New Reported Case and Death from nCoV out of Saudi Arabia Increases Mortality Rate to 60 Percent

Another confirmed case of nCoV out of Saudi Arabia has been reported making it the 15th such case of the Novel Coronavirus to be reported. A 39 year old male from the country checked into a hospital on Feb. 28th and died on March 2, 2013 becoming the 9th person infected to succumb to the illness. 

A preliminary investigation indicated that the patient had no contact with anyone from previously reported cases of nCoV infection. 

This instance raises the mortality rate to 60 percent with the death of this person.

Novel Coronavirus Shows Signs of Human-to-Human Transmission

Elizabeth R. Fischer/Rocky Mountain Labs/NIAID/NIH

The CDC issued warnings to State and Local health officials this past Thursday regarding the novel coronavirus that has killed 8 out of 14 infected.The warning comes after three confirmed British infections which suggest the virus can be transmitted from human-to-human.

The British infections occurred after a British man traveled to Pakistan and Saudi Arabia and then back home. Samples from the man show that he was infected with both the novel coronavirus and H1N1 (swine flu). After the man arrived home two of his family members became infected with the novel coronavirus. This is the basis for the human-to-human transmission of the virus. Of the two family members, one healthy female who developed a respiratory illness has recovered, the second, an elderly man who already had an underlying illness passed away.

The mortality rate is currently 57.14% based on the deaths of the 8 of 14 confirmed cases as of this writing.

The CDC said people who develop a severe acute lower respiratory illness within 10 days of returning from the Arabian Peninsula or neighboring countries should continue to be evaluated according to current guidelines.

The CDC has set up a special website with updates on the infections at www.cdc.gov/coronavirus/ncv/

Study Reveals Regular Use of N95 Masks More Effective For Protecting Healthcare Workers

Those who wore the N95 mask consistently were more than twice as likely to be protected from infection, compared with those who wore a surgical mask all the time.

Now, I know some of you already knew this. However, I am consistently surprised when I speak with people in the healthcare industry who do not. Further more, some settings do not have enough masks to go around to all workers facing the risks of exposure.

Currently N95 masks are only recommended for use only in a targeted, intermittent way for some infections.

This needs to change, and healthcare employers need to understand they are putting themselves at risk of legal action and workforce disruptions if such masks remain in short supply during outbreaks.

To read more on this please see Protecting Healthcare Workers

CDC Releases iPad App Called Solve the Outbreak

The CDC released a game based iPad App called Solve the Outbreak designed to be an engaging way to learn more about diseases and outbreaks.

From the CDC page:

New outbreaks happen every day, and CDC's disease detectives are on the front lines, working 24/7 to save lives and protect people. When new outbreaks happen, disease detectives are sent in to figure out how they started, before they can spread. In our new, free iPad app, you get to Solve the Outbreak.
In this interactive, engaging app, you get to decide what to do: Do you quarantine the village? Talk to the people who are sick? Ask for more lab results?
The better your answers, the higher your score – and the more quickly you'll save lives. You'll start out as a Trainee and will earn badges by solving cases, with the goal of earning the top rank: Disease Detective.

Fun to Play and Learn

Perfect for teens, young adults, and public health nerds of all ages, Solve the Outbreak is a great way to take the study of epidemiology outside the classroom.

• Learn about diseases and outbreaks in an engaging way.
• See how disease detectives save lives around the world.
• Try your hand at solving an outbreak.
• Post your scores on Facebook or Twitter and challenge your friends to do better!

Download the free app today!

Many U.S. Schools Still Unprepared for Pandemic

A study has found that many U.S. schools are unprepared for the next pandemic. In fact less than half of the schools participating in the study even address pandemic preparedness in their planning and only 40 percent have updated their school's plan since the 2009 H1N1 pandemic.
 
The study was published in the September issue of the American Journal of Infection Control and was conducted by a team of researchers from Saint Louis University. The researchers collected and analyzed data from survey responses from approximately 2,000 school nurses from elementary, middle, and high schools in 26 states. The goal of the study was to ascertain whether schools were prepared for another pandemic with a focus on infectious disease disasters.

The team found that less than one-third of schools (29.7 percent) stockpile any personal protective equipment, and nearly a quarter (22.9 percent) have no staff members trained on the school’s disaster plan. One-third (33.8 percent) of schools report training students on infection prevention less than once per year. Only 1.5 percent of schools report stockpiling medication in anticipation of another pandemic. On a positive note, although only 2.2 percent of schools require school nurses to receive the annual influenza vaccine, the majority (73.7 percent) reported having been vaccinated for the 2010/2011 season.

