Saudi MOH: Four New MERS Cases

 

# 10,484

 

The latest update from the Saudi MOH indicates 4 new MERS cases (2 HCWs in Riyadh, 1 in Najran, and 1 in Al Kharj), along with two recent deaths.  This makes 135 cases reported out of Saudi Arabia over the past 30 days, an unusually high number of cases for this time of year.

While most of the activity has been centered around the capital Riyadh, the past few days we’ve seen a growing number of cases from Najran, near the Yemen border.  

 

Today, we also see the first case in several weeks from Al Kharj, the source of which isn’t stated.  

 

The source of these  sporadic `primary cases’ – community cases without a known risk exposure –  are the topic of a blog overnight by Dr. Ian Mackay (see Where do these 'primary' MERS cases come from?), which includes a fascinating chart showing their incidence.

 

This is also an issue we’ve looked at previously, in  WHO EMRO: Scientific Meeting Reviews MERS Progress & Knowledge Gaps  and The Community Transmission Mystery).

 

Based on the limited scientific studies that have been released, for now, we still have more questions than answers.

Read More

#NatlPrep : Disaster Preparedness For Kids

Credit Ready.gov

 

Note: This is day 3 of National Preparedness Month.  Follow this year’s campaign on Twitter by searching for the #NatlPrep hash tag.  This month, as part of NPM15, I’ll be rerunning some updated  preparedness essays, along with some new ones.

#10,483

 

Growing up in Hurricane Alley, during the very active 1950s and 1960s, I was primed at an early age to respect the power of nature and to be prepared for the unexpected. If that wasn’t enough, our daily barrage of lightning storms during the summer months only added emphasis to the need to always keep a weather eye out. 

 

During my `formative years’, a lot of named storms crossed my path (I spent most of that time living in the green circle around Tampa Bay), and like most kids in Florida, I kept a hurricane tracking map my  bedroom wall to monitor their progress.  

 

I knew their strength, forward speed, and direction of movement, and dutifully updated the map every 6 hours.

 

Call it therapeutic. But I took comfort in knowing where these storms were, where they were likely headed, and knowing when they posed a potential threat - and more importantly – when they didn’t.   

 

I was involved, and so I felt in control.

Throw in the cold war, the 1962 Cuban Missile Crisis, and constant school duck & cover drills and evacuations, CONELRAD alerts on TV, films like Survival Under Atomic Attack and `Bert the turtle’ PSAs in elementary school, and you’d think you’d have a recipe for night terrors and phobias.

 

But amazingly, most of us just took it in stride.  In large part, I believe, because we were encouraged at a very young age to participate in disaster preparedness. 

 

While the atomic attack scenarios were certainly scary, we were empowered by being `prepared for the worst’, even if some of those preparations were a bit dubious (the protective properties of student desks against high yield atomic blasts likely being less than advertised).

 

Fortunately, disaster preparedness – particularly for kids - has come a long way from the `bad old days’ of the cold war.

 

Today, our concerns are focused on natural disasters, like floods, hurricanes, and earthquakes.  Scenarios that are far more survivable than an all-out nuclear attack, and that can be approached in a more `kid-friendly’ fashion.

 

Still, the core message – that disasters happen, and we should all be prepared – hasn’t changed.

 

Ready.gov’s kid friendly preparedness page contains games and activities for kids along with information for parents and educators on how to teach simple, but effective preparedness lessons.  

Many states have their own preparedness site for kids, such as Florida Division of Emergency Management’s Kids Get A Plan page, which provides an excellent interactive introduction to preparedness for children. 

Florida’s http://www.kidsgetaplan.com/  Disaster Preparedness For Kids

 

Most of these programs are designed for younger kids, so I was pleased earlier this year to find an online disaster preparedness game more suitable for older kids; the ISDR: The `Stop Disasters’ Simulation Game.  The game has five scenarios, with three levels of difficulty in each, to choose from.  Earthquake, tsunami, hurricane, wildfire or flood.

