Saturday, July 6, 2013

Vietnam 2013 Confirmed H5N1 Human Cases List

Date of Report:  4/9/13
Name:  4(M) Nguyễn Duy Hoàng Huy
From: Tân Hội Trung, Dist. Cao Lãnh, Dong Thap Province (southern)
Onset:  3/23
Adm:  3/26 Outpatient treatment CHS
Adm:  3/30 Hospital Cao Lanh District
Adm:  4/4 Coat Hospital, Dong Thap
Note:  Ate chicken, duck beforehand.
DOD:  4/4/13

Date of Report:  4/28/13
Name:  20(M)
From:  Long An Province
Onset:  4/11/13
Adm:  4/14/13
Note:  Dead poultry in neighborhood.  At chicken, duck beforehand.

CDC: Health Alert Advisory H3N2v - July 5, 2013

[This will be located on the right side-bar under "H3N2v Information List" for future reference].

Health Alert Network (HAN)
This is an Official CDC Health Advisory
July 5, 2013

Distributed via the CDC Health Alert Network
July 05, 2013, 09:00 ET (9:00 AM ET)

Variant Influenza Virus (H3N2v) Infections

Summary: This Health Alert Network Health Advisory provides an update on H3N2 variant virus (or “H3N2v”) activity and summarizes CDC’s updated H3N2v case definitions and recommendations for H3N2v surveillance for the summer and fall of 2013. It supersedes the last H3N2v-related HAN Health Advisory, HAN 325, which was issued August 3, 2012.


The first cases of influenza A (H3N2) variant1 (H3N2v) virus infection this year were reported in June 2013. These cases were associated with exposure to swine at an agricultural fair prior to illness onset.
H3N2v viruses with the matrix (M) gene from the 2009 H1N1 pandemic virus were first detected in people in 2011 and were responsible for a multi-state outbreak in the summer of 2012 that resulted in 306 cases, including 16 hospitalizations and 1 fatality. Genetic sequencing by CDC has confirmed that H3N2v viruses isolated in June 2013 are nearly identical to those detected during summer 2012. Most cases of H3N2v identified during 2012 were associated with exposure to pigs at agricultural fairs. Agricultural fairs take place across the United States every year, primarily during the summer months and into early fall. Many fairs have swine barns, where pigs from different places come in close contact with each other and with people. These venues may allow spread of influenza viruses both among pigs and between pigs and people. Data indicate that infected pigs may spread influenza viruses even if they are not symptomatic (e.g., coughing and/or sneezing). Although instances of limited person-to-person spread of this virus have been identified in the past, sustained or community-wide transmission of H3N2v has not occurred.
Clinical characteristics of the 2012 and 2013 H3N2v cases have been generally consistent with those of seasonal influenza, and have included fever, cough, pharyngitis, myalgia, and headache. Of the 16 H3N2v hospitalized patients, most were at increased risk for complications of influenza because of age or the presence of an underlying medical condition. None of the persons ill with 2013 H3N2v infection have been hospitalized, and no deaths have occurred among them.
Rapid detection and characterization of novel influenza viruses remain important components of national efforts to prevent further cases and evaluate clinical illness associated with these viruses. As a result, clinicians are reminded to consider influenza as a possible diagnosis when evaluating patients with acute respiratory illnesses, and clinicians should consider the possibility of H3N2v in persons presenting with respiratory illness and recent swine contact or attendance at an agricultural fair. The H3N2v case definitions for 2013 ( include laboratory-confirmed cases and cases under investigation for H3N2v virus infection; the probable case definition used in 2012 has been deleted.

CDC anticipates that state health departments will identify more H3N2v cases in 2013 as agricultural fair season continues. The number of cases may exceed those identified last year, and CDC recommends a surveillance strategy for 2013 designed primarily to identify increases in person-to-person transmission or clinical severity. Testing for H3N2v should focus primarily on persons with exposures known to be associated with H3N2v virus infection (e.g., fair attendance) and in settings where person-to-person transmission has been identified previously (e.g., influenza-like illness outbreaks in child-care centers).  For more information on 2013 testing recommendations, please see Novel influenza A virus infections, which include those caused by H3N2v, remain notifiable conditions in the United States, and all confirmed cases should be reported to CDC within 24 hours.
CDC continues to share information and guidance for local and state public health officials regarding the surveillance and investigation of human infections with H3N2v. This information is available at

Recommendations for H3N2v for clinicians, public health practitioners, and the public for the summer and fall of 2013 are summarized below:

Recommendations for Health Care Providers and Public Health Practitioners

  • Clinicians who suspect influenza in persons with recent exposure to swine should obtain a nasopharyngeal swab or aspirate from the patient, place the swab or aspirate in viral transport medium, and contact their state or local health department to arrange transport and request a timely diagnosis at a state public health laboratory.
  • Commercially available rapid influenza diagnostic tests (RIDTs) may not detect H3N2v virus in respiratory specimens. Therefore, a negative rapid influenza diagnostic test result does not exclude infection with H3N2v or any influenza virus. In addition, a positive test result for influenza A cannot confirm H3N2v virus infection, because these tests cannot distinguish between influenza A virus subtypes (i.e., they do not differentiate between other human influenza A viruses and H3N2v virus). Therefore, respiratory specimens should be collected and sent for sub-type specific real-time polymerase chain reaction (RT-PCR) testing at a state public health laboratory.
  • Enhanced surveillance for influenza during agricultural fair season is recommended to facilitate timely detection and investigation of H3N2v cases. Recommendations for influenza surveillance and testing can be found at
  • Clinicians should consider antiviral treatment with oral oseltamivir or inhaled zanamivir in patients with suspected or confirmed H3N2v virus infection. Antiviral treatment is most effective when started as soon as possible after influenza illness onset. For more information on antiviral treatment for H3N2v virus infections, please see

Recommendations for the Public

  • Persons who are at high risk for influenza complications2 should avoid exposure to pigs and swine barns at fairs this year.
  • Persons engaging in activities that may involve swine contact at fairs should wash their hands frequently with soap and running water before and after exposure to animals; avoid eating or drinking in animal areas; and avoid close contact with animals that look or act ill. For additional information, please see
  • Patients with influenza-like illness who are at high risk for influenza complications2 should see their health care provider promptly to determine if treatment with antiviral medications is warranted.
  • Patients who experience influenza-like symptoms following direct or close contact with pigs and who seek medical care should inform their health care provider about the exposure.
  • Influenza viruses have not been shown to be transmissible to people through eating properly handled and prepared pork or other products derived from pigs. For more information about the proper handling and preparation of pork, visit the USDA website fact sheet “Fresh Pork from Farm to Table” at

For more information:

1 Influenza viruses that circulate in swine are called swine influenza viruses when isolated from swine, but are called variant viruses when isolated from humans.
2 This includes persons with certain underlying chronic medical conditions such as asthma, diabetes, heart disease, or neurological conditions, pregnant women, and persons younger than 5 years, older than 65 years of age, or who have weakened immune systems. For additional information on persons at increased risk for influenza complications, please see

The Centers for Disease Control and Prevention (CDC) protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.
Department of Health and Human Services
HAN Message Types
  • Health Alert: Conveys the highest level of importance; warrants immediate action or attention. Example: HAN00001
  • Health Advisory: Provides important information for a specific incident or situation; may not require immediate action. Example: HAN00346
  • Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action. Example: HAN00342
  • Info Service: Provides general information that is not necessarily considered to be of an emergent nature. Example: HAN00345
This message was distributed to state and local health officers, state and local epidemiologists, state and local laboratory directors, public information officers, HAN coordinators, and clinician organizations.

Vietnam: #H1N1 3 Treated CHC & Hospital, 10 Treated at Home - Contacts of Confirmed Case, Death of 15yo

July 6, 2013

Currently Na Bau, Ngoc Tang (Ha Giang town) - the patient's local Protestant Ban Thi, professional bodies are discovered and 13 people with suspected influenza A/H1N1, including 3 patients who are being treated in Ha Giang General Hospital and CHCs, 10 patients are being treated at home. Currently health has stabilized.
To quell outbreaks promptly, Ha Giang Health Department has directed the professional bodies to expeditiously handle the outbreak, disinfection spray conducted in Na Bau; appoint professionals to base epidemiological investigation and monitor disease and proposed preventive measures in the community to prevent radical not to disease outbreaks. /.

Vietnam: #H1N1 Ha Giang - 1 Death, 14 Suspected

Saturday, 06/07/2013 14:15
Na Bau, Ngoc Duong, and currently there are 14 people with suspected H1N1 infection, including 15-year-old female patient died.
According to the Medical Center of Ha Giang, female patients (15 years of age, Na Bau, Ngoc Tang), tested positive for H1N1 died.
Patients with onset of illness from 19/6 to the expression as loose stools, coughing in the morning, runny nose, chest tightness, fever sweating, red face, headache, bad eating, sleeping Storage packaging.
On 22/6, the patient was taken to Medical Center of the city of testing product samples, then transferred to the provincial hospital treatment. But then the girl died.
By Day 2/7, with test results confirmed patients positive for H1N1 influenza. Authorities have taken measures to treat outbreaks, spray disinfectant in Na treasure. 

