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Goni MD, Naing NN, Hasan H, Wan-Arfah N, Deris ZZ, Arifin WN, Baaba AA. Uptake of Recommended Vaccines and Its Associated Factors Among Malaysian Pilgrims During Hajj and Umrah 2018. Front Public Health 2019; 7:268. [PMID: 31620419 PMCID: PMC6759542 DOI: 10.3389/fpubh.2019.00268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/04/2019] [Indexed: 01/18/2023] Open
Abstract
This study aimed to assess the uptake of recommended vaccines and to identify the factors associated with the vaccines' uptake among Malaysian Hajj and Umrah pilgrims. A cross-sectional survey among Malaysian Hajj and Umrah pilgrims in 2018. The uptake of the recommended vaccines was surveyed through an anonymous self-administered questionnaire to pilgrims attending a pre-departure Hajj/Umrah orientation course. Descriptive statistics were used for elaborating the demographic characteristics and vaccines uptake of the respondents. Multiple logistic regression was used for predicting the factors associated with the vaccines' uptake. A total of 1,274 pilgrims participated in the study with a mean age (standard deviation) of 42.42 (15.6). A total of 833 (65.4%) participants were females and 232 of the participants (18.2%) had at least more than one chronic disease. The uptake of influenza and pneumococcal vaccines were 28.6% (364/1,274) and 25.4% (324/1,274), respectively. Among the 527 pilgrims who were "at increased risk" of infections, 168 (31.9%) and 184 (34.9%) received influenza and pneumococcal vaccines, respectively. Gender, marital status and occupation were the common predictors associated with vaccines uptake. The vaccination uptake among Malaysian Hajj and Umrah pilgrims is low and declining from previous years. Educating the pilgrims toward vaccine uptake is essential and exploring the barriers for vaccination.
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Affiliation(s)
- Mohammed Dauda Goni
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Nyi Nyi Naing
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Medical Campus, Kuala Terengganu, Malaysia
| | - Habsah Hasan
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Nadiah Wan-Arfah
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, Kuala Terengganu, Malaysia
| | - Zakuan Zainy Deris
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Wan Nor Arifin
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Malaysia
| | - Aisha Abubakar Baaba
- Centre for Language Studies and Generic Development, Universiti Malaysia Kelantan, Kota Bharu, Malaysia
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2
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Meslé MMI, Hall IM, Christley RM, Leach S, Read JM. The use and reporting of airline passenger data for infectious disease modelling: a systematic review. Euro Surveill 2019; 24:1800216. [PMID: 31387671 PMCID: PMC6685100 DOI: 10.2807/1560-7917.es.2019.24.31.1800216] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/18/2018] [Indexed: 01/06/2023] Open
Abstract
BackgroundA variety of airline passenger data sources are used for modelling the international spread of infectious diseases. Questions exist regarding the suitability and validity of these sources.AimWe conducted a systematic review to identify the sources of airline passenger data used for these purposes and to assess validation of the data and reproducibility of the methodology.MethodsArticles matching our search criteria and describing a model of the international spread of human infectious disease, parameterised with airline passenger data, were identified. Information regarding type and source of airline passenger data used was collated and the studies' reproducibility assessed.ResultsWe identified 136 articles. The majority (n = 96) sourced data primarily used by the airline industry. Governmental data sources were used in 30 studies and data published by individual airports in four studies. Validation of passenger data was conducted in only seven studies. No study was found to be fully reproducible, although eight were partially reproducible.LimitationsBy limiting the articles to international spread, articles focussed on within-country transmission even if they used relevant data sources were excluded. Authors were not contacted to clarify their methods. Searches were limited to articles in PubMed, Web of Science and Scopus.ConclusionWe recommend greater efforts to assess validity and biases of airline passenger data used for modelling studies, particularly when model outputs are to inform national and international public health policies. We also recommend improving reporting standards and more detailed studies on biases in commercial and open-access data to assess their reproducibility.
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Affiliation(s)
- Margaux Marie Isabelle Meslé
- National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Ian Melvyn Hall
- National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, United Kingdom
- School of Mathematics, University of Manchester, Manchester, United Kingdom
- Emergency Response Department, Public Health England, Salisbury, United Kingdom
- National Institute for Health Research, Health Protection Research Unit in Emergency Preparedness and Response at Kings College London, London, United Kingdom
| | - Robert Matthew Christley
- National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Steve Leach
- National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, United Kingdom
- Emergency Response Department, Public Health England, Salisbury, United Kingdom
- National Institute for Health Research, Health Protection Research Unit in Emergency Preparedness and Response at Kings College London, London, United Kingdom
- National Institute for Health Research, Health Protection Research Unit in Modelling Methodology at Imperial College London, London, United Kingdom
| | - Jonathan Michael Read
- National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Centre for Health Informatics Computation and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
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Cruwys T, Saeri AK, Radke HRM, Walter ZC, Crimston CR, Ferris LJ. Risk and protective factors for mental health at a youth mass gathering. Eur Child Adolesc Psychiatry 2019; 28:211-222. [PMID: 29752533 DOI: 10.1007/s00787-018-1163-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/04/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mass gatherings are well-documented for their public health risks; however, little research has examined their impact on mental health or focused on young people specifically. This study explores risk and protective factors for mental health at mass gatherings, with a particular focus on characterising attendees with high levels of psychological distress and risk taking. METHOD Data collection was conducted in situ at "Schoolies", an annual informal week-long mass gathering of approximately 30,000 Australian school leavers. Participants were 812 attendees of Schoolies on the Gold Coast in 2015 or 2016 (74% aged 17 years old). RESULTS In both years, attendee mental health was found to be significantly better than population norms for their age peers. Identification with the mass gathering predicted better mental health, and this relationship became stronger across the course of the mass gathering. Attendees with high levels of psychological distress were more likely to be male, socially isolated, impulsive, and in a friendship group where risk taking was normative. CONCLUSIONS Mass gatherings may have a net benefit for attendee mental health, especially for those attendees who are subjectively committed to the event. However, a vulnerable subgroup of attendees requires targeted mental health support.
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Affiliation(s)
- Tegan Cruwys
- School of Psychology, University of Queensland, St Lucia, 4072, Australia
| | - Alexander K Saeri
- School of Psychology, University of Queensland, St Lucia, 4072, Australia
| | - Helena R M Radke
- Institute for Psychology, University of Osnabrück, Osnabrück, Germany
| | - Zoe C Walter
- Institute for Social Science Research, University of Queensland, St Lucia, Australia
| | - Charlie R Crimston
- School of Psychology, University of Queensland, St Lucia, 4072, Australia
| | - Laura J Ferris
- School of Psychology, University of Queensland, St Lucia, 4072, Australia.
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Dawson P, Malik MR, Parvez F, Morse SS. What Have We Learned About Middle East Respiratory Syndrome Coronavirus Emergence in Humans? A Systematic Literature Review. Vector Borne Zoonotic Dis 2019; 19:174-192. [PMID: 30676269 PMCID: PMC6396572 DOI: 10.1089/vbz.2017.2191] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Middle East respiratory syndrome coronavirus (MERS-CoV) was first identified in humans in 2012. A systematic literature review was conducted to synthesize current knowledge and identify critical knowledge gaps. MATERIALS AND METHODS We conducted a systematic review on MERS-CoV using PRISMA guidelines. We identified 407 relevant, peer-reviewed publications and selected 208 of these based on their contributions to four key areas: virology; clinical characteristics, outcomes, therapeutic and preventive options; epidemiology and transmission; and animal interface and the search for natural hosts of MERS-CoV. RESULTS Dipeptidyl peptidase 4 (DPP4/CD26) was identified as the human receptor for MERS-CoV, and a variety of molecular and serological assays developed. Dromedary camels remain the only documented zoonotic source of human infection, but MERS-like CoVs have been detected in bat species globally, as well as in dromedary camels throughout the Middle East and Africa. However, despite evidence of camel-to-human MERS-CoV transmission and cases apparently related to camel contact, the source of many primary cases remains unknown. There have been sustained health care-associated human outbreaks in Saudi Arabia and South Korea, the latter originating from one traveler returning from the Middle East. Transmission mechanisms are poorly understood; for health care, this may include environmental contamination. Various potential therapeutics have been identified, but not yet evaluated in human clinical trials. At least one candidate vaccine has progressed to Phase I trials. CONCLUSIONS There has been substantial MERS-CoV research since 2012, but significant knowledge gaps persist, especially in epidemiology and natural history of the infection. There have been few rigorous studies of baseline prevalence, transmission, and spectrum of disease. Terms such as "camel exposure" and the epidemiological relationships of cases should be clearly defined and standardized. We strongly recommend a shared and accessible registry or database. Coronaviruses will likely continue to emerge, arguing for a unified "One Health" approach.
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Affiliation(s)
- Patrick Dawson
- 1 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Mamunur Rahman Malik
- 2 Infectious Hazard Management, Department of Health Emergency, World Health Organization Eastern Mediterranean Regional Office (WHO/EMRO), Cairo, Egypt
| | - Faruque Parvez
- 3 Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Stephen S Morse
- 1 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Kraemer MUG, Cummings DAT, Funk S, Reiner RC, Faria NR, Pybus OG, Cauchemez S. Reconstruction and prediction of viral disease epidemics. Epidemiol Infect 2018; 147:e34. [PMID: 30394230 PMCID: PMC6398585 DOI: 10.1017/s0950268818002881] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/24/2018] [Accepted: 09/21/2018] [Indexed: 01/29/2023] Open
Abstract
A growing number of infectious pathogens are spreading among geographic regions. Some pathogens that were previously not considered to pose a general threat to human health have emerged at regional and global scales, such as Zika and Ebola Virus Disease. Other pathogens, such as yellow fever virus, were previously thought to be under control but have recently re-emerged, causing new challenges to public health organisations. A wide array of new modelling techniques, aided by increased computing capabilities, novel diagnostic tools, and the increased speed and availability of genomic sequencing allow researchers to identify new pathogens more rapidly, assess the likelihood of geographic spread, and quantify the speed of human-to-human transmission. Despite some initial successes in predicting the spread of acute viral infections, the practicalities and sustainability of such approaches will need to be evaluated in the context of public health responses.
