Thursday, May 24, 2018

Sweden: LPAI H5 At A Pheasant Plant Near Malmö



















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A couple of days ago, in ESA Epidemiological Update: HPAI Clade 2.3.4.4 Viruses in Europe as of 3rd May 2018, we looked at recent reports of HPAI (Highly Pathogenic Avian Influenza) across Europe, including the following 4 detections from Sweden.
  • Sweden: cases in two white-tailed eagles (reports on 09/04 and 26/04), in a common buzzard (report on 26/04), and in a Northern goshawk (Accipiter gentilis) (report on 26/04)
While LPAI (low pathogenic avian influenza) viruses are often found in wild birds, and are considered less dangerous than HPAI viruses, they carry one overriding concern; H5 and H7 subtypes have a habit of mutating into far more dangerous HPAI viruses when allowed to spread unchecked in poultry.

Frequently discussed in this blog, this LPAI-to-HPAI mutation was recently the subject of a study (see Frontiers Vet. Sci.: Patterns In the Emergences Of HPAI H5 & H7 Viruses In Poultry) that examined both mutation and reassortment in the generation of HPAI viruses.


Although spontaneous mutation from LPAI-to-HPAI doesn't happen all that often, the risk is considered great enough that all LPAI H5 and H7 outbreaks must be reported to the OIE, and immediate steps must be taken to contain and eradicate the virus.
A little over two weeks ago, in neighboring Denmark, we saw the DVFA order 20,000 Ducks Culled Due To LPAI H5.

Today it is Sweden's turn, as announced by the following press release today  from their Ministry of Agriculture.

 (Translated)
Bird flu at wild bird plant in Skåne
 
Press Release • May 24, 2018 16:14 CEST

A case of avian influenza of the type H5 has been found at a plant breeding pheasants in Arlöv outside Malmö. The virus is presence, that is to say, less pathogenic than the so-called highly pathogenic avian influenza virus that has recently been shown in Sweden. The samples are analysed by the National Veterinary Institute (SVA) within the regular monitoring programme for avian influenza.

"To avoid dispersal to poultry, it is important that poultry producers and hobby bird owners have good disease control procedures," says Karin Åhl, STF Head of unit for horse, poultry and game at the Swedish Board of Agriculture.

"This virus is presence, that is to say, less pathogenic than the so-called highly pathogenic avian influenza viruses that have been demonstrated in Sweden on several occasions in recent years. However, Lpai virus may, under certain circumstances, be transformed into highly pathogenic, which is the main reason for the monitoring of outbreaks with low pathogenic avian influenza, says Karl Ståhl, deputy Statsepizootolog of SVA.

Control area around the infected farm

With regard to the infected plant for pheasant farming, the Swedish Board of Agriculture has now decided on refusal and there are special restrictions which mean that no animals or animal products are allowed to leave or enter the establishment.

The Swedish Board of Agriculture has also decided to introduce a control area with a kilometre radius around the farm. The control area includes the following restrictions:

Persons visiting animal housing with poultry and other birds must comply with the hygiene rules.
  • The transport of poultry, live birds, hatching eggs and poultry products between poultry holdings shall be prohibited.
  • It shall be prohibited to transport poultry, live birds, hatching eggs and poultry products out of and into the control area.
It is possible to apply for exemptions for certain transport operations in the areas.
– To counteract the contamination of the blocked pheasant herd, the animals will be killed. This naturally means a strain on the animal owner, says Karin Åhl
Naturally found among wild birds

Avian influenza is found in many variants and is highly contagious between birds. Milder variants of the virus are found naturally among wild birds, especially in seabirds. Security Level 1 applies in Sweden, which means that poultry can be outside, but that feed and water must be given under roof or under an outdoor shelter.

It is important to have good management practices and to prevent direct and indirect contact with wild birds as far as possible. Pet owners should be attentive and contact the veterinarian if poultry shows increased mortality, changes in feed and water consumption, reduction in egg production or reduced general conditions.

