USA - Illinois man, contact of Indiana case - test negative for coronavirus MERS in follow-up tests after initial sero-positive results

[Emily]

Re: USA - Illinois man, contact of Indiana case - seropositive test result for coronavirus MERS

The way I read this, Trey, is that they think the Illinois man is currently not infective due to his clearing the virus. I didn't get the impression they were saying he was never able to transmit the MERS virus.

I'm still not convinced that he had a MERS infection at all. How accurate is the serology? Also, they have to do a second serology to see increasing antibodies to establish the first positive was due to a recent infection, whether it was from MERS or another betacoronavirus in the first place.

[gsgs]

Re: USA - Illinois man, contact of Indiana case - seropositive test result for coronavirus MERS

my estimate: 70%

[Emily]

Re: USA - Illinois man, contact of Indiana case - seropositive test result for coronavirus MERS

my estimate: 70%

Sounds reasonable to me. I've read that there is a good chance the possible case #3 is a medical researcher. I know of someone who worked in a hospital research lab and also had many, many vaccines while traveling around the world. His blood was so loaded with various antibodies that he was rejected as a volunteer donor for a research study.

So if anyone could trigger a false serology positive for a novel disease, a medical research worker could. But I'm sure CDC knows that, so the odds are in their favor.

[sharon sanders]

USA - Illinois man, contact of Indiana case - seropositive test result for coronavirus MERS

Middle East respiratory syndrome coronavirus (MERS-CoV) – update

Disease Outbreak News

22 MAY 2014 - On 2 May 2014, the National IHR Focal Point for the United States notified WHO about the first laboratory confirmed case of MERS-CoV infection in the United States.

As part of the investigation of contacts of the first confirmed case, testing for MERS-CoV was undertaken on contacts. A contact of the first case initially tested negative for MERS-CoV by PCR based on respiratory tract samples taken 10 days after contact with the first case. However, on 16 May, this contact tested positive for antibodies for MERS-CoV in a blood sample taken 14 days after contact. Currently, this individual is asymptomatic. He is a male in his 70s with comorbidities and has no history of travel to countries outside the United States.

The antibody test result suggests this individual may have been infected with MERS-CoV; however he does not meet WHO's current definition of a laboratory confirmed case of MERS-CoV, which requires positive PCR tests.

Globally, 632 laboratory-confirmed cases of infection with MERS-CoV have officially been reported to WHO, including 193 deaths. The global total includes all of the case reported in this update, plus 17 laboratory confirmed cases officially reported to WHO from Saudi Arabia between 16 and 18 May. WHO is working with Saudi Arabia for additional information on these cases and will provide further updates as soon as possible.

http://www.who.int/csr/don/2014_05_22_mers/en/

[sharon sanders]

Re: USA - Illinois man, contact of Indiana case - seropositive test result for coronavirus MERS

From: "Media@cdc.gov (CDC)" <sohco@CDC.GOV>
To: MMWR-MEDIA@LISTSERV.CDC.GOV
Subject: CDC Press Release: CDC provides update on Middle East Respiratory Syndrome Coronavirus (MERS-CoV) *Embargoed until 1:00 p.m. ET
Date: May 28, 2014 11:47 AM
Attachments: Media Advisory MERS 52814.pdf
Press Release

Embargoed until 1 p.m. ET
Wednesday, May 28, 2014

Contact: CDC Media Relations
(404) 639-3286


CDC concludes Indiana MERS patient did not spread virus to Illinois business associate

After completing additional and more definitive laboratory tests, CDC officials have concluded that an Indiana MERS patient did not spread the virus to an Illinois associate during a business meeting they had before the patient became ill and was hospitalized.

CDC and state and local public health officials are conducting voluntary testing of people who had contact with two travelers who went from Saudi Arabia to the U.S. where they were confirmed to have Middle East Respiratory Syndrome, or MERS. One type of tests conducted by state and CDC labs uses respiratory samples and can quickly indicate if a person has active infection with the virus. These tests are called PCR, or polymerase chain reaction, assays. Another type of testing, conducted on blood samples in CDC labs, is called serology and is designed to look for antibodies to Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Antibodies would indicate that a person had been previously infected with the virus and developed an immune response. To conduct serology for MERS-CoV, CDC performs three separate tests ? ELISA or enzyme-linked immunosorbent assay, IFA or immunofluorescent assay, and a third more definitive test called the neutralizing antibody assay which takes longer than the other two tests.

The Illinois resident, a business associate who had extended face-to-face contact with the Indiana MERS patient, tested negative for active MERS-CoV infection by PCR in the days after his interaction with the man. Given the Illinois man?s contact with the MERS patient, CDC conducted serology testing to see if the Illinois man had antibodies to MERS-CoV. Preliminary ELISA and IFA results announced by CDC on May 17 indicated that the Illinois resident appeared to be positive for MERS-CoV antibodies.

?The initial ELISA and IFA serology results indicated the possibility that the Illinois resident had been previously infected with MERS-CoV,? said David Swerdlow, M.D., who is leading CDC?s MERS-CoV response. ?This compelled us to notify and test those people with whom he had close contact in the days following his interaction with the Indiana MERS patient.?

CDC scientists have since tested additional blood samples and completed the slower, definitive serology test, the neutralizing antibody test, which requires at least five days before a result is available. Based on the result of all of these tests, which require careful interpretation, CDC has concluded that the Illinois resident was not previously infected with MERS-CoV.

?While we never want to cause undue concern among those who have had contact with a MERS patient, it is our job to move quickly when there is a potential public health threat,? said Swerdlow. ?Because there is still much we don?t know about this virus, we will continue to err on the side of caution when responding to and investigating cases of MERS in this country.?

To date, active MERS-CoV infection has not been found in any of the contacts of the two people in the U.S. confirmed to have the disease. However, investigations are ongoing, including voluntary serology testing of contacts. This vigilant approach is intended to help CDC reduce any immediate public health threat, as well as help the global scientific community gain a better understanding of how MERS-CoV spreads so we can more effectively control this disease in the future. There is currently no evidence of sustained spread of MERS-CoV in community settings.

As CDC continues to gather additional information, officials will update the agency?s MERS recommendations as needed. At this time, CDC?s recommendations to the public, travelers, doctors and other healthcare providers have not changed.

For more information about MERS-CoV, please visit:

Middle East Respiratory Syndrome: http://www.cdc.gov/coronavirus/mers/index.html
Frequently Asked MERS Questions and Answers: http://www.cdc.gov/coronavirus/mers/faq.html
Indiana State Department of Health: http://www.state.in.us/isdh/
Illinois Department of Public Health: http://www.idph.state.il.us/

###

U.S. Department of Health and Human Services

[sharon sanders]

Re: USA - Illinois man, contact of Indiana case - test negative for coronavirus MERS in follow-up tests after initial sero-positive results

I have removed this person from our coronavirus case list. He joins 4 other test reversals: 2 in Spain and 2 in Italy.

[Emily]

Re: USA - Illinois man, contact of Indiana case - test negative for coronavirus MERS in follow-up tests after initial sero-positive results

Thanks for the update on the other reversals, (or 'false positives' as the news story I heard on the radio today referred to the Illinois non-case).

A Saudi immunologist on Twitter said that exposure to pets might give false MERS-CoV positives on serology. It makes sense since cats and dogs do get coronavirus infections. Even their live vaccines might be conferring some immunity, or at least seropositivity.

http://www.ncbi.nlm.nih.gov/pubmed/15019110

http://cid.oxfordjournals.org/content/37/3/407.full

http://www.wormsandgermsblog.com/2009/12/articles/animals/dogs/bordetella-pneumonia-in-a-person-from-dog-vaccine/

There is some good info here from CDC's Dr. David Swerdlow about the general technical challenges of serology:

http://www.livescience.com/45922-ill...have-mers.html

3rd Case of MERS in US Was False Alarm, CDC Says
By Bahar Gholipour, Staff Writer | May 28, 2014 01:00pm ET

[gsgs]

Re: USA - Illinois man, contact of Indiana case - test negative for coronavirus MERS in follow-up tests after initial sero-positive results

hopefully one day they'll give probability estimates instead
of word formulations ...

serology is not an exact science, I read
(about the old samples from 1947,1957,1968 when it was the standard)

[Emily]

Re: USA - Illinois man, contact of Indiana case - test negative for coronavirus MERS in follow-up tests after initial sero-positive results

I hope so, too, gsgs. Infectious disease terrifies people like no other threat - and we have a large segment of the population who are immune compromised in some way, or without access to good healthcare and are especially frightened. Additional stress is not healthy for those people.

But CDC did the right thing in logistically managing risk until confirmation.

[Pathfinder]

Re: USA - Illinois man, contact of Indiana case - test negative for coronavirus MERS in follow-up tests after initial sero-positive results

May 29, 2014

CDC says handshake didn't spread MERS to Illinois man

(AP) ? Health officials on Wednesday backtracked on an earlier report that a mysterious Middle East virus had apparently spread from one person to another in the United States.
...
The Centers for Disease Control and Prevention announced the revised diagnosis on Wednesday.
...
Asked if they had jumped the gun with the earlier announcement, one official said the CDC will continue to err on the side of caution if it might stop potential spread of a dangerous new disease. "We can't wait until we have all the tests back in order to take public health action," said Dr. David Swerdlow, who is managing the CDC's response to the recent MERS reports.

It's not clear what caused the earlier false positive test results. It's possible the tests reacted to the antigen for a virus with similarities to MERS, officials said.

Health officials were relieved to get the new results. They had believed the virus must have spread from the Indiana man to the Illinois man during a business meeting that involved no closer contact than a handshake. That suggested it might spread a little easier than some had thought ? in the Middle East, the virus has spread more intimately, to family members or health care workers caring for a MERS patient.

CDC officials said they still think it's possible the virus can spread in an extended, face-to-face business meeting. But "it is a little reassuring that this gentleman is not a case," Swerdlow said.
...

http://www.chicagobusiness.com/article/20140529/NEWS03/140529757/cdc-says-handshake-didnt-spread-mers-to-illinois-man