Background and summary of novel coronavirus infection – as of 30 November 2012

Over the past two months, WHO has received reports of nine cases of human infection with a novel coronavirus. Coronaviruses are a large family of viruses; different members of this family cause illness in humans and animals. In humans, these illnesses range from the common cold to infection with Severe Acute Respiratory Syndrome (SARS) coronavirus (SARS CoV).

Thus far, the cases reported have come from Qatar, Saudi Arabia and Jordan. All patients were severely ill, and five have died.

The two Qatari patients are not linked. Both had severe pneumonia and acute renal failure. Both are now recovering.

A total of five confirmed cases have been reported from Saudi Arabia. The first two are not linked to each other; one of these has died. Three other confirmed cases are epidemiologically linked and occurred in one family living within the same household; two of these have died. One additional family member in this household also became ill, with symptoms similar to those of the confirmed cases. This person has recovered and tested negative, by polymerase chain reaction (PCR) tests, for the virus.

Two confirmed cases have been reported in Jordan. Both of these patients have died. These cases were discovered through testing of stored samples from a cluster of pneumonia cases that occurred in April 2012.

The two clusters (Saudi Arabia, Jordan) raise the possibility of limited human-to-human transmission or, alternatively, exposure to a common source. Ongoing investigation may or may not be able to distinguish between these possibilities.

The current understanding of this novel virus is that it can cause a severe, acute respiratory infection presenting as pneumonia. Acute renal failure has also occurred in five cases.

WHO recognizes that the emergence of a new coronavirus capable of causing severe disease raises concerns because of experience with SARS. Although this novel coronavirus is distantly related to the SARS CoV, they are different. Based on current information, it does not appear to transmit easily between people, unlike the SARS virus.

WHO has closely monitored the situation since detection of the first case and has been working with partners to ensure a high degree of preparedness should the new virus be found to be sufficiently transmissible to cause community outbreaks. Some viruses are able to cause limited human-to-human transmission under condition of close contact, as occurs in families, but are not transmissible enough to cause larger community outbreaks.

Actions taken by WHO in coordination with national authorities and technical partners include the following:

Investigations are ongoing to determine the likely source of infection and the route of exposure. Close contacts of confirmed cases are being identified and followed up. 
An interim surveillance recommendation has been updated to assist clinicians to determine which patients should undergo laboratory testing for the presence of novel coronavirus.
Laboratory assays for the virus have been developed. Reagents and other materials for testing are available, as are protocols, algorithms and reference laboratory services. WHO has activated its laboratory network to assist in testing and other services. WHO has also issued preliminary guidance for laboratory biorisk management.
Guidance is available for infection control.


Based on the current situation and available information:

WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.
Further, testing for the new coronavirus of patients with unexplained pneumonias should be considered, especially in persons residing in or returning from the Arabian peninsula and neighboring countries. Any new cases should be promptly reported both to national health authorities and to WHO.

In addition, any clusters of SARI or SARI in health care workers should be thoroughly investigated, regardless of where in the world they occur. These investigations will help determine whether the virus is distributed more widely in the human population beyond the three countries that have identified cases.

WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied.
WHO continues to work with Member States and international health partners to gain a better understanding of the novel coronavirus and the disease in humans and will continue to provide updated information. As the situation evolves, WHO will reassess its guidance and revise it accordingly.http://www.who.int/csr/disease/coron...e_20121130/en/

WHO confirms 2 more fatal cases of new virus in Jordan, possible virus spread between peopl

By: Maria Cheng, The Associated Press
LONDON - International health officials have confirmed two more fatal cases of a mysterious respiratory virus in the Middle East.
The virus has so far sickened nine people and killed five of them. The new disease is a coronavirus related to SARS, which killed some 800 people in a global epidemic in 2003, and belongs to a family of viruses that most often causes the common cold.
The two cases date back to April and are part of a cluster of a dozen people, mostly health workers, who fell sick in an intensive care unit at a hospital in Zarqa, Jordan. Officials are investigating whether the 10 other people who grew sick in Zarqa also were infected and how the virus might have spread.
"It's too early to say whether human-to-human transmission occurred or not, but we certainly can't rule it out," said WHO spokesman Gregory Hartl.
One of the Jordanian cases was a 40-year-old female. All of the other patients to date have been men. The new virus has so far been identified in patients from Saudi Arabia and Qatar.
Scientists haven't found any links between the sporadic cases of the coronavirus so far, first detected in September. "We don't know how the virus gets around and there are more questions than answers right now," Hartl said.
Several of the patients sickened by the new coronavirus have had rapid kidney failure and others have suffered severe pneumonia and respiratory illnesses. The virus is most closely related to a bat virus and scientists are also considering whether bats or animals like camels or goats are a possible source of infection.
Scientists are also considering whether fruit contaminated by animal droppings may have spread the virus.
Still, not all of the cases had contact with animals and WHO said it was possible the virus was spread between humans in the Jordan hospital and in a cluster of cases in Saudi Arabia, where four members of the same family fell ill and two died.
WHO says the virus is probably more widespread than just the Middle East and recommended that countries test any people with unexplained pneumonia.
http://www.winnipegfreepress.com/bre...181561141.html

WHO: 2 MORE CASES OF NEW VIRUS IN JORDAN

LONDON (AP) -- International health officials have confirmed two more fatal cases of a mysterious respiratory virus in the Middle East.

The virus has so far sickened nine people and killed five of them. The virus is related to SARS, which killed some 800 people in a global epidemic in 2003.

