WHO Novel Coronavirus Infection – Update

As a leader in risk management and emergency preparedness services, we would like provide an update from the BC Centre for Disease Control and the World Health Organization regarding further detections of the novel coronavirus originally posted by the WHO  in September, 2012. 

What’s New – Novel Coronavirus

Four additional confirmed cases of the novel coronavirus identified.

  • Three in Saudi Arabia (including one death)
  • One in Qatar

The Qatar case had onset of severe respiratory symptoms in October, recovered and was released from care in November. Onset dates for the recent Saudi Arabia cases are not yet available.

To date, this brings the total number of laboratory confirmed cases to six.

  • Two cases fatal
  • All linked either to Saudi Arabia or Qatar

Of the four most recently confirmed cases, two are from the same family in Saudi Arabia and represent the first epidemiologically-linked cases.

One of these died and the other has recovered. In addition, two other members of the same family presented with similar symptoms of which one also died and one is recovering.

It has yet to be determined whether this family cluster signifies human-to-human transmission or rather shared exposure to a common animal (i.e. bat) source. Investigations are underway.

Novel Coronavirus

What’s Advised

The WHO advises that until more information is available; consider the novel coronavirus virus likely to be more broadly distributed than Saudi Arabia and Qatar.

Information on the full clinical presentation is only available for the first two cases reported in September 2012.

In the absence of other details or guidance, clinicians may reasonably consider novel coronavirus testing for patients presenting with signs or symptoms of severe acute respiratory infection (SARI), particularly in the absence of other explanation.

Acute Respiratory Infections

Worldwide Acute Respiratory Infections

Any clusters of SARI or SARI in health care workers should be thoroughly investigated regardless of where they occur.

Where this novel coronavirus is considered, the local health unit and/or Medical Health Officer should be immediately notified and guidance sought.

Patients should be managed in strict respiratory isolation including contact and droplet precautions.

The message from the WHO is not to panic but rather to  ask countries to be more vigilant.

WHO Update – November 23

The most recent WHO update is available at the following link:
http://www.who.int/csr/don/2012_11_23/en/index.html

H1N1 More Deadly Than Previously Thought

H1N1 Emerges

In 2009 the world was taken by surprise. A new global flu pandemic swooped into our lives, creating media frenzy.

As pandemic and emergency preparedness specialists, we at Iridia Medical were prepared to fight the outbreak and did just that.

But by August 2012, little over a year after the H1N1 virus became breaking news, the Director-General of the World Health Organization declared an end to the pandemic and left everyone wondering, “did the WHO exaggerated the danger,” spreading fear and confusion.

Influenza Virus - H1N1

Influenza Virus

When the H1N1 virus spread around the world three years ago, there was little over 18,500 deaths reported; a number much lower than the global media attention would have one believe.

Shedding New Light

Criticism and finger pointing are inevitably part of an outbreak cycle. During the H1N1 outbreak some even went as far to call it a “false pandemic.” Contrary to this belief, a new study suggests the outbreak was more severe than originally thought.

Now that the dust has settled, the actual number of deaths from the 2009 H1N1 pandemic has been pegged at more than 15 times higher than earlier estimates.

Based on a study published online in The Lancet Infectious Diseases, researchers estimate 284,400 people actually died in the first year alone.

According to the study authors, the actual number of deaths linked to the H1N1 flu virus could range anywhere from 151,700 to 575,400.

H1N1 Map

H1N1 reported cases from 2009

H1N1 – A Numbers Game

The sudden change in statistics is due to a number of reasons:

• Health officials did not take into account laboratory-confirmed flu deaths can considerably underestimate of the actual number of deaths from the flu.
• During the 2009 pandemic, many countries, particularly in Africa and Southeast Asia, lacked the ability to perform routine laboratory tests and therefore had difficulty identifying H1N1-related deaths.
• The WHO data suggests less than 12% of the confirmed deaths were in Africa and Southeast Asia, this new study estimates 51% of the deaths may have been from those two regions alone.

Lessons Learned

Dawood, a medical epidemiologist (also known as a disease detective) at the Centers for Disease Control and Prevention, says she hopes this research will help “limit the loss of human life in future pandemics.”

Studies like this are important as they can provide us with solid evidence of disease spread, infection rates and the impact of pandemics in various geographical regions; leading to future prevention efforts.

H5N1 – The Great Debate

In 2009 we experienced a global pandemic. The H1N1 influenza spread so quickly many were unprepared. The virus has caused 18,000 deaths to date.

18,000 deaths is a staggering number, but not when you realise that the virus caused 600 thousand infections, a fatality rate of .03%. Although it spread easily from human to human, it was not very deadly overall.

As a leader in emergency preparedness, Iridia has worked with many organizations to develop their pandemic plans. In most cases these plans had to be created from scratch as a pandemic is a state of emergency, of which many were unprepared. These plans consisted of:

• Communication tools and protocols
• Human resources policies
• Vaccine and antiviral usage
• Personal protective equipment strategies
• Infection control measures

Throughout the H1N1 pandemic, it became clear that our society was not ready. But what would happen if it had been worse?