 

For more ideas on teaching kids to be disaster resilient (albeit, earthquake centric) SHAKEOUT.ORG has a long list of educational resources divided up by suitable school grade brackets (K-6, 7-12). 

 

Although most parents want to protect their kids from undo worry - when a disaster threatens, it threatens all of us – regardless of our age. 

 

Helping kids to understand more about emergency preparedness and community resilience will help them cope (and perhaps, even help) in the event they, or their community, are caught up in a disaster.

Read More

ECDC: Epidemiological Update On MERS-CoV - Sept 2nd

MERS by month of Onset – Credit ECDC

# 10,482

 

The ECDC has published an updated Epidemiological Update on MERS cases, which includes the 1st four Jordanian cases of 2015, along with Saudi cases reported through September 2nd.  As always, they pack a lot of information, and some excellent graphics, into their updates.

As the chart above illustrates, while our history of tracking  MERS is pretty short, we do seem to be seeing more MERS activity the past few months than we have during previous summers. These numbers, however, are largely being propelled by three major nosocomial outbreaks (Hofuf, South Korea, Riyadh). 

 

I’ve only included the outbreak summaries, so follow the link for the entire update:

 

Epidemiological update: Middle East respiratory syndrome coronavirus (MERS-CoV)

02 Sep 2015

 

Jordan

According to WHO the four cases reported from Jordan between 26 and 28 August 2015 seem to be part of a MERS-CoV outbreak at a hospital in Amman.

The first case reported was a 60-year-old man who lived in Jeddah, Saudi Arabia, but had travelled to Amman on 28 July 2015. The onset of symptoms began on 31 July and he was hospitalised for the first time from 10 to 18 August. However, he was readmitted to another hospital on 20 August. It is not known how this case  became infected.

The second case is a 38-year-old man from Kuwait City who travelled to Amman on 7 August 2015. He developed symptoms on 12 August. He was hospitalised on 17 August in the same hospital where the first case was treated. One possible exposure is that he frequently visited a family member who was being treated at the same hospital as the first case.

The third case is a 76-year-old man from Amman who was hospitalised for treatment of a chronic health condition on three different occasions at the same hospital as the two previous cases. According to WHO he was hospitalised twice for an underlying condition and then admitted on 20 August 2015 after he was diagnosed with MERS-CoV.

The fourth case is a 47-year-old woman from Kuwait City who travelled to Amman on 15 July 2015. She is a contact of the second case and tested positive for MERS-CoV on screening tests. She is asymptomatic and is in home isolation. Her only known exposure is that she visited family members at the hospital where the first patient was being treated.

In addition to the four cases mentioned, Jordan has announced two extra cases, a 56-year-old Jordanian man who was diagnosed with MERS-CoV after undergoing surgery and a 74-year-old woman who has pre-existing medical conditions.

 

Saudi Arabia

Since the beginning of 2015, Saudi Arabia has reported 367 cases, of which 30 were reported after ECDC’s risk assessment of 27 August 2015. Twenty-eight of the cases occurred in Riyadh (Figure 4) and two in Najran.

Figure 3. Number of cases (n=131) reported by Saudi Arabia in Riyadh, 3 August 2015 – 2 September 2015, by date of reporting

For four of the 30 cases it was clearly indicated that they did not have any contact with a previously identified or suspected case. The remaining 26 cases had either had contact, or were under review for having had contact, with suspected or confirmed cases in the community or hospital. This may indicate that there might be a low-level community transmission but the majority of the cases are clearly related to nosocomial transmission of MERS-CoV in Saudi Arabia. Six of the 30 cases are healthcare workers.

(Continue . . .)

 

 

Read More

WHO MERS Update – Saudi Arabia Sept 2nd

Credit WHO

#10,481

 

We’ve another lengthy WHO GAR update on the ongoing MERS outbreak in Saudi Arabia.  Today’s update lists 15 cases reported by the MOH between August 24th and 25th. Due to the length of this update, I’ve elected to briefly chart the cases (see spreadsheet below), rather than print the entire update.

