12 test positive for MERS-Cov in Italy

Sars [MERS], according to test negative for eight patients Rezza: "There are no new cases." Lorenzin: "No scaremongering."
original link: http://www.lettera43.it/beness...
link to translated article: : http://translate.google.com/tr...

Tuesday, June 4, 2013

According to the World Health Organization, the cases reported so far around the planet would be about fifty.
No need to panic and, above all, accurate information on lung virus from Jordan and already nicknamed 'new' Sars. Gianni Rezza, director of the infectious diseases department of the ISS, the National Institute of Health, assured that "the samples of eight people in contact with ip atients affected by the virus and hospitalized in Florence were negative on the second test. " On the other hand, the first test result was positive. Rezza reiterated that "there are no new clinical cases confirmed so far, but continues monitoring by the Region of individuals who come in contact with patients."

VIRUS LESS AGGRESSIVE THAN EXPECTED. Minister of Health, Beatrice Lorenzin has pointed out that "the people who came in contact with the three infected individuals are all well. There is no kind of scaremongering, the situation is under control. "

"At the moment there is no evidence of a new mutation of the coronavirus responsible for SARS," he explained Rezza explaining that the ISS "has so far not confirmed any positive to the virus in asymptomatic patients reported and await the final analysis." The experts are in fact questioning the behavior of the virus that appears to be more easily transmitted than you knew but less aggressively than had appeared in the past.

NO EVIDENCE OF MUTATION. "To be able to say with absolute certainty that the virus has mutated," said Rezza, "we need to sequence it and analyze it and so far this has not been done. Of this virus does not yet know much and we have therefore for comparison purposes to say that looks like more aggressive than in other cases. For now we can only say that there is no scientific evidence of a mutation or particular aggressiveness of the virus. " However, the expert added, "the situation is at present under control. The three confirmed cases of patients who contract the new SARS cases are mild and there are no new confirmed cases from Saturday, June 1. "

coyote wrote: Sars [MERS], according to test negative for eight patients Rezza: "There are no new cases." Lorenzin: "No scaremongering." original link: http://www.lettera43.it/beness... link to translated article: : http://translate.google.com/tr... Tuesday, June 4, 2013 According to the World Health Organization, the cases reported so far around the planet would be about fifty. No need to panic and, above all, accurate information on lung virus from Jordan and already nicknamed 'new' Sars. Gianni Rezza, director of the infectious diseases department of the ISS, the National Institute of Health, assured that "the samples of eight people in contact with ip atients affected by the virus and hospitalized in Florence were negative on the second test. " On the other hand, the first test result was positive. Rezza reiterated that "there are no new clinical cases confirmed so far, but continues monitoring by the Region of individuals who come in contact with patients." VIRUS LESS AGGRESSIVE THAN EXPECTED. Minister of Health, Beatrice Lorenzin has pointed out that "the people who came in contact with the three infected individuals are all well. There is no kind of scaremongering, the situation is under control. " "At the moment there is no evidence of a new mutation of the coronavirus responsible for SARS," he explained Rezza explaining that the ISS "has so far not confirmed any positive to the virus in asymptomatic patients reported and await the final analysis." The experts are in fact questioning the behavior of the virus that appears to be more easily transmitted than you knew but less aggressively than had appeared in the past. NO EVIDENCE OF MUTATION. "To be able to say with absolute certainty that the virus has mutated," said Rezza, "we need to sequence it and analyze it and so far this has not been done. Of this virus does not yet know much and we have therefore for comparison purposes to say that looks like more aggressive than in other cases. For now we can only say that there is no scientific evidence of a mutation or particular aggressiveness of the virus. " However, the expert added, "the situation is at present under control. The three confirmed cases of patients who contract the new SARS cases are mild and there are no new confirmed cases from Saturday, June 1. "

False negs I can understand, but how exactly do you get a false positive?  Those lab techs doing the original testing in this case are seriously inept, or need to layoff the drugs at work.

Quite frankly, a gov't lie about the negatives seems a lot more probable then false positives.  Have never seen a false positive in the last near 8 years here, and still wondering how it's possible to get a false positive.  Assuming it's possible for that to happen, this has to be one of the strangest situations to date, and we've seen our share around here. 

Lopper said:
So if a highly contagious lethal virus was in the early stages of spreading among the population and containment was impossible due to the nature of transmission and incubation period would the government tell you the truth or try to prevent panic and lie? I think we all know the answer to that one.





Yaaaa,We know. They will try to prevent panic and lie,lie,lie!

