Wednesday, September 5, 2018

PRO/AH/EDR> Undiagnosed respiratory illness - USA: (New York),ex Middle East, flight, RFI

UNDIAGNOSED RESPIRATORY ILLNESS - USA: (NEW YORK), ex MIDDLE EAST,
FLIGHT PASSENGERS AND CREW, REQUEST FOR INFORMATION
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Wed 5 Sep 2018
Source: Stat News [edited]
<https://www.statnews.com/2018/09/05/plane-quarantined-at-kennedy-airport-amid-reports-of-100-ill-passengers/>


An Emirates Airline flight was held in quarantine for a period at New
York's John F. Kennedy International Airport after a large number of
passengers were reported feeling ill during the flight.

The airline said in a statement that about 10 passengers on the flight
from Dubai to New York had become ill on board. But the Centers for
Disease Control and Prevention [CDC] said the estimated number was
about 100. Passengers and some crew complained of illness including
cough, according to the CDC; some had developed a fever.

"CDC public health officers are working with port authority, EMS, and
CBP officials to evaluate passengers including taking temperatures and
making arrangements for transport to local hospitals," the CDC said.
"Passengers who are not ill will be allowed to continue with their
travel plans, and if necessary will be followed up with by health
officials."

A spokesman for New York Mayor Bill de Blasio said 19 passengers had
taken ill -- 10 were sent to a hospital and another 9 refused medical
attention. There were approximately 521 passengers on the flight.

A number of the passengers on the flight were returning from the Hajj,
the annual mass pilgrimage to Mecca, in Saudi Arabia, a source told
STAT. It was unclear if the people who were ill were the same
passengers who had attended.

Saudi Arabia has reported cases of MERS, Middle East respiratory
syndrome, which passes to people from camels. But the fact that so
many people became ill during the flight would make MERS seem an
unlikely cause.

[Byline: Helen Branswell]

--
Communicated by:
Meghan May
University of New England
<mmay3@une.edu>

******
[2]
Date: Wed 5 Sep 2018
Source: BBC [edited]
<https://www.bbc.com/news/world-us-canada-45425412>


A total of 19 people have been taken ill after an Emirates airline
plane landed in New York, officials say. The plane was quarantined at
JFK airport as those on board were checked by health officials. As
many as 10 were taken to hospital but others refused treatment.

The US Centers for Disease Control and Prevention (CDC) said that
initially about 100 people including some crew had complained of
illness. Flight 203 from Dubai landed at 09:10 (13.10 GMT) with 521
passengers.

Emergency vehicles were seen on the runway as it landed. Soon
afterwards, Emirates airline tweeted that the sick passengers were
being attended to and those who were unaffected would be allowed to
leave the plane.

The CDC said in a statement that is was "aware of an Emirates flight
from Dubai that arrived this morning at JFK".

"Approximately 100 passengers, including some crew on the flight,
complained of illness including cough and some with fever.

"CDC public health officers are working with... officials to evaluate
passengers including taking temperatures and making arrangements for
transport to local hospitals those that need care."

Later Eric Phillips, spokesman for New York Mayor Bill de Blasio,
confirmed that all the passengers were off the plane and the sick
people had been taken to hospital.

He said that some of the passengers had originally come from the Saudi
Arabian city of Mecca, which was currently experiencing a flu
outbreak, and that the passengers' symptoms were "pointing to the
flu".

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[3]
Date: Wed 5 Sep 2018, 10:55 AM ET
Source: NPR [edited]
<https://www.npr.org/2018/09/05/644826743/emirates-airline-says-about-10-passengers-fell-ill-on-flight-to-new-york>


Health and safety officials are investigating an illness that struck
people on an Emirates Airline flight from Dubai, United Arab Emirates,
to New York's John F. Kennedy International Airport on Wednesday
morning.

A total of 7 crew members and 3 passengers were taken to the hospital,
Emirates Airline said. It added that [Wed 5 Sep 2018] return flight
from New York to Dubai would leave 3 hours late.

The Centers for Disease Control and Prevention said around 100 people
on the overnight Flight 203 had complained of illness. For some, the
symptoms were limited to a cough; others had a fever.

An Emirates A380 in quarantine at JFK Airport right now awaiting CDC
officials after about 100 passengers became ill with fevers over 100
degrees and coughing. Flight 203 had just arrived from Dubai.

Ten people were taken off the plane for treatment at Jamaica Hospital
Medical Center, said Eric Phillips, press secretary for New York City
Mayor Bill de Blasio. He said 9 others were found to be sick but
refused medical attention.

The aircraft was carrying around 521 passengers. Health officials
allowed people to disembark only after checking each one for symptoms,
Phillips stated, adding, "The plane's been quarantined and the CDC is
on the scene."

As for what the sickness might be, Phillips referred to a "flu
outbreak" in Mecca, Saudi Arabia, and said that might be a
possibility, stating, "It appears some of the ill passengers came from
Mecca before getting on in Dubai."

[One] passenger called it the "worst flight ever," saying on Twitter
that the plane "was basically a flying infirmary. Many of these people
should never have been allowed to board."

By around noon, 432 passengers had been cleared and allowed to go to
the customs area, according to Phillips. A few others who showed
symptoms were held for treatment and possible transport to the
hospital.

NPR's Rob Stein reports that the Centers for Disease Control and
Prevention is working with local authorities. The Airbus A380 jet was
isolated on the tarmac at JFK, as officials took stock of the
situation. Images from the scene showed a row of ambulances alongside
the aircraft.

[Another] passenger said via Twitter that CDC staff came onto the
plane and that everyone aboard was asked to fill out a form providing
their contact information for the next 3 weeks.

[Byline: Bill Chappell]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Mention a plane load of individuals with febrile respiratory symptoms
coming from the Middle East and immediate panic of "could this be
MERS-CoV?" Equally or more serious than this is an outbreak of
influenza. According to the media coverage, there is an ongoing
outbreak of influenza in Mecca (Makkah) (Saudi Arabia, where Hajji's
congregate) now, concurrent with the Hajj, and a rapid onset of
respiratory symptoms is more likely to be influenza than it is
MERS-CoV. We still do not have information as to the origins of the
ill passengers to know if they were beginning their trips in Mecca and
were returning Hajji's or if they began their travels elsewhere.
Presumably the crew members began their working journeys in Dubai, but
may have commuted in from elsewhere in or outside of the region (and
there is mention of ill crew members).

Returning to the possibility that this is related to the Hajj, a mass
gathering of more than 2 million individuals from all over the world,
making a religious pilgrimage to Mecca, it is interesting to review
the Saudi Hajj/Umrah health requirements. While some vaccines are
mandatory (meningitis vaccine, polio if coming from a country with
ongoing poliovirus transmission, and yellow fever if coming from a
known yellow fever endemic area, in contrast, influenza vaccine is
recommended but not obligatory.

"Seasonal Influenza:
"The Saudi Ministry of Health recommends that international pilgrims
be vaccinated against seasonal influenza before arrival into the
Kingdom of Saudi Arabia, particularly those at increased risk of
severe influenza diseases, including pregnant women, children under 5
years, the elderly, and individuals with underlying health conditions
such as HIV/AIDS, asthma, and chronic heart or lung diseases. In Saudi
Arabia, seasonal influenza vaccination is recommended for internal
pilgrims, particularly those at risk described above, and all
health-care workers in the Hajj premises."
<https://www.saudiembassy.net/hajj-and-umrah-health-requirements>

Given concerns re: possible MERS-CoV transmission to pilgrims visiting
Saudi Arabia, many countries have increased surveillance of
respiratory illnesses in returning pilgrims (notably post Hajj), and
in the 6 years since identification of the MERS-CoV, there have been
no cases among returning Hajji's and just a handful of cases among
individuals returning from having performed the Umrah pilgrimage.
Movement and exposures of visiting Hajj pilgrims are controlled -
camels are not permitted in the area where Hajjis are congregated,
healthcare workers and others identified as contacts of confirmed
MERS-CoV cases are not permitted to go to the Hajj area Studies
addressing the etiologies of respiratory illnesses in returning
Hajji's have identified influenza virus, respiratory syncytial virus,
parainfluenza virus, adenovirus and rhinovirus (see Respiratory
infections - UK: Hajj returnees
http://promedmail.org/post/20151011.3706464 and Respiratory virus
infections - Saudi Arabia: Hajj pilgrims 2012
http://promedmail.org/post/20130730.1854631). Note that the incubation
period for influenza ranges from 1-4 days so transmission during
travel is a plausible event.

