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PostPosted: Mon May 12, 2014 4:22 pm 
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MERS seqs from Indiana not yet at Genbank, but will be soon.

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PostPosted: Mon May 12, 2014 4:25 pm 
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In the News: Second MERS Case Diagnosed in U.S.
by Amesh A. Adalja, M.D., FACP, FACEP . 0 Comments

The announcement today of a second U.S. case of the Middle East Respiratory Syndrome (MERS) in a healthcare worker who had traveled to Florida from the Middle East has caused understandable worry given its many similarities with the 2003 pandemic of Severe Acute Respiratory Syndrome (SARS).

MERS is an acute respiratory illness that has been smoldering in the Middle East region of the globe accruing more than 500 cases since 2012. Most worrisome is that the disease—for which there is no vaccine or specific treatment—has the ability to cause severe illness with fatality rates of 36 percent. MERS has also exploited lapses in hospital infection control practice to spread within healthcare facilities. The fact that both U.S. cases were healthcare workers who contracted the illness while working in Saudi Arabia is no accident.

One difference with SARS is that much of the spread of SARS was attributed to the existence of superspreaders, individuals who disproportionately shed the virus in excessive amounts. Fortunately, no MERS superspreaders have been identified to date.

MERS represents yet another example of an emerging virus spilling from an animal population into humans. In this case, it is hypothesized that camels may have contracted this virus from bats and are now spreading it among human populations.

Earlier this month, the first domestic MERS case was discovered in Munster, Indiana, in a healthcare worker who traveled from Saudi Arabia. His travel was not thought to pose a risk to fellow travelers although passengers that flew with him were contacted. Fortunately, his case was mild and did not require ICU level care. He has since left the hospital.

The second case, which is not connected to the first domestic case, is also related to travel from Saudi Arabia.

Domestic cases of MERS are not to be unexpected as this virus has already made appearances in the United Kingdom, Italy and France. The world is a small place and an infection on one side of the planet can easily appear on the other side. In fact, during SARS eight U.S. cases occurred, including one in Pennsylvania. More importations are anticipated.

Members of the general public need not panic as this virus does not pose a threat to them. However, if one has traveled to the Middle East (in the last 3 weeks) or been in contact with those who have traveled to the region and are experiencing fever and upper respiratory symptoms they should contact their physician.

The detection of this case represents proof of the concept that astute clinicians, aware of a patient’s travel history, in possession of the knowledge of infectious disease outbreaks worldwide, and given the ability to confirm cases are able to detect novel infectious diseases and hopefully mitigate their consequences.

For more information on MERS, check out Dr. Adalja’s blog Tracking Zebra.

http://insideupmc.upmc.com/in-the-news- ... ed-in-u-s/

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PostPosted: Mon May 12, 2014 4:53 pm 
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PHE advised of a case of MERS-CoV in a person flying from flying from Jeddah to the USA and transiting through London on 1 May 2014.

Public Health England (PHE) was today (12 May 2014) advised of a case of Middle East Respiratory Syndrome (MERS-CoV) in a person flying from Jeddah to the USA and transiting through London on Thursday 1 May 2014.

The passenger was on Saudi Airlines flight 113 from Jeddah to London, and transferred at Heathrow for onward travel to the USA, where they were later confirmed positive for MERS-CoV.

This is the second incident involving a passenger transiting via Heathrow, following a case of MERS-CoV in the US from a passenger who travelled from Riyadh to Chicago and transited through London on Thursday 24 April 2014. Follow up with passengers on that flight found no cases of MERS-CoV.

Risk of transmission is considered extremely low but as a precautionary measure, PHE is working with the airline to be able to contact UK passengers who were sitting in the vicinity of the affected passenger to provide health information.

Any UK based passengers travellers on flight SV113 on 1 May who have since become unwell or experienced respiratory symptoms, such as shortness of breath, are advised to seek medical advice.

The period between exposure and when symptoms might develop (the incubation period) for MERS-CoV is currently considered to be up to 14 days. Any illness that passengers might experience more than 14 days after the flight (i.e. starting on or after Wednesday 14 May), would not be considered to be related.

