Saudi Arabian MOH Reports New Coronavirus Case

Coronavirus – Credit CDC PHIL

 

# 6730

 

A hat tip to Gert van der Hoek at FluTrackers for picking up a report overnight from the Saudi Gazette indicating that another coronavirus case (presumably #4) is being treated at a hospital in Riyadh.

 

The details of this case, though scant, are somewhat similar (location, and the fact that the patient is recovering) to the case reported nearly 3 weeks ago (see Saudi Arabia MOH Announces Third Coronavirus Case). If confirmed, this will be the 4th case detected since mid-summer.

 

 

Ministry confirms coronavirus case in Riyadh

Last Updated : Wednesday, November 21, 2012 12:32 AM

RIYADH — A new case of coronavirus infection was discovered in Riyadh, according to a statement by the Ministry of Health Tuesday.

 

“A citizen who visited one of the hospitals in Riyadh complaining of flu-like symptoms raised suspicion. Following appropriate tests and after cross checking the results in an specialized lab abroad, it was confirmed that the man tested positive for the virus," the statement said.

 

It said the patient was given appropriate treatment and his condition has improved.

(Continue . . . )

 

 

I see that ProMed Mail has picked up another media report this morning, this time from 5ABR.Com.

 

NOVEL CORONAVIRUS - SAUDI ARABIA (17): 4TH CASE, REQUEST FOR INFORMATION

*************************************************************
Date: 20 Nov 2012
Source: 5abr.com [machine trans., edited]

http://www.5abr.com/2012/11/20/article_50675.html

Ministry of Health announces coronavirus case in Riyadh

(continue . . . )

 

 

While the English language side of the The Saudi Arabia Ministry of Health doesn’t appear to have this news release posted yet, the Arabic side has the following press release (machine translated) dated 06 Muharram 1434 H (Tuesday Nov 20th, 2012).

 

Ministry News

The Ministry of Health issued a statement about the progress of the virus (La Coruna), confirms that the situation is reassuring

 

Continuation of what you do and the Ministry of Health of the survey and epidemiological and surveillance and preventive for all infectious diseases, as part of its efforts to maintain the health and safety of citizens and residents, in line with the approach of transparency adopted by the ministry with all citizens and the media, and the desire to keep everyone updated on the situation with regard to these diseases , the Ministry wishes to announce the discovery of cases of HIV (Corona) a citizen in a hospital in the city of Riyadh, where he was suspected in his case, and was immediately conduct tests and analyzes necessary for him to laboratories ministry, were also sent a sample to a specialized laboratory outside the Kingdom.

 

The results were confirmed for a positive case, and it was the ministry at the time to take all actions and precautionary measures to deal with this case, according to the norms of scientific and medical WHO guidelines, as well as recommended by the National Scientific Committee for Infectious Diseases, which includes in its membership consultants representing all sectors of health government.

 

The Ministry wishes to point out that the patient may receive appropriate treatment and recovered, and health status reassuring, not to worry, where these cases are sporadic, and equal most people infected with the virus to heal, God willing, after providing supportive therapy appropriate for such cases, like viruses that cause respiratory infections such as seasonal influenza and others.

 

The ministry would also like to reassure everyone that the ministry continues to follow the developments in the situation about this virus, in coordination with international organizations and international medical bodies and regional organizations. May God protect our country from all evils, and the pleasures of all-time health and wellness.

 

 

Yesterday, in mBio: New Coronavirus Linked To Bats, we saw additional evidence that this novel virus is most likely of bat origin, but exactly how it is making its way into the human population, and why now, are questions yet to be answered.

 

The good news is, thus far, there is no evidence of human-to-human transmission.

Stay tuned.

»» Read More

Saudi Arabia MOH Announces Third Coronavirus Case

 

Coronavirus – Credit CDC PHIL

# 6695

 

Just after the Hajj has ended and pilgrims are returning home, Saudi Arabia’s Ministry of Health has announced the detection, and recovery of, a third case infected with the novel Coronavirus (see Coronavirus: WHO Update & Genome Sequence) first announced in September.

 

Details are scant, including when this case was detected. Other than the location (Riyadh), and the fact that the patient appears to have recovered, we know very little at this point.

 

A machine translation of the announcement posted today on the Saudi MOH website follows. Despite its length, it reveals little:

 

Discovery of the first case of infection Corona citizen in a hospital in the city of Riyadh

December 19, 1433

Continuation of what you do and the Ministry of Health of the survey and epidemiological and surveillance and preventive for all infectious diseases, as part of its efforts to maintain the health and safety of citizens and residents, in line with the approach of transparency adopted by the ministry with all citizens and the media, and a desire to see everyone updated on the situation with regard to these diseases ; Ministry wishes to announce the discovery of a case of getting infected with Corona citizen in a hospital in the city of Riyadh; were suspected in his case, and was immediately conduct tests and analyzes necessary for him in the laboratories of the ministry. As the sample was sent to a specialized laboratory outside the Kingdom, noting that the patient did not leave the Riyadh area.

 

The results were confirmed for a positive situation; Therefore, the ministry at the time to take all actions and precautionary measures to deal with this situation, and in accordance with the norms of scientific and medical WHO guidelines, as well as recommended by the National Scientific Committee for Infectious Diseases, whose membership includes specialized consultants representing all sectors of health government.

 

The Ministry wishes to point out that the patient had received appropriate treatment, and recovered, and that the health status of reassuring not to worry; where are these cases individually, and equal most people infected with the virus to heal - God willing - after providing supportive therapy appropriate for such this topic cases like viruses that cause for respiratory infections such as influenza and other seasonal. The Ministry wishes to reassure everyone that it continues to follow developments in the situation about this virus in coordination with international organizations and international medical bodies and regional organizations. May God protect our country from all evils, and the pleasures of all-time health and wellness.

 

 

Reuters is carrying the following report this afternoon on this latest development:

 

Saudi confirms third case of newly discovered SARS-like virus

ABU DHABI | Sun Nov 4, 2012 11:51am EST

(Reuters) - A Saudi citizen in the capital Riyadh is the world's third confirmed case of a newly discovered SARS-related virus but he has now recovered from his illness, the official Saudi Press Agency reported on Sunday.

(Continue . . )

 

UPDATE:  After posting this blog, I see that ProMed Mail has a few more details, via a correspondence from Ziad A Memish, MD Deputy Minister for Public Health & Director WHO Collaborating Center for Mass Gathering Medicine. 

 

Although I’ve received the email alert, this update does not appear to be on the ProMed website yet.  I’ll post a link when it becomes available.

 

Adding to what we already heard:

 

• This case was initially hospitalized for pneumonia, and after testing negative for the usual suspects, was tested for the novel coronavirus.
• This new case has no epidemiological links to the 2 other cases.
• The patient is now out of intensive care, and is said to be recovering.
• There are no secondary cases detected, but investigations continue.
• The patient visited a farm a week before the illness struck.

 

 

Hopefully a more detailed report will be provided to the World Health Organization, or the media, in the near future.

»» Read More

Uganda MOH: Update On Marburg Outbreak

  Credit Wikipedia

 

 

# 6675

 

The Ugandan Minister of Health, Dr. Christine Ondoa, has issued the following update on the Marburg virus outbreak which has been ongoing in that nation since October 19th.

 

The major points are that there are now 8 deaths confirmed, and that cases have now been confirmed in three districts; Kabale , Ibanda, and Mbarara.

 

This from the Ugandan Media Centre.

 

 

PRESS STATEMENT ON THE UPDATE OF MARBURG OUTBREAK

October 29th 2012

Today on behalf of the Ministry of Health, I take this opportunity to welcome you all to this press briefing organized to update you on the outbreak of Marburg in the country. You will recall that we declared an outbreak of this highly infectious disease on October 19th and since then the Ministry of Health and its partners have undertaken a number of interventions to control the spread of the disease.

 
I wish to inform you that cases are now reported in the neighbouring districts of Ibanda and Mbarara. However, I want to assure you that the Ministry of Health and its partners are on the ground in the mentioned districts to contain the spread and manage the identified cases.

 

To date, the death toll of both the probable and confirmed cases stands at eight, with the latest being a case that died at the isolation facility at Rushoroza Health Centre III on October 27th (Saturday). The case that was referred from Ibanda Hospital – Ibanda to Mbarara Regional Referral Hospital died on October 24th.

 

I wish to clarify that since the onset of the outbreak, we have collected a total of 45 samples of which nine were confirmed positive; five in Kabale, two in Kampala and two from Ibanda.

 

Working closely with the US Center for Disease Control and Prevention (CDC), we have set up a field diagnostic laboratory at Kabale Regional Referral Hospital. All samples from the affected neighbouring districts will hence be taken to this laboratory for quick diagnostics. This will shorten the time when we get results to three hours from the original 24 hours due to distance. Further serological testing will be undertaken at the Uganda Virus Research Institute (UVRI).

 

Due to the presence of cases in other districts, we have established temporary isolation facilities to accommodate the suspected and confirmed cases. In Ibanda, a temporary isolation ward has been created at Ibanda Hospital, while plans are underway to set up a proper isolation facility by tomorrow.

 

At Mbarara Regional Referral Hospital, a separate temporary has been designated for the suspect Marburg cases. A triage has also been set up at the causality ward.

 

We have assembled a team of experts to work in the newly established isolation facilities and they are expected in these districts today.  We also plan to undertake infection control procedures in these facilities as safety measures for the workers and the admitted patients.

 

Today, the total number of cases admitted is 12. Eight are currently admitted at Rushoroza Health Center III in Kabale. Two confirmed cases, a couple (husband and wife) still remain admitted at Mulago National Referral Hospital. Another two suspect cases are currently admitted at Mayanja Memorial Hospital in Mbarara.

 

There are seven suspect cases (student nurses) quarantined at Ibanda. These cases attended to the confirmed case that later died at Mbarara Regional Referral Hospital on October 24th. Other health workers who attended to the patient are closely being monitored.

 

We have line-listed a total of 436 contacts for close observation in four districts of  Kabale, Kam-pala, Ibanda, Mbarara, Fort Portal and Rukungiri. Those being monitored got into contact with either the dead or confirmed cases. The team continues to monitor them on a daily basis for possible signs and symptoms of this highly infectious disease until they have completed 21 days without showing any signs and symptoms.

 

We have completed an orientation of the Kabale district taskforce on Marburg case presentation and prevention, barrier nursing and infection control. Plans are underway to conduct the orien-tation at Ibanda and at Mbarara Regional Referral Hospital.
We have trained a total of 42 volunteers from the Uganda Red Cross Society and deployed them to conduct house to house community sensitization and active case tracing.

 

We plan to set up burial committees in Ibanda district to manage burials of people suspected to have died of the disease. The committee will be oriented on burial procedures and infection prevention and control. This is one of the control measures to curb the spread of the highly con-tiguous disease.

The Ministry of Health would also wish to clarify on media reports that one of its officers, Dr. Sheila Ndyanabangi, the head of the Mental Health Unit Division, had contracted Marburg and had been isolated. Dr. Ndyanabangi has not been isolated but has been advised to exercise social distancing. She is one of the contacts who are being monitored. She has not developed any signs or symptoms of the disease and therefore cannot be isolated from the community. She is due to complete the 21 days of observation.

 

I once again urge the public to take the following measures to avert the spread of the disease.

• Report immediately any suspected patient to a nearby health unit
• Avoid direct contact with body fluids of a person suspected to be suffering from Marburg by using protective materials like gloves and masks
• Persons who have died of Marburg must be handled with strong protective wear and buried immediately
• Avoid eating dead animals
• Avoid unnecessary public gathering especially in the affected district
• Burial of suspicious community deaths should be done under close supervision of well trained burial teams
• Report all suspicious deaths to a nearby health facility 

Once again the Ministry of Health calls upon the public to stay calm as all possible measures are being undertaken to control the situation. 

 

For a history of the Marburg virus, you may wish to revisit Marburg Virus Reported In Western Uganda.

»» Read More

Ugandan MOH Statement On Marburg Outbreak

Credit Wikipedia

 

# 6662

 

While we’ve been following reports of a Marburg virus outbreak in Uganda since late last week, the Ugandan government has had very little public comment. Even today, the front page of the Ugandan Ministry of Health makes no mention of the outbreak.

 

But earlier today (h/t Treyfish on FluTrackers) the MOH published the following statement on the Uganda Media Centre Website providing details on the outbreak.

 

 

PRESS STATEMENT ON THE UPDATE ON THE MARBURG OUTBREAK

October 25th 2012 MINISTRY OF HEALTH

The Ministry of Health declared an outbreak of Marburg in Kabale district on October 19th 2012 after receiving laboratory results from the Uganda Virus Research Institute (UVRI) confirming that two family members had died of the highly infectious viral hemorrhagic fever.  Three other members of the same family had earlier died of a strange disease in a period of one month.

 

The death of these people prompted the District Health Office to undertake further investigations of this strange disease that had ravaged Kitumba parish in Kitumba sub-county, Kabale district.

 

According to the reports, the patients presented with symptoms of diarrhoea, vomiting, fever, headache, dizziness and generalized convulsions. Initial samples of blood and cerebral spiral fluid taken from the sick people ruled out Malaria and Meningitis. The family then invited a cult leader, a retired Reverend from Rukungiri, district to visit their household and pray for the sick.

 

The index case is believed to have been a member of a family in Rwabirondo village, Kitumba parish in Kitumba sub-county which occurred on 20th September 2012.  After the death of the index case, two other people, a sister and mother reportedly got sick and died.

 

This outbreak comes barely two weeks after the Ministry declared an end to another viral Hemorrhagic Fever (Ebola) on October 4th 2012. The last Marburg outbreak was witnessed in October 2007 in Kamwenge district.

 

Marburg is a highly infectious viral hemorrhagic fever which kills in a short time but can be prevented. Marburg is spread through direct contact with, body fluids like blood, saliva, vomitus, stool and urine of an infected person.

 

A person suffering from Marburg presents with sudden onset of high fever with any of the following; headache, vomiting blood, joint and muscle pains and bleeding through the body openings, i.e. eyes (red eyes), nose, gums, ears, anus and the skin.

How is Marburg Spread?

• It is spread through;
• Direct contact with wounds, body fluids like blood, saliva, vomitus, droplets, stool and urine of a person suffering from Marburg.
• Unsterilised injections, contaminated linen, beddings and clothes.
• Using skin piercing instruments that have been used by an infected person.
• Direct physical handling of persons who have died of Marburg

Current Status (Update)

The Ministry of Health has developed a response plan and budget for the Marburg control amounting to sh2.3b of which sh1.75 is for central level activities including Ministry of Health, six general hospitals and Kampala Capital City Authority. This will be majorly for case management, surveillance, research and social mobilisation and procurement of protective gears. The district budget totals 651,047,576 and it covers case management, surveillance, research and social mobilisation.

• Out of the six people who have died so far, only three were confirmed positive for Marburg. 
• Currently, there is only one confirmed case admitted in our isolation facility at Mulago National Referral Hospital. One convalescent case is detained at  Rushoroza Health Center III while five suspect cases linked to the initial cases  are admitted there awaiting blood results.  Special teams of doctors and nurses have been assigned to attend to the patients in both the isolation facilities. The patient admitted at Mulago National Referral Hospital is from Kitumba sub-county and is a relative of the index case. 
  
