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  • Sharp jump in SARS cases - World News - Castanet.net

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  • FW: PRO/AH/EDR> MERS-CoV - Eastern Mediterranean (31): Saudi Arabia, Malaysia, Philippines

    Posted on 18/04/2014 - 0 Comments Rob_LW



    -----Original Message-----
    From: promed-bounces@promedmail.org [mailto:promed-bounces@promedmail.org] On Behalf Of promed@promedmail.org
    Sent: 16 April 2014 23:25
    To: promed-post@promedmail.org; promed-edr-post@promedmail.org; promed-ahead-post@promedmail.org
    Subject: PRO/AH/EDR> MERS-CoV - Eastern Mediterranean (31): Saudi Arabia, Malaysia, Philippines


    MERS-COV - EASTERN MEDITERRANEAN (31): SAUDI ARABIA, MALAYSIA, PHILIPPINES
    **************************************************************************
    A ProMED-mail post
    <http://www.promedmail.org>
    ProMED-mail is a program of the
    International Society for Infectious Diseases <http://www.isid.org>

    In this update:
    [1] Malaysia ex Saudi Arabia, 1 death
    [2] Saudi Arabia, Jeddah, 6 new cases, 1 death MOH 16 Apr 2014 [3] Saudi Arabia, Jeddah, 5 new cases, 1 death MOH 15 Apr 2014 [4] Saudi Arabia, update on Jeddah outbreak 37 cases, 7 deaths [5] Saudi Arabia, update on 194 cases (69 deaths) [6] UAE, 10 new cases WHO [7] Philippines ex UAE, asymptomatic

    ******
    [1] Malaysia ex Saudi Arabia, 1 death
    Date: 16 Apr 2014
    Source: The Star [edited]
    <http://www.thestar.com.my/News/Nation/2014/04/16/MERS-detected-in-malaysia/>


    The Middle East respiratory syndrome-coronavirus (MERS-CoV) has killed its 1st victim in Asia, a Malaysian man who developed respiratory complications after returning from Mecca.

    The 54-year-old man, from Batu Pahat, Johor, had arrived in Malaysia on [29 Mar 2014] after performing the Umrah. He died on [13 Apr 2014] after being admitted to the Hospital Sultanah Nora Ismail for 3 days, following complaints of fever, cough and breathing difficulties.

    Passengers on-board the Turkish Airlines flights TK93 and TK60 on the Jeddah-Istanbul-Kuala Lumpur route on [29 Mar 2014] are urged to contact the Health Ministry for a health screening, said Health Minister Datuk Seri Dr S. Subramaniam.

    The MERS-CoV was 1st detected in the Middle East in 2012, but researchers have yet to determine its cause [the "cause" is the MERS associated coronavirus, what is still not fully identified is the route of transmission for the sporadic and index cases. - Mod.MPP].

    The World Health Organization has recorded 238 cases of the disease and 92 deaths related to the MERS-CoV globally to date.

    [Byline: Lee Yen Mun]

    --
    Communicated by:
    ProMED-mail
    <promed@promedmail.org>

    [This is the 1st confirmation of a MERS-CoV infection in a returning pilgrim from Saudi Arabia in Malaysia. Information on possible risk factors/exposures of this individual including all places visited during the pilgrimage, contact with other individuals who may have had respiratory disease, possible contacts with animals, especially camels while there, as well as history of prior co-morbidities that may have pre-disposed to more severe illness would be very much appreciated by ProMED-mail.

    For a map of Malaysia, see <http://healthmap.org/r/awCL>. - Mod.MPP]

    ******
    [2] Saudi Arabia, Jeddah, 6 new cases, 1 death MOH 16 Apr 2014
    Date: 16 Apr 2014
    Source: Saudi MOH [edited]
    <http://www.moh.gov.sa/CoronaNew/PressReleases/Pages/mediastatemenet-2014-04-16-001.aspx>


    In the context of the work of epidemiological investigation and ongoing follow-up carried out by the Ministry of Health, the MOH announces the confirmation of 6 new cases of MERS-CoV infection in Jeddah.

    The 1st is a 54-year-old citizen receiving intensive care treatment.
    The 2nd is a 52-year-old male citizen who has passed away.
    The 3rd is a 41-year-old male resident in stable condition.
    The 4th is a 44-year-old male resident in stable condition.
    The 5th is a 28-year-old male citizen working in the health field, and his condition is stable.
    The 6th is a 35-year-old male resident working in the health field, and his condition is stable.

    Of 200 samples tested, the above 6 were the only positive cases.

    --
    Communicated by:
    ProMED-mail
    <promed@promedmail.org>

    [These newly reported cases bring the total number of laboratory confirmed MERS-CoV infected individuals in Saudi Arabia to 205, including 71 deaths, and the total number of cases reported in the ongoing transmission in Jeddah up to 37. Of note, 2 of the 6 cases were in health care workers [HWC]. See the report contained in [4] with more information on the profile of the Jeddah outbreak.

    For a map of Saudi Arabia, see <http://healthmap.org/promed/p/131>. - Mod.MPP]

    ******
    [3] Saudi Arabia, Jeddah, 5 new cases, 1 death MOH 15 Apr 2014
    Date: 15 Apr 2014
    Source: Saudi MOH [in Arabic, machine trans., edited] <http://www.moh.gov.sa/CoronaNew/PressReleases/Pages/mediastatemenet-2014-04-15-002.aspx>


    In the context of the work of epidemiological investigation and ongoing follow-up carried out by the Ministry of Health for MERS-CoV, the Ministry announces the registration of 5 cases of MERS-CoV infection in Jeddah.

    The 1st is a 30-year-old male resident who has recovered.
    The 2nd is a 59-year-old male citizen who passed way.
    The 3rd is a 64-year-old male resident who works in the health sector whose condition is stable.
    The 4th and 5th cases are both 27-year-old females working in the health sector and who are asymptomatic.

    --
    Communicated by:
    ProMED-mail
    <promed@promedmail.org>

    [Of note, 3 of the 5 cases reported on [15 Apr 2014] were health care workers (HCWs). - Mod.MPP]

    ******
    [4] Saudi Arabia, update on Jeddah outbreak, 37 cases, 7 deaths
    Date: 16 Apr 2014
    Source: Saudi Press Agency [in Arabic, trans. by Proj.Man.ZH, edited] <http://www.spa.gov.sa/details.php?id=1221501>


    The Ministry of Health, represented by members of the National Committee for Infectious Diseases conducted a satellite meeting with experts from the WHO in Geneva and Cairo within the ministry's efforts to follow up on updates on MERS CoV. The meeting showcased MERS CoV cases that were detected in Jeddah province and confirmed that all procedures taken were aligned with the type and pattern of disease.

    The ministry provided WHO in Geneva with the recorded cases as of March 2014; the following have been diagnosed: 37 positive MERS CoV cases in 5 hospitals in Jeddah province after testing 2517 specimen of patients and their [contacts]. Work is still underway for more tests for suspected cases and their [contacts], noting that 2 cases had been recorded in Jeddah before that date.

    The ministry also declared that according to their records, 21 cases of healthcare workers were recorded, 15 of which were without symptoms, and 9 of which are believe to have contracted the disease from the community. Six [of those healthcare workers] had contact with patients, and one case was a household contact but does not have any symptoms according to the epidemiological surveillance/investigation by that date. Of the total cases recorded in Jeddah, 7 died, and those cases were recorded according to their primary [location of transmission] and source of infection.

    In Jeddah, there were 3 cases confirmed in Hospital A; the source for the 1st case is from the community, and the other 2 were [presumably healthcare workers].

    Hospital B had 2 cases, and their [presumed] sources were from the community.
    Hospital C had one case presumed sourced from the community.
    Hospital D had one case who is a healthcare worker thought to have contracted the disease in the community.
    Hospital E recorded 30 cases, 19 of which were healthcare workers, 4 cases presumed to be community-acquired, one case sourced from a household contact, and 6 cases were contacts [who presumably visited the cases while in the hospital].

    --
    Communicated by:
    ProMED-mail
    <promed@promedmail.org>

    [According to the above report, 57 percent (21 out of 37 cases) of the laboratory confirmed cases of MERS-CoV infection in this current outbreak in Jeddah are in healthcare workers (HCWs). Of these 21 HCWs,
    71 percent (15) were asymptomatic and were diagnosed as part of contact tracing activities conducted by the Saudi MOH. Looking at the hospital breakdown, it appears as though Hospital E has the majority of the MERS-CoV cases -- 81 percent (30 out of 37 cases) -- as well as the majority of the cases seen in HCWs, 90 percent (19 out of 21). - Mod.MPP]

    ******
    [5] Saudi Arabia, update on 194 cases (69 deaths)
    Date: Tue 15 Apr 2014
    Source: Saudi Arabia Ministry of Health [in Arabic trans. Proj.Man.ZH, edited] <http://www.moh.gov.sa/CoronaNew/PressReleases/Pages/mediastatemenet-2014-04-15-001.aspx>


    Members of the National Scientific Committee for Infectious Diseases [NSCID] confirmed that the health status in Jeddah city is reassuring [after an evaluation of the situation in the governorate of Jeddah] and that the clustering of cases found in the city is actually in line with the nature of the disease, which tends to affect an aggregate of cases, and the infection pattern of the virus does not differ from that in the rest of the Kingdom. The members also added that the preparedness of hospitals and healthcare facilities follows national and international infection control standards and does not need any additional preparation, as all necessary machines and supplies required to treat cases are available.

    This was surmised during [after] an investigational visit conducted by a team of the NSCID, who represent several health sectors from within and outside the Ministry of Health [MoH]. [This visit targeted] hospitals in the city of Jeddah [with the objective] of monitoring the health status, hospital preparedness with regards to MERS-CoV, and meeting a group of healthcare providers in these facilities.

    Additionally, the Minister of Health, Dr Abdullah Al-Rabiah, met this morning [15 Apr 2014] with NSCID committee members at the library in Jeddah. Also present at the meeting were Deputy Minister for Health Affairs Dr Mansour Al-Hawasi and Deputy Minister for Planning and Development Dr Mohammed Khashim. [The meeting] discussed latest developments in the city, as well as efforts undertaken by the Ministry of Health to renew and ensure communication with vaccine-manufacturing companies and international research centers to discuss the development of an effective vaccine for MERS-CoV and the willingness of the Ministry of Health and the national scientific committee to collaborate in this regard.

    The Minister of Health was also briefed on the Ministry of Health report on the status of MERS-CoV since its detection. The report pointed out that MERS-CoV is an emerging disease, similar to other emerging diseases such as H1N1 influenza virus in 2009 and the SARS virus in 2003, and that these diseases are challenging; it takes time for scientists to identify the source of infection and means of transmission and to develop a drug that can treat the disease as well as a vaccine to prevent it, all of which apply to MERS-CoV. The 1st case was recorded in the Kingdom of Saudi Arabia in June 2012, in a patient with respiratory symptoms from the province of Bisha who sought treatment in Jeddah. A sample from the patient was sent to a laboratory in Europe, which concluded that it was a new disease caused by a virus of the coronavirus family.

    Following receipt of this information, the ministry called on members of the National Committee of Scientific Infectious Disease -- consisting of consultants in infectious diseases and family medicine as well as community and public health representatives of all health authorities in the Kingdom, the Ministries of Defense, the National Guard, Interior, Education, and Health and the Faculty of Medicine at King Saud University, King Faisal Specialist Hospital, and Saudi Aramco [Saudi Arabian Oil Co] -- to put forth preventive policies. The Ministry of Health initiated surveillance and studies on the epidemiology of the disease in all regions of the Kingdom as well as preparing the reference laboratories in Jeddah, Dammam, Riyadh, Medina, and Mecca to receive the samples.

    The report also pointed out that the disease was recorded in several countries in the Middle East and that the Ministry of Health and national scientific committee consulted with experts and specialists from WHO and other international entities and universities, some of whom participated with the MoH in the field to the study the disease.

    As for the history of epidemiological surveillance of the disease, the report discussed the recordings of individual and scattered cases, the clustering of a few cases among family members where there was no spread of infection (such as the case in Bisha and other scattered cases in Riyadh). In April 2013, and for the 1st time, a cluster of cases was recorded in a hospital in Al-Ahsa province among individuals with compromised immune systems, resulting in the transmission of infection among some of these patients. The virus then was recorded in the eastern region in hospitals run by Saudi Aramco. These cases in Al-Ahsa and the eastern region were under control. During the 2nd half of March 2014, King Fahd Hospital in Jeddah started recording cases that amounted to 26 in addition to 2 other cases recorded earlier.
    Currently, there are MoH teams working around the clock to implement infection control measures, [including] disinfection as well as continuing efforts to prevent the spread of disease. The report gave assurances that the MoH is still monitoring the disease and is doing what is necessary to deal with it.

    The report also noted that the ministry only announces cases after laboratory confirmation and re-examination in reference laboratories inside and outside of the country to confirm the results. It also notes that this disease has no vaccine or preventive treatment, that the source of the virus is still unknown, and that the contagion and how infection is transmitted from one person to another are also as of yet unknown. Research to identify the source of primary infection is still ongoing, as samples from camels and their handlers are being taken in several regions of the Kingdom, in collaboration with the Ministry of Agriculture. The results of this research will be announced upon completion.

    As for the epidemiological surveillance of MERS-CoV infections, the number of confirmed cases to date is 194 cases, including 69 deaths, bringing the case fatality rate to 35 percent, whereas in the earlier days, the case fatality rate was almost 60 percent, which is less than the international case fatality rate of 41.5 percent. To date 12 out of 20 districts and provinces have recorded MERS-CoV cases. The largest number of cases has been reported in Riyadh with 82 cases, and a case fatality rate of 42.2 percent, followed by the province of Jeddah with 28 cases and a case fatality rate of 14.4 percent, Al-Ahsa province with 25 cases and a case fatality rate of 12.8 percent, and the eastern region with 23 cases and a case fatality rate of 11.8 percent.

    The distribution of cases by regions and provinces is as follows:

    Region or province: number of cases
    Al-Ahsa: 25
    Aseer: 7
    Bisha: 1
    Eastern region: 23
    Hafr-Al-Batin: 11
    Jeddah: 28
    Al-Jof: 2
    Al-Madinah: 7
    Najran: 1
    Al-Qassim: 2
    Riyadh: 82
    Al-Taif: 5
    Total: 194

    As for gender and nationality distribution among cases, males represent the largest number with 127 cases or 65.5 percent, with females having 67 cases or 34.5 percent. 158 cases were Saudis (81.5
    percent) and 36 were non-Saudis (18.5 percent).

