Monday, December 23, 2013

Suspected Ebola outbreak in Uganda old story with a new date!

December 21, 2013 - 23:13

 Ebola in Uganda than six people have been hospitalized with suspected.

The hospitalized cases of Ebola in Uganda in the case proves to be the number of those infected in this month will be increased to 26.

Go to the beginning of the outbreak of the Kibale Health Minister Stephen Bayaruhang, first outbreak in a village just now spread to other villages said they received reports that the.

A Bayaruhang outbreak occurred in villages where many people ill, infected with Ebola taken to the hospital for fear that they are not willing to be taken to the hospital, he said.

Ebola in Uganda so far captured 14 people lost their lives.


Sunday, December 15, 2013

Two PNEUMONIC plague cases have been found in Madagascar

  Two pneumonic plague cases have been found in Madagascar, said a health official there. The pneumonic plague is deadlier than the bubonic plague. This new report comes after confirmation that there was also an outbreak of the deadly bubonic plague in the island’s northwest region in a tiny village.

Pneumonic plague can be transmitted from human to human without any involvement of fleas or animals. It is also the least common and most virulent form of plague, which can kill in less than 24 hours.

Bubonic plague was found in the town of Mandritsara in northwestern Madagascar last week. Twenty people and possibly more have been reported killed by the plague. This week it was confirmed by The Pasteur Institute of Madagascar that tests on some of the bodies from the village near Mandritsara showed that the cause of death had been the plague. However, the institute did not give a number of how many died from the outbreak.

Pneumonic plague occurs from the same bacteria, which cause bubonic plague, the so-named Black Death, which ravaged Europe by killing an what was estimated to be over 25 million people during the Middle Ages.

[link to]

 14 Décembre 2013 08:27

..The latest statistics speak of 41 deaths and 96 people infected in the space of three months. Mandritsara district in the North East of the island, is on alert . The delay in diagnosis and management have exacerbated the situation. Emergency measures were taken to stop the outbreak of this epidemic, including a campaign of extermination and temporary evacuations of populations at risk. The epidemic is spread by rats pushed houses including uncontrolled deforestation of the island.A doctor Branch of Health in Antananarivo said that 90% of cases took the form of pneumonic plague is worse than the most common form ( bubonic plague or Black Death ), because it can kill in three days. Garbage, poor sanitation and lack of respect for hygiene conducive to the spread of the disease. The capital is more than ever a place at risk. Scientists at the Pasteur Institute of Madagascar are particularly concerned that these cases occur outside the period usually spreads the plague .

Dongguan, a 39 -year-old man infected with H7N9 in critical condition

Dongguan, a 39 -year-old man infected with H7N9 is currently in critical conditionAt 20:38 on December 15th, 2013China news agency, Guangzhou, December 15 (Reporter Tang Guijiang) - Health and Family Planning Commission of Guangdong Province on the 15th Bulletin, Dongguan, Guangdong discovered a new case of human infection of H7N9 patient was a 39 -year-old man is currently in critical condition in patients whose 53 close contacts through medical observation , currently found no abnormalities.According to reports, the patient was a 39 -year-old man surnamed Ho , Nanchong City, Sichuan Province , who now live in Fenggang Town, Dongguan City . December 14 , Dongguan Municipal Center for Disease Control and Prevention for testing their specimens , showing people infected with H7N9 avian influenza nucleic acid positive ; December 15 , Guangdong Province, the result is consistent with the CDC for review .After receiving the report , the Guangdong provincial CDC dispatched night guard Planning Commission and the First Affiliated Hospital of Guangzhou Medical University, Institute of Respiratory Diseases experts , to assist in the investigation and Dongguan patient treatment. Dongguan City, Guangdong Province, and the expert group to rescue the patient , and conduct epidemiological investigations immediately.Health departments of the 53 patients who were in close contact with medical observation , and given anti-flu drugs Tamiflu prophylaxis is not currently found abnormalities


...After preliminary investigation , the patient started on December 6 with fever , headache and fatigue and discomfort, did not improve after the self-medication , he worked in a local clinic , Fenggang town , 11 to Fenggang hospital treatment , 13 patients with dyspnea was progressively increased transferred to ICU treatment.
Currently , Dongguan City has launched a human infection with H7N9 avian influenza emergency response mechanism , sent municipal medical treatment expert group stationed in Fenggang Hospital and Medical Device with the best treatment , medical treatment under the guidance of the expert group of the province , to treat patients. Currently initially identified in close contact with the relevant medical staff and other patients and their families a total of 53 people , will be a week-long medical observation . Fenggang town in the area, all medical institutions will carry out surveillance of ILI cases of pneumonia and fever surveillance .

Add one case of H7N9 bird flu in Guangdong critically ill patients

At 18:27 on December 15 2013 Nanfang Daily , I have something to say ( 16 participants )Nanfang Daily ( Reporter / Correspondent Luo Xiao Hua / Guangdong Wilson ) afternoon , the Guangdong Provincial Health and Family Planning Commission informed , Guangdong new case of human infection of H7N9 avian influenza.

It is understood why some patients , male, 39 years old , Nanchong City , Sichuan Province , who now live in Fenggang Town, Dongguan City . December 14 , Dongguan Municipal Center for Disease Control and Prevention throat swab specimens of patients infected with human H7N9 avian influenza nucleic acid as positive. December 15 provinces by the CDC to review the results for the same. Currently patients in critical condition .
After receiving the report , the Provincial Planning Commission that night sent the provincial CDC Guardian First Affiliated Hospital of Guangzhou Medical College, Institute of Respiratory Diseases , Dongguan experts to assist in the investigation and treatment of patients . Provinces expert group to rescue the patient , carry out epidemiological investigations immediately on 53 close contacts were under medical observation , and given the anti- flu drug Tamiflu to prevent, not currently found exception.

: Failed « Central » in the diagnosis « Corona » kills Fawaz

Sakaka - Abdulaziz Nabati
Sunday, December 15th, 2013
Fawaz cruiser died young (37 years ) after spending more than two weeks in intensive care in a hospital in the city of Prince Abdul Rahman Al-Sudairy Sakaka without hospital diagnosed health condition accurately .

Friends and revealed a young man 's «life » that Fawaz wounded Pfyrus « Corona » since that enter the intensive care unit at the hospital , surprising discreetly from the hospital to detect the injury Fawaz Balvyrus .

He said that the hospital with a case of complacency Fawaz and not to deal with it as it should , that led to the bad condition of Fawaz health until his death yesterday .

