Tracking the next pandemic: Avian Flu Talk |
12 test positive for MERS-Cov in Italy |
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LOPPER
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Posted: June 03 2013 at 1:19pm |
Italy: A dozen close contacts of first patient tested positive for the corona virus, currently asymptomatic
There are about ten, so far, the people tested positive for the New Sars but completely asymptomatic. The samples, said today Professor Alessandro Bartoloni, head of infectious diseases at the AOU Careggi, were sent to the Institute of Health for confirmation. The positive test, by throat swab, not having any symptoms, were not hospitalized and remain at home, obviously under observation. Meanwhile continue the tests on other people, even without symptoms, come in contact with the three patients with New SARS. It is not excluded so that the number of positives can still go up in the coming hours. "People with positive screening results - continues the professor - have not been isolated and are at home because they have no symptoms. We continue to take samples and examine them to see how far the virus has spread. " The behavior of New SARS seems to have surprised the experts. "There was a belief, as indicated by the World Health Organization - continues the infectious disease - that the virus was transmitted recently and was quite aggressive. What we're seeing so far seems to be, however, just the opposite. The pattern is reversed. " http://www.basketfrance.com/_juridique/s/le/fruitshop/get.php?q=aHR0cDovL3d3dy5iYXNrZXRmcmFuY2UuY29tL19qdXJpZGlxdWUvaW1hZ2VzL3NhbXBsZWRhdGEvZnJ1aXRzaG9wL2dldC5waHA%2FcT1hSFIwY0RvdkwzZDNkeTVzWVhOMFlXMXdZUzVwZEM4eU1ERXpMekEyTHpBekwybDBZV3hwWVM5amNtOXVZV05vWlM5dWRXOTJZUzF6WVhKekxYVnVZUzFrWldOcGJtRXRaR2t0Y0dGNmFXVnVkR2t0Y0c5emFYUnBkbWt0WVdrdFkyOXVkSEp2Ykd4cExXMWhMWE5sYm5waExYTnBiblJ2YldrdGRYSldSV3AwTkRCaVQyNUpZMVkxVW00elFrSk9VQzl3WVdkcGJtRXVhSFJ0YkElM0QlM0Q%3D - http://www.lastampa.it/2013/06/03/italia...agina.html |
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Albert
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12 new cases? Here it comes....
They may not be fully asymptomatic, but merely in the incubation period and symptoms may not have developed as of yet. |
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LOPPER
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Well it would seem at the very least that this virus is more widespread than the confirmed cases and asymptomatic carriers of it are simply spreading it quietly.
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Albert
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Good point Lopper, if the news is accurate, it would appear that a pandemic is imminent. Very bad news.
Just a guess, but Canada and New York should really be on alert for this. |
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LOPPER
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The virus responsible for the MERS-CoV threat is part of the coronavirus family. The coronavirus family is the cause of the common cold, SARS and a variety of animal diseases. So it is likely this virus is spread much like that of the common cold and they can't say it isn't H2H now as it seems one person infected 12 so how many did those 12 infect? And that doesn't even take into account of all the clusters in SA and the possible rate of spread of the virus which would be exponential at this point in SA. Guess we'll find out as the incubation period seems rather long anywhere from 10 days to what 14? And they don't really know how long the incubation period is it could be longer.
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Albert
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It may have just now have made the final leap to humans - and now achieved sustained h2h. Mutated and has potentially gone airborne.
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LOPPER
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That's the whole thing if it is spreading as efficiently as the common cold, because it is just a related jacked up virus of the same genus.
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JorgeFoto
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Darn..... It sounded like this was under control or that is what thet wanted us to think.
Its like a ***** filled Twinkie. |
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LOPPER
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oriel
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None of the original links to the 12 testing positive work.
Please provide the source. My Italian is excellent and I can research.