    As for the distribution of cases by different health sectors, the report indicated that the following health sectors recorded cases:
    Ministries of Defense, National Guard, Interior and Health, as well as the private sector, university hospitals, and Saudi Aramco [hospital].
    A breakdown of the cases by sector shows that the Ministry of Health hospitals recorded 72 cases, the Ministry of Defense hospitals 39 cases, the Ministry of National Guard hospitals 30 cases, security forces hospitals 4 cases, university hospitals 5 cases, Aramco hospitals 14 cases, private health sector hospitals 20 cases, the King Faisal Specialist hospitals in Riyadh and Jeddah 10 cases, since the onset of the disease in 2012. The report also pointed out that the cases recorded in the Ministry of Health hospitals include both patients as well as their contacts with positive results in both hospitals of the Ministry of Health and hospitals in the other sectors. The following table shows the distribution of these cases:

    Health sector: number of cases
    Ministry of Health hospitals (includes patients and their contacts who tested positive): 72 Department of Defense hospitals: 39 National Guard hospitals: 30 Security forces hospitals: 4 Saudi Aramco hospitals: 14 Private hospitals: 20 University hospitals: 5 King Faisal Specialist hospitals in Riyadh and Jeddah: 10
    Total: 194

    --
    Communicated by:
    ProMED-mail
    <promed@promedmail.org>

    [The summary update above is a helpful synopsis of the current situation in Saudi Arabia, providing a glimpse at the geographic distribution of cases both in terms of administrative divisions around the country as well as within the various health sectors in the country, including public as well as private healthcare providing institutions. It appears as though cases are not being hospitalized in all geographical locations, but they are occurring in most sectors, including public and private hospitals, the petrol industry facilities, and the military sector.

    Hopefully, moving forward, these types of epidemiologic information will be updated as new cases are reported.

    For a map of Saudi Arabia, see <http://healthmap.org/promed/p/131>.
    For a map showing administrative divisions in Saudi Arabia, see <http://www.worldofmaps.net/en/middle-east/map-saudi-arabia/map-administrative-divisions-saudi-arabia.htm>.
    - Mod.MPP]

    ******
    [6] UAE, 10 cases WHO 16 Apr 2014
    Date: 16 Apr 2014
    Source: WHO Global Alert and Response [edited] <http://who.int/csr/don/2014_04_16_mers/en/>


    On [13 and 14 Apr 2014], United Arab Emirates (UAE) reported a cluster of 10 laboratory-confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection among health-care workers identified through screening of contacts of a previously laboratory-confirmed case from Abu Dhabi who died on [10 Apr 2014].

    The following details were provided to WHO:
    - A 37-year-old woman from Abu Dhabi with no reported underlying medical condition. She was screened and hospitalized on [9 Apr 2014] with mild illness.
    - A 41-year-old man from Abu Dhabi with no reported underlying medical condition. He was screened and hospitalized on [9 Apr 2014].
    - A 43-year-old woman from Abu Dhabi with underlying medical conditions. She was screened and hospitalized on [9 Apr 2014] with mild illness.
    - A 33-year-old man from Abu Dhabi with no reported underlying medical condition. He was screened and hospitalized on [9 Apr 2014] with mild illness.
    - A 46-year-old man from Abu Dhabi with underlying medical conditions.
    He was screened and hospitalized on [9 Apr 2014] with mild illness.
    - A 48-year-old man from Abu Dhabi with underlying medical conditions.
    He was screened and hospitalized on [9 Apr 2014] with symptoms of pneumonia.
    - A 37-year-old man from in Abu Dhabi with no reported underlying medical condition. He was screened and hospitalized on [9 Apr 2014] with mild illness.
    - A 43-year-old man from Abu Dhabi with no reported underlying medical condition. He was screened and hospitalized on [10 Apr 2014] without any illness.
    - A 27-year-old man from Abu Dhabi with underlying medical conditions.
    He was screened and hospitalized on [10 Apr 2014] without any illness.
    - A 43-year-old man from Abu Dhabi with no reported underlying medical condition. He was screened and hospitalized on [10 Apr 2014] without any illness.

    Currently, all the cases are in stable condition, and their family and health care contacts are being followed up.

    Globally, from September 2012 to date, WHO has been informed of a total of 238 laboratory-confirmed cases of infection with MERS-CoV, including 92 deaths.

    --
    Communicated by:
    ProMED-mail
    <promed@promedmail.org>

    [Of note is a reminder that the 10 newly confirmed cases in the UAE mentioned in the above WHO report were all identified as part of contract tracing for the epidemiologic investigation surrounding the fatal case in a Filippino paramedic working in the UAE. Of these 10 contacts found to be positive for MERS-CoV infection, 5 were described as having "mild illness," 3 were described as asymptomatic, one was noted to have pneumonia, and for one there is no mention of clinical status. If there had not been contact screening, it is highly likely that as many as 8 of the 10 MERS-CoV infected individuals might not have been identified as they had mild or no clinical illness.

    For a map showing the location of the UAE and other countries in the region, see <http://healthmap.org/r/awCA>. - Mod.MPP]

    ******
    [7] Philippines ex UAE, asymptomatic infection
    Date: 16 Apr 2014
    Source: ABS-CBNnews.com [edited]
    <http://www.abs-cbnnews.com/nation/04/16/14/ofw-uae-tests-positive-mers-cov>


    An overseas Filipino worker (OFW) who arrived in Manila Tuesday [15 Apr 2014] from the United Arab Emirates (UAE) tested positive for the Middle East respiratory syndrome-coronavirus (MERS-COV).

    Four members of his family from the UAE have been quarantined plus the
    5 people who fetched him at the airport.

    Even though these 10 people have not exhibited symptoms of MERS-COV, Ona said they have been placed under isolation to prevent the possible spread of the virus.

    "They are now in isolation together with the family. All of them are without symptoms," he said.

    He explained that the OFW, a nurse, tested positive for MERS-COV after he was exposed to the Filipino paramedic who died from the disease in Al Ain.

    He said the Department of Health (DOH) received the information regarding the nurse from its counterparts in the UAE.

    The OFW nurse and his relatives will have to undergo separate tests during their stay at an undisclosed hospital. The results of the tests will be issued on Friday or Saturday [18-19 Apr 2014].

    "Since they are symptom-less, we are just doing some preventive measures. We will give them medicines once they exhibit symptoms," he said. The incubation period of the virus is 10 to 14 days.

    At the moment, there is no vaccine against MERS-CoV, he said.

    Ona said the DOH is "contact-tracing" those who were near or had been in contact with the OFW. "We need to observe them so that they can undergo tests," he said.

    So far, authorities have been able to contact those in front, at the back, and those beside the OFW on the plane from UAE to Manila. Ona assured the public that there is no need to panic. "I don't even think a travel restriction to and from UAE is necessary," he said.

    The Bureau of Quarantine will strictly implement monitoring procedures, he said. He also said the DOH will be sending an epidemiology expert and an infectious disease specialist to the UAE to assist the Filipinos there.

    "The decision to send these health experts was made to look into the situation where a Filipino health worker died and 6 others were found to be positive, as reported by health authorities of the country of origin," the DOH said.

    The DOH also urged the OFWs with respiratory illnesses to see their healthcare providers. It also reminded the public to observe frequent handwashing and to cover their mouths when coughing.

    The World Health Organization (WHO) says the symptoms of MERS-CoV include fever, cough, shortness of breath, and even diarrhea.

    Human cases of MERS-CoV have also been reported in other Middle Eastern countries, such as Saudi Arabia, Qatar, Kuwait, Jordan and Oman.

    [Byline: Adrian Ayalin]

    --
    Communicated by:
    ProMED-mail Rapporteur Mary Marshall

    [This incident serves as a reminder that we live in a global village and that microbial organisms can travel worldwide silently. Had the UAE not done contact tracing, this individual might never have been identified in a potential chain of transmission. But it should be pointed out here that at present, there is no evidence documenting that asymptomatic individuals infected with the MERS-CoV are transmitters of the virus to other individuals.

    For a map of the Philippines, see <http://healthmap.org/r/awCM>.

    >From the multiple laboratory confirmations of MERS-CoV infection that
    have been reported in recent weeks, it does appear as though MERS-CoV activity is increasing. There was mention that MERS-CoV activity may be somewhat seasonal as there was an increase in MERS-CoV cases in Saudi Arabia around this time of year in 2013 as well, and April 2012 was when the 1st nosocomial outbreak occurred (the outbreak in Jordan that was retrospectively diagnosed once the novel coronavirus had been identified). There has also been a significant amount of concern vocalized about the possibility of "super spreaders" similar to what was seen in SARS, and the possibility of a change in the virus leading to more easy transmission. What should also be mentioned is the addage of "seek and ye shall find," and with increased awareness, it is quite possible that many more cases are being identified that might not have been previously.- Mod.MPP]

    [See Also:
    MERS-CoV - Eastern Mediterranean (30): Saudi Arabia, UAE, WHO, RFI
    20140414.2403986
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    20140128.2235722
    MERS-CoV - Eastern Mediterranean (03): Oman, WHO 20140109.2162284 MERS-CoV - Eastern Mediterranean (02): animal reservoir, camel, UAE, serology 20140104.2151807 MERS-CoV - Eastern Mediterranean (01): Saudi Arabia, UAE, Oman, WHO
    20140103.2150717
    2013
    ----
    MERS-CoV - Eastern Mediterranean (106): animal reservoir, camel, Qatar, OIE 20131231.2145606 MERS-CoV - Eastern Mediterranean (102): Dubai, fatal 20131221.2128612 MERS-CoV - Eastern Mediterranean (101): animal reservoir, camel, goat
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    MERS-CoV - Eastern Mediterranean (05): Tunisia ex Saudi Arabia/Qatar, fatal, RFI 20130520.1725864 Novel coronavirus - Eastern Mediterranean (24): France, 2nd case
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    20130221.155410
    Novel coronavirus - Eastern Med. (04): UK, pers to pers trans susp
    20130213.1541531
    Novel coronavirus - Eastern Med. (02): UK ex Saudi Arabia, Pakistan
    20130212.1539086
    2012
    ----
    Novel coronavirus - Eastern Mediterranean: WHO, Jordan, conf., RFI
    20121130.1432498
    Novel coronavirus - Saudi Arabia (18): WHO, new cases, cluster
    20121123.1421664
    Novel coronavirus - Saudi Arabia (14): KSA MOH 20121022.1358297 Novel coronavirus - Saudi Arabia (12): RFI 20121019.1353615 Novel coronavirus - Saudi Arabia (04): RFI, Jordan, April 2012
    20120925.1308001
    Novel coronavirus - Saudi Arabia (03): UK HPA, WHO, Qatar
    20120923.1305982
    Novel coronavirus - Saudi Arabia (02): additional cases, RFI
    20120923.1305931
    Novel coronavirus - Saudi Arabia: human isolate 20120920.1302733] .................................................mpp/zh/mj/mpp/msp/zh/mpp/msp/mpp
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  • Researcher reviews influenza, bacterial superinfections in Nature Reviews Microbiology

    Posted on 18/04/2014 - 0 Comments http://medicalxpress.com/news/2014-04-influenza-bacterial-superinfections-nature-microbiology.html

    Posted by Rob LW
  • Emailing: Novel stapled peptide nanoparticle combination prevents RSV infection, study finds Science Codex

    Posted on 18/04/2014 - 0 Comments

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    Novel stapled peptide nanoparticle combination prevents RSV infection, study finds
    Posted By News</user/37> On April 17, 2014 - 9:30pm
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    [Novel stapled peptide nanoparticle combination prevents RSV infection, study finds]

    Boston, MA, and Tampa, FL (April, 17, 2014) -- New therapies are needed to prevent and treat respiratory syncytial virus (RSV) – a potentially lethal respiratory infection that can severely affect infants, young children and the elderly.

    Despite a wide range of anti-RSV efforts, there are no vaccines or drugs on the market to effectively prevent or treat the infection.

    Now researchers at the Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School in Boston, MA, and the James A. Haley VA Hospital and the University of South Florida (USF) in Tampa, FL, have developed novel double-stapled peptides that inhibit RSV in cells and in mice. The team also showed that this peptide's capacity to block infection was significantly boosted when delivered to the lungs by miniscule, biodegradable particles known as nanoparticles.

    The team's findings are reported online today in The Journal of Clinical Investigation.

    RSV employs a fusion protein with a helical structure to enable the virus to bind to and penetrate epithelial cells lining the nose and lungs.

    The Dana-Farber/Boston Children's/Harvard laboratory led by co-senior author Loren Walensky, MD, PhD, used their chemical strategy known as hydrocarbon stapling to make "double-stapled" RSV peptides. Stapling helps the peptides retain their natural helical shape and resist degradation by the body's enzymes while disrupting the fusion process needed for RSV to infect host cells.

    The VA/USF group led by co-senior author Shyam Mohapatra, PhD, tested these double-stapled peptides, alone and in combination with propriety nanoparticles, in mice to demonstrate significant inhibition of RSV infection.

    "This is an exciting advance in the fight against respiratory syncytial virus infection," said Dr. Mohapatra, director of the USF Nanomedicine Research Center and the USF Health Morsani College of Medicine's Division of Translational Medicine, and a research career scientist at James A. Haley VA Hospital.

    "We found that double-stapled peptide interference targeting the virus fusion protein can be administered in the form of a nasal drop or spray. The treatment suppressed viral entry and reproduction, including spread from nose to lungs, providing substantial protection from infection when administered several days before viral exposure."

    "Designing therapeutic peptides based on a virus' very own fusion apparatus was previously exploited to block HIV-1 infection, but this class of drugs was severely limited by the pharmacologic liabilities of peptides in general, including loss of bioactive structure and rapid digestion in the body," said Dr. Walensky, associate professor of pediatrics at Harvard Medical School, pediatric hematologist/oncologist at Dana-Farber/Boston Children's and principal investigator in Dana-Farber's Linde Program in Cancer Chemical Biology.

    "Peptide stapling restores the natural helical shape, which also inhibits proteolysis, providing a new opportunity to take advantage of a well-validated mechanism of action to thwart viruses like RSV that otherwise lack drugs for preventing or treating infection."

    Dr. Mohapatra and his team developed nose drops containing the Walensky laboratory's double-stapled peptides after combining them with TransGenex's chitosan nanoparticles that stick to mucous-producing cells lining the lungs.

    First, the researchers treated mice intranasally with stapled peptide nose drops, both before and during infection with RSV. The treated mice showed significantly lower levels of virus in the nose and lungs, and less airway inflammation, compared to untreated mice.
    [http://www.sciencecodex.com/aggregated-images/body/vj4t5FDhb120dK8x.jpg]

    Shyam Mohapatra, Ph.D., leads the VA/University of South Florida research team with expertise in nanoparticle technology. He holds a test tube of nanoparticle solution.

    (Photo Credit: © University of South Florida)

    Then, double-stapled peptides encapsulated in nanoparticles were delivered to the lungs via the trachea to test whether the combination could further increase the effectiveness of this experimental therapy. The nanoparticle preparation markedly improved delivery of the peptides to the lungs, and the combination worked better and longer in preventing RSV pneumonia than the double-stapled peptide alone.

    The researchers say to the best of their knowledge this preclinical study is the first to combine peptide stapling and nanoparticle technologies to maximize the delivery, persistence, and effectiveness of an antiviral therapy.

    RSV is the most common virus causing lung and airway infections in infants and young children. Most have had this infection by age 2, and it can be especially serious, even deadly, in high-risk groups, such as babies born prematurely and those whose immune systems do not work well. The virus hospitalizes thousands of infants each year for pneumonia or brochiolitis and has been associated with a significantly greater risk of developing asthma later in life. The elderly are also at high risk of complications from RSV infection.

    "This is a new way forward in the development of strategies to prevent RSV infection," said Terrence Dermody, MD, the Dorothy Overall Wells professor of pediatrics and director of the Division of Pediatric Infectious Diseases at Vanderbilt University School of Medicine, who was not involved with the research. "The authors are to be complimented on the clever design, interdisciplinary approach and extension from cell-culture experiments to animal studies. I am particularly excited about the possible application of this technology to other viruses."
    [http://www.sciencecodex.com/aggregated-images/body/she6P62O5ecSq2c6.jpg]

    Loren Walensky, MD, Ph.D., leads the Dana-Farber/Boston Children's/Harvard laboratory with expertise in stapled peptide technology. The screen image shows the chemical structure of a stapled peptide, with the arrow pointing to the hydrocarbon staple (in yellow).

    (Photo Credit: © Dana-Farber/Boston Children's Cancer and Blood Disorders Center/Harvard)
    Source: University of South Florida (USF Health)<http://www.hsc.usf.edu>
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  • FW: PRO/AH/EDR> MERS-CoV - Eastern Mediterranean (30): Saudi Arabia, UAE, WHO, RFI

    Posted on 15/04/2014 - 0 Comments Posted by Rob LW

    Rob_LW



    -----Original Message-----
    From: promed-bounces@promedmail.org [mailto:promed-bounces@promedmail.org] On Behalf Of promed@promedmail.org
    Sent: 15 April 2014 04:42
    To: promed-post@promedmail.org; promed-edr-post@promedmail.org; promed-ahead-post@promedmail.org
    Subject: PRO/AH/EDR> MERS-CoV - Eastern Mediterranean (30): Saudi Arabia, UAE, WHO, RFI


    MERS-COV - EASTERN MEDITERRANEAN (30): SAUDI ARABIA, UAE, WHO, REQUEST FOR INFORMATION
    **************************************************************************************
    A ProMED-mail post
    <http://www.promedmail.org>
    ProMED-mail is a program of the
    International Society for Infectious Diseases <http://www.isid.org>

    In this update:
    [1] Saudi Arabia, 5 new cases, 1 death - MOH 14 Apr 2014 [2] Saudi Arabia, 15 new cases (2 deaths), UAE 1 case (1 death) - WHO
    14 Apr 2014
    [3] UAE, colleagues of fatal case - media report 14 Apr 2014 [4] & [5] Need for transparency - media reports

    ******
    [1] Saudi Arabia, Jeddah, 5 new cases, 1 death - MOH 14 Apr 2014
    Date: 14 Apr 2014
    Source: Saudi MOH [in Arabic, machine translation, edited] <http://www.moh.gov.sa/CoronaNew/PressReleases/Pages/mediastatemenet-2014-04-14-001.aspx>


    In the context of epidemiological investigation and ongoing follow-up carried out by the Ministry of Health for the coronavirus causing Middle East respiratory syndrome (MERS CoV), the ministry announces the registration of 5 cases of HIV infection in Jeddah.

    The 1st resident, a 70-year-old male, has passed away. The 2nd, a 51-year-old citizen, is receiving intensive care. The 3rd is a 28-year-old healthcare worker who is asymptomatic [there is a mention of "for citizenship," suggesting an expatriate who may have applied for citizenship]. The 4th is a 45-year-old female resident healthcare worker without symptoms, and the 5th is a 56-year-old male resident in stable condition.

    During the last period [since 12 Apr 2014, when the last information was provided?], 190 samples have been tested, of which all but the aforementioned [5] were negative for infection with MERS-CoV.

    --
    Communicated by:
    ProMED-mail Rapporteur Mary Marshall

    [With the addition of these 5 newly confirmed cases, including one death, of MERS-CoV infection, this increases the total number of MERS-CoV infections reported by Saudi Arabia to 192 including 69 deaths, and if this moderator's count is correct, it brings the number of cases reported in Jeddah since 27 Mar 2014 to 28, including 4 deaths, 5 in intensive care, 6 in stable condition, and 13 reported as asymptomatic infections.

    Of additional note is that 9 of these 28 reported cases (32 percent) in Jeddah were in healthcare workers (HCWs). One wonders what protocol is being followed in Saudi Arabia for respiratory precautions and what proportion of HCWs are following these protocols. Of curiosity is that in the 12 Apr 2014 Saudi MOH update announcing 4 new laboratory confirmed cases of MERS-CoV infection, the update in the Arabic language report mentions that 3 of the 4 cases were in HCWs, whereas the English language version only mentions 2, not mentioning the 26-year-old female as an HCW. Thanks to Helen Branswell for pointing this discrepancy out. Clarification from knowledgeable sources in the region would be greatly appreciated.

    For a map of Saudi Arabia, see <http://healthmap.org/promed/p/131>. - Mod.MPP]

    ******
    [2] Saudi Arabia, 15 new cases (2 deaths), UAE 1 case (1 death) - WHO
    14 Apr 2014
    Date: 14 Apr 2014
    Source: WHO Global Alert and Response [edited] <http://www.who.int/csr/don/2014_04_14_mers/en/>


    WHO has been informed of an additional 16 laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus
    (MERS-CoV) from Saudi Arabia and the United Arab Emirates (UAE).

    The 15 additional laboratory-confirmed cases, including 2 deaths announced on the Ministry of Health of Saudi Arabia website and provided to WHO between [6 and 11 Apr 2014] include:

    - A 70-year-old man from Jeddah with underlying medical conditions. He became ill on [24 Mar 2014], was hospitalized on [29 Mar 2014] and died on [5 Apr 2014].
    - A 28-year-old man from Jeddah with no reported symptom of illness.
    The man is a household contact of the above mentioned laboratory-confirmed case.
    Three health-care workers:
    - a 26-year-old woman, a 26-year-old man, and a 33-year-old man with no symptoms of illness.
    - A 28-year-old man who is a healthcare worker in Jeddah. He became ill on [28 Mar 2014], was admitted to a hospital on [3 Apr 2014], and is currently receiving treatment in an intensive care unit.
    - A 35-year-old man from Jeddah with no reported symptom of illness.
    - A 32-year-old woman from Jeddah who is a healthcare worker with no reported symptom of illness.
    - A 45-year-old man from Riyadh. He became ill on [30 Mar 2014], was hospitalized on [5 Apr 2014], and is currently receiving treatment in an intensive care unit. He had no history of exposure to animals nor contact with a laboratory-confirmed case.
    - A 90-year-old man from Riyadh. He became ill on [30 Mar 2014], was hospitalized on [1 Apr 2014], and is currently receiving treatment in an intensive care unit. He had no history of exposure to animals nor contact with a laboratory-confirmed case.
    - A 57-year-old man from Riyadh with underlying medical conditions. He became ill on [16 Mar 2014], was admitted to a hospital on [19 Mar 2014], and died on [30 Mar 2014].
    - Four men aged 29, 33, 34 and 70 years old from Jeddah.