Furthermore, din Mgrdon in the social networking site « Twitter » created Hashtaq behalf (# Fawaz _ cruiser _ need _ evacuation _ Urgent ) , anger after the announcement of his death yesterday , Mstgrbin of survival Fawaz in the hospital without evacuate to a specialized hospital until they are diagnosed condition and treatment in the absence of necessary medical potential in the central hospital .

The «life» published on ( Tuesday ) last topic about the inability of the central hospital for diagnosis if Fawaz , mention was made of the level of care low in the hospital « Central » , in addition to « confusion » of clinical staff and administration in the treatment of patients with Pfyrus « Corona » , has contributed to the spread of rumors several warns people of the region to come to the hospital because of an outbreak of the virus within the corridors of the hospital.

The Hospital, Prince Abdul Rahman Al-Sudairy is one of the oldest hospitals in the region and has conducted ongoing reforms did not intercede to him that has the confidence of the people of the region , and who rely too much on hospitals and specialized treatment centers at home and abroad for treatment.

Saturday, December 14, 2013

the death of Fawaz

The news
News Sakaka
Yes. Died before the death of Fawaz conscience and humanity before I went go Fawaz.
Yes. Died before the death of Fawaz conscience and humanity before I went go Fawaz.
02-11-1435 10:42 AM Hollow news: (private) Majid Al Rwaili

We were waiting for radiation sun and a glimmer of hope when you publish suffering (Fawaz cruiser), which suffered a lot during his stay intensive care and doctors are standing idly by., But disappointed hope and Antafit candle we thought that remain radioactive thanks to God and the hearts closed pulses toward the subject, despite the existence or humanity to it.
It was cheap that a person dies without stops wishers and health officials.
 Yeah Matt conscience before the death of Fawaz and went humanity before go Fawaz ... despite the fact that the newspaper story Hollow to publish the news a few days ago and installed to try to (treat) but to no avail due to lack of credibility of the future news from Ministry of Health officials oblivious to all the ills of the world as if it happened to one of those officials or their relatives ask God to one of wellness.

Fawaz cruiser after his family's appeal for health officials to more than once for the possibility of treatment and evacuated to a hospital specialist Despite his deteriorating health, and the difficulty of his condition, died today.

China detects H7N9 bird flu in Shenzhen

 Thursday, 12.12.2013, 12:04 (GMT +7)
(SGGPO.) - 12-12 days Xinhua reported that the Shenzhen health authorities declared detect avian influenza H7N9 virus in two cargo Gang and Kang Qiao. The second sample taken from the market gave a positive result for H7N9 virus.
Meanwhile, the Committee of Health and family planning said Guangdong H7N9 virus was detected in three samples of blood and urine taken from live poultry stalls in two markets in Longgang district also belong Shenzhen City.
Authorities conducted in Shenzhen H7N9 influenza virus in test markets after much doubt this is the source of new infections detected after 2 H7N9 influenza virus infection in Hong Kong (China). The first cases was a woman nationality Indonesian maid, who was traveling to the city of Shenzhen and have contact with live poultry in here. Second victim was a 80-year-old man from living in the city of Shenzhen.

Housewife detention on suspicion of being infected with bird flu Menoufia

Housewife detention on suspicion of being infected with bird flu Menoufia

Saturday 12/14/2013 - 13:33
Detained hospital fevers Shebin in Menoufia Governorate , housewife Batanoon resident in the village of the center after suspected of being infected with bird flu .Confirmed Dr. Hana pleasure Undersecretary of the Ministry of Health Menoufia had been detained toxicity Sharif 28 years old housewife, resident of the village of Batanoon Bmchwy diets after the appearance of the symptoms of flu Tabaor of Ge and diarrhea and high fever after coming into contact with domestic birds and dead animals .And Hughes added that it had been notified of the concerned authorities of Agriculture and Veterinary Medicine , and taking samples to be sent to the central laboratory for analysis and action.

«Health» faces «Corona» therapeutic and preventative and an awareness

Discuss scored the virus at a meeting in Kuwait b «World Health»

«Health» faces «Corona» therapeutic and preventative and an awareness

Saturday, December 14th, 2013
 At a time when Prime rapid intervention to counter the virus Corona d. Ghanem Hujaylan in a press statement recently that he was eliminated «virus», contain and cure the first case of the virus, in addition to intensify awareness campaigns in this area by the committee formed by the Undersecretary of the Ministry of Health. Khaled AlSahlawi headed by Dr.. Ghalia Al-Mutairi, and take the Ministry of Health all preventive measures and treatment in hospitals, health centers and ministry sectors different, which confirms the completeness and the readiness of the ministry to cope with the virus respects «therapeutic preventive awareness», the Commission on Emergency Health International Health Regulations WHO fourth meeting recently to discuss the reports of the amount of Kuwait, Saudi Arabia, Oman, Qatar and the United Arab Emirates and Spain for the Middle East syndrome cases of acute respiratory inflammation «Corona».
The meeting, which took about 4 hours system Talli conferencing details of the reported cases recently of the organization as well as evaluation of the epidemiological situation in the light of developments relating to new cases, and new information about the presence of the virus in the beauty, which is what has already been announced by Qatar and Saudi Arabia, note that in light of The new data saw the Emergency Committee of the World Health Organization that there was no reason to make any adjustments to its previous recommendations brought by the Director-General of the Organization, which confirmed by the Commission on the importance of strengthening the surveillance system and report any new cases and support the diagnostic capabilities and exchange of information between countries, also confirmed the Emergency Committee also on the importance of further epidemiological studies and try to detect the relationship between injuries related to isolate the virus in the beauty and animals and continue to infection control procedures and the emphasis on what recommended by the Commission before on strengthening the system of reporting and surveillance and infection control in hospitals and continuing communication between the Commission and the health authorities in WHO and the countries of the Middle East, and under the umbrella of the WHO International Health Regulations.
The meeting of the High-level effect of informing the organization about 3 cases additional confirmed cases of infection with respiratory syndrome Middle Eastern virus Coruna in the United Arab Emirates, as the organization has received a tip about the death of two of Qatar has been reaffirmed laboratory earlier on 15 and November 21, which is called Organization in light of those cases, in addition to the cases detected in Kuwait, to hold the fourth meeting of the Emergency Committee of the International Health Regulations, which already met on December 4, and includes those Committee Professor Hiriz Bajolet from Australia, Wed. Teresa Tam of Canada Wed. Salah Alaubi of Oman, Professor Tagiandra Aditama of Indonesia, and Dr. Martin will see from America, and Professor Claudia Gonzalez of Chile, Wed. Amnadesai prohibited from Georgia, Wed. Kamal al-Din virtue of Malaysia Dr. Jorn Larsen of Norway, Wed. Ziad Mamish of Saudi Arabia, Wed. Pope Carr Nodaway from Senegal, and Professor important role Rahman of Bangladesh, Professor Maha Talaat of the unit the U.S. Navy for Research in Cairo, Prof. Tomori of Nigeria, Professor Maria Zembon of Ireland.
World Health Organization in its latest report did not recommend any additional measures or special entry points currently does not recommend applying any restrictions on travel or trade, but that the organization has advised to avoid intense communion to animals when visiting farms or barns areas while avoiding contact with sick animals.

