Monday, September 30, 2013

Additional MERS Infections Reported; WHO Declines to Raise Warning Level

WHO spokesman discusses MERS virus on CNN
The Saudi Health Ministry has reported three more MERS cases in Riyadh bringing the total to 114 in that country and 133 world wide, if confirmed by the World Health Organization. There are an additional 17 probable cases. Middle east Respiratory Syndrome, or MERS has killed 58 of those infected, or about 50%.

The latest victims are elderly and all suffer from chronic medical conditions. They are currently in intensive care.

On September 25, WHO released the findings of the third meeting of the IHR Emergency Committee concerning MERS-CoV by teleconference. Saudi Arabia and Qatar presented information on the outbreaks in their countries.

The Emergency Committee consists of experts and makes recommendations to the Director General on public health emergencies of international concern and measures member states can implement to control the spread of the disease. The WHO considers a Public Health Emergency of International Concern (PHEIC) to be:
"an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”. 
The Committee did not feel that conditions had been met to raise alerts to that level. The report states:
"The Committee concluded that it saw no reason to change its advice to the Director-General. Based on the current information, and using a risk-assessment approach, it was the unanimous decision of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met."
Although the committee did not raise the warning level, they repeated the importance for health officials to continue vigilance in identifying and reporting suspected cases through:
  • Strengthening surveillance, especially in countries with pilgrims participating in Umrah and the Hajj;
  • Continuing to increase awareness and effective risk communication concerning MERS-CoV, including with pilgrims;
  • Supporting countries that are particularly vulnerable, especially in Sub-Saharan Africa taking into account the regional challenges;
  • Increasing relevant diagnostic testing capacities;
  • Continuing with investigative work, including identifying the source of the virus and relevant exposures through case control studies and other research; and
  • Timely sharing of information in accordance with the International Health Regulations (2005) and ongoing active coordination with WHO. 
The public is advised to follow common hygiene procedures and wash hands, cover coughs and sneezes, avoid unneeded contact with wild or domestic animals and avoid eating uncooked meat or unwashed fruits and vegetables.

Saturday, September 21, 2013

WHO Reports Changing MERS Demographics; Rise in Sporadic Cases

MERS Corona virus
The World Health Organization issued an update on the MERS virus which has infected scores in the middle east with a few cases in Europe and Tunisia. 37 new cases have been confirmed since the last update.

130 cases in nine countries have been laboratory confirmed and 17 are considered 'probable', including two from the Italian cluster which had previously been considered 'confirmed'. 58 of those have died or about 45%. About 63% are male and the median age is now 50, down significantly from the 59.5 years in the last report.

The new numbers reflect a change in the demographics of the reported cases. Before July 2013, 83% of MERS victims were men, but the latest victims are increasingly female, including many from the health care field. Others caught the illness from family members and, in about one in four cases, the method of exposure is unknown.

Nine of the newest cases are considered 'sporadic' or having no known prior contact with another infected person. 63% of these sporadic infections have been in women. These cases tend to be more deadly and most victims have underlying medical conditions. 89% of these recent sporadic cases were severe or later died.
"The recent upsurge in case reporting is of concern and represents both an increase in sporadic cases and several coincident clusters of infection in contacts. ...The reason for the increase in sporadic cases is unknown but could be the result of increased surveillance, an expansion of the virus in the unknown reservoir, seasonal variation, or a change in exposure patterns."
Genetic research on samples from 30 victims of the virus has shown it has passed between humans and animals and through human to human contact several times since it first emerged around July of 2011. They suspect an 'unknown reservoir' of the virus exists which has repeatedly infected humans. 
"The analysis supports a geographically dispersed reservoir of MERS-CoV with movement of virus among geographic locations through movement of an animal reservoir, animal products, or possibly infected humans, though movement of animals was thought to be the most likely explanation."
The search for this unknown reservoir for the virus continues with studies of domestic and wild animals ongoing in the region. Possible genetic matches were found among bats and some camels have antibodies indicating possible exposure, but neither of these clues have led to the source of this deadly corona virus.

Friday, September 20, 2013

Eighteen More MERS Cases; 'Silent' Carriers Confirmed

Middle East Respiratory Syndrome Corona Virus
The World Health Organization has confirmed the MERS virus in eighteen more patients including three deaths in hard hit Saudi Arabia. The newest victims range in age from three to 75 years. This brings the total of WHO laboratory confirmed cases to 132 including 58 fatalities.

