Category Archives: Global

Global: Novel coronavirus summary and literature update

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As of 8 May 2013, 30 laboratory-confirmed cases of human infec­tion with novel coro­n­avirus (nCoV) have been reported to WHO: two from Jor­dan, two from Qatar, 23 cases from Saudi Ara­bia, two from the United King­dom (UK), and one from the United Arab Emi­rates. Most patients are male (79.3%; 23 of 29 cases with sex reported) and range in age from 24 to 94 years (median 56 years). The first cases had onset of ill­ness in late March or early April 2012; the most recent cases reported had onset on 1 May 2013 (13 cases with onset 14 April — 1 May 2013). Most patients pre­sented with severe acute res­pi­ra­tory dis­ease requir­ing hos­pi­tal­iza­tion and even­tu­ally required mechan­i­cal ven­ti­la­tion or other advanced res­pi­ra­tory sup­port. Eigh­teen patients have died.

Sev­eral cases have occurred in clus­ters, includ­ing in a health care set­ting in Jor­dan in April 2012 (of two con­firmed and 11 prob­a­ble cases, 10 were health care work­ers) and in the UK among fam­ily mem­bers of an infected patient who had recently arrived from Saudi Ara­bia. The Jor­dan­ian out­break illus­trated the poten­tial of this virus to spread through health care facil­i­ties and the UK out­break con­firmed the poten­tial of the virus to trans­mit between humans with close con­tact. In nei­ther instance did trans­mis­sion appear to go beyond the imme­di­ate out­break into the community.

Since 14 April 2013, 13 new cases of infec­tion have been con­firmed and reported in Saudi Ara­bia (ten males and three females, median age 58 years). Seven of these have died, four remain crit­i­cally ill in inten­sive care and two are hos­pi­tal­ized but clin­i­cally improved. All patients were reported to have at least one comor­bid med­ical con­di­tion and most had more than one. Most of the cases were patients at a sin­gle health care facil­ity. Two were fam­ily mem­bers of two patients from that facil­ity; no health care work­ers have been affected. Although inves­ti­ga­tions are still ongo­ing into the source of this out­break, early infor­ma­tion indi­cated that only a small minor­ity of these cases had con­tact with ani­mals in the time lead­ing up to their illness.

Five viruses from the United King­dom (n=2), Saudi Ara­bia (n=1), Jor­dan (n=1), and Ger­many (n=1) have been cul­tured and genome sequences have been made pub­licly avail­able. No sequence data are yet avail­able from the lat­est clus­ter. All five of the sequenced viruses have a high degree of genetic sim­i­lar­ity. Pre­lim­i­nary analy­ses show that the viruses are genet­i­cally some­what sim­i­lar to bat viruses. It should be noted, how­ever, that the sim­i­lar­ity does not nec­es­sar­ily imply that bats are the reser­voir for the human virus or that direct expo­sure to bats or bat exc­reta were respon­si­ble for infec­tion. The nCoV itself has not yet been found in an animal.

The full arti­cle may be accessed at http://www.who.int/csr/disease/coronavirus_infections/update_20130508/en/index.html

(WHO 5/8/2013)

Global: WHO to combat resistance to key malaria drug

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The World Health Orga­ni­za­tion (WHO) is to launch a vig­or­ous response to the wor­ry­ing emer­gence of resis­tance to the anti­malar­ial drug artemisinin in the Greater Mekong Sub­re­gion of South-East Asia.

Artemisinin is the front­line drug in the fight against malaria, and WHO says the emer­gence of resis­tance in Cam­bo­dia, Myan­mar, Thai­land and Viet Nam poses a seri­ous global health threat. “We are tak­ing the sit­u­a­tion very seri­ously,” says Dr Shin Young-soo, WHO Regional Direc­tor for the West­ern Pacific. “If resis­tance to artemisinin emerges elsewhere—particularly in Africa, which has the world’s great­est num­ber of malaria cases—the con­se­quences for global health could be incalculable.”

Artemisinin-based com­bi­na­tion ther­a­pies (ACTs) are the most effec­tive anti­malar­ial treat­ments avail­able today. They have been cen­tral to recent suc­cesses in global malaria con­trol. Artemisinin-based com­bi­na­tion ther­a­pies com­bine artemisinin—a tra­di­tional Chi­nese herbal drug—with another anti­malar­ial drug. The artemisinin com­po­nent kills the major­ity of par­a­sites at the start of the treat­ment, while the part­ner drug clears the remain­ing parasites.

In response to the threat to resis­tance, WHO is to launch its “Emer­gency Response to Artemisinin Resis­tance in the Greater Mekong Sub­re­gion” (ERAR) —a strate­gic frame­work of sup­port for the six coun­tries of the Greater Mekong Sub­re­gion. Apart from the four affected coun­tries, the region also includes China’s Guangxi Zhuang Autonomous Region and Yun­nan province and the Lao People’s Demo­c­ra­tic Republic—both of them seen as poten­tially at risk of resis­tance to artemisinin in a region that is highly inter-connected. The response will involve many part­ners work­ing together across the region to scale up efforts to con­tain resistance.

The full arti­cle may be accessed at http://www.wpro.who.int/mediacentre/releases/2013/20130423/en/index.html

(WHO WPRO 4/23/2013)

Global: WHO updates novel coronavirus status, cites unanswered questions

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Com­ing about a year since the first known novel coro­n­avirus (nCoV) patient got sick with the dis­ease, the World Health Orga­ni­za­tion (WHO) on 24 April 2013 posted an update on what is known about the new virus, which has resulted in 17 infec­tions, 11 of them fatal. No new cases have been reported since a man from the United Arab Emi­rates was treated for the dis­ease in Ger­many, where he died in March 2013. Though four clus­ters have been iden­ti­fied, person-to-person trans­mis­sion has been con­firmed in only three UK cases, sug­gest­ing no sus­tained trans­mis­sion. Four viruses have been posted to Gen­Bank, and all are highly sim­i­lar. The WHO said sero­logic tests and a new sen­si­tive poly­merase chain reac­tion test may help reveal how com­mon the virus is in the com­mu­nity. Other unan­swered ques­tions include how humans are exposed to the virus, the pathogen’s geo­graphic extent, and opti­mal clin­i­cal man­age­ment. So far, evi­dence points to a zoonotic source, though experts are explor­ing the role of human-to-human spread and the pos­si­bil­ity of an inter­me­di­ary host. Pro­to­cols are clin­i­cal man­age­ment tri­als should be devel­oped to help treat future cases, the group said. The emer­gence of nCoV shows the impor­tance of global vig­i­lance and sur­veil­lance for unusual res­pi­ra­tory dis­ease clus­ters, accord­ing to the WHO.

The full WHO update may be accessed at http://www.who.int/csr/disease/coronavirus_infections/update_20130424/en/index.html

(CIDRAP 4/24/2013)