Canada - Mosquito Surveillance Reveals the Aedes aegypti Species in Southern Ontario.

We need a new Map.

Canada - Mosquito Surveillance Reveals the Aedes aegypti Species in Southern Ontario. (Wechu). HT: Crof.

In the United States, the Aedes aegypti mosquito primarily exists in the southern states and along the eastern seaboard, where temperatures are more favourable for its survival. There are records of this mosquito being found in some northern states, including Michigan and New Hampshire; however, these were only temporary summer incursions, as the relatively cold winters prevented establishment. To our knowledge, this is the first time Aedes aegypti has been collected in Canada.  

Although it is unknown exactly how the larvae arrived in Ontario, one possibility is that the eggs were transported from the U.S. in shipping containers or other cross-border vehicle traffic. Aedes aegypti eggs could also have been imported in recycled products, such as tires or other containers. Given that this is a tropical mosquito, the extremely hot temperatures this past summer allowed for the species to exist in Windsor. 

“We will continue to ensure that our community stays informed about infectious diseases and the local mosquito surveillance program. It is a key public health service that we provide to Windsor-Essex County residents. The discovery of the yellow fever mosquito larvae through enhanced surveillance of the Aedes albopictus mosquito is an important reminder that we should continue to protect ourselves and our families from mosquito bites,” said Dr. Kirk.   

The Aedes aegypti mosquito is even less cold tolerant than the Aedes albopictus and will not survive the cold winter temperatures. For Zika virus transmission to occur, the Aedes aegypti mosquito would need to feed on an infected person, within the first several days of infection, and then feed upon another susceptible person. 

The greatest risk to contracting Zika virus continues to be centered on those who have travelled to Zika-risk areas (such as South America, the Caribbean and Florida) or who are or have been in sexual contact with these travelers. Read the full story here. More on this story here.

Medical research charity warns: "Expect ZIKA to spread to India and Africa".

Global map of the predicted distribution of Aedes albopictus, another mosquito of the Aedes family that researchers believe transmits the Zika virus. (1 = Full presence of Aedes mosquito, 0= No presence of Aedes mosquito) Source

Medical research charity warns:  "Expect ZIKA to spread to India and Africa". (Guardian).

The Zika virus, which causes brain damage in babies, is likely to spread to India and the continent of Africa, according to the director of the Wellcome Trust, a medical charity deeply involved in research to try to limit the damage.  

“I think we can anticipate global spread,” said Jeremy Farrar, speaking to the Guardian alongside Sue Desmond-Hellmann, the chief executive officer of the Bill and Melinda Gates Foundation. “Given the [Aedes aegypti] mosquito’s availability across the world, I think the spread will next be across Asia and I think we really have to be prepared for it spreading in Africa. I don’t see any reason why it wouldn’t.” 

Last month, 16 pregnant women in Singapore were confirmed to have zika virus. “You can anticipate reports from Vietnam, from Indonesia, from India. I don’t think we’re even at the start of the Zika knowledge base yet,” said Farrar.

The two philanthropic organisations, together with the Brazilian, US and UK governments, have announced $18m (£14.7m) funding for an ambitious project to release mosquitoes infected with Wolbachia bacteria in two urban areas of Brazil and Colombia. The bacteria renders the mosquitoes unable to transmit viruses. They breed with local mosquitoes, producing offspring with Wolbachia, a bacteria carried by 60% of insects that is harmless to humans. 

If it works, it will help limit not just Zika but also other flaviviruses, including dengue and yellow fever. Read the full story here.

"Yes We Can" - American scientists controversially recreate deadly Spanish Flu virus.

"Yes We Can" - American scientists controversially recreate deadly Spanish Flu virus. HT: Independent.

The extinct influenza virus that caused the worst flu pandemic in history has been recreated from fragments of avian flu found in wild ducks in a controversial experiment to show how easy it would be for the deadly flu strain to reemerge today.

Scientists said the study involved infecting laboratory ferrets with close copies of the 1918 virus – which was responsible for the Spanish Flu pandemic that killed an estimated 50 million people – to see how easy it can be transmitted in the best animal model of the human disease.

But other researchers have denounced the research as foolhardy and dangerous. Critics said that any benefits of the attempts to recreate 1918-like flu viruses from existing avian flu strains do not justify the catastrophic risks if such a genetically engineered virus were to escape either deliberately or accidentally from the laboratory and cause a deadly influenza pandemic.

However, Professor Yoshihiro Kawaoka of the University of Wisconsin-Madison dismissed the criticisms of his research saying that it is necessary for the development of influenza vaccines and other countermeasures designed to minimise the risks of a future flu pandemic.

