UK officials detail novel coronavirus cluster findings

Lisa Schnirring  Staff Writer

Mar 14, 2013 (CIDRAP News) – Investigation findings on a family cluster of novel coronavirus (NCoV) infections in Britain indicate some SARS-like qualities but a wider disease spectrum and other differences, according to a report today in Eurosurveillance.

Though earlier clusters were reported among hospital staff in Jordan and a family in Saudi Arabia, Britain's three-patient cluster is the first to be fully documented and published.

An investigation team with the UK Health Protection Agency (HPA) wrote that the index patient is a 60-year-old man who got sick shortly before returning to the United Kingdom after visiting Pakistan and Saudi Arabia. As of Mar 1 the man is still hospitalized and on extracorporeal membrane oxygenation (ECMO). Earlier tests found that he was co-infected with 2009 H1N1 influenza.

HPA officials said the man traveled in Pakistan for 5 weeks, then made a pilgrimage to Mecca and Medina during his 8-day stay in Saudi Arabia. He had no history of contact with animals or to people with severe respiratory infection in the 10 days before he got sick.

Other cases include a 38-year-old male household contact of the man who died from a severe NCoV infection on Feb 17 and a 30-year-old female family member who lived in a different household and became ill with a mild form of the illness after visiting the index patient three times in the hospital. Neither of those patients had a recent travel history, and the HPA said they were likely infected in the United Kingdom.

Today's report said the man who died had an underlying malignant condition and had been receiving treatment that likely resulted in immunosuppression. Tests found type 2 parainfluenza virus as well as NCoV in his nose and throat swabs. The woman recovered from her illness after 9 days, and tests also detected type 2 parainfluenza virus in her sputum sample, according to HPA investigators.

Extensive contact tracing of all three patients so far has revealed no other cases, though several had other respiratory viruses. Investigators identified 103 close contacts of the index case, including 19 who sat near him on airline flights. Eighteen contacts were identified for the man who died, and 25 of the woman's close contacts were evaluated.

Paired serum samples are being obtained from all patients' household and healthcare contacts, regardless of symptoms, to test for evidence of NCoV infection, according to the report.

Findings from all three patients suggest evidence of person-to-person transmission, but spread appears to be limited, consistent with the other two reported clusters.

The HPA highlighted the co-infection in all three patients, noting that the findings raise questions about how other infections might impact disease severity and its spread. The other illnesses may have delayed the NCoV diagnosis, and the cases show how important it is to consider NCoV in atypical cases, such as the index patient's poor response to antiviral drugs before his NCoV infection was detected.

Ever since the first NCoV cases emerged and scientists characterized the virus, health officials have emphasized that the disease isn't like SARS (severe acute respiratory illness, which caused more than 8,000 cases and about 900 deaths globally a decade ago). The HPA scientists, however, said in the report that some aspects of NCoV patterns resemble SARS: severe respiratory illness and incubation period.

The presence of a milder case, though, suggests a wider disease spectrum that will become more clear once the results of serological tests are known, they wrote.

Analysis of the three cases has allowed officials to make preliminary estimates of the disease's incubation period (1 to 9 days) and serial intervals (13 to 14 days). The HPA said that although the information is extremely limited, the upper incubation range is more similar to SARS than seasonal coronavirus infection.

"It is therefore not possible to ascertain with certainty whether the index case acquired his infection in Saudi Arabia or in Pakistan, although previous nCoV cases have been linked to the Middle East," they wrote.

The group said their findings emphasize the importance of vigilance for and rapid investigation of severe respiratory infections in residents of and travelers to the Middle East, and more work is needed to determine if NCoV is circulating elsewhere.

WHO working on guidance updates

In other NCoV developments, the World Health Organization (WHO) said today in an update that it is reassessing its guidance in light of new information, but also repeated that the virus doesn't spread easily. "Case definitions, surveillance recommendations, and other guidance are undergoing continuous reassessment in light of new information and reports of new cases," the agency said.

Three fatal cases have been reported in Saudi Arabia since late February, including one this week. In all, 15 confirmed NCoV cases with 9 deaths have been confirmed since the virus was identified last September.

In other comments, the agency said that in testing patients for the virus, lower respiratory specimens should have priority, since they are more likely to yield accurate results. The WHO also has published guidance on clinical management of NCoV cases.

News editor Robert Roos contributed to this story.

HPA UK Novel Coronavirus Investigation Team.Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2012. Eurosurveillance 2013 Mar 14;18(11):[Full text]

http://www.cidrap.umn.edu/cidrap/content/other/sars/news/mar1413coronacases.html

WHO INTERIM GUIDANCE DOCUMENT

Clinical management of severe acute respiratory infections 

when novel coronavirus is suspected: What to do and what not to do

Introduction 2

Section 1. Early recognition and management 3

Section 2. Management of severe respiratory distress, hypoxemia and ARDS 6

Section 3. Management of septic shock 8

Section 4. Prevention of complications 9

References 10

Acknowledgements

The emergence of novel coronavirus in 2012 (see http://www.who.int/csr/disease/coronavirus_infections/en/index.

html for the latest updates) has presented challenges for clinical management. 

Pneumonia has been the most common clinical presentation; five patients developed Acute Respiratory Distress Syndrome (ARDS). Renal failure, pericarditis and disseminated intravascular coagulation 

(DIC) have also occurred. 

Our knowledge of the clinical features of coronavirus infection is limited and no virus-specific prevention or treatment (e.g. vaccine or antiviral drugs) is available. Thus, this interim guidance document 

aims to help clinicians with supportive management of patients who have acute respiratory failure and 

septic shock as a consequence of severe infection. Because other complications have been seen (renal 

failure, pericarditis, DIC, as above) clinicians should monitor for the development of these and other 

complications of severe infection and treat them according to local management guidelines. 

As all confirmed cases reported to date have occurred in adults, this document focuses on the care of 

adolescents and adults. Paediatric considerations will be added later. 

This document will be updated as more information becomes available and after the revised Surviving 

Sepsis Campaign Guidelines are published later this year (1).

This document is for clinicians taking care of critically ill patients with severe acute respiratory infection (SARI). It will be helpful if you work in an Intensive Care Unit (ICU) that has limited resources – 

i.e. limited access to mechanical ventilation, invasive hemodynamic monitoring and arterial blood gas 

analyzers – or if you have limited access to specialty training. It is not meant to replace clinical training 

or specialist consultation but rather to strengthen your current clinical management of SARI and link 

you to the most up-to-date guidance. 

This document is organized into four sections, which correspond to clinical management steps. Section1

focuses on the early recognition and management of patients with SARI and includes early initiation of 

supportive and infection prevention and control measures, and therapeutics. Section 2 focuses on management of patients who deteriorate and develop severe respiratory distress and ARDS. Section 3 focuses 

on the management of patients who deteriorate and develop septic shock. Section 4 focuses on ongoing 

care of the critically ill patient and best practices to prevent complications. 

Three symbols are used: j

Do: the intervention is known to be beneficial.

h Don’t: the intervention is known to be harmful.

fBe careful when considering this intervention. 

The recommendations in this document are derived mainly from evidence-based guidelines that WHO 

has published, including the WHO Integrated Management of Adolescent and Adult Illness (IMAI) District Clinician Manual (2). Where WHO guidance is not available, we have used widely accepted global 

consensus statements, such as guidelines of the Surviving Sepsis Campaign, and the results of recently 

published randomized controlled trials. The recommendations have also been reviewed by a WHO 

global network of clinicians (see Acknowledgements for names and affiliations). 

Links are given here to additional sources and evidence. If you have further questions, contact us by 

e-mail to outbreak@who.int with ‘Novel coronavirus clinical question’ in the subject line. 

This interim guidance document will expire in 12 months from the date of publication...

http://www.who.int/csr/disease/coronavirus_infections/InterimGuidance_ClinicalManagement_NovelCoronavirus_11Feb13.pdf

Update the risk assessment of the RKI to disease cases by the novel coronavirus (HCoV-EMC)

On the background of a possible human-to-human transmission
A first cluster was reported in a cluster in a family in Saudi Arabia in 2012. In this family, two males were infected, in which a very narrow, unprotected contact with the care of the patient was considered as a transmission as possible.
In February 2013 last three disease cases had been confirmed with the novel coronavirus from the UK. This affected a patient who had visited before his illness in Saudi Arabia, and two family members of the index patient. One of the family members died, the other was diagnosed with milder respiratory symptoms and recovered quickly.
Risk assessment
There is still no evidence of continuous human-to-human transmission. In Germany, there has been only one imported case of disease, while no secondary infections. The risk of contact persons becoming infected is low overall and the general population is extremely low.
In the care of probable cases in the hospital shall continue, mainly because of the severe course of the previously known diseases, strict hygiene measures carried out according to the recommendations for diseases caused by the SARS virus. For patients receiving further clarification also specifically avoid contact with sick persons with history of travel with respect to the Arabian Peninsula, are in demand.
The Robert Koch Institute has possibly further differential diagnostic laboratory tests (see case definition of the RKI of 12 December 2012). The specific diagnosis of novel coronavirus has been established at the Robert Koch Institute and the Institute of Virology at the University of Bonn (see also notes the RKI for laboratory diagnostics).
For more information
Table of confirmed cases of infection with the new coronavirus (HCoV-EMC) (PDF, 100KB, file is not accessible)
Recommendations of the Robert Koch Institute for Hygiene and infection control in patients with heavy acute respiratory syndrome (SARS) (PDF, 49KB, file is not accessible)
Case definition of the RKI to severe respiratory disease associated with a novel coronavirus (12/12/2012) (PDF, 118KB, file is not accessible)
Notes for the laboratory diagnosis of suspected severe acute respiratory syndrome due to infection with a new human beta 2c EMC/2012 coronavirus (HCoV-EMC)
As of 13/03/2013 http://www.rki.de/DE/Content/InfAZ/C/Corona/Risikoeinschaetzung.html

