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

[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.
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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

[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.

[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

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

[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.

[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]

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/

[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.

[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

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.

[Treyfish]

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

?The second round of test results from oral and nasal swabs show the Illinois resident is not infectious,? said Dr. Hasbrouck. ?What this means is, although the resident was infected at one time, if he sneezes or coughs, the virus is not in his nose or mouth and therefore cannot be spread to others. The risk of MERS-CoV to the general public remains very low. We will continue to follow-up with this individual.?

...cannot spread to others...okkkaayyy...The guy just got it from a "handshake"..He might have reported a slight runny nose...On April 25, the Illinois man had a 40-minute face-to-face meeting ..follow up test shows he was infected.. I am feeling we are NOT getting timely information, moresoever, a whole bunch of WE DON'T KNOW.after 2 years!

[sharon sanders]

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

Anything is possible. He has never tested positive for active infection. I think we still have a lot to learn about this virus.

[Emily]

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

Additional blood testing related to his positive MERS-CoV antibody test result is currently underway.

Is there a chance that was a false-positive?

[Pathfinder]

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

Press Release
FOR IMMEDIATE RELEASE
May 19, 2014
CONTACT:
Melandy Arnold (217) 558-0500
Shelia Porter (312) 814-3524

www.idph.state.il.us

Illinois Department of Public Health Reports Negative Results for MERS-CoV

CHICAGO – Illinois Department of Public Health (IDPH) Director Dr. LaMar Hasbrouck today announced the Illinois resident who previously tested positive for Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) antibodies in his blood, has again tested negative for the ability to spread the virus.

“The second round of test results from oral and nasal swabs show the Illinois resident is not infectious,” said Dr. Hasbrouck. “What this means is, although the resident was infected at one time, if he sneezes or coughs, the virus is not in his nose or mouth and therefore cannot be spread to others. The risk of MERS-CoV to the general public remains very low. We will continue to follow-up with this individual.”

Health officials first tested this person using oral and nasal swabs for active MERS-CoV infection on May 5. Those test results were negative. On May 16, a blood test result was positive for the Illinois resident, showing that he had antibodies to MERS-CoV. Over the weekend, the resident was again tested using oral and nasal swabs and those have come back negative. Additional blood testing related to his positive MERS-CoV antibody test result is currently underway.

Health officials continue to follow-up with anyone who had close contact with the Illinois resident. Family members who had close contact with the Illinois resident have all tested negative, but will continue to be monitored.
The Illinois resident is considered to have had close contact with the first imported case in the United States, a Saudi Arabian resident who traveled to Indiana on April 24. All people considered to have had close contact with first case have been followed-up with and closely monitored.

“MERS-CoV is a relatively new virus and we still have much to learn about it, including how it is transmitted. The World Health Organization, U.S.

Centers for Disease Control and Prevention, state health departments and local health departments continue to investigate this virus as well as identify new cases around the world, conduct testing and implement infection control practices,” said Dr. Hasbrouck. “Additional cases are expected, but we are working diligently to eliminate the spread of this virus.”

As with other respiratory illnesses, IDPH recommends people take everyday preventive actions like washing their hands often; avoiding touching their face with unwashed hands; avoiding contact with people who appear sick; and disinfecting frequently touched surfaces.
IDPH has reactivated the expert medical staff at Illinois Poison Center to operate the MERS-CoV hotline. Illinois residents and medical professionals who have concerns or questions should call 1-844 565-0256.

For more information about the infected individual and the two confirmed MERS-CoV cases in the U.S., visit www.cdc.gov/coronavirus/mers/index.html. General information about MERS-CoV can be found on the IDPH website, including Frequently Asked Questions.

IDPH continues to implement its Five Year Strategy 2014-2018 to maximize IDPH’s effectiveness, influence and value for promoting wellness, health equity, safety and improved health outcomes. Strategic plan priorities include developing and expanding partnerships; improving data utilization; reducing health disparities; improving regulatory compliance; and branding, marketing and communicating IDPH’s value.

http://www.idph.state.il.us/public/press14/5.19.14_IDPH_Reports_Negative_Results_for_MERS-CoV.htm

[Pathfinder]

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

Illinois man tests positive for MERS virus without falling ill

By Nick Carey
CHICAGO Sat May 17, 2014 7:12pm EDT
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The Illinois resident did not seek or require medical care and is reported to be feeling well, but officials involved in investigating the first casehave been monitoring his health since May 3. A blood test on Friday showed he had developed antibodies to MERS.
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On April 25, the Illinois man had a 40-minute face-to-face meeting with the Indiana patient, a business associate, Swerdlow said. The two men shook hands but the Indiana patient did not have a cough at the time.
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The first case of MERS was confirmed in Indiana in early May and the second, in Florida, on May 11. Swerdlow said 50 people who came into contact with the Indiana patient have tested negative for MERS but are undergoing more tests. Health officials are now trying to identify and monitor close contacts of the Illinois resident.
...

http://www.reuters.com/article/2014/05/17/us-mers-illinois-idUSBREA4G08G20140517