WHO Update On Jordanian MERS Cluster

Credit WHO

 

#10,477

 

The World Health Organization has released an update (h/t @lisaschnirring) on the first 4 cases of the Jordanian MERS cluster which we’ve been following for a week,  and which now numbers 6 cases.  As suspected, this cluster appears to have begun with an imported case, but has since spread within a healthcare facility and in one case,  to a contact of one in that facility.

The index case was treated, and released after a week, from a hospital in Amman.  He relapsed, and was admitted to another hospital five days later, where he tested positive for MERS two days post-admission, and died two days later. 

 

During this symptomatic period of roughly two weeks prior to being properly diagnosed, there appear to have been ample opportunities for others to be exposed.  Where he contracted the virus is unknown at this time.

 

Two of the other three cases are described as having been admitted to the same hospital as this index case, but there is no documentation of direct exposure to, or contact with, the first case  One case (#4) is a contact of one of those hospitalized cases (#2). 

 

Patterns of spread similar to those we’ve seen in other hospital outbreaks both in the Middle East and South Korea.

 

Middle East Respiratory Syndrome coronavirus (MERS-CoV) – Jordan

Disease outbreak news
1 September 2015

Between 26 and 28 August 2015, the National IHR Focal Point of Jordan notified WHO of 4 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 1 death. All these cases are associated with a MERS-CoV outbreak currently occurring in a hospital in Amman city.

Details of the cases

1. A 60-year-old male living in Jeddah city, Saudi Arabia travelled to Amman city, Jordan on 28 July. He developed symptoms on 31 July and, on 10 August, was admitted to hospital. The patient, who had comorbidities, was treated symptomatically and discharged on 18 August. As symptoms relapsed, on 20 August, the patient was admitted to another hospital in Amman on 23 August. He tested positive for MERS-CoV on 25 August and passed away on 27 August. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.
2. A 38-year-old male from Kuwait city, Kuwait travelled to Amman city, Jordan on 7 August. He developed symptoms on 12 August and, on 17 August, was admitted to the hospital where a laboratory-confirmed MERS-CoV case was hospitalized (case no. 1 – see above). Since his arrival in Amman city, he frequently visited a family member at the same hospital. The patient, who has no comorbidities, has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. He tested positive for MERS-CoV on 26 August. Currently, the patient is in critical condition in ICU. Investigation of possible epidemiological links with the index case or with shared health care workers is ongoing.
3. A 76-year-old male from Amman city developed symptoms. On 16 August, due to his chronic condition, the patient was admitted to the hospital where a laboratory-confirmed MERS-CoV case was hospitalized (case no. 1 – see above). He was discharged on the same day. On 20 August, the patient was admitted to the same hospital for a medical procedure for his chronic condition and, on 24 August, was discharged. On 25 August, he developed symptoms and was admitted to the same hospital. The patient tested positive for MERS-CoV on 25 August. Currently, he is in critical condition in ICU. Investigation of possible epidemiological links with MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing.
4. A 47-year-old female from Kuwait city, Kuwait travelled to Amman city, Jordan on 15 July. She was identified through the screening of contacts of a laboratory-confirmed MERS-CoV case (case no. 2 – see above). The patient, who has no comorbidities, tested positive for MERS-CoV on 27 August. Currently, she is asymptomatic in home isolation. The patient visited her family members at the hospital where a laboratory-confirmed MERS-CoV case was hospitalized (case no. 1 – see above). She has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.

Contact tracing of household contacts and healthcare contacts is ongoing for these cases. The National IHR Focal Point of Jordan informed the National IHR Focal Point for the Kingdom of Saudi Arabia about the index case to trace contacts in Saudi Arabia.

Globally, the WHO has been notified of 1,478 laboratory-confirmed cases of infection with MERS-CoV, including at least 516 related deaths.

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NIOSH Video: Adventures In Toilet Plume Research

#10,476

 

I ran across a video today from NIOSH which explores a topic we’ve looked at before, and one that just might have some relevance when it comes to the hospital spread of viruses such as MERS, Ebola, and Norovirus. 

 

The idea being that toilet flushes can aerosolize viruses in waste products, contaminate nearby surfaces, and potentially spread diseases.

 

Back in 2012, in Norovirus: The Gift That Keeps On Giving, we looked at an outbreak of norovirus that was believed due to just such an event, when a reusable open top grocery bag stored in a hotel bathroom became contaminated by one infected individual, and ended up spreading the virus to the other members of a girls soccer team.

