#Minnesota | USDA confirms highly pathogenic #H5N2 avian influenza in commercial turkey flock #HPIA

The United States Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) has confirmed the presence of highly pathogenic H5N2 avian influenza (HPAI) in a commercial turkey flock in Lac Qui Parle County, Minnesota.

This is the second confirmation in a commercial flock in Minnesota. The flock of 66,000 turkeys is located within the Mississippi flyway where this strain of avian influenza was previously identified.

CDC considers the risk to people from these HPAI H5 infections in wild birds, backyard flocks and commercial poultry, to be low.  No human infections with the virus have been detected at this time.

Samples from the turkey flock, which experienced increased mortality, were tested at the University of Minnesota Veterinary Diagnostic Laboratory and the APHIS National Veterinary Services Laboratories in Ames, Iowa confirmed the findings. APHIS is working closely with the Minnesota Board of Animal Health on a joint incident response. State officials quarantined the affected premises and birds on the property will be depopulated to prevent the spread of the disease. Birds from the flock will not enter the food system.

The Minnesota Department of Health is working directly with poultry workers at the affected facility to ensure that they are taking the proper precautions. As a reminder, the proper handling and cooking of poultry and eggs to an internal temperature of 165 ˚F kills bacteria and viruses.

As part of existing avian influenza response plans, Federal and State partners are working jointly on additional surveillance and testing in the nearby area. The United States has the strongest AI surveillance program in the world, and USDA is working with its partners to actively look for the disease in commercial poultry operations, live bird markets and in migratory wild bird populations.

USDA will be informing the World Organization for Animal Health (OIE) as well as international trading partners of this finding. USDA also continues to communicate with trading partners to encourage adherence to OIE standards and minimize trade impacts. OIE trade guidelines call on countries to base trade restrictions on sound science and, whenever possible, limit restrictions to those animals and animal products within a defined region that pose a risk of spreading disease of concern.

These virus strains can travel in wild birds without them appearing sick. People should avoid contact with sick/dead poultry or wildlife. If contact occurs, wash your hands with soap and water and change clothing before having any contact with healthy domestic poultry and birds.

All bird owners, whether commercial producers or backyard enthusiasts, should continue to practice good biosecurity, prevent contact between their birds and wild birds, and report sick birds or unusual bird deaths to State/Federal officials, either through their state veterinarian or through USDA’s toll-free number at 1-866-536-7593.  Additional information on biosecurity for backyard flocks can be found at http://healthybirds.aphis.usda.gov.

Additional background

Avian influenza (AI) is caused by an influenza type A virus which can infect poultry (such as chickens, turkeys, pheasants, quail, domestic ducks, geese and guinea fowl) and is carried by free flying waterfowl such as ducks, geese and shorebirds. AI viruses are classified by a combination of two groups of proteins: hemagglutinin or “H” proteins, of which there are 16 (H1–H16), and neuraminidase or “N” proteins, of which there are 9 (N1–N9). Many different combinations of “H” and “N” proteins are possible. Each combination is considered a different subtype, and can be further broken down into different strains. AI viruses are further classified by their pathogenicity (low or high)— the ability of a particular virus strain to produce disease in domestic chickens.

The HPAI H5N8 virus originated in Asia and spread rapidly along wild bird migratory pathways during 2014, including the Pacific flyway. In the Pacific flyway, the HPAI H5N8 virus has mixed with North American avian influenza viruses, creating new mixed-origin viruses. These mixed-origin viruses contain the Asian-origin H5 part of the virus, which is highly pathogenic to poultry. The N parts of these viruses came from North American low pathogenic avian influenza viruses.

USDA has identified two mixed-origin viruses in the Pacific Flyway: the HPAI H5N2 virus and new HPAI H5N1 virus. The new HPAI H5N1 virus is not the same virus as the HPAI H5N1 virus found in Asia, Europe and Africa that has caused some human illness. Only the HPAI H5N2 virus has been detected in the Pacific, Mississippi and Central Flyways.

Detailed analysis of the virus is underway in cooperation with the U.S. Centers for Disease Control and Prevention.  For more information about the ongoing avian influenza disease incident visit the APHIS website. More information about avian influenza can be found on the USDA avian influenza page. More information about avian influenza and public health is available on the CDC website.

