Friday, November 29, 2013

Man and Pregnant Wife Hospitalized With MERS in UAE

MERS virus (image from the CDC)
Health officials have urged residents not to panic following reports that a Jordanian man and his pregnant wife have been hospitalized with the MERS virus in the UAE.

The 38 year old man was admitted to the hospital with breathing difficulties and diagnosed with Middle East Respiratory Syndrome, or MERS.

His wife, who is eight months pregnant, was also suspected of being infected with the disease and was hospitalized. It is thought to be the first case of a pregnant woman contracting the virus.

Infectious Disease chief, Dr. Asim Malik at Mafraq Hospital in Abu Dhabi, cautioned that, “This is the first ever involving a pregnant woman so we do not know anything about the possible outcome."

Health officials in the UAE have advised residents not to panic as the infections in the gulf state continue to climb. If confirmed by the World Health Organization, these latest infections could raise the total MERS infections reported in the UAE to ten.

Dr. Malik said that they are well prepared for any outbreak and urged calm. “We are well equipped...in preparation and anticipation of suspected or confirmed cases of coronavirus."

A leading researcher in establishing a possible camel connection to the virus, Dr. Ulrich Wernery, Director of the Central Veterinary Research Laboratory in Dubai, also urged calm. “It is not a big concern. People should not panic. All of the people to have died from MERS so far have had underlying, pre-existing conditions and anything, such as flu, could affect those with a weaker immune system."

To date, WHO has laboratory confirmed 160 cases of MERS in twelve countries and the virus has been blamed for 68 deaths.

Researchers caution that these numbers may represent only a fraction of the actual infections. A recent study found that only about a third of actual cases are being reported due to testing policies which focus only on critically ill patients. The report characterized the spread of the dangerous virus as a 'slowly moving epidemic.'

MERS Found in Camels in Qatar

November 29, 2013

Three camels in Qatar have tested positive for MERS. The animals were housed in a barn where two men who previously became ill with the virus had worked.

Both men have recovered from the disease which has killed at least 68 of the 160 confirmed cases worldwide.

The three camels, from a herd of 14, are the first reported MERS cases in animals in Qatar.

Camels have been suspected of carrying the illness and clues to a possible connection continue to be found in the dromedary population. Camels which contained the antibodies to the virus, indicating past exposure, were found in Oman, Egypt and Spain in August.

Saudi Arabia reported a camel and his owner were sick with the virus on November 11 and on November 15, Saudi agriculture officials reported that eight camels had been quarantined which had tested positive for the virus in preliminary tests.

Although camels are suspected of carrying the virus, but most victims have reported no contact with animals. It is unclear at this time if the camels are responsible for infecting humans or if ill humans are spreading the virus to camels, or both.

Image from http://dohanews.co

Tuesday, November 26, 2013

MERS Epidemic Claims More Lives in Saudi Kingdom

Most MERS infections have originated in Saudi Arabia
The grim death count from the MERS epidemic has risen again, according to the World Health Organization. WHO now puts the total MERS infections worldwide at 160, including 68 deaths.

Approximately 133 of the laboratory confirmed cases of Middle East Respiratory Syndrome have originated in the Saudi Kingdom. 57 of those have died.

Researchers agree that most cases are going unreported. A recent study estimated 62% of symptomatic cases are undetected and actual infection numbers may be closer to a thousand.

Saudi Arabia has reported three more victims of the virus, two of which have passed away. Both fatalities are from the Riyadh area and suffered from chronic medical problems.

A 73 year old woman became ill with the virus on November 12 and was hospitalized on the 14th. On November 9, a 37 year old man began to show symptoms and he was admitted to the hospital on the 13th. Both suffered from underlying medical conditions and both died on November 18.

A 65 year old man is also sick with MERS, according to Saudi health officials. He is from the Jawf region and has pre-existing medical conditions. He became ill on November 4 and was hospitalized on the 14th.

None of the latest cases reported contact with animals or previously diagnosed MERS patients. These infections, whose source cannot be identified, are called 'sporadic' cases.

A recent report by WHO raised concern about the sharp increase in sporadic infections. In September of this year, they represented about a quarter of new infections. According to the report released on November 22, sporadic cases now account for more than two thirds of new MERS infections.

Researchers concluded that the virus is being spread by both humans and through an 'unknown reservoir' which continues to infect humans. An animal connection is suspected, but most cases mirror these most recent ones: the victims had no contact with animals.

In other MERS news, Innovo Pharmaceuticals have announced success in pre-trials on a vaccine for the MERS virus. They report 'robust and durable immune responses' in tests of the drug on mice.