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In all things there is the possibility of evolution or revolution
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LOPPER
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Here you go try this. http://www.lastampa.it/2013/03/06/italia/cronache/carne-di-cavallo-pure-nei-ragu-star-KU0njHq2uajsrU5WzVEyGM/pagina. - http://www.lastampa.it/2013/03/06/italia/cronache/carne-di-cavallo-pure-nei-ragu-star-KU0njHq2uajsrU5WzVEyGM/pagina.html
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Satori
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#Coronavirus #MERS Italy - Prof. A. Bartoloni: "Dozen of Positive Without Symptoms" http://pandemicinformationnews.blogspot.com/2013/06/coronavirus-mers-italy-prof-bartoloni.html |
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LOPPER
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Those 12 infected are also not being isolated.
http://pandemicinationnews.blogspot.com/2013/06/coronavirus-mers-italy-prof-bartoloni. - http://pandemicinformationnews.blogspot.com/2013/06/coronavirus-mers-italy-prof-bartoloni.html
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albert
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We are on the brink of a significant global event.
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quietprepr
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"Learning is not compulsory... neither is survival." - W. Edwards Deming
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Kyle
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They were worried about superspreaders. Well here they are, refusing to isolate them even if they aren't showing symptoms is going to have tragic consequences.
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oriel
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Ok I have check the original reports in Italian and they seem legitimate.
What is worrying to me is that the index case 45m returned from jordan on the 25th of May. So he has not had a lot of time to infect other nor have those infected by him had much time to develop symptoms if they were infected after his return. A total of 9 days (from his return) and that seems on the very very very short end of the incubation period reported. These dozen cases must me monitored and in my opinion quarantined.
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In all things there is the possibility of evolution or revolution
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KiwiMum
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Are these 12 people contagious? Is there any way to test to see if they are? Also, when did they come into contact with MERS? How many days has it been since they were exposed?
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Those who got it wrong, for whatever reason, may feel defensive and retrench into a position that doesn’t accord with the facts.
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Pixie
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Modern-Day Typhoid MarysSuperspreaders can turn a minor outbreak into a pandemic.By Carrie Arnold|Posted Thursday, Dec. 27, 2012, at 3:35 PM Patients put on face masks as they leave a SARS clinic in Toronto in 2003 Photo by J.P. Moczulski/AFP/Getty Images. If germs hung a recruiting sign for their hosts, it would probably be a version of the World War I poster of Uncle Sam pointing: We want YOU to help us reproduce. All hosts were equally eligible for service, infectious-disease researchers thought. Assuming the recruits weren’t immune due to a prior infection or vaccination, anyone should have roughly the same potential to spread a disease’s pathogens. But then came severe acute respiratory syndrome, or SARS. This pandemic started as just another strange pneumonia from southern China, but in 2003 it turned into a global outbreak that infected 8,098 people and killed 774. Key to the disease’s spread, researchers found, was a small but crucial portion of the population that became known as “superspreaders,” people who transmitted the infection to a much greater than expected number of new hosts. The more scientists learn about superspreaders, the more they are beginning to realize that this tiny segment of the population is the driving force behind the emergence and spread of infectious diseases. Perhaps the most infamous superspreader in history was Mary Mallon, aka Typhoid Mary. An Irish cook in New York City in the 1900s, she was chronically infected with Salmonella typhi. Although the infection didn’t cause any symptoms for Mallon, she did excrete large numbers of typhoid bacteria in her feces. Her career as a cook made it easy to transmit fecal bacteria to customers through the food she prepared. She infected about 50 people and killed several (official counts vary) before she was arrested and jailed for refusing to give up her career as a cook. To epidemiologists, people like Typhoid Mary were seen as an anomaly and not the main drivers of infectious disease spread. Instead, epidemiologists focused on a number they called R0, the average number of people a single person could infect. The value of R0depends on three main factors: the number of susceptible individuals in the population, the number currently infected, and those resistant to infection. If the value of R0 is less than one, it means that each individual infects less than one other person, and the outbreak will ultimately die out. However, if the value of R0 is greater than one, the disease has the potential to spread. When you look across a large population, R0 is a good estimate of whether and how a particular infection might