New cases of coronavirus: the Ministry of Health does not confirm

The Point.fr - Published on 11/06/2013 at 23:01

The ministry said 40 cases are being investigated, but they were all negative. One case in Tours been vigilanceNo new cases of coronavirus has been confirmed so far in France, said Tuesday the Ministry of Health, stating that an investigation was underway regarding a patient Tours. "There is so far no new cases in France coronavirus confirmed nor Tours, or elsewhere," said the Ministry of Health, following reports of two suspected cases of coronavirus in a hospital Tours. "Since the identification of the two carriers coronavirus patients, 40 cases were investigated. All were negative. One investigation is underway concerning a patient Tours. Results are expected in tomorrow , "the ministry said.Medical sources had reported the hospitalization of two men in Tours, suspected of being infected with coronavirus. Both patients had, in France Bleu Touraine, stayed in Saudi Arabia and had symptoms that make you think coronavirus. Two French patients have so far been infected with the new coronavirus, one died at the University Hospital of Lille on 28 May. The second patient, who had been contaminated by the first to the end of April, when he shared his room at the hospital in Valenciennes, is still his hand in a "steady state" at the University Hospital of Lille. Several suspects in the entourage of the two patients had been investigated, but were ultimately negative.  http://www.lepoint.fr/societe/nouveaux-cas-de-coronavirus-le-ministere-de-la-sante-ne-confirme-pas-11-06-2013-1679852_23.php

International collaboration needed to find elusive source of MERS virus

 

Helen Branswell, The Canadian Press
Tue, 11 Jun 2013 14:49:00 CST

A colorized transmission of the MERS coronavirus that emerged in 2012 is shown. THE CANADIAN PRESS/HO, National Institute for Allergy and Infectious Diseases

TORONTO - International collaboration will be needed to find the source of the elusive MERS virus, says a Canadian SARS expert who has been involved in efforts to investigate and contain an outbreak of the new coronavirus in Saudi Arabia.
Health officials in the kingdom have put a lot of work into finding and containing the virus — more work, actually, than has been publicly disclosed, Dr. Allison McGeer said in an interview.
But she said with comparatively few cases to investigate spread out over a number of countries, puzzling out where the virus lives in nature and how people are contracting it will take a bigger effort than has been made to date.
"The Kingdom of Saudi Arabia has done a lot of work in the investigation of both the human-to-human transmission (cases) and the source of community infections, but it's very clear that a great deal more work needs to be done," said McGeer, who just returned from her second MERS-related trip to Saudi Arabia.
"And that a very substantial amount of international collaboration is the only way that we're going to be able to move knowledge about this virus forward at the speed that everybody wants to see it move."
McGeer was one of the members of a World Health Organization-led mission to Saudi Arabia to investigate the country's MERS outbreak. The team concluded its six-day mission on Sunday. On Monday, it released a statement warning health-care workers around the globe to be on the lookout for the new virus because of its proven capacity to spread.
McGeer, who is head of infection control at Toronto's Mount Sinai Hospital, also travelled to Saudi Arabia in May at the request of the Saudi government to help investigate an outbreak in a hospital in Al-Ahsa, in the eastern part of the country. McGeer was a major player in Toronto's SARS response in 2003 and even contracted the virus during the early days of the virus's spread through city hospitals.
The SARS and MERS viruses are cousins, both members of the coronavirus family.
McGeer said it appears the hospital-based outbreak in Al-Ahsa may be over, though there is still one facility where there remains a possibility of additional cases caused by person-to-person spread.
Saudi officials have to date only publicly acknowledged spread in one or possibly two hospitals in Al-Ahsa. McGeer said in fact the Al-Ahsa outbreak has involved person-to-person spread in several hospitals, though she declined to specify how many facilities have been involved.
"In the majority of facilities, the outbreak appears to be under control, although it's really important to recognize that because this (disease) has a long incubation period, that you can't declare an outbreak over (too soon)," she said.
"One of the lessons from SARS was about not declaring an outbreak over until a long enough period of time has passed."
In Toronto, an assumption that spread of SARS had been interrupted led the Ontario government to declare victory against the virus in mid-May of 2003. Hospital workers were told they no longer had to wear the N-95 respirators that shielded their mouths and noses and many quickly doffed the hot and cumbersome equipment. Within days, sick health-care workers started to show up in emergency rooms, signalling the virus was still spreading in the city's hospitals.
McGeer suggested the fact that the Al-Ahsa outbreak appears to be coming under control is good news for those concerned about the spread of the virus to other parts of the world — or at least to parts of the world with strong health-care systems. The WHO has voiced concerns about the possibility that guest workers — citizens of Bangladesh, the Philippines and other parts of Asia who work in Saudi Arabia — could take the virus home with them and trigger outbreaks in less developed countries.
"The hospital person-to-person transmission appears to be manageable. It may not be easy. But it appears to be manageable, at least in the developed world," she said. "But the critical piece of understanding this virus is understanding what the reservoir is and how people get infected in the community."
McGeer offered some insight into why that is proving to be such an enormous — and frustrating — challenge.
While there have been 55 confirmed cases of MERS, in reality there have been relatively few cases that could be described as index cases — people who were infected by contact with the virus's source. Quite a few of the cases — McGeer would not say how many — have likely been infected through limited person-to-person spread.
That latter type of case can teach public health officials about the conditions under which the virus can spread from person to person. But to find the source of the virus, they have to investigate cases where it is clear the infection came from a non-human source. And with relatively few such cases, spread over a number of countries, co-ordinating the search has proved difficult, she said.
"We get back to there's a really small number of cases, they're in a bunch of different countries, the process of doing the exploratory work to figure out what exposures might be important has to happen with people ... on the ground in all those countries talking to each other on a regular basis," McGeer said.
"That's not something we're set up to do. It's really hard to get that organized and working well."
Adding to the complexity is the fact that a successful epidemiological investigation will require someone who understands the culture of the countries in which infections are taking place, someone who can decipher the clues seen in the pattern of cases to date. Most have been in men. Many cases have been seen in travellers — men from Britain, Italy and Tunisia who travelled to Saudi Arabia, a man from France who travelled to the United Arab Emirates.
"There's a bunch of hints in the data we have so far about the cases. But that's exactly what they are," McGeer said. "And they do help to some degree guide how you should do the investigation. But they're not enough for somebody to say: 'Ah! It's the dates.'"
Saudi Arabia's Eastern Province is a major date-producing area, and people have mused about the possibility that virus from bats may be contaminating dates in some way. (The genetic sequence of the virus suggests it originated in bats.) But McGeer noted it isn't currently date harvest time.  http://www.mysask.com/portal/site/main/template.MAXIMIZE/?javax.portlet.tpst=635b2ff202604ea181fa421740315ae8_ws_MX&javax.portlet.prp_635b2ff202604ea181fa421740315ae8_viewID=story&javax.portlet.prp_635b2ff202604ea181fa421740315ae8_topic_display_name=Health%20News&javax.portlet.prp_635b2ff202604ea181fa421740315ae8_topic_name=Health&javax.portlet.prp_635b2ff202604ea181fa421740315ae8_news_item_id_key=23766729&javax.portlet.begCacheTok=com.vignette.cachetoken&javax.portlet.endCacheTok=com.vignette.cachetoken