#Wyoming | USDA confirms highly pathogenic #H5N2 avian influenza in wild bird #HPIA

The United States Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) has confirmed the presence of highly pathogenic H5N2 avian influenza (HPAI) in a wild Canada goose in Laramie County, Wyoming.  

This is the first finding of the Eurasian lineage avian influenza viruses in wild birds in the Central flyway.

CDC considers the risk to people from these HPAI H5 infections in wild birds, backyard flocks and commercial poultry, to be low.  No human infections with the virus have been detected at this time.

The sample, taken from a sick bird, was tested by the Wyoming State Veterinary Laboratory and confirmed by USDA’s National Veterinary Services Laboratories in Ames, Iowa.  The United States has the strongest AI surveillance program in the world, and USDA is working with its partners to actively look for the disease in commercial poultry operations, live bird markets and in migratory wild bird populations.

USDA will be informing the World Organisation for Animal Health (OIE) as well as international trading partners of this finding. USDA also continues to communicate with trading partners to encourage adherence to OIE standards and minimize trade impacts. OIE trade guidelines call on countries to base trade restrictions on sound science and, whenever possible, limit restrictions to those animals and animal products within a defined region that pose a risk of spreading disease of concern.

These virus strains can travel in wild birds without them appearing sick. People should avoid contact with sick/dead poultry or wildlife. If contact occurs, wash your hands with soap and water and change clothing before having any contact with healthy domestic poultry and birds.

All bird owners, whether commercial producers or backyard enthusiasts, should continue to practice good biosecurity, prevent contact between their birds and wild birds, and report sick birds or unusual bird deaths to State/Federal officials, either through their state veterinarian or through USDA’s toll-free number at 1-866-536-7593.  Additional information on biosecurity for backyard flocks can be found at http://healthybirds.aphis.usda.gov.

Additional background

Avian influenza (AI) is caused by an influenza type A virus which can infect poultry (such as chickens, turkeys, pheasants, quail, domestic ducks, geese and guinea fowl) and is carried by free flying waterfowl such as ducks, geese and shorebirds. AI viruses are classified by a combination of two groups of proteins: hemagglutinin or “H” proteins, of which there are 16 (H1–H16), and neuraminidase or “N” proteins, of which there are 9 (N1–N9). Many different combinations of “H” and “N” proteins are possible. Each combination is considered a different subtype, and can be further broken down into different strains. AI viruses are further classified by their pathogenicity (low or high)— the ability of a particular virus strain to produce disease in domestic chickens.

The current viruses are related to the HPAI H5N8 virus which originated in Asia and spread rapidly along wild bird migratory pathways during 2014, including the Pacific flyway. In the Pacific flyway, the HPAI H5N8 virus has mixed with North American avian influenza viruses, creating new mixed-origin viruses. These mixed-origin viruses contain the Asian-origin H5 part of the virus, which is highly pathogenic to poultry. The N parts of these viruses came from North American low pathogenic avian influenza viruses.

USDA has identified two mixed-origin viruses in the Pacific Flyway: the HPAI H5N2 virus and new HPAI H5N1 virus. The new HPAI H5N1 virus is not the same virus as the HPAI H5N1 virus found in Asia, Europe and Africa that has caused some human illness. The HPAI H5N2 virus has been detected in the Pacific, Central and Mississippi Flyways.

Detailed analysis of the virus is underway in cooperation with the U.S. Centers for Disease Control and Prevention.  For more information about the ongoing avian influenza disease incident visit the APHIS website. More information about avian influenza can be found on the USDA avian influenza page. More information about avian influenza and public health is available on the CDC website.

#Florida | #Measles case in international traveler confirmed in #Osceola County

The Florida Department of Health has confirmed measles in an adult international traveler who attended a conference in Kissimmee, Florida, at the Gaylord Palms Resort and Convention Center March 16-17, 2015.

The traveler spent time in several central and south Florida counties. Most of the traveler’s time was spent in Osceola County; however, the traveler also spent time in Miami-Dade, Orange and Sarasota during the infectious period of March 14-20, 2015.

The traveler did not visit any theme parks during his visit. The traveler was hospitalized between March 20-24 in Miami and after recovery left Florida by plane on March 25.

