Global & Disaster Medicine

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WHO: List of Blueprint priority diseases (i.e. diseases and pathogens to prioritize for research and development in public health emergency contexts)

WHO

2018 annual review of the Blueprint list of priority diseases

For the purposes of the R&D Blueprint, WHO has developed a special tool for determining which diseases and pathogens to prioritize for research and development in public health emergency contexts. This tool seeks to identify those diseases that pose a public health risk because of their epidemic potential and for which there are no, or insufficient, countermeasures. The diseases identified through this process are the focus of the work of R& D Blueprint. This is not an exhaustive list, nor does it indicate the most likely causes of the next epidemic.

The first list of prioritized diseases was released in December 2015.

Using a published prioritization methodology, the list was first reviewed in January 2017.

February 2018 – Second annual review

The second annual review occurred 6-7 February, 2018. Experts consider that given their potential to cause a public health emergency and the absence of efficacious drugs and/or vaccines, there is an urgent need for accelerated research and development for*:

  • Crimean-Congo haemorrhagic fever (CCHF)
  • Ebola virus disease and Marburg virus disease
  • Lassa fever
  • Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS)
  • Nipah and henipaviral diseases
  • Rift Valley fever (RVF)
  • Zika
  • Disease X

Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease, and so the R&D Blueprint explicitly seeks to enable cross-cutting R&D preparedness that is also relevant for an unknown “Disease X” as far as possible.

A number of additional diseases were discussed and considered for inclusion in the priority list, including: Arenaviral hemorrhagic fevers other than Lassa Fever; Chikungunya; highly pathogenic coronaviral diseases other than MERS and SARS; emergent non-polio enteroviruses (including EV71, D68); and Severe Fever with Thrombocytopenia Syndrome (SFTS).

These diseases pose major public health risks and further research and development is needed, including surveillance and diagnostics. They should be watched carefully and considered again at the next annual review. Efforts in the interim to understand and mitigate them are encouraged.

Although not included on the list of diseases to be considered at the meeting, monkeypox and leptospirosis were discussed and experts stressed the risks they pose to public health. There was agreement on the need for: rapid evaluation of available potential countermeasures; the establishment of more comprehensive surveillance and diagnostics; and accelerated research and development and public health action.

Several diseases were determined to be outside of the current scope of the Blueprint: dengue, yellow fever, HIV/AIDs, tuberculosis, malaria, influenza causing severe human disease, smallpox, cholera, leishmaniasis, West Nile Virus and plague. These diseases continue to pose major public health problems and further research and development is needed through existing major disease control initiatives, extensive R&D pipelines, existing funding streams, or established regulatory pathways for improved interventions. In particular, experts recognized the need for improved diagnostics and vaccines for pneumonic plague and additional support for more effective therapeutics against leishmaniasis.

The experts also noted that:

  • For many of the diseases discussed, as well as many other diseases with the potential to cause a public health emergency, there is a need for better diagnostics.
  • Existing drugs and vaccines need further improvement for several of the diseases considered but not included in the priority list.
  • Any type of pathogen could be prioritised under the Blueprint, not only viruses.
  • Necessary research includes basic/fundamental and characterization research as well as epidemiological, entomological or multidisciplinary studies, or further elucidation of transmission routes, as well as social science research.
  • There is a need to assess the value, where possible, of developing countermeasures for multiple diseases or for families of pathogens.

The impact of environmental issues on diseases with the potential to cause public health emergencies was discussed. This may need to be considered as part of future reviews.

The importance of the diseases discussed was considered for special populations, such as refugees, internally displaced populations, and victims of disasters.

The value of a One Health approach was stressed, including a parallel prioritization processes for animal health. Such an effort would support research and development to prevent and control animal diseases minimising spill-over and enhancing food security. The possible utility of animal vaccines for preventing public health emergencies was also noted.

Also there are concerted efforts to address anti-microbial resistance through specific international initiatives. The possibility was not excluded that, in the future, a resistant pathogen might emerge and appropriately be prioritized.

 

*The order of diseases on this list does not denote any ranking of priority.

 


Saudi Arabia’s MERS totals since 2012 come to 1,836, including 744 deaths.