At the date of December 2 Organization announced that the total laboratory-confirmed cases that have been reported Alablagha since September 2012 has reached 163 laboratory-confirmed case he died, including 70 cases.
The organization stressed in its statement on the importance for Member States to notify WHO of any new cases of infection with full information about the conduct of inquiry about the source of exposure to infection in order to assist the organization to keep track of cases and prevent further transmission of the virus.
The d. Ghanem Hujaylan may also confirmed earlier that the injured cases infected with coronavirus in continuous improvement since entering the hospital, adding that the situation in intensive care hospital Adan has improved a great Chavt virus corona, and the device was removed, assistant lung function and breathing a a supply of oxygen directly into the blood and this is evidence of the patient's recovery and will later remove all devices assistance related to the patient fully and thus became the patient does not need insulation for the absence of the possibility of transmission of the virus and in the coming days will be transferred the patient to the pavilion after removing the devices connected to it, either the second case and the existing intensive care hospital communicable diseases has improved, but not at the required level with the health status of the patient is constantly evolving, but still connected to the device helper to work lung ventilator and still needs to supply blood oxygen directly as he needs to bring out the secretions dense existing lung but with the passage of days expected that his condition improved and we are still doing everything possible medical means to help him recover.
Health sources informed confirmed in a statement to «news» that coordination is still going on between the Doctors of communicable diseases at the Ministry of Health and their counterparts in Saudi Arabia for the exchange of the latest data and information on cases of «Corona», pointing out that he was talking also about the procedures and protocols for dealing with the injured and contacts , and laboratory diagnosis, as well as send samples to reference laboratories of the virus identified by the World Health Organization.

The sources said that the frequent meetings between the two sides showed a consensus in the application of the latest World Health Organization protocols for dealing with Corona and contacts to critical situations, pointing to continued coordination between the two parties in this regard and the exchange of information.
The sources pointed out the absence of any new cases of Corona virus in the country, stressing the readiness of health and preparations to face any emergency in this regard in all respects curative, preventive and awareness, where they were to take all preventive and curative measures in hospitals and health centers.
On the awareness, resume Awareness Committee virus «Corona» campaigns to increase awareness of HIV prevention, which included two phases to now, the first was during the pilgrimage season, and the second will continue until this time, and included schools, universities and colleges Saad Al-Abdullah for Security Sciences, and other places in order to spread health education for the prevention of corona virus.

The death of a citizen's Hospital Sudairi Sakaka

Proven case of Corona patient "Fawaz cruiser" and his family appeal to the Minister of Health quickly evacuated
News Hollow: Majid Al Rwaili lying young man / Fawwaz cruiser 37-year-old in intensive care hospital Abdulrahman Sudairi for more than 12 days in a coma folks patient said in a telephone interview with the newspaper, the news of Al-Jouf to put "Fawaz" grave and his condition is stable and during these days have not been diagnosed by doctors, raising fear and anxiety in our souls. and demanded across the news Hollow officials in the health Speed ​​evacuated to a specialized hospital until they are diagnosed and the speed of treatment update: confirmed doctors proven case of Corona by the tower will the people of the patient's daily news Hollow that the doctors said to them that after the suspicion was confirmed case "Fawaz" wounds of Corona was isolated today Chamber of private and prevent the visit with him. This development comes after the denial of health-Jouf and no cases of Corona in the region, which calls to reconsider and take the subject into consideration and not to underestimate the health of the citizens of this and appealed to the people of the patient and the health minister quickly evacuated, "Fawaz" to Hospital specialist after blunders by health Hollow  The death of a citizen's Hospital Sudairi b # Sakaka after the failure of early diagnosis of HIV # Corona and delays transferred to a specialized hospital # Ministry of Health _

Monday, November 11, 2013

Ten-Year-Old Kampot Boy Dies From Bird Flu

Ten-Year-Old Kampot Boy Dies From Bird Flu
By Mech Dara and Simon Henderson - November 11, 2013

A 10-year-old boy from Kampot province died of bird flu on Saturday bringing the total number of deaths from the virus to 13 this year, with 24 confirmed cases overall, according to the World Health Organization (WHO).
...See More
Ten-Year-Old Kampot Boy Dies From Bird Flu | The Cambodia Daily
A 10-year-old boy from Kampot province died of bird flu on Saturday bringing the total number of deaths from the virus

Thursday, November 7, 2013

Spain-Health studied 40 people in contact with the new virus

Health studied 40 people in contact with the new virus

  • Besides family, friends and health, has contacted the plane's passengers

  • The woman traveled to Saudi Arabia to Spain with respiratory symptoms

Electron micrograph of MERS-CoV (scanned image to ...
Electron micrograph of MERS-CoV (scanned image to color). CDC
Although this is an imported case and that there is a risk from the standpoint of public health, detection of the first case of Saudi coronavirus Spain was forced to launch a complex machinery of surveillance and prevention put on alert physicians, microbiologists, epidemiologists ... As confirmed by the Ministry of Health to THE WORLD right now especially is monitored 40 people who have been in contact with the Moroccan woman who remains hospitalized and stable Majadahonda Puerta de Hierro Hospital in Madrid.
Sources Ana Mato department heads explain that you are doing track "about 40 people between health, family and patients, who have had close contact" with the woman.
Spanish authorities are getting in contact with the persons of the flight near the woman traveled from Saudi Arabia to our country. Specifically, clarify, on the plane is considered 'contact' to those in two rows in a circle from the seat of the patient: "I mean, two passengers on the right and two left, two rows in front left and right and the same thing back. " In this case, as the configuration of the aircraft was three seats on each side of the aisle and as affected riding in the middle seat, you are analyzing only the two people traveling beside (in addition to the two rows in front and back).
Health authorities also include among this group contagion risk to members of the cabin crew that were in direct contact with the affected and health workers that could having attended at first without adequate protection (masks, gloves. ..)

