It is official now that Outbreak of 2019-nCoV constitutes is a Public Health Emergency of International concern

It is official now that Outbreak of 2019-nCoV constitutes is a Public Health Emergency of International concern

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV)

30 January 2020 

Representatives of the Ministry of Health of the People’s Republic of China reported on the current situation and the public health measures being taken. There are now 7711 confirmed and 12167 suspected cases throughout the country. Of the confirmed cases, 1370 are severe and 170 people have died. 124 people have recovered and been discharged from hospital. 

 The WHO Secretariat provided an overview of the situation in other countries. There are now 83 cases in 18 countries. Of these, only 7 had no history of travel in China. There has been human-to-human transmission in 3 countries outside China. One of these cases is severe and there have been no deaths. 

 The Committee believes that it is still possible to interrupt virus spread, provided that countries put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk.

 The Director-General declared that the outbreak of 2019-nCoV constitutes a PHEIC and accepted the Committee’s advice and issued this advice as Temporary Recommendations under the IHR. 

Role of CMAAO and other countries

It is expected that further international exportation of cases may appear in any country.

All countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoVinfection, and to share full data with WHO. 

 Countries are reminded that they are legally required to share information with WHO under the IHR. 

 Any detection of 2019-nCoV in an animal (including information about the species, diagnostic tests, and relevant epidemiological information) should be reported to the World Organization for Animal Health (OIE) as an emerging disease.

 Countries should place particular emphasis on reducing human infection, prevention of secondary transmission and international spread, and contributing to the international response though multi-sectoral communication and collaboration and active participation in increasing knowledge on the virus and the disease, as well as advancing research.  

 The Committee does not recommend any travel or trade restriction based on the current information available.  

 Countries must inform WHO about any travel measures taken, as required by the IHR. Countries are cautioned against actions that promote stigma or discrimination, in line with the principles of Article 3 of the IHR. 

 The Committee asked the Director-General to provide further advice on these matters and, if necessary, to make new case-by-case recommendations, in view of this rapidly evolving situation. 

The case fatality rate of corona virus so far has been the lowest

Do not panic, time to fight out

The case fatality rate of corona virus so far has been the lowest

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

Comparison with deadly viruses

	Wuhan 2019 m CoV	MERS	SARS	Common cold caused by coronavirus
Detected	Dec 2019	2012, Southey Arabia	2002 in southern China.	Winter each year
Origin	Bats, Snakes	Bats, Camel	Bats, civets
Cases	14 countries	All cases linked to Arabian Peninsula, with 80% in Saudi Arabia. Others in about two dozen countries, including U.S. Cases and deaths have been declining since 2016.	No new cases reported since 2004. 87% of previous cases in China and Hong Kong.	Four coronavirus strains are thought to be responsible for 15-30% of common colds.
India	None	None	None
Human to human	Close contact	Close contact	Close contacts	Close contact
		2,494 confirmed cases; 858 deaths (as of Nov. 30, 2019).	8,098 cases; 774 deaths	Millions each year
Mortality	3%	34%	10%	Generally nonlethal with rare exceptions.

Case fatality rate

1.       2019 corona 3%

2.       MERS 35%

3.       SARS 10%

4.       Diphtheria 5-10%

5.       Polio: 2-5% children, 15-30% adults

6.       Swine flu < 0.15

7.       Whooping cough 4% infants < 1yr, 1% children < 4 years

8.       Ebola 50%

9.       Small-Pox 30-40%

10.   Measles 10-15% developing countries

Malaysia Reports Vaccine Derived Polio VDPV1: Need to Switch to IPV and Stop OPV

Malaysia Reports Vaccine Derived Polio VDPV1: Need to Switch to IPV and Stop OPV

Dr KK Aggarwal

President CMAAO and HCFI

AP: KUALA LUMPUR - Malaysia began a vaccination campaign in a rural town on Borneo island after a 3-month-old boy was confirmed to have vaccine derived polio after 27 years.
               

The infant from Tuaran town in Sabah state tested positive for polio on Friday after he was hospitalized with fever and muscle weakness.

Poliovirus is classified as a circulating vaccine-derived poliovirus type 1 (VDPV1), which originates from a poliovirus that has been weakened by the orally-administered polio vaccine.

Vaccine-derived polioviruses (VDPV) are Sabin (OPV) virus derivatives that circulate in settings of low population immunity (eg, with low immunization rates) and revert to neurovirulence with ongoing transmission.

The emergence of VDPV requires that use of all OPV vaccines must cease in order to achieve the goal of global poliomyelitis eradication.

Malaysia is the second Asian country to have reported a vaccine derived polio case after an outbreak in the Philippines in September.

Tests showed the baby's strain had genetic links to the vaccine derived polio virus detected in Philippines.

The strain originated from a weakened virus contained in oral polio vaccine that was excreted from the body through feces and believed to have spread in an unsanitary environment to those who haven't been immunized.
              

Concerns

1.     Since 2005, approximately 80 percent of cases occurring during cVDPV outbreaks have been caused by type 2 OPV virus. The recognition of cVDPVs dictates that all OPV use will need to cease to achieve full polio eradication.

2.     This case is VDPV1

3.     Each use of OPV2 response to a VDPV2 outbreak carries a risk of seeding new VDPV2 outbreaks. Therefore, timely control of VDPV2 outbreaks in the context of a growing cohort of children who do not have immunity to type 2 poliovirus is critical to the success of polio eradication.

4.     The present immunisation should be IPV and not OPV

More inputs are invited

201 cases of polio-like acute flaccid myelitis in 2018

201 people, mostly young kids, developed a polio-like condition known as acute flaccid myelitis (AFM) in 2018, as per US Centers for Disease Control (CDC) who still does not have a prime suspect. This number may well increase, as it can take long to confirm a suspected case.

AFM resembles polio, is likely caused by a virus.

Coxsackievirus A16, EV-A71, and EV-D68 viruses have been isolated in the spinal fluid of four of 527 confirmed cases of AFM since 2014. No pathogen has been detected in the spinal fluid in other cases.

Also, it is not easy to isolate a virus in patients who are not acutely infected. AFM often appears as an infection wanes, and it can take days for doctors to suspect the condition and start testing.

More than 80% of patients have had fevers and respiratory illnesses of some sort. EV-A71 and EV-D68 both cause respiratory infections. Coxsackievirus A16 causes hand, foot and mouth disease. Several patients have also had rhinovirus, which causes the common cold.

It is also unclear whether a virus is directly attacking nerves, as poliovirus does, or is causing an autoimmune reaction, as seen in Guillain-Barré syndrome.

No deaths have been reported but some of the patients are severely disabled.

The last case of polio from India was reported in the year 2011; the non-polio acute flaccid paralysis (NPAFP) rate in India was 13.35/100,000 in this year, which was much higher than the expected rate of 1-2/100,000. Some states had a higher rate of NPAFP than others. In 2011, the NPAFP rate in UP was 25/100,000; in Bihar, the rate was 35/100,000 (Int J Environ Res Public Health. 2018;15(8):pii:E1755).

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA