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Prior to the report of the Middle East Respiratory Syndrome (MERS) outbreak in the Republic of Korea (South Korea) in mid-May, more than 1000 cases of MERS had been reported from around the world since 2012. Most of these cases, about 87%, have been reported from the Kingdom of Saudi Arabia (Saudi Arabia). Only about 3% of the MERS cases reported through mid-May from Saudi Arabia can be can be classified as pediatric cases (cases less than 18 years old). There has been speculation that Saudi Arabia has had pediatric cases of MERS that were unreported ( link ). Through June 14, 2015, South Korea has reported 150 MERS cases. The number MERS cases reported from South Korea is second only to Saudi Arabia. Since the beginning of the outbreak in South Korea only a single pediatric MERS case has been reported, a hospitalized, 16-year-old male. As unfortunate as the outbreak in South Korea is, it provides an important data set for analyzing the nature of MERS infections. The South Korea outbr...

Currently, at least 122 people have been infected with MERS in South Korea, all from a single index case who became sick in mid-May. The index case had visited several health care facilities before being diagnosed and hospitalized. Several health care workers became infected while examining this individual prior to hospitalization. The index case exposed a number of people to the MERS coronavirus during his hospitalization. Several of these exposed individuals were released from the hospital and later became symptomatic and were later diagnosed with MERS. By that time, some these individuals had infected others and the chain of transmission began. An important component of breaking the transmission chain and containing an infectious disease outbreak is restricting its geographic spread. As of June, 11, 2015, South Korean health authorities have identified 38 hospitals where MERS patients are currently being treated or where MERS patients apparently visited prior to being diagnosed. Th...

The MERS outbreak in the Republic of Korea began when a 68-year-old man returned from visiting countries on the Arabian Peninsula in early May. He was symptomatic after returning to Korea and visited several hospitals.  He infected a few health care workers before being diagnosed with MERS and hospitalized.  Since then at least 50 people have been infected.  Some of these cases represent third generation infection; hundreds of people are currently being monitored. This outbreak is far from over. Below is a preliminary timeline of the first 35 cases reported by the Korea Ministry of Health. The data and information used here have been derived from numerous publicly available sources including WHO, various ministries of health, internet bloggers, internet forums, and other media reports available online. For some individual cases, specific details are lacking or conflicting information is presented in online reports. However, the information and graphics presented here are ...

Since December 2014, the United States Department of Agriculture (USDA) has confirmed H5 Highly Pathogenic Avian Influenza (HPAI) in commercial and backyard poultry flocks in the United States. At least 142 separate incidents have been detected through May 7, 2015; most are the H5N2 virus.[1] According to USDA, more than 29 million birds have been infected including chickens, ducks, pheasants, and turkeys mostly in commercial poultry flocks. Chickens represent about 81% of all infected poultry followed by turkeys with 18% of the total. In addition to the poultry flock infections in the United States, at least 60 incidents of detection of H5 HPAI in wild birds have also been reported since early December 2014 from the 13 states [2] shown in the map below. H5 HPAI has been detected in poultry flocks in 13 states as well. However, there is no on-to-one correspondence between the states reporting wild bird infections and those with poultry flock infections as show on the map below. Base...

The most recent, cumulative World Health Organization (WHO) table of human H5N1 cases was published on March 3, 2015.[1] This table notes a total of 88 human H5N1 cases in Egypt through March 3, 2015. As I noted previously [2] the tabulation of counts based on the line list of cases published in the monthly risk summaries only totals 82 cases for Egypt in 2015 based on onset dates in reports of 2015. To understand the confusion in the Egyptian case counts in the WHO table, it is necessary to consider the 2014 totals provided by WHO. The current WHO cumulative table reports 46 cases of H5N1 in 2014 with 31 cases from Egypt.[1] However, individual enumeration of WHO-confirmed H5N1 cases based on line lists in the monthly risk assessments shows a total of 52 H5N1 cases in 2014 (based on onset dates), with 37 of these reported from Egypt.[3] The table below identifies the distribution of WHO-confirmed H5N1 from Egypt by each of the monthly summaries for 2014 through the most recent asse...

In late December 2014, Egypt surpassed Indonesia in the number of reported A(H5N1) cases.[1] As of March 3, 2015, the World Health Organization (WHO) has confirmed a worldwide cumulative total of 784 human H5N1 cases, about 37% or 292 of these cases have been reported from Egypt (Table 1). Eighty-two of those cases from Egypt occurred in the first two months of 2015.[2] In addition, media reports suggests that another four cases have occurred since late February in Egypt and may be included in future monthly updates by WHO.[3]   The recent WHO report from 3 March 2015 notes “ The number of laboratory-confirmed human cases of avian influenza A(H5N1) virus infection in Egypt with onsets of illness in the months of December 2014, January and February 2015 are the highest numbers reported by any country in a single month.” To put these statistics in perspective, about 36% of all H5N1 cases reported from Egypt have occurred in the last 3 months. The graph below shows the distributi...

So far, North America has been lucky. Community acquired infections of avian   influenza have not yet occurred, although an imported case of H5N1 was identified in Alberta Canada in 2013 and two imported cases of H7N9, a husband and wife, were reported from British Columbia in just this past week. Because of recent outbreak of highly pathogenic avian influenza (H5 subtypes) in wild birds and domestic flocks in North America, the Center for Disease Control has issues guidance for health care workers for identifying and testing patients with potential avian influenza infections. As of January 31, 2015, no H5 subtype human avian influenza infections have been recorded from these outbreaks which have been reported from six western states along the Pacific Flyway (Washington, Oregon, Idaho, Nevada, Utah, and California ). ( link ) CDC document: Interim Guidance on Testing, Specimen Collection, and Processing for Patients with Suspected Infection with Novel Influenza A Viruses with the P...