Surveillance for 21 days

According to agreed protocols between Health and the CCAA for these cases, monitoring is recommended for two weeks all these people to monitor respiratory symptoms from appearing. Besides all epidemiological data were collected a blood sample in the first seven days (which will be analyzed at the National Center of Microbiology, Institute Carlos III) and, if they remain without symptoms, a second sample at 21 days.
Inmaculada Casas and Francisco Pozo, Unit Respiratory and Flu Virus Carlos III, explain that to confirm the diagnosis respiratory samples taken from both the upper respiratory tract (nasopharyngeal) and lower (bronchoalveolar lavage and tracheal aspirate sample even Sputum). "Do not forget that serum samples from symptom onset and after 10 days of onset of these symptoms are of great interest to perform serology studies that complement the information obtained from respiratory specimens."
As acknowledged by the Ministry in its document 'Procedure of action against infections with the new coronavirus (MERS-CoV)', aimed at health professionals, today is not known for how long you can keep infecting a patient, so that "all samples collected for laboratory investigation should be treated as potentially infectious." And that includes not only respiratory samples (sputum, bronchial aspirate, nasopharyngeal ...), but also the urine and feces, which also detected the presence of the virus.
According to this protocol, the woman remains isolated in a negative pressure room in Madrid hospital (with special filters and a lower pressure outside to open the door to anything you have on the environment pops out) and although presents a picture of pneumonia with severe respiratory problems, "the situation is stable and progressing well".
This is a 61 year old Moroccan citizen, resident in Spain, who traveled to Saudi Arabia between October 2 and November 1 (although whether traveled to participate in the pilgrimage to Mecca, health authorities had strengthened itself epidemiological surveillance for this reason). This is precisely the focus country of origin of this new respiratory virus, never before seen in humans. Since 2012 has affected some 150 people (mostly in Arabia and neighboring countries) and although it is a very high figure, especially concerned about the mortality rate of the virus, about 50%.
In Spain, this is the first time a case is reported with suspected coronavirus infection. 

Wednesday, November 6, 2013

Indonesia-Five pilgrims DIY Declared Suspect Had Mers-CoV

Thursday, November 7, 2013, 8:57 pmREPUBLIKA.CO.ID, YOGYAKARTA - Five pilgrims on their return to DIY DIY was declared suspect Mers-CoV (Middle East Respiratory Syndrome Corona Virus). They had been treated at Dr Sardjito (two people), Hospital Morangan-Sleman (one person), Hospital-Panembahan Senopati Bantul (one person), and Bethesda Hospital Yogya (one person).
'' From the Laboratory of the Ministry of Health (MoH) in Jakarta was declared negative,'' said Head of Prevention and Control of Health Department of Health Problems DIY Daryanto Chadorie.

Of these five, there was one person who died last Wednesday, which is being treated at Bethesda Hospital, but because of comorbidities. In fact, if there are mild cases of Mers-CoV health center can handle it, but when it's weight category should be referred to hospital.

Currently, hospitals in the province designated by the Ministry of Health as a referral hospital for Mers-CoV is Sardjito Hospital and Hospital Panembahan Senopati Bantul. Although the pilgrims had gone all DIY, DIY Health Department and staff remain alert to Mers-CoV.

'' To prevent lest Mers-CoV entry into DIY by screening at airports for passengers returning from countries that have no cases of Mers-CoV and high body temperature (38 degrees Celsius) to the top,'' he said. ,

Meanwhile Director General of Disease Control and Environmental Health, Ministry of Health, Prof. Tjandra Yoga Aditama, said a person who is declared "suspected" completely not necessarily mean pain. Most of the "suspect" bird flu, or "suspected" Mers CoV and others that ultimately negative laboratory results.

The term "suspect" made for caution to health care and screening forms for further detection, he said. All the people who are coughing, fever, no pneumonia, and home of the Arabian peninsula that could be categorized as a "suspect" Mers CoV. They then carefully examined in the laboratory, particularly with PCR.

'' If the result is negative, meaning that the patient was suffering from bacterial pneumonia. It's just by chance had just returned from Saudi Arabia and because it called "suspected" Mers CoV,'' he said.

Update: Middle East respiratory syndrome coronavirus (MERS-CoV)

November 05, 2013 - Update: Middle East respiratory syndrome coronavirus (MERS-CoV) ~ More cases reported
Reports: 14 13 12 11 10 > >>
Event Update: The Public Health Agency of Canada reports that since April 2012, Middle East respiratory syndrome coronavirus (MERS-CoV) cases have been identified in nine countries:  France, Oman, Italy, Jordan, Qatar, Saudi Arabia, Tunisia, the United Arab Emirates and the United Kingdom (UK). The initial cases in France, Italy, Tunisia and the UK were linked to travel to the Middle East. Some of the infections have occurred in clusters through close contacts or in a health care setting. This suggests that the virus can spread between humans, however, there has been no sustained person-to-person transmission and the risk of contracting this infection is still considered to be low.

To date, WHO has been informed of a global total of 150 laboratory-confirmed cases of infection with MERS-CoV, including 64 deaths. For the latest updates on MERS-CoV including the total number of cases and deaths please visit the World Health Organization’s Global Alert and Response website.
Coronaviruses are the cause of the common cold but can also be the cause of more severe illnesses including Severe Acute Respiratory Syndrome (SARS). At this time, there is still more to learn about this new strain of coronavirus. People who have been infected with MERS-CoV have experienced influenza-like illness with signs and symptoms of pneumonia, which may include coughing, mucous, shortness of breath, malaise, chest pain and/or fever. Many have also had gastrointestinal symptoms such as diarrhea.
The World Health Organization continues to work with relevant ministries of health and other international partners to support investigations to gain a better understanding of the disease and its risks. There continues to be no travel restrictions as the risk to travellers remains very low.
RecommendationsConsult a doctor, nurse or health care provider, or visit a travel health clinic at least six weeks before you travel.
1. Protect yourself and others from the spread of germs and flu-like illnessIf you are sick with symptoms from an flu-like illness, delay travel or stay home:• Travellers should recognize signs and symptoms of flu-like illness, and delay travel or stay home if not feeling well.
• Travellers should note that they may be subject to quarantine measures in some countries including Saudi Arabia if showing flu-like symptoms.

Wash your hands frequently:• Avoid touching your eyes, nose and mouth with your hands as germs can be spread this way. For example, if you touch a doorknob that has germs on it then touch your mouth, you can get sick.
• Wash your hands with soap under warm running water for at least 20 seconds, as often as possible.
• Use alcohol-based hand sanitizer if soap and water are not available. It’s a good idea to always keep some with you when you travel..