• The Ministry of Health surveillance team has listed up a total of 196 contacts for close monitoring. These contacts are mainly in Kabale, Rukungiri and Ibanda districts while 29 are from Kampala. Those being monitored reportedly got into contact with either the dead or confirmed cases. The team continues to monitor them on a daily basis for possible signs and symptoms of this highly infectious disease until they have completed 10 days without showing any signs and symptoms. 
  
• A team of experts from the Ministry of Health, U.S Center for Disease Control and Prevention and World Health Organization have so far collected a total of 18 n  samples from suspected cases for further investigations. The samples are being analyzed at the Uganda Virus Research Institute, Entebbe.
  
• The Ministry is conducting an orientation of local healthcare workers in Kabale Regional Referral Hospital and in the other peripheral health facilities on infection prevention and control, barrier nursing, surveillance and clinical case management. This is being done to build health workers’ capacity to handle such cases.  
  
• In Rushoroza Health Centre, a burial committee has  been set up to manage burials of people suspected to have died of Marburg. The committee has been oriented on burial procedures and infection prevention and control. This is one of the control measures to curb the spread of the highly contiguous disease. The committee has so far supervised two burials.
  

A team from the Centers for Disease Control (CDC) is expected in the country to undertake anthropological studies.

 

The Ministry of Health once again urges the public to take the following measures to avert the spread of the disease.

• 
  Report immediately any suspected patient to a nearby health unit 
  
• Avoid direct contact with body fluids of a person suspected to be suffering from Marburg by using protective materials like gloves and masks 
  
• Persons who have died of Marburg must be handled with strong protective wear and buried immediately
  
• Avoid eating dead animals 
  
• Avoid unnecessary public gathering especially in the affected district 
  
• Burial of suspicious community deaths should be done under close supervision of well trained burial teams   
  
• Report all suspicious deaths to a nearby health facility 

Once again the Ministry of Health calls upon the public to stay calm as all possible measures are being undertaken to control the situation. 

Hon. Dr. Christine Ondoa
Minister of Health

 

 

I’ve blogged (here & here) on this outbreak earlier in the week, including a history of the Marburg virus. To keep up with breaking news, you’ll want to visit this FluTrackers Thread.

»» Read More

Indonesian MOH Announces Bird Flu Fatality

 

 

 

# 6420

 

 

The Indonesian Ministry of Health has posted a fairly detailed account of their 190th H5N1 infection, that of an 8 year-old girl from Falkirk District, West Java who died on July 3rd. 

 

 

The girl (initials K.K.) initially developed a fever on June 18th – five days after reported contact with poultry at a live market near her home – and while on holiday in Singapore with her family was diagnosed as having strep throat.

 

She was seen at a local hospital upon her return from Singapore, but appears to have been discharged. Two days later, with her conditioning worsening, she was admitted to a different hospital and then transferred to another facility, where the diagnosis of H5N1 was finally made on June 29th.

 

I’ve a machine translation from the announcement that appears on the Indonesian Ministry of Health website.

 

Bird Flu Case report 190

July 5, 2012 | 8:07 am

 

Ministry of Health, "Directorate General of Disease Control and Environmental Health" announced one new case of H5N1 have been confirmed by the Center for Basic Biomedical and Health Technology, Balitbangkes.

 

Case on behalf of the families (female, 8 years) who Falkirk District, West Java. On June 18, 2012 the case began to experience fever, June 19, the case went on holiday to Singapore and the next day for treatment didokter private practice, was diagnosed with strep throat.

 

On June 24, returned to Jakarta. June 25, the case went to the hospital. Falkirk District B with a complaint over a week heat, vomiting, cough, no appetite and was diagnosed with febrile and impairment of consciousness and no radiographic results Duplex bronchopneumonia.

 

June 26, forced to go home, then went to the hospital. S West Jakarta, the situation gets worse case then mounted ventilator and ICU admission, on June 28, referred to the RSP with the diagnosis of suspected bird flu, on June 29, the results of the sample by the Research and Development (BTDK) Positive H5N1.Kondisi case worsened and finally died world on July 3, 2012 at 22:45 pm.

 

Epidemiological investigations have been done to the house of the case, the environment, markets and hospitals where the case was referred to hospital were treated before referral FB (RSP). Acquired risk factors, namely the possibility of contact with poultry as before (date June 12) the case goes to market with his father and brother, bought 5 chickens living in which case the vote and cut the chicken in the poultry abattoir (TPU), the case also hold the chicken been deducted. Every day the case to the school through a new market Falkirk existing poultry seller.

 

With the increase of these cases, the cumulative number of bird flu in Indonesia since 2005 until this news was broadcast on 190 cases with 158 deaths.

 

Director General of Disease Control and Environmental Health Prof. dr. Tjandra Yoga Aditama as the focal point of the International Health Regulations (IHR) has been informed about the case to the WHO.

 

 

Today’s report is the first one we’ve seen out of Indonesia since early May.  The apparent CFR (Case Fatality Ratio), based on known cases in Indonesia, remains a sobering 83% (158 fatalities out of 190 cases).

 

The fact that this girl traveled to Singapore while actively infected will no doubt raise new concerns in the region over the ability of this virus to quietly cross borders.