“These critics fail to appreciate the precautions and safeguards built into our work, the regulation, review and oversight these studies receive….The risks of conducting this research are not ignored, but they can be effectively managed and mitigated,” Professor Kawaoka said. Read the full story here.

Saudi Arabia now starting MERS tests for camels and livestock.

Saudi Arabia now starting MERS tests for camels and livestock. HT: Croft.

Via Arab News: MERS tests for camels and livestock. Excerpt:

The Kingdom has started testing camels in the country for the Middle East Respiratory Syndrome-Coronavirus (MERS-CoV), according to Minister of Agriculture Fahd Balghuneim. 

Speaking at a workshop in Riyadh recently on registering and numbering livestock in the country, Balghuneim said the ministry would start testing all livestock in the Kingdom starting next week to make sure they do not have MERS. 

He said there would be coordination with the Saudi Wildlife Authority to take samples from wild animals kept in nature reserves to determine the level of coronavirus infection in the Kingdom. 

He said there is no suitable equipment to conduct speedy tests for coronavirus. Officials have to take blood or mucus samples, which takes a long time. 

Balghuneim confirmed that there are no tests for the coronavirus at quarantine sites in countries exporting animals to Saudi Arabia. 

He said the measure is part of the ministry’s program to control the spread of infectious diseases. Livestock entering the Kingdom just before Ramadan would be quarantined and vaccinated in exporting countries. 

“We started registering and numbering livestock last year in Um Raqaiba. We started with camels belonging to Prince Mishal bin Abdulaziz to encourage other camel owners to do the same. Next week we will speed up the operation. The numbering of livestock will include sheep and camels in Badia through contractors working for the Ministry of Agriculture,” he said.

How MERS could topple the House of Saud, and beyond

How MERS could topple the House of Saud, and beyond. HT: Croft.

The Tyee has published my article How MERS Could Topple the House of Saud, and Beyond. Excerpt:

Statistically, the bug now known as Middle East respiratory syndrome coronavirus (MERS-CoV) is a trivial threat. In the two years we've known about it, the World Health Organization has officially recognized just 635 cases of MERS, with 193 deaths. All appear to have originated in the Middle East, chiefly Saudi Arabia and the United Arab Emirates. 

By comparison, Saudi Arabia suffered 6,596 traffic fatalities in 2010, and about 20 per cent of the people in the Persian Gulf region suffer from diabetes. 

But look again at those MERS deaths: a 30 per cent case fatality rate, where SARS had a rate of eight per cent. A disease that deadly will get attention, especially when it comes from a previously unknown virus and it flourishes in hospitals. 

The Gulf monarchies also have political reasons to fear MERS, and Saudi Arabia just announced that it's been fudging the case numbers for a year -- a confession likely to have major repercussions.Read the full story here.

CIDRAP on the new Saudi MERS numbers '133 detections including 92 fatal cases'

CIDRAP on the new Saudi MERS numbers '133 detections including 92 fatal cases' HT: Croft.

Via CIDRAP, Robert Roos writes: Review raises Saudi MERS case count 20%, death toll 48%. After summarizing the KSA MOH statements today, the post concludes:

Experts who commented on today's announcement welcomed the Saudi move toward greater transparency and expressed hope that it continues and increases. 

Connie Savor Price, MD, chief of infectious diseases at Denver Health and Hospital, commented, "When the new [minister of health] came into office, I do believe one of his priorities was to re-examine the data to ensure experts were getting accurate data to inform interventions. More rigorous case findings identified the additional cases and deaths that you heard about today. My sense is that most of these cases are healthcare associated." 

She denied any knowledge of the reasons for Memish's dismissal, but said she found the timing of today's announcement "interesting." 

"The MOH seems to want to be clear that they are here to collaborate and value transparency. That is a step in the right direction," she added. 

Michael T. Osterholm, PhD, MPH, who has done consulting work on MERS-CoV in the Middle East, said it's unclear why the additional cases were not reported earlier and what implications they have for understanding the MERS outbreak in Saudi Arabia. He is director of the University of Minnesota's Center for Infectious Disease Research and Policy, publisher of CIDRAP News. 

"We welcome this new level of transparency and hope it will continue with more detailed information about these cases and what will be done so that this doesn't happen in the future," he said. 

"It also reinforces the point that we need much more information about the risk factors for transmission, which can be answered only by the completion of a comprehensive case control study.  

"The bottom line message that we've got to understand is that this is not a Kingdom of Saudi Arabia problem or even a Middle East problem; this is an international problem," he said. "All it would take is one super-shedder of this virus to land in Tokyo or New York or London or Toronto, and this situation would turn on a dime."