MERS-CoV is a new type of coronavirus, first identified in a Middle Eastern citizen in 2012. Although cases continue to be reported from the Middle East with an increase in reported cases in recent weeks, no new cases of MERS-CoV have been detected in the UK since the cases linked to the Middle East in February 2013.

Professor Nick Phin, Head of Respiratory Diseases for Public Health England said:


“As with the incident earlier this month, the risk is very low. We will be following up with any UK passengers who were sitting in the vicinity of the passenger with MERS-CoV, as a precautionary measure.

“Any UK based travellers who become unwell with a fever, cough or shortness of breath within 14 days of being in the Middle East, should make sure they call their doctor and tell them where they have travelled.

“Although the source of MERS-CoV is currently unknown, there is growing evidence of the possible role of camels in transmitting MERS-CoV to humans. We advise travellers, particularly those with underlying or chronic medical conditions, to avoid contact with camels in the Middle East. All travellers should practice good hand and respiratory hygiene to reduce the risk of respiratory illness.”

Notes to editors
1.Middle East Respiratory Syndrome (MERS-CoV) was initially identified in a patient with severe respiratory symptoms in September 2012. Following its emergence, cases have continued to occur, primarily from within KSA and the UAE. However, cases have been imported to several European countries (France, Germany, Italy, UK, Greece) as well as other parts of the Middle East (Egypt, Jordan, Qatar, Kuwait and Oman) and the rest of the world (Malaysia, Philippines, Tunisia). For more information, visit PHE’s MERS-CoV webpages
2.Public Health England’s mission is to protect and improve the nation’s health and to address inequalities through working with national and local government, the NHS, industry and the voluntary and community sector. PHE is an operationally autonomous executive agency of the Department of Health. http://www.gov.uk/phe Follow us on Twitter @PHE_uk



Infections press office


PHE press office - infections
61 Colindale Avenue
London
NW9 5EQ



Email
infections-pressoffice@phe.gov.uk


Phone
020 8327 7901


Out of hours
020 8200 4400

https://www.gov.uk/government/news/seco ... ugh-london

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PostPosted: Mon May 12, 2014 5:07 pm 
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MERS 1 hour interview tonight at 11 PM EST

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PostPosted: Mon May 12, 2014 5:08 pm 
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niman wrote:
MERS 1 hour interview tonight at 11 PM EST


Dr. Henry L. Niman, PhD
MERS Now Confirmed
In FL - Special Report

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PostPosted: Mon May 12, 2014 5:18 pm 
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MERS Watch: Second U.S. Case in Florida

Published: May 12, 2014 | Updated: May 12, 2014


By Michael Smith, North American Correspondent, MedPage Today

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania


A healthcare provider who lives and works in Saudi Arabia is the second confirmed case of the Middle East coronavirus (MERS) in the U.S., the CDC says.

The case, which is not linked to the first case reported 10 days ago, is "unwelcome but not unexpected," according to CDC Director Tom Frieden, MD, adding that the risk to the general public is "extremely low."

The man, whose age was not given, left Saudi Arabia May 1 on a flight from Jeddah to London and continued on, through Boston and Atlanta, to Orlando, Frieden told reporters in a telephone briefing Monday afternoon.

While traveling, the patient began to feel unwell, with fever, chills and a slight cough, according to Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases.

But the illness was not severe enough to seek further medical attention until May 8, when the patient went to Dr. P. Phillips Hospital and was admitted. Hospital staff are using standard contact and airborne infection control measures, she said.

A hospital spokesman said the risk of transmission appears low, since the man's symptoms were mild and he was not coughing when he arrived at the hospital.

Testing by the hospital suggested a MERS infection, which was confirmed Sunday night by the CDC.

The patient is isolated in the hospital and is doing well, Frieden said.

He added that CDC staff and health officials in 20 states are now trying to track down the "in excess of 500" passengers who shared the patient's three U.S. flights.

British officials are tracing contacts from the patient's Jeddah-London flight, Frieden said.

"It's a very big job," he said.

There is probably little risk to those people, Schuchat said, since transmission of MERS seems to depend on close contact, such as between a healthcare worker and patients or family members caring for an ill person.

