1. Novel Coronavirus and H7N9 Influenza Infections Situation update May 2013 Craig Roberts, PA-C, MS ACHA Emerging Public Health Threats & Emergency Response Coalition

2. Novel Coronavirus (MERS-CoV) overview Coronaviruses are common viruses that most people get at some time in their life. Human coronaviruses usually cause mild to moderate upper-respiratory illness. A new coronavirus was identified as the cause of respiratory illness in 43 people from Saudi Arabia, Qatar, Jordan, the United Kingdom, the United Arab Emirates, Germany and France from April 2012 to May 2013.

3. MERS-CoV: epi MERS – Middle East Respiratory Syndrome European cases all linked to Middle East cases No known cases in U.S. Suspected to be of animal origin with sporadic transmission to humans via unknown route Index case was a 25yo college student (4/2012) Age range 24y-96y (median 56y); 79% male

4. MERS-CoV: characteristics Severe respiratory illness with high mortality – ARDS, renal failure, coagulopathies, pericarditis, GI symptoms Underlying conditions common Limited person-to-person transmission – Family members – Health care personnel

5. MERS-CoV: surveillance Travel status: Watch Applies to 14 Arabian countries* Travel history is important in evaluation of acute respiratory illness See CDC guidance at www.cdc.gov/coronavirus/ncv/case-def.html *Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen

6. H7N9 influenza Novel variant not seen in humans before 132 cases reported in China, 36 deaths (27%) Males aged 50+ at highest risk of disease Sporadic infections in humans; many with poultry exposure No sustained or community transmission No known cases in the U.S., 54 travelers tested

7. Avian Influenza A (H7N9) Infection

8. India Nepal Russia Mongolia Bangladesh Bhutan Burma Thailand Laos 0 0 500 Kilometers 500 Miles Vietnam Philippines South Korea North Korea Pakistan INNER MONGOLIA HENAN ANHUI ZHEJIANG SHANGHAI JIANGSU FUJIAN JIANGXI HUBEI SHANXI SHANDONG HEBEI BEIJING TIANJIN LIAONING Taiwan Province/ City Number of Cases Anhui4 Beijing2 Fujian5 Henan4 Hunan2 Jiangsu α 27 Jiangxi6 Shandong2 Shanghai34 Zhejiang46 Location of H7N9 Influenza Cases in China SHAANXI 132 total cases/36 deaths* GUANGDONG HUNAN GUANGXI CHONGQING GUIZHOU NINGXIA GANSU SICHUAN YUNNAN JILIN HEILONGJIANG QINGHAI XIZANG XINJIANG HAINAN α- includes a case hospitalized in Taiwan *as of 5/20/2013

9. H7N9 surveillance Travel status: Watch (China) Going to China? avoid contact with poultry Returning from China? Monitor for ILI X 10 days Travel history should be routinely collected in evaluation of any influenza-like illness ILI surveillance continues 52 weeks per year Most PH Labs have capacity to test for H7N9

10. H7N9 Influenza - Guidance Specific guidance for U.S. health care professionals: – Infection control Use full PPE (glove/gown/eye protection), N95 mask – Use of antiviral medication “treatment with oseltamivir or inhaled zanamivir should be initiated when confirmed cases, probable cases, or H7N9 cases under investigation are recognized, even if more than 48 hours from illness onset and even for apparently uncomplicated illness” – Diagnosis and laboratory testing See: www.cdc.gov/flu/avianflu/h7n9-healthprofessionals.htm

11. What, Me Worry? We are just one plane ride away…