France reports new suspected cases of MERS virus

MENAFN - AFP - 11/06/2013

MENAFN - AFP) French medical authorities on Tuesday reported two new suspected cases of infection with the SARS-like virus MERS which has killed more than 30 people worldwide, the bulk of them in Saudi Arabia.

The patients suspected of having contracted the virus are both men who have recently spent time in Saudi Arabia and they have been hospitalised in Tours, a town in the Loire region south of Paris...  http://www.menafn.com/1093643537/France-reports-new-suspected-cases-of-MERS-virus

Coronavirus: the French second patient still in a "stationary" state

The second patient northerner, from Aulnoye-Aymeries, reached by the new coronavirus was still Monday in a "stationary" state, two weeks after the death of the first patient in the University Hospital of Lille.



By Emmanuel Magdalene
Published 10/06/2013 | 5:27 p.m.



"There is no change either in the right or in the wrong direction" for the patient, who remains hospitalized in the intensive care unit, told AFP a spokesman for the hospital .

  The last medical report of the second patient, published by the University Hospital on May 28, evoked a state "stable but still very serious." This man has been contaminated by the virus similar to SARS in late April, when he shared the Valenciennes hospital room the first patient in France, fell ill after returning from a trip to Dubai.


55 people affected worldwide

The first patient died on May 28, when he was hospitalized in intensive care in Lille since May 9 Both patients were under extracorporeal support to take over their lung function. This new virus, now designated by the WHO as respiratory syndrome coronavirus in the Middle East (MERS), touched since September 55 people in the world, 31 have died.

  The majority of cases were reported in Saudi Arabia, with the remainder divided between Qatar, Jordan, Tunisia, the United Arab Emirates, Germany, the United Kingdom and France.  http://nord-pas-de-calais.france3.fr/2013/06/10/coronavirus-le-2eme-patient-francais-toujours-dans-un-etat-stationnaire-267573.html

Coronavirus: two suspects in Tours

Tuesday, June 11, 2013 at 15:25

 Two patients who may be infected with coronavirus were hospitalized at the University Hospital of Tours.  This is information of France Bleu Touraine.  They returned from the Middle East, where the coronavirus appeared last year. Only testing will indicate whether or not the third and fourth cases identified in France.  The virus has killed 31 people in the world including one in France.

As the first French cases, new patients returning from a trip to the Middle East, specifically in Mecca.  Both were hospitalized at the University Hospital of Tours, in the infectious diseases implanted Bretonneau hospital. They complain of respiratory problems and stomach aches, known coronavirus symptoms.
 To prevent possible transmission, the hospital set up in host protocol patients who presented themselves with similar symptoms.

Lethal to 50% over

With 31 victims in 55 cases identified worldwide, coronavirus kills more than half of those it infected. ....  http://www.francebleu.fr/sante/coronavirus/info-france-bleu-coronavirus-deux-cas-suspects-tours-638664  hattip Tetano

   



Middle East respiratory syndrome coronavirus: Joint Kingdom of Saudi Arabia/WHO mission

Between 4 and 9 June 2013, a joint mission of the Kingdom of Saudi Arabia (KSA) and the World Health Organization (WHO) met in Riyadh to assess the situation due to a new coronavirus in the Kingdom. This virus has recently been named the Middle East respiratory syndrome coronavirus (MERS-CoV). It is a new, emerging virus that is distantly related to the virus that caused SARS.
The first documented cases of MERS occurred in Jordan in early 2012. Globally, to date there has been a total of 55 cases confirmed by laboratory testing. Of these, 40 have occurred in KSA, and the rest have been reported from other countries in the Middle East (Qatar and the United Arab Emirates), from Tunisia in North Africa, and from France, Germany, Italy and the United Kingdom of Great Britain and Northern Ireland in Europe.
The overall number of cases is limited, but the virus causes death in about 60% of patients. So far, about 75% of the cases in KSA have been in men and most have occurred in people with one or more major chronic conditions.
There appears to be three main epidemiological patterns.

In the first pattern, sporadic cases occur in communities. At present, we do not know the source or how these people became infected.

In the second pattern, clusters of infections occur in families. In most of these clusters, there appears to be person-to-person transmission, but it seems that this transmission is limited to people who are in close contact with a sick family member.

The third pattern comprises clusters of infections in health care facilities. Such events have been reported in France, Jordan and KSA. In these clusters, the sequence seems to be that an infected person is admitted to hospital where that person then transmits the virus to other people in the health care facility.

Two important points need to be stressed.

First, there is no evidence of widespread person-to-person transmission of MERS-CoV. Where it has been suspected that the virus has been transmitted from person to person, it appears that there had been close contact between somebody who was sick and another person: a family member, a fellow patient or a health care worker.