Vietnam: Ha Giang Confirmed Death: 13 Contacts Suspected, 3 Hospitalized #H1N1

[This is a post regarding the death in the previous post in Ha Giang - here:
Ha Giang Province
Name: 15 (F) - Bàn Thị Lành
From: Na Bau, Ngoc Duong, Ha Giang city,
Onset:  6/19, diarrhea, coughing in a.m., runny nose, chest tightness, fever sweating, headache
Adm:  6/22 Medical Center
Adm:  6/28  Provincial Hospital
sym’s on adm: high fever, cough, breathless
Diag. on Adm:  Resp. Tract Infec.
Confirmed:  6/27
Note:  14 Suspected; 3 Hospitalized
DOD:  4/7

It is a bit rough in it's translation]
July 6, 2013

When shifting about, Ban Thi L., in Ha Giang still eat normally, then colic diarrhea, accompanied by cough, bloodshot eyes, chest pain, fever sweating After 9 days ... coma, Storage Packaging, L., died.
Test results of the Institute of Hygiene and Epidemiology showed that patients Ban Thi L., defined positive for influenza A (H1N1). According to the Medical Center of Ha Giang City, outside Ban Thi L., Na is in Bau, Ngoc Duong, Ha Giang (where the female rural living) there with 13 other people and suspected influenza A (H1N1). Currently 3 patients are being treated at the Provincial Hospital and CHS, 10 patients were treated at home, health is stable. Immediately after the incident, Ha Giang Health Department has Document No. 529/SYT-NVY, 4-7 days "About deploying measures to handle outbreaks of influenza A (H1N1). Ha Giang Health Department has directed the Center for Preventive Medicine provinces, provincial Hospital, Medical Center City outbreak handled expeditiously.

Vietnam: 1 Death Ha Giang Province #H1N1

July 6, 2013
Mr. Tran Duc Quy, director of Ha Giang Department of Health said patient Bàn Thị Lành, 15 years old, residing in Na Bau, Ngoc Duong, Ha Giang city, was hospitalized on 28/6 with millions more cough, high fever and lethargy breathlessness, was diagnosed respiratory tract infections, infectious medical treatment.
However, after treatment, disease symptoms for the worse, appearing lesions in the lungs. The test specimens at the Institute of Hygiene and Epidemiology for positive results with influenza A/H1N1 virus.
Refer the patient to a hospital intensive care department, the treatment regimen of influenza A/H1N1. But due to severe disease progresses, so after 7 days of treatment, on 4/7 patients died. Soon Ha Giang Provincial Health Department has directed disinfection in patient treatment areas and implement prevention for those who have contact with patients.
Earlier, the end of the month 5/2013, Nguyễn Văn Liều, 56 -  villages in Lùng Sinh, Việt Lâm Commune, Vị Xuyên district also died A/H1N1 flu virus.
Medical Director of Ha Giang Tran Duc Quy said: As soon as the evolution of the disease appear, the Department of Health has held leadership deployed to deployed units and clinics until the contents Prevention of influenza in general, including H1N1, H5N1 and H7N9 ...
Also trained physicians in the province of preventive, detection of influenza patients via respiratory infections.However, due to the sporadic disease appear so very unpredictable and difficult to implement prevention. /.

Finland braces for coronavirus

July 6, 2013

Health authorities in Finland are prepared for the virus, which could mutate into a form more easily transmitted between humans. No infections have so far been reported in Finland, but new cases are emerging all the time in the Middle East.

The National Institute for Health and Welfare (THL) is in a state of readiness concerning the Middle Eastern respiratory syndrome coronavirus (MERS-CoV). According to THL researcher Pamela Österlund, the health authority has prepared tests for detecting the virus, which causes serious respiratory system infections.
The World Health Organisation (WHO) said on Friday it was preparing for an outbreak of the coronavirus. The WHO is convening an emergency committee to track the virus’ spread, and to decide on possible counter measures.


CDC: Case Count: Detected U.S. Human Infections with H3N2v by State since August 2011

July 5, 2013

On this Page

* Case in Utah occurred in April 2012.
This chart indicates the number of CDC-reported infections with H3N2v variant influenza A viruses since August 2011 and is current as of June 28, 2013. This case count will be updated each Friday as new cases are reported.
NOTE: The state totals reported by CDC may not always be consistent with those reported by state health departments. If there is a discrepancy between these two counts, data from the state health departments should be used as the most accurate number.