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Affiliation(s)
- M. U. G. Kraemer
- Harvard Medical School, Harvard University, Boston, MA, USA
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, USA
- Department of Zoology, University of Oxford, Oxford, UK
| | - D. A. T. Cummings
- Department of Biology, University of Florida, Gainesville, Florida, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - S. Funk
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - R. C. Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - N. R. Faria
- Department of Zoology, University of Oxford, Oxford, UK
| | - O. G. Pybus
- Department of Zoology, University of Oxford, Oxford, UK
| | - S. Cauchemez
- Mathematical Modelling of Infectious Diseases and Center of Bioinformatics, Biostatistics and Integrative Biology, Institut Pasteur, Paris, France
- CNRS UMR2000: Génomique évolutive, modélisation et santé, Paris, France
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Estimating the probability of dengue virus introduction and secondary autochthonous cases in Europe. Sci Rep 2018; 8:4629. [PMID: 29545610 PMCID: PMC5854675 DOI: 10.1038/s41598-018-22590-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/20/2018] [Indexed: 12/19/2022] Open
Abstract
Given the speed of air travel, diseases even with a short viremia such as dengue can be easily exported to dengue naïve areas within 24 hours. We set out to estimate the risk of dengue virus introductions via travelers into Europe and number of secondary autochthonous cases as a result of the introduction. We applied mathematical modeling to estimate the number of dengue-viremic air passengers from 16 dengue-endemic countries to 27 European countries, taking into account the incidence of dengue in the exporting countries, travel volume and the probability of being viremic at the time of travel. Our models estimate a range from zero to 167 air passengers who are dengue-viremic at the time of travel from dengue endemic countries to each of the 27 receiving countries in one year. Germany receives the highest number of imported dengue-viremic air passengers followed by France and the United Kingdom. Our findings estimate 10 autochthonous secondary asymptomatic and symptomatic dengue infections, caused by the expected 124 infected travelers who arrived in Italy in 2012. The risk of onward transmission in Europe is reassuringly low, except where Aedes aegypti is present.
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O'Hagan JJ, Carias C, Rudd JM, Pham HT, Haber Y, Pesik N, Cetron MS, Gambhir M, Gerber SI, Swerdlow DL. Estimation of Severe Middle East Respiratory Syndrome Cases in the Middle East, 2012-2016. Emerg Infect Dis 2018; 22:1797-9. [PMID: 27648640 DOI: 10.3201/2210.151121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Using data from travelers to 4 countries in the Middle East, we estimated 3,250 (95% CI 1,300-6,600) severe cases of Middle East respiratory syndrome occurred in this region during September 2012-January 2016. This number is 2.3-fold higher than the number of laboratory-confirmed cases recorded in these countries.
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8
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Ahmed AE. The predictors of 3- and 30-day mortality in 660 MERS-CoV patients. BMC Infect Dis 2017; 17:615. [PMID: 28893197 PMCID: PMC5594447 DOI: 10.1186/s12879-017-2712-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 09/04/2017] [Indexed: 12/19/2022] Open
Abstract
Background The mortality rate of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) patients is a major challenge in all healthcare systems worldwide. Because the MERS-CoV risk-standardized mortality rates are currently unavailable in the literature, the author concentrated on developing a method to estimate the risk-standardized mortality rates using MERS-CoV 3- and 30-day mortality measures. Methods MERS-CoV data in Saudi Arabia is publicly reported and made available through the Saudi Ministry of Health (SMOH) website. The author studied 660 MERS-CoV patients who were reported by the SMOH between December 2, 2014 and November 12, 2016. The data gathered contained basic demographic information (age, gender, and nationality), healthcare worker, source of infection, pre-existing illness, symptomatic, severity of illness, and regions in Saudi Arabia. The status and date of mortality were also reported. Cox-proportional hazard (CPH) models were applied to estimate the hazard ratios for the predictors of 3- and 30-day mortality. Results 3-day, 30-day, and overall mortality were found to be 13.8%, 28.3%, and 29.8%, respectively. According to CPH, multivariate predictors of 3-day mortality were elderly, non-healthcare workers, illness severity, and hospital-acquired infections (adjusted hazard ratio (aHR) =1.7; 8.8; 6.5; and 2.8, respectively). Multivariate predictors of 30-day mortality were elderly, non-healthcare workers, pre-existing illness, severity of illness, and hospital-acquired infections (aHR =1.7; 19.2; 2.1; 3.7; and 2.9, respectively). Conclusions Several factors were identified that could influence mortality outcomes at 3 days and 30 days, including age (elderly), non-healthcare workers, severity of illness, and hospital-acquired infections. The findings can serve as a guide for healthcare practitioners by appropriately identifying and managing potential patients at high risk of death.
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Affiliation(s)
- Anwar E Ahmed
- Associate Professor, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
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9
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Abstract
Since the identification of the first patients with Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, over 1,600 cases have been reported as of February 2016. Most cases have occurred in Saudi Arabia or in other countries on or near the Arabian Peninsula, but travel-associated cases have also been seen in countries outside the Arabian Peninsula. MERS-CoV causes a severe respiratory illness in many patients, with a case fatality rate as high as 40%, although when contacts are investigated, a significant proportion of patients are asymptomatic or only have mild symptoms. At this time, no vaccines or treatments are available. Epidemiological and other data suggest that the source of most primary cases is exposure to camels. Person-to-person transmission occurs in household and health care settings, although sustained and efficient person-to-person transmission has not been observed. Strict adherence to infection control recommendations has been associated with control of previous outbreaks. Vigilance is needed because genomic changes in MERS-CoV could result in increased transmissibility, similar to what was seen in severe acute respiratory syndrome coronavirus (SARS-CoV).
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10
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Regan JJ, Jungerman MR, Lippold SA, Washburn F, Roland E, Objio T, Schembri C, Gulati R, Edelson PJ, Alvarado-Ramy F, Pesik N, Cohen NJ. Tracing Airline Travelers for a Public Health Investigation: Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection in the United States, 2014. Public Health Rep 2017; 131:552-9. [PMID: 27453599 DOI: 10.1177/0033354916662213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE CDC routinely conducts contact investigations involving travelers on commercial conveyances, such as aircrafts, cargo vessels, and cruise ships. METHODS The agency used established systems of communication and partnerships with other federal agencies to quickly provide accurate traveler contact information to states and jurisdictions to alert contacts of potential exposure to two travelers with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) who had entered the United States on commercial flights in April and May 2014. RESULTS Applying the same process used to trace and notify travelers during routine investigations, such as those for tuberculosis or measles, CDC was able to notify most travelers of their potential exposure to MERS-CoV during the first few days of each investigation. CONCLUSION To prevent the introduction and spread of newly emerging infectious diseases, travelers need to be located and contacted quickly.
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Affiliation(s)
- Joanna J Regan
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine, Quarantine and Border Health Services Branch, Atlanta, GA
| | - M Robynne Jungerman
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine, Quarantine and Border Health Services Branch, Atlanta, GA
| | - Susan A Lippold
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine, Quarantine and Border Health Services Branch, Atlanta, GA
| | - Faith Washburn
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine, Quarantine and Border Health Services Branch, Atlanta, GA
| | - Efrosini Roland
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine, Quarantine and Border Health Services Branch, Atlanta, GA
| | - Tina Objio
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine, Quarantine and Border Health Services Branch, Atlanta, GA
| | - Christopher Schembri
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Immunization Safety Office, Atlanta, GA
| | - Reena Gulati
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine, Quarantine and Border Health Services Branch, Atlanta, GA
| | - Paul J Edelson
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine, Quarantine and Border Health Services Branch, Atlanta, GA
| | - Francisco Alvarado-Ramy
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine, Quarantine and Border Health Services Branch, Atlanta, GA
| | - Nicki Pesik
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine, Quarantine and Border Health Services Branch, Atlanta, GA
| | - Nicole J Cohen
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine, Quarantine and Border Health Services Branch, Atlanta, GA
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Wu T, Perrings C, Kinzig A, Collins JP, Minteer BA, Daszak P. Economic growth, urbanization, globalization, and the risks of emerging infectious diseases in China: A review. AMBIO 2017; 46:18-29. [PMID: 27492678 PMCID: PMC5226902 DOI: 10.1007/s13280-016-0809-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/16/2016] [Accepted: 07/18/2016] [Indexed: 05/17/2023]
Abstract
Three interrelated world trends may be exacerbating emerging zoonotic risks: income growth, urbanization, and globalization. Income growth is associated with rising animal protein consumption in developing countries, which increases the conversion of wild lands to livestock production, and hence the probability of zoonotic emergence. Urbanization implies the greater concentration and connectedness of people, which increases the speed at which new infections are spread. Globalization-the closer integration of the world economy-has facilitated pathogen spread among countries through the growth of trade and travel. High-risk areas for the emergence and spread of infectious disease are where these three trends intersect with predisposing socioecological conditions including the presence of wild disease reservoirs, agricultural practices that increase contact between wildlife and livestock, and cultural practices that increase contact between humans, wildlife, and livestock. Such an intersection occurs in China, which has been a "cradle" of zoonoses from the Black Death to avian influenza and SARS. Disease management in China is thus critical to the mitigation of global zoonotic risks.