The two cases date back to April and are part of a cluster of a dozen people who fell sick in Zarqa, Jordan. Officials are investigating whether the 10 other people sick in Zarqa also were infected and how it might have spread. Other cases of the virus have been spotted in Saudi Arabia and Qatar.
WHO doesn't know exactly how the virus spreads but said it couldn't exclude the possibility it was being transmitted from person to person.

http://hosted.ap.org/dynamic/stories...MPLATE=DEFAULT

WHO confirms 2 more fatal cases of new virus in Jordan, possible virus spread between people

..The two cases date back to April and are part of a cluster of a dozen people who fell sick in Zarqa, Jordan. Officials are investigating whether the 10 other people sick in Zarqa also were infected and how it might have spread. Other cases of the virus have been spotted in Saudi Arabia and Qatar.

WHO doesn’t know exactly how the virus spreads but said it couldn’t exclude the possibility it was being transmitted from person to person.

http://www.washingtonpost.com/world/...80_story.html?

New SARS-related coronavirus claims a third life

Jennifer Yang

Three people have now died from the new coronavirus in the Middle East — two of whom were relatives from the same Saudi Arabian household, the World Health Organization confirmed Friday.

There are now a total of seven confirmed cases, which is up one from last week. An eighth case has been deemed “probable” but confirmation of infection may not be possible, according to WHO spokesperson Glenn Thomas, who said tests are still underway.

So far, this new virus — which is genetically related to the virus that caused SARS — has been popping up in three regions: Doha, Qatar, where two citizens have been infected, and the Saudi Arabian cities of Jeddah and Riyadh, which are approximately 850 kilometres apart.

The first case was a 60-year-old Saudi Arabian man who was hospitalized in Jeddah on June 13.

“The newly reported cases demonstrate that the virus has persisted over a period of at least 5 months and is geographically distributed over a wider area than was evidenced by the first two cases,” the WHO said in a Nov. 28 surveillance recommendation report.

“Given that the exact extent of the distribution is unknown, WHO is taking the precaution of recommending an expansion of surveillance to monitor for the appearance of the virus in other countries.”

All of the victims have been male but “the significance of this is unknown,” the release said.

The WHO said it still does not know the source of the virus or its mode of transmission but the family cluster of cases has raised questions over whether the virus might be transmitting from person to person — as was the case with SARS.

Three members of the same Saudi Arabian family have now been infected, two fatally. A fourth relative is the probable case. All were treated in Riyadh, according to Thomas.

But last week, WHO spokesperson Fadéla Chaid cautioned that it is difficult to know if the family members may have infected each other or simply been exposed to the same environmental source, since they all lived in the same household.

Early investigations show that the coronavirus is closely related to one found in bats, but the WHO said there is no proof yet that bats are the animal reservoir. It is not known whether the family members who have been infected worked with animals.

“The timing of the cases in the Saudi cluster does raise that concern (of human-to-human transmission),” Chaib said last week. “But when a cluster occurs in a setting such as a household, where everyone has similar environmental exposures, it can be very difficult to separate out exposure to the same environmental source versus spread from one person to another.”

There has been some inconsistency around the number of cases and the way in which new cases have been publicized.

The first case, the 60-year-old Saudi Arabian man, died in mid-June but information about his death and the novel coronavirus was not widely disseminated until late September, when a Jeddah hospital microbiologist investigating his case posted an email on ProMed, an infectious disease reporting website.

The second case came to light after microbiologists in the United Kingdom’s Health Protection Agency noticed the ProMed posting — at the time, they were looking into a case involving a Qatari patient who had been airlifted to a London hospital with serious respiratory problems. He was quickly confirmed as the second case.

A third case was publicized by the Saudi Arabian Ministry of Health in early November in a news release. Then on Nov. 23, the WHO announced the total of cases as six, with two confirmed deaths — that same day, Germany’s national health institute published a news release confirming that a German clinic had been treating a Qatari citizen with the novel coronavirus, who had recovered and been released.

The WHO announcement said at the time that two of the confirmed cases were from the same family, one of whom had died; two other relatives had also sickened but one tested negative and the other, who passed away, still had laboratory tests pending.

On Nov. 28, the WHO published its interim surveillance recommendations for the novel coronavirus and included an update that brought the case total up to seven, with one probable case. It did not directly state the total number of deaths but said four patients had “developed acute renal failure; one of these has died.”

The recommendations were revised two days later to say that five of the seven confirmed cases had “developed acute renal failure and three of these died.”

According to Thomas, the surveillance recommendations are in the process of being updated with clarifications on the number of cases. “Significant information” about the novel coronavirus will be announced on the WHO’s website, under the Disease Outbreak News section, Thomas said in an email Friday morning.

The WHO recommendations describe the clinical picture of the new coronavirus as an acute respiratory infection. All of the confirmed cases showed signs of pneumonia.

The coronavirus is named for its crown-like appearance under the microscope and prior to 2002, there were only two known coronaviruses, both associated with the common cold. SARS was the third known coronavirus and caused an outbreak in 2003 that swept across 30 countries and killed approximately 800 people, including 44 Torontonians.  http://www.thestar.com/news/world/article/1295819--new-sars-related-coronavirus-claims-a-third-life

Novel coronavirus infection - update Jordan deaths confirmed -9 confirmed cases

Novel coronavirus infection - update

30 NOVEMBER 2012 - In addition to the fatal case of novel coronavirus in Saudi Arabia reported to WHO on 28 November, two fatal cases in Jordan have been reported to WHO today, bringing the total of laboratory-confirmed cases to nine.