 

While no additional transmission of the virus from this victim has been reported, this is the type of scenario that prompted Singapore to stockpile bird flu vaccine in 2010 (see Singapore Buys 1 Million H5N1 Shots).

 

Although we continue to see isolated human infections around the world, and the virus continues to evolve (see H5N1: An Increasingly Complex Family Tree), for now H5N1 is primarily a threat to poultry.

 

The concern, of course, is that over time that could change.

 

And so the world remains at Pre-pandemic Phase III on the H5N1 virus, and we continue to watch for signs that the virus is adapting better to humans.

»» Read More

Cuban MOH Confirms Cholera Outbreak

 

Photo Credit  Wikipedia

 

# 6519

 

Although earlier reports have indicated that the Cuban government has had little to say about the outbreak of diarrhea  (suspected to be Cholera) in Manzanillo (see Media: Reports Of Cholera In Cuba), today a notice from the Cuban Ministry of Health appears in the official newspaper of the the Cuban Communist Party; Diario Granma.

 

According to this release, there have now been 3 deaths - and as many as 1,000 cases of diarrhea - which they are blaming on contaminated of local supply wells and a variety of (mostly unnamed) pathogens. 

 

In this report they state that 53 cases have been diagnosed as Vibrio cholerae.

 

The following is a machine translation of the announcement.

 

 

Briefing Note

The Ministry of Health reports that in recent weeks has been reported in some areas, an increasing trend of diarrheal diseases, which has been influenced by high temperatures and heavy rains.

 

One of the provinces with the highest incidence is recorded Granma, with a majority of cases the municipality of Manzanillo, where there was an outbreak of gastrointestinal infection, transmitted by water, from contamination of several local supply wells, it which has been reporting by the media that territory.

 

They have treated about 1 000 patients, which has positively affected the active screening conducted more than 98% of the population of the municipality.

 

In the total patients seen, different germs have been identified and indicating the diagnosis of Vibrio cholerae in 53 cases, including 3 deaths seniors, 95, 70 and 66 years old with a history of chronic illness, what is added gastrointestinal infection, so it continues in the research rigor to determine the actual cause of death in each.

 

This outbreak is controlled city of Manzanillo and the trend is to reduce cases as a result of sanitary measures and anti-epidemic being implemented, among which are the sampling of private wells and state with the closure of the contaminated water supply chlorinated by conductive pipes and to the affected areas, the removal of water leaks, pit cleaning and sanitation and health education program to the population. It has the resources necessary for adequate patient care in all health institutions.

 

People are encouraged to comply with sanitary measures associated with personal hygiene, water and food.

Ministry of Public Health
July 2, 2012
"Year 54 of the Revolution"

 

Credit goes to an AFP (Agence France-Presse) report Cuba cholera outbreak kills Three  that mentioned the publication of the MOH statement, which allowed me to track it down.

»» Read More

Indonesia MOH Reports Bird Flu Fatality

 

Riau, Indonesia

# 6309

 

Last week we were following conflicting reports of a 2-year-old in Bali suspected of having died from the H5N1 virus (see Bali: Suspected Bird Flu Fatality), but today’s report is on a different toddler, this time from Riau.

 

A hat tip to Gert van der Hoek on FluTrackers for picking up this announcement from the Indonesian Ministry of Health.

 

Bird Flu Case Report

MAY 1, 2012 | 8:49 PM
Ministry of Health, "Directorate General of Disease Control and Environmental Health" announced one new case of H5N1 have been confirmed by the Center for Biomedical and Health Technology base, Balitbangkes.

Case on behalf of MAF (Female, 2 years) from Siak, Pekanbaru, Riau province.

Dated 17 April 2012 symptoms of fever, dated 20 April 2012 the case to the Private Clinic but no improvement so the evening went to the hospital Z.

On 21 April 2012 cases admitted to hospital and treated in EB Hospital. Treating physician to report to the Command Post Riau Provincial Health Office. On 27 April 2012 patient was referred to hospital AA. The situation gets worse case and the case died on 27 April 2012 at 23:45 pm in the Hospital AA.

Epidemiological investigations have been carried into the homes of people and the environment by the local health office team, acquired risk factors, namely the possibility of contact with poultry (quail eggs) for the case of parents selling quail eggs.

With the increase of these cases, the cumulative number of bird flu in Indonesia since 2005 until this news was broadcast on 189 cases with 157 deaths.

»» Read More

Indonesia MOH: Bird Flu Case # 188

 

 

 

# 6245

 

 

Overnight the press carried reports (see Indonesia: Sixth H5N1 death this year on Crofsblog) of a new human H5N1 infection out of Indonesia. This time, it involves a 17 year old boy from eastern Lombok island who died on March 9th.

 

Below you’ll find the the update from the Indonesian Ministry of Health, followed by the update from the World Health Organization.

 

Bird Flu Case report 188

March 26, 2012 | 9:15 am

 

Ministry of Health, "Directorate General of disease Control and Environmental Health" announced one new case of H5N1 have been confirmed by the Center for Biomedical and Health Technology, Balitbangkes.

