WHO experts to visit Saudi hospital where coronavirus spread

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  A electron microscope image of a coronavirus is seen in this undated picture provided by the Health Protection Agency in London.Reuters

World Health Organization (WHO) experts and local officials will visit a Saudi hospital where the SARS-like coronavirus has spread, killing seven people, the U.N. agency said on Wednesday.

France reported its first case on Wednesday in a 65-year-old Frenchman who had recently returned from Dubai with the virus that has emerged from the Gulf and has also spread to Britain and Germany as well as Jordan, Qatar and United Arab Emirates.

The French case brings total known infections worldwide to 31, of which 18 have died.

The Saudi patients appeared to have been infected in hospital with some family members also falling ill, WHO officials said.

Coronavirus is from the same viral family as triggered the outbreak of Severe Acute Respiratory Syndrome (SARS) that swept the world from Asia in late 2003, killing 775 people.

Health experts' concerns are growing over clusters of cases, despite no evidence of sustained human-to-human transmission - the type of infection pathway that can lead to pandemics.

The WHO-Saudi team of experts will focus on the Al-Moosa hospital in the town of Hofuf in Ahsa governate in Eastern Province, where the patients are being treated. Official statements released via the Saudi Press Agency have sought to reassure Saudis the outbreak is limited.

"One focal point of the investigation at the moment is the hemodialysis unit in the hospital," said WHO spokesman Gregory Hartl in Geneva, referring to equipment used on kidney and diabetes patients.

"The association of this outbreak with a single health care facility suggests nosocomial (hospital-acquired) transmission," it said, noting that some patients under treatment for ailments may have had increased susceptibility to infection.

"However, the presence of infection in two family members not associated with the facility itself raises a concern about potential broader transmission in the community," it said.

Saudi Arabia's Health Ministry spokesman did not respond to repeated phone calls seeking comment, while the director at Al-Moussa declined to comment. International media were not invited to a news conference with Health Ministry officials on Monday.

Statements on official media outlets were aimed at dispelling online speculation in Saudi Arabia that the virus had spread to other hospitals in Eastern Province.

A total of 23 cases have been reported since September in Saudi Arabia, including 13 since mid-April in al-Ahsa, where seven patients have died and four remain critically ill in intensive care, with two improving in hospital, the WHO said.

SPREADING TO EUROPE

Along with the French case, the WHO has registered 23 cases in Saudi Arabia, two in Jordan, two in Qatar, one in the United Arab Emirates (UAE) and two in Britain.

France's Health Minister Marisol Touraine said the man, now on a respirator in an intensive care ward, was admitted to hospital with breathing problems and a fever on April 23, a few days after his return from a week-long trip to Dubai.

"This is an imported case and it's a unique case," Touraine told a news conference, promising a thorough investigation into how the man had become infected.

Tests were now being carried out as a precaution on all friends and relatives who had been in contact with him, but all have come up negative so far, officials said.

"He is in a critical condition. His situation is worrying," the government's health director Jean-Yves Grall told the news conference. The man, who is from the northern Nord Pas de Calais region, has needed blood transfusions, he said.

The most recent German case was in March. The man fell ill in UAE and went to Germany for treatment where he died. The previous case, in November, was a man who was infected in Qatar, treated in Germany and then discharged from hospital.

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New transplant guidance could have stopped rabies case, experts say

Experts say a Maryland man who died last month of rabies might have been spared under transplant recommendations that hadn't yet been published when he got a kidney from an infected donor in 2011.

The guidance from the federally funded United Network for Organ Sharing came out in June, nine months after organs from the Florida donor went to four patients. The guidelines urge caution when considering donors with encephalitis, a brain inflammation that is one symptom of rabies. The Florida donor suffered from the condition.

The only other known U.S. case of rabies transmission through a transplant occurred in 2004 in Texas. Four organ recipients died, and the case helped stir the creation of a UNOS committee dedicated to reducing disease transmission through transplants. The Disease Transmission Advisory Committee was formed in 2006 as part of a government agreement with the private group, based in Richmond, Va.

The committee says it took so long to publish the encephalitis guidelines partly because it had to gather and analyze enough data about rare transmission events to provide a solid basis for its recommendations.

The committee also decided to address more common diseases first.

In 2010, it issued guidance on influenza, suggesting that lungs and intestines from donors infected with the H1N1 virus not be recovered for transplant. In 2011, the panel published guidance on the cancer-causing HTLV-1 virus, and last November, recommendations on tuberculosis. The group now is working on guidance for West Nile virus.

