments and an experimental infection in pigs with four H3N8 viruses from different origins (equine, canine, avian and seal) were performed. As positive control, a H3N2 swine influenza virus A was used. While equine and canine viruses hardly replicated in the respiratory apparatus of pigs, avian and seal viruses replicated substantially and caused detectable lesions in inoculated pigs without previous adaptation. Interestingly, antibodies against HA could not be detected after infection by hemaglutination inhibition test (HAI) with the avian and seal virus.

This phenomenon was observed not only in pigs but also in mice immunized with the same virus strains. Our data indicated that H3N8 IAV from wild aquatic birds have the potential to cross the species barrier and establish successful infections in pigs that might spread unnoticed using HAI as diagnostic tool.

IMPORTANCE SECTION:

Although natural infection of humans with an avian H3N8 influenza A virus has not yet been reported, this influenza A virus subtype has already crossed the species barrier. Therefore, we have examined the potential of H3N8 from canine, equine, avian and seal origin to productively infect pigs.

Our results demonstrated that avian and seal viruses replicated substantially and caused detectable lesions in inoculated pigs without previous adaptation. Surprisingly, we could not detect specific antibodies against HA in any H3N8-infected pigs. Therefore, special attention should be focused towards viruses of the H3N8 subtype as they could behave as stealth viruses in pigs.

 

 

While H3N8 doesn’t currently appear to be established in swine populations, for much of the world testing of pigs is rarely (if ever) done.  In 2009 we did see evidence of H3N8 detected in Chinese swine in the middle of the last decade (see Isolation and molecular characterization of equine H3N8 influenza viruses from pigs in China).

 

For more background on this increasingly promiscuous virus, you may wish to revisit:

EID Journal: Equine H3N8 In Mongolian Bactrian Camel

Study: Dogs As Potential `Mixing Vessels’ For Influenza

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Saudi MOH Announces 2 Additional MERS Cases

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The number of new MERS cases being reported out of Riyadh has dropped in recent days, which may be an indication that the affected hospitals are starting to get a handle on containing the outbreak.  Today Riyadh only reports 1 new case, while once again we see a sporadic case from Najran.

 

The Najran case had already expired by the time his was announced by the MOH.

Whether this is a sign that the outbreak in Riyadh is ending – or is just a temporary lull – August 2015 will go down as the third heaviest MERS month for the Saudis, and the most active month since June 2014. .

Credit ECDC 20th MERS Risk Assessment

This spike is notable also because the hot summer months have not previously been associated with heavy MERS activity on the Arabian peninsula. The seasonality of MERS outbreaks – previously believed to favor spring outbreaks – has proven less predictable during 2015.

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CDC FluView: 1 Novel H1N1v Case Reported From Iowa

 

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For the 4th time this year, the CDC is reporting the detection of a novel swine variant virus in a human.  Human infections with these swine-origin viruses are only rarely reported, but presumably happen more often than we know because testing for novel viruses is very limited.

The first two swine variant infections this year were H1N1v (see here and here), while the third case reported just a month ago, was H3N2v.

 

The CDC describes Swine Variant viruses in their Key Facts FAQ.

What is a variant influenza virus?

When an influenza virus that normally circulates in swine (but not people) is detected in a person, it is called a “variant influenza virus.” For example, if a swine origin influenza A H3N2 virus is detected in a person, that virus will be called an “H3N2 variant” virus or “H3N2v” virus.

 

Up until about six years ago the CDC only received 1 or 2 swine variant infection reports each year.  In 2010, that number jumped to 8, and in 2011 to 12.  In 2012 we saw more than 300 cases – mostly mild - and nearly all associated with exposure to pigs at state and local agricultural fairs. 

 

Of the 376 swine variant infections reported in the United States, that vast majority (350+)  have been of the H3N2v variety. Far behind, in second place, is H1N1v.   A bit surprisingly, of the 4 cases discovered this year, 3 have been of the less common H1N1v variety.

This update from today’s FluView report.

 

Novel Influenza A Viruses:

One human infection with a novel influenza A virus was reported by the state of Iowa. The person was infected with an influenza A (H1N1) variant (H1N1v) virus and was hospitalized as a result of their illness. No human-to-human transmission has been identified and the case reported close contact with swine in the week prior to illness onset.

Early identification and investigation of human infections with novel influenza A viruses are critical so that risk of infection can be more fully appreciated and appropriate public health measures can be taken. Additional information on influenza in swine, variant influenza infection in humans, and strategies to interact safely with swine can be found at http://www.cdc.gov/flu/swineflu/index.htm.

 

While occasional cases are not particularly alarming, we keep an eye on these viruses because they belong to the same subtypes as do human flus (H1, H2 & H3), and presumably would  need less of an evolutionary leap to adapt to humans than avian flu strains. 

 

The CDC’s FAQ states:

Why are human infections with variant viruses of concern?

Influenza viruses that infect pigs may be different from human influenza viruses. Thus, influenza vaccines made against human influenza viruses are generally not expected to protect people from influenza viruses that normally circulate in pigs. In addition, because pigs are susceptible to avian, human and swine influenza viruses, they potentially may be infected with influenza viruses from different species (e.g., ducks and humans) at the same time. If this happens, it is possible for the genes of these viruses to mix and create a new virus that could spread easily from person-to-person. This type of major change in the influenza A viruses is known as antigenic shift. Antigenic shift results when a new influenza A virus to which most people have little or no immune protection infects humans. If this new virus causes illness in people and can be transmitted easily from person-to-person, an influenza pandemic can occur. This is what happened in 2009 when an influenza A H1N1 virus with swine, avian and human genes emerged in the spring of 2009 and caused the first pandemic in more than 40 years.

 

With the fall county and state fair season getting full swing, we’ll be watching to see if more cases are detected this fall. 

 

While infections have been generally mild (with a few exceptions), fairgoers should consider taking a little extra care washing their hands, particularly around the animal exhibits. The CDC’s webpage Take Action to Prevent the Spread of Flu Between People and Pigs at Fairs provides additional advice.

 

For more on swine variant influenza, you may wish to revisit:

Keeping Our Eyes On The Prize Pig

Waiting For The Next Flu To Drop

Fair Biosecurity & H3N2 In North Dakota Show Pigs

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