Category: U.S. Centers for Disease Control and Prevention

MERS-CoV: Middle East respiratory syndrome coronavirus – poorly understood and on the rise

On By A.P.In Albert Osterhaus, CDC, coronavirus, Coronavirus Study Group, Erasmus Medical Center, France, Haj pilgrimage, International Committee on Taxonomy of Viruses, Margaret Chan, Medicine, MERS-CoV, Middle East respiratory syndrome coronavirus, Saudi Arabia, The Netherlands, U.S. Centers for Disease Control and Prevention, Virus, WHA, WHO, World Health Assembly, World Health Organization1 Comment

MERS-CoV

Saudi Arabia reported today that five more people have been infected with the Middle East respiratory syndrome coronavirus (MERS-CoV), as if to underline yesterday’s warning from the head of the World Health Organization (WHO) that the novel virus is a global threat.

In a brief statement, the Saudi Ministry of Health (MOH) said, “Within the framework of the epidemiological surveillance of the novel Coronavirus (MERS-CoV), the Ministry of Health (MOH) has announced that five novel Coronavirus cases have been recorded among citizens in the Eastern Region, ranging in age from 73 to 85 years, but they have all chronic diseases.”

Also, two more deaths from MERS have been reported in the past few days. Yesterday Agence France Presse (AFP) reported the death of France’s first MERS-CoV patient, a 65-year-old man whose illness was first reported on May 8. And on May 26 the Saudi MOH announced the death of an 81-year-old woman.

With today’s Saudi announcement, the unofficial global case count has reached 49; the death toll stands at 24, according to the US Centers for Disease Control and Prevention (CDC). Unofficially, Saudi Arabia has had 37 cases, with 18 deaths.

WHO concern
Deep concern about MERS-CoV was expressed yesterday by WHO Director-General Margaret Chan, MD, MPH, as she closed the annual World Health Assembly (WHA), the WHO’s policy-making body.

“Looking at the overall global situation, my greatest concern right now is the novel coronavirus,” she said as quoted in a WHO press release. “We understand too little about this virus when viewed against the magnitude of its potential threat. Any new disease that is emerging faster than our understanding is never under control.

“These are alarm bells and we must respond. The novel coronavirus is not a problem that any single affected country can keep to itself or manage all by itself. The novel coronavirus is a threat to the entire world.”

The WHO plans to send a second team to Saudi Arabia in coming weeks to help investigate the mysterious virus, according to a May 25 Arab News story that quoted Chan. The source of the pathogen remains unknown, but several case clusters have shown that it can spread between people in close contact.

“Without that proper risk assessment, we cannot have clarity on the incubation period, on the signs and symptoms of the disease, on the proper clinical management and then, last but not least, on travel advice,” Chan told Arab News.

The WHO, which sent a group of experts to Saudi Arabia earlier this month, will provide a fresh risk assessment ahead of this year’s Haj pilgrimage, which will take place in October, the story said.

Details on deaths
Concerning the five new cases, the Saudi MOH left many questions unanswered, including whether the patients are part of a hospital-centered outbreak of MERS-CoV that began in April in the Al-Ahsa region of Eastern province. The cluster has been reported to include 22 cases with 10 deaths. The statement gave no information on the patients’ conditions, gender, where they live, or how long they have been sick.

The French patient who died became ill on Apr 23, six days after he returned home from a vacation in Dubai, United Arab Emirates. Another person contracted the virus after sharing a hospital room with him from Apr 27 to 29.

The 81-year-old Saudi woman who died was among the previously announced cases in Al-Ahsa governorate, the Saudi MOH said in a May 26 statement. It said she was suffering from chronic kidney failure and other chronic diseases.

Her case appears to be the one announced by the WHO on May 18. That announcement said the 81-year-old’s illness was the 22nd case in the hospital-centered cluster in Al-Ahsa.

The May 26 MOH statement also said that nine other case-patients have recovered and been discharged from hospitals since the first MERS-CoV in Saudi Arabia, which occurred in June 2012.

MERS-CoV designation
In other developments, the WHO announced today that it is accepting the name MERS-CoV for the novel virus, despite a general aversion to geographic references in the names of newly discovered viruses.

“Given the experience in previous international public health events, WHO generally prefers that virus names do not refer to the region or place of the initial detection of the virus,” the agency said in a statement. “This approach aims at minimizing unnecessary geographical discrimination that could be based on coincidental detection rather than on the true area of emergence of a virus.”

The name was proposed by the Coronavirus Study Group of the International Committee on Taxonomy of Viruses, the WHO noted. The statement said the term emerged from consultations with a large group of scientists and represents an acceptable consensus

Patent issues
Also today, a story in BMJ offered more details on intellectual property issues related to MERS-CoV. Albert Osterhaus, DVM, PhD, head of viriology at Erasmus Medical Center in the Netherlands, told the journal that Erasmus has applied for patents on MERS-CoV genetic sequences and on possible related products such as diagnostics and vaccines.