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Affiliation(s)
- Tong Wu
- School of Life Sciences, Arizona State University, LSA 123, 427 East Tyler Mall, Tempe, AZ 85287 USA
| | - Charles Perrings
- School of Life Sciences, Arizona State University, LSA 127, 427 East Tyler Mall, Tempe, AZ 85287 USA
| | - Ann Kinzig
- School of Life Sciences, Arizona State University, LSA 124, 427 East Tyler Mall, Tempe, AZ 85287 USA
- Global Institute of Sustainability, Arizona State University, 800 South Cady Mall, Tempe, AZ 85287 USA
| | - James P. Collins
- School of Life Sciences, Arizona State University, LSC 402, 427 East Tyler Mall, Tempe, AZ 85287 USA
| | - Ben A. Minteer
- School of Life Sciences, Arizona State University, LSA 262, 427 East Tyler Mall, Tempe, AZ 85287 USA
| | - Peter Daszak
- EcoHealth Alliance, 460 West 34th Street - 17th Floor, New York, NY 10001 USA
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12
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Carias C, O'Hagan JJ, Jewett A, Gambhir M, Cohen NJ, Haber Y, Pesik N, Swerdlow DL. Exportations of Symptomatic Cases of MERS-CoV Infection to Countries outside the Middle East. Emerg Infect Dis 2016; 22:723-5. [PMID: 27358972 PMCID: PMC4806968 DOI: 10.3201/eid2204.150976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 2012, an outbreak of infection with Middle East respiratory syndrome coronavirus (MERS-CoV), was detected in the Arabian Peninsula. Modeling can produce estimates of the expected annual number of symptomatic cases of MERS-CoV infection exported and the likelihood of exportation from source countries in the Middle East to countries outside the region.
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13
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O'Hagan JJ, Carias C, Rudd JM, Pham HT, Haber Y, Pesik N, Cetron MS, Gambhir M, Gerber SI, Swerdlow DL. Estimation of Severe Middle East Respiratory Syndrome Cases in the Middle East, 2012–2016. Emerg Infect Dis 2016. [PMID: 27648640 PMCID: PMC5038414 DOI: 10.3201/eid2210.151121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Our traveler-based estimate was 2.3-fold higher than the number of laboratory-confirmed cases recorded. Using data from travelers to 4 countries in the Middle East, we estimated 3,250 (95% CI 1,300–6,600) severe cases of Middle East respiratory syndrome occurred in this region during September 2012–January 2016. This number is 2.3-fold higher than the number of laboratory-confirmed cases recorded in these countries.
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14
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Poletto C, Boëlle PY, Colizza V. Risk of MERS importation and onward transmission: a systematic review and analysis of cases reported to WHO. BMC Infect Dis 2016; 16:448. [PMID: 27562369 PMCID: PMC5000488 DOI: 10.1186/s12879-016-1787-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 08/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The continuing circulation of MERS in the Middle East makes the international dissemination of the disease a permanent threat. To inform risk assessment, we investigated the spatiotemporal pattern of MERS global dissemination and looked for factors explaining the heterogeneity observed in transmission events following importation. METHODS We reviewed imported MERS cases worldwide up to July 2015. We modelled importations in time based on air travel combined with incidence in Middle East. We used the detailed history of MERS case management after importation (time to hospitalization and isolation, number of hospitals visited,…) in logistic regression to identify risk factors for secondary transmission. We assessed changes in time to hospitalization and isolation in relation to collective and public health attention to the epidemic, measured by three indicators (Google Trends, ProMED-mail, Disease Outbreak News). RESULTS Modelled importation events were found to reproduce both the temporal and geographical structure of those observed - the Pearson correlation coefficient between predicted and observed monthly time series was large (r = 0.78, p < 10(-4)). The risk of secondary transmission following importation increased with the time to case isolation or death (OR = 1.7 p = 0.04) and more precisely with the duration of hospitalization (OR = 1.7, p = 0.02). The average daily number of secondary cases was 0.02 [0.0,0.12] in the community and 0.20 [0.03,9.0] in the hospital. Time from hospitalisation to isolation decreased in periods of high public health attention (2.33 ± 0.34 vs. 6.44 ± 0.97 days during baseline attention). CONCLUSIONS Countries at risk of importation should focus their resources on strict infection control measures for the management of potential cases in healthcare settings and on prompt MERS cases identification. Individual and collective awareness are key to substantially improve such preparedness.
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Affiliation(s)
- Chiara Poletto
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), 75012, Paris, France.
| | - Pierre-Yves Boëlle
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), 75012, Paris, France
| | - Vittoria Colizza
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), 75012, Paris, France.,Institute for Scientific Interchange Foundation, via Alassio 11/c, 10126, Torino, Italy
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15
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Nah K, Otsuki S, Chowell G, Nishiura H. Predicting the international spread of Middle East respiratory syndrome (MERS). BMC Infect Dis 2016; 16:356. [PMID: 27449387 PMCID: PMC4957429 DOI: 10.1186/s12879-016-1675-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 06/10/2016] [Indexed: 11/22/2022] Open
Abstract
Background The Middle East respiratory syndrome (MERS) associated coronavirus has been imported via travelers into multiple countries around the world. In order to support risk assessment practice, the present study aimed to devise a novel statistical model to quantify the country-level risk of experiencing an importation of MERS case. Methods We analyzed the arrival time of each reported MERS importation around the world, i.e., the date on which imported cases entered a specific country, which was modeled as a dependent variable in our analysis. We also used openly accessible data including the airline transportation network to parameterize a hazard-based risk prediction model. The hazard was assumed to follow an inverse function of the effective distance (i.e., the minimum effective length of a path from origin to destination), which was calculated from the airline transportation data, from Saudi Arabia to each country. Both country-specific religion and the incidence data of MERS in Saudi Arabia were used to improve our model prediction. Results Our estimates of the risk of MERS importation appeared to be right skewed, which facilitated the visual identification of countries at highest risk of MERS importations in the right tail of the distribution. The simplest model that relied solely on the effective distance yielded the best predictive performance (Area under the curve (AUC) = 0.943) with 100 % sensitivity and 79.6 % specificity. Out of the 30 countries estimated to be at highest risk of MERS case importation, 17 countries (56.7 %) have already reported at least one importation of MERS. Although model fit measured by Akaike Information Criterion (AIC) was improved by including country-specific religion (i.e. Muslim majority country), the predictive performance as measured by AUC was not improved after accounting for this covariate. Conclusions Our relatively simple statistical model based on the effective distance derived from the airline transportation network data was found to help predicting the risk of importing MERS at the country level. The successful application of the effective distance model to predict MERS importations, particularly when computationally intensive large-scale transmission models may not be immediately applicable could have been benefited from the particularly low transmissibility of the MERS coronavirus.
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Affiliation(s)
- Kyeongah Nah
- Bolyai Institute, University of Szeged, Aradi vértanúk tere 1, Szeged, H-6720, Hungary.,Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.,Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo-shi, Hokkaido, 060-8638, Japan
| | - Shiori Otsuki
- Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.,CREST, Japan Science and Technology Agency, Honcho 4-1-8, Kawaguchi, Saitama, 332-0012, Japan
| | - Gerardo Chowell
- School of Public Health, Georgia State University, Atlanta, Georgia, USA.,Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Hiroshi Nishiura
- Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan. .,CREST, Japan Science and Technology Agency, Honcho 4-1-8, Kawaguchi, Saitama, 332-0012, Japan. .,Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo-shi, Hokkaido, 060-8638, Japan.
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16
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Gardner LM, Chughtai AA, MacIntyre CR. Risk of global spread of Middle East respiratory syndrome coronavirus (MERS-CoV) via the air transport network. J Travel Med 2016; 23:taw063. [PMID: 27601536 PMCID: PMC7531608 DOI: 10.1093/jtm/taw063] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Middle East respiratory syndrome coronavirus (MERS-CoV) emerged from the Kingdom of Saudi Arabia (KSA) in 2012 and has since spread to 26 countries. All cases reported so far have either been in the Middle East or linked to the region through passenger air travel, with the largest outbreak outside KSA occurring in South Korea. Further international spread is likely due to the high travel volumes of global travel, as well as the occurrence of large annual mass gathering such as the Haj and Umrah pilgrimages that take place in the region. METHODS In this study, a transport network modelling framework was used to quantify the risk of MERS-CoV spreading internationally via air travellers. All regions connected to MERS-CoV affected countries via air travel are considered, and the countries at highest risk of travel-related importations of MERS-CoV were identified, ranked and compared with actual spread of MERS cases. RESULTS The model identifies all countries that have previously reported a travel acquired case to be in the top 50 at-risk countries. India, Pakistan and Bangladesh are the highest risk countries which have yet to report a case, and should be prepared for the possibility of (pilgrims and general) travellers returning infected with MERS-CoV. In addition, the UK, Egypt, Turkey and the USA are at risk of more cases. CONCLUSIONS We have demonstrated a risk-analysis approach, using travel patterns, to prioritize countries at highest risk for MERS-CoV importations. In order to prevent global outbreaks such as the one seen in South Korea, it is critical for high-risk countries to be prepared and have appropriate screening and triage protocols in place to identify travel-related cases of MERS-CoV. The results from the model can be used by countries to prioritize their airport and hospital screening and triage protocols.