 

Only one is listed as having direct contact with a known case, while 10 appear to be the unlucky recipients of  `collateral infection’  while admitted to - or visiting - a healthcare facility. In four cases, the mode of infection isn’t stated.

 

Two are healthcare workers, but none are described as having provided care to a known MERS case.  As we’ve seen previously, the actual chain of transmission within hospitals is often murky. .  

 

The average patient age for this batch is 63.57 years, 6 are female while 9 are male. Four are listed in critical condition, 2 have died, while the rest are listed in stable condition.  The average delay between testing positive and being reported by the MOH is near to 3 days, with a maximum of 7.

 

 

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

Disease outbreak news
2 September 2015

Between 24 and 25 August 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 15 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 2 deaths. Eleven (11) of these reported cases are associated with a MERS-CoV outbreak currently occurring in a hospital in Riyadh city.

(SNIP DETAILS OF CASES)

 

Contact tracing of household and healthcare contacts is ongoing for these cases.

The National IHR Focal Point for the Kingdom of Saudi Arabia also notified WHO of the death of 9 MERS-CoV case that were reported in previous DONs on 26 August (case no. 4, 5, 8, 13, 14, 17), on 21 August (case no. 4, 9) and on 18 August (case no. 7).

Globally, since September 2012, WHO has been notified of 1,493 laboratory-confirmed cases of infection with MERS-CoV, including at least 527 related deaths.

Read More

Korea Announces Major Changes In Wake Of MERS Outbreak

Coronavirus – Credit CDC PHIL

 

#10,480

 

The explosive spread of MERS in South Korea’s medical establishment last May and June was credited to both design deficits in hospital wards and emergency rooms that helped to spread the virus and cultural practices that encouraged family members to stay with hospitalized patients to provide routine care. 

 

The following excerpt comes from the WHO summary Middle East Respiratory Syndrome (MERS) in the Republic of Korea issued 15 June 2015.

 

MERS CoV spread in Korea

Conditions and cultural traditions specific to Korea have likely also played a role in the outbreak’s rapid spread. The accessibility and affordability of health care in Korea encourage “doctor shopping”; patients frequently consult specialists in several facilities before deciding on a first-choice facility.

Moreover, it is customary in Korea for many family members and friends to visit loved ones when they are in the emergency room or admitted to hospital. It is also customary for family members to provide almost constant bedside care often staying in the hospital room overnight, increasing the risk of close exposures in the health care setting.

 

Now that their MERS outbreak is over, hospitals are examining ways to prevent future outbreaks of MERS  . . . or any other infectious disease.

 

The hardest hit hospital in the Korean outbreak was Samsung Hospital in Seoul, which accounted for nearly half (90 of 186) patients.  Today they have announced a 50 Billion Won (42 million USD) renovation plan designed to limit the spread of any future outbreak. 

 

Among the planned changes:

• The hospital will allow only one visitor per patient in the emergency room.  Visitors will be required to book their visits in advance.
• Emergency rooms will have separate areas to treat infections vs. non-infectious patients
• The SMC will enlarge their ER room size by 60%
• SMC will add negative pressure isolation rooms to the ER
• SMC will also partner with the International Vaccine Institute (IVI) to try to develop a MERS vaccine.

 

Additional details are available via the following Korea Times article.

Samsung hospital announces post-MERS measures

By Kim Se-jeong

Samsung Medical Center (SMC) will refurbish its emergency room and limit the number of visitors for patients in an effort to prevent another infectious disease from spreading there and to ensure the safety of patients.

SMC's director Song Jae-hoon said Wednesday that the hospital will spend almost 50 billion won to build necessary infrastructure and facilities.