The latest confirmed case from Saudi Arabia occurred in October 2012 and is from the family cluster of the two cases confirmed earlier.

The two cases from Jordan occurred in April 2012. At that time, a number of severe pneumonia cases occurred in the country and the Ministry of Health (MOH) Jordan promptly requested a WHO Collaborating Centre for Emerging and Re-emerging Infectious Diseases (NAMRU – 3) team to immediately assist in the laboratory investigation. The NAMRU-3 team went to Jordan and tested samples from this cluster of cases.

On 24 April 2012 the NAMRU-3 team informed the MOH that all samples had tested negative for known coronaviruses and other respiratory viruses. As the novel coronavirus had not yet been discovered, no specific tests for it were available.

In October 2012, after the discovery of the novel coronavirus, stored samples were sent by MOH Jordan to NAMRU-3. In November 2012 NAMRU-3 provided laboratory results that confirmed two cases of infection with the novel coronavirus.

The MOH Jordan has requested WHO assistance in investigating these infections. A mission from WHO Eastern Mediterranean Regional Office (EMRO) and headquarters arrived in Amman on 28 November 2012 to assist in further epidemiological surveillance and to strengthen the sentinel surveillance systems for severe acute respiratory infections (SARIs).

In summary, to date a total of nine laboratory-confirmed cases of infection with the novel coronavirus have been reported to WHO – five cases (including 3 deaths) from Saudi Arabia, two cases from Qatar and two cases (both fatal) from Jordan.
http://www.who.int/csr/don/2012_11_30/en/index.html

Dien Bien province has announced the end of avian influenza in the commune

On 30/11, Dien Bien province has announced the end of avian influenza in the commune Do not scream, Dien Bien district.

Disinfection spray for ducks.

This is the final local H5N1 avian influenza in Dien Bien province. Cao Thi Tuyet Lan, Director of the Department of Animal Health of Dien Bien province, the H5N1 bird flu appeared on 12/10 in 2 villages Do and Do not all, of Dien Bien district, 1570 children infected poultry, must be destroyed. Due to these outbreaks are detected in time, vets and force local governments quickly quickly identify the organized destruction and implementing measures siege, isolate, control of the disease does not spread to other localities.

Nguồn đọc thêm: http://www.xaluan.com/modules.php?name=News&file=article&sid=507017#ixzz2Dh22qn9h
http://www.xaluan.com/

CMO gets panic calls from Bandipur staff

TNN | Nov 30, 2012, 11.45 AM IST

MYSORE: A day after a forest employee from Alegowdanakatte anti-poaching camp was diagnosed with a suspected case of monkey fever, staff working at the Bandipur Tiger Reservestarted panicking.

Gundlupet chief medical officer (CMO) R Srinivas said he got panic calls from three to four employees on Thursday asking about vaccines for preventing Kyasanur forest disease or monkey fever. "I have told the callers not to worry about the disease and asked them to wait till the National Institute of Virology, Pune, confirms it," he said.

The CMO added he has asked employees to take precautions and bathe soon after reaching home from work as a precaution.

http://timesofindia.indiatimes.com/city/mysore/CMO-gets-panic-calls-from-Bandipur-staff/articleshow/17425600.cms

KYASANUR FOREST DISEASE - INDIA (03): (KARNATAKA), SUSPECTED

A ProMED-mail post

Date: Wed 28 Nov 2012

Source: Daily News and Analysis, India [edited]

http://www.dnaindia.com/bangalore/report_monkey-fever-outbreak-suspected-at-bandipur-reserve_1770767





Veterinary experts suspect an outbreak of Kyasanur Forest disease (KFD), popularly known as monkey fever, in the Maddur range of the Bandipur Tiger Reserve, bordering Mysore district. It is also reported to have affected humans.



The tiger reserve authorities have reported the deaths of 8 bonnet macaques [_Macaca radiata_] and 2 common langurs [_Semnopithecus entellus_], and it has been transmitted to 5 workers of the forest department's anti-poaching camp. The workers are undergoing treatment at Gundlupet government hospital, and the condition of one of them is serious.



Following the outbreak, tiger reserve officials sounded a high alert. Animal and veterinary scientists from the Institute of Animal Health and Veterinary Biologicals (IAHVB) in Bangalore and the National Institute of Virology (NIV) in Pune have rushed to the area for further analysis.



This fever is caused by a viral infection among primates, and the 1st to be affected were bonnet macaques and common langurs. These primates usually move through the trees about 30-50 feet above the ground. When they eventually touch the ground due to various factors, particularly during the cutting of forests, they transmit the virus through ticks on their bodies to rodents, shrews, and reptiles. This usually happens when forests are cut for building roads, among other things. The ticks from infected monkeys get transferred to various domestic animals, including cattle, and then to humans.



The disease was 1st detected in Shimoga district in 1957 and has been appearing every now and then in the thickly wooded areas of Dakshina Kannada, Udupi, Chikmagalur, Shimoga, and Chamarajanagar and has affected humans too.



According to tiger reserve officials, NH 212, passing through the reserve, was one clearing where the monkeys have to touch the ground to cross the road. They said that the anti-poaching camp was also situated just next to the highway, where 5 persons became infected.



An expert team from the health department of Shimoga district has rushed to the area and begun spreading awareness about the infection.



[Byline: M. Raghuram]



--

Communicated by:

ProMED-mail



[This posting reports human and monkey cases of KFD in a different locale of Karnataka state. Previously, there have been human KFD cases in the Shimoga district of Karnataka state this year (2012), and in 2011, and 2009.