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Affiliation(s)
- Lauren M Gardner
- School of Civil and Environmental Engineering, UNSW Australia, Sydney, NSW 2052, Australia
| | - Abrar A Chughtai
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Australia, Sydney, NSW, 2052, Australia
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Australia, Sydney, NSW, 2052, Australia College of Public Services and Community Solutions, Arizona State University, Tempe, AZ, USA
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17
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Nelson B, Morrison S, Joseph H, Wojno A, Lash RR, Haber Y, Berro A, Cetron M, Grills A. Travel Volume to the United States from Countries and U.S. Territories with Local Zika Virus Transmission. PLOS CURRENTS 2016; 8. [PMID: 27990321 PMCID: PMC5135401 DOI: 10.1371/currents.outbreaks.ac6d0f8c9c35e88825c1a1147697531c] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Air, land, and sea transportation can facilitate rapid spread of infectious diseases. In May 2015 the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infection in Brazil. As of March 8, 2016, the U.S. Centers for Disease Control and Prevention (CDC) had issued travel notices for 33 countries and 3 U.S. territories with local Zika virus transmission. Methods: Using data from five separate datasets from 2014 and 2015, we estimated the annual number of passenger journeys by air and land border crossings to the United States from the 33 countries and 3 U.S. territories listed in the CDC’s Zika travel notices as of March 8, 2016. We also estimated the annual number of passenger journeys originating in and returning to the United States (primarily on cruises) with visits to seaports in areas with local Zika virus transmission. Because of the adverse pregnancy and birth outcomes that have been associated with Zika virus disease, the number of passenger journeys completed by women of childbearing age and pregnant women was also estimated. Results: An estimated 216.3 million passenger journeys by air, land, and sea are made annually to the United States from areas with local Zika virus transmission (as of March 8). The destination states with the largest numbers of arrivals were Texas (by land) and Florida (by air and sea). An estimated 51.7 million passenger journeys were made by women of childbearing age and an estimated 2.3 million were made by pregnant women. Conclusion: Travel volume analyses provide important information that can be used to effectively target public health interventions as well as direct public health resources and efforts at local, regional, and country-specific levels.
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Affiliation(s)
- Bradley Nelson
- Eagle Medical Services, LLC for Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephanie Morrison
- Eagle Medical Services, LLC for Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heather Joseph
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Abbey Wojno
- Karna, LLC for Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - R Ryan Lash
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yoni Haber
- Eagle Medical Services, LLC for Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andre Berro
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Martin Cetron
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, USA; Departments of Medicine and Epidemiology, Emory University School of Medicine and Rollins School of Public Health, Atlanta, Georgia, USA
| | - Ardath Grills
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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18
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Neave PE, Heywood AE, Gibney KB, Leder K. Imported infections: What information should be collected by surveillance systems to inform public health policy? Travel Med Infect Dis 2016; 14:350-9. [PMID: 27235839 PMCID: PMC7110684 DOI: 10.1016/j.tmaid.2016.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 05/10/2016] [Accepted: 05/17/2016] [Indexed: 11/17/2022]
Abstract
Background International travel carries the risk of imported diseases, which are an increasingly significant public health problem. There is little guidance about which variables should be collected by surveillance systems for strategy-based surveillance. Methods Surveillance forms for dengue, malaria, hepatitis A, typhoid and measles were collected from Australia and New Zealand and information on these compared with national surveillance forms from the UK and Canada by travel health experts. Variables were categorised by information relating to recent travel, demographics and disease severity. Results Travel-related information most commonly requested included country of travel, vaccination status and travel dates. In Australia, ethnicity information requested related to indigenous status, whilst in New Zealand it could be linked to census categories. Severity of disease information most frequently collected were hospitalisation and death. Conclusions Reviewing the usefulness of variables collected resulted in the recommendation that those included should be: overseas travel, reason for travel, entry and departure dates during the incubation period, vaccination details, traveller's and/or parents' country of birth, country of usual residence, time resident in current country, postcode, hospitalisation and death details. There was no agreement about whether ethnicity details should be collected. The inclusion of these variables on surveillance forms could enable imported infection-related policy to be formulated nationally and internationally.
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Affiliation(s)
- Penny E Neave
- School of Public Health and Psychosocial Studies, Auckland University of Technology, 90, Akoranga Drive, Northcote, Auckland, New Zealand.
| | - Anita E Heywood
- School of Public Health and Community Medicine, University of New South Wales, Kensington, New South Wales, Australia.
| | - Katherine B Gibney
- School of Public Health and Preventive Medicine, The Alfred Centre, Monash University, Commercial Road, Melbourne, Victoria, Australia.
| | - Karin Leder
- School of Public Health and Preventive Medicine, The Alfred Centre, Monash University, Commercial Road, Melbourne, Victoria, Australia.
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19
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German M, Olsha R, Kristjanson E, Marchand-Austin A, Peci A, Winter AL, Gubbay JB. Acute Respiratory Infections in Travelers Returning from MERS-CoV-Affected Areas. Emerg Infect Dis 2016; 21:1654-6. [PMID: 26291541 PMCID: PMC4550174 DOI: 10.3201/eid2109.150472] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We examined which respiratory pathogens were identified during screening for Middle East respiratory syndrome coronavirus in 177 symptomatic travelers returning to Ontario, Canada, from regions affected by the virus. Influenza A and B viruses (23.1%) and rhinovirus (19.8%) were the most common pathogens identified among these travelers.
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20
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Modeling Disease Spread at Global Mass Gatherings: Data Requirements and Challenges. RECENT ADVANCES IN INFORMATION AND COMMUNICATION TECHNOLOGY 2016 2016. [PMCID: PMC7123910 DOI: 10.1007/978-3-319-40415-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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Mathai D, Shamsuzzaman AKM, Feroz AA, Virani AR, Hasan A, Ravi Kumar KL, Ansari K, Forhad Hossain KA, Marda M, Wahab Zubair MA, Ali MM, Ashraf N, Basha R, Mirza S, Ahmed S, Akhtar S, Ashraf SM, Haque Z. Consensus Recommendation for India and Bangladesh for the Use of Pneumococcal Vaccine in Mass Gatherings with Special Reference to Hajj Pilgrims. J Glob Infect Dis 2016; 8:129-138. [PMID: 27942192 PMCID: PMC5126751 DOI: 10.4103/0974-777x.193749] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Respiratory tract infections are prevalent among Hajj pilgrims with pneumonia being a leading cause of hospitalization. Streptococcus pneumoniae is a common pathogen isolated from patients with pneumonia and respiratory tract infections during Hajj. There is a significant burden of pneumococcal disease in India, which can be prevented. Guidelines for preventive measures and adult immunization have been published in India, but the implementation of the guidelines is low. Data from Bangladesh are available about significant mortality due to respiratory infections; however, literature regarding guidelines for adult immunization is limited. There is a need for extensive awareness programs across India and Bangladesh. Hence, there was a general consensus about the necessity for a rapid and urgent implementation of measures to prevent respiratory infections in pilgrims traveling to Hajj. About ten countries have developed recommendations for pneumococcal vaccination in Hajj pilgrims: France, the USA, Kuwait, Qatar, Bahrain, the UAE (Dubai Health Authority), Singapore, Malaysia, Egypt, and Indonesia. At any given point whether it is Hajj or Umrah, more than a million people are present in the holy places of Mecca and Madina. Therefore, the preventive measures taken for Hajj apply for Umrah as well. This document puts forward the consensus recommendations by a group of twenty doctors following a closed-door discussion based on the scientific evidence available for India and Bangladesh regarding the prevention of respiratory tract infections in Hajj pilgrims.
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Affiliation(s)
- Dilip Mathai
- Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Hyderabad, Telangana, India
| | | | | | - Amin R Virani
- Prince Aly Khan Hospital, Mazagaon, Mumbai, Maharashtra, India
| | - Ashfaq Hasan
- Department of Pulmonary Medicine, Deccan College of Medical Sciences, Hyderabad, Telangana, India
| | - K L Ravi Kumar
- Department of Microbiology, Central Research Laboratory, Kempegowda Institute of Medical Sciences Hospital, Bengaluru, India
| | - Khalid Ansari
- Kalsekar Hospital, Thane, Mumbai, Maharashtra, India
| | | | - Mahesh Marda
- Premier Hospital, Mehdipatnam, Hyderabad, Telangana, India
| | - M A Wahab Zubair
- Princess Durru Shehvar Children and General Hospital, Hyderabad, Telangana, India
| | | | - N Ashraf
- Khadija National Hospital, New Delhi, India
| | - Riyaz Basha
- Rajiv Gandhi University of Health Sciences, Bengaluru, India
| | | | - Shafeeq Ahmed
- Haj Committee of India, Haj House, CST, Mumbai, Maharashtra, India
| | - Shamim Akhtar
- Department of Respiratory Medicine, St. Stephens Hospital, New Delhi, India
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22
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Ramanathan A, Pullum LL, Hobson TC, Steed CA, Quinn SP, Chennubhotla CS, Valkova S. ORBiT: Oak Ridge biosurveillance toolkit for public health dynamics. BMC Bioinformatics 2015; 16 Suppl 17:S4. [PMID: 26679008 PMCID: PMC4674898 DOI: 10.1186/1471-2105-16-s17-s4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The digitization of health-related information through electronic health records (EHR) and electronic healthcare reimbursement claims and the continued growth of self-reported health information through social media provides both tremendous opportunities and challenges in developing effective biosurveillance tools. With novel emerging infectious diseases being reported across different parts of the world, there is a need to build systems that can track, monitor and report such events in a timely manner. Further, it is also important to identify susceptible geographic regions and populations where emerging diseases may have a significant impact. Methods In this paper, we present an overview of Oak Ridge Biosurveillance Toolkit (ORBiT), which we have developed specifically to address data analytic challenges in the realm of public health surveillance. In particular, ORBiT provides an extensible environment to pull together diverse, large-scale datasets and analyze them to identify spatial and temporal patterns for various biosurveillance-related tasks. Results We demonstrate the utility of ORBiT in automatically extracting a small number of spatial and temporal patterns during the 2009-2010 pandemic H1N1 flu season using claims data. These patterns provide quantitative insights into the dynamics of how the pandemic flu spread across different parts of the country. We discovered that the claims data exhibits multi-scale patterns from which we could identify a small number of states in the United States (US) that act as "bridge regions" contributing to one or more specific influenza spread patterns. Similar to previous studies, the patterns show that the south-eastern regions of the US were widely affected by the H1N1 flu pandemic. Several of these south-eastern states act as bridge regions, which connect the north-east and central US in terms of flu occurrences. Conclusions These quantitative insights show how the claims data combined with novel analytical techniques can provide important information to decision makers when an epidemic spreads throughout the country. Taken together ORBiT provides a scalable and extensible platform for public health surveillance.
