The Saudi authorities are also continuing the investigation into the outbreak that began in a health care facility since the beginning of April 2013 in Al-Ahsa. As of 23 May 2013, a total of 22 patients including 10 deaths have been reported from the outbreak. Globally, from September 2012 to date, WHO has been informed of a total of 44 laboratory-confirmed cases of infection with MERS-CoV, including 22 deaths.

WHO has received reports of laboratory-confirmed cases from the following countries in the Middle East: Jordan, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). France, Germany, Tunisia and the United Kingdom also reported laboratory-confirmed cases; they were either transferred for care of the disease or returned from Middle East and subsequently became ill. In France, Tunisia and the United Kingdom, there has been limited local transmission among close contacts 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. Health care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. Specimens from patients’ lower respiratory tracts should be obtained for diagnosis where possible. Clinicians are reminded that MERS-CoV infection should be considered even with atypical signs and symptoms, such as diarrhea, in patients who are immunocompromised. Health care facilities are reminded of the importance of systematic implementation of infection prevention and control (IPC). Health care facilities that provide care for patients suspected or confirmed with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients, health care workers and visitors.

All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions. WHO continues to closely monitor the situation.

WHO novel coronavirus summary and literature update available at http://www.who.int/csr/disease/coronavirus_infections/update_20130517/en/index.html

(WHO 5/23/2013)

Since yellow fever vaccination began in the 1930s, only 12 known cases of yellow fever post-vaccination have been identified, after 600 million doses have been dispensed. Evidence showed that among this small number of “vaccine failures”, all cases developed the disease within five years of vaccination. This demonstrates that immunity does not decrease with time.

The full article may be accessed at http://www.who.int/mediacentre/news/releases/2013/yellow_fever_20130517/en/index.html

(WHO 5/17/2013)

However, ACT Chief Health Officer Paul Kelly said the establishment could reopen within days. “Now we’ve really pinpointed the problem, we can work with them towards reopening in the coming days,” he said. “There are still a few issues to sort through but they’re keen to open and we’re keen for them to open as well once we’ve sorted out these issues.”

Dr. Kelly said homemade mayonnaise, made using raw eggs, was “really coming up as a problem”. “There are products on the market that pasteurize eggs. That may lead to a slightly less foodie answer to the problem, but it’s certainly safer.” Dr Kelly said ACT Health had not recorded any further cases overnight, but some patients remained in hospital. “This illness can last for up to a week. We haven’t had any more cases arrive in hospital overnight, but we are still continuing with our investigation and talking to the restaurant to sort out what we can do to prevent it in the future.”

The full article may be accessed at http://www.canberratimes.com.au/act-news/bad-mayonnaise-poisons-140-people-20130515-2jlu2.html

(Canberra Times 5/15/2013)

(CIDRAP 5/22/2013)

The first outbreak involves 146 people infected with Salmonella Typhimurium in 26 states. Patients range in age from less than 1 year to 70, but 66% are 10 years old or younger. Of 91 patients with available data, 27 (30%) were hospitalized. Illness-onset dates range from 4 March to 26 April 2013. Of 88 people interviewed, 84 (94%) had contact with live poultry such as chicks, chickens, ducks, or ducklings before becoming ill. Almost all who had purchasing information said they bought live baby poultry from 13 different agricultural feed stores in multiple states.

The second outbreak comprises 61 cases in 18 states and involves Salmonella Infantis and Mbandaka strains. Patients range in age from less than 1 year to 88 years, and 48% are 10 years old or younger. Among 34 patients with available data, 12 (35%) have been hospitalized. Illness-onset dates range from 8 March to 22 April 2013. “Epidemiologic, laboratory, and traceback findings have linked this outbreak of human Salmonella Infantis and Salmonella Mbandaka infections to contact with chicks, ducklings, and other live baby poultry from Mt. Healthy Hatchery in Ohio,” the CDC said. The agency first alerted the public to the outbreaks on 25 April 2013 but had no case details at that point. In 2012, the CDC reported three separate outbreaks linked to live chicks, involving at least 334 cases.

