Wednesday, October 30, 2013

Oman Reports First MERS Case

Oman reports first MERS infection. Image from Google Maps
The Gulf State of Oman is reporting the first infection with the Middle East Repiratory Syndrome (MERS) virus in that country.

According to this article, the victim is a man who is in stable condition and suffering from a 'chest infection.' No other details have been released.

This marks the ninth country where the virus has been found. The others include Saudi Arabia, UAE, Qatar, Jordan, Tunisia, UK, Germany and France. So far, WHO has confirmed 144 cases of MERS with 64 fatalities, most occurring in the Saudi Kingdom.

In other MERS related announcements, the Saudi Minister of Health (MOH) reported three new MERS infections in that country.

The victims are two females aged 87 and 53, and a 63 year old man. All are reported to suffer from chronic medical conditions and all are in the ICU in Saudi hospitals. According to the Saudi Health Ministry website, the total infections in that country are currently at 124 with 52 deaths.

This report from the Center for Disease Control and Prevention (CDC) looked at antibodies to the virus in Saudi men and children from the hard hit eastern province in 2012. Results suggest that exposure to the virus was not widespread in the population at that time.

The MERS corona virus is a cousin to SARS. Both viruses can lead to severe pneumonia-like symptoms but the Middle East Respiratory Syndrome can also cause diarrhea and kidney failure. It is also considerably more deadly with a mortality rate of nearly 50%.

Tuesday, October 29, 2013

MERS Death and Infection Counts Rise in Saudi Arabia

MERS Corona virus, image from the CDC
The Center for Infectious Disease and Prevention (CIDRAP) is reporting two new cases of Middle East Respiratory Syndrome (MERS) in Saudi Arabia and the death of a previously reported victim.

The newest cases involve a 54 year old health care worker and a 49 year old, both are reported to have chronic medical conditions and are in stable condition in ICU.

According to this translated statement from Saudi Ministry of Health (MOH), the latest fatality is an 83 year old woman with pre-existing health problems who was reported by the World Health Organization (WHO) last week.

The two latest cases have not yet been confirmed by the WHO but Saudi Health Officials put their current total of infections in that country at 124 cases with 52 deaths.

Monday, October 28, 2013

Asymptomatic MERS Case Discovered in Qatar

MERS has been confirmed in eight countries
Qatar's Minister of Health is reporting a new case of Middle East Respiratory Syndrome (MERS) in that country. The latest victim is a 23 year old foreign worker who showed no symptoms and was discovered during 'epidemic investigation procedures', according to this short article.

The patient has been released from the hospital and is in stable condition. Close contacts of the person have been checked and show no signs of MERS.

UPDATE October 30, 2013: WHO reports that this recent Qatari case is a close contact and employed in an animal barn of the previous MERS patient where he was exposed to camels, sheep and chickens.

If confirmed, it would raise the total of MERS infections in Qatar to seven, two of which were reported in the last two weeks alone. So far, the World Health Organization has verified 144 cases of the dangerous corona virus in eight countries. 64 of those infected have died.

image from pentagonpost.com

Thursday, October 24, 2013

WHO Confirms Five Additional MERS Cases

Middle East Respiratory Syndrome Corona Virus
The World Health Organization via Infection Control Today confirmed five more cases of Middle East Respiratory Syndrome (MERS) in Saudi Arabia, two of which have died.

The latest victims are four men and one woman and range in age from 35 to 83 years old. Two are from the Medinah area and three are from Riyadh. Four had underlying medical problems and two reported no previous contact with other MERS patients or animals.

This brings the total of WHO laboratory confirmed MERS infections to 144 with 62 deaths, most in the country of Saudi Arabia. Health officials worldwide are advised to remain vigilant and watch for signs of respiratory distress in travelers who have recently returned from the Middle East. Suspected cases should be tested promptly and Infection Control Procedures (ICP) implemented.

Tuesday, October 22, 2013

Saudi Health Ministry Reports Two More MERS Cases

Saudi officials have reported two additional MERS cases, both occurring in men from the Riyadh area. This statement from the Saudi Ministry of Health (translation) reports a 54 year old man with chronic medical conditions is in intensive care after coming down with the virus.

The second case involves a 73 year old man who also suffers from pre-existing medical conditions and is in intensive care in a Saudi hospital according to Arab News. Neither man has traveled outside the Riyadh recently.

If confirmed by the World Health Organization, these cases would bring the total WHO confirmed MERS cases to 140 with 60 deaths. Most infections have originated in Saudi Arabia and many victims have come from the Riyadh area.

The annual Hajj pilgrimage just concluded and millions of travelers have returned home. So far, there have been no cases of MERS among Hajj visitors but health officials world wide will be monitoring closely to see if the virus will break outside of the Middle East.


