Jordan - Cluster of approximately 13 people with acute pneumonia type illness, 2 fatalities - April 20 - May 2012 - Novel coronavirus confirmed

[alert]

Re: Jordan - Cluster of approximately 11 people with acute pneumonia type illness, 2 fatalities - April 20 - May 2012 - Novel coronavirus confirmed

I think the author of this piece is the same person who made the (now incorrect) tweet several posts above, almost exactly two months ago, that the coronavirus had been excluded:

http://www.npr.org/blogs/health/2012...r-cases?live=1

SARS-Like Virus Found In Jordan, Hunt Is On For Other Cases
The World Health Organization says a new Arabian coronavirus has killed two people in Jordan ? the third country where the novel microbe has been traced.

That brings lab-confirmed cases to nine, with five fatalities.

The latest cases are actually the oldest known so far. They push the SARS-like virus's timeline three months back from the first reported case involving a 60-year-old man who died in Jedda, Saudi Arabia, last June.

Jordan's cases were found through new testing of blood and tissue samples from patients in a cluster of pneumonias of unknown origin that occurred last April at a hospital in Zarqa, near Jordan's capital of Amman.

Until now known cases have occurred further south in Qatar and Saudi Arabia.

The Jordan cases are also significant because they're part of an 11-person cluster of pneumonia that involved seven nurses and a doctor.

[snip]

[alert]

Re: Jordan - Cluster of approximately 11 people with acute pneumonia type illness, 2 fatalities - April 20 - May 2012 - Novel coronavirus confirmed

Who is the second confirmed fatality? The first is obviously the 40F nurse in this thread, but is the second one the doctor (that has been repeatedly denied as a false report) or an index patient that was never reported in April?

Published Date: 2012-11-30 15:05:39
Subject: PRO/AH/EDR> Novel coronavirus - Eastern Mediterranean: WHO, Jordan, conf., RFI
Archive Number: 20121130.1432498

NOVEL CORONAVIRUS - EASTERN MEDITERRANEAN: WHO, JORDAN, APRIL 2012, CONFIRMED, REQUEST FOR INFORMATION
************************************************** ************************************************** **
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:[1] WHO GAR report - Jordan April 2012[2] WHO summary of nCoV as of 30 Nov 2012******[1] WHO GAR report - Jordan April 2012Date: 30 Nov 2012
Source: WHO GAR
http://www.who.int/csr/don/2012_11_30/en/index.html


Novel coronavirus infection - update [30 Nov 2012]
---------------------
In addition to the fatal case of novel coronavirus in Saudi Arabia reported to WHO on [28 Nov 2012], 2 fatal cases in Jordan have been reported to WHO today, bringing the total of laboratory-confirmed cases to 9.

The latest confirmed case from Saudi Arabia occurred in October 2012 and is from the family cluster of the 2 cases confirmed earlier.

The 2 cases from Jordan occurred in April 2012. At that time, a number of severe pneumonia cases occurred in the country and the Ministry of Health (MOH) Jordan promptly requested a WHO Collaborating Centre for Emerging and Re-emerging Infectious Diseases (NAMRU - 3) team to immediately assist in the laboratory investigation. The NAMRU-3 team went to Jordan and tested samples from this cluster of cases.

On [24 Apr 2012] the NAMRU-3 team informed the MOH that all samples had tested negative for known coronaviruses and other respiratory viruses. As the novel coronavirus had not yet been discovered, no specific tests for it were available.

In October 2012, after the discovery of the novel coronavirus, stored samples were sent by MOH Jordan to NAMRU-3. In November 2012 NAMRU-3 provided laboratory results that confirmed 2 cases of infection with the novel coronavirus.

The MOH Jordan has requested WHO assistance in investigating these infections. A mission from WHO Eastern Mediterranean Regional Office (EMRO) and headquarters arrived in Amman on 28 November 2012 to assist in further epidemiological surveillance and to strengthen the sentinel surveillance systems for severe acute respiratory infections (SARIs).

In summary, to date a total of 9 laboratory-confirmed cases of infection with the novel coronavirus have been reported to WHO - 5 cases (including 3 deaths) from Saudi Arabia, 2 cases from Qatar and 2 cases (both fatal) from Jordan.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

******
[2] WHO summary of nCoV as of 30 Nov 2012
Date: 30 Nov 2012
Source: WHO GAR
http://www.who.int/csr/disease/coron.../en/index.html


Background and summary of novel coronavirus infection - as of [30 Nov 2012]
-------------------------
Over the past 2 months, WHO has received reports of 9 cases of human infection with a novel coronavirus. Coronaviruses are a large family of viruses; different members of this family cause illness in humans and animals. In humans, these illnesses range from the common cold to infection with Severe Acute Respiratory Syndrome (SARS) coronavirus (SARS CoV).

Thus far, the cases reported have come from Qatar, Saudi Arabia and Jordan. All patients were severely ill, and 5 have died.

The 2 Qatari patients are not linked. Both had severe pneumonia and acute renal failure. Both are now recovering.

A total of 5 confirmed cases have been reported from Saudi Arabia. The 1st 2 are not linked to each other; one of these has died. Three other confirmed cases are epidemiologically linked and occurred in one family living within the same household; 2 of these have died. One additional family member in this household also became ill, with symptoms similar to those of the confirmed cases. This person has recovered and tested negative, by polymerase chain reaction (PCR) tests, for the virus.

Two confirmed cases have been reported in Jordan. Both of these patients have died. These cases were discovered through testing of stored samples from a cluster of pneumonia cases that occurred in April 2012.

The 2 clusters (Saudi Arabia, Jordan) raise the possibility of limited human-to-human transmission or, alternatively, exposure to a common source. Ongoing investigation may or may not be able to distinguish between these possibilities.

The current understanding of this novel virus is that it can cause a severe, acute respiratory infection presenting as pneumonia. Acute renal failure has also occurred in 5 cases.

WHO recognizes that the emergence of a new coronavirus capable of causing severe disease raises concerns because of experience with SARS. Although this novel coronavirus is distantly related to the SARS CoV, they are different. Based on current information, it does not appear to transmit easily between people, unlike the SARS virus.

WHO has closely monitored the situation since detection of the 1st case and has been working with partners to ensure a high degree of preparedness should the new virus be found to be sufficiently transmissible to cause community outbreaks. Some viruses are able to cause limited human-to-human transmission under condition of close contact, as occurs in families, but are not transmissible enough to cause larger community outbreaks. Actions taken by WHO in coordination with national authorities and technical partners include the following:

Investigations are ongoing to determine the likely source of infection and the route of exposure. Close contacts of confirmed cases are being identified and followed up.
An interim surveillance recommendation has been updated to assist clinicians to determine which patients should undergo laboratory testing for the presence of novel coronavirus.

Laboratory assays for the virus have been developed. Reagents and other materials for testing are available, as are protocols, algorithms and reference laboratory services. WHO has activated its laboratory network to assist in testing and other services. WHO has also issued preliminary guidance for laboratory biorisk management.
Guidance is available for infection control.

Based on the current situation and available information:

- WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.
Further, testing for the new coronavirus of patients with unexplained pneumonias should be considered, especially in persons residing in or returning from the Arabian peninsula and neighboring countries. Any new cases should be promptly reported both to national health authorities and to WHO.

- In addition, any clusters of SARI or SARI in health care workers should be thoroughly investigated, regardless of where in the world they occur. These investigations will help determine whether the virus is distributed more widely in the human population beyond the 3 countries that have identified cases.

- WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied.

- WHO continues to work with Member States and international health partners to gain a better understanding of the novel coronavirus and the disease in humans and will continue to provide updated information. As the situation evolves, WHO will reassess its guidance and revise it accordingly.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The above WHO report now increases the official number of laboratory confirmed cases of severe acute respiratory illness (SARI) due to infection with the novel coronavirus (nCoV) to 9, with 5 fatalities.

In a prior ProMED-mail report on this nCoV, Dr. Irene Lai had reported on an as yet undiagnosed outbreak of SARI in Jordan, querying if that outbreak would be reviewed to see if perhaps this nCoV was the etiology of the outbreak.

Information available at that time came from an ECDC report from May 2012 available at http://ecdc.europa.eu/en/publication...ay%202012.pdf:

"Severe respiratory disease of unknown origin - Jordan - Outbreak in ICU
Opening date: 26 April 2012 Latest update: 3 May 2012

An outbreak of a respiratory illness was reported on 19 April 2012 by the Ministry of Health in Jordan in an intensive care unit in a hospital in Zarqa. Seven nurses and one doctor were among the 11 affected. One of the nurses died. The cause of this
outbreak remains unknown to date."

From the above reports it appears as though the outbreak in Jordan in April 2012 was due to this nCoV, and most likely does represent limited human-to-human transmission -- involving the ICU healthcare personnel caring for a patient with SARI. With respect to the family cluster reported in Saudi Arabia, more information on the epidemiology of this outbreak including dates of onsets of cases, locations of contact between the family members (were they all from a common household, were any caretakers for earlier onset illness cases) might help in ascertaining if that cluster involved person-to-person transmission or if there had been a common source exposure in the household setting.

More information on results of testing of the other members of this cluster of cases in Jordan would be greatly appreciated. If the recovered cases are negative through currently available laboratory tests, it would add to an observation that milder cases are not "detected" through the currently available laboratory techniques.

If one looks at a map of the region, one sees that Saudi Arabia shares a border with Jordan to the Northwest and Qatar to the Southeast. - Mod.MPP]

[alert]

Re: Jordan - Cluster of approximately 11 people with acute pneumonia type illness, 2 fatalities - April 20 - May 2012 - Novel coronavirus confirmed

http://www.cidrap.umn.edu/cidrap/con...012corona.html

Two Jordan cases in April shift novel coronavirus picture
Robert Roos News Editor

Nov 30, 2012 (CIDRAP News) ? The World Health Organization (WHO) reported today that two cases of novel coronavirus (CoV) infection occurred as part of a cluster of hospital respiratory infections in Jordan back in April. Besides adding one more to the list of affected countries, the announcement signaled that the virus emerged 2 months earlier than previously thought and increased the likelihood that it can spread from person to person.

[snip]

[sharon sanders]

Re: Jordan - Cluster of approximately 11 people with acute pneumonia type illness, 2 fatalities - April 20 - May 2012 - Novel coronavirus confirmed

hat tip Michael Coston

WHO Coronavirus Update: 9 Confirmed Cases



Coronavirus ? Credit CDC PHIL

# 6754


Today the World Health Organization is reporting two more confirmed cases of infection from the novel coronavirus, this time from Jordan, and stemming from last April.

The two cases were part of an of cluster of an up-until-now unidentified severe respiratory illness that infected at least 11 people at a hospital in Zarqua (including 8 healthcare workers), last spring - killing two. (See ECDC Report and FluTrackers Thread)

Today?s revelation (which has been hinted at the past couple of weeks) raises additional questions over just how transmissible this virus may actually be.

Here is the latest update, bringing the total of confirmed cases to 9.

Novel coronavirus infection - update

30 November 2012 - In addition to the fatal case of novel coronavirus in Saudi Arabia reported to WHO on 28 November, two fatal cases in Jordan have been reported to WHO today, bringing the total of laboratory-confirmed cases to nine.

The latest confirmed case from Saudi Arabia occurred in October 2012 and is from the family cluster of the two cases confirmed earlier.

The two cases from Jordan occurred in April 2012. At that time, a number of severe pneumonia cases occurred in the country and the Ministry of Health (MOH) Jordan promptly requested a WHO Collaborating Centre for Emerging and Re-emerging Infectious Diseases (NAMRU ? 3) team to immediately assist in the laboratory investigation. The NAMRU-3 team went to Jordan and tested samples from this cluster of cases.

On 24 April 2012 the NAMRU-3 team informed the MOH that all samples had tested negative for known coronaviruses and other respiratory viruses. As the novel coronavirus had not yet been discovered, no specific tests for it were available.

In October 2012, after the discovery of the novel coronavirus, stored samples were sent by MOH Jordan to NAMRU-3. In November 2012 NAMRU-3 provided laboratory results that confirmed two cases of infection with the novel coronavirus.

The MOH Jordan has requested WHO assistance in investigating these infections. A mission from WHO Eastern Mediterranean Regional Office (EMRO) and headquarters arrived in Amman on 28 November 2012 to assist in further epidemiological surveillance and to strengthen the sentinel surveillance systems for severe acute respiratory infections (SARIs).

In summary, to date a total of nine laboratory-confirmed cases of infection with the novel coronavirus have been reported to WHO ? five cases (including 3 deaths) from Saudi Arabia, two cases from Qatar and two cases (both fatal) from Jordan.

Posted by Michael Coston at <a class="timestamp-link" href="http://afludiary.blogspot.com/2012/11/who-coronavirus-update-9-confirmed-cases.html" rel="bookmark" title="permanent link"><abbr class="published" title="2012-11-30T13:31:00-05:00">1:31 PM</abbr>

[Treyfish]

Re: Jordan - Cluster of approximately 11 people with acute pneumonia type illness, 2 fatalities - April 20 - May 2012 - Novel coronavirus confirmed

Sunday, December 2, 2012
Health: proven and فاتين بالكورونا and failure to monitor new cases

Amman - Petra - Health Minister Dr. Abdul Latif Wreikat officially on Sunday proved wounding two died in April last illness Coruna new time in which the failure to monitor any case the disease in the Kingdom.

said Wreikat at a press conference on Sunday in the ministry building following the announcement of the World Health Organization yesterday, for the registration of cases of disease Koruna new "today after been definitely confirmed that two deaths in Jordan Natjtin disease Coruna new that were not until recently known internationally is not available with reagents was announced to remove ambiguity imposed nature new disease The knowledge derived for the world around him and the availability of reagents for him. "

and added that the announcement today gives the opportunity for the WHO team is currently in Jordan to investigate and investigate the epidemiological situation, a measure taken by Saudi Arabia and Qatar after recording injuries sick new as well as allow scope for raising the capacity of the epidemiological monitoring laboratory for diseases flu kinds of laboratory Jordanian all.

stressed Wreikat that the ministry did not register from last April until today any case virus Koruna new characterized deploy limited.

and chronology to record injuries explained that cases fired on them and the media in the month of April, the mysterious disease "as that at the time recorded in the care Algesithih in hospital blue state 11 cases of pneumonia severe during the period from 7 to April 21, including two cases of doctors and 9 cases among cadres nursing, and underwent all the treatment and turned cases of highly pathogenic to a private hospital., adding that the ministry has taken preventive measures and treatment by protocols health tired globally in such cases were withdrawn samples Laboratory for examination in laboratories Ministry and King Hussein Cancer Center and the University of Science and Technology did not show laboratory results then any positive result for the disease intractable and the results were negative for any type of flu viruses such as bird flu and swine and SARS and even krona except some positive results for the bacteria pseudomonas aeroginosa. said "Meanwhile and on April 19 died nurse Arbainet of who develop pulmonary severe Hospital blue is under treatment at the private hospital, and died later on April 26 also a college student at the age of 25 years, a resident of the blue and said the ministry in time for these deaths. "

He said he instructed then in April to transfer university student from hospital blue government to Prince Hamzah Hospital as he was complaining of a sore membranes heart and suspicion disease tuberculosis and encountered his hospitalization in conjunction with the pandemic in it. "It did not stop the ministry for further monitoring and survey epidemiological laboratory for cases with symptoms similar in blue did not report any injury outside the hospital and close the file at the time for lack of evidence of any cases of disease flu kinds laboratory either in the laboratory of Jordan or reference to the World Health Organization as well as the lack of injuries similar to the monitoring and survey epidemiological. "
And that in the evolution of global later announced the World Health Organization abruptly for two deaths resulting from a new disease types of flu called krona new in Saudi Arabia in July of this year and announced it officially in September.
The health minister said that the ministry and in the light of this announcement, intensified procedures preventive, as vaccinated pilgrims Bmtaum flu seasonal before traveling to Saudi Arabia, as well as giving Scion of health personnel in hospitals, and when pilgrims return to Jordan was a process of monitoring them and give them precautionary preventive treatment for flu at border crossings.

and pay announcement WHO ministry to demand from laboratories Navy SEAL (NAMRU 3) in Cairo, re-examination of samples of the disease called crowns new which was not known previously, that particular lab reagents for the disease became available after the announcement of the deaths in Saudi Arabia Bcesp new disease.
showed results of laboratory tests to NAMRU 3 in November 14 last, that Arbain deceased (nurse) and the young university was positive for Corona new.

informed the ministry WHO on Thursday registered cases of injury بالكورونا new after confirming diagnostic laboratory, although not record any injury Similar since April this year so far, according to Dr. Wreikat who said that this confirms that the cases were limited to section intensive care in hospital blue.
his part, considered representative of the World Health Organization in Amman Dr. Akram Toum, Jordan beacon for technical cooperation in the various fields of health , especially monitoring, they are from developed countries and advanced level region compared with other regions in the world, because the Kingdom has strong health systems.

explained that the number of cases detected disease Coruna new 9 cases recorded in the Eastern Mediterranean Region, five cases in Saudi Arabia, and two in Qatar , and two in Jordan. He sent the organization a professional team to support the efforts of the Ministry of Health in the survey and surveillance of the disease and respiratory epidemiological situation in general at the level of folders it depends protocols to investigate the disease, especially new viruses Lyman Organization importance of research and survey in the detection of infected cases and provide early treatment and conduct field research and laboratory.

said Dr. Tom to need to pay attention to strengthening monitoring systems and control of communicable diseases and investigate how HIV infection, location, rates spread in the States, more than the importance of knowledge of the chronology of the injuries, which rely on recorded history laboratory analysis and evidence of injury.

And the director of Primary Health Care Department, Dr. Bassam Hijjawi that disease Koruna new is a viral disease that affects the respiratory system and is accompanied by a rise in temperature, dry cough and difficulty in breathing which often infects humans and animals and is similar to SARS is not available to him vaccine does not treat the two types.
said Hijjawi, the ministry adopted since 2008 monitoring system in 3 hospitals in Amman The north and south, to investigate the respiratory disease severe as it has been withdrawn 234 sample from April until the end of last June were sent to laboratories (NAMRU 3) and appeared results negative is, they is infected with coronavirus new.

pointed out that the Survey teams epidemiological according monitoring systems adopted in the ministry, in cooperation with a technical team from the World Health Organization, headed today to Karak to make sure monitoring systems capabilities there and investigate the epidemiological situation.http://www.alrai.com/article/554543.html

[Treyfish]

Re: Jordan - Cluster of approximately 11 people with acute pneumonia type illness, 2 fatalities - April 20 - May 2012 - Novel coronavirus confirmed

Jordan did not score any new cases of HIV Coruna

: Health Minister Jordanian Abdul Latif Wreikat Sunday that his country had not recorded any new cases of coronary virus (Corona) after testing two deaths in Jordan as a result of the virus in April / April.

Said Wreikat "The ministry has not recorded since the month of April last until today any case corona virus in the Kingdom."

And he said in remarks reported by the Jordanian news agency that "the World Health Organization (WHO) announced yesterday (Saturday) proved injury cases (in Jordan) died in the month of April past Pkorona".

"The care Algesithih in hospital blue state (23 km north-east of Amman) had recorded 11 cases of pneumonia severe during the period from 7 to April 21, including two cases of doctors and 9 cases among cadres nursing underwent all the treatment and turned cases of highly pathogenic to a private hospital. "

He noted that "on April 19 died nurse Arbainet with severe pneumonia in a blue hospital under treatment."

He added, "and later on April 26 also died a college student at the age of 25 years, a resident of the blue."

He added that "laboratory results at the time did not prove any positive result for intractable disease and the results were negative for any type of flu viruses such as bird flu and SARS and swine even Koruna except some positive results for bacteria."

The minister said that "Today's announcement gives the opportunity to the World Health Organization (WHO) team is currently in Jordan to investigate and investigate the epidemiological situation," adding that "action taken by Saudi Arabia and Qatar after new bird flu disease."

For his part, said the WHO representative in Oman Akram Toum that "the number of cases the new Corona disease discovered nine cases recorded in the eastern Mediterranean, five cases in Saudi Arabia and two in Qatar and two in Jordan."http://www.elaph.com/Web/news/2012/1...tml?entry=arab

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Re: Jordan - Cluster of approximately 11 people with acute pneumonia type illness, 2 fatalities - April 20 - May 2012 - Novel coronavirus confirmed

Who is the second confirmed fatality? The first is obviously the 40F nurse in this thread, but is the second one the doctor (that has been repeatedly denied as a false report) or an index patient that was never reported in April?

OK. So we have it as a 25-year-old man, who died on April 26. This isn't the reported doctor (reports of the death of that case started around the 24th), and it isn't either of the children mentioned in this thread (they're both too young). Sharon has posted an article above dated the 27th that mentions 2 deaths. At the time, I was presuming it was the doctor, but could it have been this student? It certainly appears that local papers were aware of a second death, even if we did not find one that explicitly reported the details.

What is his relationship to the other cases? He could certainly be the "brother of the nurse" mentioned in the first few posts of this thread, but if the two fatal confirmed cases were brother and sister, I would have expected that in the WHO release. Perhaps the initial reports are incorrect as to which nurse died, and this student is the brother of a different nurse, one who survived and has not yet been confirmed. Alternatively, perhaps he is a nursing student, and is already being counted as one of the 9 "nurses" in the 11 cases?

Or is this student's death unconnected to the 11 person cluster?

Either way, it's not the index case because it came a week AFTER the death of the nurse.

On a related note, Treyfish's post above indicates that several cases tested positive for Pseudomonas bacteria as well, which might have caused the speculation in the April articles about resistant bacteria and MRSA and/or Klebsiella.

[alert]

Re: Jordan - Cluster of approximately 11 people with acute pneumonia type illness, 2 fatalities - April 20 - May 2012 - Novel coronavirus confirmed

http://www.foxnews.com/health/2012/1...e-coronavirus/

[snip]


The Jordan cases were among a total of 12 cases of severe acute respiratory illness that erupted last April linked to a hospital in Zarqa some 40 kilometers (24 miles) outside Amman, Hartl said. Most were health workers, he added.

"The link is the hospital. It could be some environmental thing or human-to-human transmission," he said

[snip]

[alert]

Re: Jordan - Cluster of approximately 19 people with acute pneumonia type illness (11 confirmed) - 1 confirmed death

Predicted the death of'' Amjad'' because of his unknown virus

Thursday, April 26, 2012 22:40

Denied the Department of Health and there is no relationship between the death of young Ashrana yesterday in a hospital Princess Hamza was suffering a disease in the membranes of the heart, and "virus unknown" that caused severe pneumonia to a number of cadres of hospital blue state, resulting in the death of nurse emotions Balawi.

The Director of Primary Health Care Department at the Ministry Bassam Hijjawi for "the way" on Thursday, said the cause of death of the young man transferred from the hospital blue state a condition to attack Hamza Hospital, due to a bug hit the heart membranes.

The conversion of the deceased young Prince Hamza Hospital before the discovery of "unknown virus" in the blue government hospital.

But with the young deceased Amjad Akram livelihood leading to "the way" paper Marwsh of Prince Hamzah Hospital says "Enter the (young) to the hospital on 15/4 adapter from the hospital blue and he was suffering from symptoms of pneumonia and inflammation of the heart muscle (the membrane and muscle) and given the late necessary treatment and samples were taken for diagnosis with the possibility of a viral infection or pulmonary TB, and began treatment based on it. and go to Allah's mercy pm Wednesday, 25.04. "http://www.assabeel.net/important-to...%88%D9%84.html

The translation here was a bit rough, but this might refer to the second confirmed case, as the date of death is correct within a few hours.

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Re: Jordan - Cluster of approximately 12 people with acute pneumonia type illness, 2 fatalities - April 20 - May 2012 - Novel coronavirus confirmed

http://jordantimes.com/nationwide-ca...el-coronavirus

Nationwide campaign planned to detect potential cases of novel coronavirus
by Khetam Malkawi | Dec 02, 2012 | 22:03 Updated: Dec 02, 2012 | 22:03
AMMAN ? The Ministry of Health will launch a nationwide monitoring campaign for the detection of any potential cases of novel coronavirus, Health Minister Abdul Latif Wreikat said on Sunday.

Following the confirmation of the novel coronavirus in two Jordanians who died in April, the ministry, in cooperation with the World Health Organisation (WHO), will keep an eye on cases of acute respiratory diseases and test them for the virus, Wreikat added.

A team of WHO experts is currently in Jordan to assist in further epidemiological surveillance and to strengthen the sentinel surveillance system for severe acute respiratory infections.

In a sentinel surveillance system, a designated group of reporting sources ? hospitals, agencies ? agrees to report all cases of one or more notifiable conditions.

[snip]

[alert]

Re: Jordan - Cluster of approximately 12 people with acute pneumonia type illness, 2 fatalities - April 20 - May 2012 - Novel coronavirus confirmed

Hat-tip IOH. Copied from (http://www.flutrackers.com/forum/sho...d.php?t=196619).

http://www.who.int/csr/disease/coron.../en/index.html

[snip]

Two confirmed cases have been reported in Jordan. Both of these patients have died. These cases were discovered through testing of stored samples from a cluster of pneumonia cases in health care workers that occurred in April 2012.

In November 2012 staff from WHO Headquarters and the Eastern Mediterranean Regional Office were invited to Jordan to assess severe acute respiratory infection (SARI) surveillance and infection prevention and control measures, and to review the April 2012 outbreak. The mission included hospital site visits, interviews with patients, relatives and caregivers, and review of case files. In addition to the two previously confirmed cases, a number of health care workers with pneumonia associated with the cases were also included in the review and are now considered probable case.

The main findings of this mission are:

The index case among this cluster could not be determined.
All patients had significant respiratory disease presenting as pneumonia. Disease was generally milder in the unconfirmed probable cases. One patient who is a probable case had symptoms that were mild enough to be managed at home and was not admitted to hospital.
No patient in this cluster had renal failure.
One patient presented with pneumonia and was discovered to also have pericarditis. This patient had laboratory confirmation of infection and has died.
A second patient developed disseminated intravascular coagulation as a complication of severe respiratory disease. This patient also had laboratory confirmation of infection and has died.
The method of exposure is uncertain.
There was no history of travel or contact with animals among confirmed or probable cases.
Most family members and health care workers who were closely exposed to confirmed and probable cases did not develop respiratory disease. However, the appearance of pneumonia in some who provided care and in at least two family members with direct personal contact increases the suspicion that person-to-person transmission may have occurred. The possibility of exposure to a common source has not been definitively excluded. Further investigation with serological testing (when it becomes available) to confirm additional cases may help determine the types of exposures that result in infection.

The current understanding of this novel virus is that it can cause a severe, acute respiratory infection presenting as pneumonia. The additional unconfirmed probable cases in Jordan indicate that milder presentations may also be a part of the clinical appearance associated with infection. Acute renal failure has occurred in five of the nine confirmed cases but was not a prominent feature of the Jordanian cluster. In addition, pericarditis and disseminated intravascular coagulation have now been seen in two confirmed cases.

[snip]

[alert]

Re: Jordan - Cluster of approximately 12 people with acute pneumonia type illness, 2 fatalities - April 20 - May 2012 - Novel coronavirus confirmed

They may yet confirm more cases in this cluster:

http://thestar.blogs.com/worlddaily/...us-expert.html

[snip]



Are there serological studies currently underway?

The Jordanians have just completed an investigation using serology of their cases that happened a year ago. We?re expecting the results from that study in the next couple of weeks.

In that initial cluster, we only had two confirmed cases ? there were about a dozen people that had a similar illness but there were only clinical materials remaining to be tested from two or three people. So what they have to do now is go back and draw blood from all of those people to see if the illness that they had was actually this infection.

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Re: Jordan - Cluster of approximately 12 people with acute pneumonia type illness, 2 fatalities - April 20 - May 2012 - Novel coronavirus confirmed

And the index case has been found, raising the count to 13 cases here. Notably, his case was one of the later ones reported, perhaps due to the longer period between onset and death.

http://www.cidrap.umn.edu/cidrap/con...213corona.html

Jordanian cluster
Details on the Jordanian case cluster were provided yesterday in an online report from the Eastern Mediterranean Health Journal, published by the WHO's Regional Office for the Eastern Mediterranean.

The hospital cluster involved 2 confirmed and 11 probable cases in April 2012. They marked the emergence of MERS-CoV, but they were not identified as such until about 7 months later, after the discovery of the virus in a Saudi Arabian man and a Qatari in September.

After the virus was discovered, Jordanian officials sent stored samples from some of the patients to a US Navy laboratory in Cairo, and two of them tested positive in November. Both of the confirmed case-patients died, while all the probable cases survived.

Of the 13 confirmed and probable cases, 10 were in healthcare workers (HCWs) and 2 were in family contacts of patients, according to the report by Jordanian Ministry of Health officials. They occurred in the public hospital in Zarqa, Jordan's second-largest city.

Investigators found that the illnesses came in two waves or phases: four with onset between Mar 21 and Apr 2, and nine with onset between Apr 11 and 26. Only three patients were women, which is in line with the findings for MERS-CoV cases in general. But the median age was only 33, as compared with a median of 56 years for the recent Saudi case cluster.

The first (index) case in the cluster was in a 25-year-old university student who got sick on Mar 21 but was not hospitalized until Apr 4, according to the report. The second and third cases involved a 30-year-old male nurse who fell ill on Mar 30 and a 40-year-old female nurse who got sick on Apr 2. The 25-year-old and the 40-year-old were the patients who died and whose cases were later confirmed.

The index patient, who died on Apr 25, had no travel history and no reported contact with animals in the 10 days before his first symptoms. His contacts included the second and third case-patients, as well as his mother, who remained healthy.

Oddly, however, the second and third patients got sick before the first case-patient was hospitalized, leaving it unclear how the second patient became infected. Among other possibilities, the authors speculate that the two nurses might have been exposed to the index case in an outpatient clinic, before he was admitted to the hospital.

The nine patients in the second phase of the cluster all had probable cases, and all but one were likely to have had significant contact with at least one of the two confirmed case-patients, according to the report.

In other findings, the report says:

To prevent "stigmatization of patients," the HCWs didn't use any personal protective equipment except gloves when caring for them.
The HCWs had no recent travel history or reported contact with animals.
None of the patients had renal failure, a condition that has been reported in several MERS-CoV cases elsewhere, though the index case had pericarditis.
The apparent incubation period for the illness was no more than 10 days.
Overall, the findings "suggest that although person-to-person infection is possible, there is no evidence at present of sustained person-to-person transmission of nCoV [novel coronavirus] in relation to this cluster," the authors write.

------------------------------------

adding retroactive WHO confirmation:

Novel coronavirus infection - update

30 NOVEMBER 2012 - In addition to the fatal case of novel coronavirus in Saudi Arabia reported to WHO on 28 November, two fatal cases in Jordan have been reported to WHO today, bringing the total of laboratory-confirmed cases to nine.

The latest confirmed case from Saudi Arabia occurred in October 2012 and is from the family cluster of the two cases confirmed earlier.

The two cases from Jordan occurred in April 2012. At that time, a number of severe pneumonia cases occurred in the country and the Ministry of Health (MOH) Jordan promptly requested a WHO Collaborating Centre for Emerging and Re-emerging Infectious Diseases (NAMRU ? 3) team to immediately assist in the laboratory investigation. The NAMRU-3 team went to Jordan and tested samples from this cluster of cases.

On 24 April 2012 the NAMRU-3 team informed the MOH that all samples had tested negative for known coronaviruses and other respiratory viruses. As the novel coronavirus had not yet been discovered, no specific tests for it were available.

In October 2012, after the discovery of the novel coronavirus, stored samples were sent by MOH Jordan to NAMRU-3. In November 2012 NAMRU-3 provided laboratory results that confirmed two cases of infection with the novel coronavirus.

The MOH Jordan has requested WHO assistance in investigating these infections. A mission from WHO Eastern Mediterranean Regional Office (EMRO) and headquarters arrived in Amman on 28 November 2012 to assist in further epidemiological surveillance and to strengthen the sentinel surveillance systems for severe acute respiratory infections (SARIs).

In summary, to date a total of nine laboratory-confirmed cases of infection with the novel coronavirus have been reported to WHO ? five cases (including 3 deaths) from Saudi Arabia, two cases from Qatar and two cases (both fatal) from Jordan.

http://www.who.int/csr/don/2012_11_30/en/

[alert]

Re: Jordan - Cluster of approximately 13 people with acute pneumonia type illness, 2 fatalities - April 20 - May 2012 - Novel coronavirus confirmed

Hat-tip Pathfinder. Eight additional cases in this cluster have been confirmed, including six HCW, bringing the total number of confirmed cases in this cluster to ten:

http://www.flutrackers.com/forum/sho...444#post501444

[alert]

Re: Jordan - Cluster of approximately 13 people with acute pneumonia type illness, 2 fatalities - April 20 - May 2012 - Novel coronavirus confirmed

Published Date: 2013-06-17 15:33:30
Subject: PRO/AH/EDR> MERS-CoV - Eastern Mediterranean (31): Jordan, retro. case ID, WHO, RFI
Archive Number: 20130617.1777989

MERS-COV - EASTERN MEDITERRANEAN (31): JORDAN, RETROSPECTIVE CASE IDENTIFICATION, WHO, REQUEST FOR INFORMATION
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A ProMED-mail post
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International Society for Infectious Diseases
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In this update:
[1] Jordan - April 2012, 8 additional cases confirmed
[2] Saudi Arabia - WHO report on latest 3 cases and 4 deaths

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[1] Jordan - April 2012, 8 additional cases confirmed
Date: 17 Jun 2013
Source: The Times Colonist [edited]
http://www.timescolonist.com/life/ea...eople-1.323843


A retrospective study has shown that the earliest known outbreak of the MERS coronavirus infected at least 10 people [see ProMED-mail posts Novel coronavirus - Saudi Arabia (04): RFI, Jordan, April 2012 20120925.1308001 and Novel coronavirus - Eastern Mediterranean: WHO, Jordan, conf., RFI 20121130.1432498 for details on the outbreak in Jordan. - Mod.MPP].

Two of those cases, from an outbreak in Jordan in April of 2012, have been previously reported [Novel coronavirus - Eastern Mediterranean: WHO, Jordan, conf., RFI 20121130.1432498].

An official of Jordan's Ministry of Health revealed the news today [17 Jun 2013] in an interview from Amman.

Dr. Mohammad Al-Abdallat says blood samples from 124 people were tested for antibodies to the Middle Eastern respiratory syndrome coronavirus.

He says 8 people tested positive, including 6 people who had been known to be sick at the time of the outbreak, one health-care worker and one household contact of a confirmed case.

The 2 previously confirmed cases died at the time of the outbreak but were confirmed later using samples that had been stored.

The study was a joint effort by the Jordanian health ministry and scientists from the U.S. Centers for Diseases Control [and Prevention] [CDC] in Atlanta.

The additional cases, if added to the World Health Organization's global tally, would bring the global count to 72 cases, 38 of which have been fatal.

The cases in Jordan occurred at Zarqa, southwest of Amman. The outbreak happened before the existence of the new virus was recognized. At the time, no cause for the cluster of severe pneumonias was identified.

In June of 2012, scientists at Erasmus Medical Centre in Rotterdam, the Netherlands identified a previously unknown coronavirus -- a cousin of the virus that caused SARS -- in a sample taken from a Saudi man who had died from a similar pneumonia in a hospital in Jeddah.

The bulk of the diagnosed infections to date have occurred in Saudi Arabia, which on Sunday [16 Jun 2013] revealed they had found 3 new cases in disparate parts of the country.

A recent outbreak of hospital-related cases in Saudi Arabia has racked up several dozen cases in the kingdom's Eastern Province. But in recent days, cases have popped up in Taif, near the holy city of Mecca, Jeddah and Riyadh.

[Byline: Helen Branswell]

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[The significance of these findings includes the ability to identify and confirm milder illness and presumably asymptomatic infection retrospectively through serologic antibody assay. Prior studies had "ruled out" the MERS-CoV infection in now healthy close contacts of the 2 confirmed fatal cases from the April 2012 outbreak in Jordan. Of additional note and significance is the mention that of the 8 saved specimens that were positive for MERS-CoV infection, "6 people had been known to be sick at the time of the outbreak, one health-care worker and one household contact of a confirmed case." This suggests that the health-care worker and household contact were not known to be sick at the time, and hence were presumed to be asymptomatic infections with the MERS-CoV. If this supposition is correct, this will represent the 1st time asymptomatic infection with the MERS-CoV has been laboratory confirmed. Serosurveys in communities where there have been cases of severe illness attributable to MERS-CoV infection may now be possible and may identify further "silent" (asymptomatic) infections as well as milder disease occurring in the community and among previously healthy individuals. This may well be additional supportive data that pre-existing illness predisposes to severe disease with MERS-CoV infection, whereas infection in previously healthy individuals tends to follow a milder clinical course.

We await more information on the details of the testing performed and any follow up studies on laboratory confirmed infected individuals.

With these newly confirmed infections, the global tally of laboratory confirmed infections with MERS-CoV increases to 72 cases, of which there have been 38 deaths.