In February 2018, avian influenza was discovered by the type H5N6 of a sea eagle and a buzzards on the Blekinge coast. Subsequently, further cases have been found in a hobby crew in Uppsala County and more wild birds.

General hygiene Rules

  • Ensure that only those who manage Tamfåglarna have access to the animal spaces.
  • Keep clean around houses and enclosures.
  • Be careful with the hygiene procedures.
  • Wash hands after contact with the birds.
  • After a stay abroad, you should not have contact with poultry until at the earliest after 48 hours.

NHC: 80% Chance Of Tropical Development In Gulf This Weekend






















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Technically, the Atlantic Hurricane Season doesn't start for another week, but as I mentioned on Tuesday (see A Pre-Season Reminder To Prepare), the tropics don't always follow the rules.   
What was given a 40% chance to develop on Tuesday now has an 80% chance of becoming a tropical or sub-tropical system over the next 5 days. 
None of this speaks to its intensity - which is likely to top out as a tropical depression or possibly a tropical storm - but it does remind us of the value of being ready for the upcoming hurricane season.

Yesterday NOAA released their estimate for the Pacific Hurricane season (see NOAA predicts a near- or above-normal 2018 hurricane season in the central Pacific), and we should get their take on the Atlantic hurricane season in the next week or so. 
If you haven't started your 2018 hurricane preparedness, I'd invite you to revisit Tuesday's blog and  Hurricane Preparedness Week 2018 (May 6th - May 12th).
The 8am Tropical Outlook from the NWS National Hurricane Center follows:

ZCZC MIATWOAT ALL
TTAA00 KNHC DDHHMM

Special Tropical Weather Outlook
NWS National Hurricane Center Miami FL
740 AM EDT Thu May 24 2018

For the North Atlantic...Caribbean Sea and the Gulf of Mexico:

1. A broad, stationary surface low pressure system centered over the southeastern Yucatan Peninsula is gradually becoming better defined.


Although showers and thunderstorms, along with strong gusty winds, are confined primarily to the adjacent waters of the northwestern Caribbean Sea, gradual development of this system is expected during the next couple of days as it drifts northward near the Yucatan Peninsula.  Environmental conditions are forecast to become more conducive for development through early next week, and a subtropical or tropical depression is likely to form by late Saturday over the southeastern Gulf of Mexico.  


Regardless of development, locally heavy rainfall is forecast across western Cuba and over much of Florida and the northern Gulf Coast into early next week. In addition, the threat of rip currents will steadily increase along the Gulf coast from Florida westward to Louisiana over Memorial Day weekend. For more information on these threats, please see products issued by your local weather office. 
The next Special Tropical Weather Outlook on this system will be issued by 200 PM EDT this afternoon.
* Formation chance through 48 hours...medium...40 percent.
* Formation chance through 5 days...high...80 percent.

Forecaster Stewart

CDC Update: Candida Auris - April 2018


https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html
















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Not quite two years ago (June 2016) the CDC issued a Clinical Alert to U.S. Health care facilities about the Global Emergence of Invasive Infections Caused by the Multidrug-Resistant Yeast Candida auris.

C. auris is an emerging fungal pathogen that was first isolated in Japan in 2009. It was initially found in the discharge from a patient's external ear (hence the name `auris').  Retrospective analysis has traced this fungal infection back over 20 years.
Since then the CDC and public health entities have been monitoring an increasing number of cases (and hospital clusters) in the United States and abroad, generally involving bloodstream infections, wound infections or otitis.
Adding to the concern:
  1. C. auris infections have a high fatality rate
  2. The strain appears to be resistant to multiple classes of anti-fungals  
  3. This strain is unusually persistent on fomites in healthcare environments.
  4. And it can be difficult for labs to differentiate it from other Candida strains
The CDC has updated their C. Auris surveillance page, where they show - as of April 30th  - 279 confirmed cases and 29 probable cases, across 11 states.  An increase of more than 10% over the previous month.
 
https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html
 

Additionally, based on targeted screening in four states reporting clinical cases, the CDC reports an additional 517 patients have been discovered to be asymptomatically colonized with C. auris.

As previously mentioned, this isn't just a United States' problem, but a global health threat.  This fungal infection, which was first detected in Japan in 2009, has now turned up on multiple continents.
For more on this emerging fungal pathogen, you may wish peruse the CDC's dedicated web page:
General Information about Candida auris
Tracking Candida auris
Patients and Family Members
Healthcare Professionals
Fact Sheet
Publications
And for some older blogs on the topic, you may wish to revisit:
MMWR: Ongoing Transmission of Candida auris in Health Care Facilities
MMWR: Investigation of the First Seven Reported Cases of Candida auris In the United States
mSphere: Comparative Pathogenicity of UK Isolates of the Emerging Candida auris


Wednesday, May 23, 2018

EID Journal: Reemergence of Reston Ebolavirus in Cynomolgus Monkeys, the Philippines, 2015














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Long time readers with good memories will recall in September of 2015, in Ebola Reston Discovered In Philippine Lab Monkeys, we looked at the  announcement of the discovery of Ebola Reston among laboratory monkeys being kept at an unnamed research laboratory in the Philippines.
Ebola Reston is one of five known Ebola virus species, and the only one found to be endemic outside of Africa.
Unlike its African cousins, Ebola Reston – while capable of infecting humans – is not known to produce illness or death in man.  It can, however, produce serious illness in non-human primates, and can infect pigs (generally asymptomatically).
Ebola Reston was first discovered in crab-eating macaques - imported from the Philippines - at a research laboratory in Reston, Virginia (USA) (hence the name) in 1989. This discovery was recounted somewhat sensationally in the book, The Hot Zone, by Richard Preston.
In the October 2014 CDC Review of Human-to-Human Transmission of Ebola Virus described the 1989 Reston laboratory outbreak and subsequent infection of personnel. 
Similarly, an outbreak of Reston virus (Reston ebolavirus species, which does not cause EVD in humans) infection occurred in a quarantine facility housing non-human primates in separate cages and the transmission route could not be confirmed for all infected primates.
Multiple animal handlers developed antibody responses to Reston virus suggesting asymptomatic infection was occurring in humans with direct animal contact and implicating animal handling practices in transmission between primates
Somewhat famously, in late 2008 Ebola Reston made another high profile appearance when it was reported for the first time in pigs, again from the Philippines.  This from the FAO.
First detection of Ebola-Reston virus in pigs

23-12-2008
FAO/OIE/WHO offer assistance to the Philippines

Manila/Roma, 23 December 2008 - Following the detection of the Ebola-Reston virus in pigs in the Philippines, FAO, the World Organization for Animal Health (OIE) and the World Health Organization (WHO) announced today that the government of the Philippines has requested the three agencies send an expert mission to work with human and animal health experts in the Philippines to further investigate the situation.
An increase in pig mortality on swine farms in the provinces of Nueva Ecija and Bulacan in 2007 and 2008 prompted the Government of the Philippines to initiate laboratory investigations. Samples taken from ill pigs in May, June and September 2008 were sent to international reference laboratories which confirmed in late October that the pigs were infected with a highly virulent strain of Porcine reproductive and respiratory syndrome (PRRS) as well as the Ebola-Reston virus.

(Continue . . .)

Roughly a month later, we learned that several farm workers in contact with infected pigs tested positive for antibodies to the Ebola-Reston virus.  None displayed any signs of illness (see Ebola Reston in pigs and humans in the Philippines).

While not currently viewed as a human health threat, the World Health Organization hedges its bets slightly with Ebola Reston by stating:
Among workers in contact with monkeys or pigs infected with Reston ebolavirus, several infections have been documented in people who were clinically asymptomatic. Thus, RESTV appears less capable of causing disease in humans than other Ebola species.
However, the only available evidence available comes from healthy adult males. It would be premature to extrapolate the health effects of the virus to all population groups, such as immuno-compromised persons, persons with underlying medical conditions, pregnant women and children. More studies of RESTV are needed before definitive conclusions can be drawn about the pathogenicity and virulence of this virus in humans.
Two years ago (March 2016) we took another look at this Ebola outlier (see I'm Not Dying, I'm Just Reston) after a study was published in Nature Scientific Reports that found relatively few differences between Ebola Reston and the deadlier strains.
By focusing on a few key areas of the virus that are believed to affect its virulence in a human host, the authors concluded that only a few changes in one Ebola virus protein (VP24) might be needed to turn Ebola Reston into a virus that can cause human disease.
Although somewhat speculative, this study does remind us that viruses can change behavior over time, and that just because Ebola Reston doesn't appear to produce disease in humans today, that doesn't guarantee how it will behave tomorrow.