Monday, October 21, 2013

MERS Replikin Count Increases; Updated Data Needed

The increase in Replikin Count on the surface of the H1N1 virus
as the pandemic developed. From Replikins.com
The Middle East Respiratory Syndrome corona virus (MERS) has undergone several fluctuations in the virus' ability to replicate and could be rising again, according to Bioradar UK Ltd the company which developed a method for quantifying the amount of 'Replikin' peptides in the genome of a virus. Replikins appear to be related to how quickly the virus is able to replicate within a host.

According to Bioradar, the MERS peaked in virulence and infectivity in September of 2012 with a count of 27.7% and dropped sharply to a low of 14.3% by February of 2013. The count began to rise again and as of June, 2013, the last month which data is available, had reached 20%.

The statement stresses that Replikin Counts can change rapidly and the present data is over four months old. They urge specimens be genetically sequenced quickly and results published as soon as possible, ideally within a few days of collection. Replikin analysis should be performed within 24 hours thereafter.

The press release from Bioradar compares the progression of the Replikin Counts in MERS to the SARS outbreak in 2002-2003 and the H1N1 Flu of 2009. It demonstrates a strong correlation between the Replikin peptide levels in the virus and clinical outcomes in the public:
"The rapid quantitative decline here found in Mers CoV gene Replikins resembles that previously found by Replikins Bioradar in the 2002-2003 outbreak of SARS, a coronavirus related to Mers CoV (see Figure). After an abrupt rise in gene Replikin Count in 2002, SARS Replikins began their immediate decline in concentration as the clinical outbreak occurred and quickly terminated in 2003 (1). In another example, this one in real-time gene tracking, the occurrence of the H1N1 pandemic of 2009 was predicted and published one year in advance, its termination in 2009 (see Figure)(1) and its recurrence in 2010, all were predicted by the Replikin Count alone (1-5)."
For comparison, this chart shows the Replikin Counts for five strains of influenza and this article reports the numbers for SARS just preceding the 2003 outbreak. It appears that, even at below peak levels, MERS has a significantly higher Replikin Count than either SARS or H1N1.

Elenore and Samuel Bogoch patented a method of identifying replikins in 2001 and the specific group of peptides (short chains of amino acids) was discovered and patented by the company 'Replikins' who trademarked the term 'Replikin Count' and produces synthetic vaccines.

Friday, October 18, 2013

Qatar Reports Sixth MERS Infection

Qatari researcher
A 61 year old man from Qatar is being treated for MERS according to the Qatar Minister of Health and the Center for Infectious Disease Research and Policy (CIDRAP). The man suffers from pre-existing medical conditions and is in stable condition.

Officials report that he has not traveled outside the country recently or been in contact with a known MERS case. Preliminary tests have not shown the virus to be present in family members or close contacts.

The previous cases of MERS in Qatar involved three cases in August 2013 and two the previous fall. The World Health Organization (WHO) has not confirmed the case and their count stands at 138 cases so far with 60 deaths. The European Centre for Disease Prevention and Control (ECDC) via Vaccine News Daily reports 141 confirmed cases with 62 fatalities.

 Photo from doahnews.co

Monday, October 14, 2013

Two More MERS Deaths in Riyadh

Hajj pilgrims are advised to wear masks in crowds. Photo from CNN
The World Health Organization (WHO) has reported two more deaths from the Middle East Respiratory Syndrome (MERS) virus in the Saudi city of Riyadh. These victims were men aged 55 and 78 years. They became sick at the end of September and passed away at the beginning of October.

Both cases are considered 'sporadic' or having no known contact with other infected persons. Bats have recently been shown to be the genetic source of the virus but the method of transmission to humans is still unknown. WHO has confirmed 138 victims with 60 deaths to date, most in the Saudi Kingdom.

Saudi Arabia will be hosting millions of global visitors this week for Hajj, one of the five pillars of Islam. This pilgrimage is required for all Muslims who are physically and financially able and many have been on waiting lists for over a decade for their turn to make this trip.

The Saudi Health Ministry has advised children, elderly and chronically ill to avoid Hajj this year due to the MERS outbreak in that country. Pilgrims who make the trip are advised to wear face masks in crowded places and follow common sense hygiene procedures, avoid contact with animals and not eat uncooked meat or unwashed fruits and vegetables.   

WHO recommends member states to continue surveillance and watch for unusual patterns of illness in those returning from the Arabian Peninsula and implement Infection Prevention and Control (IPC) procedures in any suspected cases. 