Ya, I caught that too regarding 8 cases instead of 10.  This is getting a little strange.  

Whether they're lying or they don't know how to test, very odd, and both not good.

It seems to me that the problem lies with the test for MERS. If more was known about the disease and its incubation period then more informed diagnosis could be made. I suspect they need to map out the progression of MERS from day of suspected infection, as they may well find that, for example, on days 1-4 all tests show neg, days 5-9 faint positive with no symptoms etc etc. 

Latest reports put the figures at 51 confirmed cases of infection and 30 deaths—or a mortality rate of 60 percent. The SARS-like virus first detected in Saudi Arabia in 2012, initially named novel coronavirus or nCoV but now officially dubbed the Middle East respiratory syndrome coronavirus (MERS-CoV), has killed 24 persons in the kingdom; it has also spread to eight other countries, Italy being the latest to report a MERS-CoV infection that afflicted a 45-year-old man who had traveled to Jordan.

The other countries with reported cases of the ailment now include Jordan, Qatar, the United Kingdom, France, Germany, and the United Arab Emirates.

What do these countries have in common, especially those in the Middle East? They all have sizable OFW populations, with some 1.5 million Filipinos working and residing in Saudi Arabia alone. Given what is known so far of the virus—that, as pointed out by Keiji Fukuda, assistant director general for health security and the environment of the World Health Organization, “the different clusters seen in multiple countries increasingly support the hypothesis that when there is close contact this novel coronavirus can transmit from person-to-person”—Filipino workers in the kingdom and in other countries with a similar outbreak are at risk of contracting the ailment.

President Aquino must thus heed the call of the OFW group Migrante-Middle East for the Philippine government to send medical attachés to Saudi Arabia to educate the workers and prepare them for contingencies.

“There are lots of medical concerns by our fellow OFWs not only in Saudi Arabia but also in other Mideast countries. Giving them right information, education, and guidance would be of help to prevent work-related diseases,” said John Leonard Monterona, Migrante-ME regional coordinator for the Middle East and North Africa, in a statement.

An information and education campaign is the least the government can do to prepare OFWs for any health emergency in their host countries. While virologist Nathan Wolfe, in a National Geographic interview, has said that there is still much to be discovered about the virus—“We do not know how MERS originated, and while human-to-human transmission has been confirmed, we do not know the precise mechanism of transmission. We still don’t know definitively what percentage of people who are infected will die (i.e., the case mortality rate)”—the rapid rate of transmission and the ease with which it has crossed borders has also left scientists like him worried.

A “threat to the entire world” was how Dr. Margaret Chan, the director-general of WHO, recently described the virus. “We understand too little about this virus when viewed against the magnitude of its potential threat. Any new disease that is emerging faster than our understanding is never under control,” she said.

MERS-CoV is from the same viral family as the bug behind SARS or Severe Acute Respiratory Syndrome, the outbreak that leapt out of China and East Asia in 2003, spread to other parts of the world and eventually killed 775 people. Like SARS, the Middle Eastern virus is said to produce severe respiratory symptoms from fever and cough to pneumonia, as well as gastrointestinal symptoms and kidney failure.

It was eventually established that the SARS virus infected humans from their original animal hosts, and was spread through coughing or sneezing. In the case of MERS-CoV, Wolfe said “human-to-human transmission has been reported… particularly in cases with sustained contact such as health-care workers.”

As new cases have been reported with increasing frequency, the Philippine government must take a proactive stance and prepare for the possibility that any one or two of the millions of OFWs in the Middle East and other affected countries will not only come down with the disease but also unknowingly bring it home. Some 25,000 OFWs are deployed every month to Saudi Arabia alone. They need to be alerted to take extra precautions in their personal health and hygiene, and to keep themselves updated on new developments, health measures and warnings about the illness.

Migrante has another sensible suggestion: Make the deployment of a team or teams of medical attachés in Saudi Arabia permanent, to continuously serve the needs of the OFW population there, outbreak or no outbreak. Meanwhile, in the Philippines, it’s time for the Department of Health to put in place contingency measures, and to officially alert the public about the deadly MERS-CoV.

Right now all that the data says is that: of the 51 confirmed cases of infection 30 of those cases have died so far.

I still want an answer on the false positives.

Nope - this is a new one on me. Makes no sense

Albert wrote: Can't wait to hear niman on this one.

The main point seems to be:
Since the samples came from asymptomatic cases, the viral RNA levels would be expected to be near the limits of detection and if two labs used assays with different sensitivities, the more sensitive test would generate weak positives, while the less sensitive test would generate false negatives.