spread. At an individual level, it turns out, R0 is less accurate. Most people won’t spread the disease at all, but a very few people will spread the infection to tens or even hundreds of others. As computer models of infectious disease grew more powerful and precise, scientists began to realize that a lot of infectious disease spread is due to superspreaders. Researchers call it the 80/20 rule: Twenty percent of the population is responsible for 80 percent of disease spread. The key to understanding and stopping outbreaks of infectious disease means homing in on this small portion of the population that drives the majority of transmission. Accounting for the presence of superspreaders also means accounting for their much more common counterparts: people who don’t spread the disease to anyone. Their R0 is zero. Taken together, that means a disease is much more likely to be introduced into new areas by superspreaders, but it is also more likely to fizzle out in those places due to nonspreaders. Only occasionally, as with SARS, can the pathogen be introduced to somewhere new and then, like a spark on dry kindling, ignite a massive blaze of infection. On Feb. 21, 2003, a 64-year-old doctor checked into Room 911 at the Hotel Metropole in Hong Kong. He was already sick with SARS but felt well enough to travel. Public health officials documented a total of seven people directly infected by the doctor, making him a superspreader. Several of the people he infected were also superspreaders. One young man infected every doctor, nurse, and medical student who examined him in a Hong Kong hospital—more than 100 health care workers in total. A flight attendant from Singapore went on to infect at least 160 others. These travelers then brought the SARS virus home with them as a very unwelcome souvenir. One of these infected individuals arrived in Toronto. Several days after she returned home, she developed symptoms consistent with SARS and ultimately died. Nine other SARS cases and three deaths were directly linked to her, and the outbreak ultimately spread to 257 others. This chain of contagion accounted for more than 70 percent of Toronto’s total SARS cases. Although Toronto was besieged by SARS in 2003, Vancouver (with a similar population) saw only a handful of cases. The reason? No superspreaders were infected in Vancouver, said infectious disease expert James Lloyd-Smith of the University of California, Los Angeles. “SARS made the superspreader phenomenon so obvious we could no longer ignore it,” he said. But “SARS is just one point along a continuum—all infectious show this [pattern] to some degree.” Superspreaders are not limited to humans. When researchers began to deconstruct the outbreaks of West Nile virus that hit the United States in the first decade of the 21stcentury, they found that certain areas, like the western suburbs of Chicago, were hit especially hard. Tony Goldberg, an epidemiologist at the University of Wisconsin-Madison, began to study the mosquitoes that transmitted West Nile virus in an attempt to figure out why some places had so many more cases than others. Using traps and a device that operates like a giant vacuum cleaner, Goldberg and colleagues collected mosquitoes from around Chicago. A few of these mosquitoes had blood in their abdomen from a recent meal, which allowed researchers to identify which animals the mosquitoes had been biting. Overwhelmingly, the mosquitoes had been feeding on Turdus migratorius, the American robin. West Nile virus is traditionally associated with crows, blue jays, and other corvids, Goldberg said. These are the birds that get sick and die in large numbers during West Nile outbreaks. Public health officials knew to brace themselves for a West Nile outbreak in humans this summer when they began to see large numbers of dead crows. Although researchers knew that other birds could become infected, they were thought to be fairly minor contributors to West Nile spread. The fact that robins don’t die or become noticeably ill made them both invisible to public health authorities and remarkably good spreaders of West Nile. When crows and related birds die, they are unable to transmit the virus to other birds. They become literal dead ends. Robins, on the other hand, continue the everyday activities that bring them in contact with new mosquitoes, which drink the virus from the birds’ blood and continue the spread of the disease. Whether they are individuals or an entire species, superspreaders have certain traits that make them efficient engines of infection. According to disease ecologist Sara Paull at the University of Colorado, Boulder, superspreaders share three major qualities. They shed large quantities of the pathogen. They transmit it to a large number of people. And they do so for a long period of time. A combination of an individual’s physiology and behavior determines whether he or she will become a superspreader. Take Typhoid Mary. If she hadn’t been a cook and hadn’t harbored an asymptomatic infection of Salmonella typhi in her gall bladder, she wouldn’t have infected many other people. In the case of SARS, many local outbreaks centered on hospitals. A health care worker who hacked up large amounts of virus had a much greater potential of spreading SARS to a wide range of people, many of whom had impaired immune systems, compared to someone who rarely had contact with the outside world. Scientists still don’t know why SARS superspreaders were so effective at transmitting the disease, although a major factor appears to be invasive respiratory procedures like intubation and nebulizer treatments that aerosolized large amounts of virus. Identifying superspreaders seems like