Jordan-Womans death and her unborn child as a result of swine flu

Thursday, March 14, 2013
Woman died Jordanian and her unborn child, today, as a result of swine flu.said hospital director Princess Basma in Irbid Akram Al-Khasawneh said "Ms. fetus died Thursday due to swine flu." he said in remarks told the official news "Petra" that "Mrs. (27 years ) was introduced to the intensive care after being transferred from another hospital in a difficult situation and on a respirator. " He said he "was isolated the patient and provide the necessary attention to it," but she died. This was the fourth event of the death in Jordan because of HIV infection "H 1 to 1" known as swine flu this year. led swine flu to the death of 25 people in Jordan over the past years. In 2009, an outbreak of the virus, "H 1 to 1" in the form of an epidemic in the whole world from Mexico and back, at the time, 17 000 deaths  http://www.nna-leb.gov.lb/ar/show-news/24037/%D9%88%D9%81%D8%A7%D8%A9-%D8%A7%D8%B1%D8%AF%D9%86%D9%8A%D8%A9-%D9%88%D8%AC%D9%86%D9%8A%D9%86%D9%87%D8%A7-%D9%86%D8%AA%D9%8A%D8%AC%D8%A9-%D8%A7%D8%B5%D8%A7%D8%A8%D8%AA%D9%87%D8%A7-%D8%A8%D8%A7%D9%86%D9%81%D9%84%D9%88%D9%86%D8%B2%D8%A7-%D8%A7%D9%84%D8%AE%D9%86%D8%A7%D8%B2%D9%8A%D8%B1

Eurosurveillance, Volume 18, Issue 11, 14 March 2013

Rapid communications

EVIDENCE OF PERSON-TO-PERSON TRANSMISSION WITHIN A FAMILY CLUSTER OF NOVEL CORONAVIRUS INFECTIONS, UNITED KINGDOM, FEBRUARY 2013

The Health Protection Agency (HPA) UK Novel Coronavirus Investigation team ()¹

1. The members of the team are listed at the end of the article

---

Citation style for this article: The Health Protection Agency (HPA) UK Novel Coronavirus Investigation team. Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013 . Euro Surveill. 2013;18(11):pii=20427. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20427
Date of submission: 05 March 2013

---

In February 2013, novel coronavirus (nCoV) infection was diagnosed in an adult male in the United Kingdom with severe respiratory illness, who had travelled to Pakistan and Saudi Arabia 10 days before symptom onset. Contact tracing identified two secondary cases among family members without recent travel: one developed severe respiratory illness and died, the other an influenza-like illness. No other severe cases were identified or nCoV detected in respiratory samples among 135 contacts followed for 10 days.

---

On 8 February 2013, the Health Protection Agency (HPA) in London, United Kingdom (UK), confirmed infection with novel coronavirus (nCoV) in a patient in an intensive care unit, who had travelled to both Pakistan and Saudi Arabia in the 10 days before the onset of symptoms [1]. This patient (hereafter referred to as Case 1) was the 10th confirmed case reported internationally of a severe acute respiratory illness caused by nCoV. Two secondary cases of nCoV were subsequently detected. We describe the public health investigation of this cluster and the clinical and virological follow-up of their close contacts.

The nCoV was first described in September 2012 in a Saudi Arabian national who died in June 2012 [2,3]. The UK detected its first case of nCoV infection in a male foreign national transferred from Qatar to London in September 2012 [4]. By February 2013, a total of two clusters had been described globally: one cluster (n=2) among staff in a hospital in Jordan and a family cluster (n=3) in Saudi Arabia [5]. No clear evidence of person-to-person transmission was documented in either cluster [6].

Index case exposure history and laboratory investigations

The index case was a middle-aged UK resident, who had travelled to Pakistan for five weeks. He then travelled directly to Saudi Arabia on 20 January where he remained until his return to the UK on 28 January 2013. During his stay in Saudi Arabia, he spent time in Mecca and Medina on pilgrimage. On 24 January, while in Saudi Arabia, he developed fever and upper respiratory tract symptoms (Figure 1). No direct contact with animals or with persons with severe respiratory illness was reported in the ...

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20427

How deadly new coronavirus infects human cells

New research identifies a protein on the cell surface called dipeptidyl peptidase 4 (DPP4), a key receptor for disease

Scientists have discovered how the deadly new coronavirus , which until last year was not detected in humans, infects human cells and causes serious and potentially fatal lung damage, reportedReuters , citing a publication in the journal " Nature . " In one of the first detailed studies of the virus identified in the Middle East in September last year and so far infected 15 people worldwide, killing nine of them, Dutch experts have identified a protein on the cell surface, which he uses to enter and infect human cells. discovery published in the journal "Nature" comes at a time when the World Health Organization confirmed the 15th case of virus called NcoV, patient in Saudi Arabia, died on 2 March NcoV new coronavirus is the same family as the causes of colds and showed for the first time in Asia in the 2003 SARS (Severe Acute Respiratory Syndrome). Posted February survey found that NcoV virus is well adapted to infect humans and is amenable to treatment with interferon - drugs that stimulate the immune system recalls the agency.specialists in the study of the medical center "Erasmus" in the Netherlands have set themselves to find answer to the question how the virus enters the cell, which uses receptors where the body most often found these receptors. 