Continued (for Table 2)

CDC: H3N2v Fact Sheet: Protect Yourself - July 5, 2013

[This document will be located on the right side-bar under "H3N2v Information List" for future reference]

July 5, 2013


A number of human infections with a variant influenza A H3N2 virus ("H3N2v") have been detected in the United States since August 2011 (see Case Count: Detected U.S. Human Infections with H3N2v by State since August 2011). These are viruses that do not usually infect people but that occur in pigs and that are very different from human seasonal H3N2 viruses.
Most of the infections with H3N2v have occurred after contact with pigs. Influenza viruses are thought to spread from infected pigs to humans in the same way that seasonal influenza viruses spread between people. Mainly, the spread of influenza happens when droplets infected with influenza - spread through the air after an infected pig coughs or sneezes - land in your nose or mouth, or when the droplets are inhaled. There is also some evidence that you might get infected by touching something that has virus on it and then touching your own mouth or nose. A third way to possibly get infected is to inhale particles containing influenza virus. Scientists aren’t really sure which of these ways of spread is the most common. In some cases, the H3N2v virus seems to have spread from person-to-person. So far spread has not continued beyond one or two people. The symptoms and severity of H3N2v illness have been similar to seasonal flu.
The H3N2v virus is related to human flu viruses from the 1990s, so adults should have some immunity against these viruses, but young children probably do not. Early steps to make a vaccine against H3N2v have been taken, but no decision to mass produce such a vaccine has been made. Seasonal vaccine is not designed to protect against H3N2v. For more information, please visit Information on H3N2 Variant Influenza A Viruses.

Take Action to Prevent Influenza Virus Spread Between People

The risk of infection and spread of influenza viruses between people, including H3N2v, can be reduced by taking a combination of actions. CDC recommends you:
  • Take everyday preventive actions, including:
    • Try to avoid close contact with sick people.
    • Cover your nose and mouth with a tissue when you cough or sneeze. (Throw the tissue in the trash after you use it.)
    • Wash your hands often with soap and water, especially after you cough or sneeze. If soap and water are not available, an alcohol-based hand rub may be used.
    • Avoid touching your eyes, nose or mouth. Germs spread that way.
    • If you are sick, stay home from work or school until your illness is over.

Take Action to Prevent the Spread of Flu Viruses Between People and Pigs

These actions can reduce the risk of influenza viruses spreading from pigs to people.
  • Don’t take food or drink into pig areas; don’t eat, drink or put anything in your mouth in pig areas.
  • Don’t take toys, pacifiers, cups, baby bottles, strollers, or similar items into pig areas.
  • Wash your hands often with soap and running water before and after exposure to pigs. If soap and water are not available, use an alcohol-based hand rub.
  • Avoid close contact with pigs if possible.
  • Take protective measures if you must come in contact with pigs that are known or suspected to be sick. This includes minimizing contact with pigs and wearing personal protective equipment like protective clothing, gloves and masks that cover your mouth and nose when contact is required.
  • To further reduce the risk of infection, minimize contact with pigs and swine barns.
  • Watch your pig (if you have one) for signs of illness and call a veterinarian if you suspect it might be sick.
  • Avoid contact with pigs if you have flu-like symptoms. Wait 7 days after your illness started or until you have been without fever for 24 hours without the use of fever-reducing medications, whichever is longer. If you must have contact with pigs while you are sick, take the protective actions listed above.
Note that certain people are at higher risk for serious flu complications if they get infected with influenza viruses, including H3N2v. This includes children younger than 5 years, people 65 years and older, pregnant women, and people with certain long-term health conditions (like asthma and other lung disease, diabetes, heart disease, weakened immune systems, and neurological or neurodevelopmental conditions). CDC has issued guidance for “high risk” people attending fairs where swine might be present. Those people should avoid pigs and swine barns at fairs this year.
Additional information and materials, including educational posters that can be displayed around animal exhibits, also are available at the following web page NASPHV: Zoonotic InfluenzaExternal Web Site Icon.
Swine influenza has not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. For more information about the proper handling and preparation of pork, visit the USDA website fact sheet Fresh Pork from Farm to TableExternal Web Site Icon.

