Influenza

WHO reports first patient-to-nurse spread of new SARS-like virus

Two health workers in Saudi Arabia have become infected with a potentially fatal new SARS-like virus after catching it from patients in their care - the first evidence of such transmission within a hospital, the World Health Organization said

Reuters,

15 May, 2013

The new virus, known as novel coronavirus, or nCoV, is from the same family of viruses as those that cause common colds and the one that caused the deadly outbreak of Severe Acute Respiratory Syndrome (SARS) that emerged in Asia in 2003.

"This is the first time health care workers have been diagnosed with (novel coronavirus) infection after exposure to patients," the Geneva-based U.N. health agency said in a disease outbreak update late on Wednesday.

The health workers are a 45-year-old man, who became ill on May 2 and is currently in a critical condition, and a 43-year-old woman with a coexisting health condition, who fell ill on May 8 and is in a stable condition, the WHO said.

France has also reported a likely case of transmission within a hospital, but this was from one patient to another patient who shared the same room for two days.

NCoV, like SARS and other similar viruses, can cause coughing, fever and pneumonia.

Scientists are on the alert for any sign that nCoV is mutating to become easily transmissible to multiple recipients, like SARS - a scenario that could trigger a pandemic.

WHO experts visiting Saudi Arabia to consult with the authorities on the outbreak said on Sunday it seemed likely the new virus could be passed between humans, but only after prolonged, close contact.

Initial analysis by scientists at Britain's Health Protection Agency last year found that nCoV's closest relatives were most probably bat viruses. Yet further work by a research team in Germany suggests nCoV may have come through an intermediary - possibly goats.

The WHO's Wednesday update said that, while some health care workers in Jordan had previously contracted nCoV, these Saudi cases were the first clear evidence of the virus passing from infected patients.

"Health care facilities that provide care for patients with suspected nCoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients and health care workers," it said.

It also advised health care providers to be "vigilant among recent travelers returning from areas affected by the virus" who develop severe acute respiratory infections.

Since nCoV first emerged and was identified in September 2012, the WHO says it has been informed of a total of 40 laboratory-confirmed cases worldwide, including 20 deaths.

Saudi Arabia has had most of the cases - with 30 patients infected, 15 of them fatally - but nCoV cases have also been reported in Jordan, Qatar, Britain, Germany and France.

Death toll rises to 36 in H7N9 outbreak

The first patient in China's Hunan province with confirmed H7N9 influenza has died, lifting the outbreak's fatality count to 36, according to official and media reports today.

CIDRAP,

15 May, 2013

The patient is a 64-year-old woman who died yesterday morning at a hospital in Shaoyang, about 20 days after her illness was detected, according to a report from Xinhua, China's state news agency. The source of the information is the Hunan Provincial Health and Family Planning Commission.

The number of new H7N9 infections has tailed off in recent week, with the latest one reported May 7, which edged the number of cases to 131. However, the death toll continues to rise, because many of the previously confirmed patients are still hospitalized, battling the often serious complications of the disease, which can include acute respiratory distress syndrome and organ failure.

It's not clear why the outbreak has stalled. Influenza experts suspect closures of live-poultry markets could be curbing infections in humans, or the virus could be showing a drop in warm weather months seen with other avian influenza viruses. Another possibility is that H7N9 could be dying out, a pattern that has been seen before with other novel flu viruses.

In other developments, a veterinary epidemiologist from Scotland yesterday raised the possibility that H7N9 could emerge and circulate in the poultry trade without a link to commercial farms. Nick Honhold, BVSc, MSc, PhD, a consultant based in Edinburgh, detailed his suggestion in a post on ProMED Mail, the online reporting system of the International Society for Infectious Diseases.

Despite extensive testing by Chinese animal health authorities, the virus has not been detected on poultry farms and has mainly been found in a fairly small number of poultry wholesalers and live-poultry markets. The lack of poultry farm findings has been one of the puzzling aspects of the H7N9 outbreak.

Honhold wrote that the poultry market and trading system in China is varied and complex and more testing is needed to determine the proportions of people who had contact with poultry markets who did and didn't get sick. He added, however, that the lack of another common source suggests that live-poultry markets must somehow be involved.

He questioned if movements of birds, equipment, and people between the markets could spread and maintain the disease. Also, he wrote that more details are needed about the farms that have been tested for the virus, such as whether they're backyard units or facilities that are supplying the markets.

An understanding of China's poultry market system is essential to understanding how the virus could be spreading, he wrote. China's system might resemble that of other countries in which collection points aggregate birds from several sources before smaller shipments make their way to live markets.