The department continues to work closely with health care professionals and organizations in an effort to maintain its current level of readiness to identify cases and respond to any diagnosed cases of measles in Florida. The department is also working with the Centers for Disease Control and Prevention as well as the organizer of the international conference to notify all conference attendees as well as all other establishments the traveler visited while infectious to identify potentially exposed individuals. In addition, Florida Department of Health monitors emergency room and urgent care center visits in order to rapidly identify and respond to any possible cases of measles in the state.

The Measles Mumps and Rubella (MMR) shot is the best way to protect against measles. Those who are fully immunized have very little risk of developing measles. Ideally, children should receive two doses, the first dose at 12 to 15 months of age, and the second dose at four to six years of age. Children and adults who have not ever received MMR vaccine in the past should also get vaccinated. Information regarding adult vaccines and vaccines for children is available through doctor’s offices or local health department clinics.

The symptoms of measles generally begin approximately seven to 14 days after a person is exposed to someone with measles, and include:

  • Blotchy rash
  • Fever
  • Cough
  • Runny nose
  • Red, watery eyes (conjunctivitis)
  • Feeling run down, achy (malaise)
  • Tiny white spots with bluish-white centers found inside the mouth (Koplik’s spots)

People who develop these symptoms should contact their doctor. Measles is spread through the air by infectious droplets and is highly contagious. It can be transmitted from four days before the rash becomes visible to four days after the rash appears.

For more information about measles and vaccination information, go to http://www.flhealth.gov/ or www.cdc.gov/measles/index.html.  Residents who have questions about measles or how to get vaccinated are encouraged to call their local county health department.  A complete listing of county health departments is available at http://www.floridahealth.gov/programs-and-services/county-health-departments/find-a-county-health-department/index.html..

Northern Territory #NT | Flood warnings for #Katherine and #Waterhouse Rivers – and a reminder to be Crocwise

Residents are reminded to be crocwise following a sighting in flooded waterways.

“A saltwater crocodile was sighted in the billabong at Beswick. Residents and visitors are reminded to be crocwise. Do not enter flooded waterways,” said A/Assistant Commissioner Michael Murphy.

“Saltwater crocodiles do use wet season flooding to move into new areas. Please be aware and do not put your life at risk.”

Katherine River – Gorge Road – Minor Flood Warning

Katherine River at Nitmiluk Centre is currently above the three-metre minor flood level for Gorge Road and levelling off below four metres.

The river is expected to remain steady into this evening before receding.

“Based on the advice received from the Bureau of Meteorology, Police anticipate that at this stage there may be minor flooding along Gorge Road only,” said A/Assistant Commissioner Michael Murphy.

“Gorge Road is closed, with 600mm of water across the road at Maud Creek.

“At the Katherine Bridge, the level is 9.7 metres and rising, still well within the riverbanks.

“I can reassure the community that flooding will not occur in the Katherine Township at this time, however Katherine Town Council have closed all low access points to the river, including the low level crossing.”

 

Waterhouse River – Major Flood Warning

The Wugularr (Beswick) community bottom camp is now being affected by floodwaters.

Additional police and NTES personnel have been deployed to the community from Katherine by helicopter to assist in managing the relocation of affected people and services.

“The Wugularr School has been closed by the Education Department, to be used as the Evacuation Centre,” said A/Assistant Commissioner Murphy. “The school will remain closed tomorrow.

“Six houses in the bottom camp have been affected by water; it is believed the water inside the homes is only shallow. The community’s service centres, including the clinic, aged care facility and council building, remain clear of water.”

A Major Flood Warning has been advised for the Waterhouse River. At Beswick Bridge the river level at 3.40pm was above the major flood level at 8.62 metres and appears to be levelling.

“The river level is expected to remain steady into this evening before receding overnight.

“The Central Arnhem Highway remains closed at Beswick as there is water across the road and Police will continue to monitor the situation during the day and keep the community informed.”

“It is expected that Jilkminggan Community will experience some nearby localised flooding as a result of the Waterhouse River system. Police have been in liaison with the community and established that there are no vulnerable people within Jilkminggan. The store has supplies to last two weeks. When the water reaches the location in the next day or so, the access road into the community will be impassable until it recedes,” said A/Assistant Commissioner Murphy.