If You Get Sick

At this time, CDC recommends the following:
  • If you go to a doctor for flu symptoms (see below) following direct or close contact with swine, tell your doctor about this exposure.
  • If you have flu symptoms, follow CDC’s regular recommendations for seeking treatment for influenza.
    1. If you have symptoms of flu and are very sick or worried about your illness contact your health care provider.
    2. Certain people are at greater risk of serious flu-related complications (including young children, elderly persons, pregnant women and people with certain long-term medical conditions) and this is true both for seasonal flu and novel flu virus infections. (A full list of people at higher risk of flu related complications is available at People at High Risk of Developing Flu-Related Complications.)
      • If these people develop ILI, it’s best for them to contact their doctor as soon as possible. (The majority of recent H3N2v cases have been in children.)
    3. Your doctor may prescribe antiviral drugs that can treat the flu, including H3N2v. These drugs work better for treatment the sooner they are started. If you are prescribed antiviral drugs by your doctor, you should finish all of the medication, according to your doctor’s instructions.
  • Also, whenever you have flu symptoms and are seeing a health care provider, always remember to tell them if you have asthma, diabetes, heart disease, neurological and neurodevelopmental conditions, are pregnant, or are older than 65 or younger than 5 years. These conditions and age factors put you at high risk of serious complications if you have the flu.
  • Flu signs and symptoms usually include fever and respiratory symptoms, such as cough and runny nose, and possibly other symptoms, such as body aches, nausea, vomiting, or diarrhea.
  • Health care providers will determine whether influenza testing and possible treatment are needed.
  • There are influenza antiviral drugs that can be used to treat infection with H3N2v viruses as well as seasonal influenza viruses. More information about influenza antiviral drugs is available at Treatment (Antiviral Drugs).
Resources:  Click on link below

WHO: #MERS #Coronavirus - Guidelines For Investigation of Cases - July 5, 2013

[This will be located on the right side-bar, under "Coronavirus MERS-Cov" for future reference]

1. Introduction   
Coronaviruses are a large family of viruses that can cause a range of illnesses in humans, from the common cold to severe acute respiratory syndrome (SARS).  These viruses also cause disease in a wide variety of animal species.
In  late  2012,  a  novel  coronavirus  that  had  not  previously  been  seen  in  humans  was  identified  for  the  first   time  in  a  resident  of  the  Middle  East.  The  virus,  now  known  as  the  Middle  East  Respiratory  Syndrome   Coronavirus  (MERS-­‐CoV),1  has  caused  more  than  50  laboratory-­‐confirmed  cases  of  human  infection.   Thus  far,  all  patients  infected  with  MERS-­‐CoV  have  had  a  direct  or  indirect  link  to  the  Middle  East,   however,  local  non-­‐sustained  human-­‐to-­‐human  transmission  has  occurred  in  other  countries,  in  people   who  had  recently  travelled  to  the  Middle  East. 
All  MERS-­‐CoV  patients  have  primarily  had  respiratory  disease,  although  a  number  of  secondary   complications  have  also  been  reported,  including  acute  renal  failure,  multi-­‐organ  failure,  acute   respiratory  distress  syndrome  (ARDS),  and  consumptive  coagulopathy.  In  addition,  many  patients  have   also  reported  gastrointestinal  symptoms,  including  diarrhoea.  More  than  half  of  infected  patients  have   died.  The  majority  has  had  at  least  one  comorbid  condition,  but  many  have  also  been  in  previous  good   health.  A  small  number  of  cases  had  had  co-­‐infection  with  other  viruses  including  influenza  A,   parainfluenza,  herpes  simplex,  and  pneumococcus.  As  of  6  June,  the  median  age  of  reported  laboratory-­‐ confirmed  cases  is  56  years  (Range  2–94  years)  and  majority  (72%)  are  males.2  A  current  update  of  the   cases  can  be  found  at  WHO’s  Coronavirus  website. 

The  MERS-­‐CoV  virus  is  thought  to  be  an  animal  virus  that  has  sporadically  resulted  in  human  infections,   with  subsequent  limited  transmission  between  humans.  The  evidence  for  the  animal  origin  of  the  virus   is  circumstantial.  Nevertheless,  the  alternative  explanation  to  explain  the  sporadic  appearance  of  severe   human  cases  with  long  periods  of  time  between  them,  and  the  wide  geographical  area  over  which  the   virus  was  apparently  distributed,  is  unrecognized  ongoing  transmission  in  people.  Surveillance  efforts   since  the  discovery  of  the  virus  and  retrospective  testing  of  stored  respiratory  specimens  suggest  this  is   not  the  case.  
The  virus  has  been  demonstrated  to  grow  well  in  cell  lines  that  in  the  past  have  commonly  been  used  for   diagnostic  viral  cultures.  Finally,  early  comparisons  with  other  known  coronaviruses  suggest  a  genetic   similarity  to  viruses  previously  described  in  bats.  However,  even  if  an  animal  reservoir  is  identified,  it  is   critical  to  identify  the  types  of  exposures  that  result  in  infection  and  the  mode  of  transmission.  It  is  unlikely  that  transmission  occurs  directly  from  animals  to  humans  and  the  route  of  transmission  may  be   complex  requiring  intermediary  hosts,  or  through  contaminated  food  or  drink.  
A  considerable  proportion  of  MERS-­‐CoV  cases  have  been  part  of  clusters  in  which  limited  non-­‐sustained   human-­‐to-­‐human  transmission  has  occurred.  Human-­‐to-­‐human  transmission  has  occurred  in  health  care   settings,  among  close  family  contacts,  and  in  the  work  place.  Sustained  transmission  in  the  community   beyond  these  clusters  has  not  been  observed  and  would  represent  a  major  change  in  the  epidemiology   of  MERS-­‐CoV.  
A  number  of  unanswered  questions  remain  on  the  virus  reservoir,  how  seemingly  sporadic  infections  are   being  acquired,  the  mode  of  transmission  from  animals  to  humans  and  between  humans,  the  clinical   spectrum  of  infection,  and  the  incubation  period.  
2. Purpose and scope of the document   
This  document  provides  a  standardized  approach  for  public  health  authorities  and  investigators  at  all   levels  to  plan  for  and  conduct  investigations  around  confirmed  and  probable  cases  of  MERS-­‐CoV   infection.  It  should  be  read  in  conjunction  with  other  detailed  guidance  referenced  throughout  the  text,   such  as  current  laboratory  testing  guidelines  and  study  protocols.  It  will  be  updated  as  necessary  to   reflect  increased  understanding  of  MERS-­‐CoV  transmission  and  control.   

