Tag Archives: pandemic

Oman’s Ministry of Agriculture Weighs In On MERS-CoV In Camels

Oman spins image
Photo Credit Wikipedia

 
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Our MERS-centric Monday continues with yet another announcement from an Omani Ministry following the update this morning that 5 people have been infected in Oman, and two have died. 

This time it is from the twitter account of the Oman Ministry of Agriculture and Fisheries (MAF), which appears to reassure that local camel herds have been tested for MERS-CoV and are negative for the virus.

The translatable text from the tweet reads:

The ministry confirms the absence of the cattle and camels in the Sultanate of the Middle East Respiratory Syndrome (Corona) virus

 

https://twitter.com/agrifishoman/status/1092397489926344712

A (translated) media report (below) – while slightly syntax challenged – appears to reassure that camels in and around where these human cases were detected have been tested, and are negative for the virus.

Agriculture confirms the absence of cattle and camels in the Sultanate of the Corona virus

February 4, 2019

Monitoring – Oman affairs:

The Ministry of Agriculture and Fisheries in a statement published today on its account in the blogging site “Twitter” that it followed what is being circulated through social media about the presence of human infections with the virus of the Middle East respiratory syndrome (Corona), adding that the Ministry – earlier – immediately received The preliminary information of the infected cases in coordination with specialists in the Ministry of Health, and also conducted the sampling and taking the necessary samples and follow the herds of cattle and camels in the country of citizens suspected of infection, noting that the results of laboratory tests showed the absence of these animals from the virus.

The ministry offered sincere condolences and condolences to the families of the two deceased, may Allah be pleased with them.

The Ministry also confirmed in its statement that the herds of livestock in the Sultanate are free from the Middle East Respiratory Syndrome virus to date, as well as the continued efforts of specialists in the investigation, surveys, sampling and laboratory analysis.

The ministry urged animal breeders, especially camels, to abide by all necessary precautions when dealing with different animals.

 
It is worth noting that six years ago, when camels were first implicated in the carriage and transmission of the MERS virus (see Lancet: Camels Found With Antibodies To MERS-CoV-Like Virus) that antibodies to the MERS coronavirus were detected in all 50 of the dromedary camel samples gathered (from multiple locations) in Oman.

Camels, however, only shed the virus (and test positive by PCR) for a few weeks, making the detection of an active infection problematic (see EID Journal: Replication & Shedding Of MERS-CoV In Inoculated Camels).

In 2017, in MERS-CoV In Camels: The Gift That Keeps On Giving, we saw a study that demonstrated that camels can be reinfected by the MERS virus, despite having substantial antibody titers.

Even so, camels will test negative for the virus for all but a few weeks of their life.

So the statement that `herds of livestock in the Sultanate are free from the Middle East Respiratory Syndrome virus’ has to be taken both in context and with a grain of salt.

     

WHO Update & Risk Assessment: Hantavirus Pulmonary Syndrome – Argentine Republic

Chubat%2BArgentina.png

Credit Wikipedia

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Nine days ago, in Argentina’s Growing Hantavirus Outbreak, we looked at an unusually large cluster of hantavirus cases – which began in late November – in the small village of Epuyén in the Patagonian province of Chubut.

At that time there were reportedly 28 cases and 10 deaths, including media reports of a 29 year-old nurse who died in neighboring Santiago, Chile (see Hantavirus travels to Argentina and arrives in Chile: nurse dies in Santiago).

Today the World Health Organization has published a large update and risk assessment on the outbreak. Although the number of new cases have dropped markedly over the past 3 weeks (n=3), due to the long incubation period (1-8 weeks) of the Andes Hantavirus, additional cases could turn up.

I’ve only posted excerpts from a much longer WHO report.  Follow the link to read it in its entirety.

Hantavirus Pulmonary Syndrome – Argentine Republic


Disease outbreak news
23 January 2019

On 19 December 2018, the Argentinian Ministry of Health and Social Development issued an epidemiological alert regarding an increase in cases of hantavirus pulmonary syndrome (HPS) in Epuyén, Chubut Province. Between 28 October 2018 – 20 January of 2019, a total of 29 laboratory-confirmed cases of HPS, including 11 deaths have been reported in Epuyén, Chubut Province. Epuyén has a population of approximately 2 000 persons, and Chubut Province is located in Patagonia in southern Argentina.

