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Old 05-14-2014, 05:15 PM   #1
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Lightbulb MERS Outbreak U.S.A.

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MERS ORF8b Truncated In Munster IndianaRecombinomics Commentary May 14, 2014

The 29-nucleotide deletion results in the splitting of a single ORF8ab into two overlapping ORFs; ORF8a and ORF8b. The ORF8ab region encodes for a single protein 8ab of 122 amino acids while ORF8a and ORF8b encode for proteins 8a and 8b of 39 and 84 amino acids, respectively

The above comments on the 29 nt deletion in SARS-CoV in 2003 serves as a reminder of the linkage between a genetic change in one small protein and the explosion and international spread of SARS cases. This deletion was identified in cases linked to a February stay at the Metropole Hotel. Tourists of visitors to 13 rooms on the 9th floor (see 9th floor layout) developed SARS symptoms and were linked to superspreader events in hospitals in Hong Kong, Singapore, Hanoi, and Toronto.

MERS-CoV is a coronavirus (beta 2c) that is related to SARS-CoV (beta 2b). The above ORF (Open Reading Frame) 8 in SARS is adjacent to the N gene, while in MERS it overlaps with N gene. The encoded protein in MERS is 112 amino acids and the functional relationship between the two gene products is not well understood.

However, changes in ORF8b in MERS have raised serious concerns. The CDC has released the sequence from the first confirmed MERS case in the United States, Indiana/USA-1_Saudi Arabia_2014, which has a termination codon at position 78 in ORF8b, leading to a truncated protein of 77 amino acids. This same truncation was found in the sequence of Qatar 3. In addition to truncating ORF8b, C28996T encodes S144L in the overlapping N gene.

Similarly, the novel sub-clade in Jeddah has three non-synonymous changes in ORF8b (L6Q, L40P, K60N) with the latter also changing the N gene (D126H) raising concerns that the ORB8b is also compromised in the Jeddah sub-clade, which has been confirmed in export to Greece. The second confirmed case in the United States was from Jeddah, and it is likely that the sequence from this case (44M), will have the changes that define the Jeddah novel sub-clade.

Moreover, the sequence from Indiana has a receptor binding domain change, L411F, in the Spike protein, which has not been reported in prior MERS sequences, and the Jeddah sub-clade also have a novel S gene change, Q833R (also confirmed in Geece), raising serious adaptation and transmission concerns.

http://www.recombinomics.com/News/05...b_Indiana.html

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Old 05-14-2014, 05:30 PM   #2
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"The spread of a puzzling respiratory virus in the Middle East and beyond doesn't yet constitute a global health emergency despite a recent spike in cases, the World Health Organization said Wednesday."

http://news.yahoo.com/mers-virus-isn...170402354.html


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Old 05-14-2014, 07:09 PM   #3
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Default MERS 'urgency' not a public health emergency, WHO says

MERS 'urgency' not a public health emergency, WHO says
May 14, 2014
http://www.cbc.ca/news/health/mers-u...says-1.2642310

SARS-like virus has seen a sharp increase, but mainly in hospital settings and not in communities.............................


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Old 05-16-2014, 09:42 AM   #4
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I put my foil hat in the recycle bin back in 2005.

However, I am building my food store back up. I think I got about 6 months stored up.

This is going to be interesting.
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Old 05-16-2014, 11:12 AM   #5
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Moved this to medical as it isn't flu.
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Old 05-16-2014, 11:57 AM   #6
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Also, I don't think there is an "outbreak" in the US. There were two imported cases and to date all of the contacts have tested negative. Not that it doesn't need to be watched, but I don't think its taken root here yet.
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Old 05-16-2014, 01:18 PM   #7
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Nope - two IMPORTED cases... when we start seeing cases develop here & plenty of them... time to worry about an outbreak.
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Old 05-16-2014, 01:49 PM   #8
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Originally Posted by CanadaSue View Post
Nope - two IMPORTED cases... when we start seeing cases develop here & plenty of them... time to worry about an outbreak.
As sick as I've been this week, I'm beginning to think I had it. Worst "cold" I've ever had. 7 days and still haven't shaken it.
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Old 05-16-2014, 04:55 PM   #9
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Originally Posted by Twoolf View Post
As sick as I've been this week, I'm beginning to think I had it. Worst "cold" I've ever had. 7 days and still haven't shaken it.

