Category Archives: 4. Articles

Middle East Respiratory Syndrome Coronavirus (MERS-CoV); Announcement of the Coronavirus Study Group

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de Groot RJ, Baker SC, Baric RS, et al. J Virol. 15 May 2013. doi: 10.1128/JVI.01244–13.
Avail­able at http://jvi.asm.org/content/early/2013/05/08/JVI.01244–13.long

Excerpt. Dur­ing the sum­mer of 2012, in Jed­dah, Saudi Ara­bia a hith­erto unknown coro­n­avirus was iso­lated from the spu­tum of a patient with acute pneu­mo­nia and renal fail­ure. The iso­late was pro­vi­sion­ally called human coro­n­avirus EMC. Shortly there­after, Sep­tem­ber 2012, the same type of virus, named human coro­n­avirus Eng­land 1, was recov­ered from a patient with severe res­pi­ra­tory ill­ness, who had been trans­ferred from the Gulf region of the Mid­dle East to Lon­don, United King­dom. The onset of the new dis­ease was traced back to an even ear­lier time point. Already in April 2012, a clus­ter of pneu­mo­nia cases in health care work­ers occurred in an inten­sive care unit of a hos­pi­tal in Zarqa, Jor­dan. Two per­sons died, both of which were con­firmed to have been infected with the novel coro­n­avirus through ret­ro­spec­tive analy­sis of stored sam­ples. These find­ings met with con­sid­er­able con­cern. Although the num­ber of cases doc­u­mented is lim­ited (thirty as of 6 May 2013), the mor­bid­ity and mor­tal­ity of the infec­tion is alarm­ing, as is its uncanny resem­blance –at least in its clin­i­cal fea­tures– to SARS. While a small minor­ity of the known cases devel­oped mild dis­ease, most patients pre­sented with a severe acute res­pi­ra­tory con­di­tion requir­ing hos­pi­tal­iza­tion; the mor­tal­ity rate is approx­i­mately 60%.

Coronavirus

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East Mediter­ranean Health Jour­nal. 2013. 19(Supp1).
Avail­able at http://www.emro.who.int/emhj-volume-19–2013/volume-19-supplement-1-coronavirus/volume-19-supplement-1-coronavirus.html

The East­ern Mediter­ranean Health Jour­nal is the flag­ship health peri­od­i­cal of the World Health Orga­ni­za­tion Regional Office for the East­ern Mediter­ranean. In 2013, the jour­nal pub­lished a sup­ple­ment with a series of arti­cles on the emerg­ing Mid­dle East res­pi­ra­tory syn­drome coro­n­avirus (MERS-CoV).

Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study

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Kot­loff DL, Nataro JP, Black­welder WC, et al. Lancet. 14 May 2013. doi:10.1016/S0140-6736(13)60844–2.
Avail­able at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60844–2/abstract

Back­ground. Diar­rhoeal dis­eases cause ill­ness and death among chil­dren younger than 5 years in low-income coun­tries. We designed the Global Enteric Mul­ti­cen­ter Study (GEMS) to iden­tify the aeti­ol­ogy and population-based bur­den of pae­di­atric diar­rhoeal dis­ease in sub-Saharan Africa and south Asia.

Meth­ods. The GEMS is a 3-year, prospec­tive, age-stratified, matched case-control study of moderate-to-severe diar­rhoea in chil­dren aged 0—59 months resid­ing in cen­sused pop­u­la­tions at four sites in Africa and three in Asia. We recruited chil­dren with moderate-to-severe diar­rhoea seek­ing care at health cen­tres along with one to three ran­domly selected matched com­mu­nity con­trol chil­dren with­out diar­rhoea. From patients with moderate-to-severe diar­rhoea and con­trols, we obtained clin­i­cal and epi­demi­o­log­i­cal data, anthro­po­met­ric mea­sure­ments, and a fae­cal sam­ple to iden­tify enteropathogens at enrol­ment; one follow-up home visit was made about 60 days later to ascer­tain vital sta­tus, clin­i­cal out­come, and inter­val growth.

Find­ings. We enrolled 9439 chil­dren with moderate-to-severe diar­rhoea and 13 129 con­trol chil­dren with­out diar­rhoea. By analysing adjusted pop­u­la­tion attrib­ut­able frac­tions, most attrib­ut­able cases of moderate-to-severe diar­rhoea were due to four pathogens: rotavirus, Cryp­tosporid­ium, entero­tox­i­genic Escherichia coli pro­duc­ing heat-stable toxin (ST-ETEC; with or with­out co-expression of heat-labile entero­toxin), and Shigella. Other pathogens were impor­tant in selected sites (eg, Aeromonas, Vib­rio cholerae O1, Campy­lobac­ter jejuni). Odds of dying dur­ing follow-up were 8·5-fold higher in patients with moderate-to-severe diar­rhoea than in con­trols (odd ratio 8·5, 95% CI 5·8—12·5, p<0·0001); most deaths (167 [87·9%]) occurred dur­ing the first 2 years of life. Pathogens asso­ci­ated with increased risk of case death were ST-ETEC (haz­ard ratio [HR] 1·9; 0·99—3·5) and typ­i­cal enteropath­o­genic E coli (HR 2·6; 1·6—4·1) in infants aged 0—11 months, and Cryp­tosporid­ium (HR 2·3; 1·3—4·3) in tod­dlers aged 12—23 months.

Inter­pre­ta­tion. Inter­ven­tions tar­get­ing five pathogens (rotavirus, Shigella, ST-ETEC, Cryp­tosporid­ium, typ­i­cal enteropath­o­genic E coli) can sub­stan­tially reduce the bur­den of moderate-to-severe diar­rhoea. New meth­ods and accel­er­ated imple­men­ta­tion of exist­ing inter­ven­tions (rotavirus vac­cine and zinc) are needed to pre­vent dis­ease and improve outcomes.