All of which serves as prelude to a new study, published this week in the CDC's EID Journal, which provides us with details on the 2015 Ebola Reston outbreak and subsequent investigation at the Primate lab in the Philippines.


Volume 24, Number 7—July 2018
Research

Reemergence of Reston ebolavirus in Cynomolgus Monkeys, the Philippines, 2015
 
Catalino Demetria, Ina Smith, Titus Tan, Daniel Villarico, Edson Michael Simon, Rex Centeno, Mary Tachedjian, Satoshi Taniguchi, Masayuki Shimojima, Noel Lee J. Miranda, Mary Elizabeth Miranda, Melissa Marie R. Rondina, Rowena Capistrano, Amado Tandoc, Glenn Marsh, Debbie Eagles, Ramses Cruz, and Shuetsu Fukushi
Abstract

In August 2015, a nonhuman primate facility south of Manila, the Philippines, noted unusual deaths of 6 cynomolgus monkeys (Macaca fascicularis), characterized by generalized rashes, inappetence, or sudden death. We identified Reston ebolavirus* (RESTV) infection in monkeys by using serologic and molecular assays.
We isolated viruses in tissues from infected monkeys and determined viral genome sequences. RESTV found in the 2015 outbreak is genetically closer to 1 of the 4 RESTVs that caused the 2008 outbreak among swine. Eight macaques, including 2 also infected with RESTV, tested positive for measles. Concurrently, the measles virus was circulating throughout the Philippines, indicating that the infection of the macaques may be a reverse zoonosis. Improved biosecurity measures will minimize the public health risk, as well as limit the introduction of disease and vectors.
(SNIP)

Discussion

In 2015, 19 years after the last known epizootic occurrence of RESTV in macaques in the Philippines, we detected and confirmed the incidence of RESTV in macaques in a primate facility south of Manila, by serologic and molecular testing. In spite of the long hiatus, RESTV was found in a controlled environment in which monkeys are systematically housed to avoid spread of diseases and to which no wild monkeys have been introduced. Personnel in the facility had no evidence of infection because no RESTV antibodies were detected.

We observed rats in cages in the primate facility that housed the primates being tested, indicating the potential for small animals to gain access to the facility. A recent study identified the microbat Miniopterus schreibersii as a possible reservoir of RESTV (6); therefore, this bat species and similar ones of this size may be the source of infection in the quarantine facility. If this is the case, improved biosecurity measures are warranted to limit the introduction of disease. However, we do not claim the bat species as the direct source of infection in 2015 outbreak. Because the facility building has its own anteroom with welded wire window screens, there is little likelihood that bats entered the facility.

Dual infections of RESTV and simian hemorrhagic fever virus (SHFV) in cynomologus monkeys has been reported in a facility in Reston, Virginia, and SHFV is the suspected causal agent for mortality in monkeys (17). Dual infections of RESTV and PRRSV in swine have been identified in the Philippines (5) and in Shanghai, China (18). In these cases, all of the RESTV-positive swine were coinfected with PRRSV. In contrast, we found in this study that 1 (ID: DrpZ1–26D-B) of the 10 macaques positive for RESTV antibody was also positive for MV antibody. Furthermore, another macaque (ID: DrpZ2–10B-G) was confirmed to have dual infection of RESTV and MV by using PCR. The results show similarities with dual infections such as SHFV and RESTV in macaques (17), or RESTV and PRRSV infections in swine (5). However, MV was not detected among most macaques positive for RESTV that died from the disease. Also, it remains unclear whether the MV infection supports an increase in RESTV replication in macaques. We found that 8 macaques had antibodies against MV, and 1 was MV PCR positive. Considering the risk for human-to-primate transmission (19,20), there is a possibility that MV infection in macaques is associated with human MV outbreak in the Philippines, although further studies are required to identify the mode of transmission of MV infection in macaques.