 

Case on behalf of D (male, 17 years) who Lingsar, West Lombok regency, West Nusa Tenggara Province, is a construction worker. Dated February 28, 2012 symptoms of fever, dated March 1, 2012 cases to the health center outpatient Lingsar, and on March 4, 2012 cases treated at health centers Narmada. On March 7, 2012 cases were referred to the RSU Mataram and treated in hospital. Circumstances of the case got worse and on March 9, 2012 cases died at 23:50 pm.

 

Epidemiological investigations have been carried into the homes of people and the environment by the Integrated Team Ministry of Health and local health office, obtained the possibility of environmental risk factor is contact with the death of poultry (chicken) in the neighborhood.

 

With the increase of these cases, the cumulative number of bird flu in Indonesia since 2005 until this news was broadcast on 188 cases with 156 deaths.

 

Ailing Director General of Control and Environmental Health, Prof. dr. Tjandra Yoga Aditama as the focal point of the International Health Regulations (IHR) has been informed about the case to the WHO.

 

 

 

 

Avian influenza – situation in Indonesia – update

26 March 2012 - The Ministry of Health of Indonesia has notified WHO of a new case of human infection with avian influenza A(H5N1) virus.

 

The case is a 17 year-old male from Nusa Tenggara Barat Province. He developed fever on 28 February 2012 and sought treatment on 1 March 2012. His condition deteriorated and he was admitted to a referral hospital but he died on 9 March 2012.

 

Epidemiological investigation conducted by a team from the health office indicated that there were sudden poultry die-offs in his neighbourhood.

 

To date, of the 188 cases reported in Indonesia since 2005, 156 have been fatal.

 

 

 

The case fatality rate (CFR) of `known’ cases in Indonesia continues to hover just over 82%, with just 4 of the last 26 cases surviving.

 

What we don’t know (and is highly contested in some scientific circles) is how many cases we are missing.

 

While surveillance and reporting almost certainly misses some number of cases (mild and fatal), researchers have turned up very little compelling evidence to indicate that there are a lot of `mild’ cases going uncounted.

 

Leaving us with a CFR that – while probably artificially high – strongly suggests a significant level of lethality from the H5N1 virus.

 

Fortunately, the virus remains difficult for humans to acquire, as it is presently far better adapted to avian physiology.

 

The concern is (as has been demonstrated as being possible in the laboratory), that over time the virus will pick up the mutations it will need to adapt to a human host and spark a pandemic.

»» Read More

Indonesia: Bird Flu Fatality & Suspect Cases

 

 

# 6160

 

Overnight Indonesia’s Ministry of Health (MOH) announced their 3rd H5N1 fatality of 2012: A 19 year old maid from Tangerang who developed symptoms on February 8th, and died on the 13th.

 

Tangerang is a major population center located just 25 km west of the Capital City, Jakarta.

 

 

The epidemiological investigation investing the route of her infection has stated that her risk factors were unclear, suggesting this woman had no known direct contact with poultry.

 

Of note, the  greater Jakarta area has been a bit of a bird flu hotspot these past couple of months.

 

The two other confirmed fatalities this year out of Indonesia (both from January) occurred in nearby Jakarta, while another suspected (but never confirmed) bird flu death was reported in Tangerang on January 21st. 

 

Here is the translation of the statement from the MOH.

 

Update Reports Bird Flu Case

February 21, 2012 | 9:47 am

Ministry of Health through the Directorate General of Disease Control and Environmental Health, announced a new case of H5N1 have been confirmed by the Center for Basic Biomedical and Health Technology, Balitbangkes.

 

Case on behalf of Kh (female, 19 years)who Kebumen, working as maids in Tangerang South, Banten province. On February 8, 2012 symptoms of fever, February 9, went to the doctor in private clinics, and on February 12, 2012 were treated at Mercy Hospital Sari Karawaci Tangerang. Kh died on February 13, 2012.

 

Epidemiological investigations have been conducted in the home environment where employers and patients in Tangerang Integrated Team Ministry of Health and local Health Department with the results of risk factors is unclear.

 

With the increase of these cases, the cumulative number of bird flu in Indonesia since 2005 until this news was broadcast on 185 cases with 153 deaths.

 

Director General of Disease Control and Environmental Health, Prof. dr. Tjandra Yoga Aditama as the focal point of the International Health Regulations (IHR) has been informed about the case to the WHO.

 

This information is published by the Center for Public Communication, Secretariat General of the Ministry of Health. For further information please contact via telephone: 021-52907416-9, fax: 021-52921669, 52960661, P

 

 

Meanwhile, the newshounds on the flu forums have been following reports of a family of 4 or 5 from South Sulawesi (another recent hub of bird flu reports), that are hospitalized with suspected H5N1.

 

I see Crof has picked up an English language media report overnight (see Indonesia: Four suspected H5N1 cases in South Sulawesi) via VIVAnews: Four Residents Feared Bird Flu Suspects.

 

Editor, senior moderator, and master map/chart maker Laidback Al on FluTrackers  has plotted this latest suspect cluster, along with two other suspected clusters this year on Sulawesi which you can view HERE.

 

Since January 1, 2012 there have been media reports of two clusters of suspected H5N1 infections in Gowa Regency in South Sulawesi in Indonesia.