This latest report was followed by an announcement that scientists from the UK and Saudi Arabia had completed analysis of the genome of the MERS virus.

Researchers believe the virus has passed between animals and humans perhaps several times in addition to being transmitted among humans. According to lead author Professor Paul Kellam, “Our findings suggest that different lineages of the virus have originated from the virus jumping across to humans from an animal source a number of times.” The animal source is still unknown and tests of wild and domestic animals is ongoing.

According to Professor Memish, “Further studies need to be carried out. The animal source of MERS-CoV and the way that it is transmitted to humans is not yet known...This is critical for developing interventions for reducing the risk of transmission, defining the epidemiology and developing effective control measures.”

The study cautions that some of the infected showed no symptoms but are capable of acting as a 'carrier' and spreading the virus to others. This raises the possibility that there could be considerably more un-diagnosed infections than officially reported. The questions over confirmed numbers are exemplified in this report from Infection Control Today showing the MERS cluster in Italy has been re-classified as 'probable' from 'confirmed' because the samples were not collected per current WHO standards:
"A "probable" designation by WHO criteria refers to patients who are considered to have a high likelihood of having been infected with MERS-CoV, but from whom adequate samples could not be obtained for complete testing according to the current criteria established for laboratory confirmation."
This cluster involved a two year old and 42 year old who became ill after close contact with a man who had recently returned from Jordan. According to WHO, this raises the number of  probable MERS infections to seventeen. (See 'Progression of Italian MERS Cluster Described', Aug 23, 2013). 

Thursday, September 19, 2013

MERS Deaths Rise as WHO Updates Guidelines for Labs

MERS Corona Virus
Three more cases of MERS have been reported by the Saudi Ministry of Health. Two of the latest cases were fatal.  According to the report, this brings the total infections in Saudi Arabia to 107 with 49 deaths. If confirmed by the World Health Organization, it will bring the total MERS cases worldwide to 117 including 56 which later died.

Two of the latest cases occurred in Medina in the western part of the country. They involve a 37 year old who is currently in intensive care and a 75 year old woman with chronic medical conditions who passed away. The third infection resulted in the death of an 83 year old man from Riyadh who also had pre-existing illnesses.

With millions of Hajj pilgrims traveling to Saudi Arabia over the next month, the World Health Organization (WHO) has released revised guidelines which includes updated information on testing for MERS in the laboratory and collection and shipment of specimens from suspected victims.

According to the WHO guidelines,
"Access to timely and accurate laboratory testing of samples from cases under investigation is an essential part of the surveillance of this emerging infection. All countries should have access to reliable testing either nationally, or internationally, in laboratories willing to perform primary detection or confirmatory testing. WHO can assist Member States to access testing internationally should the need arise"

Wednesday, September 11, 2013

MERS Virus Looms as Hajj Pilgrims Arrive in Saudi Arabia

Millions of pilgrims will travel to Saudi Arabia for the Hajj
The first groups of Hajj pilgrims are setting out to Saudi Arabia for the annual ritual. This physical and spiritual journey is required of all Muslims who are able to make the trip. Most wait more than a decade for their turn to perform this important rite.

Jakarta Post reports the first groups of more than 26,000 are embarking from Java alone. They represent a small fraction of the more than three million people from over a hundred countries are expected to visit Mecca during this month. The places they will gather will be crowded with the faithful from all social classes and countries.

In addition to being the destination for millions of travelers, Saudi Arabia is also 'ground zero' for the mysterious Middle East Respiratory Syndrome (MERS) which has infected over a hundred people in the middle east, most from Saudi Arabia.

MERS is a genetic cousin to the SARS virus but with some important differences. SARS was more easily transmitted between humans but MERS is more deadly, with a shockingly high mortality rate of 50%.

Central Java Governor Ganjar Pranowo doesn't seem concerned about MERS. According to the Jakarta Post:
“There is no need to be afraid of the virus,” said Ganjar, adding the meningitis vaccine the pilgrims had already received and a healthy lifestyle during their stay in the holy land would see them avoid contracting the virus...He said all pilgrims had been given meningitis shots from the end of July but admitted the vaccine did not cover the corona virus."
Health groups are worried about the potential for these pilgrims to carry the virus back to their home countries, spreading the virus around the world. So far, it has only been found in eight countries on the Arabian Peninsula and Europe. The Center for Disease Control and Prevention (CDC) reports 114 cases of MERS with 54 deaths to date.