"Once identified receptor and knowing its distribution in the body, we can get more information about the pathogenesis of the virus - how it infects humans, and its possible transfer," explains Bart Haagmans the research team. Experts have identified a protein on the cell surface called dipeptidyl peptidase 4 (DPP4), a key receptor for the disease.They also found that cells containing DPP4 receptors are distributed in the lower respiratory tract, but not above. This explains why the virus affects the lungs, not the nose and throat as influenza viruses.discovery will help in the search for new ways to develop drugs and vaccines that block receptors DPP4 and prevent infection. Several drugs that block these receptors are already on the market, licensed for diabetes. The authors of this study have used them to try in the laboratory to stop the virus, but have found that they do not actagainst him. specialists are working with new molecules that can block the receptors and DPP4 underlie vaccine .  http://www.vesti.bg/index.phtml?tid=40&oid=5605011

The two respiratory severe men and women confirmed that not for a new virus

[20:23] 2013/03/14

 an informed CHP today received the Princess Margaret Hospital and Pamela Youde Nethersole Hospital reported a total of two novel coronavirus, the cause of serious respiratory disease suspected cases.

The first case was a 63-year-old man, itself is in good health, fever, cough, sore throat, runny nose, headache and muscle pain, to the Princess Margaret Hospital seeking treatment since March 11, is currently being treated in isolation in stable condition.

Initial investigations revealed that the patient had to Tunisia on March 1 to 8, and stay for about two hours after the turning point in Qatar Airport on March 8, to return to Hong Kong on March 9.

His lung X-ray is normal, and today the preliminary test results show that the negative reaction of the patient's respiratory sample of the new coronavirus caused severe respiratory disease, were positive for seasonal influenza A (H3).

Two cases for a 23-year-old woman, good health, fever, cough, runny nose and sore throat, today to Pamela Youde Nethersole Eastern Nethersole Hospital for treatment since March 10, is now open for the isolation treatment, in stable condition.

Initial investigations revealed that the patient had traveled to Turkey on February 27 to March 12, Abu Dhabi and Dubai, and Hong Kong on March 12.

Her lung X-ray examination is normal today preliminary test results show that the patient's respiratory samples of the new coronavirus caused severe respiratory disease were negative.

http://news.on.cc/cnt/news/20130314/bkn-20130314202352536-0314_00822_001.html

Finding shows how it enters cells, could lead to vaccine, researchers report

Finding shows how it enters cells, could lead to vaccine, researchers report
March 13, 2013 
By Barbara Bronson Gray
HealthDay Reporter

WEDNESDAY, March 13 (HealthDay News) -- A discovery that shows how a novel -- and often fatal -- virus infects cells may help fight a health threat that has recently emerged on the world stage, researchers report.

A unique coronavirus was identified as the cause of severe respiratory illness in 14 people from Jordan, Qatar, Saudi Arabia and the United Kingdom between April 2012 and February 2013, according to the U.S. Centers for Disease Control and Prevention. Eight people have died after contracting the virus.

Coronaviruses -- named for their crown-like projections visible under a microscope -- are causes of the common cold but also are associated with more severe illness, such as SARS (Severe Acute Respiratory Syndrome), which killed hundreds of people worldwide in 2003.

Although no deaths have been reported in the United States, the fact that there were clusters of people infected in the United Kingdom shows the new virus can be transmitted between humans, according to the CDC.

Now there's a possible clue on how to stop the virus, which was first identified last September. Dutch researchers said they've identified the receptor that is used by the coronavirus to invade cells.

Approaches to preventing the virus from binding to the receptor and gaining entry to cells may help combat infection, said study author Bart Haagmans, a virologist at the Erasmus Medical Center, in Rotterdam. "These findings provide further insight into how the virus causes severe pneumonia, as the receptor is present in the lower respiratory tract [trachea, airways or lungs]," he explained. 

The research was published in the March 14 issue of the journal Nature.

The severity of the disease appears to vary, mirroring minor flu-like infections in some people and becoming life-threatening in others. Those with the most serious infections seem to have had other viral or bacterial infections at the same time, which may help explain the more severe cases, experts said.

The virus doesn't seem as contagious as seasonal flu, and Haagmans said this appears to confirm the role of the receptor he identified. "This may be due to the fact that the receptor is minimally expressed in cells of the upper respiratory tract," he said. "Therefore, it is also unlikely that the virus can become much more capable of spreading more universally."

The discovery of the receptor could potentially help researchers inhibit the spread of the virus, said Haagmans. One approach would be to develop a vaccine that securely locked the cell door to the coronavirus receptor, preventing the virus from being able to storm the cell. 

Haagmans said he doesn't know why the virus seems to be deadly. He said it's possible that scores of people with a less harmful form of the disease have not been identified, due to limited testing in the Arabian Peninsula, where the disease seems to have originated.

Analysis of the virus's genome showed that it is related to coronaviruses found in bats. Coronaviruses can infect a wide range of mammals and birds, and are considered to have what is called "zoonotic potential," which means they can be transmitted to people.

Dr. Susan Gerber, a medical epidemiologist with the division of viral diseases at the CDC, said she thinks Haagmans's research will be valuable because it helps scientists understand what happens at the cellular level of the disease. "This is going to be very important in the treatment of the virus," she said.

Yet Gerber stressed that there is still much to learn about the virus and the infection it causes. "There are so few cases that have been identified of this virus infection," she said. "We need more information."