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23
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Aberle JH, Popow-Kraupp T, Kreidl P, Laferl H, Heinz FX, Aberle SW. Influenza A and B Viruses but Not MERS-CoV in Hajj Pilgrims, Austria, 2014. Emerg Infect Dis 2015; 21:726-7. [PMID: 25811672 PMCID: PMC4378469 DOI: 10.3201/eid2104.141745] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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24
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Abstract
The Middle East Respiratory Coronavirus (MERS-CoV) was first isolated from a patient who died with severe pneumonia in June 2012. As of 19 June 2015, a total of 1,338 MERS-CoV infections have been notified to the World Health Organization (WHO). Clinical illness associated with MERS-CoV ranges from mild upper respiratory symptoms to rapidly progressive pneumonia and multi-organ failure. A significant proportion of patients present with non-respiratory symptoms such as headache, myalgia, vomiting and diarrhoea. A few potential therapeutic agents have been identified but none have been conclusively shown to be clinically effective. Human to human transmission is well documented, but the epidemic potential of MERS-CoV remains limited at present. Healthcare-associated clusters of MERS-CoV have been responsible for the majority of reported cases. The largest outbreaks have been driven by delayed diagnosis, overcrowding and poor infection control practices. However, chains of MERS-CoV transmission can be readily interrupted with implementation of appropriate control measures. As with any emerging infectious disease, guidelines for MERS-CoV case identification and surveillance evolved as new data became available. Sound clinical judgment is required to identify unusual presentations and trigger appropriate control precautions. Evidence from multiple sources implicates dromedary camels as natural hosts of MERS-CoV. Camel to human transmission has been demonstrated, but the exact mechanism of infection remains uncertain. The ubiquitously available social media have facilitated communication and networking amongst healthcare professionals and eventually proved to be important channels for presenting the public with factual material, timely updates and relevant advice.
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25
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Omrani AS, Shalhoub S. Middle East respiratory syndrome coronavirus (MERS-CoV): what lessons can we learn? J Hosp Infect 2015; 91:188-96. [PMID: 26452615 PMCID: PMC7114843 DOI: 10.1016/j.jhin.2015.08.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/10/2015] [Indexed: 01/12/2023]
Abstract
The Middle East Respiratory Coronavirus (MERS-CoV) was first isolated from a patient who died with severe pneumonia in June 2012. As of 19 June 2015, a total of 1,338 MERS-CoV infections have been notified to the World Health Organization (WHO). Clinical illness associated with MERS-CoV ranges from mild upper respiratory symptoms to rapidly progressive pneumonia and multi-organ failure. A significant proportion of patients present with non-respiratory symptoms such as headache, myalgia, vomiting and diarrhoea. A few potential therapeutic agents have been identified but none have been conclusively shown to be clinically effective. Human to human transmission is well documented, but the epidemic potential of MERS-CoV remains limited at present. Healthcare-associated clusters of MERS-CoV have been responsible for the majority of reported cases. The largest outbreaks have been driven by delayed diagnosis, overcrowding and poor infection control practices. However, chains of MERS-CoV transmission can be readily interrupted with implementation of appropriate control measures. As with any emerging infectious disease, guidelines for MERS-CoV case identification and surveillance evolved as new data became available. Sound clinical judgment is required to identify unusual presentations and trigger appropriate control precautions. Evidence from multiple sources implicates dromedary camels as natural hosts of MERS-CoV. Camel to human transmission has been demonstrated, but the exact mechanism of infection remains uncertain. The ubiquitously available social media have facilitated communication and networking amongst healthcare professionals and eventually proved to be important channels for presenting the public with factual material, timely updates and relevant advice.
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Affiliation(s)
- A S Omrani
- Department of Medicine, Section of Infectious Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | - S Shalhoub
- Department of Medicine, Division of Infectious Diseases, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
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26
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Wilder-Smith A, Leong WY, Lopez LF, Amaku M, Quam M, Khan K, Massad E. Potential for international spread of wild poliovirus via travelers. BMC Med 2015; 13:133. [PMID: 26044336 PMCID: PMC4470344 DOI: 10.1186/s12916-015-0363-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/08/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The endgame of polio eradication is hampered by the international spread of poliovirus via travelers. In response to ongoing importations of poliovirus into polio-free countries, on 5 May 2014, WHO's Director-General declared the international spread of wild poliovirus a public health emergency of international concern. Our objective was to develop a mathematical model to estimate the international spread of polio infections. METHODS Our model took into account polio endemicity in polio-infected countries, population size, polio immunization coverage rates, infectious period, the asymptomatic-to-symptomatic ratio, and also the probability of a traveler being infectious at the time of travel. We applied our model to three scenarios: (1) number of exportations of both symptomatic and asymptomatic polio infections out of currently polio-infected countries, (2) the risk of spread of poliovirus to Saudi Arabia via Hajj pilgrims, and (3) the importation risk of poliovirus into India. RESULTS Our model estimated 665 polio exportations (>99 % of which were asymptomatic) from nine polio-infected countries in 2014, of which 78.3 % originated from Pakistan. Our model also estimated 21 importations of poliovirus into Saudi Arabia via Hajj pilgrims and 20 poliovirus infections imported to India in the same year. CONCLUSION The extent of importations of asymptomatic and symptomatic polio infections is substantial. For countries that are vulnerable to polio outbreaks due to poor national polio immunization coverage rates, our newly developed model may help guide policy-makers to decide whether imposing an entry requirement in terms of proof of vaccination against polio would be justified.
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Affiliation(s)
- Annelies Wilder-Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University, Mandalay Road 11, Singapore, 308232, Singapore. .,Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | - Wei-Yee Leong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Mandalay Road 11, Singapore, 308232, Singapore.
| | - Luis Fernandez Lopez
- Florida International University, Miami, USA. .,School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Marcos Amaku
- Faculty of Veterinary Medicine, University of São Paulo, São Paulo, Brazil.
| | - Mikkel Quam
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
| | - Kamran Khan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. .,Faculty of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, ON, Canada.
| | - Eduardo Massad
- School of Medicine, University of São Paulo, São Paulo, Brazil. .,London School of Hygiene and Tropical Medicine, London, UK.
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27
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Tabatabaei SM, Metanat M. Mass Gatherings and Infectious Diseases Epidemiology and Surveillance. ACTA ACUST UNITED AC 2015. [DOI: 10.17795/iji-22833] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Salamati P, Razavi SM. Be vigilant: New MERS-CoV outbreaks can occur in the Kingdom of Saudi Arabia. Travel Med Infect Dis 2015; 13:269-70. [PMID: 25858100 PMCID: PMC7128803 DOI: 10.1016/j.tmaid.2015.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/12/2015] [Accepted: 03/25/2015] [Indexed: 11/22/2022]
Affiliation(s)
- Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Sina Hospital, Hassan Abad Square, Imam Khomeini Avenue, Tehran, Iran.
| | - Seyed Mansour Razavi
- Department of Community Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Pour Sina Street, Ghods Avenue, Enghelab Avenue, Tehran, Iran
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29
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Abstract
Developing countries are at risk of importing Middle East Respiratory Syndrome Corona Virus (MERS CoV) from the Middle East. Hospitals in the Middle East currently reporting the disease are staffed by immigrants. In the current hot spots for MERS CoV a sizeable portion of the population is from other countries, but many of these countries have yet to detect any importation of MERS CoV. To assess the disease transmission in these countries, supplemental surveillance strategies are urgently needed beyond the currently recommended measures. A few strategies to address the situation are: (i) improving preparedness with enhanced surveillance in particular regions; (ii) targeting certain sentinel groups for surveillance in hot spots; and (iii) limited use of serosurveillance. Recovered, immune patients can be employed to give patient care during outbreaks.