Saturday, November 23, 2013

WHO: MERS in a Dozen Countries; Jump in Sporadic Cases

MERS confirmed and probable cases by month of onset and type (WHO)
The World Health Organization has issued an update on the MERS virus epidemic which is occurring in the middle east. (see .pdfCIDRAP summary)

WHO confirms that three new countries have reported infections with the Middle East Respiratory Syndrome virus, they include Spain, Kuwait and Oman.

MERS has been confirmed in a dozen countries so far. Six countries in the middle east have reported the virus, five in Europe and Tunisia in Northern Africa.

Previous infections have occurred in Jordan, Saudi Arabia, the United Arab Emirates (UAE) and Qatar in the Middle East and France, Germany, the United Kingdom (UK) and Italy in Europe. Two probable cases in India are awaiting official confirmation by health officials.

To date, WHO recognizes 179 cases worldwide, with 157 laboratory confirmed and another 19 considered 'probable'. Of those, 69 have died, or about 39%.

The death rate appears to have dropped a bit in the last two months, or since the last WHO summary update which was issued in September. At that time the mortality rate was about 45%. This 6% decline could be due to better reporting of less severe cases discovered through contact testing. The average age remained about the same, 51 years in this report versus 50 previously.

In September, researchers had expressed concern at the rise in sporadic cases which accounted for about a quarter of infections. Sporadic cases are those having no prior contact with an infected person or the first case within a cluster.

This reports shows there has been a sharp increase in the number of sporadic cases of the virus, According to the report, two thirds (67%) of new cases are now considered sporadic.

WHO researchers raised concerns about the spread to previously unaffected countries and the rise in sporadic cases. "This appearance of the virus in new countries and the steady increase in sporadic cases continues to raise concerns about possible expansion of virus in the as yet unknown reservoir."

A recent study published in The Lancet Infectious Disease calculated that there are five to ten undetected MERS cases for every reported case. They estimate there could be nearly a thousand symptomatic but unreported cases of the virus.

WHO confirms that many cases are going unreported due to MERS testing policies that only include victims who end up in hospital ICUs. According to the report:
"Countries in the affected area should strongly consider expanding testing to include community-acquired pneumonias that are admitted to hospital, even if they do not require mechanical ventilation or intensive care, especially if no alternate diagnosis explains the illness. Testing for MERS-CoV should be considered for incorporation into routine diagnostic algorithms for community-acquired pneumonias and not limited to severe cases in ICU."
Researchers are also concerned about the large numbers of infections which are occurring in medical facilities, either because the disease is not recognized or due to false-negative screening tests: 
"WHO has reports of a number of examples of laboratory confirmed MERS-CoV cases who initially tested negative from upper respiratory samples, while lower respiratory samples tested positive for MERS-CoV."
About 62% of secondary cases (49 confirmed, 11 probable) are believed to have been exposed in health care facilities. These represent health care workers, other patients and visitors. 

Exposure rates by country (WHO)
The study affirms previous research which suggests the virus is being sustained through human to human contact but also through an 'unknown reservoir' which continues to infect humans.

This unknown reservoir is suspected to be related to animals but the connection is still a mystery. The report noted the latest four victims in Qatar had all recently been exposed to farm animals.

Despite reports of the virus being found in camels and a genetic link to bats is suspected, neither are believed to be the source of infection in humans.  Most index and sporadic cases have had no contact with animals of any kind.

Intriguing clues to the origin of the virus continue to surface, but researchers caution that there are still important questions regarding the method of human exposure: 
"Specifically, the remaining questions include 1) the specific behaviors and exposures that bring humans into contact with sources of the virus, 2) whether camels are a part of the chain of transmission to humans or whether they are coincidentally infected, and 3) whether other animals may also play a role in transmission or act as a reservoir." 
WHO recommends that persons who have chronic illnesses use 'appropriate precautions' when visiting farm environments in the region. 

So far, only India has reported MERS in returning Hajj pilgrims, where two women who traveled together came down with the virus. Both have since recovered and official confirmation is still pending. 

WHO recommends that, "Countries outside of the affected region should maintain a high level of vigilance, especially those with large numbers of travellers or guest workers returning from the Middle East."

The report concludes with WHO's request that "Member States report all confirmed and probable cases along with information about their exposures, testing, and clinical course." and they "strongly recommend detailed case investigations for every case, case-control studies for index cases and intensive follow-up of contacts".

Friday, November 22, 2013

More MERS Deaths in Qatar, Saudi Arabia


MERS virus from the CDC
Saudi Arabia and Qatar are reporting more deaths from the deadly MERS virus. Both countries reported fatalities from the disease just two days ago.

The Saudi Health Ministry posted a brief, machine translated statement on Thursday which said a 37 year old man from Riyadh had died. No further information was given about the case. The Health Ministry website puts the total infections in that country at 130 with 55 deaths.