The CDC is advising people who develop severe acute lower respiratory illnesses, such as pneumonia, within 10 days after traveling from the Arabian Peninsula or neighboring countries to see their health provider. 

The agency also recommended that those who haven't traveled to the Arabian Peninsula but come into close contact with someone who has should be evaluated if they develop a severe acute lower respiratory illness.
http://health.usnews.com/health-news/news/articles/2013/03/13/secrets-of-new-sars-like-virus-uncovered

Poultry positive for influenza A (H5N1) on sale at the market

14/03/2013 3:00

On 13.3, Nguyen Thanh Huy, Director of the Department of Animal Health Ca Mau province, said in February last, the unit conducted 21 random sampling of poultry at markets in the province take the tests to 16 samples were positive for influenza A H5N1.

In markets TP.Ca Mau has 4/6 samples; market town of Thoi Binh (H.Thoi Binh) 5/6 samples; market Khanh Hoi (HU Ming) 1/3 sample; Rach that and Song Doc (H.Tran Van Time) each Market 3/3 samples were positive for influenza A H5N1.

"To control the epidemic, the provincial Animal Health Department has directed all veterinary stations to strengthen anti-epidemic activities such as strengthening quarantine, epidemiological surveillance, livestock operations, trafficking, "said Huy.

Veterinary Medicine in Aswan denies outbreak of "IB" in Aswan

Dr. Jamal Mustafa Director General of Veterinary Medicine in Aswan Ali does not appear any bronchitis Aswan known as "IB". explained Jamal Mustafa that this disease is a virus that affects the respiratory system of birds and does not constitute any danger to humans, which is at the same time has no direct relationship with bird flu or SARS-like. said that the symptoms are in a Nominated to the bird and the emergence of nasal secretions outside and are treated sera allocated to it, with follow preventive measures for non-injury.

SARS-like virus targets cells in human airway

March 14, 2013

The virus actually targets the lower respiratory tract in humans

A virus that emerged in the Middle East last year, causing severe respiratory problems, kidney failure and even death among many persons it infected, was gaining entry by latching on to a molecule found on the surface of certain cells deep in the human airway, according to a team of scientists whose research appears in this week's issue of the journal Nature.

Their discovery opens the way to uncovering key aspects about how the virus is transmitted and produces disease as well as of finding ways to treat those affected by it.

The virus was first detected in sputum samples taken from a 60-year-old man hospitalised in Saudi Arabia last June with pneumonia and kidney failure, who later died. There have been 15 confirmed cases of human infection with this virus, with nine deaths, reported from Saudi Arabia, Jordan, Qatar and Britain, according to the World Health Organisation.

Virologists at the Erasmus Medical Centre in the Netherlands, who isolated and characterised the microbe, found that it was a novel coronavirus. As the outbreak of ‘severe acute respiratory syndrome’ (SARS), which began in southern China in 2002 and then suddenly exploded across the world the following year, had also been caused by a coronavirus, the discovery of this new pathogen sparked considerable concern among public health professionals.

In their Nature paper, the Erasmus Medical Centre team, along with their collaborators, have reported that the new coronavirus, given the designation hCoV-EMC, was using the protein ‘dipeptidyl peptidase 4’ (DPP4, also known as CD26) as a receptor to latch on to cells lining the respiratory tract and infect them. Viruses need to enter cells and hijack their molecular machinery in order to replicate and spread.

“The identification of the receptor for this novel coronavirus provides evidence that the virus actually targets the lower respiratory tract in humans,” said Bart L. Haagmans, senior author of the paper, in an email.

Cells with the DPP4 receptor being more abundant in the lower respiratory tract “could be one of the reasons there is limited transmission of this virus [among people],” noted V. Stalin Raj, the paper's first author who is part of the Erasmus Medical Centre group. If, on the other hand, virus replication had been taking place in the upper respiratory tract, it might have been able to transmit more quickly from person to person, he told this correspondent.

Now that the receptor had been identified, the next step would be to use animals, such as ferrets, to study which other cells and tissues in the body the virus was infecting, the mechanisms by which it caused disease and how it was able to spread, remarked Dr. Raj.

Dr Raj hails from Tamil Nadu and did his doctoral research at the Central Institute of Brackishwater Aquaculture in Chennai before moving to Europe.

As with the SARS virus, the new hCoV-EMC coronavirus appears to have originated in bats. However, unlike the former, the latter is still able to infect bat cells. Moreover, the structure of the DPP4 receptor has been evolutionarily conserved in many different animals.

“The interesting and perhaps troubling findings from studies of this virus thus far are that there may be a plethora of sources for its intrusion into the human population,” remarked Tom Gallagher and Stanley Perlman in a commentary on the paper published in the same issue of the journal. More work was needed to address this issue.  http://www.thehindu.com/sci-tech/health/sarslike-virus-targets-cells-in-human-airway/article4505452.ece?

