Enhanced UK MERS surveillance found 2 imported cases in 2012-13
An enhanced system of surveillance for MERS-CoV in England turned up 2 cases of the disease among 77 potential candidates meeting case definitions in its first year of operation, according to a dispatch yesteday in Emerging Infectious Diseases. The numbers are small, say the authors, but in the context of emerging pathogens, reporting data like theirs can help optimize case detection and surveillance systems.
The surveillance system was instituted by England's Health Protection Agency, now called Public Health England (PHE), in September 2012 after isolates from an ill Qatari patient who was transferred to an English hospital showed a virtual match to the virus identified in the first MERS-CoV (Middle East respiratory syndrome coronavirus) patient in Saudi Arabia earlier in the year.
PHE defined a possible MERS case as acute respiratory syndrome (fever of at least 38°C [100.4°F] or history of fever and cough) requiring hospitalization as well as clinical or radiologic evidence suggesting lower airway involvement not explained by another cause in a patient who had traveled to or resided in Saudi Arabia or Qatar (the only places with MERS at the time) within 10 days of illness onset.
Of 77 individuals meeting the case definition from Sep 24, 2012, to Oct 15, 2013, 2 cases were confirmed, as were cases in 2 contacts of the second case-patient. The positive predictive value of clinical manifestations increased as the severity of disease increased.
The authors write, "We encourage other countries to similarly report the characteristics of all patients tested for MERS-CoV to improve understanding of the predictive value of different clinical and epidemiologic manifestations in various populations at different times. This will help inform the evolving international public health response to this novel pathogen."
Aug 4 Emerg Infect Dis dispatch
CDC study: Reclassification affected foodborne outbreak data since 2009
At least some of the substantial decline in reports of foodborne disease outbreaks since 2009, when the National Outbreak Reporting System (NORS) began reporting all enteric disease outbreaks rather than only foodborne outbreaks, is accounted for by workers giving different classifications to outbreaks that would previously have been categorized as foodborne, say the authors of a study yesterday in Emerging Infectious Diseases.
In addition, a shortage of resources during the 2009 pandemic influenza outbreak may have played a role, they found.
With the enhanced reporting platform, enteric outbreaks that are transmitted by person-to-person contact, animal contact, environmental contamination, and indeterminate source are reported in addition to those classified as foodborne and waterborne.
The researchers, from the Centers for Disease Control and Prevention, conducted a voluntary survey of state and territory health department workers who enter enteric disease outbreak data into NORS.
Workers gave high priority to reporting foodborne disease outbreaks. However, 35 of 47 (74%) reported sometimes having difficulties in determining the primary mode of transmission in an outbreak in the enhanced system.
Specifically, 20 of 25 respondents (80%) said they had difficulty distinguishing between foodborne and person-to-person transmission. In addition, 26 of 47 (55%) reported they had used the new "indeterminate/other/unknown" category in cases in which the mode of transmission wasn't clear. Most respondents said they likely or very likely would have reported such outbreaks as foodborne in the pre-2009 system.
In answer to questions pertaining to health department resources during the 2009 flu pandemic, 19 of 35 (57%) said there were fewer resources available at that time for foodborne disease outbreak investigations.
"The results of this survey provide unique insights into the decline in the number of foodborne outbreak reports submitted in 2009 and thereafter," say the authors.
Aug 4 Emerg Infect Dis study