The RESTV sequences obtained were most similar to Reston-08-E from the Philippines 2008 outbreak in swine (5) (Figure 1). There were 3 nucleotide variations between the viral isolates that were sequenced, 2 of which in isolate DrpZ5–2B-F resulted in nonconservative changes in the NP and VP24 proteins that were unique when compared to all of the RESTV isolates sequenced. 

Because of the similarity with other Ebola viruses and the virus’ ability to infect humans, there is a concern that RESTV could mutate during passage through animals like macaques and cause an epidemic of disease in humans. Because it could mutate to pose health consequences for humans, continued surveillance is required to reduce the risk of transmitting Reston Ebola virus. 


Dr. Demetria is the head of the Rabies and Special Pathogens Laboratory at the Research Institute for Tropical Medicine in The Philippines. He has a strong interest in emerging zoonotic infectious diseases.
Ebola viruses, the Marburg Virus, Nipah, MERS, and a long list of other pathogens are carried by bats, making their study increasingly important in the world of virology and epidemiology.

A list of some recent bat-related blogs include:

Indian Government Responds To Reported Nipah Outbreak In Kerala

Back To The Bat Cave: More Influenza In Bats

EID Journal: A New Bat-HKU2–like Coronavirus in Swine, China, 2017

Emerg. Microbes & Infect.: Novel Coronaviruses In Least Horseshoe Bats In Southwestern China

SARS-like WIV1-CoV poised for human emergence

WHO DRC Ebola Update - May 23rd



















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We are just a few weeks into the DRC's 9th Ebola outbreak of the past 40 years, and already there are (as of May 21st) 58 confirmed or suspected Ebola virus disease (EVD) cases, including 27 deaths reported from 3 separate regions of Equateur Province.
Last week (see WHO Statement On 1st Urban Ebola Case Reported in DRC) we learned the virus has been detected in Wangata, part of the heavily populated city of Mbandaka (pop. 1.2 million), some 150 km from the initial outbreak in the Bikoro health zone.
Today's report indicates that the number of cases in Wangata has now increased to 7 (4 confirmed and 3 suspected cases), raising concerns over futher transmission in this heavily populated region.  

Details, however, remain scant and multiple epidemiological investigations are ongoing.  We know that 3 of the 58 cases are health care workers, and about 600 potentially exposed people are being monitored.


The full update follows:

Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news
23 May 2018 


On 8 May 2018, the Ministry of Health (MoH) of the Democratic Republic of the Congo declared an outbreak of Ebola virus disease (EVD). This is the ninth outbreak of Ebola virus disease over the last four decades in the country, with the most recent outbreak occurring in May 2017 (Figure 1). Additional information on this outbreak is available from situation reports in the links below. 

Since the last Disease Outbreak News on 17 May 2018, an additional fourteen cases with four deaths have been reported. On 21 May 2018, eight new suspected cases were reported, including six cases in Iboko Health Zone and two cases in Wangata Health Zone. On 20 May, seven cases (reported previously) in Iboko Health Zone have been confirmed. Recently available information has enabled the classification of some cases to be updated1.

As of 21 May 2018, a cumulative total of 58 Ebola virus disease (EVD) cases, including 27 deaths (case fatality rate = 47%), have been reported from three health zones in Equateur Province. The total includes 28 confirmed, 21 probable and 9 suspected cases from the three health zones: Bikoro (n=29; ten confirmed and 19 probable), Iboko (n=22; fourteen confirmed, two probable and six suspected cases) and Wangata (n=7; four confirmed and three suspected case). 

Of the four confirmed cases in Wangata, two have an epidemiological link with a probable case in Bikoro from April 2018. As of 21 May, over 600 contacts have been identified and are being followed-up and monitored field investigations are ongoing to determine the index case. Three health care workers were among the 58 cases reported.