Also, she said, the incubation period for the virus seems to run between 5 and 14 days, so "we're getting toward the end of the period" in which symptoms might be expected to appear.

It's not clear yet how the new patient was infected, Schuchat said. "We do believe that the patient was working at a facility that was caring for people with MERS," she said.

Meanwhile, the first American patient -- a healthcare worker in his 60s -- was released from an Indiana hospital over the weekend after testing negative for the virus.

The patient is considered "fully recovered," will not be required to remain in home isolation, and can even travel if he wishes, according to the Community Hospital in Munster.

The patient, who has not been named, has no symptoms and "poses no threat to the community," Alan Kumar, MD, the hospital's chief medical information officer, said in a statement.

Schuchat said the man's virus has been genetically analyzed and compared with isolates from earlier patients. It shows no "significant changes that would explain the current increase in reported cases" in the Middle East, she said.

The new patient was visiting family in Orlando and had limited contacts in the community outside of family members, according to John Armstrong, MD, the state's health secretary.

Armstrong told reporters the family is "staying home," but no members have tested positive for the virus.

The recent surge in MERS in the Middle East included more than twice the number of cases previously reported to the World Health Organization.

In an updated summary of the effects of the disease, posted online over the weekend, the agency said it has been officially informed of 536 cases and 145 deaths since April 2012.

But 330 laboratory-confirmed cases and 59 deaths have been reported since the last summary update on March 27, the agency said. Most of those were reported in April in Saudi Arabia.

Because of reporting delays, the WHO totals usually lag behind the actual numbers seen in various countries. For instance, they do not include the 18 cases reported in Saudi Arabia since Friday.

The surge took place in Saudi Arabia and the United Arab Emirates, with just a handful of cases reported in other countries -- all with epidemiological links to the Middle East, the WHO said. For instance, the first American patient worked in healthcare in Saudi Arabia.

The WHO summary also elaborated on the outcome of an expert mission that studied the large healthcare-associated clusters of cases in the Saudi city of Jeddah, on the Red Sea.

The expert team analyzed data on 128 patients with symptom onset between Feb. 17 and April 26, who were treated in 14 Jeddah hospitals, including one institution with 45 cases.

More than 60% of the cases, including 39 healthcare workers, are thought to have been infected in hospital. Most of the affected healthcare workers had mild or no symptoms, but 15% had severe illness and several died, the agency summary said.

Health officials screened 554 household contacts of cases were screened for MERS and turned up seven who were positive for the virus, a secondary attack rate of 1.3%.

Also, the WHO said, there have been 37 cases in the United Arab Emirates since the last summary, all from the emirate of Abu Dhabi, and including 28 cases in a hospital cluster in Al Ain City.

But only one person had severe illness, a 45-year-old male shopkeeper who died April 10 and was the index case of the large cluster. Contact tracing turned up 27 contacts who were positive for the virus but had few or no symptoms.

The remaining cases include two sporadic cases, a mother-and-daughter cluster, and an unrelated 4-year-old child who tested positive. An additional four cases were reported from Abu Dhabi May 8, but the agency said it is not clear if they are related to the Al Ain cluster.

In Saudi Arabia, meanwhile, health officials reported seven cases Saturday, three Sunday, and eight today, including:
Nine patients in the capital, Riyadh.
Six in Jeddah.
Two in Medina.
And one in Mecca.


The Saudi health ministry also reported a total of 14 deaths, including 11 among people previously reported to be ill with MERS, as well as 17 people who had recovered and been discharged from hospital.

The new cases bring the Saudi totals to 491 cases and 147 deaths since the virus was first recognized in 2012.

News reports from Jordan say that the country has registered its fifth death from MERS, a healthcare worker in his 50s.

Earlier reports:

MERS Watch: No Easing of Outbreak

MERS Surge: Many Questions, Few Answers

MERS Watch: Investigate Virus, Dems Urge

MERS Watch: U.S. Patient Improving, Off Oxygen

MERS Watch: First U.S. Case Reported

MERS Watch: 100 Cases in a Month

http://www.medpagetoday.com/InfectiousD ... ease/45739

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PostPosted: Mon May 12, 2014 5:31 pm 
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U.S. confirms second case of MERS, this time in Florida

By Julie Steenhuysen

(Reuters) - U.S. health officials confirmed the country's second case of MERS, a deadly virus first discovered in the Middle East in 2012, and said the patient was in good condition in an Orlando, Florida hospital.