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30
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Annan A, Owusu M, Marfo KS, Larbi R, Sarpong FN, Adu-Sarkodie Y, Amankwa J, Fiafemetsi S, Drosten C, Owusu-Dabo E, Eckerle I. High prevalence of common respiratory viruses and no evidence of Middle East respiratory syndrome coronavirus in Hajj pilgrims returning to Ghana, 2013. Trop Med Int Health 2015; 20:807-12. [PMID: 25688471 PMCID: PMC7169725 DOI: 10.1111/tmi.12482] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012 on the Arabian Peninsula and has caused severe respiratory disease with more than 800 laboratory-confirmed cases. The return of infected pilgrims to their home countries with a putative spread of MERS-CoV necessitates further surveillance. METHODS A cross sectional study of 839 adult African Hajj pilgrims returning to Accra in Ghana, West Africa, was conducted in 2013 to assess the prevalence of respiratory symptoms as well as of MERS-CoV, human rhinovirus (HRV), respiratory syncytial virus (RSV) and influenza A virus (FLU A) infection. RESULTS Six hundred and fifty-one (77.6%) pilgrims had respiratory symptoms. Tests were positive for at least one of the viruses other than MERS-CoV in 179 (21.3%) of all pilgrims, with 22.4% detection in symptomatic vs. 17.6% detection in asymptomatic pilgrims. No MERS-CoV was detected, although common respiratory viruses were prevalent, with positive findings for HRV in 141 individuals (16.8%), RSV in 43 individuals (5.1%) and FLU A in 11 individuals (1.3%). Results were positive for more than one virus in 16 (1.9%) individuals, including 14 (1.7%) RSV/HRV co-infections and 2 (0.2%) FLU A/HRV co-infections. A total 146 (22.4%) of the symptomatic returnees tested positive for at least one respiratory virus compared with 33 (17.6%) of the asymptomatic pilgrims who had at least one detectable virus in their sample. CONCLUSIONS The prevalence of viral respiratory infections among Hajj pilgrims in both symptomatic and asymptomatic subjects was high. Although it is reassuring that MERS-CoV was not detected in the tested population, there is a need for active surveillance of Hajj pilgrims.
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Affiliation(s)
- Augustina Annan
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Sridhar S, Gautret P, Brouqui P. A comprehensive review of the Kumbh Mela: identifying risks for spread of infectious diseases. Clin Microbiol Infect 2014; 21:128-33. [PMID: 25682278 PMCID: PMC7128512 DOI: 10.1016/j.cmi.2014.11.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 11/21/2014] [Accepted: 11/21/2014] [Indexed: 11/17/2022]
Abstract
The Kumbh Mela in India is the largest mass gathering in the world which witnessed close to 100 million visitors in 2013. An event of this magnitude presents challenges. Increased population density, reduced hygienic conditions and exposure to environmental pollutants pave the way for easy transmission of pathogens. Due to the possibility of epidemics, the primary focus should be on identifying the potential risk factors and implementing appropriate preventive measures. The context of religion and psychology of the pilgrims is also closely associated with the evolution of the risk factors and so forms an important part of the discussion. We provide a brief background to the Kumbh Mela with a description of the existing and potential risk factors that require our attention.
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Affiliation(s)
- S Sridhar
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, Marseille, France
| | - P Gautret
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, Marseille, France
| | - P Brouqui
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, Marseille, France.
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Maltezou HC, Tsiodras S. Middle East respiratory syndrome coronavirus: implications for health care facilities. Am J Infect Control 2014; 42:1261-5. [PMID: 25465253 PMCID: PMC7132773 DOI: 10.1016/j.ajic.2014.06.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/20/2014] [Accepted: 06/20/2014] [Indexed: 01/21/2023]
Abstract
Background Middle East respiratory syndrome coronavirus (MERS-CoV) is a novel coronavirus that causes a severe respiratory disease with high case fatality rate. Starting in March 2014, a dramatic increase of cases has occurred in the Arabian Peninsula, many of which were acquired in health care settings. As of May 9, 2014, 536 laboratory-confirmed cases and 145 deaths have been reported globally. Methods Review of publicly available data about MERS-CoV health care–associated transmission. Results We identified 11 events of possible or confirmed health care–associated transmission with high morbidity and mortality, mainly among patients with comorbidities. Health care workers are also frequently affected; however, they tend to have milder symptoms and better prognosis. Gaps in infection control were noted in all events. Currently, health care–associated outbreaks are playing a pivotal role in the evolution of the MERS-CoV epidemic in countries in the Arabian Peninsula. Conclusion There is a need to increase infection control capacity in affected areas and areas at increased risk of being affected to prevent transmission in health care settings. Vaccines and antiviral agents are urgently needed. Overall, our knowledge about the epidemiologic characteristics of MERS-CoV that impact health care transmission is very limited. As the MERS-CoV epidemic continues to evolve, issues concerning best infection control measures will arise, and studies to better define their effectiveness in real life are needed. Health care–associated transmission plays a pivotal role in the Middle East respiratory syndrome coronavirus epidemic. Gaps in infection control were noted in all health care–associated events. There is a need to increase infection control capacity. Studies about the effectiveness of infection control measures are needed. Vaccines and antiviral agents against Middle East respiratory syndrome coronavirus are urgently needed.
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Affiliation(s)
- Helena C Maltezou
- Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece.
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, University of Athens Medical School, Attikon University Hospital, Athens, Greece
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Gautret P, Gray GC, Charrel RN, Odezulu NG, Al-Tawfiq JA, Zumla A, Memish ZA. Emerging viral respiratory tract infections--environmental risk factors and transmission. THE LANCET. INFECTIOUS DISEASES 2014; 14:1113-1122. [PMID: 25189350 PMCID: PMC7106556 DOI: 10.1016/s1473-3099(14)70831-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The past decade has seen the emergence of several novel viruses that cause respiratory tract infections in human beings, including Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia, an H7N9 influenza A virus in eastern China, a swine-like influenza H3N2 variant virus in the USA, and a human adenovirus 14p1 also in the USA. MERS-CoV and H7N9 viruses are still a major worldwide public health concern. The pathogenesis and mode of transmission of MERS-CoV and H7N9 influenza A virus are poorly understood, making it more difficult to implement intervention and preventive measures. A united and coordinated global response is needed to tackle emerging viruses that can cause fatal respiratory tract infections and to fill major gaps in the understanding of the epidemiology and transmission dynamics of these viruses.
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Affiliation(s)
- Philippe Gautret
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, Marseille, France.
| | - Gregory C Gray
- College of Public Health and Health Professions and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Remi N Charrel
- Aix Marseille Université, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR-D 190 "Emergence des Pathologies Virales" and IHU Méditerranée Infection, APHM Public Hospitals of Marseille, Marseille, France
| | - Nnanyelugo G Odezulu
- College of Public Health and Health Professions and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, and Indiana University School of Medicine, Indiana, USA
| | - Alimuddin Zumla
- Center for Clinical Microbiology, Division of Infection and Immunity, University College London, and NIHR Biomedical Research Center, University College London Hospitals, London, UK
| | - Ziad A Memish
- WHO Collaborating Center for Mass Gathering Medicine Ministry of Health and Al-Faisal University, Riyadh, Saudi Arabia
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Pavli A, Tsiodras S, Maltezou HC. Middle East respiratory syndrome coronavirus (MERS-CoV): prevention in travelers. Travel Med Infect Dis 2014; 12:602-8. [PMID: 25457301 PMCID: PMC7110598 DOI: 10.1016/j.tmaid.2014.10.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 10/06/2014] [Accepted: 10/09/2014] [Indexed: 01/19/2023]
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV), a novel coronavirus that causes a severe lower respiratory tract infection in humans, emerged in the Middle East in 2012. Since then, MERS-CoV has caused an ongoing epidemic in the Arabian Peninsula with sporadic cases imported in Europe, North Africa, Southeast Asia, and the United States of America. As of 28th May 2014, 636 laboratory-confirmed cases of infection with MERS-CoV have been reported to World Health Organization including 14 cases imported by travelers. The epicenter of the current MERS-CoV epidemic is located in Saudi Arabia, where millions of pilgrims travel for two mass gatherings annually. In this review we summarize MERS-CoV cases in relation to travel with focus on the epidemiology and prevention in travelers. It is important to increase awareness of travelers about the risks and appropriate preventive measures and for health professionals to be on alert if a patient with severe respiratory symptoms reports a recent history of travel to the region affected with MERS-CoV. Measures should be taken by local health authorities of the affected countries in order to improve hospital hygiene. Finally, it is crucial to investigate the reasons for travelers' poor compliance with rules and recommendations issued by Saudi officials and to take appropriate measures in order to improve them.
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Affiliation(s)
| | - Sotirios Tsiodras
- Hellenic Center for Disease Control and Prevention, Athens, Greece; University of Athens Medical School, Athens, Greece
| | - Helena C Maltezou
- Department for Interventions in Health Care Facilities, Athens, Greece.