Related:

Via his VDU's blog, Dr. Ian Mackay writes: MERS-CoV charting on hold after 113 new cases reported without details... Excerpt:

With the announcement overnight that a bunch (133 detections including 92 fatal cases) of old laboratory confirmed MERS-CoV detection had been found, but without any specific data to identify them, I will not be posting any further MERS-related charts. 

I believe there is a big WHO Disease Outbreak News update coming soon and it will provide all the detail - we bloggers will need to take a week off from our day jobs to add this detail to our line lists - but I'll resume charts some time after those data appear. 

This is all obviously being dumped at the feet of the stood down Deputy Minister of Public Health whose reputation for total control was well reported. Let's not forget that Minister, Abdullah al-Rabeeah, was stood down 21-April by King Abdullah. While Prof Memish obviously loved a good paper, and that was his chosen method of science communication (I've talked about that as a less-than-ideal route for public health matters), but I personally have no evidence for or against the scope of his control over this latest debacle. 

This is Acting Health Minister Adel Faqih's second try for "transparency" in reporting MERS. On the first try, we were all impressed with the new details, until the details began to vanish and the infographics had nothing new. This time we have tables plus infographics, and one big announcement, but we need a lot more.

Especially we need a lot more specialists in the KSA MOH to tell the Acting Minister that he can't fire his way to a MERS-free Kingdom by the start of the next Hajj in October. 

All he can really do is tell the world the truth, the whole truth, and nothing but the truth, and hope the world will help him find the answer.

New MERS Cov virus + Hajj: Maybe not a recipe for disaster.

New MERS virus + Hajj: Maybe not a recipe for disaster.HT: Croft.

Via NBC News.com, a good report by Maggie Fox: New MERS virus + Hajj: Maybe not a recipe for disaster. Excerpt:

It seems like the perfect storm — millions of people from all over the world, descending on a few cities all in the space of a few weeks, just as a deadly and mysterious new virus is spreading. 

But global health officials say they are not especially worried that the annual Hajj pilgrimage in Saudi Arabia will help spread the MERS coronavirus when it starts next week. That’s even though this virus has demonstrated that it’s only a single flight away from any city in the world, and even though it’s an especially deadly virus. 

Why not? MERS hasn’t yet acquired the ability to spread easily from one person to another. 

And while U.S. health officials are keeping an eye out for it, they’re not especially concerned, either. “We think the risk is low,” says Dr. David Trump, state epidemiologist for Virginia. 

Watching out for the virus across the United States this year may fall mostly on the shoulders of state health officials such as Trump, as the government shutdown has closed most activities of the Centers for Disease Control and Prevention.

Related:  WHO has published Middle East respiratory syndrome coronavirus (MERS-CoV) - update. Excerpt:

WHO has been informed of an additional two laboratory-confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Saudi Arabia. 

The patients, both men, aged 55 and 78, were from Riyadh region. They became ill at the end of September 2013 and died in the beginning of October 2013. Both the patients were reported to have had no contact to a known laboratory-confirmed case with MERS-CoV. 

Globally, from September 2012 to date, WHO has been informed of a total of 138 laboratory-confirmed cases of infection with MERS-CoV, including 60 deaths.

Dr. Mackay: The Hajj begins.....will we see MERS going global?

Dr. Mackay: The Hajj begins..........will we see MERS going global?HT: Croft.

On his VDU's blog, virologist Dr. Ian Mackay writes: The Hajj begins. Excerpt:

Given a 14-day incubation period (most lengthy estimate), if the MERS-CoV is going to show up any differently among hajis this year than it did as a result of last year's Hajj (you may have noticed that no pandemic ensued), we should see those cases having presented with symptoms by Sunday the 27th. If we really want to get a feel for how easily transmissible this virus is, then this is the opportunity to observe and test. 

Of course, this is an artificial date, given pilgrims have been assembling and mingling for some time during the lead-up to Sunday evening, but I'm using that date as the outer limit for appearance of symptomatic cases using a timepoint in which many people definitely congregated together in large numbers. 

We may also see a rise in cases appearing outside the KSA as returning pilgrims picking up infection just before they depart, become symptomatic on home soil. Or we may not.

Speaking as a hyperchondriac (a perfectly healthy ignoramus who fears for the health of others, especially from rare diseases), I suspect the Hajj will result in little beyond the usual run of flu and colds among returning pilgrims. 

To risk MERS they will also have to start swarming into Saudi hospitals' ICUs, or somehow expose themselves to the still-unknown outside source of the disease (dates garnished with bat guano?).

At least Dr. Mackay has given us a day by which MERS will have to put up or shut up as a Hajj problem

Saudi Arabia: Two new fatal MERS cases.

Saudi Arabia: Two new fatal MERS cases.HT: Croft.

