Category Archives: 1. Infectious disease news

Global: Middle East respiratory syndrome coronavirus (MERS-CoV) update

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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

(WHO 6/5/2013)

Australia: Detection of enterovirus 71 sub-genogroup C4a in specimens from cases of acute flaccid paralysis

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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.]

(ProMED 5/26/2013)

Japan: Rubella situation update and comment on vaccination

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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.

(ProMED 6/6/2013)