In the 28 Feb 2009 post on KFD in India (ProMED-mail archive number 20090302.0860), Mod.CP posted the following excellent commentary:



"Kyasanur forest disease (KFD) is caused by Kyasanur forest disease virus (KFDV), a member of the family _Flaviviridae_. KFDV was identified in 1957 when it was isolated from a sick monkey from the Kyasanur forest in Karnataka (formerly Mysore) state, India. The main hosts of KFDV are small rodents, but shrews, bats, and monkeys may also carry the virus. KFD is transmitted from the bite of an infected tick (_Haemaphysalis spinigera_ is the major vector). Humans can get this disease from a tick bite or by contact with an infected animal, such as a sick or recently dead monkey. Larger animals such as goats, cows, and sheep may become infected with KFD, but they do not have a role in the transmission of the disease. Furthermore, there is no evidence of the disease being transmitted via the unpasteurized milk of any of these animals. It occurs principally in the Shimoga and Kanara district of Karnataka, India and is common in young adults exposed during the dry season in the forest.



After an incubation period of 3-8 days, the symptoms of KFD begin suddenly with fever, headache, severe muscle pain, cough, dehydration, gastrointestinal symptoms and bleeding problems. Patients may experience abnormally low blood pressure and low platelet, red blood cell, and white blood cell counts. After 1-2 weeks of symptoms, some patients recover without complications. However, in most patients, the illness is biphasic, and the patient begins experiencing a 2nd wave of symptoms at the beginning of the 3rd week. These symptoms include fever and signs of encephalitis (inflammation of the brain). The diagnosis is made by virus isolation from blood or by serologic testing using enzyme-linked immunosorbent serologic assay. There are approximately 400-500 cases of KFD per year with a case fatality rate of 3-5 percent."

Kabale Hit by African Swine Fever Again

The Kabale acting District Veterinary officer says that the disease has so far killed over 100 pigs in a period of one week.   http://ugandaradionetwork.com/a/story.php?s=47779

We need a clear message on whether Luweero is Ebola-free or not

LETTERS

Recently, when news of an Ebola outbreak in Luweero District was announced, schools went on operating normally. When the school term ended, some health officials issued statements claiming that more deaths had been registered. The marking session of UNEB exams which was due to take place at Ndejje Secondary School was halted. Examiners from Luweero were ordered not to travel out of the district to participate in this year’s session lest they infect others.

Despite these knee-jerk reactions on the part of the officials, Luweero is normal. Weekly markets are vibrant and so are parties, concerts, etc. Taxis and buses transport people in and out of Luweero. Senior Four and Senior six exams have been going on smoothly.

Some deaths due to Ebola reported in the district have been vehemently denied by relatives of the deceased who insist their beloved died of other chronic ailments, claims vindicated by Mulago Hospital, that tested the victims and found them negative.

You will recall the swine flu outbreak two years ago in Luweero.’ It is alleged that some ‘healthy’ people were ordered to stay in bed until further notice. A medical personnel said he made a fortune during that period. I don’t wish to doubt the professional competence of medical officers. But I have witnessed two occasions in Luweero, a display of self-aggrandisement as medical personnel fight to be at the centre of managing ‘the outbreak’.   http://www.monitor.co.ug/OpEd/Letters/We-need-a-clear-message-on-whether-Luweero-is-Ebola-free-or-not/-/806314/1632870/-/fsymei/-/index.html

Kyasanur forest disease: an epidemiological view i

Erratum in

• Rev Med Virol. 2008 May-Jun;18(3):211.

Abstract

Kyasanur forest disease (KFD) was first recognised as a febrile illness in the Shimoga district of Karnataka state of India. The causative agent, KFD virus (KFDV), is a highly pathogenic member in the family Flaviviridae, producing a haemorrhagic disease in infected human beings.

 KFD is a zoonotic disease and has so far been localised only in a southern part of India. The exact cause of its emergence in the mid 1950s is not known. A variant of KFDV, characterised serologically and genetically as Alkhurma haemorrhagic fever virus (AHFV), has been recently identified in Saudi Arabia. KFDV and AHFV share 89% sequence homology, suggesting common ancestral origin. Homology modelling of KFDV envelope (E) protein exhibited a structure similar to those of other flaviviruses, suggesting a common mechanism of virus-cell fusion.

 The possible mechanism of receptor-ligand interaction involved in infection by KFDV may resemble that of other flavivirses. 

Present understanding is that KFDV may be persisting silently in several regions of India and that antigenic and structural differences from other tick borne viruses may be related to the unique host specificity and pathogenicity of KFDV. From January 1999 through January 2005, an increasing number of KFD cases have been detected in Karnataka state of Indian subcontinent despite routine vaccination, suggesting insufficient efficacy of the current vaccine protocol. 

However, the exact cause of the increase of KFD cases needs further investigation. Considering the requirement of safer and more effective vaccines in general, there is clearly a need for developing an alternative vaccine as well as a rapid diagnostic system for KFD. The changing ecology of the prime focus of the KFD also warrants attention, as it may lead to establishment of the disease in newer localities, never reported before.  

http://www.ncbi.nlm.nih.gov/pubmed/16710839

Monkey fever: Forest men recovering

Gundlupet, Nov 29, 2012, DHNS:

There is an improvement in the health condition of five forest personnel who have been admitted at the town hospital here for suspected monkey fever. 

Chikkarangaiah, a forest department staffer is undergoing treatment, while others Srinivasa, Rajappa, Pradeep and  hospital have been discharged.
  