Via the Ministry of Health's Arabic corona page: Health: registered cases of HIV infection (Corona) New in the Riyadh region. A Google translation:

In the framework of the epidemiological investigation and ongoing follow-up carried out by the Ministry of Health for HIV (Corona) new syndrome that causes  Middle East of MERS-CoV respiratory ministry announces the registration of two cases in the Riyadh region. 

First of a citizen at the age of 78 years old, suffers from several chronic diseases, has died of God's mercy.  The second case to another citizen at the age of 55 years old and suffering from chronic diseases, has died God's mercy.

The English page has the updated numbers—119 cases, 51 deaths—but not the news release. Neither of these cases appears to be the person in Al-Kharj mentioned my earlier post today. That city is about 80 km south of Riyadh.

Thanks to my friend Tim Walker in Helsinki for retweeting the link to the Press Freedom Index 2013, published on the Reporters Without Borders website.

 It lists Finland as #1 in freedom of the press. Canada comes in at #20, right behind Namibia; the UK is at #29, just ahead of Ghana; the US is at #32, right between Suriname and Lithuania; and Saudi Arabia is at #163, between Sri Lanka and Uzbekistan.

  We should probably bear this in mind in assessing both the quality and quantity of Saudi MERS reports.

Saudi Arabia: Arab News channel gets nervous about MERS.

Saudi Arabia: Arab News channel gets nervous about MERS.HT: Croft.

Via Arab News: MERS challenge gets bigger with new cases.This is of interest chiefly because it's the most anxious story I've seen in Saudi reports on MERS. Excerpt and then a comment:

The global number of infections with the deadly MERS virus has risen to 136, after hard-hit Saudi Arabia confirmed six new cases, the World Health Organization said Friday. 

Glenn Thomas, spokesman for the UN health agency, said it had been informed by Saudi authorities that the virus had been detected in three men and three women in Riyadh, according to AFP. 

The virus, which appeared first in the Kingdom last year, has killed 58 people worldwide, 49 of them in Saudi Arabia, according to official Saudi figures and the World Health Organization (WHO). 

MERS stands for Middle East Respiratory Syndrome coronavirus, in a nod to the fact that the bulk of the cases have been in that region. 

The fact that Saudi Arabia accounts for the overwhelming majority of cases and deaths has raised concerns about this month’s annual Haj pilgrimage to Makkah and Madinah. 

The Haj is one of the largest gatherings in the world, and there are fears that pilgrims could carry the virus back to their homelands. 

But Saudi authorities have said they are optimistic that Haj will pass off without outbreaks, given that faithful Muslims undertake lower-level pilgrimages at other times and there has been no mass spread of MERS. Saudi Arabia has, however, urged the elderly and chronically ill to avoid the event.

Maybe I'm insulated by my Stark Insensibility, but I share the authorities' optimism. Their refusal to share all their MERS information is especially maddening because in mass-gathering medicine, the Saudis clearly know what they're doing.

They have had H5N1 poultry outbreaks, but no human cases. I don't think they had a single SARS case, and the Hajj was not an issue in the H1N1 pandemic. Yes, the pilgrims tend to leave the Kingdom with a lot of colds and flu, but nothing too critical.

So a report like this, intended mostly for non-Saudi readers, looks like hedging against an unwelcome and unlikely surprise.

And that makes me wonder: What's got them spooked about MERS? Dr. Ziad Memish and his colleagues are clearly highly competent professionals. They could simply invoke their admirable record in public health, tell us everything they know, and enjoy the grateful thanks of the global-health community.
Instead, they release confusing bits and scraps of information, leaving us to wonder what the hell is going on. As crisis communications, their policy leaves a lot to be desired.

Hmmmm.........

MERS? Four Elderly Iranian pilgrims die in Mecca.

WHO has been informed of an additional six cases of MERS-CoV infection in Saudi Arabia.

WHO has been informed of an additional six cases of MERS-CoV infection in Saudi Arabia. HT: Croft.

WHO has now published Middle East respiratory syndrome coronavirus (MERS-CoV) - update. Excerpt:

WHO has been informed of an additional six laboratory-confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Saudi Arabia. 

The six new patients are from Riyadh region with ages from 14 to 79 years old, of which three are women and three men. The dates of onset of the patients range from 15 to 26 September 2013. One patient has mild symptoms while the others are hospitalized. Three patients are contacts of previously confirmed cases with MERS-CoV, two are reported to have had no exposure to animals or a confirmed case, and there is no information on exposure of one patient.

Globally, from September 2012 to date, WHO has been informed of a total of 136 laboratory-confirmed cases of infection with MERS-CoV, including 58 deaths.