Practise proper cough and sneeze etiquette:• Cover your mouth and nose with your arm to reduce the spread of germs. Remember if you use a tissue, dispose of it as soon as possible and wash your hands afterwards.

Try to avoid close contact with people who are sick.
2. Stay up-to-date with your vaccinationsThere is no vaccine for this novel coronavirus, however, it is important to be up-to-date on all of your routine and recommended vaccinations, including this year's seasonal flu vaccine, prior to travel.

3. Be aware that the risk may be higher for travellers with chronic medical conditions (e.g.: diabetes, heart disease, kidney disease, respiratory disease) who may require medical care while abroad
4. Practice
safe water and food precautions.
5. Avoid close contact with live farm or wild animals.
6. Monitor your health
If you develop flu-like symptoms such as fever, cough and/or shortness of breath within 14 days after your return to Canada, especially if you have a chronic medical condition:
• Seek medical attention immediately.
• Tell your health care provider which countries you have visited while travelling.

For the latest updates on coronavirus including the total number of cases and deaths please visit the World Health Organization’s Global Alert and Response website.

H7N9 influenza Central Epidemic Command Center has recommended the Guangdong Provincial Tourism epidemic level raised, and the same as a Grade II Zhejiang: "Alert (Alert).

Mainland China and Hong Kong media reported on the 6th, Dongguan City, Guangdong determined following the new H7N9 avian influenza infection after one case, Jiaxing City, also reported a 64-year-old farmer women infected H7N9, but serious condition. H7N9 influenza Central Epidemic Command Center has recommended the Guangdong Provincial Tourism epidemic level raised, and the same as a Grade II Zhejiang: "Alert (Alert)." Dongguan case was a 3-year-old five-month-old boy with mild symptoms, is currently isolated observation; in this case this year, Guangdong Province, the first two cases.

MERS In Hajj Pilgrim Raises Transparency Concerns

Recombinomics Commentary 23:30
November 6, 2013
According to the director explained how the Coordinating Center and Emergency Health Alerts, Fernando Simón, it is "a woman of 61 years who was in Saudi Arabia between October 2 and November 1" and "initiated a respiratory symptoms with fever and cough on 15 October. "

After that, "the 28 and October 20 began a process in which he was diagnosed with pneumonia in a hospital in Saudi Arabia." Later, Simon explained that she "traveled back to Spain on November 1 and was diagnosed back in Puerta de Hierro".

The above translation provides additional information on the Hajj pilgrim (61F) who was MERS confirmed in Spain (see map).  She developed symptoms on October 15, during the Hajj.  Although the hospital in the Kingdom of Saudi Arabia (KSA) diagnosed pneumonia, they failed to identify the etiological agent, which was done is Spain.

Consequently, the pilgrim returned to Spain, leading to significant exposure of other passengers as well as contacts in Spain, including health care workers.  However, the vast majority of Hajj pilgrims did not come from Spain raising concerns that MERS was widely dispersed, although only Spain has reported a confirmed case and all recent confirmed cases in KSA were in Riyadh and the Eastern Region (primarily Jubail).

Many countries reported symptomatic returning pilgrims, but all reported cases were negative, including a fatality in Egypt who was H1N1pdm09 confirmed.

Detection of MERS is a challenge as seen by the failure of KSA to identify MERS in any of the millions of pilgrims participating in the Hajj.  The Spain pilgrim was hospitalized with pneumonia, which is similar to the Al Hasa outbreak where 11 cases were classified as probably because they had pneumonia and contacts with a confirmed MERS case, but were either not tested or only tested once.

The current confirmed case in Spain raises concerns that MERS was widely dispersed from KSA and largely missed by receiving countries.

Spain has first MERS case; woman went to Hajj

Health officials in Spain have detected a case of MERS in a woman who recently returned to the country after attending last month’s Hajj pilgrimage in Saudi Arabia.
The Spanish Ministry of Health said the woman was admitted to hospital in Madrid on Nov. 1 and is in stable condition. In its press release, the ministry said it is following up with people who were in contact with her to determine if others have contracted the sickness.
That will likely involve tracking people who travelled on the same plane or planes with the ill woman, who journeyed back to Spain from Saudi Arabia shortly before being hospitalized.
The woman was already experiencing signs of her illness before she left the Kingdom of Saudi Arabia, a World Health Organization expert said Wednesday.
“She became symptomatic while she was in KSA,” said Dr. Anthony Mounts, the WHO’s point person for the new virus, a cousin of the coronavirus that caused the 2003 SARS outbreak.
We understand that she did perform the Hajj and came back and was admitted to hospital in Spain and was tested there.”
Mounts did not know if the woman flew on a commercial airline or on one of the charter flights used by many who travel to Saudi Arabia for the Hajj, the massive annual international pilgrimage that draws Muslims from around the world to their religion’s most sacred sites, Mecca and Medina.
This year’s Hajj took place from Oct. 13 to 18, though pilgrims started converging on Saudi Arabia in late September and typically many remain in the country for a period afterwards. This woman is believed to have spent most of the month of October in the kingdom.
Countries elsewhere have been on the lookout for illness in their returning pilgrims. In the past couple of weeks there have been a number of false alarms where people ill with flu-like systems were identified as possible MERS cases. But until now, all have tested negative for the virus.
In fact, Mounts said earlier this week he felt the world might soon be able to conclude that the Hajj had not served as a transmission event to spread the virus from Saudi Arabia — which has recorded 125 of the 151 confirmed cases — to other parts of the globe.
On Wednesday, he said it may be too soon to conclude that yet.
“I think it does give us pause,” he said of the case. “I think it means that we really do have to wait a little while longer before we’re sure we’re out of danger.”

Detected a case of the new coronavirus in Spain

  • The patient, who remained during the month of October in Saudi Arabia, is stable

  • According to the Ministry of Health, 'no risk to public health in Spain'

  • To date 63 deaths have been reported and 150 cases confirmed

  • United Kingdom, Germany, France and Italy, other European countries with cases

Image of a strain of the family of coronaviruses.
Image of a strain of the family of coronaviruses. AFP
The Ministry of Health, Social Services and Equality has reported the detection of an imported case in Spain with laboratory evidence for human infection with the novel coronavirus. A pathogen of the same family as the SARS virus that generated 10 years ago 8,000 infections and 700 deaths.
The new affected woman is a resident of Spain, born in Morocco, who had traveled to Saudi Arabia and is admitted to the Hospital Puerta de Hierro Majadahonda (Madrid), where they have taken all over the case, well as possible contacts as operating procedures agreed between the Ministry and the autonomous.
According to the director explained how the Coordinating Center and Emergency Health Alerts, Fernando Simón, it is "a woman of 61 years who was in Saudi Arabia between October 2 and November 1" and "initiated a respiratory symptoms with fever and cough on October 15, "according to Efe.
After that, "the 28 and October 20 began a process in which he was diagnosed with pneumonia in a hospital in Saudi Arabia." Later, Simon explained that she "traveled back to Spain on November 1 and was diagnosed back in Puerta de Hierro".
At present, the patient has a "developing pneumonia with severe respiratory problem", while in "stable condition and evolving favorably"....