Another person Ninga who was being treated at Vivekananda hospital near Begur is also recovering, said assistant conservator of Forest Shivashankarswamy.

The forest department as a precautionary measure has distributed DMP, a disease control, repellant medicine to the daily wage labourers working in the Maddur region’s Alegowdanakatte anti-poaching camp and surrounding area where the monkey fever is spreading. 

As there are not many villages in the border areas the chances of the disease spreading is less. Hence there is no need for the villagers and the tribals living in the haadis to be scared of the disease attacking them. In order to find out the virus which spreads the disease, samples have been collected and send to the National Virology Institute, Pune. The report will come either on Friday or Saturday. 

Once the report comes it will be decided whether the patients are suffering from monkey fever virus and then the process of vaccinating the people will begin, said Shivashankarswamy.

The disease also called the Kyasanur forest disease is a viral disease, which was first reported din Kyasanur forest in Shimoga district in 1957.  http://www.deccanherald.com/content/295308/monkey-fever-forest-men-recovering.html

Saudi Arabia-Free treatment for contagious diseases

Last Updated : Friday, November 30, 2012 12:32 AM

 

MADINAH — King Abdullah, Custodian of the Two Holy Mosques, has approved a proposal by Minister of Health Dr. Abdullah Al-Rabeeah to treat foreigners suffering from contagious diseases free of charge while ensuring their deportations are facilitated quickly.

Dr. Khaled Marghalani, Ministry of Health spokesman, said the Kingdom has always been committed to protecting citizens and foreigners from diseases.

He said the ministry would immediately implement the royal order.

Earlier, Al-Rabeeah submitted a proposal to King Abdullah that non-Saudis who suffer from contagious diseases should be treated free of charge like patients suffering from AIDS.  http://www.saudigazette.com.sa/index.cfm?method=home.regcon&contentid=20121130144468

WHO cites 7th coronavirus case, gives surveillance guidance

Robert Roos  News Editor

Nov 29, 2012 (CIDRAP News) 

– A third case in a family cluster of novel coronavirus infections has been confirmed, raising the global case count to seven, and the fourth illness in the family is now listed as a probable case, the World Health Organization (WHO) has announced.

In a statement dated yesterday, the WHO also indicated that only one death has been attributed to the novel virus so far, contradicting a Nov 23 announcement that reported two deaths among the first six cases.

The WHO also offered new surveillance recommendations for the novel virus. The agency called for testing of patients in any cluster of severe, unexplained respiratory infections, regardless of location or travel history, and testing of healthcare workers who suffer unexplained pneumonia after caring for patients with severe respiratory infections.

And in a related development, the Saudi Medical Journal reported that the person who had the third known novel coronavirus case is a 45-year-old gym teacher who visited a farm 3 days before he got sick and who survived his severe illness despite having preexisting health problems and only one kidney.

Update on cases
In reporting on cases 3 through 6 on Nov 23, the WHO said two of the confirmed patients belonged to the same family and household in Saudi Arabia and that two more members of the same family were sick, but their cases had not been confirmed. The latest statement said three of the confirmed case-patients and the person with the probable case all belong to the same family.

The statement did not specify whether the family members are thought to have passed the virus to one another or caught it from another source. "The source of the virus is unknown, as is the mode of transmission," the statement says.

The cases occurred in the Jeddha and Riyadh areas of Saudi Arabia, which are bout 850 kilometers apart, and in Doha, Qatar, the WHO noted.

The new announcement notes only one death from the novel coronavirus so far, a change from last week's statement noting two deaths among the first six cases. The WHO did not respond to a query about this point this afternoon.

The statement says all seven patients had an acute respiratory infection with signs and symptoms of pneumonia. Four patients had renal failure, and one of these died. "The remaining three patients had pneumonia that required intensive support, without renal failure, and recovered," it adds.

The WHO gave no update on the second case-patient, a Qatari man who was flown to London for treatment in September and has been hospitalized there since then.

Surveillance advice

The WHO's updated surveillance guidance follows up on comments the agency made last week about a need to broaden testing for the novel coronavirus. At that point the agency said the virus might be more widely distributed than just Saudi Arabia and Qatar, and suggested that health authorities consider testing patients with unexplained pneumonias even if they had no history of travel to the two countries.

The updated guidance recommends investigation for four categories of people:

• Those with an unexplained acute respiratory infection, suspected pneumonia, and residence in or travel to the Arabian Peninsula or neighboring countries within 10 days before onset of illness
• People with an acute respiratory illness who were in close contact with a confirmed or probable novel coronavirus case-patient within 10 days before getting sick
• Any cluster of severe acute respiratory infections, regardless of location or travel history, and especially if patients need intensive care
• Healthcare workers who care for patients with severe acute respiratory infections and fall ill with unexplained pneumonia, regardless of location or travel history

In addition, the WHO said countries that have the capacity may want to consider testing any patient who has unexplained, severe pneumonia. Also, the agency suggested the possibility of retrospective testing of stored respiratory specimens from patients who had unexplained pneumonia.

Details on third case

A team of Saudi and British authors provided details on the third novel coronavirus case, which was first announced by Saudi authorities Nov 4. The 45-year-old patient was hospitalized for 22 days and needed breathing support and hemodialysis before his eventual recovery, according to the report.

The article describes the patient as a heavy smoker who has type 2 diabetes, a history of ischemic heart disease, and only one functioning kidney.