Secondly, many fewer infections with MERS-CoV have been reported in health care workers in KSA than might have been expected on the basis of the previous experience of SARS. During the SARS epidemic, health care workers were at high risk of infection. The MERS-CoV is different from the SARS virus. Although the reason why fewer health care workers have been infected with MERS-CoV is not clear, it could be that improvements in infection control that were made after the outbreak of SARS have made a significant difference. In this context, infection control measures in KSA appear to be effective.

Currently, the diagnosis of MERS CoV relies heavily on clinical awareness combined with confirmatory testing for the presence of MERS-CoV by the polymerase chain reaction. No bedside test exists.

Treatment is primarily supportive and there are no convincing data that the use of potent antiviral agents, such as ribavirin and interferon, brings any benefit. The use of steroids in high doses should be avoided.
The joint mission reviewed the response in KSA, and concluded that the country has done an excellent job in investigating and controlling the outbreaks. Once the first cases were identified in 2012, several steps were taken, including the following:

Measures, including infection control measures, were introduced to stop hospital outbreaks

surveillance for MERS CoV cases was significantly increased

awareness campaigns to alert and educate the public were started

cases of MERS CoV were reported to WHO

epidemiological investigations were initiated to identify the sources of infection, risk factors and routes of transmission

international experts were invited to help.

At this point, the right prevention and control measures have been applied, and the KSA Government is to be congratulated for urgently taking crucial actions.

Some final points must be stressed.

First, large gaps in our knowledge about this virus remain. Although extensive work has been done and is ongoing, it should be remembered that it often takes time for scientific investigations to produce results.

Secondly, international concern about these infections is high, because it is possible for this virus to move around the world. There have been now several examples where the virus has moved from one country to another through travellers.

Consequently, all countries in the world need to ensure that their health care workers are aware of the virus and the disease it can cause and that when unexplained cases of pneumonia are identified, MERS CoV should be considered. If cases of MERS CoV are found, they should be reported to WHO under the terms of the International Health Regulations (2005).

So far, all cases of community acquired MERS CoV infection have been seen in the countries of the Middle East. All countries in this region should urgently intensify their surveillance efforts for infection by MERS-CoV. http://www.emro.who.int/press-releases/2013/corona-virus-who-saudi-arabia-mission.html

Health Affairs denied Batin province registration of any injury to the virus, "Corona" affiliate hospitals.

This came on the San media spokesman for the Department of Health Batin Governorate Abdul Aziz Abdullah Al-Anzi, who said, according to "above": all that were traded during the last few days rumors, and maintaining health affairs did not record any case of "Corona".

The users of social networking sites "August الواتس" and "Twitter" deliberated news for injured workers at King Khaled province Batin, infected with "Corona", after mixing to a patient in the hospital.

People were newly infected Corona, Saudi Arabia and suspicion of the existence of 124 cases in Jordan

People were newly infected Corona, Saudi Arabia and suspicion of the existence of 124 cases in Jordan


 The Ministry of Health Saudi Arabia recorded new cases of HIV Corona citizen Ahsa region at the age of 61 years and suffers failure كلويا and other chronic diseases, according to what reported, bringing the total number of people infected to 36 cases in the Kingdom.
The ministry also revealed for the deaths of 3 patients in the Eastern Province who infected announced in earlier and admitted to hospital last month aged 60, 58 and 24 years and all of them have also renal failure and other chronic diseases.
Thus, the final number of deaths rising death toll due to the virus to 21 cases.
And revealed the Jordanian Ministry of Health on Wednesday on suspicion of coronavirus disease, injuries to 124 people in Jordan.The ministry said in a statement it was sending samples from these patients to the center of American control of communicable diseases to ascertain their health status.
The statement stressed that he did not record any new case of the virus in Jordan since the death of two cases in a blue state hospital in April last year.

http://www.news.gov.kw/ndetail.aspx?nid=25580&cid=2

 

hatip Valerie Mansuy

The Intentional Concealment of the new Coronavirus

That's right, the true facts are being hidden from you by several govt's and international health agencies. Some of you aren't surprised, while others are completely unaware of it.. that's the idea right?

Even after almost a year, you are told it is not known what the actual source of the virus is!! Why is it you can't be told the answer to this basic question? Do you still believe they "just don't know"?

I see I am not the only one talking about this.
Here are a few examples for you.

Saudi Arabia continues to delay reporting of cases and scientific information. Saudi paperwork demands delay work to research to find MERS source: CDC http://www.calgaryherald.com/health/Saudi+paperwork+demands+delay+work+research+find+MERS+source/8495078/story.html
Saudi Silence on Deadly MERS Virus Outbreak Frustrates World Health Experts
http://news.yahoo.com/saudi-silence-deadly-mers-virus-outbreak-frustrates-world-213000665.html
Thanks to Helen Branswell for those reports!

8 months and US CDC still waiting on their MERS-CoV samples from the KSA.
http://www.uq.edu.au/vdu/#080613

The U.S. has not been forthcoming with much news and what they have been doing is under the radar.
On May 29, 2013, the Secretary determined that
there is a significant potential for a public health emergency that has a significant potential to affect national security or the health and security of United States citizens living abroad and that involves Middle East respiratory syndrome coronavirus (MERS-CoV). http://www.ahanews.com/ahanews/jsp/display.jsp?dcrpath=AHANEWS/AHANewsNowArticle/data/ann_060513_coronavirus&domain=AHANEWS
Yet.. That little news item never made it to the big screen. In fact, there has been no news on
the MSM at all lately.


While complaining about samples and timely information, they have actually contributed to the future spread of MERS, by authorizing a new open skies policy with the very country that is contaminated. Does this make any sense to you at this time??

United States and Saudi Arabia Sign Open Skies Air Transport Agreement

Office of the Spokesperson

Washington, DC

May 28, 2013

Today in Jeddah, Saudi Arabia, U.S. Ambassador James B. Smith and Saudi Arabia’s Deputy Director of the General Authority of Civil Aviation, Dr. Faisal bin Hamad Al-Sugair, signed an Open Skies air transport agreement.
The United States-Saudi Arabia Open Skies agreement will, following..

http://www.state.gov/r/pa/prs/ps/2013/05/209995.htm


Really? An uncontrollable deadly virus is spreading globally from this country, and we start an open skies policy..as our CDC  and  WHO say they are waiting for samples and timely reporting of cases?? Doesn't really give you a sense of security, Huh? No cases in the U.S.?..WELL..just give it a few days.

We have many bases and armed forces in the middle east and Saudi Arabia, many thousands in fact soldiers and students  flying from there all day long.   Bahrain,  OMAN,  and other areas close to SA are denying cases, yet are only a few miles away from current outbreaks.  Italy walked back it's recent case count, after already declaring 10 were confirmed. All countries with current or recent cases are quickly denying anything is going on and don't want to raise any alarms, declare any travel alerts or even acknowledge the disease exists. Saudi Arabia denies any Filipino drs to come on their soil to help screen their workers, who willingly go there to act as servants.. if I were them, I would pull them all out immediately.

The situation is out of hand,  but is being covered up for oil, money, power, gov't continuity and greed. 
 A patent? Vaccine rights? Biological terrorism? Panic control? What excuse will be next on the list?
How long can you be told lies and kept in the dark? Apparently as long as you keep quiet about the lack of information you are getting. Keeping case counts and watching for clusters will not change the fact that we are on the edge of a new sars related virus outbreak, all the while most people in the world are oblivious to it.




Based on the information available, WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions. http://www.who.int/ith/updates/20130605/en/index.html



 

Saudi paperwork demands delay work to research to find MERS source: CDC

 

By Helen Branswell, The Canadian Press June 7, 2013 3:20 PM

TORONTO - Last October, scientists from the U.S. Centers for Disease Control went to Saudi Arabia to help investigate a newly discovered virus that had killed one Saudi man and left another from Qatar gravely ill.
The CDC scientists are still waiting for a chance to test the samples they took during that investigation. Those specimens remain in Saudi Arabia, tied up in prolonged negotiations for a material transfer agreement the Saudi government has insisted the American agency sign.
The situation is frustrating the American scientists and impeding efforts to find the source of a virus which has now infected 55 people, killing 31 of them.
It's also ironic. Dr. Ziad Memish, the Saudi deputy health minister, has complained bitterly and publicly because Erasmus Medical Centre, the Dutch laboratory that first identified the MERS coronavirus, applied for a patent on its genetic sequence and has been requiring labs that want virus samples to sign a material transfer agreement, known in research lingo as an MTA.

"We are told at this point that we are close," Pallansch said. "So I do have some degree of hope that we will indeed have this completed in the near future."
Pallansch acknowledged the delay is frustrating. But he suggested the numerous outstanding questions about MERS are more pressing at this point, as public health agencies find themselves hampered in efforts to assess the risk posed by the new virus, a cousin of the coronavirus that caused the 2003 SARS outbreak.
"We are certainly in discussion with WHO, the European CDC and other key partner public health agencies. And I think there is very little disagreement among all of those agencies in terms of what are the important epidemiologic and virologic questions that need to be addressed. So I think that we all are trying to find out how that information can be made more readily available," Pallansch said.
The fact that the CDC is still waiting to test samples collected last October came as a shock to an international health law expert who has been following the issues related to intellectual property claims on the Middle Eastern Respiratory Syndrome virus, or MERS.
"The fact that negotiations are still going on about an MTA ... is very surprising," David Fidler, who teaches at Indiana University, said Friday when informed of the situation.
Fidler wrote an analysis on the coronavirus situation, entitled Who Owns MERS?, that was published Friday on the website of Foreign Affairs, the publication of the U.S. Council on Foreign Relations.
In an interview, he noted Memish had complained at the recent World Health Assembly — the annual meeting of the World Health Organization — that the need for laboratories to sign an MTA with Erasmus Medical Centre was slowing down scientific research on the MERS virus.
"Well here we have apparently a Saudi MTA with the CDC, the negotiation of which is causing delays in terms of getting samples and getting scientific research done," he said, adding it raises questions about whether "decisions that Saudi Arabia has made are themselves one of the key obstacles to getting research done on the coronavirus."
"We need to dig into that as well as these other questions that have been thrown around."
It's not clear why the Saudi government is requiring the CDC to sign an MTA or whether it is making the same demand of other international laboratories with which it is partnering on MERS research. Memish did not reply Friday to an emailed request for an interview.
Nor did Dr. Ian Lipkin, a Columbia University scientist famed as a "virus hunter" who has been working with the Saudi government to try to find where the coronavirus hides in nature.
Lipkin, who is the director of the Center for Infection and Immunity at Columbia's Mailman School of Public Health, has had a team in Saudi Arabia on at least two occasions collecting samples for study. Lipkin did not reply to emailed questions Friday asking whether his lab too has had to sign an MTA with the Saudi government and whether, if he has, the process has been similarly protracted.
But even if Lipkin has been able to skip the MTA step, or to work through it more quickly, his efforts to isolate the source of the virus face another major hurdle, experts say.
The U.S. Department of Agriculture would move to block entry to any samples from Saudi Arabia that came from animals like sheep, goats or camels. That's because Saudi Arabia is not free of foot-and-mouth disease, a severe and highly contagious livestock disease. The U.S. prohibits importation of animals or animal byproducts from countries affected by foot-and-mouth disease.
That prohibition wouldn't apply to human samples from Saudi Arabia, or samples taken from bats, which are thought to be where the virus probably originates. But it's believed bats aren't infecting people directly; some intermediate animal species are probably playing a bridging role.
And specimens from the types of animals people have wondered about — goats and camels in particular — would fall under the USDA's ban, Pallansch said.
"I am aware that negotiations are underway in trying to find out how there can be an arrangement made for either the USDA involvement or some other approved way for the USDA to grant a permit," Pallansch said, expressing doubt that the agriculture department would budge. The WHO and several national public health agencies have expressed concern that the lack of information flow from Saudi Arabia is limiting the world's ability to assess the risk posed by MERS.
While infections have occurred in several other Middle Eastern countries — Jordan, Qatar and the United Arab Emirates — and cases have been exported to Britain, France, Tunisia and Italy, the lion's share of cases have occurred in Saudi Arabia. According to the WHO's tally, 41 cases have occurred or emerged from the kingdom, and 26 of them have been fatal.