Friday, October 11, 2013

Scientists Confirm MERS Originated in Bats

Researchers have shown the MERS virus originated in bats.
Scientists have shown that the deadly Middle East Respiratory Syndrome (MERS) virus originated in bats before it adapted to spread to humans. They have identified three receptors which show the virus has been circulating in the bat population for some time and several adaptations were evolved to combat it. According to this report from Virology Journal:
"Cell-surface receptors such as DPP4 play a key role in facilitating viral invasion and tropism. As a consequence, the long-term co-evolutionary dynamics between hosts and viruses often leave evolutionary footprints in both receptor-encoding genes of hosts and the receptorbinding domains (RBDs) of viruses in the form of positively selected amino acid residues (i.e. adaptive evolution)... 
These residues therefore provide direct evidence of a long-term co-evolutionary history between viruses and their hosts. We also observed several variable regions within the bat RBD, that may also have resulted from virally-induced selection pressure and which merit additional investigation in a larger data set."
This is one more piece to the puzzle regarding the origins of this mysterious disease. The report did not shed any light on how the disease is being transmitted to humans as most victims have had no contact with bats.  Researchers suspect an 'unknown reservoir' of the virus exists in Saudi Arabia, perhaps in an intermediary animal host, which has repeatedly infected humans and has resulted in three genetically distinct versions of the virus in humans.

Friday, October 4, 2013

WHO Confirms Six More MERS Infections

MERS Corona Virus
The World Health Organization confirmed six more MERS infections in Saudi Arabia, three had been previously reported and three are new cases. The latest victims are from Riyadh and range in age from 14 to 79 years old.

One of the new cases has mild symptoms and the others are in the hospital. Three were in contact with confirmed cases, two have no known contacts with other victims or animals and no information has been released on the source of infection in one.

These latest cases brings the total of WHO confirmed cases to 136 including 58 fatalities. They advise vigilance by medical workers, the elderly or chronically ill postpone the Hajj, masks be worn by Hajj pilgrims in crowded events and basic good hygiene practices.

A meeting by the WHO Emergency Committee under the International Health Regulations  and concluded "
"...the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met... WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions."
Saudi health officials are not overly concerned about the millions of Hajj pilgrims due to arrive in Saudi Arabia this month. They point to the recent Umrah pilgrimage to the Saudi Kingdom which did not result in widespread infections from returning visitors.

The Center for Disease Control and Prevention and the National Institutes of Health in the US are currently operating on minimal staff due to the US Government Shutdown. This CDC statement reads:
"CDC will continue minimal support to protect the health and well-being of US citizens here and abroad through a significantly reduced capacity to respond to outbreak investigations, processing of laboratory samples, and maintaining the agency’s 24/7 emergency operations center."

Wednesday, October 2, 2013

US Government Shutdown Slows MERS Research, Monitoring

This notice appears on the website of the
National Institutes of Health
The impasse in Congress which has resulted in a shutdown of non-essential government services will have large impacts on the agencies which operate behind the scenes, inspecting our food, protecting our health and monitoring for disease outbreaks, including MERS.

The Department of Health and Human Services (HHS) will furlough 40,000 employees, covering a wide range of agencies from the Center for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to the Food and Drug Administration.

The NIH has issued temporary pink slips for 73% of its staff and will be forced to halt important disease research. They have placed a notice on their website which reads,
"Notice
Due to the lapse in government funding, the information on this web site may not be up to date, transactions submitted via the web site may not be processed, and the agency may not be able to respond to inquiries until appropriations are enacted.
Updates regarding government operating status and resumption of normal operations can be found at USA.gov."
The CDC, which will lose 63% of its employees, says the cutbacks will prevent them from monitoring the major flu outbreaks currently being tracked, including the Middle East Respiratory Syndrome (MERS) and the H7N9 Avian Flu.

The HHS, in their "2014 Contingency Staffing Plan for Operations in the Absence of Enacted Annual Appropriations" says that
"CDC will continue minimal support to protect the health and well-being of US citizens here and abroad through a significantly reduced capacity to respond to outbreak investigations, processing of laboratory samples, and maintaining the agency’s 24/7 emergency operations center."
These budget cuts come at a crucial time in the progression of the MERS virus. Its source is unknown and has a terrifying death rate of about 50%. It can be spread by seemingly healthy carriers and no vaccine is available. The vast majority of cases have originated in Saudi Arabia and this month millions of religious pilgrims will be traveling there from over a hundred countries.

There are unconfirmed reports of an ill woman in a hospital in Ottawa, Canada who recently traveled from Dubai who is being tested for MERS and CIDRAP reports three more cases in Saudi Arabia.

As Congress' political games bring vital disease research and monitoring to a halt, health professionals hold their collective breath knowing this dangerous virus could be reaching a tipping point and jump from being a regional concern to a global pandemic.