    Additionally, a previously laboratory-confirmed case has died. The concerned health authorities in Saudi Arabia are currently conducting investigations into the contacts of the cases.

    The additional laboratory-confirmed case reported by the Ministry of Health of the UAE on [10 Apr 2014] includes:
    - A 45-year-old man from Abu Dhabi who became ill on [6 Apr 2014], was hospitalized on [7 Apr 2014] and died on [10 Apr 2014]. The patient was not known to have any chronic disease. He did not have a recent history of travel or contact with animals or with a previously laboratory-confirmed case.

    The concerned health authorities in the UAE are conducting investigations into the contacts of the case.

    Globally, from September 2012 to date, WHO has been informed of a total of 228 laboratory-confirmed cases of infection with MERS-CoV, including 92 deaths.

    --
    Communicated by:
    ProMED-mail Rapporteur Marianne Hopp

    [According to the above WHO report, as of 11 Apr 2014 globally, there have been a total of 228 laboratory confirmed cases of MERS-CoV infections including 92 deaths (case fatality rate 40 percent). The above report mentions a single laboratory confirmed case (who died) in UAE in an individual with no identified exposure risk factors (absence of co-morbidities, no history of travel to areas with known MERS-CoV transmission, and no known contact with animals or with a previously laboratory-confirmed case). Media reports surrounding this event in the UAE have mentioned that this individual was a paramedic working in ambulance transport in the UAE (see prior ProMED-mail posts MERS-CoV - Eastern Mediterranean (29): Saudi Arabia, Yemen, UAE, RFI
    20140413.2401723 and MERS-CoV - Eastern Mediterranean (28): Jordan, UAE, Saudi Arabia 20140412.2398280 for media reports on this event).
    As previously mentioned one wonders if this indvdual was involved in transport of an individual with undiagnosed MERS-CoV infection.

    Of note, the case reported by Jordan in the 11 Apr 2014 WHO Disease Outbreak Notification is a 52-year-old male with co-morbidities who reportedly travelled to Saudi Arabia from 20-29 Mar 2014, became ill on 25 Mar 2014 and visited a hospital in Jeddah, returned to Jordan on
    29 Mar 2014, and visited a hospital in Amman on 29 Mar 2014, and again on 2 Apr 2014. As the apparent index case in the current outbreak in Jeddah had a date of onset of illness of 16 Mar 2014 and an HCW in Jeddah had a date of onset of illness on 22 Mar 2014, information on possible in-hospital contacts the Jordanian case may have had would be helpful to determine whether this case is part of the current Jeddah cluster.

    This moderator has been unable to reconcile all reports in the above WHO update with information previously reported on the Saudi MOH website and posted previously on ProMED-mail covering the stated period (6-11 Apr 2014). Information correlating these cases with those reported on the Saudi MOH website would be greatly appreciated (information identifying variables such as age and gender were not always available)..

    For a map of the area showing Saudi Arabia and the UAE, see <http://healthmap.org/promed/p/131>. - Mod.MPP]

    ******
    [3] UAE, colleagues of fatal case - media report 14 Apr 2014
    Date: 14 Apr 2014
    Source: The National [edited]
    <http://www.thenational.ae/uae/health/uae-health-authorities-monitoring-mers-cases-in-filipinos>


    Health authorities and Philippine embassy officials in Abu Dhabi are closely monitoring medical staff who may have been infected with the MERS coronavirus. A 45-year-old male died on Thursday [10 Apr 2014] after contracting the virus. Four paramedics and a nurse are in quarantine as a precautionary measure.

    "The 5 Filipinos are under observation and are stable, according to the local health authorities," said Grace Princesa, the Philippine ambassador to the UAE. "They're doing well and are recovering."

    A team from the embassy went to Al Ain at the weekend to check on the condition of the 5 patients.

    An engineer in Al Ain identified the ill as 4 paramedics and one nurse. He confirmed they were still being kept in quarantine but were doing well as of Monday [14 Apr 2014]. The 4 paramedics, 2 men and 2 women, are in Al Ain Hospital, and the nurse, a man from Abu Dhabi, is being treated at Mafraq Hospital.

    A friend of all 5, said: "My friends and I have also been screened, and the tests all came back negative for the virus."

    [This friend] hosted a birthday party on [3 Apr 2014] attended by [the 45-year-old who died of MERS-CoV]. The paramedic was already suffering from a fever that week. He worked as a paramedic for Al Ain Rescue and Ambulance Section, part of the Ministry of Interior. A few months before his death, he was transferred to its logistics section.

    Dr Asim Malik, a consultant and head of infectious disease at Mafraq Hospital, said people with flu-like symptoms such as a fever, cough and shortness of breath are asking doctors to be tested to eliminate the possibility they may have the coronavirus. "The symptoms are just so similar to regular flu," he said. "You cannot differentiate unless you test for it. So it is not unusual that people are coming to be tested. As Ramadan approaches and more people travel to and from Saudi Arabia, I expect more and more people to be tested for MERS-CoV."

    Dr Malik said the UAE was prepared to track and control infectious outbreaks and people should remain calm. He said the "number one priority" was for people not to panic and to strictly adhere to advice being issued to the community. "Don't rely on rumours, trust experts, and listen to their advice."

    Manila's department of foreign affairs issued an advisory on Monday
    [14 Apr 2014] urging Filipinos in the Middle East to take precautions.

    Cases of [MERS-CoV infection] have been reported in Saudi Arabia, Qatar, Kuwait, Jordan and Oman.

    The department "continues to urge Filipino nationals in affected countries to remain calm and to heed the advice given by local health authorities such as washing hands thoroughly, using sanitisers, and observing other general hygiene practices," the advisory said. It
    added: "Those who experience any of the disease's symptoms are urged to immediately seek medical attention."

    [Byline: Jennifer Bell and Ramona Ruiz]

    --
    Communicated by:
    ProMED-mail
    <promed@promedmail.org>

    [The information in the above media report is on the contacts of the case mentioned in the WHO update above (see [2] above). Of note, prior newswires suggested that the 5 individuals who were colleagues of the 45-year-old male who died were asymptomatic (see MERS-CoV - Eastern Mediterranean (28): Jordan, UAE, Saudi Arabia 20140412.2398280 and MERS-CoV - Eastern Mediterranean (27): Saudi Arabia, UAE, WHO, screening 20140410.2395733). The mention in the above newswire that these individuals are "stable" and are "recovering" suggests that there may have been some clinical disease associated with the MERS-CoV infections. Clarification from knowledgeable sources would be greatly appreciated. It is curious that only the fatal case has been reported as a confirmed case of MERS-CoV infection whereas the media continue to report on 6 additional colleagues of this individual as being infected with the MERS-CoV. Clarification of the actual situation would be greatly appreciated.