The index case had environmental exposure prior to symptom onset on 2 November, and subsequently attended a party on 3 November. Six cases who also attended the party experienced the onset of symptoms between 20-27 November 2018.

An additional 17 cases, all of whom were epidemiologically-linked to previously confirmed cases, experienced symptom onset between 7 December 2018 and 3 January 2019 (Figure 1). Potential human-to-human transmission is currently under investigation.

Of the confirmed cases, 59% were female, and had an incubation period ranging from 8 to 31 days. Approximately 50% of these confirmed cases reported symptoms within the past three weeks. Cases were confirmed by ELISA IgM u-captura or by polymerase chain reaction (PCR).

As of 17 January 2019, a total of 98 asymptomatic contacts have been identified and are being monitored for the potential development of symptoms.

In Argentina, four endemic regions have been identified: North (Salta, Jujuy), Centro (Buenos Aires, Santa Fe, and Entre Ríos), Northeast (Misiones) and Sur (Neuquén, Río Negro, and Chubut). Between 2013 and 2018, an average of 100 confirmed cases were registered annually, with the provinces of Buenos Aires, Salta, and Jujuy having the highest numbers of cases. Between 2013 and 2018, 114 confirmed deaths from hantavirus were reported in Argentina, with a case-fatality rate of 18.6%, though this figure was close to 40% for some provinces in the southern region of the country.

In Chile, one of the confirmed cases was a healthcare worker who resides in Palena Province, Los Lagos Region, and reported experiencing symptoms on 2 January 2019. The case had a travel history to Epuyén for one day in mid-November, and later hosted and cared for a confirmed case from Epuyén while she was in her prodromal phase. This is the first confirmed case of hantavirus in Los Lagos Region in 2019. During 2018, there were eight cases of hantavirus reported in Chile, including two deaths.

Figure 1. Distribution of confirmed cases of HPS by week of symptom onset in Epuyén, Chubut Province, Argentina.

https://www.who.int/csr/don/23-January-2019-hantavirus-argentina/en/

 SNIP)

WHO risk assessment

HPS is a zoonotic, viral respiratory disease. The causative agent belongs to the genus Hantavirus, family Bunyaviridae. The infection is acquired primarily through inhalation of aerosols or contact with infected rodent excreta, droppings, or saliva of infected rodents. Cases of human hantavirus infection usually occur in rural areas (e.g. forests, fields, and farms) where sylvatic rodents hosting the virus might be found and where persons may be exposed to the virus.

This disease is characterized by headache, dizziness, chills fever, myalgia, and gastrointestinal problems, such as nausea, vomiting, diarrhea, and abdominal pain, followed by sudden onset of respiratory distress and hypotension. Symptoms of HPS typically occur from two to four weeks after initial exposure to the virus. However, symptoms may appear as early as one week and as late as eight weeks following exposure. The case-fatality rate can reach 35-50%.

In the Americas, HPS cases have been reported in several countries. Environmental and ecological factors affecting rodent populations can have a seasonal impact on disease trends. Since the reservoir for hantavirus is sylvatic rodents, mainly Sigmodontinae species, transmission can occur when people come in contact with the rodent habitat. Limited human-to-human transmission of HPS due to Andes virus in Argentina has been previously documented. There are no specific evidence-based procedures for HPS patient isolation. Standard precautions1 should always be put in place, as well as rodent control measures.

        (Continue . . . .)

Hong Kong’s Flu Express Wk 2: A Rapid Increase In Institutional Outbreaks

pandemic time again – two weeks until Lunar New Year

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We’re seeing a highly variable 2018-2019 Northern Hemisphere flu season, with Canada and South Korea kicking off very early, while Russia – which over the past two decades has seen a shift to earlier flu seasons (see Eurosurveillance: Changes In Timing Of Influenza Epidemics – WHO European Region 1996-2016 –  still remains far below their epidemic threshold (see Russia Influenza Surveillance Week 1, 2019).

Last week Hong Kong announced they had passed their epidemic threshold – and like most of the globe – is reporting mostly H1N1, which typically has a greater impact on younger people than does H3N2.

A good illustration of this demographic impact is the chart (above) showing an impressive 30-fold increase in institutional (mostly school) outbreaks in Hong Kong over the previous reporting week.  This is their biggest, and fastest ramp up in recent memory.

Over the past 3 days Hong Kong’s CHP has announced investigations into numerous influenza outbreaks, including:

CHP investigates case of severe paediatric influenza A infection and outbreaks of influenza A at primary school and kindergartens

Update on cluster of Influenza A cases in Kowloon Hospital

CHP investigates cases of severe paediatric influenza A infection and outbreaks of influenza A and influenza-like illness at kindergartens

CHP investigates influenza A outbreaks at kindergarten-cum-child care centre and primary school 


One week into their flu season and already hospitals are getting slammed,  with yesterday’s average hospital occupancy rate reaching 111%.  With the Chinese New Year’s celebration only about 2 weeks away – where millions of families will gather all over Asia – these numbers could continue to rise.

http://gia.info.gov.hk/general/201901/17/P2019011700277_301958_1_1547690981807.pdf



The headlines in the South China Morning Post (SCMP) this morning – just one week into their flu season – highlight the pressures their healthcare system is already under.

Nurses plan protest as Hong Kong’s public hospitals reach flu season breaking point

Medical staff having to work extra shifts and skip meals to care for influx of flu patients

Bed occupancy rate across Hong Kong’s public hospitals reached average of 111 per cent on Wednesday
PUBLISHED : Thursday, 17 January, 2019, 1:26pm

 Some excerpts from today’s much longer CHP Flu Express follow:

VOLUME 16, NUMBER 02 (PUBLISHED ON Jan 17, 2019)

FLU EXPRESS

Flu Express is a weekly report produced by the Respiratory Disease Office of the Centre for Health Protection. It monitors and summarizes the latest local and global influenza activities.s.

Local Situation of Influenza Activity (as of Jan 16, 2019)

  • Reporting period: Jan 6 – 12, 2019 (Week 2)The latest surveillance data showed that the local influenza activity increased markedly last week.
  • Currently the predominating virus is influenza A(H1).
  • Children aged under 6 years were particularly affected as reflected by the very high number of outbreaks of influenza-like illness (ILI) in kindergartens and child care centres, as well as
    influenza-associated admission rate in public hospitals among children aged below six years.
  • Among the severe influenza cases in adults, persons 50-64 years constituted a relative higher proportion (36%), as compared with 15% and 20% during the 2017 summer season predominated by influenza A(H3) and the 2017/18 winter season predominated by influenza B respectively.
  • Influenza can cause serious illnesses in high-risk individuals and even healthy persons. Given that seasonal influenza vaccines are safe and effective, all persons aged 6 months or above except those with known contraindications are recommended to receive influenza vaccine to protect themselves against seasonal influenza and its complications, as well as related hospitalisations and deaths.

(SNIP)

Global Situation of Influenza Activity In the temperate zone of the northern hemisphere influenza activity continued to increase slowly. In East Asia, influenza season appeared to have started, with predominantly influenza A(H1N1)pdm09 detected. In Europe, influenza activity increased, with both A viruses circulating. In the temperate  zones of the southern hemisphere, influenza activity returned to inter-seasonal levels with exception of some parts in Australia. Worldwide, seasonal influenza A viruses accounted for the majority of detections.

  • In the United States (week ending Jan 5, 2019), influenza activity remained elevated. The proportion of outpatient visits for ILI decreased from 4.0% to 3.5%, but remained above the national baseline of 2.2%. The percent of respiratory specimens testing positive for influenza decreased to 12.72% from 16.58% recorded in the previous week. Influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B viruses continued to co-circulate.

  • In Canada (week ending Jan 5, 2019), influenza activity remained high. The influenza season started in late October which was earlier than in recent years. Laboratory detections for influenza declined from the previous week, suggesting that nationally the influenza season may have reached peak levels in the last week of December. Influenza A was the most common influenza virus, and the majority of these viruses were A(H1N1)pdm09.

  • In the United Kingdom (week ending Jan 6, 2019), there was evidence that influenza was now circulating in the community as activity indicators breached baseline threshold levels at low intensity. The positivity of influenza detection was 16.4%, which was above the baseline threshold of 9.2%.

  • In Europe (week ending Jan 6, 2019), influenza activity continued to increase. 44.6% of sentinel specimens were tested positive for influenza virus. The majority of influenza virus detections were type A. Both influenza A(H3N2) and A(H1N1)pdm09 viruses were detected.

  • In Mainland China (week ending Jan 6, 2019), influenza activity in southern and northern provinces continued to increase, reaching the peak of the influenza season currently. Influenza viruses detected were mainly influenza A(H1N1), followed by influenza A(H3N2), and there were few influenza B(Victoria) and B(Yamagata) detections.

  • In Taiwan (week ending Jan 12, 2018), influenza activity increased significantly and was above the national baseline. Influenza A(H1N1) (43.1%) and A(H3N2) (29.4%) viruses co-circulated in the community in recent four weeks.

  • In Macau (Jan 16, 2019), influenza activity remained at the peak level. The proportions of ILI cases in emergency departments among both adults and children remained at a high level, and were on an
    increasing trend. The proportion of influenza detections reached 42% in the first two weeks of 2019. Influenza viruses detected were influenza A(H1) (75%) and influenza A(H3) (25%).

  • In Japan (week ending Jan 6, 2019), influenza activity continued to increase and the influenza season started in early December. The average number of reported ILI cases per sentinel site increased to 16.30 in the week ending Jan 6, 2019, which was above the baseline level of 1.00. The predominating virus in the past four weeks was influenza A(H1N1)pdm09

(Continue . . . )

 
During the run up to last year’s Chinese New Year’s Holiday – during an unusually severe influenza B season – Hong Closed Schools & Called For Stringent NPIs To Combat Flu. According to an EID analysis published last November, the decision was made after the peak of the outbreak, and only had modest effect.

Mitigation of Influenza B Epidemic with School Closures, Hong Kong, 2018

Abstract

In winter 2018, schools in Hong Kong were closed 1 week before the scheduled Chinese New Year holiday to mitigate an influenza B virus epidemic. The intervention occurred after the epidemic peak and reduced overall incidence by ≈ 4.2%. School-based vaccination programs should be implemented to more effectively reduce influenza illnesses.

Although school closures can be disruptive – particularly to working families –  previous studies have shown a more profound effect can be achieved when the trigger is pulled earlier.

As no two flu seasons are ever alike, a one size-fits-all solution isn’t guaranteed to work.  It will be interesting to see what Hong Kong decides to do this year, based on the conflicting results from past school closures.

Argentina’s Growing Hantavirus Outbreak

Chubat%2BArgentina.png
Credit Wikipedia
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Hantaviruses – which are carried by rodents in many parts of the world – are contracted by humans primarily through the inhalation or ingestion of aerosolized rodent feces, urine, saliva.
Once infected, however, humans are sometimes able to transmit the virus to those they are in close contact with. 
Scientists have identified dozens of viruses within the genus Hantavirus (named after the Hantaan River of Korea), with mortality that varies from 1%-2% for some varieties (i.e. Seoul Virus, Puumala Virus) to more than 30% for the North American Sin Nombre and South American Andes Virus.

In humans, there are two severe (sometimes fatal) diseases caused by Hantavirus: Hemorrhagic Fever with Renal Syndrome (HFRS) and Hantavirus Pulmonary Syndrome (HPS). 

HFRS is found in Europe, Asia, and Africa, while HPS is found in the Americas (North, Central and South).  
 
While relatively rare, every year the U.S. reports between 10 and 50 Hantavirus Pulmonary Syndrome (HPS) cases, of which, roughly 35% prove fatal. Cases have been reported in 35 states (see map below), with 96% of all cases reported west of the Mississippi River.


Hantavirus%2BUS.png



For the past few days there have been reports of an unusually large outbreak of Hantavirus in the small village of Epuyén in the Patagonian province of Chubut.  The local provincial government’s website (Gobierno del Chubat) front page prominently displays the following warning:

http://www.chubut.gov.ar/site/inicio

 


Argentina’s Ministry of Health website shows their last update on January 11th, where they talk in general terms about their response and identify the virus as the Southern Andes strain.  

They state the National Administration of Laboratories and Health Institutes (ANLIS) has `. . .  also initiated studies of viral genome sequencing entire human genome and to identify whether there are mutations that increase the transmissibility and lethality‘.

Health continues to work with Chubut coordinated by the outbreak of hantavirus in Epuyén
In order to study and contain the outbreak, authorities and technical teams from both jurisdictions held meetings to assess the evolving outbreak affecting the Patagonian locality.

Published on Friday January 11, 2019

Meanwhile, media reports indicate there are now 28 cases and 10 deaths, including reports of a 29 year-old nurse who died in neighboring Santiago, Chile.

This (translated) report from LaRepublica.pe:

Hantavirus travels to Argentina and arrives in Chile: nurse dies in Santiago

The 29-year-old woman died in Santiago de Chile and joins the nine fatalities of the Hantavirus outbreak that originated in Argentina.

The Republic

13 Jan 2019 | 9:21 pm

The Hantavirus caused the death of a person in Chile. A 29-year-old nurse had contact with a person from Epuyén, the town where the outbreak of the viral disease began, and died at a health center in her country. In addition, there are two more cases of contagion.

The woman, identified by Chilean media such as Patricia Martínez, was an officer of the Hospital de Palena, an area where there were conflicts bordering Argentina and Chile. She is the first victim of the Chilean Los Lagos region. He died of a cardiopulmonary picture caused by the Hantavirus in Santiago.

According to the authorities of Los Lagos, his death is related to infections in Epuyen, Argentina. The woman would be the tenth mortal victim of the Hantavirus. The Government of Chile would have imposed the sanitary barrier.

“We were informed of the death of the patient from Palena, as a result of her case of cardiopulmonary syndrome due to hantavirus,” said José Antonio Vergara, the Epidemiology physician at the Los Lagos health center, according to Clarín. It was linked to the outbreak that originated in the town of Epuyen, in the province of Chubut, “he said.

(Continue . . . )

A summary of the outbreak was published yesterday by Navva.org.

The first people affected by the virus were people who attended a birthday party on 24 November in an event hall, reported the mayor of Epuyen, Antonio Reato.

A field spy from the area was the first to be infected after cleaning a shed where he would have been in contact with an infected mouse. Later the man attended the celebration in which he infected his wife and other assistants.

The outbreak is motivated safety precautions in the Patagonian city that has already been proclaimed quarantine. Meetings are forbidden and even to view the deceased.

A court decision ordered the insulation for 30 days to 85 residents who had contact with neighbors tested positive for Hantavirus or suspected of having it. Isolated people are not allowed to leave their homes and receive visitors.
 

Complicating matters is the potentially long incubation period for the virus.  A 2006 EID Journal Dispatch (below) suggests – that with new cases still being identified  – it could be some time before this outbreak can be resolved.

Volume 12, Number 8—August 2006
Dispatch

Incubation Period of Hantavirus Cardiopulmonary Syndrome

Pablo Vial*email.gif , Francisca Valdivieso*, Gregory Mertz†, Constanza Castillo‡, Edith Belmar*, Iris Delgado*, Mauricio Tapia§, and Marcela Ferrés¶

Abstract

The potential incubation period from exposure to onset of symptoms was 7–39 days (median 18 days) in 20 patients with a defined period of exposure to Andes virus in a high-risk area. This period was 14–32 days (median 18 days) in 11 patients with exposure for < 48 hours.

Given its unusual size and duration, we’ll be keeping an eye on this outbreak in the days and weeks ahead.