Erasmus scientists were the first to analyze the virus and identify it as novel last year, after an Egyptian physician working in Saudi Arabia sent them a sample. Last week Chan and Saudi officials complained that restrictions imposed by Erasmus on use of MERS-CoV samples that it has supplied to other labs were impeding the investigation of the outbreak.

Erasmus officials have rejected the criticism and said they have supplied samples to all labs that want to use it for public health research and are equipped to handle if safely. But Osterhaus told BMJ, “We have patent applications submitted and that is on the sequences and the possibilities to eventually make diagnostics, vaccines, antivirals, and the like. It’s quite a normal thing if you find something new to patent it.”

He added that Erasmus has not made a deal with any company yet, because it’s too early. “At the end of the day, if you want something to happen for the benefit of public health—including making a vaccine, antivirals, whatever—you need to have at least some intellectual property. Otherwise the companies will not be interested,” he said.

http://www.cidrap.umn.edu/cidrap/content/other/sars/news/may2813corona.html

New bird flu well-adapted to infect people

On By A.P.In bird flu, China, Dr. Ron Fouchier, Dr. Tim Uyeki, H7N9 flu strain, Medicine, Nancy Cox, New England Journal of Medicine, Oseltamivir, PB2 E627K, Relenza, Substitution Q226L, Tamiflu, U.S. Centers for Disease Control and Prevention, WHO, World Health Organization, zanamivirLeave a comment

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A new variation of bird flu that the WHO says has caused at least 11 deaths in China has genetic characteristics that make it well-adapted to infect people. In a report published late Thursday in the New England Journal of Medicine, samples from three patients — all of whom died — had mutations that have previously been shown to increase transmissibility, and to help the virus grow in a mammal’s respiratory tract. The analysis comes amid a modest but steady stream of human cases since the end of March. Saturday, China reported a 7-year-old Beijing girl is the latest person to become infected with the H7N9 flu strain, bringing the total to 44.

The strain is normally found in birds, and until last month was never known to infect people. “The H7N9 situation is evolving very quickly,” said Nancy Cox, director of the Influenza Division at the U.S. Centers for Disease Control and Prevention. “One thing of concern is the pace at which we are seeing the identification of cases.”

On a more reassuring note, investigators have found no evidence that the virus has passed directly from person to person. More than a thousand “close contacts” of the patients are being monitored by Chinese health officials, according to the World Health Organization. One concerning mutation, known as “Substitution Q226L,” was found in two of the first three victims. Past experiments have shown it to make viruses — including the H5N1 bird flu virus — more likely to infect ferrets, which are commonly used in flu research. The same mutation was also found in the viruses that caused the 1957 and 1968 flu pandemics. A second mutation, known as “PB2 E627K,” was found in all three virus samples. According to Dr. Ron Fouchier, a Dutch virologist, this mutation allows the virus to reproduce at much lower temperatures than a standard avian influenza virus. The change lets it grow in a human respiratory tract, which is cooler than the virus’ natural home: a bird’s gastrointestinal tract. In mice, Fouchier said, the mutation makes the infection as much as 1,000 times more virulent. A number of other mutations were found as well, including changes that are characteristic of viruses found in mammals.

“Known normal bird viruses have to adapt substantially to infect people, but not these,” said Fouchier, who said the changes are enough that he would no longer call the H7N9 strain “bird flu.” The first three patients to be identified are an 87-year-old man and a 27-year-old man from Shanghai, and a 35-year-old housewife from Anhui. The woman had visited a chicken market about a week before falling ill. The younger man was a butcher who worked in a market where live birds were sold, although he did not butcher any birds. The 87-year-old had no known exposure to live birds. All three died after suffering severe respiratory symptoms, including acute respiratory distress syndrome and eventually septic shock and multiple organ failure.

In a commentary that ran with the article, Cox and Dr. Tim Uyeki, a physician with the CDC, noted that patients were not given antiviral medication until their illness became severe. Oseltamivir (Tamiflu) or zanamivir (Relenza) should be administered as soon as possible to patients with a suspected or confirmed H7N9 infection, the two wrote. Cox said it remains unclear whether the severe illnesses are typical of H7N9 infection or simply the tip of a large iceberg in which a large number of mild cases are going unnoticed.

“As surveillance has expanded, we’re also seeing individuals with milder cases,” said Cox. “We’re still seeing very severe disease in some cases, but overall I think it’s somewhat reassuring.” The CDC is in the final steps of refining a diagnostic test to identify H7N9 in patients, and Cox said it should be available for distribution in a matter of days. A widely available diagnostic test would allow faster identification of patients who actually have the infection, and would also help disease detectives zero in on how people are being exposed.

Work has begun on a vaccine, although Cox and others said that even if it is eventually needed, a vaccine likely won’t be available for several months. While the overall picture is concerning, flu experts urged calm. “I wouldn’t say a pandemic is more likely than it was a year ago,” Fouchier said. “The only thing we can do as virologists right now is to point out the interesting characteristics of the virus, try to get to the bottom of this story and try to stop further infections.”

http://www.cnn.com/2013/04/12/health/bird-flu/index.html?hpt=hp_t2