Tien Giang announced on avian flu A/H5N1

(TNO) Date 6:11, Tien Giang Province People's Committee issued Decision No. 2677/QD-UBND, announced A/H5N1 flu in poultry in two Tan Phu and Tan Thoi commune, Tan Phu Dong district.

PPC requires districts and mobilize all manpower, material resources necessary for the epidemic to epidemic areas, agriculture directed Veterinary Department, the units coordinate with the departments, organizations implementing prevention measures against A/H5N1 flu .
According to the Veterinary Department of Tien Giang, from 31.10 to 4:11, veterinary noted in 4 households in the area two Tan Phu and Tan Thoi have ducks disease and death. Total of 4 ducks are 938 households, of which, 315 557 children die of the disease. All ducks are 4 signs of bird flu and the test results were positive for influenza A/H5N1 virus. All the remaining ducks were destroyed functional forces.
So far, veterinary vaccinated more than 12,000 surrounded the cam/54 households in two communes in Tan Phu and Tan Thoi; while disinfection organized, sterile environment for the household and the household poultry disease neighborhood

Vaccine Approved for Japanese encephalitis

Vaccine Approved for Brain Fever

The World Health Organization has approved a new vaccine for a strain of encephalitis that kills thousands of children and leaves many survivors with permanent brain damage.
The move allows United Nations agencies and other donors to buy it.
The disease, called Japanese encephalitis or brain fever, is caused by a mosquito-transmitted virus that can live in pigs, birds and humans. Less than 1 percent of those infected get seriously ill, but it kills up to 15,000 children a year and disables many more. Up to four billion people, from southern Russia to the Pacific islands, are at risk; it is more prevalent near rice paddies.
There is no cure.
The low-cost vaccine, approved last month, is the first authorized by the agency for children and the first Chinese-made vaccine it has approved.
It is made by China National Biotec Group and was tested by PATH, a nonprofit group in Seattle with funding from the Bill and Melinda Gates Foundation.
Dr. Margaret Chan, W.H.O.’s director-general, said she hoped that approval would encourage other vaccine makers from China and elsewhere to enter the field.
China had given the vaccine domestically to 200 million children over many years but had never sought W.H.O. approval.
India, which previously bought 88 million doses from China, launched the first locally produced version last month.
A Novartis vaccine for Japanese encephalitis, Ixiaro, is approved by the Food and Drug Administration. But travel clinics charge $200 or more for it. Two weeks after the W.H.O. approved the Chinese vaccine, the F.D.A. granted Ixiaro’s maker seven years of exclusivity.

Spain press release on corona case

Press Releases

Detected an imported case of the new coronavirus in Spain

  • The patient had traveled to Saudi Arabia
  • The patient, who remained during the month of October in Saudi Arabia, is located in a favorable position and stable
  • The case does not pose a risk to public health in Spain
  • Health authorities have followed national and international procedures for dealing with this case
November 6, 2013.'s Ministry of Health, Social Services and Equality has reported the detection of an imported case in Spain with positive laboratory results for human infection with the new coronavirus.
This is a woman living in Spain, born in Morocco, who had traveled to Saudi Arabia and is admitted to the Hospital Puerta de Hierro Majadahonda (Madrid), where they have taken all over the case, and on possible contacts as operating procedures agreed between the Ministry and the autonomous.
The patient, who was admitted on November 1, remains in a favorable and stable. The samples analyzed in the National Microbiology Center have tested positive to the new coronavirus infection.
The Ministry and the Community of Madrid are proceeding to identify all close contacts of the patient, as recommended in the procedures agreed at national and international level.
An imported case in which all these measures have been established, no risk to public health in Spain.
Following the provisions of the International Health Regulations, the Ministry of Health, Social Services and Equality has notified the World Health Organization and the European rapid alert network (EWRS), with which it maintains close monitoring of the situation, together with the Ministry of Health of the Community of Madrid.
The Respiratory Syndrome coronavirus Middle East was identified in 2012 in Saudi Arabia. Most people affected by this respiratory virus acute respiratory disease presents with fever, cough and difficulty breathing.
To date there have been reported 150 confirmed cases, 125 of them in Saudi Arabia. All cases have been reported in five countries in the Middle East (Saudi, Jordan, United Arab Emirates, Qatar and Oman). In Europe there have been cases, all imported from this area, in four countries: United Kingdom (two cases), Germany (two cases), France (one case) and Italy (one case).

Friday, July 5, 2013

MERS coronavirus doesn’t yet have pandemic potential yet, but Hajj, other factors could change disease:

The new MERS coronavirus currently doesn’t spread well enough among people to trigger a pandemic, says a new study that calculates the rate at which the virus is transmitting person to person.
But the senior author says the pattern of how the virus is spreading now cannot be used to predict whether MERS will become a bigger threat in the future.
“There is absolutely no guarantee that this virus will stay as it is. It could very well follow the same path as SARS did 10 years ago,” Dr. Arnaud Fontanet, who heads the emerging diseases epidemiology unit at the Institut Pasteur in Paris, said in an interview.

