The Ministry of Health in Saudi Arabia has notified WHO of an additional laboratory-confirmed case with Middle East respiratory syndrome coronavirus (MERS-CoV). The patient is a 14-year-old girl with underlying medical conditions who became ill on 29 May 2013. She is reported from the Eastern region, but not from Al-Ahsa where an outbreak began in a health care facility since April 2013. The patient is in stable condition.
Globally, from September 2012 to 5 June 2013, WHO has been informed of a total of 54 laboratory-confirmed cases of infection with MERS-CoV, including 30 deaths. WHO has received reports of laboratory-confirmed cases originating in the following countries in the Middle East to date: Jordan, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). France, Germany, Italy, Tunisia and the United Kingdom also reported laboratory-confirmed cases; they were either transferred there for care of the disease or returned from the Middle East and subsequently became ill. In France, Italy, Tunisia and the United Kingdom, there has been limited local transmission among patients who had not been to the Middle East but had been in close contact with the laboratory-confirmed or probable cases.
Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.
The full article may be accessed at http://www.who.int/csr/don/2013_06_05/en/index.html
Australia conducts surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years of age as part of the national polio surveillance program funded by the Australian government. From January to early May 2013, human enterovirus 71 (EV71) was detected in stool specimens from 5 of 14 (36%) AFP cases in children. EV71 was also detected in specimens from cases of hand-foot-mouth disease (HFMD) and non-paralytic neurological illness by members of the Enterovirus Reference Laboratory Network of Australia. A phylogenetic analysis of the VP1 genomic region identified homology with the EV71 C4a sub-genogroup circulating in China and South East Asia, which has been associated with more severe neurological complications than other sub-genogroups in recent years.
The identification of a more virulent strain of EV71 highlights the importance of referring stool specimens from patients suffering from AFP (including transverse myelitis and Guillain-Barre syndrome) to a WHO accredited polio reference laboratory not only to exclude poliovirus infection but also to identify non-polio enteroviruses of public health significance.
The Enterovirus Reference Laboratory Network of Australia was established in mid-2009 to broaden surveillance for poliovirus and now includes ten public diagnostic virology laboratories. The network has accumulated more than 1,100 enterovirus typing results nationally and of the EV71 detections, sub-genogroup B5 was the predominant strain detected from 2009–2011, with sporadic identifications of EV71 sub-genogroups C2 and C4a in 2012, none of which were associated with cases of AFP. It is also noteworthy that so far in 2013, echovirus 6 constituted the major enterovirus serotype associated with meningitis Australia-wide, with 74 of 311 (24%) identifications overall reported to the Enterovirus Reference Laboratory Network. This emphasizes the value of enterovirus typing to differentiate pathogens and their clinical manifestations.
[ProMED note: EV71 for some years now has been the predominant virus in South and East Asia associated with the childhood disease HFMD. In particular, in contrast to other enteroviruses responsible for HFMD, EV71 has been associated with non-paralytic neurological illness. The association of a particular strain of EV71 (a member of sub-genogroup C4a) with cases of AFP in Australia is a warning that this virus may be evolving into a more dangerous pathogen and that it merits increased surveillance.]
According to the National Institute of Infectious Diseases in Japan, as of week 20–26 May 2013, 672 cases of clinically or laboratory-confirmed rubella were reported in Japan. There are 47 prefectures in Japan; the epidemiological situation varies from prefecture to prefecture. 204 cases of rubella were reported from Osaka prefecture during 20–26 May 2013, the most, followed by Tokyo metropolitan (112 cases), Hyogo prefecture (85 cases), Kanagawa prefecture (61 cases), Wakayama prefecture (33 cases), and Chiba prefecture (24 cases). The number of reported cases in these six prefectures amount to 77% of the total in Japan. All of these six prefectures have begun to subsidize vaccination fees for adult people who are at risk. The governments of many other prefectures or cities are also implementing subsidization.