I hope we will soon get some supplementary information on these new cases. What WHO and the KSA MOH have given us is frustratingly sketchy.

Saudi Arabia - MERS safety: Hajj Pilgrims must wear masks.

MERS safety: Hajj Pilgrims must wear masks.HT: Croft.

Via Arab News: MERS safety: Pilgrims must wear masks. Excerpt:

The Ministry of Health advised Haj pilgrims on Wednesday to wear face masks in the holy cities to protect themselves from the deadly MERS virus. 

Dr. Nazreen Sherbini, a specialist in infectious diseases and influenza, said MERS is transmitted through droplets from coughing and sneezing. 

“Pilgrims should wear protective masks that cover the noses and mouths in crowded places and follow basic health etiquette while sneezing or coughing,” Sherbini said. 

She advised pilgrims to avoid people who cough and sneeze incessantly, have runny noses, and temperature over 38 degrees Celsius. 

To prevent MERS spreading in the holy cities, she said the ministry has asked the elderly with chronic diseases to postpone their Haj.

Hmmmm....... MERS? Four Elderly Iranian pilgrims die in Mecca.

MERS? Four Elderly Iranian pilgrims die in Mecca.

MERS? Four Elderly Iranian pilgrims die in Mecca.(Taz).

Four Iranian pilgrims, who departed for Mecca, died, head of Iran's Hajj and Pilgrimage Organization staff for Mecca city Masoud Mujarradi said, ISNA agency reported on Wednesday.

The pilgrims - three men and a woman were more than 60 years, Mujarradi said.

"The bodies of three pilgrims will be transported to Iran, one will be buried in Mecca," Mujarradi said.

According to him, half of the outgoing pilgrims (35,000 people) have already arrived in Mecca.

For more info on MERS see Croft.

Related?

MERS - Three new cases in Saudi Arabia, Woman at Ottawa hospital being tested for MERS.

MERS - Three new cases in Saudi Arabia, Woman at Ottawa hospital being tested for MERS.

MERS - Three new cases in Saudi Arabia, Woman at Ottawa hospital being tested for MERS.HT: Croft.

In the past hour, the Saudi MOH has posted a brief announcement regarding three additional MERS-CoV cases in or near Riyadh.  While we only have a machine translation to work with for now, one appears to be a 14 year-old contact of a previously confirmed cases, who is reported in stable condition.    

Two others (ages 79, and 45) are described as having `chronic diseases”, and appear to be contacts of previously confirmed cases as well.   

As usual, we learn very little beyond a general location, age, and a vague description of their condition.  Onset dates or date of lab confirmation are not provided.  

Via Ahmnews.com, an Arabic news source: Three new infections b «Kororna» in the Riyadh region. The complete report, as Google translated:

The Health Ministry said in a statement published on its website today announced the discovery of three new cases of people living with Corona in the Riyadh region, the ministry said the details of the statement that in the context of the work of inquiry epidemiological and continuous follow-up carried out by the ministry for the virus (Corona) that causes AIDS Middle East respiratory MERS-CoV announces the registration of three cases of HIV infection in Riyadh. 

First of a citizen at the age of 79 years is suffering from several chronic diseases and Mkhalt to confirmed cases, and the second for citizenship at the age of 14 years of contact with a confirmed case too, suffer from the symptoms of simple and stable health status. The third is a citizen at the age of 45 years old Mkhalt of the confirmed cases, and suffer from chronic diseases and receiving intensive care treatment.  

 Via The Toronto Sun, which is not my idea of a reliable source: Woman at Ottawa hospital being tested for MERS. Excerpt:

OTTAWA — A woman admitted to an Ottawa hospital Saturday may have MERS, the Middle Eastern Respiratory Syndrome, a disease similar to SARS, a source told QMI Agency. 

Symptoms of the potentially fatal ailment include shortness of breath, acute pneumonia and kidney failure. The source says the woman arrived in Ottawa from Dubai and was in the Queensway Carleton Ottawa Hospital on Tuesday. 

Judy Brown, a spokesperson for the hospital, confirmed that a woman had been admitted and is currently being tested for several different illnesses. 

"When someone comes in to emergency, they are triaged, assessed to see what possible injuries they have, and then we get into their medical history," she said. 

Brown emphasized the woman's test results hadn't yet been seen. 

"No one has been diagnosed with MERS," she said. "We are working to rule out respiratory infection." 

Brown said all hospital protocol had been followed and said the woman would have been in contact with between six and 12 hospital staff members since she arrived Saturday.

The hospital's website says nothing about this case; its last news release was published almost a month ago. But I'll keep an eye out for any further reports.Read the full story here and here.

Related: 

Saudi Arabia: Scientific Committee says no coronavirus cases detected among pilgrims

Saudi Arabia: MOH confirms 114 MERS cases, but no details on latest 4 cases.