Most  of  the  advice  given  in  this  document  will  apply  primarily  to  countries  in  which  infection  is   presumed  to  have  originated  from  an  animal  or  environmental  source,  and  the  exposures  that  result  in   infection  remain  the  critical  questions.  In  countries  that  have  secondary  transmission  related  to   imported  cases,  however,  the  recommendations  for  finding  secondary  cases  and  observing  subsequent   community  transmission  are  still  valid,  though  on  a  more  limited  scale.  Similarly,  the  case-­‐control  study   recommended  as  a  high  priority  in  the  second  part  of  the  document  is  not  applicable  to  countries  with   imported  cases,  since  the  purpose  of  the  study  is  to  uncover  the  non-­‐human  exposures  leading  to   infection.  However,  other  studies  on  health  care  facility  transmission  and  clinical  management  are  still   recommended.  
As  with  nearly  all  recent  emerging  novel  pathogens,  most  early  cases  of  MERS-­‐CoV  infection  will  likely   be  detected  by  astute  clinicians  rather  than  through  established  indicator  or  sentinel  surveillance   systems.  Therefore,  the  most  effective  tool  in  detection  will  be  awareness  among  the  health  care   providers.  An  effective  detection  system  will  also  need  to  include  a  readily  available  channel  by  which clinicians  can  report  suspect  cases,  and  an  effective  response  mechanism.  The  Western  Pacific  Regional   Office  of  WHO  (WPRO)  has  published  a  guide  for  event  surveillance.3  

This  document  addresses  two  general  categories  of  activities  that  need  to  be  undertaken  to  deal  with   newly  identified  cases.  The  first  involves  further  case  finding,  case  description,  and  surveillance   enhancements  in  the  area  where  the  case  is  discovered.  The  primary  purpose  of  these  activities  is  to   fully  describe  the  epidemiology  of  the  cases,  identify  and  monitor  close  contacts  of  the  cases  and   determine  the  extent  of  spread  of  the  virus  in  the  area  (sections  3  and  4).  The  second  group  of  activities   is  a  number  of  discrete  studies  aimed  at  answering  critical  questions  related  to  MERS-­‐CoV  (section  5).

 [Continued, see Document link below]

2  WHO  Coronavirus  website:

Document Link:

2nd Time WHO has set up Emergency Committee - 1st time was during 2009 H1N1 Pandemic -

WHO Middle East respiratory syndrome coronavirus (MERS-CoV) - update July 5, 2013

The Ministry of Health (MoH) in Saudi Arabia has announced two additional laboratory-confirmed cases and two deaths in previously confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Saudi Arabia. 

The new cases are a 69 year-old male and a 66 year-old male from Riyadh. Both were admitted to hospital on the 28 June 2013 and are currently in critical condition in an intensive care unit. 

In addition, the two deaths in previously confirmed cases are a 63 year-old female from Riyadh and a 75 year-old male from Al Ahsa. 

Globally, from September 2012 to date, WHO has been informed of a total of 79 laboratory-confirmed cases of infection with MERS-CoV, including 42 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.

Health care providers are advised to maintain vigilance. Recent travelers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. Specimens from patients’ lower respiratory tracts should be obtained for diagnosis where possible. Clinicians are reminded that MERS-CoV infection should be considered even with atypical signs and symptoms, such as diarrhea, in patients who are immunocompromised.
Health care facilities are reminded of the importance of systematic implementation of infection prevention and control (IPC). Health care facilities that provide care for patients suspected or confirmed with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients, health care workers and visitors. 

All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.
WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.
WHO continues to closely monitor the situation. 

