Sunday, December 11, 2016

Saudi MOH Announces 1 Primary MERS Case



Saudi Arabia's 15 day running tally of MERS cases stands at 22, with a new case announced today in Buraidah, that of a 64 y.o. woman listed in critical condition with no known exposure history.

Additionally, 1 death and 1 recovery are announced.

Of these 22 recent MERS cases, 6 reportedly had recent camel exposure, 1 was a household contact of a known case, and 15 listed as `primary' with no known exposure.

H7N9: Jiangsu Reports 4 Cases, Fujian Reports 1 For November


Nearly two years ago, after having been remarkably open about   H7N9 for their first two winter outbreaks, China's MOH abruptly stopped issuing real-time (often daily) updates on new cases, and instead moved to making batch announcements, sometimes weeks after the fact.

Some provinces (particularly Guangdong) continued to notify Hong Kong when new cases were discovered - although delays in those notifications have grown as well.

The upshot is that we have only a partial grasp on what going on in China with H7N9, H5N1, or H5N6 in real time. And no news isn't necessarily good news.

Officially China has only reported 3 H7N9 cases since the start of October (1 in Jiangsu & 1 in Zhejiang both in October & 1 in Guangdong Province presumably in November).

Today we are starting to see end-of-month epidemiology reports start to trickle out of China's provinces, and we learn that Jiangsu Province reports 4 H7N9 cases for the month of November and Fujian Province reported 1. 

The Jiangsu notice is buried near the bottom of a chart included with their end-of-month epidemiology report (see below).

Ministry of Health and Family Planning Commission announced in November 2016 the province's statutory reporting infectious diseases  
At 0:00 on November 1 2016 to November 30 24, the province reported a total of A and B infectious diseases statutory reporting 7997 cases, 23 deaths; this month, in addition to plague, cholera, SARS, spinal cord polio, human infection with highly pathogenic avian influenza, anthrax, whooping cough, diphtheria, neonatal tetanus, leptospirosis, schistosomiasis no incidence report, the remaining 17 kinds of categories A and B infectious diseases were case reports. Reported incidence of the top five diseases: tuberculosis, syphilis, hepatitis, gonorrhea, dysentery, accounting for 94.20 percent of the total reported cases. Report deaths to the top three diseases: AIDS, rabies and tuberculosis, accounting for 91.30 percent of total deaths.

Schedule: November 2016, Jiangsu Province, statutory reporting and B infectious disease, mortality tables

December 5, 2016
While there is no mention of H7N9 anywhere in the body of the report, the accompanying two-page schedule - at the very bottom - lists 4 new H7N9 cases during the month of November.  No details are provided.

The Fujian EOM report mentions 1 case in the body of their report, again with no details.

Published: 2016-12-09
November 2016 (November 20, 2010 0:00 to November 30 24:00, the same below), the province reported a total of 10,407 cases of Class B infectious diseases, 19 deaths. In addition to plague, cholera, infectious atypical pneumonia, polio, people infected with highly pathogenic avian influenza, rabies, epidemic encephalitis, anthrax, epidemic cerebrospinal meningitis, whooping cough, diphtheria, schistosomiasis No case reports, the rest were reported, including human infection H7N9 1 case, imported dengue fever in 3 cases, 20 cases of local infection with dengue. Syphilis, syphilis, tuberculosis, gonorrhea, AIDS, accounting for 98.03% of the total number of the incidence; reported infectious diseases are: AIDS, tuberculosis, viral hepatitis, the incidence of infectious diseases.

In November 2016, the province reported a total of 11557 cases of Class C infectious diseases, one person died. The top five reported diseases are HFMD, other infectious diarrheal diseases (excluding cholera, bacterial and amebic dysentery, typhoid and paratyphoid), influenza, mumps , Acute hemorrhagic conjunctivitis, accounting for 99.92% of the total incidence of C infectious diseases; reported dead infectious diseases: influenza.

With just two of China's provinces reporting, the number of H7N9 cases we know about this fall has jumped to 8.  Not a sign of a major outbreak by any means, but it does show that the virus isn't quite as quiet as initial reports would have us believe.

These cases represent only the `sickest of the sick' - those ill enough to seek medical attention and lucky enough to be tested for the virus - and so the true burden of H7N9 on the human population remains unknown. 
We generally get a recap from Beijing once all of the Provinces have reported, followed a week or two later by a WHO update.

Stay tuned.

Saturday, December 10, 2016

Saudi MOH Announces 1 MERS Case (Primary-Camel Contact) 


After a couple of rough days where the Saudi MOH website was either offline, or responding slowly, it appears as if they have got things back under control.
Late yesterday they posted an update for the 9th, with no new cases and 1 recovery. 
Today's update adds 1 new case - the 21st in the past 14 days. This newest patient is the second one in the past three days from Mahyel Aseer, with both reported to have had recent direct contact with camels.   
The first case - reported yesterday - had already died at the time of the report.  Today's case is listed in stable condition.

Additionally, 2 more deaths among previously reported cases are announced. 

Friday, December 09, 2016

Texas: DSHS Announces Additional Local Zika Cases In Cameron County

Credit Wikipedia


Twelve days ago, in DSHS Announces 1st Locally Acquired Zika Case, Texas authorities called for enhanced surveillance after that state's first locally acquired Zika case was detected in Cameron county which lies along the Mexican border. 
Today the DSHS has announced the detection of four additional locally acquired cases, all found within `close proximity' to the first case. 000. 
The DSHS just released the following statement:

Texas Announces Additional Local Zika Cases in Cameron County 

The Texas Department of State Health Services and Cameron County Department of Health and Human Services have identified four additional cases of suspected locally transmitted Zika virus disease in Cameron County. The cases were identified as part of the follow up to the state’s first case of Zika likely transmitted by a mosquito in Texas, announced Nov. 28.