Additional information available at http://www.cdc.gov/salmonella/typhimurium-live-poultry-04–13/index.html and http://www.cdc.gov/salmonella/live-poultry-04–13/index.html

(CIDRAP 5/10/2013)

Investigators say they haven’t pinpointed a menu item or ingredient that’s the likely culprit. Inspectors who visited the restaurant on 26 April 2013 documented food stored at improper temperatures and employees handling food without gloves. The restaurant was one of Vegas’ most highly rated eateries on the review site Yelp.com. Health District spokeswoman Stephanie Bethel says it was shuttered 26 April 2013 and remains closed.

[ProMED note: The serotype of S. enterica in this outbreak has not been stated. Given the location of the restaurant (on the Las Vegas Strip) and its apparent popularity, it is not at all surprising that cases have been diagnosed in multiple states as well as internationally. We await more information regarding potential vehicles of transmission.]

(ProMED 5/15/2013)

The city’s best hope to curb the outbreak is to vaccinate as many at-risk men as possible, focusing on those most in danger: men who regularly hook up with other men whom they meet at parties, bars, clubs, and through apps like Grindr. Dr. Don Weiss, the director of surveillance for the city’s Bureau of Communicable Disease, has called it “Russian roulette sex,” because “sooner or later, you are going to come across this organism and be exposed.”

The health department’s own vaccination efforts at several gay bars have had limited success. Men out partying want to have fun, not be told that they may fall prey to a lethal disease by doing so. Hence Dr. Daskalakis’s early-morning club crawl, medical bag in hand. Being a nonthreatening gay man who does not wear a white coat helps. So does his empathy and sense of humor.

The bacterium that causes meningococcal meningitis is carried in the nose and mouth. Though not as contagious as a cold or flu, it can be spread through kissing, sneezing, or sharing a spoon. (Sharing cigarettes is also bad, but there is a theory in the literature that this is not because of the exchange of saliva but because smoking irritates the mucous membranes and facilitates bacterial invasion.)

The full article may be accessed at http://www.promedmail.org/direct.php?id=20130520.1725339

(ProMED 5/20/2013)

Situation updates on human H7N9 influenza infections: http://www.who.int/influenza/human_animal_interface/avian_influenza/archive/en/index.html

Number of confirmed human cases for influenza A(H7N9) reported to WHO:
http://www.wpro.who.int/outbreaks_emergencies/H7N9/en/index.html
http://www.who.int/influenza/human_animal_interface/influenza_h7n9/Data_Reports/en/index.html

WHO risk assessment on human H7N9 influenza infections (last updated 5/10/2013):
http://www.who.int/influenza/human_animal_interface/influenza_h7n9/RiskAssessment_H7N9_10May13.pdf

Interim WHO surveillance recommendations for human infection with avian influenza A(H7N9) virus:
http://www.who.int/influenza/human_animal_interface/influenza_h7n9/InterimSurveillanceRecH7N9_10May13.pdf

Update of WHO biosafety risk assessment and guidelines for the production and quality control of human influenza vaccines against avian influenza A(H7N9) virus:
http://www.who.int/biologicals/areas/vaccines/influenza/biosafety_risk_assessment_10may2013.pdf

China-WHO joint mission on human infections with avian influenza A(H7N9) virus:
http://www.who.int/influenza/human_animal_interface/influenza_h7n9/ChinaH7N9JointMissionReport2013.pdf

FAO risk mitigation report on addressing the avian influenza A(H7N9) emergency:
http://www.fao.org/docrep/018/aq241e/aq241e.pdf

Authorities in affected locations continue to maintain enhanced surveillance, epidemiological investigations, close contact tracing, clinical management, laboratory testing and sharing of samples as well as prevention and control measures. The Shanghai and Zhejiang provincial governments have started to normalize their emergency operations into their routine surveillance and response activities. WHO offices in country, regional and headquarters continue to work closely to ensure timely information updates.

Until the source of infection has been identified and controlled, it is expected that there will be further cases of human infection with the virus. So far, there is no evidence of sustained human-to-human transmission.

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions. WHO continues to work with Member States and international partners. WHO will provide updates as the situation evolves.

(WHO 5/17/2013)

In Tibet, H5N1 struck geese and chickens in the village of Qionglin, starting on 13 May 2013. The virus killed 35 birds, and 372 more were culled to control disease spread. Tibet’s last H5N1 outbreak occurred in October 2012.

(CIDRAP 5/13/2013)