General advice

“Residents in areas where roads likely to be affected by flooding are advised to exercise caution if driving and to drive to the conditions,” said A/Assistant Commissioner Murphy.

“Do not attempt to cross flooded waterways unless you are sure of the depth and speed of the water.

“Stay away from flooded drains, rivers, streams and waterways and stop children playing in or near floodwaters.

“Stay away from fallen power lines, they are dangerous and should always be treated as live.”

For most recent updates on NT road conditions visit: www.roadreport.nt.gov.au

For more information call 1800 500 070 or go to the Bureau of Meteorology website www.bom.gov.au/nt/warnings

For information on preparing for floods, go to www.secureNT.nt.gov.au

New South Wales #NSW | #Sydney #CBD Emergency Warning System to be tested tomorrow

Police are advising the public the regular monthly test of the Sydney CBD Emergency Warning System will be conducted tomorrow (Friday 27 March 2015) at 12.15pm.

Members of the public should not be alarmed. This is a test only.

Those who reside, work or travel through the Sydney CBD need to be aware of the warning system, what it sounds like and what it is used for.

The system is in line with similar warning systems overseas where monthly tests are conducted to educate and remind the public of the existence of the warning system, and to ensure the system works.

While the Sydney CBD Emergency Warning System is normally tested on the last day of each month, the December has been brought forward due to Christmas and Boxing Day being next week.

Tomorrow’s test will be conducted at selected sites within the Sydney CBD.

There are 98 speakers located throughout the CBD, as well as 13 variable messaging signs which are positioned at transport hubs in the city, all of which play a major role in the Sydney CBD Emergency Plan.

New South Wales #NSW | A Christmas Eve miracle – #ResuscitationReunion between patient and life savers

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A fit 48-year-old man who went into cardiac arrest on Christmas Eve during a run in Nelson Bay, has given praise to the members of the community and paramedics who helped save his life.

Brad Ridge was found by cyclists, Peter Morrison and his brother-in-law Mike Coghlan who saw him fall during a morning jog.

They immediately called Triple Zero (000) and started CPR via instructions over the phone from the NSW Ambulance call-taker. Shortly after, local lifesaver Steve Wilson saw the group as he was heading to worked and pulled over to help.

NSW Ambulance paramedics Phil Martin and Adam Roditis arrived around four minutes later knowing less than ten percent of people will survive an out-of-hospital cardiac arrest, with most of those surviving because people on scene provided effective CPR in the critical minutes before paramedics arrived.

“In this case, Steve’s chest compressions were so good we directed him to keep going. More people were arriving and helping then, assisting Steve with CPR until we took over and started administering advanced care via a defibrillator,” Phil Martin said.

Phil Martin said the community actions in calling Triple Zero (000) so quickly and in providing effective CPR literally helped save Brad’s life. He and Adam were able to restart Brad’s heart and transport him to the waiting Westpac Rescue Helicopter, which they’d called in and was now waiting on a nearby oval.

Brad spent Christmas Day in an induced coma, waking up sometime in the afternoon on Boxing Day to the sound of cricket on tv, with no memory past the midpoint of his run.

“I am very thankful to all those who acted to help me when I collapsed,” Brad said. “Being able to return to Nelson Bay again to meet everyone who had a hand in my survival is unbelievable.”

New South Wales #NSW | Volunteers unite for Xtreme training in state’s north

About 100 NSW Ambulance and emergency services volunteers and personnel will have their skills put to the test when they take part in the Xtreme 3 marine rescue event and conference at Coffs Harbour this weekend.

The Xtreme 3 conference, scheduled for Saturday 28 March, will be attended by NSW Ambulance volunteers and Community First Responders, paramedics, and emergency services personnel.

NSW Ambulance Manager Volunteers and Community First Responders, Superintendent Susan Webster, said Community First Responders will receive training in emergency management at large
scale incidents, and discuss the latest updates in trauma and aeromedical matters particular to the New England and Northern Rivers areas.

The afternoon will be spent at the state-of-the-art simulation centre where skills updates will be undertaken.

In the evening, NSW Ambulance Commissioner Ray Creen will host a dinner for the volunteers and first responders to thank them for their commitment to emergency service delivery.