Public health response

The Ministry of Health is leading the response in affected health zones with the support of WHO and partners. Priorities include the strengthening of surveillance and contract tracing, laboratory capacity, infection prevention and control, case management, community engagement, safe and dignified burials, response coordination, and vaccination.
  • WHO is working with the Ministry of Health, Gavi, the Vaccine Alliance, Médecins Sans Frontières (MSF), UNICEF and other partners, including the Ministry of Health of Guinea, to conduct vaccination against Ebola for people at high risk of infection in affected health zones.
  • On 21 May 2018, ring vaccination started along with vaccination of health workers in Mbandaka (WHO) and Bikoro (MSF). Merck has provided WHO with 8 640 doses of the rVSVΔG-ZEBOV vaccine of which 7 540 doses are available in the Democratic Republic of the Congo (approximately enough for 50 rings of 150 people). An additional 8 000 doses will be available in the coming days.
  • WHO continues to strengthen surveillance and contract tracing activities. The Early Warning Alert and Response (EWAR) System was deployed to Wangata to improve the collection and management of information cases and contacts.
  • Staff in health facilities in Wangata and Bikoro continue to be trained to use EWARS and enhance surveillance activities. A hotline was re-established to assist the detection of new cases, and an alert system was setup with MSF in Wangata. Rapid Response Teams (RRT) and “relais communautaires” have been trained and activated to investigate new cases and conduct contract tracing.
  • WHO continues to coordinate with the UN Humanitarian Air Service (UNHAS) for daily air transport between Mbandaka and Bikoro. In Iboko, an airstrip has been cleared for helicopters to land.
  • Case management and infection, prevention and control activities continue to be scaled up with the establishment, stocking and staffing of Ebola Treatment Units (ETUs) within affected areas. MSF-Belgium continues support case management within the Bikoro Reference Hospital. WHO is coordinating with clinical teams (EMTs) to be on standby should further ETUs be required, and to mobilize four teams to support triage, IPC and maintenance of essential health services for the population at the major health facilities in Mbandaka, as well as a team to support a safe ambulance referral system for patients.
  • WHO, UNICEF and partners are supporting the Ministry of Health to raise awareness and engage affected communities to promote the early identification of signs and symptoms of EVD, seek prompt treatment, and practice safe and dignified burials. Risk communication activities are continuing in the affected areas and Kinshasa.
  • As of 21 May, WHO has deploymed 123 personnel. WHO is working with the Global Outbreak Alert and Response Network (GOARN) partners and technical networks, including the Emerging Diseases Clinical Assessment and Response Network (EDCARN) and the WHO Emerging and Dangerous Pathogen Laboratory Network (EDPLN) to coordinate response planning and technical support, and to deploy additional technical support. As of 21 May, 15 exerts from GOARN partners are being deployments to strengthen field teams.
  • Preparation Support Teams (PST) missions are underway in several priority countries in the region to enhance preparedness and readiness in the event of further spread.

WHO risk assessment

Information about the extent of the outbreak is still limited and investigations are ongoing. The confirmed case in Mbandaka, a large urban centre located on major national and international rivers, roads and domestic air routes, increases the risk of spread within the Democratic Republic of the Congo and to neighbouring countries. WHO has, therefore, revised the assessment of public health risk to very high at the national level and high at the regional level. Nine neighbouring countries, including Congo-Brazzaville and Central African Republic, have been advised that they are at high risk of spread, and preparedness activities are being undertaken. At the global level the risk currently remains low. This risk assessment is continuously being review as further information becomes available.

Based on the current situation and information available, the WHO Director-General convened an Emergency Committee under the International Health Regulations (IHR) (2005) on Friday 18 May to provide advice on whether the current outbreak constitutes a public heath event of international concern2. It was the view of the Committee that the conditions for a Public Health Emergency of International Concern have not currently been met.