Saw this and thought of you ----



Silently among us: Scientists worry about milder cases of MERS




Scientists leading the fight against Middle East Respiratory Syndrome say the next critical front will be understanding how the virus behaves in people with milder infections, who may be spreading the illness without being aware they have it.

Establishing that may be critical to stopping the spread of MERS, which emerged in the Middle East in 2012 and has so far infected more than 500 patients in Saudi Arabia alone. It kills about 30 percent of those who are infected.

It is becoming increasingly clear that people can be infected with MERS without developing severe respiratory disease, said Dr David Swerdlow, who heads the MERS response team at the U.S. Centers for Disease Control and Prevention.

"You don't have to be in the intensive care unit with pneumonia to have a case of MERS," Swerdlow told Reuters. "We assume they are less infectious (to others), but we don't know."

The CDC has a team in Saudi Arabia studying whether such mild cases are still capable of spreading the virus. Swerdlow is overseeing their work from Atlanta.

They plan to test the family members of people with mild MERS, even if these relatives don't have any symptoms, to help determine whether the virus can spread within a household.

Cases of the disease, which causes coughing, fever and sometimes fatal pneumonia, have nearly tripled in the past month and a half, and the virus is moving out of the Arabian peninsula as infected individuals travel from the region.

Since late April, the first two cases of MERS have been reported on U.S. soil. Dutch officials reported their first two cases this week. Infections have also turned up in Britain, Greece, France, Italy, Malaysia and elsewhere.

Since MERS is an entirely new virus, there are no drugs to treat it and no vaccines capable of preventing its spread. It is a close cousin of the virus that caused Severe Acute Respiratory Syndrome or SARS, which killed around 800 people worldwide after it first appeared in China in 2002.

Because MERS patients can have "mild and unusual symptoms," the World Health Organization advises healthcare workers to apply standard infection control precautions for all patients, regardless of their diagnosis, at all times.

"Asymptomatic carriers of diseases can represent a major route for a pathogen to spread," said Dr Amesh Adalja of the University of Pittsburgh Medical Center.

"Just think of Typhoid Mary," he said, referring to the asymptomatic cook who spread typhoid fever to dozens of people in the early 20th century.

NOT EVEN A COUGH

Milder symptoms played a role in the second U.S. case of MERS, a man who started having body aches on a journey from Jeddah on Saudi Arabia's Red Sea coast to the United States.

It took the patient more than a week before he sought help in an emergency department in Orlando, Florida. Once he arrived, he waited nearly 12 hours in the ER before staff recognized a MERS link and placed him in an isolation room. The patient did not have signs of a respiratory infection, not even a cough.[ID:nL1N0O002W]

Dr Kevin Sherin, director of the Florida Department of Health for Orange County, believes that made it less likely that he could spread the infection. Hospital workers have tested negative, but the health department and the CDC are still checking on hundreds of people who might have been in contact with the patient.

A CDC study published earlier this week looked at some of the first cases of MERS that occurred in Jordan in 2012.

Initially, only two people in that outbreak were thought to have MERS. When CDC disease detectives used more sensitive tests that looked for MERS antibodies among hospital workers, they found another seven people had contracted MERS and survived it.

That suggests there may be people with mild cases "that can serve as a way for the virus to spread to other individuals, which makes it a lot harder to control," Adalja said.

Scientists are especially concerned because a lot of recent cases of MERS are among people who did not have contact with animals such as camels or bats that are believed to be reservoirs for the virus.

"If they don't have animal contact, where do they pick it up? Potentially, asymptomatic cases," said Dr Michael Osterholm, an infectious disease expert from the University of Minnesota.


http://news.yahoo.com/silently-among...ZTDloAU7vQtDMD
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Old 05-18-2014, 05:13 AM   #10
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Dr. Niman has posted an excellent MERS phylogenetic tree above this "Commentary" but I can't get it to move, so if interested, you will need to check it out in this Commentary at the recombinomics website (link below).

Quote:
Jeddah MERS Sub-Clade Sustained Transmission

Recombinomics Commentary, May 17, 2014

The above MERS phylogenetic tree posted by Andrew Rambaut at his website helps visualize the clonal expansion of the novel Jeddah MERS sub-clade. All eight sequences (six nearly full sequences from cases from four hospitals in Jeddah and Mecca generated by Christian Drosten, (C8826 and C9055) collected on April 12 and April 14 from hospital A and C, respectively, as well as Mecca (C9355) collected on April 15. The three earlier sequences were from two hospitals ((C7149 and C7770 from hospital A collected on April 3 and 7, respectively as well as C7569 from hospital B collected on April 5), 1 complete sequence s generated by the CDC from a Jeddah export case in Orlando, Florida USA, Florida/USA-2_Saudi Arabia_2014, and 1 partial sequence generated by the CDC from another Jeddah export case in Athens, Greece, Spike and N gene sequences, Greece-Saudi Arabia_2014, are all located on the same branch (blue shading).

