WHO gives details on 6 Saudi MERS-CoV cases

The World Health Organization (WHO) today issued a statement offering new details on 6 cases of MERS-CoV reported on Jun 19 and 20 in Saudi Arabia. Four of the cases are related to the current outbreak at King Khalid University Hospital in Riyadh.

Three of the patients are female hospital workers who worked with the index patient at the hospital. The healthcare workers, all foreigners in their early 30s, were asymptomatic or exhibited only mild symptoms and were identified and tested through tracing of the index patient's healthcare contacts. They had no other risk factors or history of exposure, and are in home isolation.

Another patient, a 42-year-old Saudi man from Riyadh, tested positive for MERS-CoV (Middle East respiratory syndrome coronavirus) on Jun 19 after developing symptoms 3 days earlier. He is a household contact of a known case-patient and is also in stable condition in home isolation.

The two other patients come from different cities in southern Saudi Arabia. A 44-year-old Saudi man from Najran developed symptoms on Jun 4 and tested positive for MERS-CoV on Jun 18. His exposure history is being investigated while he remains hospitalized in critical condition. He has no known risk factors, but is a smoker. A 51-year-old Saudi man from Taif is in stable condition after testing positive for the disease on Jun 19. His exposure history is also being investigated while he is hospitalized in a negative-pressure room.

The WHO also reported that Saudi Arabia notified the organization of the death of one MERS-CoV patient, a 49-year-old female from Buraydah.

Jun 22 WHO update

Related Jun 20 CIDRAP News story

Study: Diagnosed drug-resistant TB cases in kids are just tip of iceberg

Using mathematical modeling, researchers estimate that the number of drug-resistant tuberculosis (TB) cases in children around the world dwarfs the number actually reported, according to a report published yesterday in The Lancet Infectious Diseases.

A team from two British universities and the World Health Organization (WHO) relied on data collected by the WHO's TB drug resistance surveillance program between 1988 and 2014 to generate their estimates. They used WHO data on adult TB cases to approximate the annual risk of TB infection in children, and employed data on demographic characteristics, BCG vaccine coverage, HIV prevalence, and the natural history of disease in children to estimate TB incidence in each of 180 countries.

The researchers estimated that 850,000 children fell ill with TB in 2014, including 58,000 with isoniazid-resistant TB, 25,000 with multidrug-resistant (MDR) TB, and 1,200 with extensively drug-resistant (XDR) disease.

As for latent TB cases, they estimated that 67 million children are infected with Mycobacterium tuberculosis. That includes 5 million with isoniazid monoresistance, 2 million with MDR-TB, and 100,000 with XDR-TB.

"Vastly more drug-resistant tuberculosis disease exists in children than is currently diagnosed, with the number of reported cases of multidrug-resistant tuberculosis in the scientific literature dwarfed by our estimate of 25,000 global cases annually," the authors said.

They added that the high estimate of latent cases "has substantial implications for the design of empirical regimens for disease treatment and for preventive therapy, especially in the era of the GeneXpert diagnostic test roll-out."

Jun 21 Lancet Infect Dis abstract

To speed research, NIH aims for one review board for multi-site studies

The National Institutes of Health (NIH) yesterday issued a policy calling for the use of just one institutional review board (IRB) for NIH-funded clinical research studies conducted at multiple sites, saying this would save time and prevent duplication.

"Today, the time it takes to go from a sound research idea to the launch of a new, multi-site clinical research study is too long," NIH Director Francis S. Collins, MD, PhD, said in a statement. "A major contributor to the delay is that too many IRBs are reviewing the protocol and consent documents for the same study, often with no added benefit in terms of the protections for research participants."

IRBs evaluate the potential benefits of clinical studies and the risks to participants. Collins said that most clinical studies in the past were done at one institution, but studies now are increasingly being conducted at multiple sites. In most cases, the IRB at each participating institution still conducts its own review. "This new NIH policy seeks to end duplicative reviews that slow down the start of the research," he said.

The NIH will provide guidance and resources to support institutions as they implement the new policy, Collins said.

Jun 21 NIH statement