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Khalid M, Khan B, Al Rabiah F, Alismaili R, Saleemi S, Rehan-Khaliq AM, Weheba I, Al Abdely H, Halim M, Nadri QJ, Al Dalaan AM, Zeitouni M, Butt T, Al Mutairy E. Middle Eastern Respiratory Syndrome Corona Virus (MERS CoV): case reports from a tertiary care hospital in Saudi Arabia. Ann Saudi Med 2014; 34:396-400. [PMID: 25827696 PMCID: PMC6074560 DOI: 10.5144/0256-4947.2014.396] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Middle Eastern respiratory syndrome caused by novel coronavirus (MERS CoV) has been a major public health challenge since it was first described in 2012 in Saudi Arabia. So far, there is no effective treatment for this serious illness, which features a high mortality rate. We report an initial experience of the use of ribavirin and interferon (IFN)-a2b in the management of MERS CoV at a tertiary care hospital. DESIGN AND SETTINGS A case series of 6 patients admitted with a confirmed diagnosis of MERS CoV were treated with ribavirin and IFN-a2b in addition to supportive management. The patients' demographics, clinical parameters, and outcomes were recorded. Fifty-four close contacts of these patients were screened for MERS CoV. METHODS Six patients with MERS CoV infection were included in this study. Four cases featured symptomatic disease, including pneumonia and respiratory failure, while 2 were asymptomatic close contacts of the MERS CoV patients. The MERS CoV infection was confirmed by reverse transcription-polymerase chain reaction detection of the consensus viral RNA targets upstream of the E gene (UPE) and open reading frame (ORF1b) on a sputum sample. The patients' demographics, comorbid conditions, time to diagnosis and initiation of treatment, and clinical outcomes were recorded. RESULTS Three out of 6 patients who had comorbid conditions died during the study period, while 3 had suc.cessful outcomes. The diagnosis and treatment was delayed by an average of 15 days in those patients who died. Only 2 close contacts out of the 54 screened (3.7%) were positive for MERS CoV. CONCLUSION Treatment with ribavirin and IFN-a2b may be effective in patients infected with MERS CoV. There appears to be a low infectivity rate among close contacts of MERS CoV patients.
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Affiliation(s)
- Mohammad Khalid
- Dr. Mohammad Khalid, Department of Medicine, King Faisal Specialist Hospital & Research Center PO Box 3354 Riyadh 11211 Saudi Arabia,
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Gardner LM, Rey D, Heywood AE, Toms R, Wood J, Travis Waller S, Raina MacIntyre C. A scenario-based evaluation of the Middle East respiratory syndrome coronavirus and the Hajj. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2014; 34:1391-400. [PMID: 25041625 PMCID: PMC4238841 DOI: 10.1111/risa.12253] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Between April 2012 and June 2014, 820 laboratory-confirmed cases of the Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported in the Arabian Peninsula, Europe, North Africa, Southeast Asia, the Middle East, and the United States. The observed epidemiology is different to SARS, which showed a classic epidemic curve and was over in eight months. The much longer persistence of MERS-CoV in the population, with a lower reproductive number, some evidence of human-to-human transmission but an otherwise sporadic pattern, is difficult to explain. Using available epidemiological data, we implemented mathematical models to explore the transmission dynamics of MERS-CoV in the context of mass gatherings such as the Hajj pilgrimage, and found a discrepancy between the observed and expected epidemiology. The fact that no epidemic occurred in returning Hajj pilgrims in either 2012 or 2013 contradicts the long persistence of the virus in human populations. The explanations for this discrepancy include an ongoing, repeated nonhuman/sporadic source, a large proportion of undetected or unreported human-to-human cases, or a combination of the two. Furthermore, MERS-CoV is occurring in a region that is a major global transport hub and hosts significant mass gatherings, making it imperative to understand the source and means of the yet unexplained and puzzling ongoing persistence of the virus in the human population.
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Affiliation(s)
- Lauren M. Gardner
- School of Civil and Environmental EngineeringThe University of New South WalesSydneyNSW2052Australia
- NICTASydneyNSW2052Australia
| | - David Rey
- School of Civil and Environmental EngineeringThe University of New South WalesSydneyNSW2052Australia
| | - Anita E. Heywood
- School of Public Health and Community MedicineFaculty of MedicineUniversity of New South WalesSydneyNSW2052Australia
| | - Renin Toms
- School of Public Health and Community MedicineFaculty of MedicineUniversity of New South WalesSydneyNSW2052Australia
| | - James Wood
- School of Public Health and Community MedicineFaculty of MedicineUniversity of New South WalesSydneyNSW2052Australia
| | - S. Travis Waller
- School of Civil and Environmental EngineeringThe University of New South WalesSydneyNSW2052Australia
- NICTASydneyNSW2052Australia
| | - C. Raina MacIntyre
- School of Public Health and Community MedicineFaculty of MedicineUniversity of New South WalesSydneyNSW2052Australia
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Memish ZA, Assiri A, Alhakeem R, Yezli S, Almasri M, Zumla A, Al-Tawfiq JA, Drosten C, Albarrak A, Petersen E. Middle East respiratory syndrome corona virus, MERS-CoV. Conclusions from the 2nd Scientific Advisory Board Meeting of the WHO Collaborating Center for Mass Gathering Medicine, Riyadh. Int J Infect Dis 2014; 24:51-3. [PMID: 24818990 PMCID: PMC7128856 DOI: 10.1016/j.ijid.2014.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ziad A Memish
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
| | - Abdullah Assiri
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Rafaat Alhakeem
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Saber Yezli
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Malak Almasri
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Alimuddin Zumla
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia; Division of Infection and Immunity, University College London, and UCL Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jaffar A Al-Tawfiq
- Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, Kingdom of Saudi Arabia and Indiana University School of Medicine, Indianapolis, IN (USA)
| | - Christian Drosten
- Institute of Virology, University of Bonn Medical Centre, 53127 Bonn, Germany
| | | | - Eskild Petersen
- Institute of Clinical Medicine, Departments of Infectious Diseases and Clinical Microbiology, Aarhus University Hospital, Denmark
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Poletto C, Pelat C, Levy-Bruhl D, Yazdanpanah Y, Boelle PY, Colizza V. Assessment of the Middle East respiratory syndrome coronavirus (MERS-CoV) epidemic in the Middle East and risk of international spread using a novel maximum likelihood analysis approach. ACTA ACUST UNITED AC 2014; 19. [PMID: 24957746 DOI: 10.2807/1560-7917.es2014.19.23.20824] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The emergence of the novel Middle East (ME) respiratory syndrome coronavirus (MERS-CoV) has raised global public health concerns regarding the current situation and its future evolution. Here we propose an integrative maximum likelihood analysis of both cluster data in the ME and importations in a set of European countries to assess the transmission scenario and incidence of sporadic infections. Our approach is based on a spatial-transmission model integrating mobility data worldwide and allows for variations in the zoonotic/environmental transmission and under-ascertainment. Maximum likelihood estimates for the ME, considering outbreak data up to 31 August 2013, indicate the occurrence of a subcritical epidemic with a reproductive number R of 0.50 (95% confidence interval (CI): 0.30-0.77) associated with a daily rate of sporadic introductions psp of 0.28 (95% CI: 0.12-0.85). Infections in the ME appear to be mainly dominated by zoonotic/environmental transmissions, with possible under-ascertainment (ratio of estimated to observed (0.116) sporadic cases equal to 2.41, 95% CI: 1.03-7.32). No time evolution of the situation emerges. Analyses of flight passenger data from ME countries indicate areas at high risk of importation. While dismissing an immediate threat for global health security, this analysis provides a baseline scenario for future reference and updates, suggests reinforced surveillance to limit under-ascertainment, and calls for alertness in high importation risk areas worldwide.
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Gardner LM, MacIntyre CR. Unanswered questions about the Middle East respiratory syndrome coronavirus (MERS-CoV). BMC Res Notes 2014; 7:358. [PMID: 24920393 PMCID: PMC4068970 DOI: 10.1186/1756-0500-7-358] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 05/23/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The Middle East respiratory syndrome coronavirus (MERS-CoV) represents a current threat to the Arabian Peninsula, and potential pandemic disease. As of June 3, 2014, MERS CoV has reportedly infected 688 people and killed 282. We briefly summarize the state of the outbreak, and highlight unanswered questions and various explanations for the observed epidemiology. FINDINGS The continuing but infrequent cases of MERS-CoV reported over the past two years have been puzzling and difficult to explain. The epidemiology of MERS-CoV, with many sporadic cases and a few hospital outbreaks, yet no sustained epidemic, suggests a low reproductive number. Furthermore, a clear source of infection to humans remains unknown. Also puzzling is the fact that MERS-CoV has been present in Saudi Arabia over several mass gatherings, including the 2012 and 2013 Hajj and Umrah pilgrimages, which predispose to epidemics, without an epidemic arising. CONCLUSIONS The observed epidemiology of MERS-CoV is quite distinct and does not clearly fit either a sporadic or epidemic pattern. Possible explanations of the unusual features of the epidemiology of MERS-CoV include sporadic ongoing infections from a non-human source; human to human transmission with a large proportion of undetected cases; or a combination of both. The virus has been identified in camels; however the mode of transmission of the virus to humans remains unknown, and many cases have no history of animal contact. In order to gain a better understanding of the epidemiology of MERS CoV, further investigation is warranted.
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Affiliation(s)
- Lauren M Gardner
- CE 112 School of Civil and Environmental Engineering, The University of New South Wales, Sydney, NSW 2052, Australia.
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Memish ZA, Assiri A, Almasri M, Alhakeem RF, Turkestani A, Al Rabeeah AA, Al-Tawfiq JA, Alzahrani A, Azhar E, Makhdoom HQ, Hajomar WH, Al-Shangiti AM, Yezli S. Prevalence of MERS-CoV nasal carriage and compliance with the Saudi health recommendations among pilgrims attending the 2013 Hajj. J Infect Dis 2014; 210:1067-72. [PMID: 24620019 PMCID: PMC7107361 DOI: 10.1093/infdis/jiu150] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background. Annually, Saudi Arabia is the host of the Hajj mass gathering. We aimed to determine the Middle East respiratory syndrome coronavirus (MERS-CoV) nasal carriage rate among pilgrims performing the 2013 Hajj and to describe the compliance with the Saudi Ministry of Health vaccine recommendations. Method. Nasopharyngeal samples were collected from 5235 adult pilgrims from 22 countries and screened for MERS-CoV using reverse transcriptase–polymerase chain reaction. Information regarding the participants' age, gender, country of origin, medical conditions, and vaccination history were obtained. Results. The mean age of the screened population was 51.8 years (range, 18–93 years) with a male/female ratio of 1.17:1. MERS-CoV was not detected in any of the samples tested (3210 pre-Hajj and 2025 post-Hajj screening). According to the vaccination documents, all participants had received meningococcal vaccination and the majority of those from at-risk countries were vaccinated against yellow fever and polio. Only 22% of the pilgrims (17.5% of those ≥65 years and 36.3% of diabetics) had flu vaccination, and 4.4% had pneumococcal vaccination. Conclusion. There was no evidence of MERS-CoV nasal carriage among Hajj pilgrims. While rates of compulsory vaccinations uptake were high, uptake of pneumococcal and flu seasonal vaccinations were low, including among the high-risk population.