 

A Point-Source Norovirus Outbreak Caused by Exposure to Fomites

Kimberly K. Repp1, and William E. Keene2

The authors describe the route of infection by saying:

Aerosolization of vomit and feces has been demonstrated to be of major importance in norovirus outbreaks [13]. Even viruses aerosolized from flushing a toilet can contaminate surfaces throughout a bathroom [14]. Once a fomes is contaminated, transfer to hands and other animate objects can readily occur [15]. The more confined the space (eg, most bathrooms), the more intense would be the “fallout” [13].

The authors also take notice of some of the lesser known hazards of reusable grocery bags (see my earlier blog It’s In The Bag).

 

It’s not a new idea, and in fact Mythbusters did a segment on this very early on in their series.  A couple of years ago, NIOSH and the University of Oklahoma produced a literature review on the topic.

 

Lifting the lid on toilet plume aerosol: a literature review with suggestions for future research.

Johnson-DL; Mead-KR; Lynch-RA; Hirst-DVL

Am J Infect Control 2013 Mar; 41(3):254-258

http://dx.doi.org/10.1016/j.ajic.2012.04.330

NIOSHTIC No. 20042357

Abstract

BACKGROUND: The potential risks associated with "toilet plume" aerosols produced by flush toilets is a subject of continuing study. This review examines the evidence regarding toilet plume bioaerosol generation and infectious disease transmission.

METHODS: The peer-reviewed scientific literature was searched to identify articles related to aerosol production during toilet flushing, as well as epidemiologic studies examining the potential role of toilets in infectious disease outbreaks.

RESULTS: The studies demonstrate that potentially infectious aerosols may be produced in substantial quantities during flushing. Aerosolization can continue through multiple flushes to expose subsequent toilet users. Some of the aerosols desiccate to become droplet nuclei and remain adrift in the air currents. However, no studies have yet clearly demonstrated or refuted toilet plume-related disease transmission, and the significance of the risk remains largely uncharacterized.

CONCLUSION: Research suggests that toilet plume could play a contributory role in the transmission of infectious diseases. Additional research in multiple areas is warranted to assess the risks posed by toilet plume, especially within health care facilities.

 

The next obvious step was to construct an experiment that would test, and quantify, the effect.  And here again NIOSH and the University of Oklahoma came up with a `build’ that allowed them to test the amount of aerosols generated at different flush rates.

Credit NIOSH

 

Not only was this approach flushed with success, they showed that high powered flushing units – such as those commonly used in hospital settings – gave off more aerosols than standard toilets.  Something for nursing staff to think about the next time they are charged with emptying an emesis basin or bedpan from  a suspected norovirus patient.

Then entire 6 minute video is well worth watching, including briefly revisiting the soccer team story mentioned above, at the link below.

 

The hope being that this type of research will lead to engineering changes that can reduce the generation and spread of aerosolized viruses and bacteria.  Something that could prove very important during an epidemic or pandemic scenario.

For more on research into aerosolized viruses in hospital environments, you may wish to revisit:

 

CID Study: Airborne Norovirus In Healthcare Facilities

Influenza Transmission, PPEs & `Super Emitters’

Vomiting Larry And His Aerosolized Norovirus

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Jordan Reports 2nd MERS Death

#10,475

 

Although we’ve no word of any additional MERS cases out of Jordan today (the count stands at 6), the Jordanian News Service PETRA has announced the death of the 5th case (announced Sunday),  a 56 y.o. man who was previously listed in critical condition.

The patient was described as having multiple comorbidities, and having recently undergone cardiac surgery.  

 

While details are scant, he is believed to have been one of several healthcare related infections in this cluster.  Previously we learned of the death of the first (imported) case in this cluster, a man in his 60s with recent travel to Saudi Arabia.

 

Hopefully we’ll get some additional details when the WHO posts an update.

 

"Health" recorded the second death of coronavirus

Oman 1 (PETRA)-the Ministry of Health said that a coronavirus-infected cases announced over the past few days, died Tuesday, bringing the number of deaths among those infected during this year to 2.

The Director Directorate of communicable diseases Dr. Mohammed Al-abdallat said in a press statement, the Jordanian deceased aged 56 years and has pressure and diabetes disease, renal failure, and had recently underwent open heart surgery.