    For a map of the UAE showing the location of Al Ain, see <http://www.mapsofworld.com/united-arab-emirates/maps/uae-map.gif>.
    For a map showing the location of the UAE and other countries in the region, see <http://healthmap.org/r/awCA>. - Mod.MPP]

    ******
    [4] Need for transparency - media report
    Date: 13 Apr 2014
    Source: Arab News [edited]
    <http://www.arabnews.com/news/555306>


    At a recent get-together, one of our friends surprised us by showing up wearing a medical mask. Another complained that most pharmacies were out of hand sanitizers. All this and much more is perhaps the natural reaction to the reports about the spread of coronavirus or Middle East respiratory syndrome (MERS) in Jeddah.

    About a week ago, panic gripped the city when reports about the death of a medical practitioner went public. He died of MERS in one of the government hospitals in Jeddah. In the wake of his death, various rumors started doing the rounds, and, not to be surprised, most of the social media networks went abuzz with different theories.

    Frankly speaking, despite the seriousness of this issue, one has to admit that the social media and different online news outlets blew the issue out of proportion. However, the health officials decided to maintain their silence, and perhaps rumors feed on silence. Tweets, Facebook feeds, and WhatsApp messages went crazy with rumors about closure of hospitals, huge numbers of fatalities, and list upon list of health guidelines pouring in from everywhere in cyberspace.

    Such a situation always gives rise to (sometimes) unwarranted fears, which grow due to people's natural concern for the safety of their loved ones.

    After some delay, the Ministry of Health (MoH) finally broke its silence over the issue. As always, when an official comes forward to contain a situation fatted with rumors, people receive his statements with skepticism. In the era of the fast and furious social media networks, you do not voluntarily give the crowd the chance to tell your side of the story, to speak in your behalf; by doing so, you simply lose your credibility. Despite repeated statements and photos of routine work carried out in various hospitals and official visits to one of the hospitals particularly in the news, there are those who still swear that 4 hospitals have already been closed because of the virus; they have the WhatsApp messages to prove it!

    However, the seriousness of the situation cannot be downplayed. The virus that was identified in Saudi Arabia back in April 2012 still remains a mystery. According to the World Health Organization, the coronavirus has not been previously detected in humans, and there is very limited information on its transmission, severity, and clinical impact. As of 27 Mar 2014, there were 206 confirmed MERS cases reported to the WHO, including 86 deaths.

    Obviously, we do not know a lot about the virus, such as its development, mode of transmission, and its treatment. Scientists around the world are still working on it. For that, you better have little faith in the series of social media messages spreading several tips on how to protect yourself and your family from it. If you need real information, visit the webpage of MoH, as it has posted some good information and a FAQ about the virus and how to deal with the situation. In a nutshell, it is mostly general guidelines on personal and environmental hygiene.

    I really hope the MoH and other government and private organizations take these incidents as a lesson. They need to become part of the lives of those they serve by interacting with them and addressing their fears and concerns. They cannot decide to stand on the line, when the whole game is being played in their backyard.

    Moreover, in addition to disaster management, there are more important and pressing issues that the MoH needs to address. Infection control, government hospitals statuses, and medical staff management in such circumstances are all examples of what the officials at the ministry need to revise and address.

    [Byline: Saad Dosari]

    --
    Communicated by:
    ProMED-mail
    <promed@promedmail.org>

    ******
    [5] Need for transparency - media report
    Date: 14 Apr 2014
    Source: Saudi Gazette Op Ed [edited]
    <http://www.saudigazette.com.sa/index.cfm?method=home.regcon&contentid=20140414201789>


    Saudi Arabia in general, and residents of its coastal city Jeddah in particular, have been overwhelmed with very disturbing news about the spread of the coronavirus that has so far claimed 66 lives across the country. What has been shocking and extremely disturbing are the countless stories and rumors that have spread just as quickly and just as aggressively as the virus itself. There was a great deal of panic; maybe a better word to describe the situation would be pandomonia.
    There was a clear lack of proper communication and transparency.

    The problem has been a while in the making and not new (it has been over 3 years since the 1st case was reported, to be exact) [the 1st laboratory confirmed case was publicly reported on 20 Sep 2012; ProMED-mail post Novel coronavirus - Saudi Arabia: human isolate 20120920.1302733; afterwards, in November 2012, a previously undiagnosed nosocomial outbreak in Jordan that occurred in April 2012 was retrospectively confirmed as having been due to MERS-CoV. - Mod.MPP]. One would have been [re]assured and would wish that at least there would have been a website, Twitter account, and Facebook page dedicated to monitoring the progress of combating the disease and revealing the status of each region as far as the number of cases detected, including the death toll as well.

    There were hardly enough public statements to provide the press and the community with the required reassuring information that would put all the whirling rumors to rest once and for all. It is obviously important to highlight that, with the "arrival" of the virus to Jeddah, the challenge will be even greater, as Jeddah is the point of entry and the gateway to the 2 holy mosques, which means a huge number of non-stop visitors around the year from all over the world, simply a massive challenge.

    Without proper preparation and adequate communication, the consequences could be nothing short of catastrophic. The challenge and the issue at hand is communication, which seems to be inadequate due to the over simplification of the matter for the fear of anxiety and panic a dedicated communique would cause. It seems that was not a proper conclusion, because the "lack" of it has caused a greater sense of panic.

    Saudi Arabia is not the 1st country to be facing a medical "challenge"
    of dealing with the spread of viruses and diseases. The Far East was recently entangled with dealing with SARS, bird flu, and swine flu.
    They did it with mixed results at best, and this in itself should be a very important learning opportunity to engage with the countries that faced similar challenges and understand the mistakes they made, and what did they do to improve the system.

    There is no need to reinvent the wheel at all in this case. It all starts with better communication to bring people out of the dark and put an end to rumors.

    [Byline: Hussein Shobokshi]

    --
    Communicated by:
    ProMED-mail Rapporteur Mary Marshall

    [When this moderator read the Op Ed piece in [4] above, she had a sense of deja vu from the early days of the SARS outbreak, especially the statement "...and perhaps rumors feed on silence," very reminiscent of a commentary in the British Medical Journal (BMJ) that was posted on ProMED-mail in February of 2003 (see Pneumonia - China
    (Guangdong) (07) 20030221.0452). In that report, there was an observation that "...considerable anxiety was created by an "epidemic of rumours." There was mention that "Rumours abounded about the source of the infection..." and "The rumour spread that many of the victims of the illness were hospital staff and that a number of them had died.
    ... In the absence of public statements and official information, the media communicated very little."

    Times have changed, and some of the media today, in the absence of public statements and official information, publish using information that, at times, is just reporting on the circulating rumors.

    In the 2nd Op Ed piece in [5] above, the comment: "What has been shocking and extremely disturbing are the countless stories and rumors that have spread just as quickly and just as aggressively as the virus itself," further enhances the argument for the need for transparency.

    At the time of the SARS outbreak BMJ commentary (February 2003), this moderator commented: "This is a reminder of the need for official sources to report information on outbreaks and findings of outbreak investigations sooner rather than later. In today's environment, with increased telecommunications worldwide combined with heightened concerns about bioterrorism, news of disease outbreaks travels much faster and more widely than in the past."

    The "explosion" in the use of social media in the 10+ years since the SARS outbreak has resulted in a further explosion of rumor mongering to fill the information void. - Mod.MPP

    A HealthMap/ProMED-mail map can be accessed at:
    <http://healthmap.org/promed/p/131>.]

