Middle Eastern Respiratory Virus Syndrome strikes the UK

   Coughs  Sneezes Spread Diseases2
This week
, the UK became the latest country in 2015 to suffer suspected MERS cases.  Two suspected cases of the Middle Eastern Respiratory Virus Syndrome (MERS) have forced a hospital in Manchester to shut its emergency department.  In May, similar events in South Korea (MERS-CoV in Republic of Korea at a glance), mishandled through ignorance and poor infection control within several hospitals, caused multiple outbreaks and a national emergency. Manchester has obviously learnt from their experience.

MERS is the latest virus to act as a global threat, hot on the heels of Ebola and SARS. It emerged in 2012 and has been an ongoing problem spreading to 10 countries in the Middle East, but the Ebola outbreak in West Africa in 2014, replaced it in world headlines (read MERS the next pandemic threat, which appeared also in the Global Health Knowledge Base.

What would happen should MERS ever reach a country with a poor health system?

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Accurate and timely communication is key to stopping transmission of Ebola

Ebola on TDB
Ebolavirus: coverpage for CABI's print journal Tropical Diseases Bulletin

Ebola brings out the worst and the best in mankind.

Global coverage of the Ebola outbreak in West Africa began with (the best) courageous foreign health care workers (HCWs) being flown home by their governments in a desperate attempt to save their lives, and rapidly moved on to the sheer panic amongst the local populations experiencing the outbreak: riots, health care workers and government officials abandoning their posts (the worst). Somewhere imbetween mention was made, usually by the foreign HCWS, of their local colleagues left behind who struggled on without resources and personal protection (the best).

Medicin Sans Frontiers highlighted the slow response of the international community.

Misinformation, public panic and stigma

Ebola haemorrhagic fever (caused by different ebola virus strains) has been around since 1976, with regular self-limiting outbreaks, usually in remote areas of one country. Index cases always involve some contact with animal reservoirs (bushmeat (wild animal meat), bats, rodents, monkeys), and its then spread by person-to-person transmission through contact with bodily secretions or with objects contaminated with secretions. It’s infamous for its high case-fatality rate and the ease with which it spreads among contacts of the diseased.

What makes this time different is the Zaire strain has now reached West Africa: there  it has spread from remote regions into highly populated urban areas, and it has crossed borders so that there are escalating outbreaks in 3 adjacent countries (Guinea, Sierra Leone and Liberia), with no end in sight. The epidemic (for that is what it is now), has resulted from sustained person-to-person transmission.

Cases have also been reported in Nigeria and Senegal but these countries seem to have contained the transmission of the virus. DR Congo  has an outbreak.   An up-to-date Ebola Healthmap can be found here.

Ignorance and fear, drivers of disease

Misinformation among health workers and the public fuelled panic and contributed to the spread of Ebola-zaire over the last 6 months.  HCWs abandoned their posts or were the source of rumours that created riots, government officials got out whilst they could. [The index case for Nigeria, was an official who left Liberia, who knowingly had had contact with an Ebola victim].

Fear has not just caused civil breakdown.  It is masking the magnitude of the outbreak, especially in Liberia and Sierra Leone. Families fear stigma so hide sick relatives or consider the hospitals as death sentences (breaking relatives out!) or indeed consider them the cause of the illness in the first place. Cases being cared for outside hospitals do not enter the statistics.   

Unlike the “Black Death” in medieval Europe, it’s not lack of real clinical knowledge that’s the problem but:

  1. Weak health systems, lacking skilled HCWs and resources
  2. Lack of knowledge amongst the general public
  3. Lack of community involvement & mistrust of government
  4. Misinformation among health workers, ministries of health and the public
  5. Lack of effective drugs and vaccines…supportive therapy only is current medical response.

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E. coli O104: Should we believe them this time?

Sprouting peas on tweezer small

Choose your sprouts carefully

Apparently its now thought that fenugreek seeds sourced in Egypt were the cause of the recent outbreaks in Germany and France. I suggest you read today's Update on E.coli O104 outbreaks from EFSA and draw your own conclusions.

The update tells us that the particular batch of fenugreek seeds has been withdrawn from sale and a temporary ban placed on importing fenugreek and certain seeds, beans and sprouts from Egypt. In the case of the seeds, its only if these are to be sprouted. Ground spices are unaffected.

And I quote, "evidence linking the two outbreaks to the implicated batch of fenugreek seeds is not definitive and investigations are continuing in all European countries".

Germany scores own goal…its not Spanish cucumbers!

It's not cucumbers, it might be beansprouts? E. coli O104 has killed 22 people so far, made over1400 ill and reached 11 countries. It has had a significant effect on two countries- damaging Spain’s economy and damaging the credibility of the German public health system. The fallout is broader still:  the EU – and that includes us - is now offering compensation to Spanish farmers – using a central fund. 

For the bewildered public, the clue is in the name Escherichia coli…coli, Latin for intestine; for these bacteria live in the gut of man and warm-blooded animals. Unfortunately, some strains (STEC/VTEC, see Outbreak of E. coli acronyms in Germany) produce toxins that can cause severe diarrhoea, and this is always down to someone’s lack of hygiene.
Not washing hands after defecation, using a water supply contaminated with faeces to wash or water crops or poor manure preparation. It’s transmitted because poo was on your fingers or on your food and went into your mouth!

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