As researchers struggle to find an animal host and develop effective treatments for the disease, criticism of the Saudi government is growing for a seemly lack of timely and detailed information on the continuing outbreak in that country.

The World Health Organization (WHO), in Travel Advice on MERS-CoV for Pilgrimages, have advised children under 12, elderly or chronically ill to postpone their trip and those traveling to follow common sense hygiene practices. They advise,
"Countries should make information known to departing pilgrims and travel organizations on general travel health precautions, which will lower the risk of infection in general...Health advisories should be made available to all departing travellers to Umra or Hajj by working with the travel and tourism sectors and placing such materials at strategic locations (eg. travel agent offices or points of departure in airports)...different kinds of communication, such as health alerts on board planes and ships, and banners, pamphlets and radio announcements at international points of entry, can also be used to reach advisories should include current information on MERS-CoV and guidance on how to avoid illness while travelling.
However, there is no information available at airports about the virus, no public service announcements on TV or radio. Information about the rising numbers of cases has been slow and lacks detail.

In this poorly translated and unconfirmed report from H5N1 blog, Saudi officials have complained about the 'rumors' about MERS online and stated they are not withholding information about the virus or numbers of infected. But the statement goes on to include unreported numbers of infected nurses and alleges that health care workers were required to sign a pledge not to discuss the matter with the media or online.

There is much confusion and conflicting information about this disease. The head of the World Health Organization called MERS "a threat to the entire world." Yet, it is not considered an international public health emergency and no travel restrictions or screenings for the ill at airports has been ordered.


Monday, September 9, 2013

Anti-Viral Drugs Offer Hope for MERS Treatment

Researchers from the National Institute of Health have announced that two commonly used anti-viral drugs have shown promise in slowing replication of the MERS corona virus and improving outcomes in rhesus monkeys.

The 'monkey model', first developed in April, 2013 studied the progression of the disease in rhesus monkeys and allowed researchers to experiment with existing viral treatments. This latest report shows that a combination of ribavirin and interferon-alpha 2b inhibited replication of the virus in cells.

Researchers infected six rhesus macaques with the MERS virus, then eight hours later treated half of them with the drug cocktail. Those who received the anti-viral drugs exhibited no breathing problems and chest x-rays showed less evidence of pneumonia. They showed a lower viral level and suffered less tissue damage to the lungs than the untreated monkeys.

This is hopeful news as the MERS virus has infected approximately one hundred people in the Middle East and Europe and has killed nearly half of those infected. Researchers suggest that this combination of commonly used anti-viral medications could be used as an early intervention and treatment for the disease.

MERS Claims Three More Victims in Saudi Arabia

September 9, 2013

The Saudi Ministry of Health has reported three more deaths from the MERS virus and five additional infections. The most recent fatalities involved a 74 year old man, a 56 year old health care worker and a 53 year old from Riyadh. Five new infections were also reported including a three year old child and a young man of 18 years.

There have been 110 cases of MERS reported worldwide, of which 96 have occurred in the Saudi Kingdom. 47 of the 52 reported deaths are from that country.

Thursday, September 5, 2013

Second MERS Death in Qatar

MERS Infections have been reported in nine countries
Qatar's Supreme Council of Health has reported the death of a 56 year old woman from the MERS virus on August 31.

CIDRAP reports the woman suffered from chronic medical conditions when she fell ill with the virus and was admitted into the hospital intensive care unit on August 26. How the woman contracted the virus was not reported. This brings the number of infections in that country to five, with two fatalities.

A man from Qatar died in London earlier this year after traveling to Saudi Arabia and two additional cases were reported in Qatar just this month (see Qatar Reports Second MERS Infection This Week). They involved 29 and 59 year old men with pre-existing medical conditions. The 59 year old later recovered but the younger man remains in critical condition. 

The World Health Organization has not confirmed this latest report, or the previous two infections reported in Saudi Arabia earlier this week. (see Asymptomatic MERS Cases Discovered in Saudi Children).

No additional cases have been found through the testing of contacts with these latest victims. The current official count stands at 108 infections and 50 deaths. Following WHO confirmation, possible new numbers could reach 111 infections with 51 fatalities. 

Confirmed infections have occurred in Saudi Arabia, Qatar, Jordan, and the United Arab Emirates on the Arabian Peninsula and in Europe in the United Kingdom, Germany, France, and Italy and Tunisia in northern Africa.