He noted that the total number of cases since the first infection with the virus this year 6 injuries, two died and the remaining four cases, one in a critical health status, while the other three cases, two of which described when recording the incidence that health status is critical.

-(PETRA) a t/s a/p c

1/9/2015-03:32 pm

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Saudi MOH Reports 4 More MERS Cases In Riyadh

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The `Riyadh cluster’ - which produced more than 100 cases during the month of August – continues on this first day of September with 4 new cases announced, along with 2 recoveries and 1 death.

Most of the cases reported over the past month have been the result of healthcare acquired infection, although specifics on exactly how most of those were exposed remain elusive. 

 

Of the four cases announced today, only one is currently linked to contact with a suspected or confirmed case, while two of the remainder are under review. 

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Kicking Off National Preparedness Month

 

 

# 10,473

 

September is National Preparedness Month, and as I do every year, I’ll be devoting a good deal of time in this blog to the idea of individual, business, and community preparedness.  Over the next 30 days I’ll be posting a variety of new, and updated, preparedness articles along with my usual litany of EID information.

 

I come by my penchant for preparedness honestly, having been born and raised in Florida, and having my first brush with disaster at the age of 6 when a truly impressive Hurricane Donna came to town in 1960.  Two years later Florida was practically on a war footing, with schools practicing `duck and cover’ drills and handing out civil defense pamphlets on radiation sickness and building fallout shelters, during the Cuban Missile Crisis.

 

Add in the fact that for a lot of that time my family and I lived aboard an ageing 63 foot boat (see below), and well  . . . preparedness was something we thought about, and practiced, a lot.

 

Over the years there would be other hurricanes (Betsy in 65, Agnes in 72, Elena in 85), I’d become a boy scout, then after high school I became an EMT (later a paramedic) and worked in both Florida and Arizona. Eventually I’d end up spending more than a decade living aboard a couple of sailboats, and I’d even end up spending another 10 years `going back to the land’, in the backwoods of Missouri.

 

For me, being prepared has just been part of life.  And it has come in handy more than once.

 

The popularity of Doomsday Preppers on the National Geographic Channel  has a lot of people believing that preparedness is all about getting ready for the perpetually impending apocalyptic collapse of society.  But for the vast majority of us who embrace the preparedness lifestyle - it is the far more common localized disaster that spurs us on:

 

. .. hurricanes, tornadoes, ice storms, blizzards, earthquakes, floods (and yes, even a pandemic)  . . . along with even more limited emergencies like power outages, house fires, car accidents, or personal accident and injury.

 

While we can’t pick and choose what emergencies will befall us – we can elect whether or not to be prepared to deal with them –  which is why federal agencies like FEMA and READY.GOV work year-round to encourage Americans to think about their risks, and to prepare for them.

 

Ready.gov recommends that first and foremost, you need to Make a Plan, then you can go about Building A Kit.

 

Things like having a good first aid kit at home, and another one in your car.  And just as importantly, learning how to properly use one. Taking a first-aid course, and CPR training, are both investments that could pay off big someday, for you, and for your loved ones. 

Having enough stored water for at least 3 days (1 gal/day per person + pets), a reasonable supply of non-perishable food, a NWS Emergency weather radio, a little cash in case the ATMs and Credit Card readers are down, and a safe form of emergency lighting (not candles) are all things every household should have on hand. 

 

And for my money, perhaps most importantly, having – and being – a `disaster buddy’. 

 

In NPM14: In an Emergency, Who Are You Going To Call?, I wrote that a `Disaster Buddy’ is simply someone you have prearranged that you can call on during a crisis, and who in turn, can call on you if they need help.  And the more `disaster buddies’  you have in your personal network, the more options you will have in an emergency.

I hope you’ll  take some time during the coming weeks to think about how to make your family, business, or community better prepared to deal with the next disaster, and then act on it.   And that you’ll encourage others to do the same.   

 

For more on how to prepare, visit these websites:

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

 

And if you are on twitter, follow #NatlPrep for more on National Preparedness Month activities. 