Qatar-Testing for coronavirus now available at HMC

The Hamad Medical Corporation’s Virology Laboratory is now fully equipped to test for novel coronavirus and any other suspected cases related to acute respiratory distress syndrome, two senior officials at the Supreme Council of Health yesterday said.
Both officials, Health Protection and Communicable Diseases Control manager Dr Mohamed al-Hajri and Surveillance and Outbreaks section head Dr Hamad al-Romaihi, were talking to journalists on the sidelines of a one-day “Workshop for Focal Points on Surveillance and Outbreaks Control of Communicable Diseases” organised and co-ordinated between SCH’s Public Health Department (PHD) and Qatar Petroleum HSE Regulations and Enforcement Directorate (DG).
About 70 health representatives from energy and industry sector, police clinics, Qatar Military Medical Services, Qatar University, Qatar Foundation and Aspetar took part in the event held at the Grand Heritage Doha Hotel and Spa.
The novel coronavirus (nCoV) was first reported to cause human infection last September.
To date, the World Health Organisation, (WHO) has been informed of a global total of 15 confirmed cases of human infection with the virus, which has caused nine deaths including four in Saudi Arabia, two in Jordan and one in the UK.
Last year, two people were infected with the virus in Qatar and both survived after receiving intensive treatment abroad.
“The HMC Virology Laboratory has started on-site testing for nCoV from December 2012 and to date around 70 patients suspected with the virus tested negative results,” Dr al-Romaihi said.
He explained that the tests were carried out retrospectively on 35 patients enrolled in the severe acute respiratory illness (SARI) programme as well as some 35 patients admitted with pneumonia or acute respiratory illness.
He added that the PHD has since last November to date, investigated more than 150 acute respiratory distress syndrome patients admitted in Hamad Medical Corporation (HMC).
“We in the SCH are closely monitoring the situation both locally as well as internationally (GCC and worldwide). The updates case definition from the WHO has been shared with all health facilities in the country and all hospitalised cases due to acute respiratory distress syndrome are being followed up,” Dr al-Hajri mentioned.
The official explained that the council is also working with the WHO and other partners to better understand the public health risk posed by coronavirus.
“Unfortunately, more new cases might need to appear for us to be able to understand the virus…in the meantime, we have provided all needed kits to healthcare facilities here and a guideline they should follow unless there is a new regulation from the WHO,” Dr al-Hajri stated.
He explained that an interim surveillance recommendations for human infection with novel coronavirus include a person with acute respiratory infection, who may also have fever (above 38 degrees C) and cough as well as pneumonia, or has travelled from the Arabia Peninsula and or neighbouring countries within last 10 days.
Countries considered in the Arabian Peninsula and neighbourhood include Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestine territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates and Yemen.
The official added that any case that fits into the patient under investigation definition should be managed with respiratory precautions and immediately notified to the SCH’s HP and CDC section on hotline numbers 66740948 or 66740951 or fax – 44070812.

More Media Myths On Beta2c Coronavirus Transmission

Recombinomics Commentary 16:30
March 13, 2013

"Once it gets you, it's a very serious infection," said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville.
Fortunately, he added, the virus is "very difficult to acquire."
Dr. Susan Gerber, a medical epidemiologist in the CDC's Division of Viral Diseases, agrees.

There's no evidence of sustained human-to-human transmission, she said, "where you see a chain of many cases going person to person to person."

"People shouldn't freak out," she added. "There's no evidence that this virus is easily spread, say, across a room."

The above comments on nCoV human to human (H2H) are largely based on negative data which lacks credibility.  There have been three lab confirmed clusters, and all three clusters include symptomatic contacts who tested negative.  Moreover, in the largest cluster, most of the symptomatic cases were designated as probable cases, based on interviews with symptomatic health care workers and relatives.
Most of the key detail (disease onset dates and relationships between probable cases), has been withheld for the ICU cluster in Jordan last April.  However, local media reports and WHO updates indocate that the cluster involved at least 12 people, including 2 doctors, 7 nurses, and two family members of health care workers (HCWs).  Outbreaks at ICU’s of a rare mysterious disease are usually linked to a treated patient, as was seen in the SARS-CoV outbreak in March of 2003.  Like the current nCoV, SARS-CoV was present at higher levels in the lower respiratory tract and detection in the upper respiratory tract was a challenge.  Moreover HCWs were at risk because the hospitalized cases had severe infections and coughing or intubation procedures could spread the virus “across a room”.  The key signature of the SARS spread was super-spreaders, who could infect many contacts, who were typically HCWs.
WHO has not explained why the survivors in the ICU cluster were not lab confirmed, but the failure may be linked to a low level of virus in samples collected from the upper respiratory tract.  However, they did acknowledge that the symptomatic cases were probably infected, as were at least two family members who cared for the HCWs.  Disease onset dates were not released, but the two fatal case (45F nurse and 25M intern) died a week apart, suggesting the disease onset dates supported an extended transmission chain.
The extended transmission chain was also supported in the familial cluster in Riyadh, although WHO also withheld disease onset dates for that cluster.  The index case (70M) was said to have developed symptoms in “October”.  One of his sons (39M) was hospitalized after his father’s death, and the son’s disease onset date was October 28.  His brother’s (31M) disease onset date was between November 3-5, supporting a transmission chain from the father to the older brother to the younger brother.  A fourth family member tested negative, but was also classified as a probable case due to common symptoms and contact with the three confirmed cases.
H2H transmission was also supported in the UK cluster.  The index case (60M) developed symptoms while performing Umrah in Saudi Arabia.  Three family members developed symptoms in the UK, and the two confirmed cases had no travel outside of the UK in the weeks prior to disease onset.  The son (39M) died, but the other confirmed family member (30F), who had a mild case, had no contact with the son, and contact with the index case was limited to three hospital visits.  However, since the index case was on an ECMO machine it is unlikely that the nCoV was transmitted at the hospital.  A fourth family member was a likely link between the index case and the two additional confirmed case, but that family member also tested negative.
Thus, the claims of “no evidence” for sustained transmission is heavily dependent on false negatives in symptomatic cases that were characterized as probable, and claims of no transmission “across a room” a just another media myth.