“Our volunteers donate their time to be available to respond at any time of the day or night to medical emergencies. They are not only a tremendous credit to their communities but are extremely well
valued by NSW Ambulance,” Superintendent Webster said.

Guest speaker at the dinner will be Flight Paramedic Scott Hardes who will discuss his experiences in Japan and Christchurch as part of the Australian Urban Search and Rescue (USAR) team deployments in 2011.

“His presentation is timely with NSW Ambulance paramedics  currently serving with the Australian USAR deployment to Vanuatu,” Superintendent Webster said.

The conference and dinner will be held at the Aqua Luna Resort in Coffs Harbour.

On Sunday 29 March, the focus will shift to Coffs Harbour Fishermen’s Club where about 100 ambulance and emergency service personnel will take part in a series of Xtreme 3 marine exercises.

“Coffs Harbour emergency service personnel and marine personnel will work with these volunteers to assist in their expertise in marine-based emergency responses,” Superintendent Webster said.

Volunteers and CFRs from the following locations will be attending this weekend’s activities Nana Glen, Glenreagh, Alstonville, Scotland Island, Dangar Island, Deepwater, Tambar Springs, Bundeena,
Branxton and Uralla.

The conference and marine exercises are jointly funded by the Commonwealth and NSW Governments.

Australian Capital Territory #ACT | Minister releases ACT #Ambulance Service change blueprint

Minister for Police and Emergency Services Joy Burch today released a blueprint for enhancing professionalism of the ACT Ambulance Service (ACTAS).

“Enhancing Professionalism: A Blueprint for Change is the culmination of a number of internal review processes that the ACT Ambulance Service has undertaken over the past 18 months,” Ms Burch said.

“The ACT Ambulance Service continues to deliver the highest standards in relation to response times and patient satisfaction. ACTAS staff deserve great credit for being able to achieve this outstanding performance in a time of record demand for ambulance services here in the ACT. There can be no doubt that ACTAS excels in meeting the technical challenges of delivering its services to the community.

“One of the most significant inputs to this blueprint was a cultural review undertaken by the consulting firm O2C, including a series of stakeholder interviews, workshops, worksite visits, individual submissions and an employee survey. The report identified important organisational challenges for ACTAS to address as part of a transition to a more professional culture including improvements to its capability, culture, and leadership approach.

“ACTAS has gone through a comprehensive and exhausting process to honestly examine its strengths and weaknesses as an organisation. I would like to sincerely thank all ACTAS staff and the TWU for their contribution to these reviews.

“We now have a blueprint for change which shows a genuine way forward.  ESA will establish a Change Implementation Review Group (IRG) which will include ESA Commissioner, the TWU and an independent representative external to ACTAS who will be providing me with quarterly reports on progress.

“We will be engaging with the workforce around:

  • Developing a statement and an understanding with employees (“An accord”) to promote trust; acceptance of individual accountability for performance, actions and behaviour
  • Creating an agreed vision for ambulance services to enable employees to see how they can contribute to the organisation and through the organisation to the community as a whole (“Build a buy in”)
  • Improving accountability for outcomes through greater oversight of the ambulance reform program by the ESA Commissioner and Oversight Implementation Committee;
  • A focus on leadership development and personal accountability (“Set the Right Examples”)
  • Improving internal communications through process and action
  • Transformation of the existing culture to one more aligned with a future vision (“adaptive chance”)

“I have asked the ACTAS Chief Officer, supported by the ESA Commissioner, to implement this blueprint for change as a matter of priority. I am confident that ACTAS will continue to enhance its reputation and ability in the provision of ambulance services.”

The Blueprint is located on the ESA website: http://esa.act.gov.au/wp-content/uploads/ACTAS-Enhancing-Professionalism-A-Blueprint-for-Change-Report.pdf

Saudi Arabia #KSA | 15 additional cases of #MERS including 3 deaths

Between 11 and 22 March 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 15 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 3 deaths. Cases are listed by date of reporting, with the most recent case listed first.