The actual number of individual identified as ill enough to require
medical treatment at a hospital seems to be between 19 and 27 (taking
into account the additional 8 identified and mentioned by the New York
City's mayor's spokesperson in a tweet). Presumably these individuals
had a fever above 100 F (37.8 C) and cough. The extension of the count
to approaching 100 individuals may include those with a cough,
possibly in the early stages of illness (influenza frequently begins
with a dry cough), and others possibly coughing in response to hearing
others coughing around them (think theater or lectures when coughing
begins...)

As the rapid respiratory virus screening tests should be available in
a reasonable amount of time, we will post information as it becomes
available, but should any knowledgeable sources have additional
information that can be shared with us, ProMED would be very
grateful.

The HealthMap/ProMED maps can be found at:
New York State, United States: <http://healthmap.org/promed/p/234>
Middle East: <http://healthmap.org/promed/p/12214> - Mod.MPP]

[See Also:
MERS-CoV (29): UK (England) ex Saudi Arabia, Risk Assessment ECDC
http://promedmail.org/post/20180830.5996187
2017
----
MERS-CoV (63): Saudi Arabia (QS, TB), WHO :
http://promedmail.org/post/20171009.5369268
2016
-----
Health hazards - Saudi Arabia: Hajj, Umrah, vaccination requirements
http://promedmail.org/post/20160715.4346367
MERS-CoV
(71): Saudi Arabia (MK), pilgrimage caution, WHO
http://promedmail.org/post/20160623.4305152
2015
----
MERS-CoV (138): Saudi Arabia, Jordan, post Hajj surveillance, RFI
http://promedmail.org/post/20151009.3704734
MERS-CoV
(136): Kuwait WHO, Saudi Arabia MOH, camel, Hajj
http://promedmail.org/post/20150924.3666811
MERS-CoV
(131): Saudi Arabia, animal reservoir, camels, Hajj, RFI
http://promedmail.org/post/20150914.3643612
MERS-CoV
(130): Saudi Arabia, animal reservoir, camels, Hajj
http://promedmail.org/post/20150912.3641457
MERS-CoV
(114): Saudi Arabia, animal reservoir, camels, Hajj
http://promedmail.org/post/20150823.3597358
Respiratory infections - UK: Hajj returnees
http://promedmail.org/post/20151011.3706464
Respiratory infections - Canada: (AB) Hajj returnees
http://promedmail.org/post/20151020.3729641
Influenza (51): Germany ex Saudi Arabia, Hajj returnee, RFI
http://promedmail.org/post/20151009.3704297
Influenza (49): Canada ex Saudi Arabia, Hajj returnees, susp., RFI,
Alert http://promedmail.org/post/20151005.3693052
2014
----
Meningitis, meningococcal - Saudi Arabia: prevention, Hajj travel
advice http://promedmail.org/post/20140815.2692227
2013
----
Respiratory virus infections - Saudi Arabia: Hajj pilgrims 2012
http://promedmail.org/post/20130730.1854631
2012
----
Health hazards - Saudi Arabia: updated Hajj advice
http://promedmail.org/post/20121011.1338172
2009
----
Influenza pandemic (H1N1) 2009 (113): Saudi Arabia, Hajj fatalities
http://promedmail.org/post/20091122.4013
Influenza pandemic (H1N1) 2009 (109): Saudi Arabia, Hajj pilgrims
http://promedmail.org/post/20091120.3997
2006
----
Influenza - Saudi Arabia: Hajj concerns
http://promedmail.org/post/20061209.3478]
.................................................mpp/ao/mpp
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