The encephalitis document urges organ banks and transplant surgeons to be cautious in considering organs from donors whose symptoms suggest a central nervous system infection, such as rabies. It urges "extreme caution" when the encephalitis appears to be from a virus. The document lists the rabies virus as one possible cause of encephalitis.

When the donor — 20-year-old William Edward Small — died in September 2011, doctors at Sacred Hearth Heath System in Pensacola, Fla., thought his symptoms were caused by a food-borne toxin, ciguatera, carried in saltwater fish, said Kathy Giery, director of LifeQuest Organ Recovery Services, which approved his organs for transplant.

She said nobody suspected the donor had rabies until after the Maryland recipient died. If they had, the organs wouldn't have been offered, she said.

"The guidelines from 2012 were different from what was in place in 2011, when this took place, so for our cases today and going forward, I think everyone would be looking at this through a different lens," Giery said.

Dr. Michael Green, a University of Pittsburgh pediatric surgeon and chairman of the Disease Transmission Advisory Committee, said a concern for rabies in potential donors would call for extreme caution. But he said every transplant carries risk.

"In every instance, the transplant team must weigh the rare risk of donor disease transmission against the possibly greater risk that a candidate will die without a transplant opportunity," Green wrote in an email.

Compared with other diseases, rabies is rare. It kills just a handful of U.S. residents a year. Usually transmitted by a wild animal bite, it's almost always fatal once symptoms appear. But the disease can be stopped if a bitten person gets treatment, including a series of vaccinations, soon after exposure. The people in Florida, Georgia and Illinois who also received organs from Small have shown no symptoms and are getting the vaccines.

Thirty-two other people in five states who had close contact with the recipients or donor also have been urged to get the vaccine, according to the Centers for Disease Control and Prevention.
Committee member Dr. Timothy Pruett, surgical chief of the University of Minnesota transplant programs, said deaths from transmitted diseases are horrible events — but part and parcel of the organ donation system.

"The risk of dying without an organ still is so much greater than the risk of dying with a transmitted disease, but I don't want to be cavalier about it — it's something no one wants to see," he said.

The eight years it took for the rabies guidance seems unreasonable to Jennifer Hightower of Gilmer, Texas, whose 18-year-old son Joshua was among those killed by rabies-infected transplants in 2004.

"I think it took way too long," she said. "I believe any time there's signs of encephalitis or any kind of anything wrong with the brain that they can't point to, they shouldn't use them.

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More kids swallowing powerful magnets, experts say

Injuries from swallowing magnets are a growing problem among children and could lead to potentially life-threatening complications, researchers say.

In a 2012 survey of pediatric gastroenterologists in North America, doctors reported treating 480 cases of magnet ingestion in kids during the past 10 years; about 42 percent of these cases occurred during the last 12 months.

Related: 3-year-old tears hole in stomach after swallowing 37 magnets

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And information from the Public Health Agency of Canada also suggests that the number of visits to emergency departments for magnet ingestion has increased significantly in that country over the past decade, according to researchers at The Hospital for Sick Children (SickKids) in Toronto.

The rise appears to be tied to an increase in the availability of powerful magnets called neodymium-iron-boron magnets, which are 10 to 20 times stronger than older magnets, called ferrite magnets.

In the past, children who swallowed ferrite magnets often passed the foreign objects without being hurt. However, kids who swallow the newer, more powerful magnets run the risk of suffering a more severe injury because the magnets can adhere to each other as they travel through the bowel, the researchers said.

Swallowing a single neodymium magnet usually doesn't cause harm, but "multiple magnets, especially when swallowed at different times, can attract each other through loops of the gastrointestinal tract," said study researcher Dr. Daniel Rosenfield, of SickKids. This attraction can tear a hole in the bowel, Rosenfield said.

In addition to reviewing evidence on the increase in magnet injuries, Rosenfield and colleagues also described the case of a 3-year- old child at their hospital who swallowed three small, spherical neodymium magnets. Because the child initially appeared fine and was not experiencing pain, he was sent home. His parents were told to watch for passage of the magnets in his stool.

However, two days later, the boy still hadn't passed the magnets. During surgery, the surgeon discovered them sticking together through loops of the lower intestine, the researchers said.

High-powered ball magnets — which are marketed to adults as desk toys — have also been a source of injuries to children in the past. Last year, the U.S. Consumer Product Safety Commission asked the manufacturers of these products, including the maker of the desk toy Buckyballs, to stop selling the products as they posed a risk of injury to children and teens. Buckyballs were discontinued last October.

Because warning labels have been insufficient at preventing injuries, doctors should discuss the risk of magnet injuries with parents of young children, the researchers said.

The study is published March 11 in the Canadian Medical Association Journal.

 

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