(Continue . . . )

 

This move by Samsung Seoul is just part of a much larger nation-wide initiative to prepare Korea’s hospital system to deal with infectious diseases like MERS, Ebola, and avian flu.  Korea’s government has also announced an ambitious  comprehensive `national defense strategy’ against infectious diseases:

Since this statement doesn’t translated particularly well, we’ll turn to a lengthy English language summary carried today by the Asian News Network.  Follow the link to read it in its entirety:

 

Wednesday, 2 September 2015

Seoul announces post-MERS plan for infectious diseases

Claire Lee The Korea Herald

Publication Date : 02-09-2015

All general hospitals with 300 or more patient beds in South Korea will be required to establish negative air pressure rooms to prevent cross-contamination, Seoul announced on Tuesday as part of its post-Middle East respiratory syndrome plan to better deal with contagious diseases.

The Ministry of Health and Welfare also announced that the head of Korea Center for Disease Control and Prevention will be appointed as the ministry’s joint vice minister to strengthen public health sector, and establish an emergency operations center that runs 24-hours a day to readily detect any possible epidemic.

South Korea's shortage of nursing staff and negative pressure rooms had been blamed for the MERS spread earlier this year, which claimed 36 lives. Many Koreans who contracted the virus did so while caring for their family members at MERS-affected hospital rooms.

(Continue . . . )

Read More

Saudi MERS Cluster Grows By 7 Cases

#10,479

 

Based on the limited and cryptic information we have from the Saudi MOH, it isn’t possible to tell exactly what index case sparked the current (largely) nosocomial MERS outbreak in Riyadh.  Based on FluTracker’s Tracking List there were 5 cases reported from the capital city in June, and 14 cases in July, but it wasn’t until early August that the numbers really took off.

Since then, the Saudi MOH has announced 126 additional cases from Riyadh – the vast majority of whom are believed part of this hospital-acquired cluster.

I say `believed’ because specifics, such as who infected who, when, where and how remain largely unknown. 

 

Despite multiple large nosocomial outbreaks (Jeddah, Taif, Hofuf & Riyadh) over the past couple of years, the Saudis have never shared the level of epidemiological detail such as we saw come out of South Korea this past summer. 

Nor have they released the long-promised case-control study on MERS, which is hoped will shed some light on how the virus is sporadically being acquired in the community.

Today things become even more confusing, as the latest MOH update offers conflicting information.   As they map at the top of this blog indicates, the MOH is reporting 7 new cases in Riyadh.

 

Unfortunately, the accompanying chart of cases doesn’t match.  It shows 5 new cases in Riyadh, and 2 in Najran.  (Your guess is as good as mine).

 

Three of the cases are listed as Health Care Workers, and 6 of the 7 are listed as contacts of known cases, with 1 under review.

 

Despite this confusing report, one thing remains apparent. 

 

Three weeks before the start of the Hajj – and after more than a month of trying - the Saudis still haven’t gotten control of this large, high profile MERS outbreak in the nation’s capital.

Read More

#NatlPrep : CPR Skills & AEDs

Source American Heart Association

 

Note: This is day 2 of National Preparedness Month.  Follow this year’s campaign on Twitter by searching for the #NatlPrep hash tag.  This month, as part of NPM15, I’ll be rerunning some updated  preparedness essays, along with some new ones.

 

10,478 

Although we usually talk about preparedness in terms of having an emergency plan and  the right supplies (First Aid Kit, Emergency Radio, Bottled Water, Full Pantry, etc.), it is also important to have the right skills to deal with an emergency.

 

Basic stuff – like how to use a fire extinguisher, how to turn off the gas supply to your home or business, how to stop bleeding or apply first aid.

 

And one of the most common emergency situations you are likely to encounter is witnessing a Sudden Cardiac Arrest (SCA).  More than a thousand of which occur every day across the nation, often in public places like parking lots, shopping malls, and houses of worship.

   

This from the Heart Rhythm Association:

 

• Sudden Cardiac Arrest (SCA) is a leading cause of death in the United States, claiming more than 350,000 lives each year.^1,2  
• An estimated 382,800 people experience sudden cardiac arrest in the United States each year.
• Approximately 92% of those who experience sudden cardiac arrest do not survive.
• SCA kills more than 1,000 people a day, or one person every 90 seconds ^1,2 — a number great than the number of deaths each year from breast cancer, lung cancer, stroke or AIDS.