Three days before his illness onset, the man visited a farm near his home and had brief contact with farm animals. The report does not mention any illness among the animals. The man had not traveled outside Riyadh before his illness, but he had been in contact with one of his children, who had a mild cold.

The patient fell ill on Oct 9, was seriously ill by Oct 12, and was moved to an intensive care unit (ICU) the next day. He needed breathing assistance for several days, and he received dialysis treatments for renal failure from Oct 15 to 23. He was finally released from the hospital Nov 4.

The man tested negative for a wide range of viruses and bacterial pathogens. But respiratory specimens tested positive for the novel coronavirus upE gene in two labs, a Saudi Arabian health ministry lab in Jeddah and the UK Health Protection Agency lab in Birmingham. The virus was not found in the patient's stool, plasma, or serum specimens.

The authors sequenced small pieces of two of the coronavirus genes from this case and the first case, which involved a Saudi Arabian man who died in June. They found that the sequences were identical to one another and to the same gene fragments from the second novel coronavirus case (the Qatari patient in London).

The authors comment that exposure to farm animals was identified as a risk factor in the first novel coronavirus case, but add that such exposures appear to be "an insignificant risk factor for cases 2 and 3."

"However, all cases would have been exposed to recurring dust storms through an arid summer, and possibly aerosolized virus as well," they write. 

"Investigations of possible animal reservoirs are currently in progress."

The report also raises the possibility—which has been mentioned before—that a cluster of unexplained respiratory illnesses in a Jordanian hospital ICU in April of this year might have been related to the novel virus.

"Still to be identified is the agent responsible for 11 cases of severe respiratory disease at an ICU in Zarqa, Jordan," it says. "The report by the Jordanian Minister of Health on April 17, 2012, noted that 8 cases were members of the healthcare staff."

In a report in May, the European Centre for Disease Prevention and Control (ECDC) said one nurse died in the Jordanian outbreak and that all the patients had high fever and lower respiratory symptoms. Jordanian health officials thought the outbreak was caused by a virus, but no lab results were available at the time.

British officials mentioned the Jordanian outbreak in an Oct 4 Eurosurveillancereport on the Qatari patient treated in London for a coronavirus infection, but they said only that more information was needed.

In response to a CIDRAP News query today, a WHO spokesperson said the agency had no new information on the Jordanian outbreak but was hoping to get something soon. 

http://www.cidrap.umn.edu/cidrap/content/other/sars/news/nov2912corona.html

Ten primates die of suspected monkey fever-5 Humans infected

Ten primates die of suspected monkey fever in Bandipur forest

Mysore/ Gundlupet: Nov 29, 2012 DH News Service

Five forest personnel contract infection, alert sounded

Officials have been put on high alert following the suspected outbreak of Kyasanur forest disease or monkey disease in Maddur range of the tiger reserve in Bandipur forest. 
Officials are awaiting laboratory reports to take steps to ensure that forest personnel do not contract the infection.

In the past week, eight Bonnet Macaques (monkeys) and two common langurs were found dead in areas near Alegowdanakatte anti-poaching camp, off the National Highway-212 which connects to Sulthan Bathery in Kerala.

Five members of the anti-poaching camp, Chikka Kariaiah, Pradeep, Srinivas, Rajappa and Linganna, have contracted the infection and they have been admitted to the government hospital in Gundlupet. 
The condition of Chikka Kariaiah and Pradeep is said to be serious.
A release from the director, Bandipur tiger reserve, Kumar Pushkar said that the 10 primates were dull and sluggishness before dying. 

Post mortem report

The first post-mortem was conducted on November 20 and the symptoms indicated Kyasanur forest disease. 

Veterinary officer Dr  D N Nagaraju told Deccan Herald that the blood samples and two carcasses have been sent for examination to the Institute of Animal Health and Veterinary Biologicals, Bangalore. 

A team of experts led by deputy director Dr Sandhya from Veterinary Diseases Laboratory, Shimoga, inspected the site on November 26 and collected samples of ticks (insects that feed on dead animals). 

Another set of samples will be sent to National Institute of  Virology, Pune. The reports are expected by the weekend. 

If the reports confirm monkey fever, forest personnel will be vaccinated. 
About the disease

Kyasanur forest disease is a viral disease, which was first reported in Kyasanur forest of Shimoga district in 1957. 

The disease is mainly confined to Sagar and Tirthahalli taluks of Shimoga district, and occasionally reported in Uttara Kannada, Dakshina Kannada, Chikmagalur and Udupi districts.

This is the first time that the symptoms of the disease have been reported in Chamarajanagar district. Monkey fever virus is spread through air or directly through the ticks and is highly contagious. 

There are a wide range of natural hosts such as monkeys, rats, shrews, reptiles and cattle, besides ticks. 

Humans acquire the infection from bites of infected ticks, which sucks blood. 
However, there is no evidence of man to man transmission.   http://www.deccanherald.com/content/295098/ten-primates-die-suspected-monkey.html

Cases of New Coronavirus Increase to 7, Probably 8, WHO Reports

By Simeon Bennett on November 29, 2012

The number of people infected with the new coronavirus in the Middle East rose to seven, with another probable case, as the World Health Organization recommended other countries increase monitoring for the bug.

All eight cases have been reported in Saudi Arabia in the areas around Jeddah and Riyadh, and in Doha, Qatar, the Geneva- based WHO said in an update on its website.

The source of the virus and the means of transmission is unclear, though genetic evidence suggests it’s most closely related to a coronavirus found in bats, the WHO said. All eight cases are male, though the significance of that isn’t known, the United Nations agency said.

