Novel Coronavirusand

H7N9 Influenza Infections

Situation update May 2013

Craig Roberts, PA-C, MSACHA Emerging Public Health Threats & Emergency Response Coalition

Novel Coronavirus (MERS-CoV) overview

• Coronaviruses are common viruses that most people get at some time in their life. Human coronaviruses usually cause mild to moderate upper-respiratory illness.

• A new coronavirus was identified as the cause of respiratory illness in 43 people from Saudi Arabia, Qatar, Jordan, the United Kingdom, the United Arab Emirates, Germany and France from April 2012 to May 2013.

MERS-CoV: epi

• MERS – Middle East Respiratory Syndrome• European cases all linked to Middle East cases• No known cases in U.S.• Suspected to be of animal origin with sporadic

transmission to humans via unknown route• Index case was a 25yo college student (4/2012)• Age range 24y-96y (median 56y); 79% male

MERS-CoV: characteristics

• Severe respiratory illness with high mortality– ARDS, renal failure, coagulopathies,

pericarditis, GI symptoms• Underlying conditions common• Limited person-to-person transmission

– Family members– Health care personnel

MERS-CoV: surveillance

• Travel status: Watch• Applies to 14 Arabian countries*• Travel history is important in evaluation of

acute respiratory illness• See CDC guidance at

www.cdc.gov/coronavirus/ncv/case-def.html

*Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen

H7N9 influenza

• Novel variant not seen in humans before• 132 cases reported in China, 36 deaths (27%)• Males aged 50+ at highest risk of disease• Sporadic infections in humans; many with

poultry exposure• No sustained or community transmission• No known cases in the U.S., 54 travelers

tested

Avian Influenza A (H7N9) Infection

India

Nepal

Russia

Mongolia

Bangladesh

Bhutan

Burma

Thailand

Laos

0

0

500 Kilometers

500 Miles

Vietnam

Philippines

SouthKorea

NorthKorea

Pakistan

INNER MONGOLIA

HENAN

ANHUI

ZHEJIANG

SHANGHAI

JIANGSU

FUJIAN

JIANGXI

HUBEI

SHANXI SHANDONG

HEBEI

BEIJING

TIANJIN

LIAONING

Taiwan

Province/City

Number of Cases

Anhui 4

Beijing 2

Fujian 5

Henan 4

Hunan 2

Jiangsuα 27

Jiangxi 6

Shandong 2

Shanghai 34

Zhejiang 46

Location of H7N9 Influenza Cases in China

SHAANXI

132 total cases/36 deaths*

GUANGDONG

HUNAN

GUANGXI

CHONGQING

GUIZHOU

NINGXIA

GANSU

SICHUAN

YUNNAN

JILIN

HEILONGJIANG

QINGHAI

XIZANG

XINJIANG

HAINAN

α- includes a casehospitalized in Taiwan

*as of 5/20/2013

H7N9 surveillance

• Travel status: Watch (China)Going to China? avoid contact with poultryReturning from China? Monitor for ILI X 10 days

• Travel history should be routinely collected in evaluation of any influenza-like illness

• ILI surveillance continues 52 weeks per year• Most PH Labs have capacity to test for H7N9

H7N9 Influenza - Guidance

Specific guidance for U.S. health care professionals:– Infection control

Use full PPE (glove/gown/eye protection), N95 mask– Use of antiviral medication

“treatment with oseltamivir or inhaled zanamivir should be initiated when confirmed cases, probable cases, or H7N9 cases under investigation are recognized, even if more than 48 hours from illness onset and even for apparently uncomplicated illness”

– Diagnosis and laboratory testingSee: www.cdc.gov/flu/avianflu/h7n9-healthprofessionals.htm

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