This branch has no camel sequences because all of the human sequences have a change in the Spike gene (Q833R) and orf8b gene (L6Q) which has never been reported in any camel sequence or any MERS sequence that was not from the Jeddah sub-clade which is defined by 11 polymorphisms. In addition to the eight sequences on the tree, 25 more Spike gene sequences with the two spike gene markers have been generated from patients in Jeddah. Thus, there have been 33 full are partial sequences generated from cases linked to Jeddah or Mecca and all 33 belong to the same sub-clade.

These data highlight the need for sequences from pilgrims in Mecca and Medina. The latest Jeddah exports are cases in the Netherlands who developed symptoms while in Medina (70M) and Mecca (73F). The presence of the Jeddah sub-clade in Mecca raises concerns that it has spread to both Mecca and Medina and producing symptomatic exports, which have largely tested negative by PCR.

However, today’s presser on a casual contact (in Illinois) of the confirmed cases in Munster, Indiana (who was infected with a MERS sub-clade similar to prior cases in Riyadh) and the suggestion of additional cases in contacts in Indiana, raises concerns that the PCR data is largely false due to limitations in collection of optimal samples, and that serum testing of these suspect contacts will confirm many more exports from pilgrims infected in Jeddah, Mecca, or Medina.

The above phylogenetic tree supports clonal expansion and sustained transmission which is not limited to hospital settings and instead represents sustained transmission. http://www.recombinomics.com/whats_new.html

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Old 05-18-2014, 05:41 AM   #11
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Quote:
NowVoyager;

"If they don't have animal contact, where do they pick it up? Potentially, asymptomatic cases," said Dr Michael Osterholm, an infectious disease expert from the University of Minnesota.
Good to see our old friend from the frantic H5N1 days back in print.

If we do have a number of undetected MERS infected wondering around, that would seriously impact the CFA (case fatality rate) numbers!

It seems to me that SARS had it's share of "Super Spreaders". Also SARS appeared to favore some gene pools over others (though Asian politics put the lid on that).

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Food is good but water is better (for early stockpilling).


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Old 05-18-2014, 05:57 AM   #12
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A good analysis of the emerging "Jeddah" MERS strain from Dr. Niman:

Quote:
MERS Jeddah As SARS Guangzhou - Emergence

Recombinomics Commentary, May 11, 2014

We have sequenced partial spike protein genes from another 25 viruses, showing 100 percent sequence identity with above-mentioned genomes

The above comments from a letter submitted by Christian Drosten to ProMED on April 26 suggest that the 25 cases linked to the partial spike sequences were infected by the same novel sub-clade represented by the 6 nearly full sequences (C7149 and C7770 from hospital A collected on April 3 and 7, respectively, as well as C7569 from hospital B collected on April 5, followed by Jeddah sequences C8826 and C9055 collected on April 12 and April 14 from hospital A and C, respectively, as well as Mecca (C9355) collected on April 15) uploaded to the Drosten website.

http://www.recombinomics.com/News/05...Emergence.html

All six of these sequences were nearly identical, even though they originated from 4 different hospitals in two different cites (Jeddah and Mecca).

This novel sub-clade is defined by 9 polymorphisms that have never been reported in any human MERS sequence (listed below with 4 camel sequence isolated from Taif in late 2003). Two of the polymorphisms are in the Spike gene (C23804T and A23953G), and the later encodes Q833R, which has not been reported in any MERS sequence other than the six recently uploaded from Jeddah and Mecca. Both of these polymorphisms are located between the Spike receptor binding domain and the first heptad repeat (see figure 5 here) and therefore are almost certainly within the partial spike sequence that exactly matched the released sequences (which were all identical to each other in this region).

In addition to spike polymorphism Q833R, the novel sub-clade has a change in ORF8b, T28778A, which encodes L6Q, which also has never been reported in a MERS sequences. Moreover, ORF8b has another non-synonymous change, L40P, which has never been reported in a human MERS sequence.