it would be a logical place for public health officials to start fighting disease outbreaks. “If you just apply infectious disease control measures randomly, you may not be able to actually eliminate an infectious disease. But if you target the most relevant 20 percent, then you can vaccinate or treat enough of these individuals to eliminate the disease much more quickly,” said Virginia Tech disease ecologist Dana Hawley. In order to figure out who these superspreaders really are, scientists need to define superspreading in a concrete way that can be applied to multiple different diseases. Thus far, noted Lloyd-Smith, this hasn’t been done. “This term is being bandied about, and everyone is using their own personal definition,” Lloyd-Smith said. The basic definition Lloyd-Smith developed was a person who spreads an infection to a significantly higher number of contacts than average. But no one knows exactly how much higher that number needs to be before someone crosses the line from unlucky to superspreader. Nor do researchers understand why some diseases are more prone to superspreading than others. In the meantime, scientists have begun to look at superspreaders’ mirror image—those people who don’t transmit infections to anyone else—as a way to halt disease outbreaks. Are their immune systems fundamentally different? What about their behavior? Perhaps through these individuals, researchers will crack the mystery of superspreading and ultimately stop local infections from becoming pandemics |
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KiwiMum
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Great post Pixie. Funnily enough I had been thinking of Typhoid Mary a few days ago.
I saw a documentary on the Black Death. Researchers were trying to establish why some people got it and died, some got it and survived and some didn't get it. They went to some remote villages in England where people are known to have survived it and dna tested some of their descendants. They discovered some sort of survival gene and suggested that people without this gene died from the plague, people with one of this particular gene (ie one of their parents passed it to them) got the disease but recovered, and people who had inherited it from each of their parents didn't get sick at all. I'd love to know if I have it.
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Those who got it wrong, for whatever reason, may feel defensive and retrench into a position that doesn’t accord with the facts.
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LOPPER
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Well a DNA test would show if you have the gene.
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Pixie
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This article seems to suggest many more suspect cases than we thought. 45-60? I love the statement that it isn't particularly aggressive virus. What planet are they on?
New Sars: 10 cases still positive but no symptoms, other controls 45 under observation homeSwabs were sent to the Institute of Health to confirm the positive: the result is expected for Tuesday. It extends the number of persons screened and umita and reunited the crisis Ilaria Ulivelli New Sars: There are about ten people tested positive (photo ANSA) Florence, June 3, 2013 - Ten new cases testing positive for the new Sars, but without symptoms .Swabs were sent to the Institute of Health to confirm the positive: the result is expected today.Meanwhile, extending the number of persons screened : in Additions to 45 under observation at home there are another sixty people under surveillance. "This is a precautionary measure, Because from what we've Discovered so far, this form of virus That we are studying is high transmissibility, but little virulent," says Professor Alessandro Bartoloni, director of the department of infectious diseases at Careggi. RELATED ARTICLES
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LOPPER
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Medical definition of virulent Medicine/Medical . highly infective; malignant or deadly. |
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nijack
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I'm reading through all of this and don't see any reference to WHO these infected people are and what is their exposure relationship. Are they family members, health care workers, etc.? It would be interesting to know also who are the 45 being "observed" and why...what makes them suspect for exposure? Someone is trying to figure out who is being infected and how it's happening (and how easily). If these people develop the disease (as was mentioned, it's been 9 days or so since the reported case) soon we're still talking a LONG incubation period. If a large number develop it (proving a lengthy incubation period) of those exposed we have a real problem here.
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Onefluover
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It's called MERS. If you have it you have Mid East Respiratory Syndrome Infection. MERSI. Unless if what you have is Trans/Oceanic Respiratory Infection Pneumonic Syndrome, H7N9, then you have Captain Trips.
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Albert
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Albert
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That was to Onefluover. Normally the suspected cases under observation are always 100% neg. All of them. This one, they better watch it closely. If they're under observation, run tests in another 24-48 hrs as they may be within the incubation, similar to the tests in the recent dozen cases.