Read more: http://www.vancouversun.com/health/Saudi+paperwork+demands+delay+work+research+find+MERS+source/8495078/story.html#ixzz2Va6xYOAY

Saudi Silence on Deadly MERS Virus Outbreak Frustrates World Health Experts

By Helen Branswell | Scientific American – 2 hrs 29 mins ago

Over the next few weeks officials at the World Health Organization (WHO) face a tough and politically charged call. The Muslim month of fasting, Ramadan, begins July 9 and could draw as many as two million people from around the globe to the holy sites of Saudi Arabia in a pilgrimage called umrah. But a new disease, called Middle Eastern respiratory syndrome, or MERS, could threaten them.



Infectious disease control at mass gatherings is always a challenge, but this year even more so. Saudi Arabia is currently waging battle with MERS, yet it has released only the barest of details that scientists or public health officials could use to try to prevent its spread within Saudi Arabia or around the globe. In early May Saudi officials startled the world by announcing 13 new cases over the course of a few days. Since the start of May there have been 38 new cases worldwide—31 of them in Saudi Arabia—and 20 of the victims have died. With virtually no clues to draw on about where the virus lives in nature and how people contract it, WHO is trying to figure out what guidance to give those pilgrims, and the countries they will return to, about how to avoid infection and the international dissemination of a devastating new illness.

MERS triggers severe pneumonia and kidney failure in some cases. It is a cousin of SARS, severe acute respiratory syndrome, which broke out in mainland China in late 2002, spread from there to Hong Kong in 2003, and was then transported in the lungs of international travelers to Singapore, Hanoi, Toronto and other cities. Health officials do not want to pull out the big hammers used during the SARS outbreak, such as WHO travel advisories that urged the world’s citizens to avoid infected hubs such as Hong Kong and Toronto. On the other hand, no one wants umrah and the even larger hajj pilgrimage that will follow in October to trigger a pandemic.

The new virus was first isolated in June 2012. But its existence came to the world’s attention only weeks before last October’s hajj, when an Egyptian infectious diseases specialist who had been working in Saudi Arabia’s second largest city, Jeddah, reported that he had treated a man who died from an infection caused by a new coronavirus. Whether MERS has or can gain the capacity for sustained person-to-person spread is unknown. Kamran Khan, an infectious diseases physician who researches global flight patterns as a means of predicting disease spread, has had a worried eye on the Muslim religious calendar for some time. “We still don't have a good idea where this (virus) is coming from, so taking measures to mitigate risks are constrained,” says Khan, who works at the Saint Michael’s Hospital Keenan Research Center in Toronto.

Coronaviruses such as MERS, SARS and numerous others are named for the hallmark halo, or crown, they appear to sport in their outer shells. Many infect bats; the few that infect people cause illnesses ranging from the common cold to the severe lung devastation seen with many MERS cases, forcing patients to undergo mechanical ventilation. MERS has not yet evolved to spread as well as SARS can. And SARS, which was no wimp, killed about 11 percent of cases before it disappeared in 2004.
Last fall and in the early part of 2013 MERS infections popped up sporadically in a variety of places. Testing of samples from an April 2012 outbreak in Jordan revealed the virus had killed two nurses there. Three men in a family in the Saudi capital, Riyadh, appeared to have passed the virus to one another. Sick people from Qatar and the United Arab Emirates were medivacked to the U.K. and Germany. And more recently tourists have taken the infection to the U.K., France, Tunisia and Italy.

The affected Arabian Peninsula countries have not been particularly forthcoming with information, and global health experts have yet to hit on the right strategy for persuading officials to get serious about finding the source of the infections or the scope of the illness in people. An outbreak of H7N9 bird flu virus in China at the beginning of April also distracted attention from MERS.


The latter virus, however, would not be ignored for long. The 13 new infections in early May were linked, arising in dialysis patients treated in Al Moosa Hospital at the Al-Ahsa oasis in the kingdom’s Eastern Province. Infection in hospitals is how SARS took off, so word that an institution—or as sources suggest, several institutions—were epicenters of the outbreak raises the level of concern.

Donald Low, a microbiologist at Mount Sinai Hospital in Toronto who became a SARS expert in 2003, expressed hope that the Al-Ahsa outbreak would “put their feet to the fire to get serious about this.” Low has been worried about the possibility that superspreaders will emerge, as they did during SARS. Most people who contracted SARS passed the virus to at most one other person. But some SARS patients infected large numbers of people. One patient in Singapore infected 62 others; a woman who fell ill in the early days of the Toronto outbreak infected 44. With SARS, superspreaders turned a virus that likely would have burned itself out into a global outbreak that claimed 916 lives.

Has there been a superspreader in Saudi Arabia? If so, Saudi authorities have not revealed it. But it is evident that infections are being detected at a more rapid pace. At WHO’s annual meeting—the World Health Assembly—in late May, the Saudi delegation was given what amounts to a diplomatic dressing down, with Director General Margaret Chan lauding China for its handling of the H7N9 outbreak and demanding that countries with MERS cases act as good global citizens and share information in a timely, complete manner. The next day Saudi Arabia announced five more cases in a three-line statement, which revealed only that victims ranged in age from 73 and 85; all had chronic diseases and lived in the Eastern Province.

Infectious disease experts are aghast that this late into MERS’s spread the world still has no idea what puts people at risk of infection, how long the incubation period is, when people are contagious or whether there are mild cases that are being missed because surveillance is focused on finding sick people in hospitals. They put the problem squarely at the feet of the Kingdom of Saudi Arabia (KSA), which accounts for 41 of the 55 infections to date. Says Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota: “The European countries have largely done an exemplary job of investigating and following up on the cases [that have been exported there]. Now, either the Middle Eastern countries, particularly KSA, have not, or they’re just withholding information, for whatever reason. And in a situation where this represents a potential global pandemic, that is inexcusable.”