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Saudi Arabian Ministry of Health: 1 new case of MERS-CoV related to camel contact.

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MERS-CoV and a large outbreak in Riyadh during 2017

AJIC

Unusual presentation of Middle East respiratory syndrome coronavirus leading to a large outbreak in Riyadh during 2017

Amer, Hala et al.
American Journal of Infection Control

“…..Between May 31 and June 15, 2017, 44 cases of MERS-CoV infection were reported from 3 simultaneous clusters from 3 health care facilities in Riyadh, Saudi Arabia, including 11 fatal cases. Out of the total reported cases, 29 cases were reported from King Saud Medical City. The cluster at King Saud Medical City was ignited by a single superspreader patient who presented with acute renal failure…..”


WHO: MERS-CoV situation update, March 2018

WHO

MERS situation update March

At the end of March 2018, a total of 2189 laboratory-confirmed cases of Middle East respiratory syndrome (MERS), including 782 associated deaths (case–fatality rate: 35.7%) were reported globally; the majority of these cases were reported from Saudi Arabia (1814 cases, including 708 related deaths with a case–fatality rate of 39%).

In March, 7 laboratory-confirmed cases of MERS were reported in Saudi Arabia including 1 associated death. A cluster-case from a hospital in Riyadh region was reported, with 6 laboratory-confirmed cases including 3 associated deaths. The date of onset of the first case was 23 February 2018. The date of onset of the last laboratory-confirmed case from the hospital cluster was 3 March 2018; since then, there have been no new cases reported from this cluster. Further investigation on the nature of transmission is ongoing.

The demographic and epidemiological characteristics of the cases reported in March 2018 do not show any significant difference compared to cases reported during the same period from 2012 to 2017. Owing to improved infection prevention and control practices in hospitals, the number of hospital-acquired cases of MERS has dropped significantly since 2015.

The age group 50–59 years continues to be at the highest risk for acquiring infection as primary cases. The age group 30–39 years are most at risk for secondary cases. The number of deaths is higher in the age group 50–59 years for primary cases and 70–79 years for secondary cases.”


The Saudi Arabian Ministry of Health announced three new cases of MERS-CoV

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Saudi Arabia’s MERS-CoV total cases since 2012 have now reached 1,816, including 736 deaths.

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Saudi Arabia has spent billions in fighting Middle East Respiratory Syndrome (MERS) since 2012.

Saudi Gazette

“…..The ministry has taken a number of precautionary and preventive measures to contain the disease.

More than 3,000 firms have been closed down as part of temporary and permanent punitive measures.

Seven health ministers have worked to eradicate MERS-CoV since it broke out first in the Kingdom. They are Dr. Abdullah Al-Rabeeah (1430-35 Hijri), Adel Fakeih (1435-36 Hijri), Dr. Mohammed Ali Al-Hayazie (1436 Hijri), Ahmed Oqail Al-Khateeb (1436 Hijri), Mohammed Abdulmalik Al-Asheikh (1436 Hijri), Khalid Al-Falih (1436-37 Hijri) and Dr. Tawfiq Al-Rabiah (the present minister)…..”

 


Disease X: A pathogen with the potential to spread and kill millions but for which there are currently no, or insufficient, countermeasures available.

The Telegraph

“……It was the third time the committee, consisting of leading virologists, bacteriologists and infectious disease experts, had met to consider diseases with epidemic or pandemic potential. But when the 2018 list was released two weeks ago it included an entry not seen in previous years.

In addition to eight frightening but familiar diseases including Ebola, Zika, and Severe Acute Respiratory Syndrome (SARS), the list included a ninth global threat: Disease X…….”
Diseases threatening a public health emergency*
  • Crimean-Congo haemorrhagic fever (CCHF)
  • Ebola virus disease and Marburg virus disease
  • Lassa fever
  • Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS)
  • Nipah and henipaviral diseases
  • Rift Valley fever (RVF)
  • Zika
  • Disease X

*Diseases posing significant risk of an international public health emergency for which there is no, or insufficient, countermeasures. Source: World Health Organization (WHO), 2018


Saudi MOH: Another MERS-CoV case in a presumed hospital-based outbreak that has included 3 other patients and 1 healthcare provider

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