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DANNYKELLEY
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ditto
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WHAT TO DO????
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scrutinizer
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So how did they identify it if all the patients are asymptomatic? What prompted them to test when it hasnt hit Italian shores? I've read many of the translated accounts and have yet to see a reason why they tested for coronavirus in people who exhibited NOTHING.
Strange. The plot thickens. Remember SARS super spreaders? |
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EdwinSm,
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the first Italian case came from Jordan. In the official statistics Jordan had two cases and two deaths (CFR 100%), but these were confirmed after death. At the same time there were another 11 people hospitalized that recovered and who were not tested. So they are only 'probably cases' and not counted. If they were counted then the case fatality rate for Jordan would drop to 15%
The first three cases from Italy seem as if they will recover. Now the other 10 cases that are being reported- Has MERS evolved, in Jordan, both to have a more effective spread and to be less deadly, while in Saudi Arabia it has remained limited H2H and very deadly? Or have we been given incomplete data that would make any guess wrong? |
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Dutch Josh
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I also read on Recombinomics/Henry Niman; there it is explained how they came to the tested group; close contacts of the first cases. I think next steps should be;"testing the test"; could the positive be false ? If it is not false testing the samples; is it the same coronavirus ? What would be the outcome of testing close contacts in other places in Europe (France and U.K.)? Is there a "mild" coronavirus ?
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We cannot solve our problems with the same thinking we used when we created them.
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Pixie
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Coronavirus, 2 doctors among the 10 cases of infection in FlorenceAlso 3 nurses attended the patient subsequently died from JordanFlorence, June 4 (TMNews) - Among the ten cases of people who are likely to have been infected by the coronavirus, in Florence, five are the medical staff who attended the patient arrived from Jordan and then died. This is a doctor of the department of Infectious Diseases Careggi, a doctor and three nurses of the hospital of Santa Maria Nuova. Before we talk about 'positive' to all intents and purposes, is explained by medical sources, you really have to wait for the response from the National Institute of Health. INT3 |
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Albert
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They may not be asymptomatic for long. They tested them early, and
there is a good likelihood that they're about to show symptoms. It's really about the only thing that makes sense.
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coyote
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Sounds like we are getting real close and should maybe be getting our final preps in order..
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Long time lurker since day one to Member.
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oriel
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Dr Niman explains possible testing timing as explanation of positive infection discovery.
http://www.recombinomics.com/News/06041301/MERS_Italy_Asymp_****** Note the detail that 5 of the 10 new positives are attending health care workers. Two important details to watch: Will they develop symptoms? Have they, or will they infect other patients? |
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Albert
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Commentary
MERS-CoV
Asymptomatic Health Care Workers In Italy The above translation provides additional detail on the 10 asymptomatic contacts who have tested positive for MERS-CoV in Florence, Italy (see map). The above health care workers (HCWs) included doctors and nurse who had contacts with the index case at the two facilities which treated the confirmed case (45M) who had returned to Italy from Jordan. Two contacts (his niece, 2F, and a co-worker, 42F) developed symptoms and tested positive. However, Italy expanded testing to asymptomatic contacts and positives were detected in samples from the upper respiratory tract (nasopharyngeal swabs). Thus, the key difference between the asymptomatic positives detected in Italy and negatives cited elsewhere are linked to the timing of the testing. In the Middle east, most cases have developed pneumonia and are hospitalized. These cases have a high viral load and are usually fatal. Those that survive have pneumonia are generally are severe cases. Contacts are monitored but not tested. Others, such as France, have tested mild contacts, but the testing is when the patients have largely recovered and MERS=CoV has been cleared. Thus, in France the symptomatic HCWs were released as soon as they tested negative, because they had already recovered from their illness. Similarly, the symptomatic HCWs associated with MERS-CoV cases in England and Germany were also tested long after they developed symptoms. The most striking example was the daughter of the index case in England who developed symptoms while performing Umrah in Saudi Arabia. He had been infected with MERS-CoV and H1N1pdm09. His son and sister, who had not traveled outside of England developed symptoms and were positive for MERS-CoV and type 2 parainfluenza virus (HPIV-2). They