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Affiliation(s)
- Ziad A. Memish
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health
- College of Medicine, Alfaisal University, Riyadh
- Correspondence: Ziad A. Memish, MD, FRCPC, FACP, Deputy Minister Public Health, Ministry of Health, PO Box 54146, Riyadh, Central Province, 11514, Kingdom of Saudi Arabia ()
| | - Abdullah Assiri
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health
| | - Malak Almasri
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health
| | - Rafat F. Alhakeem
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health
| | | | | | - Jaffar A. Al-Tawfiq
- Saudi Aramco Medical Services Organization, Dhahran, Kingdom of Saudi Arabia
- Indiana University School of Medicine, Indianapolis
| | | | - Essam Azhar
- Special Infectious Diseases Unit, King Abdualziz University, King Fahad Medical Research Center, Jeddah
| | | | | | - Ali M. Al-Shangiti
- General Directorate of Laboratory Services, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Saber Yezli
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health
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Gautret P, Benkouiten S, Salaheddine I, Parola P, Brouqui P. Preventive measures against MERS-CoV for Hajj pilgrims. THE LANCET. INFECTIOUS DISEASES 2013; 13:829-31. [PMID: 24070554 PMCID: PMC7128098 DOI: 10.1016/s1473-3099(13)70259-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Philippe Gautret
- Aix Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France.
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Balaban V, Stauffer W, Hammad A, Afgarshe M, Abd-Alla M, Ahmed Q, Memish Z, Saba J, Harton E, Palumbo G, Marano N. Predictors of protective behaviors among American travelers to the 2009 Hajj. J Epidemiol Glob Health 2013. [PMID: 24206790 PMCID: PMC7320419 DOI: 10.1016/j.jegh.2013.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- V Balaban
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, United States.
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Balaban V. Predictors of protective behaviors among American travelers to the 2009 Hajj. J Epidemiol Glob Health 2013; 3:189-190. [PMID: 38620152 PMCID: PMC7128170 DOI: 10.1016/j.jegh.2013.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/07/2013] [Accepted: 08/08/2013] [Indexed: 12/31/2022] Open
Affiliation(s)
- V. Balaban
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, United States
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Gautret P, Benkouiten S, Salaheddine I, Belhouchat K, Drali T, Parola P, Brouqui P. Hajj pilgrims knowledge about Middle East respiratory syndrome coronavirus, August to September 2013. ACTA ACUST UNITED AC 2013; 18:20604. [PMID: 24135123 DOI: 10.2807/1560-7917.es2013.18.41.20604] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In preparation for Hajj 2013, 360 French pilgrims were interviewed regarding their knowledge about Middle East respiratory syndrome (MERS). Respondents were aged 20–85 years, male-female ratio was 1.05:1;64.7% were aware of the MERS situation in Saudi Arabia; 35.3% knew about the Saudi Ministry of Health recommendations for at-risk pilgrims to postpone participation in the 2013 Hajj. None of 179 at-risk individuals(49.9%) decided to cancel their Hajj participation even after advice during consultation.
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Affiliation(s)
- P Gautret
- Aix Marseille Universite, Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Marseille, France
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45
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Penttinen PM, Kaasik-Aaslav K, Friaux A, Donachie A, Sudre B, Amato-Gauci AJ, Memish ZA, Coulombier D. Taking stock of the first 133 MERS coronavirus cases globally--Is the epidemic changing? ACTA ACUST UNITED AC 2013; 18. [PMID: 24094061 DOI: 10.2807/1560-7917.es2013.18.39.20596] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Since June 2012, 133 Middle East respiratory syndrome coronavirus (MERS-CoV) cases have been identified in nine countries. Two time periods in 2013 were compared to identify changes in the epidemiology. The case-fatality risk (CFR) is 45% and is decreasing. Men have a higher CFR (52%) and are over-represented among cases. Thirteen out of 14 known primary cases died. The sex-ratio is more balanced in the latter period. Nosocomial transmission was implied in 26% of the cases.
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Affiliation(s)
- P M Penttinen
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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46
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Gautret P. Middle East Respiratory Syndrome (MERS) coronavirus. What travel health advice should be given to Hajj pilgrims? Travel Med Infect Dis 2013; 11:263-5. [PMID: 24055442 PMCID: PMC7130044 DOI: 10.1016/j.tmaid.2013.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 08/30/2013] [Indexed: 01/28/2023]
Affiliation(s)
- Philippe Gautret
- Aix Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France.
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47
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Tambyah PA, Tay J. The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n8p376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
| | - Joanne Tay
- Communicable Diseases Division, Ministry of Health, Singapore
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48
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Sakurai A, Takayama K, Nomura N, Munakata T, Yamamoto N, Tamura T, Yamada J, Hashimoto M, Kuwahara K, Sakoda Y, Suda Y, Kobayashi Y, Sakaguchi N, Kida H, Kohara M, Shibasaki F. Broad-spectrum detection of H5 subtype influenza A viruses with a new fluorescent immunochromatography system. PLoS One 2013; 8:e76753. [PMID: 24223117 PMCID: PMC3819354 DOI: 10.1371/journal.pone.0076753] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 08/29/2013] [Indexed: 11/19/2022] Open
Abstract
Immunochromatography (IC) is an antigen-detection assay that plays an important role in the rapid diagnosis of influenza virus because the protocol is short time and easy to use. Despite the usability of IC, the sensitivity is approximately 10(3) pfu per reaction. In addition, antigen-antibody interaction-based method cannot be used for the detection of influenza viruses with major antigenic change. In this study, we established the use of fluorescent immunochromatography (FLIC) to detect a broad spectrum of H5 subtype influenza A viruses. This method has improved sensitivity 10-100 fold higher than traditional IC because of the use of fluorescent conjugated beads. Our Type-E FLIC kit detected all of the H5 subtype influenza viruses that were examined, as well as recombinant hemagglutinin (HA) proteins (rHAs) belonging to the Eurasian H5 subtype viruses and the Type-N diagnosed North American H5 subtype influenza A viruses. Thus, this kit has the improved potential to detect H5 subtype influenza viruses of different clades with both Type-E and Type-N FLIC kits. Compared with PCR-based diagnosis, FLIC has a strong advantage in usability, because the sample preparation required for FLIC is only mix-and-drop without any additional steps such as RNA extraction. Our results can provide new strategies against the spread and transmission of HPAI H5N1 viruses in birds and mammals including humans.
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MESH Headings
- Animals
- Antibodies, Immobilized/chemistry
- Antibodies, Viral/chemistry
- Antibody Specificity
- Chromatography, Affinity
- Dogs
- Hemagglutinin Glycoproteins, Influenza Virus/immunology
- Humans
- Immunoassay
- Influenza A Virus, H5N1 Subtype/immunology
- Influenza A Virus, H5N1 Subtype/isolation & purification
- Influenza, Human/diagnosis
- Influenza, Human/virology
- Limit of Detection
- Madin Darby Canine Kidney Cells
- Reagent Kits, Diagnostic
- Spectrometry, Fluorescence
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Affiliation(s)
- Akira Sakurai
- Department of Molecular Medical Research, Tokyo Metropolitan Institute of Medical Science, Kamikitazawa, Setagaya-ku, Tokyo, Japan
| | | | - Namiko Nomura
- Department of Molecular Medical Research, Tokyo Metropolitan Institute of Medical Science, Kamikitazawa, Setagaya-ku, Tokyo, Japan
| | - Tsubasa Munakata
- Department of Microbiology and Cell Biology, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Naoki Yamamoto
- Laboratory of Microbiology, Department of Disease Control, Graduate School of Veterinary Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | | | | | - Masako Hashimoto
- Department of Molecular Medical Research, Tokyo Metropolitan Institute of Medical Science, Kamikitazawa, Setagaya-ku, Tokyo, Japan
| | - Kazuhiko Kuwahara
- Department of Immunology, Graduate School of Medical Sciences, Kumamoto University, Honjo, Chuo-ku, Kumamoto, Japan
| | - Yoshihiro Sakoda
- Laboratory of Microbiology, Department of Disease Control, Graduate School of Veterinary Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | | | | | - Nobuo Sakaguchi
- Department of Immunology, Graduate School of Medical Sciences, Kumamoto University, Honjo, Chuo-ku, Kumamoto, Japan
| | - Hiroshi Kida
- Laboratory of Microbiology, Department of Disease Control, Graduate School of Veterinary Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Michinori Kohara
- Department of Microbiology and Cell Biology, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Futoshi Shibasaki
- Department of Molecular Medical Research, Tokyo Metropolitan Institute of Medical Science, Kamikitazawa, Setagaya-ku, Tokyo, Japan
- * E-mail:
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