WHO advice

In light of the advice of the Emergency Committee, WHO continues to advise against the application of any travel or trade restrictions. WHO continues to monitor travel and trade measures in relation to this event, and currently there are no restrictions on international traffic in place. 

The Emergency Committee while noting that the conditions for a PHEIC are not currently met, issued the following Public Health Advice:
  • Government of the Democratic Republic of the Congo, WHO, and partners remain engaged in a vigorous response – without this, the situation is likely to deteriorate significantly. This response should be supported by the entire international community.
  • Global solidarity among the scientific community is critical and international data should be shared freely and regularly.
  • It is particularly important there should be no international travel or trade restrictions.
  • Neighbouring countries should strengthen preparedness and surveillance.
  • During the response, safety and security of staff should be ensured, and protection of responders and national and international staff should prioritised.
  • Exit screening, including at airports and ports on the Congo river, is considered to be of great importance; however entry screening, particularly in distant airports, is not considered to be of any public health or cost-benefit value.
  • Robust risk communication (with real-time data), social mobilisation, and community engagement are needed for a well-coordinated response and so that those affected understand what protection measures are being recommended.
  • If the outbreak expands significantly, or if there is international spread, the Emergency Committee will be reconvened.
For more information on Ebola virus disease, please see the link below:

EMRO MERS-CoV Summary - April















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We are now just over a week into the Holy Month of Ramadan, which is second only to the Hajj in seeing religious pilgrims visiting the Holy sites of Saudi Arabia, and daily reporting from the Saudi MOH - which has been increasingly erratic the past few months - hasn't been updated since May 15th (see below).


Screen shot taken today

Missing also this month are reports for the 8th, 9th & 10th. The confirmed number of cases at the top of the page (1622+64 cases) are more than 6 months out of date (WHO reported 1831 cases as of end of April).

The World Health Organization hasn't posted a Saudi MERS-CoV DON Report (with case line listing) since January 26th (current through Jan 17th). This is (by far) the longest gap between MERS WHO DON reports since the virus was first announced in September of 2012.

Over the past week the Saudi MOH had appeared to be in the process ofredesigning their website, and until this morning, all data since the last week of January has been missing. 
They seem to have - at least temporarily - restored the old format.  Or at least some of it, as only the most recent page of daily reports appears to be accessible. 
Aside from the increasingly erratic postings by the Saudis, the only other MERS data we've seen has come from the WHO EMRO (Eastern Mediterranean Regional Office) monthly summary, which is based on reporting by the the Saudi MOH. 
As noted previously (see A Curious EMRO MERS-CoV Update - March), the numbers reported by EMRO don't necessarily match those posted by the Saudi MOH.
In any event, we have the EMRO report for the month of April (see below), which reports a total of 7 cases reported by the Saudis during that time period.

MERS situation update, April 2018

http://applications.emro.who.int/docs/EMROPub_2018_EN_20291.pdf?ua=1
 Highlights, April 2018
  • At the end of April 2018, a total of 2206 laboratory-confirmed cases of Middle East respiratory syndrome (MERS), including 787 associated deaths (case–fatality rate: 35.7%) were reported globally; the majority of these cases were reported from Saudi Arabia (1831 cases, including 713 related deaths with a case–fatality rate of 39%).
  • During the month of April, a total of 7 laboratory-confirmed cases of MERS were reported in Saudi Arabia including 2 associated deaths (case-fatality rate: 28.6%). No healthcare associated transmission or hospital outbreak was reported during this month.
  • The demographic and epidemiological characteristics of cases do not show any significant difference when compared to cases reported during the same corresponding period of 2013 to 2018. Owing to improved infection prevention and control practices in hospitals, the number of hospital-acquired cases of MERS has dropped significantly since 2015.
  • The age group 50–59 years continues to be at the highest risk for acquiring infection as primary cases. The age group 30–39 years is most at risk for secondary cases. The number of deaths is higher in the age group 50–59 years for primary cases and 70–79 years for secondary cases.
Meanwhile - despite the ongoing frustration over the lack of current and accurate numbers - the good news is we've seen no signs of any sustained or efficient transmission of the MERS virus outside of health care facilities.