Qatar also reported another death from the MERS virus. The victim was a 48 year old foreign worker, just as the two previous cases in the country which were reported earlier this week. On Tuesday, a statement from CIDRAP said that one MERS victim in Qatar had died and another had recovered and been released from the hospital.

The latest cases have not been confirmed by the World Health Organization yet. The latest statement from WHO, dated November 18, put the total, laboratory confirmed, MERS infections worldwide at 157 with 66 deaths.

Wednesday, November 20, 2013

MERS Death Toll Climbs in Saudi Arabia, Qatar

'Cough and Sneeze Etiquette' from the Saudi Ministry of Health
The Saudi Ministry of Health is reporting two more MERS infections in the Kingdom, including another death, and Qatar has announced that a previously reported victim has passed away.

The latest Saudi cases involve a 65 year old man who suffers from chronic medical problems and is hospitalized in intensive care. He is being treated in Riyadh but comes from the Jawf region, which is in the northern portion of the country.

The most recent Saudi fatality is a 73 year old woman in Riyadh who had several pre-existing health problems.

This brings the official total by the Saudi Health Ministry to 129 cases of MERS and 54 deaths from the virus in the Kingdom. There have been complaints about a lack of detailed and timely information from Saudi Health Officials, who have traditionally valued privacy over transparency.

MERS appears to have originated in Saudi Arabia and that country has seen the vast majority of cases since the virus was first identified last year. Research has shown that the disease may now have reached epidemic levels.

In the country of Qatar, one previously reported case has died and one has recovered, according to the Center for Infectious Disease Research and Policy (CIDRAP).

The death was a foreign worker who had been exposed to farm animals and was reported ill on November 15 while a 45 year old from Doha has recovered from the illness and been released from the hospital.

Monday, November 18, 2013

Second Probable MERS Case in Spain

Both women traveled to Hajj together
Image from newsrender.com
The Spanish Health Ministry reported a second probable case of MERS in Spain. The latest infection involves a woman who traveled to Saudi Arabia for Hajj with the woman who was reported ill with the virus on November 6.

The Center for Infectious Disease and Policy (CIDRAP) is reporting both women have recovered and have been released from hospitals. Health officials cannot determine if one woman caught the virus from the other or if they were both infected by the same source.

All contacts for the women have so far tested negative, including fellow passengers on the flight from Saudi Arabia and contacts since returning home to Spain.

The women have tested positive in preliminary tests for the virus. The cases are listed as probable because the World Health Organization (WHO) requires further testing for verification. According to Canada's Metro News, Spanish authorities are awaiting results for official confirmation.

There have been 157 confirmed cases so far and 66 fatalities. There have been at least 17 probable MERS cases, but due to inadequate samples or testing procedures which do not meet WHO's standards, the probable cases cannot be considered WHO confirmed.

Meanwhile, the World Organization for Animal Health (OIE) is not convinced that camels are the source of the virus in humans.  According to the OIE statement, "Currently there is no strong evidence to consider that camels are a source of infection for human cases of MERS."



Four MERS Infections in Kuwait This Week

November 18, 2013

MERS corona virus.
Image from niaad.nih.gov
Two more laboratory confirmed cases of MERS have been reported in Kuwait. According to the World Health Organization (WHO), both are in critical condition.

This brings the total confirmed infections in Kuwait to four. The first two cases in the gulf state were reported earlier this week.

The most recent infections involve a 47 year old man who became ill on October 30 and was hospitalized on November 7. The second is a 52 year old man with pre-existing medical conditions. He became ill on November 7 and was hospitalized on the 10th.

Researchers have estimated that for every reported case of MERS, there may be five to ten unreported and the virus has reached epidemic levels.

According to Medical News Today, an epidemic is "when the number of people who become infected rises well beyond what is expected within a country or a part of a country."

"A pandemic covers a much wider geographical area, often worldwide. A pandemic also infects many more people than an epidemic. An epidemic is specific to one city, region or country, while a pandemic goes much further than national borders."

WHO has confirmed 157 cases world wide, including 66 deaths. They continue to advise vigilance by health care workers and emphasize the importance of infection control measures in suspected cases. But no special screening at entry points has been recommended and no trade or travel restrictions are in place.


Saturday, November 16, 2013

MERS Claims Two More LIves; WHO Confirms More Cases

 MERS corona virus  image from ajc1 / flickr
Two more patients infected with the MERS virus have died, according to the World Health Organization via the Center for Infectious Disease and Policy (CIDRAP). They have also confirmed two suspected cases as MERS.