Scientists also have no sense of whether the virus has changed over time. Genetic sequences of only four viral isolates have been placed in GenBank, the open-access sequence database run by the National Institutes of Health’s National Center for Biotechnology Information. The most recent of the genetic blueprints dates to an infection that occurred in February. No sequences from the flurry of recent cases have been released. In fact, except for the sequence of the first spotted case—the man from Jeddah—no Saudi sequences have been placed in the public domain. The kingdom’s deputy minister of health, Ziad Memish, has promised that sequences will be shared.

This week an international team of experts convened by WHO has gathered in Saudi Arabia to make headway in prying information out of the country. With the clock counting down to Ramadan, they have little time in which to answer key questions about the disease—answers needed to help safeguard the umrah pilgrims, and the rest of the world. http://news.yahoo.com/saudi-silence-deadly-mers-virus-outbreak-frustrates-world-213000665.html

MERS Coronavirus Slams Saudi Arabia; Travelers Warned

Friday, 07 June 2013 11:57AM

(NEW YORK) -- Another person has died from the MERS coronavirus in Saudi Arabia, bringing the death toll to 31.
At least 55 people in eight countries have contracted the virus, according to the U.S. Centers for Disease Control and Prevention.  Saudi Arabia has been hit hardest with 40 cases, 25 of them fatal.
Health officials are still searching for the source of the outbreak, which began in April 2012.  All of the cases have ties to the Middle East, according to the World Health Organization.

Anyone traveling to the Middle East is encouraged to avoid close contact with people who look sick, wash hands thoroughly and often, and avoid undercooked meats as well as raw, unpeeled fruits and vegetables and unpurified water.

People who develop respiratory symptoms after visiting the Middle East are urged to cover their mouths during coughs and sneezes and seek immediate medical attention, which could result in a period of isolation if tests for the virus come back positive. http://www.kmbz.com/MERS-Coronavirus-Slams-Saudi-Arabia-Travelers-Warn/16540195

Saudi Arabia: a vial of coronavirus intercepted at the airport

An official from the Ministry of Health of Saudi Arabia, who wore a vial of the new coronavirus, was prevented from boarding a plane last Saturday from the King Fahd Airport Damman.   http://translate.google.com/translate?sl=auto&tl=en&js=n&prev=_t&hl=en&ie=UTF-8&u=http%3A%2F%2Fsciencesetavenir.nouvelobs.com%2Fsante%2F20130604.OBS1802%2Farabie-saoudite-une-fiole-de-coronavirus-interceptee-a-l-aeroport.html

Saudi Arabia-40 confirmed cases «Corona» between 2360 suspected case was examined

24 deaths until yesterday .. مرغلاني لـ «عكاظ»: Marghalani for «Okaz»:

40 confirmed cases «Corona» between 2360 suspected case was examined

Dr. Khaled Marghalani official spokesman for the Ministry of Health for «Okaz» that the ministry has examined more than 2360 cases have been confirmed injured 40 cases were infected with Corona, so after testing injury citizen in Al-Ahsa suffering from chronic diseases, pointing out that the deaths has now reached 24 situation, with similar 7 to heal, while 9 others still under intensive medical care and quarantine.

He said in his speech for «Okaz» yesterday that during the twenty-four hours last checked 43 sample and all were 'negative' and thankfully, as part of the epidemiological investigation to the new Corona virus disease (Mears).
He said Marghalani: The Ministry launched the second phase of its campaign to raise awareness of health disease virus Corona, which aims to publicize the disease and provide the community and stakeholders developments related to it and ways to prevent potential across different media within the plan complementary to achieve the goal to reach all segments of society in various categories according to developments in the disease where include This stage processing and printing of brochures identifiable disease and prevention methods as plan provides for the use of advertising awareness in television and radio as well as advertisements awareness in a number of newspapers and the media and means of social communication and said Marghalani: This stage comes to complement the health awareness campaign disease virus Corona new In the first phase, which included a number of activities and events, including holding press conferences of the leaders of the ministry and specialists from the World Health Organization and holding meetings and television interviews on satellite channels and radio stations in addition to issuing press releases on a regular basis, also included the first stage on the launch of a web page a new health awareness disease new Corona virus. http://translate.google.com/translate?hl=en&sl=ar&tl=en&u=http%3A%2F%2Fwww.okaz.com.sa%2F

Add a case of death from A/H1N1 flu

 Wednesday, 06/05/2013 - 06:44 PM (GMT +7)

 

 Nhan Dan Online-The Ho Chi Minh City, a 24-year-old female patient, after giving birth to treat H1N1 hospitalized.After three days of treatment the patient died of respiratory failure and cardiovascular collapse.

 Afternoon 5-6, Centre for Preventive Medicine, Ho Chi Minh City, she VTCV, Kon Tum country, working in District 9, Ho Chi Minh died of A/H1N1 flu.
… Before that, 2-6 days after birth at Tu Du Hospital patient was admitted to Cho Ray Hospital in a state of fever, cough sputum, shortness of breath, respiratory distress ...
 As a result, molecular biology laboratory at Cho Ray Hospital and the Pasteur Institute in Ho Chi Minh City were positive for influenza A/H1N1. Despite aggressive treatment, but bright days 5-6, patients continue to respiratory failure, cardiovascular collapse and death.
 According to Dr. Dr. Hoang Lan Phuong, deputy department for Tropical Diseases, Cho Ray Hospital, crawled through the hospital, patients are not exposed to live poultry.
 Previously, on March 3-5, indicates a case in District 11, Ho Chi Minh A/H1N1 flu death. According to doctors, the H1N1 flu season usually, people can inject vaccines - please prophylaxis. http://www.nhandan.org.vn/suckhoe/tin-tuc/item/20493102.html

CDC does not recommend that anyone change their travel plans because of these cases of MERS

A Novel Coronavirus Called "MERS-CoV" in the Arabian Peninsula

Updated: June 03, 2013

What Is the Current Situation?

