Middle East respiratory syndrome coronavirus detections on the downward trend under Acting Health Minister Fakeih..[UPDATE]

Click on image to enlarge.

Apart from the looming spike in MERS-CoV detection among farmers who have taken to YouTube to kiss their camels in proof of their obviously over-stated role in being a viral source (sigh; that's a post unto itself*), the trend, after accounting for last nights cases is still one of declining case numbers since the change in management at the KSA Ministry of Health.

Some brief thoughts on the very early morning (my time; AEST) case reports from the KSA.[1] There were 8 cases announced which included 2 deaths plus another 3 deaths from previously announced cases. No asymptomatic cases (h/t @HelenBranswell) or healthcare workers and few mentions of comorbid disease were included; all bucking the recent trend. There were 4 possible hospital-acquired infections listed too, including illness onset from 11-May. Clearly infection prevention and control (ICP) messaging/action is still not succeeding, at least in Riyadh and Al-Madinah. 

Also announced this morning was a second imported case into the USA.

• The Patient (possibly a 44-year old male[2]) was symptomatic - including a cough, (later some diarrhoea), fever and chills (1-May) -  during flights from Jeddah to London, from London to to Boston>Atlanta>Orlando, Florida.[2,3]
• Symptomatic does not necessarily mean infectious [3]
• Patient was a healthcare provider (?worker, HCW)
• Patient was admitted to hospital in Orlando 9-May and is isolated.
• Over 500 potential contacts from the US-based flights are being contacted and after 1,000 person hours by CDC staff over the weekend, no-one has been found to be reporting illness so far.[3]
• Little risk of spread from casual contact.[3]

*I'm being sarcastic

References...

1. http://www.moh.gov.sa/en/CoronaNew/PressReleases/Pages/mediastatement-2014-05-12-001.aspx
2. http://www.latimes.com/science/sciencenow/la-sci-sn-mers-florida-20140512-story.html
3. http://www.cdc.gov/media/releases/2014/t0512-US-MERS.html
4. http://www.orlandosentinel.com/health/os-mers-case-central-florida-20140512,0,5928176.story
5. http://crofsblogs.typepad.com/h5n1/2014/05/us-a-little-more-on-the-florida-mers-case.html

Why I think the 2nd wave of human influenza A(H7N9) virus infections has broken...

If you look at the chart above, it shows declining:

• Average cases per day (blue data points) in 2014
• Less noticeable but consistently declining average cases per day when calculated across all of Wave 2 (oranges data points)
• And importantly, a drastic decline in the number of new cases being announced after the 27-Jan peak. 

From 5-Feb, we have not seen more than 2 cases/day whereas in Jan we were regularly seeing 5-6 cases/day (peaking at 12/day).

The last time we saw this steep a drop in cases was 19-Apr 2014; the end of H7N9's 1st wave of human infections. 

That doesn't mean the virus has gone away or that the outbreak has been "solved". I learned that lesson last year. H7N9 is still out there. 

If these latest case numbers accurately reflect what is happening in China, then it looks like closing poultry markets did the same job in 2014 that it did in halting the 2013 Spring outbreak in southeast China. It will be down to the poultry industry and perhaps the Ministry of Agriculture in China to find evidence that specifically disproves a role for poultry in human infections; and it seem clear that changing from fresh to processed poultry has some even more safety data to support it.

We still have no data that lets us point the finger at chickens, or ducks or song birds or pigeons or geese or some other animal in the markets as the source. 

We just know there is a strong association between humans getting infected after being in the presence of "live poultry" usually in a market setting. With reports suggesting better growth of H7N9 in song birds compared to chickens as well as poor spread of virus between infected chickens, there is much work to be done outside of chickens to track the source of the virus down.