Cairo 13/03/2013

the Rabiah said Executive Office Turning to the problem of HIV Coruna and how to communicate with the World Health Organization to urge states not to link the suspected cases infected with the virus and geographical areas in which people where the virus, and work on early detection of the virus on the evidence and scientific evidence.

He added that the Executive Office agreed today to prepare a speech unified Arab for throwing by the Minister of Health of the Republic of Djibouti representatives from Arab countries before the session 66th General Assembly of the World Health Organization in Geneva in May next year to reflect the position of collective Arab meetings organization.

Where he headed the delegation of the State of Palestine in the meeting, Ambassador of the State of Palestine and Permanent Delegate to the Arab League Ambassador Barakat al-Farra, and First Secretary Tamer Abdel Rahim Delegation of Palestine in the Arab League.

ـــــhttp://www.wafa.ps/arabic/index.php?action=detail&id=149960

KSA Beta2c Coronavirus Reporting Delays

Recombinomics Commentary 14:30
March 13, 2013

The patient, a 39-year-old male, developed symptoms on 24 February 2013. He was hospitalized on 28 February 2013 and died on 2 March 2013.

The above comments from the latest WHO update on coronavirus infections reflect reporting delays which continue to increase concernsthat only a small fraction of the infections are being reported.  The novel coronavirus produces a wild range of clinical presentations including mild cases, but only fatal cases have been reported in 2013 from the Kingdom of Saudi Arabia (KSA).
The track record of reports from WHO and the KSA Ministry of Health has lacked transparency, which also suggests that human to human (H2H) transmission is significantly higher than the reported confirmed cases.  The three 2013 cases reported by the KSA MoH have been fatal and information on symptomatic contacts has been absent.
 
Unlike the initial cases in the SARS outbreak of 2002/2003, only lab confirmed cases are being reported for novel coronavirus (nCoV) cases and testing remains highly suspect.  Although WHO acknowledges probable cases in the ICU cluster in Jordan last April, as well as the Riyadh familial cluster in late 2012, detail on the probable cases, including age, disease onset date, and relationships has been withheld.
The undercount of the confirmed cases has been linked in part to testing issues.  An additional death was cited in initial reports of the first confirmed case, who was a Bisha resident who died at a hospital in Jeddah.  The second death was not confirmed, and media reports suggested that samples were not collected from that case.  More recent reports have also been delayed.  The first case from Riyadh (45M) was reported on the date of discharge.  The report on the Riyadh cluster cited the surviving confirmed case (31M) and failed to cited the death of the father (70M) and brother (39M) of the surviving case (or hospitalization of the 4th family member). 

The first case in 2013 (61F) was said to have developed symptoms overseas, but no country or location was cited.  Minimal information has been released on the two most recent 2013 cases (69M and 39M), and as noted above, the most recent case was announced 10 days after his death.

The limited information from KSA is similar to initial reports from Guangdong Province in 2003, when a “mysterious” disease was said to have cause 100 pneumonia deaths.  Details on the cases were released after the SARS CoV spread internationally, and the vast majority of cases were reported between mid-March and mid-May.
Similarities between SARS-CoV  and nCoV testing (which is heavily dependent on samples from the lower respiratory tract) and incomplete reporting continue to increase.

Coronavirus patient visited farm

Mar 13, 2013

Latest coronavirus patient had visited farm, Saudi official says
Investigators in Saudi Arabia learned that the latest person to die of a novel coronavirus (NCoV) infection had visited a farm before he got sick, according to a Saudi Arabian health official. Similar findings have been reported in at least 2 of the 14 other NCoV cases reported since the virus emerged last year. The latest case, involving a 39-year-old man in Saudi Arabia, was announced by the World Health Organization yesterday. Ziad A. Memish, MD, deputy minister for public health in Saudi Arabia, told CIDRAP News by e-mail, "What we know is that the patient has not traveled recently outside KSA [the Kingdom of Saudi Arabia] and he has been to a farm outside Riyadh owned by his brother." Previous reports revealed that a Qatari man who was treated for NCoV infection in Germany last fall owned a farm where some goats had been sick before he fell ill himself. Also, a Saudi Arabian gym teacher whose NCoV illness was reported in November had visited a farm 3 days before he got sick. The source of the novel virus has not been identified, though it is related to coronaviruses found in bats. Memish commented that all patients hospitalized with pneumonia in Saudi Arabia are being screened for NCoV infection, "a strategy not implemented to my knowledge by any country in the world and that's why we continue to sporadically detect new cases. It will be good if other countries apply the same strategy to give the world an indication how wide spread this disease." Eight of the 15 confirmed cases have occurred in Saudi Arabia.
http://www.cidrap.umn.edu/cidrap/content/other/sars/news/mar1313scan.html