“Findings from this study suggest that most schools are even less prepared for an infectious disease disaster, such as a pandemic, compared to a natural disaster or other type of event,” says Terri Rebmann, PhD, RN, CIC, lead study author and associate professor of Environmental and Occupational Health at the Saint Louis University School of Public Health. “Despite the recent H1N1 pandemic that disproportionately affected school-age children, many schools do not have plans to adequately address a future biological event.”

The researchers conclude that U.S. schools must continue to address gaps in infectious disease emergency planning, including developing better plans, coordinating these plans with local and regional disaster response agency plans, and testing the plan through disaster drills and exercises. Whenever possible, school nurses should be involved in these planning efforts, as healthcare professionals can best inform school administrators about unique aspects of pandemic planning that need to be included in school disaster plans.

School preparedness for all types of disasters, including biological events, is mandated by the U.S. Department of Education.

Read The Full Report on US school/academic institution disaster and pandemic preparedness and seasonal influenza vaccination among school nurses

Novel Corona Virus Spreads

Report on Spreading of Deadly Corona Virus

Novel SARS-like “Coronavirus” Well Suited to Attack Humans

The Novel Virus known as HCoV-EMC which emerged in the Middle-East has been found to infect the lungs and respiratory system as easily as the common cold.

Like SARS and Hepatitis C the virus may be treatable with components of the immune system, known as interferons, according to Swiss researchers.

"Surprisingly, this coronavirus grows very efficiently on human epithelial cells," said study co-author Volker Thiel of the Institute of Immunobiology at Kantonal Hospital in St. Gallen, in a news release from the American Society for Microbiology. Epithelial cells line hollow organs and glands.

"The other thing we found is that the viruses [HCoV-EMC, SARS, and the common cold virus] are all similar in terms of host responses: they don't provoke a huge innate immune response," he said.

The study was published online Feb. 19 in mBio.

HCoV-EMC, which may have jumped from animal to human very recently, was first isolated in June after a man in Saudi Arabia died from a severe respiratory infection and kidney failure. Following his death, health officials identified 11 more people infected with the virus, the latest in Great Britain. So far, six of the 12 people with known infections have died. Nearly all patients have lived or traveled in the Middle East.

Important Information About Cytokine Storm's and What Drugs Work and Don't Work

Bird Flu (Avian Influenza) Pandemic, the Cytokine Storm: What Drugs Work and Don't Work

By Steven Petrosino, Ph.D.
What is a Cytokine Storm?
by Steven P. Petrosino, Ph.D. and Angela L. Petrosino, MPH

A cytokine storm, also called "systemic inflammatory response syndrome" (SIRS) is the systemic expression of a healthy and vigorous immune system resulting in the release of more than 150 inflammatory mediators (cytokines, oxygen free radicals, and coagulation factors). Both pro-inflammatory cytokines (such as Tumor Necrosis Factor-alpha, InterLeukin-1, and InterLeukin-6) and anti-inflammatory cytokines (such as interleukin 10, and interleukin 1 receptor antagonist) are elevated in the serum, and the fierce and often lethal interplay of these cytokines is referred to as a "Cytokine Storm". The primary contributors to the cytokine storm are TNF-a (Tumor Necrosis Factor-alpha) and IL-6 (Interleukin-6). The cytokine storm is an inappropriate (greatly exaggerated) immune response that is caused by rapidly proliferating and highly activated T-cells or natural killer (NK) cells. These cells are themselves activated by infected macrophages. The cytokine storm must be treated and suppressed or lethality can result.
Acute respiratory viral infection results in a cytokine storm effecting the lungs, and subsequent damage to alveoli and lung tissue results in the lethality seen in more severe flu viral infections, especially those fatalities among young healthy adults.

In the absence of prompt medical intervention to stop the "cytokine storm", the lung will suffer permanent damage. Many of these patients will develop acute respiratory distress syndrome (ARDS), i.e. will present with pulmonary edema that is not caused by volume overload, or a depressed left ventricular function. Deaths will usually result from multisystem organ failure, and not from lung failure.
Sepsis, Viral Infections, and Cytokine Storm

Sepsis is a severe systemic inflammatory response and is one example of a pathologic condition associated with "cytokine storm". Sepsis is an often lethal hemodynamic collapse which is usually the result of a super infection by gram-negative bacterial endotoxins. Sepsis is also classified as septic shock syndrome (SSS).

Cytokine storm can also result from viral infections such as influenza, and an exaggerated systemic immune response to that particular viral infection (designated a type A, subtype "H1N1" virus) may have been the cause of high lethality seen in the influenza pandemic of 1918 to 1919. The great influenza pandemic was the most destructive pandemic in recorded world history, and killed more people (estimated between 20 to 50 million) than all casualties resulting from the first World War. Although the Spanish Flu pandemic affected an enormous percentage of the world wide population (up to 20% of the world population according to some sources), and killed between 20 and 50 million persons, no more than 5% of the people who contracted the Spanish Flu died (Brown et. al reported the highest death rate in India at 50 deaths per 1000 persons contracting the disease, or a five percent fatality rate). After 218 human cases of avian influenza (bird flu) have been confirmed world-wide (as of May, 2006), the lethality rate stands at 57%. Should this strain develop into a pandemic, and should it keep its current mortality rate, it has the potential to be 10 times more lethal than the 1918 pandemic.