‘Closer to SARS than anything else’: MERS virus in Saudi Arabia moved between humans with ease: study

A long-awaited report on a large and possibly still ongoing outbreak of MERS coronavirus in Saudi Arabia reveals the virus spreads easily within hospitals, at one point passing in a person-to-person chain that encompassed at least five generations of spread.
The study, co-written by Toronto SARS expert Dr. Allison McGeer, also hints there may have been a superspreader in this outbreak, with one person infecting at least seven others.
Read more…
Others too say the study should not be used to write off the new virus.
“The virus has shown a potential for human-to-human transmission. And whether such transmission is sustained depends on the intensity of control measures as well as the characteristics of the people involved in transmission,” said Marc Lipsitch, an infectious diseases specialist who teaches at Harvard University.
“For that reason, I think it’s premature to say that this virus does not present a pandemic threat.”
The study, published in the journal The Lancet, analyzes what is known about how often people who have been infected with the MERS virus spread it to one or more other people. The authors used the data to calculate what is called the basic reproduction number, known in the parlance of infectious diseases as the R nought.
In order for a disease to achieved sustained spread, the average infected person must spread a bacterium or virus to at least one other person. That is an R nought of one. A pathogen with a basic reproduction number of less than one would peter out.
‘I think it’s premature to say that this virus does not present a pandemic threat’
The measles virus, which is very contagious, has a basic reproductive number of between 12 and 18, meaning that among people who are susceptible to the virus, each infected person would be expected to pass the virus to between a dozen and 18 other people. In a 2003 study in the journal Science, Lipsitch and colleagues estimated the R nought of SARS to be three.
Using the publicly available data on MERS cases, Fontanet and his co-authors set out to figure out what the basic reproduction number for the new coronavirus has been to date.
There are many holes in the available data. For instance, Saudi Arabia, which is responsible for 63 of the 77 confirmed MERS cases, often does not disclose if new infections have links to previous ones — which might mean they caught the virus from another person — or are what are called sporadic cases, people thought to have been infected by an animal or exposure to the virus in the environment.
The authors tried to work around the gaps by calculating best- and worst-case scenarios. Both, it turns out, came up with a reproductive number of less than one, which suggests the virus doesn’t yet have pandemic potential, they said. Those rates were 0.60 and 0.69 respectively.
The authors noted that in the early stages of SARS it had a reproductive number of 0.80, closer to one than what is currently seen with the MERS virus. But they suggested that even though the viruses are cousins, people should be cautious about drawing too many comparisons because the viruses are different and have cropped up in different parts of the world.
SARS emerged from crowded southern China, where a taste for wild meat brought people in contact with SARS-infected civet cats. So far MERS infections have been traced only to Middle Eastern countries. While the ultimate reservoir of the virus is presumed to be bats, it is also thought that some animal species is acting as a bridge, bringing the virus from bats to people. So far, though, the source of the virus has not been identified.
Experts familiar with MERS or with the process of calculating a basic reproductive number echoed Fontanet’s suggestion that people should not over-interpret the study’s findings.
‘I just don’t think there’s any way of knowing what the future holds for MERS’
“The difference between what’s going on with MERS now and SARS then is only that MERS doesn’t seem to be moving at the same pace,” said Dr. Allison McGeer, an infectious diseases expert who was involved in Toronto’s battle against SARS and who has travelled twice to Saudi Arabia to help investigate its MERS outbreak.
“I just don’t think there’s any way of knowing” what the future holds for MERS, McGeer said. “It’s going to do what it likes.”
She had some concerns about the designation of cases as sporadic or linked in the Lancet paper, noting the authors suggested an outbreak in a hospital in Dammam in eastern Saudi Arabia was not linked to another large outbreak in several hospitals in Al-Hasa.
In fact, the Dammam cases are an extension of the Al-Hasa outbreak, she said, though she acknowledged that information has not been clearly stated. McGeer helped investigate the Al-Hasa outbreak and was a major author on a recent New England Journal of Medicine article on it.
Meanwhile, a commentary published with Fontanet’s study stresses that the MERS virus could evolve by developing mutations that allow it to be more transmissible among people. That is known to have happened with the SARS virus.
And the commentary, by researchers from the applied mathematics department of the University of Waterloo in Waterloo, Ont., said the future behaviour of the virus could also be affected by factors like changes in the season, or events like the Hajj, in which as many as three million pilgrims from around the world flock to the Muslim faith’s holiest site, Mecca.
‘We’re definitely not out of the woods’
“In terms of what the public should take home from this, it’s that we’re definitely not out of the woods,” said Waterloo’s Chris Bauch.
“It could go up not only because it [the virus] evolves but because the Hajj is coming up. And not only are you going to have slaughter of (potentially) infected animals, but you’re also going to have a possibility for transporting it to other countries.”
Fontanet said the priority now should be finding the source of the virus and limiting the chances it has to spread to people. The more times the virus infects people, the more chances it has to develop mutations that would help it adapt to spreading easily among humans, he said.
“It’s precisely because it is not yet that transmissible that it’s the perfect timing for identifying the animal reservoir and stopping it at the source,” he continued.
“If that had been done for SARS 10 years ago when it was circulating in southeast China before moving to Hong Kong and the rest of the world, it might have prevented a pandemic.”

WHO forms emergency committee on new MERS virus

The World Health Organization says it has set up an emergency committee of experts to keep an eye on the new MERS virus that’s killed 42 people, most of them in Saudi Arabia.
There’s no evidence the virus has started to cause a pandemic – a global outbreak of disease. And a study published on Friday shows that by one measure, the virus isn’t infectious enough to cause one – yet.
But WHO and other health experts say the virus is very worrying.
"We want to make sure we can move as quickly as possible if we need to,” said Dr. Keiji Fukuda, WHO’s top flu expert.
"If in the future we do see some kind of explosion or if there is some big outbreak or we think the situation has really changed, we will already have a group of emergency committee experts who are already up to speed so we don't have to go through a steep learning curve,” Fukuda told a news conference.MERS (short for Middle East respiratory syndrome) broke out just over a year ago in Saudi Arabia. WHO has official confirmation of 79 cases and 42 deaths – a rate that shows the virus is extremely deadly.
One of the latest deaths – a Qatari man who had been in a London hospital since September.
A single patient can infect many others. MERS is a relative of the severe acute respiratory syndrome (SARS) virus that spread globally from China in 2003, killed 775 people and infected close to 800 before it was stopped.
SARS spread in what are known as clusters in which certain people seemed to be far more infectious than others. These “superspreaders” infected groups of health care workers or others they came into contact with. There’s some evidence MERS might spread that way sometimes, too, although not always.
And any virus is just an airplane ride away from anywhere else in the world. SARS spread slowly within China for weeks or months before travelers carried it globally. In one notorious instance, an infected traveler became sick and threw up in a Hong Kong hotel. He infected seven other people, who eventually carried the virus to Canada, Vietnam, Singapore and elsewhere in Hong Kong.
MERS has been reported in Jordan, Qatar, Saudi Arabia, and the United Arab Emirates (UAE), France, Germany, Italy, Tunisia and Britain. MERS has not been seen in the United States, although a handful of travelers have been tested for the virus, according to the Centers for Disease Control and Prevention.
One reason experts are especially worried about MERS is that it has spread in hospitals and clinics. Also, Saudi Arabia will host the annual Hajj, with its influx of millions of observant Muslims from all over the world, in October.
But there’s some reassuring news. A French team has calculated the infectiousness of MERS and found it’s not yet as transmissible as measles, smallpox or even flu in a bad year.
Arnaud Fontanet of the Pasteur Institute in Paris and colleagues looked at a measure called R0, which reflects how many other people an infected person might transmit a disease to.
“When R0 is above 1, epidemic potential has been reached,” Fontanet’s team writes in the Lancet medical journal.
“With our most pessimistic scenario, we estimated MERS-CoV (MERS coronavirus) R0 to be 0.69; by contrast, the R0 for prepandemic SARS-CoV (SARS coronavirus) was 0.8,” they added.
“Our analysis suggests that MERS-CoV does not yet have pandemic potential.”
To compare, R0 for measles and whooping cough is 12 or higher in unvaccinated groups, for polio it’s between 5 and 7, and for HIV it’s between 2 and 5.
Researchers found after SARS was over that it had repeatedly passed from animals to people in China, mutating in the process until it took on a form that more easily infected people and that more easily passed from person to person.
“The same sequence of events might be occurring with MERS-CoV, which has been repeatedly introduced into the human population for more than a year (from an unknown animal host) and might have human pandemic potential,” Fontanet’s team wrote.
SARS was eventually traced to bats and an animal called a civet, a delicacy in China. Scientists suspect MERS also comes from an animal, but they haven’t been able to find the source yet.