Saudi Arabia: MOH confirms 114 MERS cases, but no details on latest 4 cases.HT: Croft.

Via the KSA MOH Arabic MERS page, here is the latest news release: Scientific Committee: for assignments Corona between pilgrims and add two laboratories. Excerpt from a Google translation:

The new Corona virus Press Releases Scientific Committee: for assignments Corona between pilgrims and add two laboratories Scientific Committee: for assignments Corona between pilgrims and add two laboratories 11/25/1434   Explained the Scientific Committee National infectious diseases during a press conference held Sunday morning debts of the Ministry of Health in the presence of members of the Scientific Committee of the National Infectious Diseases and the Scientific Committee for the infection of health facilities that the health status of the pilgrims comfortable and thankfully so far, indicating that the ministry has allocated medical teams specialized follow all the pilgrims coming through the various ports (land, air, sea) to examine and give pilgrims immunization vaccines and ensure the application of health requirements that were sent to all the countries concerned and that, God willing, working on dissemination of health and safety and non-proliferation of any epidemic disease among them. 

The Commission added that during the epidemiological surveillance during the past 24 hours has been registered any case, between pilgrims and so far totaling 600 thousand pilgrims, indicating that there is a continuous cooperation with the World Health Organization (WHO) to follow the developments of the disease globally. 

It also confirmed the Scientific Committee on the tongue of its president, Undersecretary of the Ministry of Health, Public Health, Dr. Ziad ميمش that has been added to the lab regional in Medina hospital laboratory Mina valley to work tests for HIV Corona new so as to ensure rapid access to results and work with both the regional laboratories in Riyadh, Jeddah and Eastern conduct laboratory tests on suspected cases infected with the virus, indicating that the test results will appear within 4 hours max. 

The Commission added that the total number of cases infected with coronavirus that was recorded in the Kingdom amounted to 114 cases so far, including 49 deaths.

This appears to be the basis of the Al-Hayat report I linked to earlier today. The press release is mostly good-news information about the work the Scientific Committee is doing, with the new case total thrown in with no details. We can only hope the MOH will get around to posting a formal statement about the new cases sometime in the next few hours.

Related: Saudi Arabia: Special labs in Madinah, Mina for MERS tests

Saudi Arabia: MERS infections rare in Eastern Province

excerpt:

While not conclusive, this study suggests that the MERS-CoV wasn’t circulating widely in the Eastern Province of Saudi Arabia prior to December of last year.  Which supports the idea that this virus is probably a recent arrival to the human population, and not something that’s been infecting people, but going undiagnosed for years. 

CIDRAP: WHO raises concerns about MERS-CoV patterns and pace.

CIDRAP: WHO raises concerns about MERS-CoV patterns and pace.HT: Croft.

Via CIDRAP, Lisa Schnirring writes: WHO raises concerns about MERS-CoV patterns and pace. Click through for the full report and important links. Excerpt:

The World Health Organization (WHO) today aired concerns about surging numbers of Middle East respiratory syndrome coronavirus (MERS-CoV) cases and clusters and said that the disease pattern seems to be trending younger and affecting women more often. 

In a separate report, the WHO downgraded two cases from confirmed to probable, which left its official global tally at 130 cases. 

The first report contained a WHO summary of outbreak events and literature review, the agency's first since Aug 13. Since then, 37 new MERS-CoV cases have been reported, 34 from Saudi Arabia and 3 from Qatar. Nine of the infections were sporadic, but the rest were parts of clusters. 

Regarding changes in demographics, the WHO said the median age of sporadic cases has dropped slightly, but a shift in gender is more pronounced and persistent. More than half (56%) of the newer case-patients have been female. This contrasts with earlier cases: Through the middle of July, 83% of the patients were male. 

The geographic focus of the outbreak still leans strongly toward Saudi Arabia. Eight of the nine newest sporadic cases were probably exposed to the virus in that country. Though new cases continue to crop up around pilgrimage sites such as Medina, the WHO said none were reported in pilgrims who visited recently to perform Umrah for Ramadan. 

Recently reported clusters are under close observation for further onward transmission, the WHO said. 

The reasons for the uptick in sporadic cases aren't clear and could be related to increased surveillance, expansion of the virus in the unknown reservoir, seasonal variation, or an exposure pattern change, according to the WHO. 

The WHO report fleshes out connections between many of the new cases. For example, it notes that a 41-year-old nurse from the Philippines didn't have contact with any known confirmed MERS-CoV cases but is thought to have infected two other healthcare workers.

"All Is quiet at the MERS front" - Why is WHO so quiet about 18 cases?