Is the World Health Organization Adequately Defending against a Potential Pandemic of Avian Influenza

Avian Influenza (also called the "Bird flu") currently is 10 times more lethal than the strain of Spanish Flu that caused the great influenza pandemic of 1918 and killed up to 50 million people world-wide, and it could become the most lethal flu pandemic of all history if the virus mutates allowing it to be more easily passed from person to person. Bird Flu patients die from acute respiratory distress syndrome (ARDS) caused by the "cytokine storm", and NOT directly from the virus. Neuraminidase inhibitors (i.e. Tamiflu, Relenza) are not proven effective for bird flu patients, although they have been recommended by the World Health Organization for this use, are currently used to treat almost all bird flu patients, and are being stockpiled by governments world-wide (including the United States) to treat a potential pandemic should the avian influenza virus undergo a final mutation which would allow it to be more easily passed from person to person. A treatment to prevent or reduce the autoimmune reaction (cytokine storm) associated with the bird flu is commercially available by prescription, but is not currently being recommended by the World Health Organization to treat these patients.

Influenza A, The most lethal influenza and the precursor of all Pandemic Viruses

Influenza viruses responsible for causing pandemics are influenza type A viruses which emerge as a result of a process called "antigenic shift". Antigenic shift causes an abrupt or sudden, major change in certain proteins on the surface of the influenza A virus (specifically the hemagglutinin or "HA" protein and the neuraminidase or the "NA" protein).Certain antigenic shifts may allow the virus to become more easily transmissible, more "contagious". Once this type of shift occurs, wide-spread infection usually follows quickly. Antigenic shift is most dangerous when it occurs in a virus that has demonstrated high lethality, such as the H5N1 bird flu.
History has recorded 10 pandemics of influenza A in the past 300 years. The sudden appearance of new influenza A virus subtypes during the 20th century has caused three pandemics, all of which spread world-wide within 1 year of first being detected.

Influenza Pandemics of the 20th Century

• 1918-19, "Spanish flu," [Type A, subtype (H1N1)], caused the highest number of known influenza deaths: more than one-half million people died within the United States (nearly half of the deaths were young healthy adults aged 20-40), and between 50 and 100 million people may have died worldwide. Most deaths occurred within the first few days after infection, some deaths within hours of symptom onset, and other deaths occurred later as a result of complications. Influenza A (H1N1) viruses still circulate today after having been reintroduced in the 1970s. Although called the "Spanish Flu" because the first widely reported deaths were in Spain, it probably originated in China.
• 1957-58, "Asian flu," [Type A, subtype (H2N2)], caused about 70,000 deaths in the United States. The "asian flu" was initially identified in China in late February 1957. Three months later, it spread to the United States with early reports of infection as early as June 1957.
• 1968-69, " Hong Kong flu," [Type A subtype (H3N2)], was responsible for about 34,000 deaths in the United States. The "Hong Kong flu" virus was first detected in Hong Kong in early 1968 and spread to the United States within a few months. Influenza A (H3N2) viruses still circulate today.
• Both the 1957-58 and 1968-69 pandemics were caused by viruses containing a combination of genes from a human influenza virus and an avian influenza virus. The origin of the 1918-19 pandemic virus is not clear, but if its origin was in China as suspected, it could have similarly been caused by a genetic recombination of human and avian influenza viruses. This can more easily occur if humans are in close proximity to both live birds and pigs, as can occur in public markets in Asia. Osterholm reports the last influenza pandemic (1968) occurred 37 years ago, emerging in China. At that time China's human population was 790 million, its pig population was 5.2 million, and its poultry population was 12.3 million. Today, these populations number 1.3 billion, 508 million, and 13 billion, respectively. The human and animal populations of other Asian countries have similarly increased exponentially, which has increased the chances for close contact between birds, pigs and humans in these countries, creating optimal conditions for the emergence of new viruses, such as the H5N1 subtype.
• On August 12, 2004, the Vietnamese Ministry of Health reported three confirmed human deaths to the World Health Organization (WHO) from confirmed avian influenza H5 infection. If the virus is confirmed to belong to the same H5N1 strain that caused 22 cases (15 deaths) in Vietnam and 12 cases (8 deaths) in Thailand in 2005, and human-to-human contact versus human to bird or human-to-swine contact is suspected, this may indicate that H5N1 has adapted to the point that it is transmissible and has the potential to cause the next pandemic. In May 2006, it was reported that a family of 7 died of the bird flu after having no detectible contact with an infected bird. If this is the case, the virus may have undergone a final mutation giving it the potential to cause a pandemic.