developed symptoms within 1 day of each other and gad no recent contact with each other. The Health Protection Agency initially suggested that another family member was responsible for the infection of the sister since she had no contact with her nephew and had limit contact with the index case. The daughter of the index case, who also traveled to Saudi Arabia was “cleared” through testing, suggesting she had had mild symptoms. Moreover, two contacts were HPIV-2 positive but MERS-CoV negative suggesting she was one of the contacts who had been infected with both viruses but had clear MERS-CoV when samples were collected for testing. Moreover, the ealriest MERS-CoV cases were in Jordan over a year ago. Although the milder cases were classified as "probable" because of the lack of sample, the disese onset dates strongly support human to human transmission among the ICU HCWs, with strong similaritys with SARS-CoV transission in 2003. Similarly, mild contacts of the case in Tunisia were quickly tested and were MERS-CoV confirmed. Thus, the chief difference between the MERS-CoV positives in mild / asymptomatic cases, and those tested elsewhere has been the timing of sample collection. The results in Italy suggested the viral load in mild cases is confined to the upper respiratory tract, which is cleared, and testing of samples collected when the patient has largely recovered yields negative results. |
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Albert
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Good post Oriel. I believe the answer is that they're going to develop symptoms.
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Albert
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Canada and the U.S. also need to be on alert. Given the incubation, I'm guessing we'll see the first case in approx the next week - 10 days, or very soon. The virus appears to have adapted further to humans, but let's hope it's still short of sustained transmission. Could be wishful thinking at this point.
When it reaches Canada or the U.S., we will most likely go to defcon 5, as people call it around here. Level 5 on the pandemic alert. |
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coyote
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Ok and thanks Albert..That will mean we should all be working on finishing off with our prepping.
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Long time lurker since day one to Member.
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Albert
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If the 10 in Italy develop symptoms, and then if we also go to level 5, I would say it's time to prep if you haven't started yet. Level 5 = Prep. Although it's always good to pick up a few extra supplies at this point.
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oriel
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I think it can still go either way. The index case in this cluster is I believe still alive and in hospital 45m but he definitely had symptoms. So the source strain was symptomatic if not yet deadly. It is interesting to note, by the way, that he worked in a hotel in Italy and I wonder if he went to work at all after returning but before going to hospital. 10 infections from one source is high in my humble opinion particularly considering that 5 are health care workers and should be taking precautions.
So I agree with many others that an important detail here is if they get sick and how sick they get. |
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Dutch Josh
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If the Italian new cases develop symptoms then there are a lot of questions. First how is it possible that that many people in this case did get infected, did they miss a the "a-symptomatic cases" in France and the UK ? How far spread could this virus be in KSA/Jordan ? Another question could be about the incubation period. Could that period be longer than 10 days ? Who needs to be tested if the Italian cases turn into severe MERS ? Where to begin ?
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We cannot solve our problems with the same thinking we used when we created them.
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Sam237
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Oriel, he must have returned to work after becoming infected as one of the cases exhibiting symptoms is a coworker of his. Not good.
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oriel
Adviser Group Joined: April 08 2013 Location: Toronto Status: Offline Points: 250 |
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ROME (AFP) - Eight people initially thought to have contracted a SARS-like virus in Italy tested negative on Tuesday after a second round of controls, according to Italy's Superior Health Institute (ISS).
An infectious diseases clinic in Florence on Monday said around 10 people had tested positive for the virus, but added that the results would have to be double checked at the Health Institute. Those concerned had been tested because they had come into contact with a sick man who brought the disease back from Jordan, but they did not show any symptoms and had not been quarantined. "There are no new clinical cases but surveillance of people who came into contact with the sick continue," said the head of the ISS's infectious disease clinic Gianni Rezza. |
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In all things there is the possibility of evolution or revolution
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Albert
Admin Joined: April 24 2006 Status: Offline Points: 47746 |
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False positives? Good grief. That's a first.
Guess there are no asymptomatic cases after all.
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