 

What bystanders who do in the first few minutes of a witnessed SCA can mean the difference between life and death for the stricken individual. Luckily, hands-only CPR (cardio-pulmonary resuscitation) is easier to do than ever before, and there are thousands of AEDs (automated external defibrillators) stationed in public venues across the nation.

 

With a little bit of training, you can literally save someone’s life.

 

AEDs are designed to be used by laypersons who ideally should have received some AED training.  Like doing CPR, the required skills are relatively simple, but they do require some degree of familiarity.  I would strongly encourage everyone to take a CPR class, and if you already done so – take a refresher course every couple of years.

 

While this blog isn’t a substitute for taking a CPR class, it can help familiarize you with the basics.

 

Witnessing a cardiac arrest, particularly of a loved-one, can be a terrifying and traumatic experience. Far too often, bystanders are paralyzed into doing nothing while they wait for rescuers to arrive. As a paramedic, only rarely did I arrive on scene to find someone attempting to resuscitate a patient.

 

Almost inevitably, however, some kind soul had placed a pillow under the head of the victim to make them more `comfortable’, effectively closing off their airway.

 

Consequently, even with the advanced life support equipment we carried, our success rate in reviving these patients was dismally low.

 

Luckily, the new hands only resuscitation method -  which eliminates the need for mouth-to-mouth ventilation - makes doing CPR easier than ever before. But hand’s on training is still important, if you expect to be able to react properly during an emergency.

 

While it won’t take the place of an actual class, you can watch how it is done on in this brief instructional video from the American Heart Association. Taking a CPR class only takes a few hours, can be fun, and is well worth the effort.

 

To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

 

As far as learning how to use an AED, the following interactive video is particularly well done, and is provided by the Medtronic Foundation in conjunction with the Heart Rescue Project.  First the three steps you should know, then the video.

What to do if you see someone suddenly collapse.

If you see someone collapse suddenly, check if the victim is responsive. If not, remember these three easy steps.

Call 911

Have them send help. Stay on the line and listen for further instructions.

Start Chest Compressions

If the person is not breathing normally, start chest compressions. Push down hard and fast in the center of the chest. Keep your arms straight. Send someone to find an AED.

Use An AED

The AED (automated external defibrillator) is a portable medical device that delivers an electrical shock to restart a person’s heart. It provides voice prompts that tell you exactly what to do and will only administer a shock if needed, so there’s no reason to hesitate.

It only takes a few minutes to familiarize yourself with the operations of an AED by visiting the following website.  

LINK

I should point out that not all cardiac arrests can be corrected by defibrillation, even if conducted in a timely manner. There are non-shockable arrhythmias that an AED cannot convert to sinus rhythm.

Non-shockable cardiac arrest arrhythmias are asystole (flat line) and PEA (Pulseless Electrical Activity) – what we used to call back in the stone age of EMS, electromechanical dissociation.

 

Neither of which respond to defibrillation.

 

Patients can sometimes still be saved with CPR alone, at least until the right cardiac meds can be administered. For more on all of this, we have the press release from the American Heart Association.

Guidelines-based CPR saves more non-shockable cardiac arrest victims

April 02, 2012

Study Highlights:

• CPR can save someone with cardiac arrest even if they don’t respond to a defibrillator.
• People with non-shockable cardiac arrest are more likely to live if they receive CPR based on recent guidelines emphasizing chest compressions.
• The American Heart Association’s CPR guidelines emphasizing chest compressions are saving more lives, according to a new study.

 

Of course, despite your best efforts, many SCA victims will not survive. But early and coordinated action taken by bystanders (calling 911, starting CPR, using AED if available) can substantially improve their chances.

 

For more on heart attacks, and CPR, you may wish to visit some of these earlier blogs.

Deadlier Than For The Male

Survivability Of Non-Shockable Rhythms With New CPR Guidelines

Fear Of Trying

NPM11: Early CPR Saves Lives

Read More