The patient, 44, is a healthcare worker who lives and works in Saudi Arabia and traveled to the United States to visit relatives. He was admitted to the Dr. P. Phillips Hospital in Orlando on May 9.

The case is the second "imported" instance of Middle East Respiratory Syndrome, or MERS, reaching U.S. soil, but the two are not related, Dr Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention said on a conference call.

Schuchat said the man traveled on May 1 from Jeddah to London, and then from London to Boston. From Boston, the patient took a flight to Atlanta, changed planes again, before arriving in Orlando.

She said the patient was feeling ill on the flight from Jeddah, but did not feel sick enough to seek treatment until last Friday.

It is not clear in which hospital the patient worked, but Schuchat said she believes he was working in a facility that was caring for people with MERS.

The CDC said it is not clear whether the person was infectious on the plane, but it is now contacting some 500 people who traveled on the same U.S. flights as the infected health worker "out of an abundance of caution," CDC Director Dr. Thomas Frieden told reporters on the call.

Frieden said the latest U.S. case of MERS was "unwelcome but not unexpected news," and added it now falls to the U.S. hospital and healthcare workers in general to observe meticulous infection control procedures to keep the virus contained.

Frieden said the CDC now has a team in Saudi Arabia working with "international partners" to try to help contain the spread of the virus and better understand how it is transmitted.

So far, an analysis of the genetic sequences of the virus suggest it has not changed in the past two years.

Geo Morales, a spokesman for the Florida hospital, which is located near the Disney theme park, said the institution is tracking any of its workers who might have come in contact with the patient.

"We do believe there is a low risk the virus is being spread by him," Morales said, noting that his symptoms were mild when he arrived at the hospital and that he did not have a cough.

The other U.S. MERS case involved a man who flew from Saudi Arabia and traveled to Indiana earlier this month.

The patient in that case, a U.S. healthcare worker who lives and works in Saudi Arabia, flew from Riyadh to London and then Chicago, before boarding a bus to Highland, Indiana. He then began experiencing symptoms of fever, shortness of breath, and sought care at Community Hospital in Munster, Indiana.

After confirming the patient had MERS, the CDC and state and hospital officials traced all of the workers with whom he had contact, and all have so far tested negative for the virus.

The CDC has also checked airline and bus manifests to see if the man might have infected others during his journey and so far have not turned up any evidence fellow travelers were infected.

The patient is now clear of the virus and was released on Friday. Hospital workers remain in home isolation until the end of a 14-day incubation period, when they will be rechecked for the virus.

Although the MERS virus has been shown to transmit from person to person, it is not easily transmissible to the general public.

Saudi officials said on Friday that the number of infections in the country has reached 473. The death toll from the virus is 133 since it was identified two years ago, according to the kingdom's health ministry.

(Reporting by Michele Gershberg and Julie Steenhuysen, additional reporting by Barbara Liston in Orlando; Editing by Chris Reese and Andre Grenon)

http://www.globalpost.com/dispatch/news ... -us-soil-0

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PostPosted: Mon May 12, 2014 5:33 pm 
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http://orlandohealth.com/drpphillipshospital/

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PostPosted: Mon May 12, 2014 5:40 pm 
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Deadly MERS Virus Detected In Florida
Monday, May 12, 2014

Rob Stein / NPR

Microbiologist Shay Wilinski works at Community Hospital in Munster, Ind., where the first U.S. case of the Middle East Respiratory Syndrome was detected.

The second U.S. case of a dangerous new virus from the Middle East has been found in Florida, the Centers for Disease Control and Prevention said Monday.

The patient is a health care worker from Jeddah, Saudi Arabia, who developed symptoms May 1, while traveling to Orlando, Fla., to visit family, the CDC said.

MERS is a life-threatening respiratory infection that first emerged on the Arabian Peninsula in 2012. The virus is related to one that cause the common cold and SARS, which sparked a worldwide alarm in 2003.

So far, there have been about 538 MERS cases reported globally, including 148 deaths. Most cases have occurred in Saudi Arabia. But travelers have carried the virus to other parts of the world, including the U.K., France and Malaysia.

State and federal health officials are working to make sure the virus does not spread in Florida, CDC Director Thomas Frieden said in a telephone briefing for reporters. But there's no reason for widespread alarm.

"Our experience with MERS, so far, suggests the risk to the public is extremely low," Frieden said. The virus doesn't appear to spread easily from one person to another, he added.

Nevertheless, officials are tracking down hundreds of people who may have had contact with the patient during flights to London, Boston, Atlanta and Orlando.

The man developed a fever, chills and a slight cough during the first flight. He was admitted to a hospital after seeking care at an emergency room. He didn't visit Disney World before getting admitted to the hospital, the CDC said.

The man is now in isolation. But he's doing well, officials said. No additional information about the patient has been released.

The first U.S. case of MERS was detected in Indiana in late April. A man caught the virus while working in a hospital in the Saudi capital. He then flew from Riyadh to London and then Chicago, where he developed symptoms. He later took a bus to Munster, Ind., where he was visiting family and went to an emergency room.

There's no indication the man infected anyone else on his trip or in the hospital where he was treated. He was released from the Community Hospital in Munster on Sunday, after doctors determined he was no longer infectious.

"The patient has tested negative for MERS, is no longer symptomatic and poses no threat to the community," Alan Kumar, the hospital's chief medical information officer, said in a written statement.

Health officials around the country are closely watching for MERS because there's no vaccine or treatment for it. And they're still not sure how people catch the virus. Most signs point to camels. The virus is widespread in the animals. And some people have had contact with camels or their milk before getting sick.

http://www.kpbs.org/news/2014/may/12/de ... n-florida/

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PostPosted: Mon May 12, 2014 5:54 pm 
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ORLANDO --

Health officials have confirmed a case of a mysterious virus that has sickened hundreds in the Middle East in a doctor from Saudi Arabia who flew into Orlando.

Officials the Florida Department of Health and Centers for Disease Control and Prevention confirmed the case of MERS, or Middle East Respiratory Syndrome, is the second confirmed in the United States, and the first in Florida.


MERS is a respiratory illness that begins with flu-like fever and cough but can lead to shortness of breath, pneumonia and death. A third of those who develop symptoms die from it.

Health officials said the 44-year-old doctor was visiting Orlando with his family, but did not visit any theme parks or attractions. He was taken to Dr. Phillips Hospital to be treated.

The patient is a health care worker from Saudi Arabia who may have been exposed to the virus at the hospital where he worked in his home country.

Health officials said the man became sick while flying to the U.S. The trip included stops in London, Boston and Atlanta before arriving in Orlando on May 1.

Most MERS cases have been in Saudi Arabia or the Middle East. But earlier in May, the first U.S. case was diagnosed in an American man who traveled from Saudi Arabia to Indiana. That man was a health care worker at a hospital in Saudi Arabia's capital city who flew to the United States on April 24.

After landing in Chicago, the man took a bus to Munster, Indiana, where he became sick and went to a hospital on April 28. He then improved and was released from the hospital late last week. Tests of people who were around the man have all proved negative, health officials have said.

MERS belongs to the coronavirus family that includes the common cold and SARS, or severe acute respiratory syndrome, which caused some 800 deaths globally in 2003.

The MERS virus has been found in camels, but officials don't know how it is spreading to humans. It can spread from person to person, but officials believe that happens only after close contact. Not all those exposed to the virus become ill.

But it appears to be unusually lethal — by some estimates, it has killed nearly a third of the people it sickened. That's a far higher percentage than seasonal flu or other routine infections. But it is not as contagious as flu, measles or other diseases. There is no vaccine or cure and there's no specific treatment except to relieve symptoms.

Overall, at least 400 people have had the respiratory illness, and more than 100 people have died. So far, all had ties to the Middle East region or to people who traveled there.

http://www.mynews13.com/content/news/cf ... _case.html

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