Johns Hopkins APL and Armed Forces Health Surveillance Center Release Open Source Electronic Disease Surveillance Software

For Immediate Release
July 1, 2013
Media Contact:
Gina Ellrich (240) 228-7796 or (443) 778-7796
Judith Evans
(301)319-2255 or (301) 222-7905
Tools now available for customization, analysis and widespread distribution
The Johns Hopkins University Applied Physics Laboratory (APL) and the Armed Forces Health
Surveillance Center (AFHSC) have released the Suite for Automated Global Electronic bioSurveillance (SAGES), a collection of flexible, open -source software products developed for electronic disease surveillance in all settings.
Public health officials around the world, especially those with limited capabilities or resources to
meet World Health OrganizationInternational Health Regulations requirements for outbreak surveillance and reporting, can use a SAGES system that is both effective and secure
Through this initial open source code release, users can download and customize the various software to fit their needs, as well as contribute to the continued development of SAGES.
Developed by APL in collaboration with the Global Emerging Infections Surveillance and Response
System (GEIS), a division of AFHSC, the free software suite is designed to collect, analyze, visualize and share information within a national disease surveillance system. Individual SAGES tools may be used to complement existing disease surveillance systems, or used all together to create an end - to - end disease surveillance capability.  
“Having the ability to quickly detect disease cases is critical for global health security,” says U.S.
Public Health Service Lt. Cmdr. Christopher Perdue, the GEIS project manager. SAGES analysis and visualization tools are modeled after the successful U.S. civilian and military surveillance systems known as the Electronic Surveillance System for the Early Notification of Community-
based Epidemics (ESSENCE), developed more than a decade ago by APL and the U.S. Department of Defense.
SAGES-based systems can use any combination of radios, simple cell phones, Android-based
smartphones, tablets, and computers to collect data. In Central and South America, Southeast Asia, and Africa, public health collaborators have used SAGES tools to develop sustainable, customized electronic disease surveillance systems and provide vital end-user feedback to APL during development. “Resource-limited countries have traditionally lagged behind the information technology revolution in public health because of the challenges they face with IT infrastructure, resources and cost of proprietary software,” says Sheri Lewis, APL’s Global Disease Surveillance program manager. “SAGES is designed to fit the needs of the local environment and uses the existing infrastructure and technology available, requiring minimal investment.”
Those who modify the computer code may share their innovations with other users. APL and GEIS
will continue to monitor the SAGES website and update the downloadable version as new components are tested and validated. “SAGES will promote fast and effective public health responses, and we want users to be involved in its ongoing development,” says Perdue. “We have designed it to be highly adaptable and easily sustainable, while allowing each national authority to maintain control over its own data systems.”
The Applied Physics Laboratory, a not-for-profit division of The Johns Hopkins University, meets criticalnational challenges through the innovative application of science and technology. For more information, visit
The AFHSC provides timely, relevant, actionable and comprehensive health surveillance information in order to promote, maintain and enhance the health of military and military-associated populations. For more information, visit


Press Conference: Audio File - WHO update on Middle East respiratory syndrome coronavirus (MERS-CoV) Dr. Keiji Fukuda, Assistant Director- General, Health Security &Environment, WHO

Download - Press Conferences (audio)
5 July 2013
WHO update on Middle East respiratory syndrome coronavirus (MERS-CoV)
Dr. Keiji Fukuda, Assistant Director- General, Health Security and Environment, WHO

Friday, July 5, 2013

CDC: Interim Guidance on Case Definitions to be Used For Investigations of Influenza A (H3N2)v Virus Cases

[This will be filed on the right side-bar under H3N2v Information List for future reference]

Posted on July 3, 2013
This document provides updated interim guidance for state and local health departments conducting investigations of infections with influenza A (H3N2) variant (H3N2v) viruses. Influenza viruses that typically infect swine are referred to as “variant” when they infect humans. The following definitions are for the purpose of investigations of confirmed cases and cases of influenza A (H3N2)v virus infection under investigation. CDC is requesting notification of all confirmed cases of influenza A (H3N2)v virus infection within 24 hours of identification. When possible, state health departments are encouraged to investigate all potential cases of influenza A (H3N2)v virus infection further to determine case status.