Full text:

MERS-CoV Asymptomatic Cases Raise More Testing Concerns
Recombinomics Commentary 22:45
June 4, 2013

The cases that yesterday, in a first screening done by the Laboratory of Virology University of Florence were low-positive results, negative results are a second inspection done by the ISS. A single screening, experts say, is not considered sufficient, the protocols provide two exams, made ​​by two laboratories different. ISS was done a second test, in different portions of the viral genome, which gave a negative result.
 
Detection end points were two copies per reaction for the upE assay, and 10 copies per reaction for the confirmatory, ORF1b gene, assay.

The above translation (in red) provide additional detail on the testing of the asymptomatic cases in Italy which generated weak positives in the PCR testing done by the Laboratory of Virology by the University of Florence.  The samples were subsequently tested by Italy’s Superior Health Institute (ISS) which used a different set of primers which produced a negative result.  Since the samples came from asymptomatic cases, the viral RNA levels would be expected to be near the limits of detection and if two labs used assays with different sensitivities, the more sensitive test would generate weak positives, while the less sensitive test would generate false negatives.
 
As seen in the comments (in blue) titration of various sets of MERS-CoV primers produce sensitivities which differ by five fold.  Thus, the ISS should retest the samples using the primers used by the University of Florence, which would produce confirmatory positives if there wasn’t extensive cross contamination in the positive tests.

Full sequences have been generated for four previously confirmed MERS-CoV cases and partial sequences have been generated for at least four additional cases by sequencing the inserts generated in PCR tests.  The sequences have been identical or closely related to the consensus sequence and sequencing of the inserts from the weak positives in Italy would confirm that the weak positives were due to MERS-CoV RNA.

The testing protocol requires positive results in two sets of primers and the likelihood that another coronavirus would generate positives for both sets is near zero.  However, testing samples with RNA levels at the limits of detection would generate weak positives for the more sensitive assay and false negatives for the less sensitive assay.

MERS-CoV RNA in samples collected from asymptomatic cases may be detected during a small window of opportunity, and use of the most sensitive sets of primers may be required.

Retesting using the primers which generated the weak positives should be done immediately, and the inserts should be sequenced.

http://www.recombinomics.com/News/06041303/MERS_Italy_Asymp_Test_More.html

Wonder if they'll actually go through with re-testing all of them. I read an article stating that over 1,300 SARS-like cases were negative, wondering...

Well, I suppose they can flip a coin in the end to resolve it.  Neg or positive. 

My reading of it was:

a) The asymptomatic results would just be at the edge of detection, and there is jsut a short window of oppurtunity to get any results.
b) the first testing produced a weak positive
c) the first testing was 5 times more sensitive than the second testing (I don't understand his logic on this point as I don't have the technical knowledge of the testing process).
d) the second testing, being less sensitive produced a negative result.

He was recommending that the second institute re-run the tests using a more sensitive test.

For me the implications of the above was that the second set of testing was set up to fail by using a process that was not sensitive enough.   I do not have the technical or medical knowledge to know it this is a reasonable claim or not. 
A milder implication would be that the viral load of an asymptomatic case is just on the boarderline of the capablities of the tests used so it would be easy to get false negatives.

I am at a loss to know what is really happening.

(ps I use DuckDuckGo for searching and this site came in no2 when I searched on "MERS Italy false positive")

My impression from Henry Nimans commentary; there were no false negatives. The testmethods seem to be failing. If the corona-virus also is responsible for the common cold that virus spreads human-to-human. University of Florency test might indicate that mostly people that get infected do not get ill. Only a small group develops severe symptoms.

According to the ISS, Italian Health Institute, there are only three carriers of the MERS-virus due two their rule that a second test has to confirm a first positive test. Eventhough they know that the second test is five times less sensitive...There are now no "asymptomatic cases" left !

Maybe Giovanni Rezza and Isabella Donatelli can explain how they got the false positives to begin with.  Still have never seen that one before. 

Five of the 8 weak positives were from health care workers (2 doctors and 3 nurses) from the two hospitals

The WHO approved primers are described here

Niman posted here 7 years ago and we follow his commentaries often at Recombinomics. If you have questions you better ask them now.   Dr. Niman is a straight shooter, which is why we like him and value his input.

One would also need to flush the eye with sterile water and you can also use the solution which is supposed to sterilize contact lenses to flush the eye with, making sure to cleanse lashes and brows which could have virus also.