Saudi Arabia reports 2 new MERS cases, 1 linked to camels

Saudi Arabia's Ministry of Health (MOH) reported two new MERS cases today, and a death in a previously reported patient. The new patients and the deceased were elderly Saudi men who were not healthcare workers.

An 84-year-old man in Hufoof is in stable condition after experiencing symptoms. His illness is considered primary, meaning he likely did not contract the disease from another person. The other patient is a 75-year-old man in Al Aflaj; he also had symptoms and is in stable condition. The MOH said he had contact with camels.

In addition, the MOH said a 72-year-old man from Hail died from MERS-CoV (Middle East respiratory syndrome coronavirus). He had preexisting illnesses when he was diagnosed.

Camels are a source of MERS infection, but how the animals transmit the disease to humans is still unclear. The World Health Organization (WHO) urges people at risk for severe MERS (diabetics, those with compromised immune systems, and the elderly) to avoid contact with camels and to refrain from eating camel meat or drinking camel milk.

The developments elevate Saudi Arabia's MERS-CoV total cases since 2012 to 1,404, including 597 deaths.

Jun 28 MOH report

2009 H1N1 flu virus originated in central Mexico, study says

The 2009 H1N1 pandemic flu virus originated in pigs in a small region of central Mexico, researchers from the Icahn School of Medicine at Mount Sinai reported in eLife today that. The pigs hosted the parent virus for at least 10 years before it jumped to humans, they added.

More than 17,000 people died from the H1N1 influenza pandemic in 2009-10. The first human cases were reported in Mexico. The investigators used genetic analysis to pinpoint when and where the virus jumped from animals to humans.

"This finding highlights how the 2009 pandemic arose from a region not considered a pandemic risk," said the authors. Most flu pandemics have originated in Asia, but international swine trade and the expansion of influenza strain diversity means future pandemics can originate from overlooked regions, they added.

The authors suggest the 2009 outbreak was closely linked to an influx of swine imports in Mexico in the 1990s.

"Our ability to predict future pandemics will require intensified viral surveillance, and an understanding of how economic forces and international trade policies affect changes in animal movements," the authors said. Currently, live swine are not routinely tested for influenza A.

Jun 28 eLife study

In another study concerning the 2009 H1N1 pandemic, researchers from the United Kingdom and Germany found that genetic changes to H1N1 during the pandemic resulted in increased viral pathogenicity and transmissibility in ferrets.

The authors, reporting in Scientific Reports, said these mutations increased viral replication in the respiratory tract and elevated respiratory droplet transmission between the animals. This is the first study to use a mammalian model to show that viral alterations and evolution in H1N1 increase viral fitness.

The authors suggest this may be the reason the second and third waves of the H1N1 outbreak caused more severe illness in patients.

Jun 24 Sci Rep study

WHO appoints first Health Emergencies Program director

The WHO today announced that it has appointed Peter Salama, MBBS, as executive director of its new Health Emergencies Program, one of the key reforms passed in the wake of a slow and uneven response to West Africa's Ebola outbreak.

Salama is a medical epidemiologist from Australia who is currently UNICEF's regional director for the Middle East and North Africa and emergency coordinator for crises in Syria, Iraq, and Yemen. He starts his position at the WHO on Jul 27 and will serve at the deputy director-general level.

Before joining UNICEF in 2002, he worked at the US Centers for Disease Control and Prevention, Concern Worldwide, and Doctors without Borders (MSF).

The WHO's new Health Emergencies Program is set up to provide rapid, predictable, and comprehensive support to countries and communities preparing for, facing, or recovering from a range of health emergencies, from political conflicts to natural disasters. It also unifies the WHO's standards and processes to improve its response to health emergencies.

A number of expert reviews suggested the new health emergencies program, and the World Health Assembly (WHA) signed off on the plan on May 26. The program is thought to signify one of the biggest changes in the WHO's history.

The WHA approved a $494 million budget to fund the program for 2016 and 2017, but the WHO said that, as of Apr 22, it had received only $140 million for the new program.

Jun 28 WHO statement

May 26 CIDRAP News story "WHA OKs new WHO health emergencies program"

Strategic National Stockpile report discusses possible improvements

The National Academies today posted a report on a 2-day workshop that discussed ways to improve the Strategic National Stockpile (SNS).

The Centers for Disease Control Prevention's (CDC's) SNS holds the nation's repository of medicine and medical supplies to be distributed and used during an emergency or disaster. Antibiotics, vaccines, antivirals, and chemical antidotes are included.

The meeting discussed ways to improve the efficacy and efficiency of the CDC's Office of Public Health Preparedness and Response's Division of Strategic National Stockpile (DSNS), which manages the supplies.

Three questions framed the meeting: (1) Should the SNS should be used to treat diseases that emerge naturally, such as Zika? (2) Should SNS contents be shared internationally? (3) Should the SNS be used to gather routine drugs that are often in short supply in medical practices?

In addition to debating these questions, meeting attendees discussed budgetary planning. The meeting closed with comments on the SNS and emerging infectious diseases. Several members noted that using the SNS for emerging diseases could rapidly diminish supplies and put undue pressure on the DSNS.

Jun 28 SNS meeting report