Details of the cases are as follows:

  • A 50-year-old, non-national male from Najran city developed symptoms on 11 March and was admitted to hospital on 20 March. The patient has no comorbidities. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently, the patient is in stable condition in a negative pressure isolation room on a ward.
  • A 54-year-old, non-national male from Riyadh city developed symptoms on 19 March and was admitted to hospital on 20 March. The patient has comorbidities condition of diabetes mellitus. He is a contact of a laboratory-confirmed MERS-CoV case (case n. 11 – see below). The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, he is in stable condition in a negative pressure isolation room on a ward.
  • A 60-year-old, non-national male from Jeddah city developed symptoms on 15 March and was admitted to hospital on 19 March. The patient has comorbidities and a history of travelling to Madinah during the 14 days prior to onset of symptoms. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently, the patient is in stable condition in ICU.
  • A 73-year-old male from Riyadh city developed symptoms on 13 March while admitted to hospital since 9 January due to an unrelated medical condition. The patient was admitted to the same hospital as other laboratory-confirmed MERS-CoV cases; investigation of epidemiological links with these cases and with shared health workers is ongoing. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, he is in critical condition in ICU.
  • A 27-year-old male from Riyadh city developed symptoms on 8 March and was admitted to hospital on 14 March. The patient has a history of frequent visits to the same hospital for an unrelated medical condition; however, he has no history of contact with the laboratory-confirmed MERS-CoV cases that were treated at the hospital. Currently, the patient is in stable condition in a negative pressure isolation room on a ward.
  • A 56-year-old male from Riyadh city developed symptoms on 12 March and was admitted to hospital on 14 March. The patient has comorbidities. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently, the patient is in stable condition in a negative pressure isolation room on a ward.
  • A 44-year-old, non-national male from AlKhafji city developed symptoms on 4 March and was admitted to hospital on 14 March. The patient has no comorbidities. He has history of frequent contact with camels and consumption of raw camel milk. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, the patient is in stable condition in a negative pressure isolation room on a ward.
  • A 60-year-old male from Taima city developed symptoms on 7 March and was admitted to hospital on 11 March. The patient has comorbidities and history of frequent contact with camels and consumption of raw camel milk. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, the patient is in stable condition in a negative pressure isolation room on a ward.
  • A 47-year-old male from Alfadliah town developed symptoms on 2 March and was admitted to hospital on 12 March. The patient has comorbidities. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently, the patient is in stable condition in a negative pressure isolation room on a ward.
  • A 21-year-old non-national male from Riyadh city, Riyadh Region developed symptoms on 8 March and was admitted to hospital on 12 March. The patient has comorbidities. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing. The patient is in critical condition in ICU.
  • A 31-year-old, non-national male from Riyadh city developed symptoms on 1 March and was admitted to hospital on 10 March. The patient was a smoker and had comorbidities. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing. The patient passed away on 12 March.
  • A 45-year-old, non-national, female health worker from Riyadh city developed symptoms on 8 March and was admitted to hospital on 10 March. The patient has no comorbid conditions. She has a history of contact with a laboratory-confirmed MERS-CoV case that was reported in a previous DON on 11 March (case n. 14). Currently, the patient is in stable condition in a negative pressure isolation room on a ward.
  • A 62-year-old female from Riyadh city developed symptoms on 3 March while admitted to hospital since 23 November 2014 due to unrelated medical conditions. The patient was admitted to the same hospital as other laboratory-confirmed MERS-CoV cases; investigation of epidemiological links with these cases and with shared health workers is ongoing. She had no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. The patient passed away on 15 March.
  • A 59-year-old male from Riyadh city developed symptoms on 7 March and was admitted to hospital on 8 March. The patient had no comorbidities. He was a contact of a laboratory-confirmed MERS-CoV case that was reported in a previous DON on 23 February (case n. 2). He had no history of exposure to known risk factors in the 14 days prior to the onset of symptoms. The patient passed away on 14 March.
  • A 55-year-old, non-national male from Jeddah city developed symptoms on 5 March and was admitted to hospital on 8 March. The patient has no comorbidities and no history of contact with camels; however, he has frequent contacts with sheep and regular consumption of raw sheep products. The patient has no history of exposure to known risk factors in the 14 days prior to the onset of symptoms. Currently, he is in stable condition in a negative pressure isolation room on a ward.

The National IHR Focal Point for the Kingdom of Saudi Arabia also notified WHO of the death of 5 previously reported MERS-CoV cases. The cases were reported in previous DONs on 20 March (cases n. 5, 12), on 11 March (cases n. 2, 10) and on 6 March (case n. 6).