Cases of respiratory illness caused by Middle East Respiratory Syndrome Coronavirus (MERS-CoV) have been identified in multiple countries. MERS-CoV was previously called "novel coronavirus." For more information, see CDC’s MERS website.

MERS Cases and Deaths, April 2012 - May 2013

   Current as of June 6, 2013

Countries	Cases (Deaths)
France	2 (1)
Italy	3 (0)
Jordan	2 (2)
Qatar	2 (0)
Saudi Arabia	40 (25)
Tunisia	2 (0)
United Kingdom (UK)	3 (2)
United Arab Emirates (UAE)	1 (1)
Total	55 (31)

For more information, see the World Health Organization (WHO).

CDC does not recommend that anyone change their travel plans because of these cases of MERS....
 http://wwwnc.cdc.gov/travel/notices/watch/coronavirus-saudi-arabia-qatar

Canada Travel Health Notice (MERS-CoV)

Updated: June 04, 2013

Travel Health Notice

Since April 2012, cases of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) have been identified in eight countries:  France, Italy, Jordan, Qatar, Saudi Arabia, Tunisia, the United Arab Emirates and the United Kingdom (UK). The initial cases in France, Italy, Tunisia and the UK were linked to travel to the Middle East.
Some of the infections have occurred in clusters through close contacts or in a health care setting. This suggests that the virus can spread between humans, however, there has been no sustained person-to-person transmission and the risk of contracting this infection is still considered to be low.
For the latest updates on MERS-CoV, including the total number of cases and deaths please visit the World Health Organization’s Global Alert and Response website.
Coronaviruses are the cause of the common cold but can also be the cause of more severe illnesses including Severe Acute Respiratory Syndrome (SARS). At this time, there is still more to learn about this new strain of coronavirus. People who have been infected with MERS-CoV have experienced influenza-like illness with signs and symptoms of pneumonia, which may include coughing, mucous, shortness of breath, malaise, chest pain and/or fever. Many have also had gastrointestinal symptoms such as diarrhea.
The World Health Organization continues to work with relevant ministries of health and other international partners to support investigations to gain a better understanding of the disease and its risks. There continues to be no travel restrictions as the risk to travellers remains low.

Recommendations

Consult a health care provider or visit a travel health clinic preferably six weeks before you travel.

1. Protect yourself and others from the spread of germs and influenza-like illness
   1. If you are sick with influenza-like symptoms, delay travel or stay home:
      • Travellers should recognize signs and symptoms of influenza-like illness, and delay travel or stay home if not feeling well.
      • Travellers should note that they may be subject to quarantine measures in some countries if showing flu-like symptoms.
   2. Wash your hands frequently:
      • Avoid touching your eyes, nose and mouth with your hands as germs can be spread this way.  For example, if you touch a doorknob that has germs on it then touch your mouth, you can get sick.
      • By washing your hands with soap under warm running water for at least 20 seconds, you will reduce your chance of getting sick.
      • Use alcohol-based hand sanitizer if soap and water are not readily available. It’s a good idea to keep some with you in your pocket or purse when you travel.
   3. Practise proper cough and sneeze etiquette:
      • Cover your mouth and nose with your arm to reduce the spread of germs. Remember if you use a tissue, dispose of it as soon as possible and wash your hands afterwards.
   4. Try to avoid close contact with people who are sick.
2. Stay up-to-date with your vaccinations
   • There is no vaccine for MERS-CoV, however it is important to be up-to-date on all of your routine and recommended vaccinations prior to travel.
3. Be aware that the risk may be higher for travellers with chronic medical conditions (e.g.: diabetes, heart disease) who may require medical care while abroad.
4. Monitor your health
   • If you develop influenza-like symptoms such as fever, cough and/or shortness of breath within 10 days after your return to Canada, especially if you have a chronic medical condition:
     • Seek medical attention immediately.
     • Tell your health care provider which countries you have visited while travelling.

Date Modified: 2013-06-04  http://www.phac-aspc.gc.ca/tmp-pmv/notices-avis/notices-avis-eng.php?id=108

SARS-like virus tests in Italy were false positives

ROME: Eight people initially thought to have contracted a SARS-like virus in Italy tested negative on Tuesday after a second round of controls, according to Italy's Superior Health Institute (ISS).
An infectious diseases clinic in Florence on Monday said around 10 people had tested positive for the virus, but added that the results would have to be double checked at the Health Institute.
Those concerned had been tested because they had come into contact with a sick man who brought the disease back from Jordan, but they did not show any symptoms and had not been quarantined.
"There are no new clinical cases but surveillance of people who came into contact with the sick continue," said the head of the ISS's infectious disease clinic Gianni Rezza....  http://www.channelnewsasia.com/news/world/sars-like-virus-tests-in-italy-were-fals/697996.html

MERS-CoV Asymptomatic Cluster In Florence Italy

MERS-CoV Asymptomatic Cluster In Florence Italy Recombinomics Commentary 23:00
June 3, 2013

There are about ten, so far, the people tested positive for the New Sars but completely asymptomatic. The samples, said today Professor Alessandro Bartoloni, head of infectious diseases at the AOU Careggi, Florence, were sent to the Institute of Health for confirmation. The positive test, by throat swab, having no symptom, were not hospitalized and remain at home, obviously under observation.

The above translation describes the detection of MERS-CoV in the contacts of the three symptomatic cases identified earlier. The index case (45M) returned to Italy from a 40 day trip to Jordan. A niece (2F) and co-worker (42F) developed symptoms and were MERS-CoV confirmed. However, the detection of the virus in 10 asymptomatic contacts is markedly different than reports reported for prior cases, who were symptomatic, as were confirmed contacts.

The results for family members in Jordan were negative, even though some had mild symptoms. The positive results in the asymptomatic cases in Florence (see map) suggested significant testing difference between the upper respiratory tract samples in Italy and those tested elsewhere.