What Are the Symptoms of the Bird Flu:

Initial Presentaion of Influenza A (H5N1) Avian Influenza:

• Pulmonary: Radiographically confirmed pneumonia, acute respiratory distress syndrome (ARDS), or other severe respiratory illness for which an alternate diagnosis cannot be established
• One or more of the following: cough and/or sore throat and/or shortness of breath, AND a history of contact with poultry (e.g., visited a poultry farm, a household raising poultry, or a bird market) or contact with a known or suspected human case of influenza A (H5N1) in an H5N1-affected country within 10 days of symptom onset.
• Dyspnea
• Fever (temperature of >38°C or >100.4°F)

Symptoms Of The Cytokine Storm:

The end stage, or final result, of cytokine storm (SIRS) or sepsis is multiple organ dysfunction syndrome (MODS). The end-stage symptoms of the bird flu, or other infection precipitating the cytokine storm may include:

• hypotension
• tachycardia
• dyspnea
• fever (temperature of >38°C or >100.4°F)
• Ischemia, or insufficient tissue perfusion (especially involving the major organs)
• uncontrollable hemorrhage
• and multisystem organ failure (caused primarily by hypoxia, tissue acidosis, and severe metabolism dysregulation

Oxygen free radicals, histamine, complement factor C5a, Beta-endorphin, thromboxane B2, and platelet activating factor are implicated in SSS. The major pro-inflammatory cytokines which are implicated in SSS are TNF-alpha, IL1, IL6 and IL8. Serum TNF alpha concentrations in excess of 1 ng/mL are frequently predictive of a lethal outcome, however serum concentrations of other inflammatory cytokines involved in the pathophysiology of Septic shock are usually not reliable predictors of the severity of the shock state or clinical outcome. These cytokines are released by macrophages following activation by bacterial endotoxins.

Preventing and/or treating the cytokine storm associated with influenza with antiviral medications, prescription medications and vaccines that are approved (or may soon be approved) by the U.S. Food and Drug Administration (FDA):

• Acambis Biotechnology Vaccine: Acambis announced on August 4, 2005 that it has entered into collaboration with a Belgian research centre to develop a single-dose flu vaccine that could offer permanent protection against all strains of both influenza A and influenza B, potentially offering protection against future influenza pandemics.
• ACE inhibitors and Angiotensin II Receptor Blockers (ARBs) make sense in the treatment of, and have proven to be beneficial in treating the cytokine storm (the major cause of lethality in Bird Flu) of SARS. See also: PUBMED, The cytokine storm and the renin-angiotensin-aldosterone system.
• Amantadine (Brand name Symmetrel: Treatment of influenza type A-2, but not type B). This drug cannot treat the cytokine storm associated with avian influenza, and has not been tested in patients with the bird flu.
• Aventis Vaccine: Preliminary research suggests the influenza A vaccine developed by Sanofi-Aventis is effective against H5N1 avian flu virus. The NIH (US National Institutes of Health) reported on August 5, 2005 (New York Times) that preliminary tests have confirmed that an experimental vaccine in development by Sanofi-Aventis Pharmaceutical Company appears to be effective in preventing infection with the bird flu (avian influenza virus). Researchers believe that the avian influenza virus, an influenza type-A, subtype H5N1, could trigger the next worldwide flu pandemic.
• Oseltamivir (Brand name Tamiflu: a neuraminidase inhibitor for treatment or prevention of both influenza type A and B, indicated for use within 2 days of symptoms). This drug cannot treat the cytokine storm associated with avian influenza, and has not been tested in patients with the bird flu. Most of the avian flu victims in SE Asia and Turkey received Tamiflu, and still suffered mortality rates exceeding 50%. Tamiflu has been declared "ineffective" against the bird flu by a physician who has personally used the drug to treat 41 bird flu patients (19% of all reported cases to date).
• Prednisone and corticosteroids: Treatment of active disease may involve the use of corticosteroids.
• Rimantadine (Brand name Flumadine: Treatment of influenza type A, but not B). This drug cannot treat the cytokine storm associated with avian influenza, and has not been tested in patients with the bird flu.
• Zanamivir (Brand name Relenza: a neuraminidase inhibitor for treatment of both influenza type A and type B, indicated for use within 2 days of symptoms). This drug cannot treat the cytokine storm associated with avian influenza, and has not been tested in patients with the bird flu. Most of the avian flu victims in SE Asia and Turkey received Tamiflu (a drug similar to Relenza), and still suffered mortality rates exceeding 50%.

This article originally posted at: http://www.cytokinestorm.com
Article Source: http://EzineArticles.com/?expert=Steven_Petrosino,_Ph.D.
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