January: http://www.flutrackers.com/forum/showthread.php?t=179571

February: http://www.flutrackers.com/forum/showthread.php?t=182747

The map below depicts the general location of these two clusters.

 

 

Although one is certainly tempted to suggest that where there is smoke, there is fire, so far none of these `clusters’  has been officially recognized as due to bird flu.

 

Given the limits of surveillance and testing, it is certainly possible that some individual cases, or even small clusters, of H5N1 infection go undetected.

 

But for now the virus remains poorly adapted to humans, and does not appear to transmit easily between them. Human infections remain rare, isolated events.

 

Clusters, while they have been reported, are rarer still.

With 20+ different clades (major versions) of the virus in circulation around the world, the concern is that one of these days one of them will mutate into a form that can transmit well among humans.

 

So we watch reports of clusters like these with interest, looking for any sign that the virus is changing.

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Indonesian MOH Announces Bird Flu Fatality

UPDATED 0800hrs EST – See Bottom

 

# 6082

 

 

Ten days ago we learned of the death of a 23 year-old man living in north Jakarta from the H5N1 virus, presumably contracted from pigeons he was raising (see Bird Flu Suspect Dies In Indonesia).

 

At the time, there were media reports that this man’s sibling (ASR, age 5) was also ill and hospitalized, but it was reported on January 9th that he/she tested negative for the H5N1 virus.

 

5-Year-Old Brother of Bird Flu Victim Cleared by Doctors

Dofa Fasila | January 10, 2012

Health authorities in Jakarta on Monday gave the 5-year-old brother of a young man who recently died of bird flu a clean bill of health.
The toddler, identified only as A.S.R., was hospitalized with a fever and cough on Saturday, the same day his 23-year-old brother, P.D.Y., died of the disease.

 

 

We know that testing for the H5N1 virus has always been difficult, particularly once a patient is placed on antivirals, and we’ve seen some cases where patients tested negative repeatedly up until their demise, and bird flu infection was only established post-mortem.

 

Which is why many observers of the bird flu situation in Indonesia take negative test results with a grain of salt.

 

Today, via a statement released from the Indonesian Ministry of Health (h/t Gert van der Hoek on FluTrackers), we now learn that a 5 year old girl from the same neighborhood (with exposure to pigeons) has died after testing positive for the virus on January 13th.

 

Most of the details match those of the 5 year-old referenced above (excluding gender), so it seems likely they are one in the same. Hopefully we’ll get a clarification of gender, and exact relationship to the first victim (if any), when the WHO updates this case. 

 

The following is a machine translation from the Sehat Negeriku (Healthy Country) website maintained by the Ministry of Health’s Center for Public Communication. While a lengthy update, conspicuous by its absence is any direct mention of the first fatality, the 23 year old who died on January 7th. 

 

I’ve bolded a few passages.

 

 

Bird Flu Case Update

January 19, 2012 | 3:16 pm

Ministry of Health, through the Directorate General of Disease Control and Environmental Health announced a new case of H5N1 have been confirmed by the Center for Biomedical and Health The basic technology, Health Research Agency.

 

The case on behalf of the U.S. (female, 5 years) who Tanjung Priok, North Jakarta, Jakarta Province. U.S. surveillance teams discovered during investigations in the region on January 7, 2012. He experienced symptoms of fever since the day before and was referred to the department of Friendship. The U.S. immediately get in the intensive care isolation room, according to the administration of examinations suspect bird flu.

 

On January 13, 2012, the patient experienced shortness of breath, and performed medical acts in accordance with procedures. At that time examination Polymirasea Chain Reaction (PCR), virus-infected patients tested positive for H5N1. Because of his condition continued to decline, eventually the patient died on January 16, 2012 at around 2:00 pm.

 

Based on the epidemiological investigation into the patient's house and the surrounding environment by Kemenkes Team and the local health office, and obtained the relevant information that is often brought into the workplace workshop PD (bird flu positive patients) where there are domesticated pigeons, are often invited to the ranch owned by friends of pigeons PD, and are often given food without washing hands after holding a dove.

 

With the increase of these cases, the cumulative number of bird flu in Indonesia since 2005 until this news broadcast is 184 cases with 152 deaths.

 

Director General of Disease Control and Environmental Health (PP and PL), Prof. dr. Tjandra Yoga Aditama, Sp (K), MARS, DTM & H, DTCE, vocal point as the International Health Regulations (IHR) have also been informed of this case to the WHO.

 

 

(Continue . . .)

 

 

Although we continue to see isolated human infections around the world, for now H5N1 is primarily a threat to poultry.

 

The virus remains poorly adapted to human physiology, and despite ample opportunities in places like Egypt and Indonesia, only causes rare, sporadic infections.

 

Still, with 20+ clades of the virus out there, continually mutating and adapting, the concern is that one of these days the virus will figure out how to infect humans efficiently.

 

So we watch these isolated cases with considerable interest, looking for any signs of enhanced transmission.

 

 

UPDATE:

Arkanoid Legent - one of the best newshounds on the net - has an update from the Antara News agency which indicates this latest victim is the niece (translated as nephew) of the first fatality.

 

Indonesia : Ministry of Health stated AS death positive bird flu

Machine translated article from Antara :

" Ministry of Health (Kemkes) in a statement here on Thursday, said the death of the girl with the initials AS (5) on Monday (16 / 1) is positive for bird flu.