“The newly reported cases demonstrate that the virus has persisted over a period of at least five months and is geographically distributed over a wider area than was evidenced by the first two cases,” the WHO said. “Given that the exact extent of the distribution is unknown, WHO is taking the precaution of recommending an expansion of surveillance to monitor for the appearance of the virus in other countries.”   http://www.businessweek.com/news/2012-11-29/cases-of-new-coronavirus-increase-to-7-probably-8-who-reports

Singapore MOH’s Notice- no cases of coronavirus in Singapore

 The Ministry of Health Singapore would like to clarify that there are no cases of novel coronavirus in Singapore, as erroneously reported in the Press Release titled " Five New Cases of SARS-like Virus Bring Total to Seven, Prompting Calls for Immediate Trials of New Synthetic Replikin Vaccine SARS2012"  (distributed by PR Newslink and eReleases).  Please refer to the MOH website for official updates on the current situation.
Last updated on 29 Nov 2012


http://www.moh.gov.sg/content/moh_web/home/pressRoom/highlights/2012/moh_s_notice.html

http://www.moh.gov.sg/content/moh_web/home.html

Egypt-Emergence of 3 new sites for bird flu

Thursday, November 29, 2012 - 15:24

The Directorate of Veterinary Medicine Menoufia Thursday afternoon, the discovery بؤرتين new bird flu house in the village of Zinedine Center Quesna. samples were taken from birds for analysis through campaigns organized by the Directorate villages and centers the province, and samples were the result positive disease, and is currently being executed health and buried roads, with clearing houses, and take a sample of her contacts to exercise a, to make sure illness or not.  http://www1.youm7.com/News.asp?NewsID=861830&SecID=296&IssueID=0

The Pingyang farm days died the thousands peacock experts said has nothing to do with the avian flu

2012-11-29 11:10

Zhejiang Online News November 29

　　Farms within a day, 20 Blue Peacock collective death. The Pingyang tripod is peacock farms responsible for Ni Ye Liang the most unwilling to see the scene, have frequently staged.From November 2, a large number of blue peacock farms after another death.

　　Peacock elbow twist the back of the neck to death

　　Pingyang tripod is peacock farms in the county Kunyang Town Creek pit chomchon, covering about 6 acres. In 2008, the farm was approved by the City, the forestry sector Peacock domestication and breeding, the business scope approved by the business sector the Blue Peacock wholesale, retail.

　　Ni Ye Liang said, he founded a joint venture with two shareholders farms, from the introduction of more than 300 Blue Peacock. After five years of breeding, this year has ushered in the fifth generation of peacocks, a total of two or three thousand peacock. Before the accident, at a zoo linked to them, to buy 58 Blue Peacock.

　　When Ni Ye Liang et al. Intends to expand the scale of farming, the unexpected suddenly upon: November 2, peacock a large number of deaths. "Dying every day dozens to hundreds." Ni Ye Liang yesterday inventory found that farms are now only about 1000 left Peacock. In addition to the first-generation and fifth-generation peacock, the other generations peacock almost military destruction.

　　Operating farms in the past five years, Ni Ye Liang never encountered a similar situation.Ni, Ye Liang said, these peacocks are already vaccinated, and disinfection and other measures taken in the breeding process.

　　Ni, leaves bright introduce death of peacocks have the same characteristics: the beginning mental Weidun, loss of appetite, the fluffy feathers diarrhea; late elbow twisted neck and other symptoms. "We found, these Blue Peacock general convulsions after 10 minutes will die." Ni Ye Liang had used some veterinary drugs to prevent and treat, but does not take effect.

　　The experts diagnosed with mixed infection

　　A large number of the farms peacock death, attracted the attention of the Municipal Forestry Bureau, the Municipal Animal Husbandry and Veterinary Bureau and other departments. On November 20, several experts came to the farm the cause of death of a large number of peacocks consultation. Pathological anatomy and laboratory testing, the cause of death basically ruled out the possibility of infection with highly pathogenic avian influenza H5, the preliminary diagnosis of mixed infection of Salmonella and paramyxovirus and secondary E. coli infection.

　　City Animal Husbandry and Veterinary Bureau recommends that farms take appropriate countermeasures based on the diagnostic results: fully isolated from sick peacock; strengthen breeding farms and disinfection of entrances and exits and the surrounding environment; audience peacock emergency vaccination of new vaccines; peacocks drinking water, add spectinomycin hormone treatment; died peacock do deep burial harmless treatment.

　　Diagnostic results obtained, the farm still appear peacock large number of deaths. In this regard, the Municipal Animal Husbandry and Veterinary Bureau, a veterinarian, this may be because the farm did not implement the proposed measures "spectinomycin in the drinking water treatment". Spectinomycin is a veterinary drug control of Salmonella, E. coli most important.  http://news.xinmin.cn/domestic/rollnews/2012/11/29/17392252.html

Interim surveillance recommendations for human infection with novel coronavirus

(28 November 2012)
Based on additional information reported since the original surveillance recommendations, WHO is
updating its previously  published guidance. WHO will continue to update these recommendations as more information becomes available.
Update
As of 28 November 2012, seven confirmed and one probable case of novel coronavirus infection 
in humans are known to have occurred. These cases range in time from June through November 2012 and 
occurred in the areas around Jeddah and Riyadh of Saudi Arabia (which are about 850 km apart), and in 
Doha, Qatar. Infection with the virus appears to have been acquired locally in each of these situations. All 
of the patients were male but the significance of this is unknown. 