Libyan Minister of Health announces five deaths swine flu

2013:03:13.09:43 Font Size: Print 
Benghazi March 12, 2013 / Health Minister Libyan Noureddine Doghman today (Tuesday) for five deaths after contracting HIV, "AT / H 1 to 1" known media swine flu in three cities in eastern and western Libya. said Doghman at a press conference this afternoon that "29 cases have been registered illness seasonal flu after reporting centers and medical units, "pointing out that" Ten cases were recorded in the capital Tripoli. " and added that "the injury as a result of weather factors and colder weather." and "The 4 cases who died from the disease in the Middle Libyan and another case in the corner west of Tripoli. " and recorded the Ministry of Health deaths five during the past two days, the two in the city of Derna (300 km east of Benghazi), and two in Benghazi, one center of Benghazi, medical and other hospital Republic for a lady from the city Ajdabiya, and fifth in the corner west of Tripoli. played down Doghman fears of the virus, saying that "the situation is under control and there are no worries of worsening the situation did not reach it to be designated as the epidemic yet." He added, "Once change weather factors and the high temperature weather will disappear injuries with the virus that causes the disease. " said Director of the Center of communicable diseases and endemic in Libya Mohammed Boghalah The "treatment (Altamflo) allocated for the treatment of this type of disease is abundant." He guessed medical source official told news ((Xinhua)) that "the virus causative is sophisticated form of the virus (A / H 1 to 1) the virus that causes swine flu, and the virus that causes bird flu. " and said that the infected cases suffering from severe pneumonia and showing symptoms of high temperature and interference in a coma. source quoted Director of the Office communicable diseases Bdrna as saying he "can not give a diagnosis of the virus, and it may be a genetic mutation or as a result of climate change," pointing out that "I took the farms of injured and sent to the city of Benghazi for the analysis and diagnosis of the type of virus."http://arabic.people.com.cn/31662/8165319.html

SARS-like virus claims victim in Saudi Arabia

Saudi health ministry says 39-year-old man died from nCov on March 2 after being hospitalised for four days. A SARS-like virus that has struck in Britain and the Middle East has claimed a new victim in Saudi Arabia, bringing the global toll from the mystery illness to nine, the World Health Organisation said. The UN agency said on Tuesday that the Saudi health ministry informed it that a 39-year-old man, who developed symptoms on February 24 and was hospitalised four days later, died on March 2. "Preliminary investigation indicated that the patient had no contact with previously reported cases," the WHO said in a statement. "Other potential exposures are under investigation." Novel coronavirus, or nCoV, was first detected in the middle of last year. Including the latest victim, a total of 15 cases have now been reported. Unusual patterns The nine fatalities have been clustered in Saudi Arabia, Jordan and Britain. In the latter country, it affected a family, one of the members of which had visited the Middle East and Pakistan. On Tuesday the WHO reiterated calls on its member states to remain vigilant for cases of severe acute respiratory infections and to carefully review any unusual patterns. "The WHO is currently working with international experts and countries where cases have been reported to assess the situation and review recommendations for surveillance and monitoring," it said. Member states should promptly assess and notify WHO of any new case of infection with nCoV, along with information about potential exposures that may have resulted in infection, it added. "The 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," it said. Coronaviruses cause most common colds and pneumonia, but are also to blame for unusual conditions such as severe acute respiratory syndrome, better known by its acronym SARS. A SARS epidemic killed more than 800 people when it swept out of China in 2003, sparking a major international health scare. The new virus however is different from SARS, especially in that it causes rapid kidney failure. http://www.aljazeera.com/news/middleeast/2013/03/201331364931689609.html

Examined 70 samples of the Corona virus Hamad Medical laboratories

He intensify surveillance and control procedures .. Health Council's flag:

Examined 70 samples of the Corona virus Hamad Medical laboratories

Mainstream methods of monitoring Coruna health facilities to quickly report cases of suspected

Epidemiological situation in Qatar reassuring .. and activate international recommendations in the diagnosis and isolation

Personal hygiene and hand washing the best ways of preventing HIV Coruna

Wrote - Ashraf Excellent:

The Supreme Council of Health that he had to step up monitoring of health status locally and globally on the spread of the new Corona virus while continuing to monitor all cases of acute respiratory infection.

The Council in its response to the report published by the flag Sunday on concern citizens of the spread of HIV Corona that was circulated guidance on HIV Corona emerging at all health facilities to ensure rapid Report suspected cases are currently following up on all cases of acute respiratory infections by a team Investigation of Protection Administration Health and Disease Control Transitional Council.

He stressed that the epidemiological situation in the State of Qatar reassuring at the moment and it has been done to activate all of the recommendations of the World Health Organization, which include disease surveillance tools and diagnosis, isolation and screening contacts

He suggested that the Virus Lab at HMC has been equipped with screening laboratory for virus Corona emerging and staff training to scan all suspected cases and results are obtained in a short period have been ....

http://www.raya.com/news/pages/dcb03abb-da08-4594-830e-f8ce4c2bfb5f