AS is the nephew of PD (23) who died on January 7, 2012 ago and also tested positive for bird flu and the two alleged victims have contracted the H5N1 virus from the same source of pet birds PD.

"Since entering the hospital, AS have been given help and given medication, but is this bird flu death rate is quite high," said Director General of Disease Control and Environmental Health (P2PL) Tjandra Yoga Aditama when contacted by AFP on Thursday."

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Egypt: Two New Bird Flu Cases (1 Fatal)

 

 

# 5512

 

 

While I was away from my desk this morning Crof over at Crofsblog picked up on a new World Health Organization announcement of H5N1 in Egypt (see WHO: Two more Egyptian H5N1 cases, 1 death).

 

Today’s WHO announcement appears to catch up with the outstanding cases on the  Egyptian MOH website (as of Apr. 17th).

 

 

 

As you can see, since testing began in 2006, more than 12,000 suspected cases have been isolated and tested, but on 143 have tested positive.

 

 

 

Avian influenza - situation in Egypt - update 51

21 April 2011 - On 16 April 2011, the Ministry of Health of Egypt notified WHO of two new cases of human infection with avian influenza A (H5N1) virus.

 

The first case was a 29 years-old male from Fayoum Governorate Wadi Elrian area who developed symptoms on 1 April , was hospitalized on 4 April and died on 7 April.

 

The second case was a one -and-a -half year-old male child from Fayoum Governorate, Sennores District who developed symptoms on 9 April and was hospitalized on 11 April. He is under treatment and is in stable condition.

 

All the cases received oseltamivir treatment at the time of hospitalization.

 

Investigations into the source of infection indicate that both the cases had exposure to sick and/or dead poultry suspected to have avian influenza. There is no epidemiological link identified between these two cases.

 

The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network.

 

Of the 143 cases confirmed to date in Egypt, 47 have been fatal .

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Egyptian MOH:`No Mutation’ Of Flu

 

 

# 5217

 

 

Invariably, when a new or novel influenza virus makes an appearance on the world stage, the concern is that over time it will mutate to a more formidable viral foe.

 

Mutating is, after all, what viruses do. 

 

And influenza viruses are particularly adept at acquiring changes – either through small incremental changes (called `drift’), or via a reassortment or swapping of genetic material with another virus, called `shift’.

 

And as any virologist will tell you, Shift Happens.

 

Yet, despite the stigma attached to the word `mutation’, viruses can also mutate into a less dangerous strains. 

 

Over the past few days we are seeing public reassurances from some public health agencies that the swine flu virus has not `mutated’ into a more virulent strain.

 

Last week, scientists from the UK’s HPA, writing in Eurosurveillance (see Eurosurveillance: Analysis Of Fatal H1N1 Cases In The UK) stated that: so far no unique mutations have been associated with severe or fatal cases of influenza A(H1N1)2009, but further comprehensive analysis is required.

 

That isn’t to say that mutations haven’t shown up.  They have, and will no doubt continue to do so.  

 

But so far, none of these changes is viewed by these HPA researchers as particularly alarming, linked to fatal cases, or indicative of a fundamental change in the H1N1 virus.

 

Today, similar assurances from the Egyptian Ministry of Health, on both H1N1 and H5N1 `bird flu’.

 

(Note: I realize there may not be universal agreement over the significance of some of the mutations that have been seen to date. Since I’m not a virologist, I’ll have to leave it to others to debate that issue.)

 

A double hat tip to Twall and Shiloh on FluTrackers for links to the Arabic and English versions of the following report.

 

No mutation of the avaian flu with swine flu, says health minister

Minister of Health asks citizens to take flu seriously but denies presence of mixed mutation of avian flu with swine flu

Ahram Online, Monday 10 Jan 2011

Egyptian Minister of Health Hatem El-Gabaly denied the presence of any mixed mutation of avian flu with swine flu (H1N1). He did, however, warn citizens against taking the flu threat lightly.

(Continue . . . )

 

 

When a novel flu virus like H5N1 co-circulates with a human-adapted influenza like H1N1 or H3N2, the concern is that the two will infect the same host at the same time, swap genetic material, and produce a new hybrid strain with the worst qualities (virulence and transmissibility) of both parent viruses.

 

We know reassortments like this can happen, as they has happened in the past. 

 

But it obviously doesn’t happen often, or easily, else we’d be hip deep in reassorted flu viruses every year.

 

Of course, it only takes one good hookup between compatible viruses, in the right host at the right time and in the right place to spark another global flu crisis.

 

 

In her keynote speech last night at Duke University, Assistant Surgeon General Dr. Anne Schuchat reminded her audience that had the 2009 novel H1N1 virus been detected just a few weeks sooner (it was already circulating), it could have been incorporated into that year’s seasonal flu shot.

 

That would have saved billions of dollars over the production of a separate pandemic jab, and would have gotten the vaccine into the arms of millions of people months sooner.

 

A step that would likely have saved many lives and billions more in health care costs.

 

Which is why surveillance, analysis, and reporting on any changes to influenza viruses circulating in humans and animals around the world remains a high priority.

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