Nosocomial MERS outbreak shows more ‘intense transmission’ of disease.

An investigation of a large outbreak of Middle East respiratory syndrome, or MERS, coronavirus at a hospital in Saudi Arabia revealed a more “intense transmission” of the infection than previously recorded in other outbreaks. “Since the first diagnosis of [MERS] … in the Kingdom of Saudi Arabia in 2012, sporadic cases and clusters have occurred throughout the country,” the researchers said. “This large MERS outbreak in a major tertiary-care hospital in Riyadh was thought to be related to emergency department overcrowding, uncontrolled patient movement and high visitor traffic. The outbreak required institution of multiple measures to interrupt transmission, including almost complete shutdown of the hospital.” A man aged 67 years was admitted to the 1,200-bed hospital in June 2015 with a history of fever and cough. Despite no identified exposure to camels, reverse transcription PCR of a nasopharyngeal swab revealed the presence of MERS coronavirus (MERS-CoV). The patient died 31 days after admittance, and had no identified contact with any subsequent cases. Three weeks after the index patient was admitted to care, a second case of MERS was confirmed. After the hospital’s infection control program initiated an outbreak investigation to identify risk factors and exposures, 81 confirmed and 49 probable cases of MERS were identified at the hospital over approximately 2 months. One-third of these cases occurred among health care workers (HCWs), and the majority of all cases were linked to the hospital’s ED. Nearly three-quarters of patients required hospitalization, 16% were asymptomatic and 53% died. During the outbreak, the hospital initiated a pre-existing Infectious Disease Epidemic Plan developed from CDC and WHO guidelines. Despite strict enforcement of infection control practices, including hand hygiene and isolation of cases, more patients and HCWs continued to be infected, leading the hospital to close its ED, postpone elective surgical procedures and suspend all outpatient appointments and visits. These measures were associated with a rapid decline in new cases, and eventually led to the outbreak’s conclusion. culled from healio.com

Evidence of probable transmission of bird flu virus between two unrelated individuals.

The study describes two patients who shared the same ward in a district hospital in Zhejiang Province, China in February 2015.Hospital acquired (nosocomial) infection most likely route of transmission, The first (index) case was a 49 year old man who became ill after buying two chickens from a live poultry market for the wedding ceremony of his elder daughter. He developed a fever, cough, and sore throat and was admitted to a district hospital on 18 February. He was diagnosed with H7N9 virus on 24 February and was admitted to a specialist hospital ward with intensive care facilities. He died of multi-organ failure on 20 April. The second case, a 57 year old man with a history of chronic lung disease (COPD), developed flu-like symptoms after staying on the same ward of the district hospital as the index case for five days (18 to 23 February). He was diagnosed with H7N9 virus on 25 February and died of respiratory failure on 2 March. A total of 38 close contacts of both cases, including family members and health workers, were tested for the virus. Two samples taken from the chickens purchased by the index patient as well as five of 11 samples from the live poultry market he visited were positive for H7N9 virus.The second patient had no history of poultry exposure for 15 days prior to his illness. Samples from his home, from chickens raised by his neighbours, and a local chicken farm were all negative for H7N9 virus. Yet the genetic sequence of H7N9 virus from the second patient was nearly identical to that from the index patient, and genetically similar to the virus samples taken from the live poultry market visited by the index patient. The researchers stress that they cannot completely rule out an unidentified environmental exposure that might explain the H7N9 infection in the second patient.They say these results "should raise our concern about the increasing threat to public health" and they call for better training and hospital hygiene as well as enhanced surveillance of both patients with influenza-like illness in hospitals and chickens in live poultry markets Read more about unconventional routes of birdflu virus transmission and how to prevent transmission.http://www.sciencedaily.com/releases/2015/11/151119095824.htm