Tuesday, June 11, 2013

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

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

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

International collaboration needed to find elusive source of MERS virus


Helen Branswell, The Canadian Press
Tue, 11 Jun 2013 14:49:00 CST
A colorized transmission of the MERS coronavirus that emerged in 2012 is shown. THE CANADIAN PRESS/HO, National Institute for Allergy and Infectious Diseases
TORONTO - International collaboration will be needed to find the source of the elusive MERS virus, says a Canadian SARS expert who has been involved in efforts to investigate and contain an outbreak of the new coronavirus in Saudi Arabia.
Health officials in the kingdom have put a lot of work into finding and containing the virus — more work, actually, than has been publicly disclosed, Dr. Allison McGeer said in an interview.
But she said with comparatively few cases to investigate spread out over a number of countries, puzzling out where the virus lives in nature and how people are contracting it will take a bigger effort than has been made to date.
"The Kingdom of Saudi Arabia has done a lot of work in the investigation of both the human-to-human transmission (cases) and the source of community infections, but it's very clear that a great deal more work needs to be done," said McGeer, who just returned from her second MERS-related trip to Saudi Arabia.
"And that a very substantial amount of international collaboration is the only way that we're going to be able to move knowledge about this virus forward at the speed that everybody wants to see it move."
McGeer was one of the members of a World Health Organization-led mission to Saudi Arabia to investigate the country's MERS outbreak. The team concluded its six-day mission on Sunday. On Monday, it released a statement warning health-care workers around the globe to be on the lookout for the new virus because of its proven capacity to spread.
McGeer, who is head of infection control at Toronto's Mount Sinai Hospital, also travelled to Saudi Arabia in May at the request of the Saudi government to help investigate an outbreak in a hospital in Al-Ahsa, in the eastern part of the country. McGeer was a major player in Toronto's SARS response in 2003 and even contracted the virus during the early days of the virus's spread through city hospitals.
The SARS and MERS viruses are cousins, both members of the coronavirus family.
McGeer said it appears the hospital-based outbreak in Al-Ahsa may be over, though there is still one facility where there remains a possibility of additional cases caused by person-to-person spread.
Saudi officials have to date only publicly acknowledged spread in one or possibly two hospitals in Al-Ahsa. McGeer said in fact the Al-Ahsa outbreak has involved person-to-person spread in several hospitals, though she declined to specify how many facilities have been involved.
"In the majority of facilities, the outbreak appears to be under control, although it's really important to recognize that because this (disease) has a long incubation period, that you can't declare an outbreak over (too soon)," she said.
"One of the lessons from SARS was about not declaring an outbreak over until a long enough period of time has passed."
In Toronto, an assumption that spread of SARS had been interrupted led the Ontario government to declare victory against the virus in mid-May of 2003. Hospital workers were told they no longer had to wear the N-95 respirators that shielded their mouths and noses and many quickly doffed the hot and cumbersome equipment. Within days, sick health-care workers started to show up in emergency rooms, signalling the virus was still spreading in the city's hospitals.
McGeer suggested the fact that the Al-Ahsa outbreak appears to be coming under control is good news for those concerned about the spread of the virus to other parts of the world — or at least to parts of the world with strong health-care systems. The WHO has voiced concerns about the possibility that guest workers — citizens of Bangladesh, the Philippines and other parts of Asia who work in Saudi Arabia — could take the virus home with them and trigger outbreaks in less developed countries.
"The hospital person-to-person transmission appears to be manageable. It may not be easy. But it appears to be manageable, at least in the developed world," she said. "But the critical piece of understanding this virus is understanding what the reservoir is and how people get infected in the community."
McGeer offered some insight into why that is proving to be such an enormous — and frustrating — challenge.
While there have been 55 confirmed cases of MERS, in reality there have been relatively few cases that could be described as index cases — people who were infected by contact with the virus's source. Quite a few of the cases — McGeer would not say how many — have likely been infected through limited person-to-person spread.
That latter type of case can teach public health officials about the conditions under which the virus can spread from person to person. But to find the source of the virus, they have to investigate cases where it is clear the infection came from a non-human source. And with relatively few such cases, spread over a number of countries, co-ordinating the search has proved difficult, she said.
"We get back to there's a really small number of cases, they're in a bunch of different countries, the process of doing the exploratory work to figure out what exposures might be important has to happen with people ... on the ground in all those countries talking to each other on a regular basis," McGeer said.
"That's not something we're set up to do. It's really hard to get that organized and working well."
Adding to the complexity is the fact that a successful epidemiological investigation will require someone who understands the culture of the countries in which infections are taking place, someone who can decipher the clues seen in the pattern of cases to date. Most have been in men. Many cases have been seen in travellers — men from Britain, Italy and Tunisia who travelled to Saudi Arabia, a man from France who travelled to the United Arab Emirates.
"There's a bunch of hints in the data we have so far about the cases. But that's exactly what they are," McGeer said. "And they do help to some degree guide how you should do the investigation. But they're not enough for somebody to say: 'Ah! It's the dates.'"
Saudi Arabia's Eastern Province is a major date-producing area, and people have mused about the possibility that virus from bats may be contaminating dates in some way. (The genetic sequence of the virus suggests it originated in bats.) But McGeer noted it isn't currently date harvest time.