Case Definitions for Infection with Influenza A (H3N2)v Virus

Confirmed: Influenza A (H3N2)v virus infection in a patient with laboratory confirmation by:
  • Reverse-transcription polymerase chain reaction (RT-PCR) testing or genetic sequencing results positive for influenza A (H3N2)v virus at the CDC Influenza Division Laboratory


CDC: Interim Guidance for Enhanced Influenza Surveillance: Additional Specimen Collection for Detection of Influenza A (H3N2) Variant Virus Infections

[This has been posted on the right side-bar, under H3N2v Information list for future reference]

Posted on July 3, 2013


This document is an update to interim enhanced surveillance guidance posted in 2012. In anticipation of the 2013 agricultural fair season, states should consider expanding surveillance to include reverse-transcription polymerase chain reaction (RT-PCR) testing of specimens from ILINet providers statewide, of specimens collected from people with ILI reporting recent swine contact or agricultural fair attendance, and of specimens collected from people with unusual or severe presentations of ILI. States should also consider collection of specimens from outbreaks of ILI among children in child-care and school settings, since these settings have been associated with person-to-person H3N2v virus transmission in 2011. CDC will continue to evaluate new information as it becomes available and will update this guidance as needed.


WHO sets up emergency committee on #MERS virus

hat-tip @makoto_au_japon
GENEVA, July 5 | Fri Jul 5, 2013 4:26pm IST
(Reuters) - The World Health Organization is forming an emergency committee of international experts to prepare for a possible worsening of the Middle East coronavirus, which has killed 40 people, WHO flu expert Keiji Fukuda said on Friday.
Fukuda said there was currently no emergency or pandemic but the experts would advise on how to tackle the disease if the number of cases suddenly grows.
"We want to make sure we can move as quickly as possible if we need to," Fukuda told a news conference in Geneva. (Reporting by Tom Miles; Editing by Kevin Liffey)

WHO: Human infection with avian influenza A(H7N9) virus – update July 3, 2013

The National Health and Family Planning Commission, China notified WHO of an additional retrospectively detected laboratory-confirmed case of human infection with avian influenza A(H7N9) virus.

The patient is a 15-year-old boy reported from Jiangsu who became ill on 25 April 2013 and hospitalized on 26 April 2013. He recovered and was discharged on 2 May 2013. The results of molecular diagnostics were positive for H3N2 seasonal influenza virus and H7N9 avian influenza virus. On 1 July, Jiangsu Provincial Health Department consulted national and provincial experts for diagnosis.

To date, WHO has been informed of a total of 133 laboratory-confirmed cases, including 43 deaths.


Chile: #H1N1 Outbreak Kills at least 11, Health Minister to travel there today, Cancelling Fiesta de la Tirana...

July 5, 2013

SANTIAGO – At least 11 people have been killed in an outbreak of H1N1 flu virus in northern Chile, where the rate of infection is more than six times higher than the rest of the country, authorities said Thursday.

“The average across the country is 24 patients per 100,000 residents, but in Tarapaca, in the past week, the rate was 148 patients per 100,000 residents,” Medical Association president Enrique Paris said.
Citing fears of aggravating the outbreak, Paris recommended postponing or cancelling the upcoming Fiesta de la Tirana, a religious celebration planned for July 15-17 where 200,000 people are expected.
Meanwhile, Health Minister Jaime Manalich announced he will travel Friday to the region 1,900 kilometers (1,180 miles) north of Santiago near the border with Bolivia.
The minister also said some 115,000 vaccines will be sent to immunize the population, which numbers around 300,000.

MERS virus doesn’t yet have pandemic potential, but that could change: study

Helen Branswell
July 4, 2013

TORONTO – The new MERS coronavirus currently doesn’t spread well enough among people to trigger a pandemic, says a new study that calculates the rate at which the virus is transmitting person to person.

But the senior author says the pattern of how the virus is spreading now cannot be used to predict whether MERS will become a bigger threat in the future.
“There is absolutely no guarantee that this virus will stay as it is. It could very well follow the same path as SARS did 10 years ago,” Dr. Arnaud Fontanet, who heads the emerging diseases epidemiology unit at the Institut Pasteur in Paris, said in an interview.

Others too say the study should not be used to write off the new virus.

“The virus has shown a potential for human-to-human transmission. And whether such transmission is sustained depends on the intensity of control measures as well as the characteristics of the people involved in transmission,” said Marc Lipsitch, an infectious diseases specialist who teaches at Harvard University.
“For that reason, I think it’s premature to say that this virus does not present a pandemic threat.”


Using the publicly available data on MERS cases, Fontanet and his co-authors set out to figure out what the basic reproduction number for the new coronavirus has been to date.

There are many holes in the available data. For instance, Saudi Arabia, which is responsible for 63 of the 77 confirmed MERS cases, often does not disclose if new infections have links to previous ones – which might mean they caught the virus from another person – or are what are called sporadic cases, people thought to have been infected by an animal or exposure to the virus in the environment.
The authors tried to work around the gaps by calculating best- and worst-case scenarios. Both, it turns out, came up with a reproductive number of less than one, which suggests the virus doesn’t yet have pandemic potential, they said. Those rates were 0.60 and 0.69 respectively.

Complete article: