News Scan for Jul 17, 2015

Prolonged hospital MERS spread
Call for better WHO Ebola response
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Study indicates 5-month hospital transmission in Riyadh

Data from a hospital outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) cases last spring suggest continuous healthcare-associated transmission for several months, a study today in Emerging Infectious Diseases noted.

Scientists from the King Fahad Medical City (KFMC) in Riyadh and the University of Hong Kong analyzed an outbreak at KFMC from Mar 29 through May 21, 2014. The outbreak involved 45 MERS-CoV patients: 8 infected outside KFMC, 13 long-term patients at KFMC, 23 healthcare workers, and 1 patient who had an indeterminate source of infection.

Comparison of 10 full-length MERS-CoV sequences and a partial sequence with other MERS-CoV sequences, as well as epidemiologic data, indicated multiple external introductions. Analysis also demonstrated that the outbreak was part of a larger one involving multiple healthcare facilities in Riyadh—including the Prince Sultan Military Medical City and King Khalid University Hospital—and "possibly arose from a single zoonotic transmission event that occurred in December 2013," the authors concluded.

"This finding suggested continued healthcare–associated transmission for 5 months," they wrote.

The investigators also reported a periodicity in peaks of transmission of about 7 days apart, which is compatible with the known incubation period. And they noted that KFMC's emergency department and one of its wards were the foci of transmission.
Jul 17 Emerg Infect Dis study


Global health security expert challenges WHO expert panel report

The report released 10 days ago by an independent panel on the World Health Organization's (WHO's) response to West Africa's Ebola epidemic failed to adequately address the problems in global health leadership that it brought to light, a leading expert on global health and security said today in a commentary from Chatham House, the UK's Royal Institute of International Affairs.

David P. Fidler, JD, an international law specialist at Indiana University and an associate fellow of Chatham House's Centre on Global Health Security, said the outbreak was a "disaster" for the International Health Regulations (IHR), which the WHO report noted. But the expert panel writing the report "largely recycled old, ineffective ideas and reflected weak analysis of the outbreak," Fidler wrote.

The panel recommended a funding plan to address IHR-related shortcomings in Guinea, Liberia, and Sierra Leone that contributed to the ineffective response. But the independent committee did not analyze why previous funding calls went unheeded, how Ebola might present unique challenges, or why IHR capacity-building deserves high priority, Fidler said.

The panel also called for exploring sanctions against WHO member states that adopt travel and trade restrictions that violate the IHR, but sanctions have not worked in the past and the panel provided no alternatives that might work, Fidler noted.

Fidler also wrote that the expert panel also recommended reforms beyond the IHR, "but its recommendations provided no priorities among the proposals made."

Chatham House is an independent policy institute based in London.
Jul 17 Chatham House
Jul 7 CIDRAP News story "
WHO independent panel calls out Ebola response flaws"

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