Morocco MERS-CoV Case ex-Middle East

Recombinomics Commentary 15:00
May 30, 2013

And it comes to a Moroccan citizen who works in the Gulf state was entered Ibn Sina University Hospital in Rabat.

Moroccan network for the defense of health" for the first injury in Morocco Corona virus, and it comes Emirati citizen submitted to Morocco in the tour, entered the Sheikh Zayed Hospital in Rabat on Wednesday 29 May.

The above translations describe a MERS-CoV case in Rabat, Morocco (see map). Although one report indicates the case is an Emirati resident on tour in Morocco, while the other claims the case is a Moroccan who works in the Gulf, both reports strongly suggest the coronavirus was contracted in the Middle East and then transported to Morocco via commercial airline.The Morocco case follows a Tunisian cluster linked to Umrah travel in the Middle East (Qatar and Saudi Arabia), and a French cluster linked to a tour that included Dubai, UAE. These exports to Africa and Europe follow two large MERS-CoV hospital outbreaks in eastern Saudi Arabia.

The export of MERS-CoV from the Middle east to Europe (England and France) and Africa (Tunisia and Morocco) via infected patients has striking similarities to SARS-CoV spread in 2003, which also included outbreaks at hospitals involving health care workers, patients, and family contacts.
The high case fatality rate in Saudi Arabia, as well as the failure of Qatar, UAE, Bahrain, and Kuwait to report any MERS-CoV cases raises serious transparency issues and reporting failures.
The failures are not being adequately addressed by WHO, which relies on negative data from insensitive PCR tests to claim that MERS-CoV is not transmitting in communities in a sustained manner. This position is strongly refuted by the sequence data from MERS-CoV cases which originated in Saudi Arabia, Jordan, Qatar, and UAE in patients diagnosed in The Netherlands, England, Germany, Saudi Arabia, Egypt, and France.
WHO’s failure to enforce IHR regulations continues to be hazardous to the world’s health.

French MERS-CoV Sequences Identical To England2

French MERS-CoV Sequences Identical To England2 Recombinomics Commentary 19:30
May 30, 2013

Confirmatory sequence analysis of the RdRp and N gene segments was done directly on RNA extracted from the bronchoalveolar lavage specimen from patient 1 and sputum specimen from patient 2. The sequences from both patients were identical. The RdRp sequences showed the C→T polymorphism at position 15196, which distinguishes all available sequences from that of the EMC/2012 isolate.5 For the N gene, sequences were identical to that of the EMC isolate and did not show the short deletion (nucleotides 29736–29741) nor any of the polymorphisms recorded at positions 29714 (A→T) and 29723 (G→T) in the England/Qatar/2012 sequence, nor that found at position 29811 (C→T) in the Jordan-N3/2012 sequence (appendix).5,15,17 These results definitively establish that both patients were infected with MERS-CoV.

The above comments from the Lancet paper on nosocomial MERS-CoV transmission in France describe the sequences from the two cases in France. The RdRp region is 182 BP in length and both sequences from France were identical to the England1/2012 sequence (from the Qatari resident who developed MERS-CoV symptoms while performing Umrah in Saudi Arabia in 2012, the Essen sequence (from the Qatari diagnosed in Germany) and England2/2013 (from the England resident who developed MERS-CoV symptoms while performing Umrah in Saudi Arabia in 2013). These sequences had zero difference with the consensus sequence, while the EMC/2012 and Jordan-N3/2012 each had one difference. In contrast the closest bat sequence (from Romania) had 20 differences.
Similarly, the N gene region, which represented 240 BP, for the two cases from France was identical with England2. This region diverges from all animal sequences, but the first 62 positions are identical in all seven human sequences, but have 7 differences with the most closely related bat sequence.
Thus, all human sequences are closely related to each other, and easily distinguished from all bat sequences, which are decades or centuries away from the human sequences. The eighth human sequence, from the first case in Riyadh represents other regions but is identical to the consensus sequence for those regions.
The two sets of sequences from the French cases increases the number of public human sequences to eight and all are virtually identical to the consensus (identities of 99.6% or higher) strongly supporting human transmission, which appears to be evolving toward greater efficiency as seen by the large hospital clusters in eastern Saudi Arabia as well as the export of MERS-CoV via infected patients traveling via commercial airline from the Middle East to England, France, Tunisia, or Morocco.

These hospital clusters and exports, coupled with the high case fatality rate, signal sustained community transmission in the Middle East.

"No coronavirus infection" in Morocco

"No coronavirus infection" in Morocco

The Ministry of Health on Thursday denied "any coronavirus infection, contrary to misinformation disseminated by some media."
"In response to information provided by the media on a probable case of coronavirus infection in a foreign citizen move to Morocco, the Ministry of Health wishes to inform the public that this is an original 67 year old patient UAE followed for severe chronic conditions, who was hospitalized on May 27 in a current hospital in Rabat a respiratory distress, "the ministry said in a statement. "A virological investigation at the Pasteur Institute Morocco on May 29 was" excluded any coronavirus infection, unlike the misinformation disseminated by some media, "the source said.
Currently, health services reported no cases of respiratory infection novel coronavirus, the ministry added, noting, moreover, that measures and devices epidemiological surveillance, as recommended by the World Health Organization (WHO), are implemented in all regions of the Kingdom and the border control points for severe acute respiratory infections.

01/06/2013  http://www.lopinion.ma/def.asp?codelangue=23&id_info=32778

hospitalized child 18 months nephew patient Florence

Sanita ': new coronavirus, hospitalized child 18 months nephew patient FlorenceFlorence, June 1 - (Adnkronos) - A little girl of 18 months and 'was admitted to the children's hospital as a precaution Florentine' Meyer ': and' the niece of 45 year old Jordanian-born hospitalized Careggi in Florence to have contracted the new coronavirus, the so-called 'New Sars'. On the small, that in view of the age 'is not in school and therefore had no contact in the school environment, analyzes are performed to see if he contracted the virus that struck his uncle.  http://www.adnkronos.com/IGN/News/Cr...253145464.html