The clinical picture in all cases was an acute respiratory infection presenting with signs and
symptoms of pneumonia. Four patients developed acute renal failure; one of these died. The remaining
three patients had pneumonia that required intensive support, without renal failure, and recovered. Three
confirmed cases and the one probable case all belong to the same family and were living in the same
household.
The source of the virus is unknown, as is the mode of transmission. Available genetic sequence 
data indicate that the virus is most closely related to a coronavirus found in bats; however, this does not 
conclusively support bats as a reservoir for the virus. Early investigations do not support direct exposure 
to bats as a mode of transmission. 
The newly reported cases demonstrate that the virus has persisted over a period of at least 5 
months and is geographically distributed over a wider area than was evidenced by the first two cases. 
Given that the exact extent of the distribution is unknown, WHO is taking the precaution of 
recommending an expansion of surveillance to monitor for the appearance of the virus in other countries.

The following should be carefully investigated and tested for novel coronavirus:
1. Patients under investigation
A person with an acute respiratory infection, which may include history of fever or measured 
fever (≥ 38°C , 100.4°F) and cough
AND 
Suspicion of pulmonary parenchymal disease (e.g. pneumonia or Acute Respiratory Distress 
Syndrome (ARDS)), based on clinical or radiological evidence of consolidation. 
ANDResidence in or history of travel to the Arabian Peninsula or neighboring countries within 10 
days before onset of illness. 
AND
Not already explained by any other infection or aetiology
1
, including all clinically indicated tests
for community-acquired pneumonia according to local management guidelines. It is not necessary
to wait for all test results for other pathogens before testing for novel coronavirus.
2. Ill contacts
Individuals with acute respiratory illness of any degree of severity who, within 10 days before 
onset of illness, were in close physical contact
2
with a confirmed or probable case of novel
coronavirus infection, while the case was ill.
Any person who has had close contact with a probable or confirmed case while the probable or 
confirmed case was ill should be carefully monitored for the appearance of respiratory symptoms. 
If symptoms develop with the first 10 days after contact, the individual should be considered a 
“patient under investigation”, regardless of the severity of illness, and investigated accordingly.

3. Clusters
Any cluster
3
of severe acute respiratory infection (SARI)

4
, particularly clusters of patients
requiring intensive care, without regard to place of residence or a history of travel
AND
Not already explained by any other infection or aetiology, including all clinically indicated tests 
for community-acquired pneumonia according to local management guidelines.

4. Health care workers:
Health care workers who care for patients with severe acute respiratory infections, particularly 
patients requiring intensive care,   http://www.who.int/csr/disease/coronavirus_infections/InterimRevisedSurveillanceRecommendations_nCoVinfection_20121128.pdf

WHO Confirms Third Fatal Novel Beta Coronavirus Case

Recombinomics Commentary 15:30
November 29, 2012

The clinical picture in all cases was an acute respiratory infection presenting with signs and symptoms of pneumonia. Four patients developed acute renal failure; one of these died. The remaining three patients had pneumonia that required intensive support, without renal failure, and recovered. Three confirmed cases and the one probable case all belong to the same family and were living in the same household.

The above comments are from the WHO November 28 guidelines on surveillance testing for the novel betacoronavirus first reported in September.  The update increases the number of confirmed cases to seven and cites four cases with renal failure.  The first two cases had renal failure and media reports indicated the two fatal cases (70 year old father and his son) also had renal failure.  Therefore the 7th confirmed case would be the father (70M) and the WHO comments above should read that one of the cases survived (the 49M from Qatar), instead of stating that only one died.

The November 23 WHO update cited two deaths in the Riyadh cluster, which were in addition to the Jeddah case (60M) who died in June.

Renal failure in four of eight cases, as well as the death of 3 of the 4 cases with renal failure is remarkably similar to clinical presentation and outcomes for the most severe SARS CoV cases from 2003.  The intensive support for the other three confirmed cases also matches results for the SARS CoV outbreak, where almost 10% of lab confirmed cases died, and the deaths were concentrated in middle aged to older patients, which had ages similar to the four cases with renal failure. 

Although the WHO has not released the ages for the cases without renal failure, all appear to be middle aged adults.

Release of ages and disease onset dates for the seven confirmed and one probable case would be useful.  http://www.recombinomics.com/News/11291202/Betacoronavirus_WHO_3.html

Caucasus-bird flu killed more than 600 birds

Can return to the Kuban bird flu

At the edge of Rosselkhoznadzor believe that the mass death of birds in Temryuk district and Anapa could be due to bird flu. It is now known about the death of more than 600 birds.

 

 

The representative of the Ministry told RIA Novosti that the preliminary diagnosis of dead birds - bird flu, is now awaiting the final results.

According to the November 28, in the region killed more than 600 birds of various species.Among them - swans, pelicans, ducks and coots.

On Wednesday, the press service of the North Caucasus EkoVahty reported that the Black Sea coast of the coast and estuaries of the Taman Peninsula, and Anapa dotted with dead birds.

More of dead birds seen on the banks of Kiziltash, Bugaz estuaries, naked on the spit, and the area between the village and hamlets Veselovka Annunciation.

Just yesterday, the country's chief sanitary doctor Gennady Onishchenko said that the world fears the spread of bird flu. Only after the registration of the strain recorded 608 cases of dangerous virus H5N1, more than half of them - deadly. In Russia, the highlight of this strain has not happened. http://www.dg-yug.ru/a/2012/11/29/Na_Kuban_vozvrashhaetsja_pt