In addition to the 9 polymorphisms not cited in any prior human MERS sequence, the novel sub-clade has two additional changes that are rarely seen in human MERS sequences. One is a synonymous change, C16174T, which has only been reported in one MERS sequence, Taif-2, while the other is non-synonymous and creates changes in two proteins, K60N in ORF8b and D126H in the overlapping N gene. Human MERS sequences with this change are limited to a sub-clade that emerged late in the Al Hasa outbreak and was detected in 4 patients who were almost certainly contacts of each other (AH19, AH26, AH27, AH28) based on matching collection dates for the latter three case (who would have been infected by the same index case, AH19).

Thus, as seen in the table below, the protein of ORF8b, which is 112 amino acids in length, has three changes in the first 60 positions (L6Q, L40P, and K60N), which may limit the function of the protein product which may be involved in regulating RNA levels. ORF8 was disrupted by the 29 nt deletion in SARS-CoV, which was associated with the dramatic spread of the virus after the incident at the Metropole Hotel on Feb 20-21, 2003 which led to major nosocomial outbreaks in Hong Kong, Singapore, Hanoi, and Toronto linked to patients who were guests or visitors on the ninth floor of the hotel (the index case was in room 911).

The presence of three changes on ORF 8b, and ORF8 disruption in SARS-CoV by the 29 nt deletion, raises serious pandemic concerns.

11 Defining Polymorphisms For Jeddah Sub-Clade
Nucleotide Protein Taif Camels + Limited Human

Orf1a
C2490T 378
C5658T P1794S 378 505 503 363
C9659T 378 505 503 363
T12257C 378 505

ORF1ab
T16174C 505 503 Taif 2
C17836T 503 363

Spike
C23804T 378 505 503
A23953G Q833R

ORF8b
T28778A L6Q
T28880C L40P 378 505
G28941C K60N 378 505 AH19 AH26 AH27 AH28

N gene
G28941C D126H 378 505 AH19 AH26 AH27 AH28

http://www.recombinomics.com/News/05...Emergence.html

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Old 05-18-2014, 07:44 AM   #13
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I think Niman wrote this very well (In Niman's way (He parses like a chef))

Commentary

Illinois MERS Transmission By Casual Contact At APSA Meeting?
Recombinomics Commentary 09:00
May 18, 2014
He came to Indiana for a conference and when he became ill he went to stay with family according to the Indiana State Department of Health.

Prior to being admitted to the hospital, the Indiana patient had extended face-to-face contact on April 25th with a business associate in Illinois. The two had another brief contact on April 26th. This business associate, who is an Illinois resident,

The above comments (in red) indicate the MERS index case (a US health care worker, HCW, working at a hospital in Riyadh) in the Indiana/Illinois cluster flew from Riyadh to London to Chicago, arriving at O’Hara Airport in the late morning of April 24 for a scienticfic conference. He took a bus to a residence in Munster, Indiana, a Chicago suburb, which is 30-45 minutes from downtown Chicago, where a scientific conference (10th Annual Meeting of American Physician Scientists Association) was beginning with a meet and greet that evening.

The two full days of the conference were April 25 and April 26, the same two days that the index case had contact with the Illinois case. Since the index case was an HCW, an Illinois “business associate” would be a likely attendee at the conference and the face to face between colleagues could be described as a “business meeting”.

The above quote (in blue) is from the CDC transcript of the presser on the sero-conversion of the above “business associate.” The CDC refused to provide additional detail in the Q&A other than the approximate length of the two meetings and a characterization of the face to face contact as a “business meeting".

However, the earlier comments in red suggest the “meeting” was at the conference, and the sero-conversion supports MERS transmission by casual contact, since the only physical contact between the two lab confirmed cases was reported as a handshake(s).

The withholding of the location of the meeting, as well as obfuscation on details of the meeting, raise serious transparency concerns. The relative ease of MERS transmission suggest more infections occurred and remarks at the end of the presser suggested more cases may be confirmed in Indiana contacts.

The Illinois case was identified by a positive serum sample in a May 16 test. Serological tests are most accurate if paired samples are tested because antibody levels take 2-4 weeks to peak, and an initial sample sets a baseline and is used to show that the subsequent increase in antibody levels is due to a recent infection.

Thus, antibody levels in infected contacts will peak in the next 1-2 weeks, when more positives are likely to arise. Similarly, another collection in that time frame from the Illinois case will likely produce a higher titer and provide a stronger indication that the Illinois case was infected at the meeting/conference.

