Northern Keltia respiratory syndrome

Northern Keltia respiratory syndrome
(NKRS)

Field	Infectious disease
Symptoms	Fever, cough, shortness of breath
Complications	ARDS
Onset	2 to 14 days post exposure
Duration	1738 AN-ongoing
Causes	Northern Keltia respiratory syndrome-related virus (NKRS-V)
Risks	Contact with infected humans and mosquito's bites
Diagnosis	rRT-PCR testing
Treatment	Symptomatic treatment and supportive treatment
Prognosis	34.5% risk of death (Vegno)
Frequency	1.122 cases (as of 1738 AN)
Deaths	392

Northern Keltia respiratory syndrome (NKRS) is a viral respiratory infection caused by Northern Keltia respiratory syndrome Virus (NKRS-V). Symptoms may range from none, to mild, to severe depending on age and risk level. Typical symptoms include fever, cough, diarrhea, and shortness of breath. The disease is typically more severe in those with other health problems. It is believed to have played part in the collapse of Cerulea and Normark, 1736–1737.

The first case was identified by lucidese physician Mark O' Munn at the San Pepinho Hospital in Santa Markovia, San Lucido, Vegno. As it stands, 1.122 documented cases were reporte and about 35% of those who are diagnosed with the disease die from it.

NKRS-V is a virus in the Filoviridae family believed to be originally from bats. However, humans are typically infected from mosquitoes that are part of the typical fauna at these latitudes, and for this reason, the disease is currently limited to this geographical region. From the first scientific findings, it is thought that this virus is a mutated version of the Alexandrian flu virus; the animal reservoir of this virus seems to have been cattle, in which the virus has no pathogenetic potential, subsequently spreading to other species, up to bats, in which the mutation occurred which allowed the virus to be pathogenic and transmitted to humans . Spread between humans typically requires close contact with an infected person. Diagnosis is by rRT-PCR testing of blood and respiratory samples.

As of 1738 AN, there is no specific vaccine or treatment for the disease, but a number are being studied and developed on the basis of the AndeVax by Farmacéutica del Ande, used in the Alexandrian flu.

Signs and symptoms

The first person, in 1738, had a fever, cough, expectoration, and shortness of breath. One review of 47 laboratory confirmed cases in San Lucido gave the most common presenting symptoms as fever in 98%, cough in 83%, shortness of breath in 72% and myalgia in 32% of people.

There were also frequent gastrointestinal symptoms with diarrhea in 26%, vomiting in 21%, abdominal pain in 17% of people. 72% of people required mechanical ventilation. There were also 3.3 males for every female. One study of a hospital-based outbreak of NKRS had an estimated incubation period of 5.5 days.

NKRS can range from asymptomatic disease to severe pneumonia leading to acute respiratory distress syndrome (ARDS). Kidney failure, disseminated intravascular coagulation (DIC), and pericarditis have also been reported.

Cause

Virology

Northern Keltia respiratory syndrome is caused by the NKRS virus (NKRS-V), a species with single-stranded RNA belonging to the family of Filoviridae. It has been ascertained that this virus originated from a mutation of the Alexandrian flu virus, with which it shares many virological characteristics. Its genomes are phylogenetically classified into two clades, Clades A and B. The virus grows readily on Vero cells and LLC-MK2 cells.

Transmission

Mosquitoes

The bite of mosquitoes is the main transmission route for the disease and the reason why it is currently limited to this geographical area. Transmission is specific to a particular type of mosquito, Aedes, which is especially resistant to the region’s cold temperatures. The mechanism involves a healthy mosquito biting an infected animal, such as a bat, or an infected human and then, with its next bite, injecting the virus into the next healthy individual.

Between people

There has been evidence of spread of NKRS-V from person to person, in particular in health care settings like hospitals. At the moment most transmission has occurred "in the circumstances of close contact with severely ill persons in healthcare settings" but there are no evidences of transmission from asymptomatic cases.

Diagnosis

According to Vegnese Health Ministry, the interim case definition is that a confirmed case is identified in a person with a positive lab test by "molecular diagnostics including either a positive PCR on at least two specific genomic targets or a single positive target with sequencing on a second".

Centers for Disease Control

The Government of Vegno established Centers for Disease Control and Prevention in San Lucido recommend investigating any person with:

• Fever and pneumonia or acute respiratory distress syndrome (based on clinical or radiological evidence) and either:
  • close contact with a symptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in North Keltia or
  • a member of a cluster of people with severe acute respiratory illness (e.g. fever and pneumonia requiring hospitalization) of unknown cause in which NKRS-V is being evaluated, in consultation with state and local health departments.
• Fever and symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath) and being in a healthcare facility (as a patient, worker, or visitor) within 14 days before symptom onset in a country or territory in or near North Keltia in which recent healthcare-associated cases of NKRS have been identified.
• Fever or symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath) and close contact with a confirmed NKRS case while the case was ill.

Laboratory testing

NKRS cases have been reported to have low white blood cell count, and in particular low lymphocytes.

Prevention

While the mechanism of spread of NKRS-V is currently not known, based on experience with the Alexandrian flu, the Vegnese Health Ministry currently recommends that all individuals coming into contact with NKRS suspects should (in addition to standard precautions):

• Wear a medical mask
• Wear eye protection (i.e. goggles or a face shield)
• Wear a clean, non sterile, long sleeved gown; and gloves (some procedures may require sterile gloves)
• Perform hand hygiene before and after contact with the person and his or her surroundings and immediately after removal of personal protective equipment

The duration of infectivity is also unknown so it is unclear how long people must be isolated, but current recommendations are for 24 hours after resolution of symptoms.

It is believed that the existing Alexandrian flu researches may provide a useful template for developing vaccines and therapeutics against a NKRS-V infection.

Treatment

As of 1738 AN, there is no specific vaccine or treatment for the disease. Neither the combination of antivirals and interferons nor corticosteroids improved outcomes.

International Response

•  Aerla: Starting in 1738 AN, it was decided that the border between Aerla and San Lucido would be temporarily closed until the pandemic subsided. However Aerla was (for the most part) unaffected by the pandemic, as much of the country sat at an altitude above the mosquito line, and many peoples in the lower-lying areas having developed immunity from the disease from previous outbreaks of NKRS in the preceding centuries. Despite this, the disease heavily affected the refugee communities of Norse refugees living in camps in the Transcaledonian Territory. This led to voices in the National Assembly, especially among Conservative Bloc, to call for the closure of the borders to Norse refugees.
•  Lac Glacei: Lac Glacei responded to news of the syndrome by announcing that it would send medical aid to Vegno but would also place a temporary travel ban on the country until the situation could be resolved. Lac Glaceian scientists offered their services to help find a cure.
•  Moorland: Moorland placed an immediate travel ban on all persons entering or exiting Vegno and halted all flights to the country. King MacMartin said in a statement that while the situation was unfortunate, the lack of a cure for the disease meant that Moorland could not risk infection spreading to the homeland. As a precautionary measure, aerial insecticides were sprayed over various areas to help reduce mosquito populations.