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Novel Coronavirus and H 7 N 9 Influenza Infections Situation update May 2013 Craig Novel Coronavirus and H 7 N 9 Influenza Infections Situation update May 2013 Craig Roberts, PA-C, MS ACHA Emerging Public Health Threats & Emergency Response Coalition

Novel Coronavirus (MERS-Co. V) overview • Coronaviruses are common viruses that most people get Novel Coronavirus (MERS-Co. V) overview • Coronaviruses are common viruses that most people get at some time in their life. Human coronaviruses usually cause mild to moderate upper-respiratory illness. • A new coronavirus was identified as the cause of respiratory illness in 43 people from Saudi Arabia, Qatar, Jordan, the United Kingdom, the United Arab Emirates, Germany and France from April 2012 to May 2013.

MERS-Co. V: epi MERS – Middle East Respiratory Syndrome European cases all linked to MERS-Co. V: epi MERS – Middle East Respiratory Syndrome European cases all linked to Middle East cases No known cases in U. S. Suspected to be of animal origin with sporadic transmission to humans via unknown route • Index case was a 25 yo college student (4/2012) • Age range 24 y-96 y (median 56 y); 79% male • •

MERS-Co. V: characteristics • Severe respiratory illness with high mortality – ARDS, renal failure, MERS-Co. V: characteristics • Severe respiratory illness with high mortality – ARDS, renal failure, coagulopathies, pericarditis, GI symptoms • Underlying conditions common • Limited person-to-person transmission – Family members – Health care personnel

MERS-Co. V: surveillance • Travel status: Watch • Applies to 14 Arabian countries* • MERS-Co. V: surveillance • Travel status: Watch • Applies to 14 Arabian countries* • Travel history is important in evaluation of acute respiratory illness • See CDC guidance at www. cdc. gov/coronavirus/ncv/case-def. html *Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen

H 7 N 9 influenza Novel variant not seen in humans before 132 cases H 7 N 9 influenza Novel variant not seen in humans before 132 cases reported in China, 36 deaths (27%) Males aged 50+ at highest risk of disease Sporadic infections in humans; many with poultry exposure • No sustained or community transmission • No known cases in the U. S. , 54 travelers tested • •

Avian Influenza A (H 7 N 9) Infection Avian Influenza A (H 7 N 9) Infection

Location of H 7 N 9 Influenza Cases in China 132 total cases/36 deaths* Location of H 7 N 9 Influenza Cases in China 132 total cases/36 deaths* Province/ City Russia HEBEI Pakistan South Korea NINGXIA SHANXI SHANDONG QINGHAI GANSU JIANGSU SHAANXI XIZANG ZHEJIANG CHONGQING HUNAN Bhutan SHANGHAI ANHUI HUBEI SICHUAN Nepal HENAN JIANGXI GUIZHOU FUJIAN India Bangladesh Taiwan YUNNAN GUANGDONG GUANGXI HAINAN Philippines Thailand 0 27 Jiangxi 6 2 34 Zhejiang 46 *as of 5/20/2013 Laos 0 2 α- includes a case hospitalized in Taiwan Vietnam Burma Hunan Shanghai TIANJIN 4 Shandong North Korea 5 Jiangsuα LIAONING BEIJING 2 Henan JILIN INNER MONGOLIA 4 Fujian Mongolia Anhui Beijing HEILONGJIANG XINJIANG Number of Cases 500 Kilometers 500 Miles

H 7 N 9 surveillance • Travel status: Watch (China) Going to China? avoid H 7 N 9 surveillance • Travel status: Watch (China) Going to China? avoid contact with poultry Returning from China? Monitor for ILI X 10 days • Travel history should be routinely collected in evaluation of any influenza-like illness • ILI surveillance continues 52 weeks per year • Most PH Labs have capacity to test for H 7 N 9

H 7 N 9 Influenza - Guidance Specific guidance for U. S. health care H 7 N 9 Influenza - Guidance Specific guidance for U. S. health care professionals: – Infection control Use full PPE (glove/gown/eye protection), N 95 mask – Use of antiviral medication “treatment with oseltamivir or inhaled zanamivir should be initiated when confirmed cases, probable cases, or H 7 N 9 cases under investigation are recognized, even if more than 48 hours from illness onset and even for apparently uncomplicated illness” – Diagnosis and laboratory testing See: www. cdc. gov/flu/avianflu/h 7 n 9 -healthprofessionals. htm

What, Me Worry? We are just one plane ride away… What, Me Worry? We are just one plane ride away…