Media Link

http://www.recombinomics.com/News/05...sual_APSA.html
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Old 05-18-2014, 08:43 AM   #14
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As sick as I've been this week, I'm beginning to think I had it. Worst "cold" I've ever had. 7 days and still haven't shaken it.
It's here too. Two co-workers had it, one bad enough to go to the clinic thinking she had the flu. Body aches, high temp, bad cough. Was told no, it's a bad cold virus going around. Daughter's friend in Portland has the same symptoms, 103.4 temp.
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Old 05-18-2014, 11:27 AM   #15
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Originally Posted by drummagick View Post
It's here too. Two co-workers had it, one bad enough to go to the clinic thinking she had the flu. Body aches, high temp, bad cough. Was told no, it's a bad cold virus going around. Daughter's friend in Portland has the same symptoms, 103.4 temp.
Twoolf and others, have you been tested? I find it hard to believe that a corona virus is spreading this quickly, and think that it is likely some other virus, and not MERS.
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Old 05-18-2014, 12:01 PM   #16
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I had a short lived virus over a week ago. High fever, cough, intense nausea, body aches, sick as a dog for 3 days and then it passed.

Some kind of crazy virus.
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Old 05-18-2014, 02:09 PM   #17
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Rough conditions this winter & spring means a lot of cruds are making the rounds. Like Mouse, I have trouble believing we'd be seeing MERS spreading this quickly.
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Old 05-18-2014, 06:07 PM   #18
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Agree, too soon for MERS. More likely a fast-hitting, hardy virus acting as a gateway for an opportunistic or resident bacteria. I caught such from my Granddaughter on Easter.

Within 2 days I had a bad "head cold", which morphed into a very painful sore throat, sinus involvment, then extremely painful tonsils. I dismissed everything as bad cold symptoms until 5-6 days after Easter. In the late afternoon, my lungs started to feel irritated (for me, an alarming sign of bacterial lung infection). Within an hour, I had developed a spontaneous, unproductive cough. I went to the neighborhood Urgent Care Clinic and was prescribed Azithromycin. It was a modern miracle! I woke up the next morning amazed; no pain, no chest involvement, everything felt normal. However, it did take a few days for my energy level to come back up.

Back to the Granddaughter; she still has the "sniffles" and that "virus" is working it's way through everybody else in the household, AGAIN. I don't think I will be visiting them for a while....

BACK TO MERS:

Many thanks to Dr. Niman for sifting through the CDC report about the newly MERS infected victem to find that the MERS sick HCW (health care worker) and the newest MERS positive person did not just attend the same conference or meeting. They shook hands!

Soooo, this thing is still contact driven. The coronovirus logically transferred hand to hand, and infection occured when the new victem touched his eyes/face, or ate a muffin, hamberger, etc., before washing his hands.

Rubberglove time?



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Old 05-18-2014, 10:47 PM   #19
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Hey guys , cut back on that camel piss.

Quote:
Western health experts are unfamiliar with litany of Muslim products that are produced from Camel's urine...

Even CNN Arabic promoted under its "Health and Technology" column an article titled "A mouthful a day" and even in capsule form – just like you would with fish oil, massage it into your hair or apply it directly to your face. For best results, the CNN report recommends "to take mouthfuls of camel urine daily for an entire year" and to make sure the camel be a female virgin. Surveys are even done to conclude from patients that, the urine of a virgin camel has a "preferable distinct flavor and aroma."

Westerners are not accustomed to how camel urine is an essential aphrodisiac to many Muslims as Ginseng is to Chinese.
.
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Old 05-18-2014, 10:50 PM   #20
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Old 05-19-2014, 06:00 PM   #21
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The CDC website has been updated to include info about the Illinois case. With a couple of exceptions, it doesn't really have much more than what has already been reported in the media.

One thing that it does specify is that the Illinois case was first tested using PCR, which was negative. The 2nd test was a serology test, which showed he was positive for MERS antibodies. Also, at this time, the WHO case count does NOT include cases which only test positive via serology.

The other significant item came from the media briefing. So far, the CDC is still using the term "close contact" in its' advisories and notices about MERS-CoV. But, as several reporters pointed out, that term is usually defined as being caregivers or family members in the same house, or co-workers. However, the CDC is now saying that the 2 brief meetings (specified as being less than 1 hour, and being within 6 feet, and one handshake) between the Indiana patient and the Illinois case qualifies as close contact.