The additional patients live in very close proximity to the first case. Though the investigation is ongoing, the infections were likely acquired in that immediate area. They reported getting sick with Zika-like symptoms between Nov. 29 and Dec. 1 and were likely infected several days earlier before mosquito control efforts intensified in that part of Brownsville. None are pregnant women. Testing of people living in an eight-block area around the homes of the identified cases continues but has yet to show any additional evidence of Zika transmission in the rest of that larger area.

“These cases were found through careful public health work and collaboration at the local, state and federal levels,” said Dr. John Hellerstedt, DSHS commissioner, “and we’ll continue to follow through with the investigation and additional surveillance to identify other cases and other places experiencing local mosquito transmission of Zika. That information will be crucial to any future public health guidance.”

It’s also important that health care providers continue to be on the lookout for Zika and pursue testing pregnant women who have traveled to Mexico or other areas where Zika is spreading and testing anyone with symptoms compatible with Zika. More specific guidance for clinicians is available at

Public health workers from Cameron County and DSHS’ regional office went door to door in the neighborhood last week to provide testing to look for other active Zika infections and educate residents about the illness and how to eliminate mosquito habitats. The education effort ultimately led to the detection of the four additional cases by prompting residents to recognize the symptoms of Zika and contact the health department for testing. Additionally, the City of Brownsville has been spraying for mosquitoes in the vicinity over the last two weeks and has seen a decrease in the number of mosquitoes in the area.

“The combination of mosquito control and colder weather has decreased mosquito activity in Cameron County and greatly decreased the probability of more widespread mosquito transmission of Zika right now,” said Dr. Hellerstedt. “However, winters are mild in southern Texas, and mosquito populations can rebound even during short periods of warmer weather. Whenever you see mosquito activity, protect yourself and your family from bites.”

People can do that by
  • Using EPA-approved insect repellent.
  • Using air conditioning or window and door screens that are in good repair to keep mosquitoes out of homes.
  • Wearing long pants and long-sleeved shirts that cover exposed skin.
  • Removing standing water in and around homes year-round, including water in trash cans, toys, tires, flower pots and any other container that can hold water.
Prompted by the additional cases, the Texas Health and Human Services Commission is expanding the Medicaid benefit for mosquito repellent beyond Dec. 31 for residents of Cameron County. The benefit was recently brought back with news of the first Zika case likely transmitted locally and is in place statewide through Dec. 31. For Cameron County, the benefit will be in place indefinitely as state health officials collect more information about the scope of transmission in Texas.

Zika virus is transmitted to people primarily through the bite of an infected mosquito, though it can also spread by sexual contact. The four most common symptoms are fever, itchy rash, joint pain and eye redness. While symptoms are usually minor, Zika can also cause severe birth defects, including microcephaly, and other poor birth outcomes in some women infected during pregnancy. DSHS recommends pregnant women avoid traveling to locations with sustained, local Zika transmission, including Mexico. Pregnant women should also use condoms or avoid sexual contact with partners who have traveled to those areas. Travelers and the general public can find more information at

Saudi MOH: 3 New MERS Cases - Dec 8th


The Saudi MOH website - which has been offline for 24 hours - is back up . . . at least partially. Connections are very slow, and now the reports on the English and Arabic MERS surveillance pages are out of sync with each other. 

Assuming the English language site is correct (a potentially risky assumption), we do have an update for yesterday's MERS cases - adding 3 - but no update (as yet) for today. 

There are two primary cases - one in Jeddah and one in Riyadh - both in middle aged males, with no risk exposure listed.  The third case - already expired - is a 60 y.o. male from Mahyel Aseer with recent direct contact with camels.

This brings the 12 day running total to 20 new MERS cases, 5 with recent camel exposure, 1 with a household exposure, and 14 listed as `primary' with no known exposure.

H5N6: Korean Culls Exceed 9 Million Birds

Credit Japan's MAFF


During the first three months after H5N8 first appeared on the Korea Peninsula (mid-January to mid-April), South Korea culled and buried in excess of 14 million birds. 

We are now just barely over 3 weeks into Korea's battled with H5N6, and already 9 million birds have been destroyed, across 177 farms. 

While the MAFRA updates are often cryptic and difficult to maintain a running tally, we've an English language report from KBS World Radio News updating the situation.

Bird flu: 9 million slaughtered poultry

Published: 2016-12-09 4:30:04 p.m. Updated: 2016-12-09 4:47:54 p.m.

While all eyes are on the National Assembly, the Minister of Agriculture, Food and Rural Affairs convened a meeting this morning to deal with the bird flu continues to spread in the country.

According to the Ministry, four new suspected cases reported between Sunday and Tuesday in the provinces of Chungcheong North and South, located in the center of the country, and that of North Jeolla, in the southwest, tested positive.

This brings the number of farms affected to 177 and that of poultry slaughtered 9 million since the declaration of the first suspected case of 16 November. In addition, 22 dead migratory bird affected by the virus have been discovered in the province of South Gyeongnam. Thus, damage caused by bird flu could set a new record, exceeding the 14 million chickens buried in 100 days during 2014.

Health authorities have decided to extend the prohibition period to move the poultry droppings until 23 December. They will also complement the manual for the abatement and treatment of the affected bodies.

Given their previous experiences with H5N8, and their strict biosecurity measures, it is a bit surprising that H5N6 has spread as much, and as far, as it has in South Korea.

As we've seen in Europe with H5N8, these clade H5 viruses appear to be gaining both in their ability to spread via migratory birds, and their virulence in wild birds and farmed poultry. 

All of which should have poultry producers on alert - including those in North America - as these viruses continues their global spread.