    [See Also:
    MERS-CoV - Eastern Mediterranean (29): Saudi Arabia, Yemen, UAE, RFI
    20140413.2401723
    MERS-CoV - Eastern Mediterranean (28): Jordan, UAE, Saudi Arabia
    20140412.2398280
    MERS-CoV - Eastern Mediterranean (27): Saudi Arabia, UAE, WHO, screening 20140410.2395733 MERS-CoV - Eastern Mediterranean (26): Saudi Arabia 20140409.2392763 MERS-CoV - Eastern Mediterranean (25): Saudi Arabia, UAE, RFI
    20140408.2390003
    MERS-CoV - Eastern Mediterranean (24): Saudi Arabia, RFI
    20140406.2385665
    MERS-CoV - Eastern Mediterranean (23): Saudi Arabia 20140404.2378035 MERS-CoV - Eastern Mediterranean (22): UAE, WHO 20140401.2373381 MERS-CoV - Eastern Mediterranean (18): Saudi Arabia 20140321.2347610 MERS-CoV - Eastern Mediterranean (17): Kuwait, UAE, Saudi Arabia, WHO, RFI 20140320.2345849 MERS-CoV - Eastern Mediterranean (16): Saudi Arabia, WHO
    20140318.2340740
    MERS-CoV - Eastern Mediterranean (15): Saudi Arabia, WHO, RFI
    20140317.2338519
    MERS-CoV - Eastern Mediterranean (14): Saudi Arabia, RFI
    20140314.2333773
    MERS-CoV - Eastern Mediterranean (13): Saudi Arabia, UAE, WHO
    20140313.2330878
    MERS-CoV - Eastern Mediterranean (12): Saudi Arabia 20140306.2317828 MERS-CoV - Eastern Mediterranean (11): Saudi Arabia, WHO
    20140301.2308415
    MERS-CoV - Eastern Mediterranean (08): Saudi Arabia 20140220.2289977 MERS-CoV - Eastern Mediterranean (07): Saudi Arabia 20140215.2280653 MERS-CoV - Eastern Mediterranean (06): UAE (Abu Dhabi)
    20140208.2264161
    MERS-CoV - Eastern Mediterranean (05): Saudi Arabia, WHO
    20140203.2252192
    MERS-CoV - Eastern Mediterranean (04): Saudi Arabia, Jordan, WHO
    20140128.2235722
    MERS-CoV - Eastern Mediterranean (03): Oman, WHO 20140109.2162284 MERS-CoV - Eastern Mediterranean (02): animal reservoir, camel, UAE, serology 20140104.2151807 MERS-CoV - Eastern Mediterranean (01): Saudi Arabia, UAE, Oman, WHO
    20140103.2150717
    2013
    ----
    MERS-CoV - Eastern Mediterranean (106): animal reservoir, camel, Qatar, OIE 20131231.2145606 MERS-CoV - Eastern Mediterranean (102): Dubai, fatal 20131221.2128612 MERS-CoV - Eastern Mediterranean (101): animal reservoir, camel, goat
    20131219.2126531
    MERS-CoV - Eastern Mediterranean (100): Saudi Arabia, WHO
    20131219.2126258
    MERS-CoV - Eastern Mediterranean (99): animal reservoir, camel, Qatar
    20131217.2120936
    MERS-CoV - Eastern Mediterranean (98): animal reserv/camel, Jordan, Saudi Arabia 20131213.2114362 MERS-CoV - Eastern Mediterranean (95): animal reservoir, camel, Qatar
    20131129.2082942
    MERS-CoV - Eastern Mediterranean (94): UAE (Abu Dhabi), Qatar
    20131129.2082330
    MERS-CoV - Eastern Mediterranean (93): animal res., camel conf, Qatar
    (RY) OIE 20131129.2082115
    MERS-CoV - Eastern Mediterranean (91): Saudi Arabia, WHO
    20131127.2078860
    MERS-CoV - Eastern Mediterranean (90): Saudi Arabia, Qatar fatal
    20131120.2064667
    MERS-CoV - Eastern Mediterranean (88): Kuwait, WHO, Spain
    20131119.2062587
    MERS-CoV Eastern Mediterranean (87): animal res. camel susp.
    precautions 20131113.2053932
    MERS-CoV - Eastern Mediterranean (86): Kuwait, 1st rep, susp, RFI
    20131113.2052320
    MERS-CoV - Eastern Mediterranean (85): animal reservoir, camel, susp, official 20131112.2051424 MERS-CoV - Eastern Mediterranean (84): Saudi Arabia, Oman, deaths, WHO, RFI 20131112.2049026 MERS-CoV - Eastern Mediterranean (82): Qatar, RFI 20131110.2047575 MERS-CoV - Eastern Mediterranean (81): Saudi Arabia, UAE ex Oman, RFI
    20131108.2044846
    MERS-CoV - Eastern Mediterranean (70): Saudi Arabia, WHO
    20130913.1936342
    MERS-CoV - Eastern Mediterranean (60): Qatar, new case, RFI
    20130827.1904425
    MERS-CoV - Eastern Mediterranean (51): Saudi Arabia, WHO, RFI
    20130801.1857286
    MERS-CoV - Eastern Mediterranean (40): Saudi Arabia, WHO
    20130709.1813691
    MERS-CoV - Eastern Mediterranean (15): Saudi Arabia, Italy ex Jordan, WHO, RFI 20130601.1749096 MERS-CoV - Eastern Mediterranean (12): Saudi Arabia, France
    20130528.1741836
    MERS-CoV - Eastern Mediterranean (05): Tunisia ex Saudi Arabia/Qatar, fatal, RFI 20130520.1725864 Novel coronavirus - Eastern Mediterranean (24): France, 2nd case
    20130512.1707305
    Novel coronavirus - Eastern Mediterranean (20): France ex UAE, WHO, Saudi Arabia 20130508.1700034 Novel coronavirus - Eastern Mediterranean (14): Germany ex UAE, WHO, fatal 20130326.1604564 Novel coronavirus - Eastern Mediterranean (12): KSA, UK fatality, RFI
    20130323.1600113
    Novel coronavirus - Eastern Mediterranean (11): UK, pers to pers transm 20130316.1588808 Novel coronavirus - East. Med. (07): Saudi Arabia, UK, Germany
    20130221.155410
    Novel coronavirus - Eastern Med. (04): UK, pers to pers trans susp
    20130213.1541531
    Novel coronavirus - Eastern Med. (02): UK ex Saudi Arabia, Pakistan
    20130212.1539086
    2012
    ----
    Novel coronavirus - Eastern Mediterranean: WHO, Jordan, conf., RFI
    20121130.1432498
    Novel coronavirus - Saudi Arabia (18): WHO, new cases, cluster
    20121123.1421664
    Novel coronavirus - Saudi Arabia (14): KSA MOH 20121022.1358297 Novel coronavirus - Saudi Arabia (12): RFI 20121019.1353615 Novel coronavirus - Saudi Arabia (04): RFI, Jordan, April 2012
    20120925.1308001
    Novel coronavirus - Saudi Arabia (03): UK HPA, WHO, Qatar
    20120923.1305982
    Novel coronavirus - Saudi Arabia (02): additional cases, RFI
    20120923.1305931
    Novel coronavirus - Saudi Arabia: human isolate 20120920.1302733] .................................................mpp/msp/mpp
    *##########################################################*
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