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AbledNews Special Repoprt: tracking the new killer viruses-MERS and H7N9 Bird FLu - image shows a cluster of the coronavirus stained green against a brownish red background as seen under a micrscope

 

Epidemiologists around the world are tracking a pair of new viruses that are leaving a deadly toll

MERS

The U.S. government has declared a public health emergency over a recently discovered coronavirus that originated in Saudi Arabia that is, so far, carrying a more than 50 percent mortality rate. It’s called Middle East Respiratory Syndrome (MERS). The U.S. emergency designation came to facilitate the quicker release of tests designed to track it.

Most cases of MERS have clustered in Saudi Arabia, but have also been tracked to Jordan, Qatar and the United Arab Emirates (UAE). Travelers have carried the infection to Germany, Italy, Tunisia and the U.K.

Doctors don’t know where the virus originated but suspect an animal, such as a bat. The big fear associated with this virus is that it’s similar to the Severe Acute Respiratory Syndrome (SARS) virus that infected over 8,000 people and killed almost 800 of them in 37 countries in 2003.

It was also thought to have originated in bats, which are a natural reservoir for a coronavirus, and it was thought that the infection spread to humans either directly or through other animals such as the masked palm civets found in China’s Guangdong Province.

However, MERS may prove to be five-times more deadly than SARS. Most people infected with MERS-CoV develop severe acute respiratory illness with symptoms of fever, cough, and shortness of breath. So far, about half of them died. Some people were reported as having a mild respiratory illness.

Men wearing surgical masks as a precautionary measure against the novel coronavirus, speak at a hospital in Khobar city in Dammam May 23, 2013. Saudi Arabia has announced another death from the SARS-like novel coronavirus (nCoV) in its central al-Qassim region, bringing the total number of deaths in the kingdom to 17. REUTERS/Stringer

 

MERS UPDATE as of July 11, 2013: From the World Health Organization (WHO) 

The Ministry of Health (MoH) in Saudi Arabia has announced an additional laboratory-confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the country.

The patient is a 66 year-old man from Asir region with an underlying health condition. He is currently in critical but stable condition.

In addition, a Qatari patient earlier confirmed with MERS-CoV infection, who was being treated in the United Kingdom died on 28 June 2013.

Globally, from September 2012 to date, WHO has been informed of a total of 81 laboratory-confirmed cases of infection with MERS-CoV, including 45 deaths.

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.

 

H7N9 Bird Flu

H7N9 is a sub-type of an avian influenza A virus that was discovered in China in March of this year. This strain has infected over 130 people and killed 37 of them, which gives it a mortality rate, after adjustments for missing data, of around 36, percent which is much less deadly that the H5N1 virus that killed about 70 percent of infected persons.

However, researchers warn against complacency; the World Health Organization said H7N9 appeared to spread much faster than the previous H5N1 virus and called it ‘one of the most lethal influenza viruses’ it had ever seen.

The infection rate subsided after China shutdown many of its live animal markets, but scientists warn the real threat is yet to come towards the end of the year when the annual flu season picks up.

Photo of two women working at the chicken market in Xining, China surrounded by cages full of chickens

 

H7N9 UPDATE: First Human to Human Transmission Reported

The British Medical Journal, now know simply as BMJ, is reporting what’s believed to be the first documented case of human to human transmission of the H7N9 bird flu.

This all occurred between March and May of this year, but is only just now coming to light.  According to BMJ, a 60 year old man in eastern China who frequently visited live poultry markets developed a fever and cough about five to six days after his last exposure to the birds and was taken to the hospital on March 11.

His condition quickly worsened and he was transferred to Intensive Care on March 15. His 32-year-old daughter, who was said to have been in previously good condition, tended to his oral care and cleaning while in the hospital and did not wear any protective masks or clothing.

She developed symptoms of H7N9 six days after her last contact with her father and was admitted to the hospital on March 24, transferred to ICU on March 28 and died of multi-system organ failure on April 24.

Her father also died in the ICU of multi-system organ failure on May 4 after developing deteriorating pulmonary function. 

The encouraging news from this report is that many other people who were exposed to these two patients did not get sick, leading medical officials to theorize that, at least as far as the current data shows, H7N9 may only be capable of limited transmission, but that may also be the result of warmer temperatures in the affected region and the closing of some bird markets in those regions.

The true test of this will be later this year when the annual flu season arrives.

 

Global Influenza Update From The World Health Organization

 

Global Influenza Map from the World health Organization as of July 5, 2013. The current statistics follow in the text below.

 

Summary

• As of 5 July, a total of 133 cases of H7N9 have been reported from China (132 from China’s National Health Family and Commission, and 1 from Taipei Centers for Disease Control) including 43 deaths.

• Influenza activity in the northern hemisphere temperate zones remained at inter-seasonal levels.

• In most regions of tropical Asia influenza activity decreased, except for Sri Lanka and Viet Nam where influenza A activity remained relatively high. 

• In Central America and the Caribbean, influenza activity remained low or similar compared to previous weeks, except in Cuba and the Dominican Republic where high influenza activity was reported and in Costa Rica, El Salvador and Panama, where influenza activity began to increase.

• Influenza activity in the southern hemisphere increased considerably in South America and in Southern Africa but remained low in Oceania. In South America, respiratory syncytial virus remained the predominant circulating virus, but the proportion of influenza positive viruses continued to increase. 

 

AbledFAQs-Banner-771x75

 

A CDC Scientist harvests H7N9 virus that has been grown for sharing with partner laboratories for research purposes.

 

We’ve compiled FAQs on both viruses from the Centers For Disease Control to give you some quick reference answers on the respective outbreaks and what you can do to be more ‘abled’ in reducing or preventing your exposure to them, as well as treatment options if you aren’t able to avoid them.

 

 

MERS

 

What is MERS?

Middle East Respiratory Syndrome (MERS) is a viral respiratory illness. MERS is caused by a coronavirus called “Middle East Respiratory Syndrome Coronavirus” (MERS-CoV).

What is MERS-CoV?

MERS-CoV is a beta coronavirus. It was first reported in 2012 in Saudi Arabia. MERS-CoV used to be called “novel coronavirus,” or “nCoV”. It is different from other coronaviruses that have been found in people before.

How was the name selected?

The Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses (ICTV) decided in May 2013 to call the novel coronavirus “Middle East Respiratory Syndrome Coronavirus” (MERS-CoV)  [1.7 MB, 5 pages].

Is MERS-CoV the same as the SARS virus?

No. MERS-CoV is not the same coronavirus that caused severe acute respiratory syndrome (SARS) in 2003. However, like the SARS virus, MERS-CoV is most similar to coronaviruses found in bats. CDC is still learning about MERS.

What are the symptoms of MERS?

Most people who got infected with MERS-CoV developed severe acute respiratory illness with symptoms of fever, cough, and shortness of breath. About half of them died. Some people were reported as having a mild respiratory illness.

Does MERS-CoV spread from person to person?

MERS-CoV has been shown to spread between people who are in close contact. Transmission from infected patients to healthcare personnel has also been observed. Clusters of cases in Saudi Arabia, Jordan, the UK, France, Tunisia, and Italy are being investigated.

Is CDC concerned?

Yes, CDC is concerned about MERS-CoV. The virus has caused severe illness in most infected people, and about half of them have died. Also, the virus spreads from person to person and has spread between countries. CDC recognizes the potential for the virus to spread further and cause more cases and clusters globally, including in the United States.

Has anyone in the United States gotten infected?

So far, there are no reports of anyone in the United States getting infected with MERS-CoV.

What is CDC doing about MERS?

CDC works 24/7 to protect people’s health. It is the job of CDC to be concerned and move quickly whenever there is a potential public health problem. CDC is closely monitoring the MERS situation and working with WHO and other partners to understand the risks of this virus. CDC is engaged in the following ways:

  • CDC developed molecular diagnostics that will allow scientists to accurately identify MERS cases. CDC also developed assays to detect MERS-CoV antibodies. These lab tests will help scientists tell whether a person is, or has been, infected with MERS-CoV. CDC will evaluate genetic sequences as they are available, which will help scientists further describe the characteristics of MERS-CoV.
  • As part of routine public health preparedness in the United States, CDC is providing MERS-CoV testing kits to state health departments. CDC is also updating guidance for public health departments, healthcare providers, and laboratories.
  • CDC is offering recommendations to travelers when needed. CDC is also helping to assess ill travelers returning from affected areas.
  • In addition, CDC participated in international public health investigations of past MERS cases in Saudi Arabia (October 2012) and Jordan (May 2013). CDC continues to provide advice and laboratory diagnostic support to countries in the Arabian Peninsula and surrounding region.

Can I still travel to countries in the Arabian Peninsula or neighboring countries where MERS cases have occurred?

Yes. WHO and CDC have not issued travel health warnings for any country related to MERS.

For more information, see CDC’s travel notice on A Novel Coronavirus Called “MERS-CoV” in the Arabian Peninsula.

What if I recently traveled to countries in the Arabian Peninsula or neighboring countries and got sick?

If you develop a fever and symptoms of lower respiratory illness, such as cough or shortness of breath, within 14 days after traveling from countries in the Arabian Peninsula or neighboring countries(1), you should see your healthcare provider and mention your recent travel.

How can I help protect myself?

CDC advises that people follow these tips to help prevent respiratory illnesses:

  • Wash your hands often with soap and water for 20 seconds, and help young children do the same. If soap and water are not available, use an alcohol-based hand sanitizer.
  • Cover your nose and mouth with a tissue when you cough or sneeze then throw the tissue in the trash.
  • Avoid touching your eyes, nose and mouth with unwashed hands.
  • Avoid close contact, such as kissing, or sharing cups or eating utensils, with sick people.
  • Clean and disinfect frequently touched surfaces, such as toys and doorknobs.

Is there a vaccine?

No, but CDC is discussing with partners the possibility of developing one.

What are the treatments?

There are no specific treatments for illnesses caused by MERS-CoV. Medical care is supportive and to help relieve symptoms.

Is there a lab test?

Lab tests (polymerase chain reaction or PCR) for MERS-CoV are available at state health departments, CDC, and some international labs. Otherwise, MERS-CoV tests are not routinely available. There are a limited number of commercial tests available, but these are not FDA-approved.

What should healthcare providers and health departments do?

For recommendations and guidance on the case definitions; infection control, including personal protective equipment guidance; case investigation; and specimen collection and shipment, see Update, Case Definitions, & Guidance.

 

Footnotes

Countries in the Arabian Peninsula and neighboring countries: Bahrain, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Palestinian territories, Oman, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.

Content source: National Center for Immunization and Respiratory Diseases, Division of Viral Diseases

 

H7N9

 

What is H7N9?

“H7N9” is the designation for one subtype of influenza viruses that is sometimes found in birds, but that does not normally infect humans. Like all influenza A viruses, there also are different strains of H7N9. Beginning at the end of March 2013, China reported human and bird (poultry) infections with a new strain of H7N9 that is very different from previously seen H7N9 viruses.

Is this new strain of H7N9 infecting humans?

Yes. While H7N9 viruses had never before been detected in people, from March 31 through April 30, 2013, China reported more than 126 cases of human infection with this new H7N9 virus.

How are people getting infected?

This virus has been found in birds (poultry) in China in some of the same areas where human infections have happened. Available evidence suggests that most people have been infected with the virus after having contact with infected poultry or contaminated environments.

How do people get infected with bird flu viruses?

Human infections with bird flu viruses are rare, but have happened in the past, usually after close contact with infected birds (both live and dead) or environments contaminated with bird flu virus.

Infected birds can shed a lot of flu virus, for example, in their droppings or their mucus. If someone touches an infected bird or an environment contaminated with virus and then touches their eyes, nose or mouth, they may be infected with bird flu virus. There is some evidence that infection may also occur if the flu virus becomes airborne somehow, such as when an infected bird flaps it wings. If someone were to breathe in airborne virus, it’s possible they could get infected.

Is infection with this virus serious?

Most of the reported cases of human infection with this virus have had very serious illness. There also are reports of some milder illness and one possible report of a person who tested positive for the virus who did not have any symptoms.

What are the symptoms of illness with this virus?

Symptoms have started with high fever and cough. A lot of the cases have progressed to very serious illness, including severe pneumonia, acute respiratory distress syndrome (ARDS), septic shock and multi-organ failure leading to death.

Is this virus spreading from person-to-person?

Chinese health authorities are investigating this situation very carefully. They are following up on close contacts of infected people to find out if they have gotten infected. This is important to find out whether there has been person-to-person spread of this virus. So far, hundreds of close contacts have been checked and there has not been any evidence of ongoing spread of this virus from person-to-person.

Is it possible that this virus will spread from person-to-person?

Yes. Based on what we know about human infections with other bird flu viruses, it’s possible and even likely that there will be some limited person-to-person spread with this virus. The important factor will be to determine whether this virus gains the ability to spread easily from one person to another. Sustainable human to human spread is needed for a pandemic to start. Health officials are watching the situation closely for this.

Is there a vaccine to protect against this new H7N9 virus?

No, right now there is no vaccine to protect against this virus. CDC and others are working to develop a vaccine candidate virus that could be used to make a vaccine if it is needed.

Are there medicines to treat illness associated with this virus?

CDC recommends oseltamivir (Tamiflu®) and zanamivir (Relenza®) for treatment of H7N9. Most of the H7N9 viruses that have been studied are likely susceptible (sensitive) to the two influenza antiviral drugs that are used to treat seasonal flu. Those drugs are oseltamivir (Tamiflu®) and zanamivir (Relenza®) (neuraminidase inhibitors). Like seasonal influenza viruses, avian A(H7N9) viruses are resistant to the influenza antiviral drugs known as the adamantanes.

It’s important to note that influenza viruses may acquire genetic changes which can make one or more influenza antiviral drugs less effective. This happens with seasonal influenza viruses and could happen with H7N9 viruses found in China. As new H7N9 virus isolates are received, CDC will conduct ongoing testing to determine the susceptibility of other H7N9 viruses to existing antiviral drugs. More information about antiviral resistance is available at Influenza Antiviral Drug Resistance: Questions & Answers.

What is the risk from this virus in the United States right now?

No cases of human or bird infection with this H7N9 virus have been detected in the United States. At this time, the risk to people in the United States is considered to be low.

Is it possible that human cases of H7N9 flu will be found in the United States?

Yes. The most likely scenario for this right now would be H7N9 infection in a traveler from China. Many people travel between China and the United States. CDC issued a health alert for public health officials and clinicians in the United States to be on the look-out for flu symptoms in travelers who are returning from countries with bird flu. CDC has issued guidance for isolating, testing, and treating such patients. However, since this virus does not seem to be spreading easily from person-to-person, a few cases in the United States with travel links to China would not change the risk of infection for the general public in the United States.

How are H7N9 virus infections diagnosed in people?

There are currently no tests available over the counter or at a doctor’s office that can quickly detect and distinguish between the H7N9 virus and other flu viruses. However, a more sophisticated test that specifically detects H7N9 virus has been developed by CDC for use by qualified public health laboratories in the United States and internationally. This test involves collecting a respiratory tract (i.e., nose, throat, lung) sample from a sick patient. The sample is then sent to a public health laboratory where a procedure known as rRT-PCR (real-time reverse transcriptase polymerase chain reaction) is conducted. rRT-PCR is very accurate and sensitive at detecting flu viruses. This procedure typically provides results within 4 hours; however, the time involved in processing and reporting results may vary depending on the laboratory.

Does CDC recommend that people delay or cancel trips to China because of H7N9 flu?

Since H7N9 is not spreading easily from person-to-person at this time, CDC does not recommend that people delay or cancel trips to China. The World Health Organization also is watching this situation closely and does not recommend any travel restrictions.

What advice does CDC have for people traveling to China?

CDC advises travelers to China to take some common sense precautions, like not touching birds or other animals and washing hands often. Poultry and poultry products should be fully cooked. CDC will update its advice for travelers if the situation in China changes. This guidance is available at Avian Flu (H7N9) in China.

Should travelers to China get a prescription for antivirals before their trip?

At this time, CDC does not recommend prescribing antiviral drugs for prevention or self-treatment of H7N9 flu. CDC recommends that travelers to China follow common sense precautions to protect themselves and monitor their health during and after their trip. Anyone with fever, coughing, or shortness of breath within 10 days of traveling to China should see a doctor and tell the doctor about the recent travel to China.

What does CDC advise for people in the United States with regard to H7N9?

CDC does not have any new or special recommendations for the U.S. public at this time regarding H7N9.

Is CDC worried that an H7N9 pandemic will start?

This is a serious public health situation and it’s possible that a pandemic could start if this virus were to change to spread easily between people. CDC is preparing for that possibility.

What is CDC doing in response to H7N9?

CDC is following this situation closely and coordinating with domestic and international partners, including China CDC and the World Health Organization. On April 8, 2013 CDC activated the Emergency Operation Center (EOC) at Level 2 (limited activation) to support the management of the emerging H7N9 situation in China. CDC also is sending a team to China to support the domestic outbreak response.

In addition, CDC is taking routine preparedness measures, including:

  • Developing a candidate vaccine virus that could be used to make vaccine if it becomes necessary.
  • Distributing a new test kit developed by CDC that can detect this virus and which can be used by other public health laboratories.
  • Conducting animal studies to learn more about the severity of disease associated with this virus and how the virus spreads.
  • Conducting studies on blood samples to see whether there is any existing immunity to this virus in the population.
  • Conducting ongoing testing to determine H7N9 susceptibility to the licensed influenza antiviral drugs, oseltamivir (commercially known as Tamiflu®) and zanamivir (Relenza®) as well as investigational antiviral drugs.
  • CDC also is gathering more information to make a more thorough public health risk assessment. This is an evolving situation and there is still much to learn.

Content sources: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD)

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