To me, and several of the reporters, that seems to be stretching the definition of "close contact". So, it will be interesting to see if the CDC changes its' advisories to say "any contact" instead of "close contact".

Link to the transcript of the CDC media telebriefing held on Saturday:
http://www.cdc.gov/media/releases/2014/t0517-mers.html

For future reference:

CDC Main page for MERS: http://www.cdc.gov/coronavirus/mers/...e_whatsnew_003

CDC Advisory - MERS: People Who May Be at Increased Risk for MERS
http://www.cdc.gov/coronavirus/MERS/risk.html

CDC: MERS in the U.S.
http://www.cdc.gov/coronavirus/mers/US.html
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Old 05-20-2014, 01:29 PM   #22
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Quote:
Mystery MERS Meeting Predicts More Indiana Confirmations

Recombinomics Commentary, May 19, 2014

Prior to being admitted to the hospital, the Indiana patient had extended face-to-face contact on April 25th with a business associate in Illinois. The two had another brief contact on April 26th.

Just in conclusion, our contact investigation indicates that there may have been some spread in the Indiana -- from the Indiana patient.

The above comments from the introduction and conclusion in prepared CDC presser remarks on the Riyadh health care worker (HCW), who traveled to Munster, Indiana via London and Chicago to attend a medical conference in Chicago (10th Annual Meeting of American Physician Scientists Association). When he went to the conference he had a 30-40 minute face to face discussion with a colleague (described as a “business associate” above) on the first full day of the conference and had a shorter, 10-20 minute discussion on the second day. The conference ended in the early afternoon of the next day, Sunday, April 27, when he drove back to Munster. The contact with the family in Munster on Sunday afternoon and evening, as well as Monday morning prior to his arrival at the Emergency Department at Community Hospital, represents the most at risk period for the Munster family contacts.

The above scenario is supported by the times of the flights, media reports indicating the he came to Chicago for a “conference” and he “went” to the family in Indiana on April 27 when his medical condition deteriorated. The dates and itinerary of the conference, in downtown Chicago about 30-45 minutes from Munster, match the travel descriptions of the CDC and Indiana Department of Health, as well as associated media reports.

The full travel log prior to the conference includes British Airways Flight 262 from Riyadh, RUH, to London, LHR, followed by American Airlines Flight 99 from London, LHR, to Chicago, ORD with a scheduled arrive of 10:50 AM CDT on April 24. He then took a bus from O’Hara to Munster, Indiana, a Chicago suburb, and arrived in the early afternoon. He then drove to the conference that afternoon/evening for meet and greet events in the evening of April 24, or drove to the conference on April 25, where he had the face to face conversation with a colleague who was an Illinois resident. He had a briefer talk with his colleague on April 26, and then returned to Munster on the 27, when the conference ended and when his symptoms became more severe.

The risk to the family was greatest on Sunday and Monday, because he was more contagious due to more severe symptomns, and an antibody test indicated he had already infected his colleague on Friday and/or Saturday via casual contact that included a handshake.

Thus, it is likely that one of more family members were infected in Indiana, which also is also true for HCWs at Community Hospital. Although all of the contacts were PCR negative, including the colleague in Illinois, detectable antibodies take several weeks to develop, so it is likely that several Indiana contacts will sero-convert and test positive this week, as indicated in closing remarks.

http://www.recombinomics.com/News/05...S_Meet_IN.html
CLOSE Contact or ANY contact?

More about that later...




Last edited by Justathought; 05-20-2014 at 03:01 PM.
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Old 05-20-2014, 03:00 PM   #23
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Close Contact, or Any Contact?

Quote:
Originally Posted by Catbird;
So far, the CDC is still using the term "close contact" in its' advisories and notices about MERS-CoV. But, as several reporters pointed out, that term is usually defined as being caregivers or family members in the same house, or co-workers. However, the CDC is now saying that the 2 brief meetings (specified as being less than 1 hour, and being within 6 feet, and one handshake) between the Indiana patient and the Illinois case qualifies as close contact.