"All Is quiet  at the MERS front" - Why is WHO so quiet about 18 cases?HT: Croft.

'What we have here, folks, is not a failure to communicate. It's a refusal to communicate: a refusal first by the Saudis and second by WHO.'

Helen Branswell has tweeted her surprise at the brevity of of WHO's September 19 MERS update. I share her surprise. Compare that update with the last one, issued on September 7. Then compare that item with WHO's first comment on the novel coronavirus in the United Kingdom, issued almost exactly a year ago on September 23.

Embarrassing, isn't it? With the first case we get floods of detail. With the September 7 update, we get the epidemiological equivalent of name, rank, and serial number. With today's update, WHO shrugs off 18 cases with details that the Brits would define by the technical term of sweet buggerall.

I've seen this before. In the early months of H5N1 in Indonesia, WHO's updates were full of detail. As the outbreaks and human cases continued, updates got shorter. Meanwhile, Indonesia's Ministry of Health shut up altogether about new H5N1 cases.

What we have here, folks, is not a failure to communicate. It's a refusal to communicate: a refusal first by the Saudis and second by WHO. 

I understand WHO's need to stay on good terms with anxious governments, just as a physician would stay on good terms with the anxious family of a very sick patient. But a ministry of health is not an anxious relative—it's a colleague under stress, the doctor in charge of a difficult case. No physician likes to criticize a colleague. Everyone makes mistakes, and next time it could be the critic's turn.

Even so, the patient's welfare is more important than the colleague's. The Saudis are risking their patients, and ensuring many more patients to come, by their refusal to give the global health community all the details of their past and present MERS cases.

WHO, meanwhile, is risking its own reputation and effectiveness by failing to demand and publicize more information from Minister Al-Rabeeah, Dr. Memish, and the other Saudi professionals.

(Dr. Memish, by the way, tells the Wall Street Journal he thinks his ministry is being very transparent just because it has a MERS website where its pious but uninformative reports are posted.)

When journals like Nature are reporting "Progress stalled on coronavirus" then WHO should recognize that in the active voice the headline would read "WHO stalls progress on coronavirus."

And WHO should understand that with every day it stalls on MERS, it makes itself less able to deal with the next phase of the disease—not to mention the next outbreak of something new.

Via Eurosurveillance: Stability of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) under different environmental conditions. The abstract:

The stability of Middle East respiratory syndrome coronavirus (MERS-CoV) was determined at 20°C – 40% relative humidity (RH); 30°C – 30% RH and 30°C – 80% RH. MERS-CoV was more stable at low temperature/low humidity conditions and could still be recovered after 48 hours. During aerosolisation of MERS-CoV, no decrease in stability was observed at 20°C – 40% RH. These data suggest the potential of MERS-CoV to be transmitted via contact or fomite transmission due to prolonged environmental presence.

Saudi Arabia: Min Of Health announces 3 new MERS cases, 2 deaths.

Saudi Arabia: Min Of Health announces 3 new MERS cases, 2 deaths.HT: Croft.

Via Giuseppe Michieli at FluTrackers: MERS-CoV, Saudi Arabia: MoH Announces Three New Cases, 2 fatal (September 18 2013). The statement is not on the English-language page of the MOH website, though it has updated the total cases to 107 and deaths to 49. From a Google translation:

In the framework of the epidemiological investigation and ongoing follow-up carried out by the Ministry of Health for the novel Coronavirus (MERS-CoV) Ministry announces the registration of three cases of infection. 

First of citizenship at the age of 75 years, mixing with the confirmed case in Medina and has several chronic diseases has and passed away Ngmayora of God rest in peace. 

The second of a citizen at the age of 35 years old, Mkhalt it confirmed case in Medina and has several chronic diseases and is currently receiving intensive care treatment. 

The third a citizen at the age of 83 years of Riyadh region, and has several chronic diseases, has passed away may he rest in peace.

Further discussion on the thread establishes that the first case is a woman and other two are men. Once again, the first thing we know about two of the cases is that they died before the Ministry could get around to informing the world they had fallen ill in the first place.

Related : number of MERS cases 152 and counting: rambaut/MERS-Cases

Saudi Arabia: Ministry takes steps to tackle MERS during Haj

Saudi Arabia: Ministry takes steps to tackle MERS during Haj.HT: Croft.

Via the Saudi Gazette: Ministry takes steps to tackle MERS in Haj. Excerpt:

Minister of Health Dr. Abdullah Al-Rabeeah said on Tuesday that the ministry has mobilized all its resources to make its Haj plan a resounding success. 

He made the remarks while chairing the meeting of preparatory committees to review the ministry’s plan for Haj. 