Contact tracing of household contacts and healthcare contacts is ongoing for these cases.

Globally, WHO has been notified of 1090 laboratory-confirmed cases of infection with MERS-CoV, including at least 412 related deaths.

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

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.

Global | MSF releases report on Ebola response

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The international medical humanitarian organisation Médecins Sans Frontières (MSF) released a critical analysis of the Ebola epidemic in west Africa over the past year, revealing the shortcomings of the global response to the crisis and warning that the outbreak, despite an overall decline in cases, is not yet over. 

The report, Pushed to the limit and beyond, is based on interviews with dozens of MSF staff involved in the organisation’s Ebola intervention. It describes MSF’s early warnings one year ago about cases of Ebola spreading in Guinea, the initial denial by governments of the affected countries, and the unprecedented steps that MSF was forced to take in the face of global inaction as the outbreak engulfed neighbouring states. Over the past year, more than 1,300 MSF international staff and 4,000 local staff have been deployed in west Africa, where they cared for nearly 5,000 confirmed Ebola patients.

“Today we share our initial reflections and take a critical look at both MSF’s response and the wider global response to the deadliest Ebola outbreak in history,” says Dr Joanne Liu, MSF international president. “The Ebola epidemic proved to be an exceptional event that exposed the reality of how inefficient and slow health and aid systems are to respond to emergencies.”

The report details the effects of the several months-long “global coalition of inaction,” during which the virus spread wildly, leading MSF to issue a rare call for the mobilisation of international civilian and military medical assets with biohazard capacity. By the end of August, MSF’s ELWA3 centre in Monrovia was overwhelmed with patients. Staff were forced to turn away visibly ill people from the front gate, in the full knowledge that they would likely return to their communities and infect others.

“The Ebola outbreak has often been described as a perfect storm: a cross-border epidemic in countries with weak public health systems that had never seen Ebola before,” says Christopher Stokes, MSF general director. “Yet this is too convenient an explanation. For the Ebola outbreak to spiral this far out of control required many institutions to fail. And they did, with tragic and avoidable consequences.”

The report also lays out the challenges MSF faced over the past year and the difficult choices made in the absence of available treatment and sufficient resources. While MSF’s Ebola experience is limited to a relatively small group of experts, it should have mobilised more resources earlier.

Facing an exceptionally aggressive epidemic and a weak international response, MSF teams focused on damage control. Unable to do everything, compromises had to be made between the competing priorities of patient care, surveillance, safe burials and outreach activities, amongst others.

“At the most severe periods of the outbreak, MSF teams were unable to admit more patients or provide the best possible care,” says Dr Liu. “This was extremely painful for an organisation of volunteer medics, leading to heated exchanges and tensions within MSF.”

MSF’s process of reflection is underway, as it seeks to learn lessons that can be applied to future outbreaks, while documenting and analysing its patient data to examine the multiple factors that can contribute to Ebola mortality. Crucially, a global strategy to sustain research and development for Ebola vaccines, treatments and diagnostic tools must be developed.

A significant challenge remains ahead. To declare an end to the outbreak, every single person in contact with someone infected with Ebola must be identified. There is no room for mistakes or complacency; the number of cases weekly is still higher than in any previous outbreak, and overall cases have not significantly declined since late January.

In Guinea, patient numbers are again rising. In Sierra Leone, many people are presenting with the virus who were not previously on lists of known Ebola contacts. On 20 March, a patient tested positive for Ebola in Monrovia, the first confirmed case in more than two weeks after the last known case was discharged in Liberia.

“The trauma of Ebola has left people distrustful of health facilities, has left health workers demoralised and fearful of resuming services, and has left communities bereaved, impoverished and suspicious,” the report says.

In the three worst affected countries, nearly 500 health workers have lost their lives in the past year, a disastrous blow to an already serious shortfall of staff before the Ebola crisis hit. It is urgent that access to health services is restored as a first step towards rebuilding functional health systems in the region.

“Global failures have been brutally exposed in this epidemic and thousands of people have paid for it with their lives. It is to everyone’s benefit that lessons be learned from this outbreak, from the weakness of health systems in developing countries, to the paralysis and sluggishness of international aid,” the report concludes.

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