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Nilai University - Malaysia

• Established in 1997 as Nilai College
• It upgraded to "university college" in 2008 before receiving full university status in 2012
• 5 faculties- Business, Allied Health Sciences, Hospitality & Tourism, Engineering, Science & Technology, & Humanities and Social Sciences
• A centre for Foundations Studies
• Offer Foundations, Diplomas, Degree & post-graduates programmes
• Located in the idyllic suburb of Putra Nilai

Intake: - January, May, October 

Scholarships

1. H.A.S (High Achiever Scholarship)

*Interview required

PERFORMANCE		ENTITLEMENT
SPM / O-Level	9As	100% tuition fee waiver
STPM	3As
UEC	6As
A-Level	3As
SAM / HSC / AUSMAT	≥TER / UAI 90
ICPU (6 best subjects)	≥90

2. E.C.E.A (Excellent-Curriculum Excellent Award)

*Interview required

PERFORMANCE		ENTITLEMENT
Extra-Curricular	National Level (Representing Malaysia)	100% tuition fee waiver
	State level (Representing any state in Malaysia)	50% tuition fee waiver

3. E.F.L (Enrichment for Life Award)

*Applicable for American Degree Transfer Program applicant as well

PERFORMANCE		ENTITLEMENT
SPM/ O-Level	Applicable for clubs/ societies/ uniform bodies and the positions below only:- President/ Chairman Vice-President/ Deputy-Chairman Secretary/ Assistant Secretary Treasurer/ Assistant Treasurer Prefect Represented School to District Level in Sports/ Other Activities	15% tuition free waiver for Foundation
		10% tuition free waiver for Diploma
STPM/ UEC/ A-Level/ SAM/ HSC/ AUSMAT/ ICPU		5% tuition free waiver for Degree*

4. Progression Scholarship

PERFORMANCE		ENTITLEMENT
		ADVANCED DIPLOMA	DEGREE	ADP
Foundation	CGPA ≥ 3.7	-	30%	20%
	CGPA ≥ 3.5	-	20%	20%
Diploma	CGPA ≥ 3.5	25%	25%	-

5. Merit Scholarship

*Applicable only for Advance Diploma

*Completed from Ministry of Education approved Malaysian Instituitions

PERFORMANCE		ENTITLEMENT
		DIPLOMA	FOUNDATION	DEGREE	ADP
SPM	8As	20%	50%	-	20%
	7As	17%	40%	-	17%
	6As	15%	30%	-	15%
	5As	13%	20%	-	13%
	4As	10%	-	-	10%
	3As	5%	-	-	5%
O-Level	6As	20%	50%	-	20%
	5As	17%	40%	-	17%
	4As	15%	30%	-	15%
	3As	13%	20%	-	13%
STPM	AAB	-	-	20%	20%
	ABB	-	-	15%	15%
	BBB	-	-	10%	13%
A-Level	AAB	-	-	20%	20%
	ABB	-	-	15%	15%
	BBB	-	-	10%	10%
UEC (6 best subjects)	≤ 14pts	20%	50%	20%	20%
	≤ 20pts	17%	40%	15%	17%
	≤ 24pts	15%	30%	10%	15%
	≤ 28pts	13%	20%	-	13%
SAM / HSC / AUSMAT	TER / UAI 85.0	20%	50%	20%	-
	TER / UAI 80.0	17%	40%	15%	-
	TER / UAI 75.0	15%	30%	10%	-
	TER / UAI 70.0	13%	20%	-	-
ICPU (6 best subjects)	85	20%	50%	20%	-
	80	17%	40%	15%	-
	75	15%	30%	10%	-
	70	13%	20%	-	-
Foundation*	CGPA ≥ 3.5	-	-	20%	20%
	CGPA ≥ 3.0	-	-	10%	10%
Diploma*	CGPA ≥ 3.0	-	-	20%	20%

Accommodation

1. Halls of Residence

- Highly recommend to 1st year students

2. Apartments

- Highly preferred by seniors

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

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Lincoln University - New Zealand

International Merit Scholarships for Taught Masters 

- IELTS 6.5 (no bands less than 6.0)

- GPA 70% in last year of degree (2.8/4)

- Tuition fees at NZ$40,000 for the whole programmes (180 credits)

- Scolarships available = NZ$10,000 for GPA 3.0/4 or 75% in last year of degree.

Applicable to the master program as given below:

• Master of Business in Accounting & Finance
• Master of Business in Global Management and Marketing (Nov intake, 12 months study, any discipline)
• Master of Tourism Management (Feb & July intake)
• Master of International Rural Development (Nov intake) 
• Master of Management in Agribusiness (Feb intake)
• Master of Management in Agricultural Systems (Feb intake)
• Master of Design (Feb intake)
• Master of Science in Food Innovation (Feb & Nov intake)

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

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