H5N1 

In contrast to the H1N1, the H5N1 avian influenza has a very hard time spreading from human to human. But once an individual has become infected, it has a 60% fatality rate. To put that in perspective, if the H1N1 virus was that deadly, it would have caused 360 thousand deaths (20x more).

h5n1 virus

H5N1 Virus

It took some time, but after months of debate and controversy, research (you can search for it online) describing how to transform the deadly H5N1 in a human-contagious form was published in May 2012.

The study has made headlines around the world since 2011. A debate quickly heated up. Many were concerned about broadcasting potentially lethal information to would-be bioterrorists who might use the information to set off a pandemic.

In December, it was recommended by the U.S. National Science Advisory Board for Biosecurity (NSABB) that the study not be published in full. An expert panel convened by the World Health Organization (WHO) later disagreed with the decision, which paved way for publication.

“Given the possibility of accidental escape from the lab — not too uncommon events — the risks seem to me enormous, while the benefits are very small,” said Richard Roberts, a Nobel Prize-winning geneticist who now works at New England Biolabs.

Conversely, over the last several months, many objections to the research have frequently been called uninformed. “Fear needs to be put to rest with solid science and not speculation,” wrote microbiologist Peter Palese of the Mount Sinai School of Medicine.

There are two sides to every debate. Through research we undoubtedly gain a better understanding of viruses and in turn we discover clues that can lead to vaccines. But do these deadly “recipes” need to make the rounds for everyone to see?

Want more details? Read the story here: Sciencemag

What do you think?

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Avian Influenza (H5N1)

Influenza is in the news again as the flu season hits full stride. No, it is not the H1N1 strain that is garnering attention this year, rather the avian influenza (H5N1) strain, which is commonly called the bird flu.

Recently a man in China has died from the H5N1 flu, the first reported human death in 18 months. The death prompted the local government to cull thousands of birds to prevent the spread of the virus. At this time no other cases have been discovered.

[youtube=http://www.youtube.com/watch?v=_jlKXAPXiSQ]

What is H5N1?

H5N1 is a particular strain of avian flu that can cause infection in humans, first discovered in Southern China in 1996. Over 300 humans in twelve different countries have died from the H5N1 bird flu.

The majority of H5N1 cases in humans have been due to the handling of infected birds. 60% of those who have been infected with H5N1 have died. The following people have an increased chance of contracting the avian flu:

  • Individuals who breed and handle poultry
  • Travellers visiting infected countries
  • Those who eat undercooked poultry

Spread

The virus usually spreads from farm to farm, and then from bird to bird, via air or bird droppings; the virus can also be carried on feet of rodents, spreading virus further.

From one country to another, virus is spread through international trade of poultry; migratory birds have also been known to spread virus, while wild ducks can pollute water supplies.

The virus can survive in cool temperatures in contaminated manure for 3 months; in water, up to four days at 22 degrees Celsius and 30 days at 0 degrees Celsius. This resilience allows ample time for the virus to affect other birds. Infected birds are then able to spread the virus from country to country through migratory patterns.

H5N1 avian influenza: Timeline of major events

Pandemic Potential

All influenza viruses have the potential to can change. It is possible that an avian influenza virus could change so that it could infect humans and could spread easily from person to person. Because these viruses do not commonly infect humans, there is little or no immune protection against them in the human population. If an avian virus were able to infect people and gain the ability to spread easily from person to person, an “influenza pandemic” could begin.

Symptoms

Infection of the H5N1 virus causes typical flu-like symptoms in humans such as:

  • Fever
  • Sore throat
  • Cough
  • Muscle aches
  • Eye infections
  • In several fatal cases, severe respiratory distress secondary to viral pneumonia

Prevention

The best way to minimize the spread is rapid destruction of all infected or exposed birds, which involves proper disposal of carcasses, rigorous quarantine and disinfection measures (virus is killed by heat, 60 degrees C for 30 minutes) and common disinfectants such as formalin and iodine compounds.

Currently there is no vaccination for H5N1. The best prevention on a personal level is to use protective gear when handling birds that may be infected, as well as avoiding live-bird markets in infected areas. It is also very important to avoid undercooked poultry and egg products.

For organizations worldwide it is a reminder to be prepared. As the H1N1 pandemic becomes a thing of the past, we need to be vigilant and ready for the next pandemic, which substantiated the H5N1 strain.

In order to protect yourself and your organization it is vital that you have in place a pandemic plan that covers the following areas:

  • Communication tools and protocols
  • Human resources policies
  • Vaccine and antiviral usage
  • Personal protective equipment strategies
  • Infection control measures

Outlook

In August 2011, the Food and Agriculture Organization of the United Nations warned of a possible major resurgence of the H5N1 virus in the coming months, saying migratory birds appeared to be carrying it and infecting domestic poultry in Bangladesh, China, Egypt, India, Indonesia and Vietnam.

While we have no way of knowing exactly when the next pandemic will take place, by having the right tools in place we can mitigate the potential risks.

While you can’t always foresee an emergency situation, you can always ensure you are prepared.