About 22,500 staffers, equipped with all necessary facilities and 50 ambulances, will be engaged in health services for pilgrims, the Saudi Press Agency (SPA) reported. The ministry has allocated SR10 million for making available highly advanced facilities at health centers and hospitals at holy sites. 

All precautionary measures have been taken to prevent the outbreak of MERS-coronavirus during Haj. 

Al-Rabeeah also explained the measures taken by the ministry to deal with MERS and swine flu viruses. “The ministry won’t prevent any pilgrim from performing Haj. However, it advises the elderly and the chronic patients to postpone their plan for Haj this year,” he said. 

The ministry has readied 25 hospitals in Makkah, Madinah and the holy sites with a total of 5,250 beds. These include seven hospitals in Makkah, nine in Madinah, and four each in Mina and Arafat, in addition to King Abdullah Medical City. There are also 141 permanent and temporary health centers, including 43 in Makkah, 80 at the holy sites and 12 in Madinah, besides 17 emergency centers on Jamrat Bridge. Some 16,000 blood units consisting of all blood groups have been made available. There are four helipads at the hospitals of Hera, Al-Nour, Arafat and Mina Emergency to attend to emergency cases. 

Al-Rabeeah said that the ministry has completed preparations for the second international mass gathering medicine conference, which will begin in Riyadh on Sept. 21. MERS-coronavirus will figure high at the three-day event, which will be held under the auspices of Custodian of the Two Holy Mosques King Abdullah. 

Several prominent figures, including director general of World Health Organization, secretary generals of Arab League and Gulf Cooperation Council as well as 15 health ministers and health experts from all over the world will address the conference.

I would rather hear what Dr. Chan says to the Saudis in private.

Arab News has a shorter version of the same story. Both versions seem dubious to me, a lot of arm-waving and rattling-off of numbers. Perhaps Dr. Al-Rabeeah would inspire more trust in this report if he'd been open and honest with the world from the start.

"The Silence of MERS" - 'One year later, MERS virus remains largely a mystery.'

"The Silence of MERS" -  'One year later, MERS virus remains largely a mystery.'HT: Croft.

Via Canada.com, Helen Branswell of The Canadian Press writes: One year later, MERS virus remains largely a mystery. This is the kind of concise but thorough overview that few others on the health beat seem able to write. Excerpt (but read the whole highly readable article, and follow her if you're not doing so already):

TORONTO — A year after SARS hit the world’s radar, scads had been learned about the virus that set off outbreaks in China, Hong Kong, Toronto and other spots, and ignited panic far beyond the affected centres. 

The coronavirus was rapidly discovered, it genome sequenced within weeks of the World Health Organization warning on March 15, 2003, of its existence and spread. The animals that transmitted it to people had been identified. Doctors knew when SARS patients were infectious and what steps needed to be taken to stop its spread. With that knowledge, the virus was quickly contained. SARS is medical history. 

Later this week — Friday — will mark a year since the world learned that a cousin of the SARS virus had burst out of some hiding spot in nature to infect and kill a man in Saudi Arabia. Since then, the world has learned of roughly 130 MERS cases, 57 of them fatal. 

But in contrast to the SARS outbreak, at this point relatively little is known about MERS. With several million Muslim pilgrims descending on Saudi Arabia — the hottest of MERS hot spots — in coming weeks for the annual Hajj, there is a real sense of worry among scientists watching the outbreak. 

Many scientists are at a loss to diplomatically explain the lack of progress.

She goes on to cite Michael Osterholm's bafflement that WHO and the US government aren't complaining about the lack of information. 

I'm baffled too, but I'm tactless enough to voice my suspicions: The House of Saud finds MERS an annoyance and a threat to the cash flow of this year's Hajj. 

King Abdullah, the Custodian of the Two Holy Mosques, is 89, and the proud owner of an obviously dyed moustache and goatee. Every time I land on a Saudi news website, I see his face on the front page, day after day. With personal wealth estimated at US$21 billion, King Abdullah clearly does things his own way, and as one only 17 years his junior, I'm inspired by his example of remaining in charge for decade after decade.
But the king and the whole royal house are not up to speed on public health issues, and don't feel the slightest pressure to improve.
Like the Buchanans in The Great Gatsby, they retreat into their money and leave others to clean up their messes. In this case, the janitor appears to be Dr. Ziad Memish, who publishes an occasional article on MERS, or issues confusing advice, but can't be bothered to answer Branswell's calls.

Just as the US government can't afford to criticize the House of Saud under any circumstances, neither can WHO or other health agencies; even lowly US scientists understand that their future research could depend on not annoying an old despot in an absurdly rich, absurdly influential, absurdly backward country...a richly ironic predicament for a global health system centuries ahead of the Saudi royals.