To me, and several of the reporters, that seems to be stretching the definition of "close contact". So, it will be interesting to see if the CDC changes its' advisories to say "any contact" instead of "close contact". [/url]
In the most recent report from Dr. Niman (see the above post, #23) the infected HCW was highly contageous when on a bus to Munster and in a car he drove (rented?):

Quote:
...He then took a bus from O’Hara to Munster, Indiana, a Chicago suburb, and arrived in the early afternoon. He then drove to the conference that afternoon/evening for meet and greet events in the evening of April 24, or drove to the conference on April 25, where he had the face to face conversation with a colleague who was an Illinois resident. He had a briefer talk with his colleague on April 26, and then returned to Munster on the 27, when the conference ended and when his symptoms became more severe.

The risk to the family was greatest on Sunday and Monday, because he was more contagious due to more severe symptoms, and an antibody test indicated he had already infected his colleague on Friday and/or Saturday via casual contact that included a handshake.
Remember what we learned about SARS? The SARS corono virus was shown to live on metalic or hard plastic surfaces for 3 to 4 days (on paper not at all), At any rate, in one huge apartment building in Asia, there was a single quarantined SARS positive person. In fact, I think they quarantined the whole building (where are the old Curevent archives when we need them?)

A second SARS positive person showed up in that building during the quarantine. It was hypothisized that the second infection was caused by contact with the virus on an elevator button or stairwell banister, etc.

So, what about the health of the next few people to drive the car the HCW used? Or whoever sits in his bus seat for the next several days, gets the virus on his/her hands and then eats a snack bare handed. How many active MERS cases and silent Super Shedders will pop up within the next three weeks as a result of infection from that HCW?

What a mess!

The CDC has to know all of this but probably does not want to cause a panic...

This reminds me of the small Western community that closed the road into town and isolated itself during the deadly 1919 Flu epidemic. They were infected anyway, and almost half of the community died. Later, they realized that they had, from habit, allowed the mailman in his horse and buggy to continue to deliver the mail (he died too).



Last edited by Justathought; 05-20-2014 at 06:11 PM.
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Old 05-29-2014, 02:12 AM   #24
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SO WHAT IS WITH THE CDC?

Quote:
Illinois MERS Case Lab Confirmed By CDC Published Definition

Recombinomics Commentary, May 29, 2014

To conduct serology from MERS Co-V, we conducted three separate tests, ELISA, or enzyme-linked immunosorbent assay, IFA, or immunofluorescence assay, and a third more definitive test called the neutralizing antibody assay, which takes longer than the other two tests. Results from these tests are not black and white but require interpretation.

To maximize specificity, we defined MERS-CoV antibody positivity as subjects having correlated, positive laboratory results from the HKU5.2N screening ELISA as well as confirmed positive results by either the MERS-CoV immunofluorescence assay (IFA) or the MERS-CoV
microneutralization assay (MNT).


The above comments (in red) are from the CDC telebriefing claiming that the Illinois MERS case, who was antibody positive by two antibody test (ELISA and IFA), was really negative because of a subsequent microneutralization test. The three tests are cited above.

However, the CDC had just published a paper on the detection of MERS antibodies in the ICU outbreak in Jordan in 2012 entitled “Hospital-associated outbreak of Middle East Respiratory Syndrome Coronavirus: A serologic, epidemiologic, and clinical description”. That paper used the same three tests, and as noted above (in blue) a positive case was defined as a patient who was positive on the ELISA test and then confirmed by the IFA test or the miconeutralization assay (MNT).

Thus, when the Illinois colleague of the Munster MERS case tested positive on the ELISA and IFA test, the CDC held a press briefing noting he was a lab confirmed positive. Since the interaction between the two subjects was brief and contact was limited to two handshakes, the transmission by casual contact received significant press.

Today, the CDC tried to walk back the positive by claiming the negative neutralization test trumped the two prior positives (by ELISA and IFA) in contradiction of their own published definition of a lab confirmed case.

The clumsy attempt to create a new definition after the fact raises concerns that a large number of contacts were antibody positive by the ELISA and IFA tests.

After the telebriefing, Recombinomics called the CDC media with a list of questions regarding the testing of the various contacts of the confirmed cases in Indiana and Florida. The CDC media refused (in writing) to answer any of the questions, raising serious transparency concerns.

The CDC should immediately release antibody testing data on all contacts of the two MERS confirmed cases in Indiana and Florida.

http://www.recombinomics.com/News/05...Confirmed.html
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Old 05-29-2014, 06:58 AM   #25
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Niman has a point. Is the CDC changing the rules? Is the CDC hiding something? Or, is this Niman "over-parsing"? Or, is it a screw up? Either way, he has a point. I LIKE this about Niman. He IS thought provoking and logical.
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