A 75 year old Omani man passed away in UAE on November 10. He became ill on October 1 and was hospitalized on October 12. He suffered from diabetes and was a heavy smoker. He was reported to be the second victim from Oman and the sixth in the UAE.

In Qatar, a 61 year old man who was reported as an expatriate has been confirmed to have the virus. He became ill on November 4 and was hospitalized on November 7. He suffers from chronic medical conditions and is in critical condition. WHO reports he had been exposed to farm animals.

A previously confirmed victim in Oman has passed away. According to CIDRAP, he was a 68 year old man with chronic medical conditions who was reported on October 30

The World Health Organization now puts the total laboratory confirmed MERS infections worldwide at 155, including 66 fatalities.

A recent report published in the Lancet Infectious Diseases reported that the majority of milder cases are not being reported due to virus surveillance policies which have focused primarily on critically ill patients.

A second report from the WHO MERS-CoV Research Group stated. "Given that many cases are probably being missed, the reported cases "probably represent the severe end of a wide clinical spectrum of disease,"

Friday, November 15, 2013

Second Report Shows MERS Epidemic is Under Way


Probable infections by country and confirmed cases. Image from PLoS
The Center for Infectious Disease and Prevention (CIDRAP) reported on two studies concerning the MERS (Middle East Respiratory Syndrome) virus which have recently been released.

Both reviewed data on MERS infection rates and determined there are many unreported cases of the disease. The virus is not believed to have achieved sustained human-to-human transmission and outbreaks of the illness can be controlled without 'overly aggressive' measures.

The first study, conducted by the Imperial College London, the University of Edinburgh, and the Institut Pasteur in Paris and published in The Lancet Infectious Diseases, found that for every identified case, there were five to ten which were unreported. They estimated there were 940 human symptomatic cases by August 8, 2013 and noted that approximately 62% of 'clinically apparent' cases have gone undetected.

They determined that each infected persons transmitted the disease to one or two others after returning home, however the size of the clusters and rate of reproduction within those clusters decreased over time. They speculated this may be due to faster detection and response to cases.

Their report put the 'R value', or the reproductive rate of the disease, at between 0.8 and 1.3 when no infection control measures were implemented. A value of 1.0 is considered the level which the virus can be self sustaining.

Three data sources indicated that the R level ceiling could not be too much above the crucial 1.0 mark, most likely between 1.2 and 1.5. However, the researchers cautioned, "Our analysis demonstrates that the transmissibility of MERS-CoV in man is close to the critical threshold of R=1 required for self-sustaining transmission."

The scientists looked at infection rates in both animals and humans. By identifying mutations in genetic sequences which occur at a regular rate, they estimated between March 2012 and August 8, 2013, there were a staggering 17,940 infections in the human and animal population, according to CIDRAP.

The report concludes there is certainly an epidemic under way, they but could not determine if the virus is self sustaining in humans or if the epidemic is being sustained through an animal reservoir.

The second, more detailed study, conducted by PLoS Currents, also determined that spread of the virus could be stopped by 'appropriate infection control measures." The researchers felt R = < 1.0 but some estimates put the R level at > 1.0.

They looked at 144 confirmed and 17 probable cases occurring between September 2012 and October 2013 including 65 deaths. The researchers determined the median age was 50 and two thirds of the victims were male. Two thirds of the cases were considered 'severe' and three quarters had an underlying medical condition. Pre-existing health problems were more common among the fatal cases.

22 of the studied cases were considered 'index cases' which is the first infection within a cluster. 95 of the infected were considered 'secondary', that is they had contact with other confirmed cases. 29 of the cases were considered 'sporadic', meaning they had no known contact with previous ill patients or animals.

Index and sporadic case patients were more likely to 'have severe disease and were generally older, 59 years median compared with the 43 years in secondary cases.

The majority of the secondary cases were infected in health care settings, accounting for 60 of the 95 cases in that group. Thirteen cases were spread through household contact and one at work. Only seven of 49 infected persons had contact with animals in the previous ten days, five were exposed to camels and two to sheep. More detailed demographic data from the study can be found here.

Maria D. Van Kerkhove, PhD, who coauthored both reports, concurred that cases are being unreported due to surveillance policies which were designed to identify severe cases. The tendency to report only the most gravely ill probably has skewed the statistical mortality rate, which has been quoted at near 50%.

The study concludes that the reported cases, "probably represent the severe end of a wide clinical spectrum of disease...Thus the case-fatality ratio (CFR) is probably lower than it looks now, though a CFR higher than 10% cannot be ruled out."

"I think countries in the region have certainly stepped up surveillance activities in recent months, but we are still likely to miss the more mild or asymptomatic cases because current surveillance recommendations will not identify those," Van Kerkhove said.

She is not surprised at the recent discovery of MERS infected camels. Regarding whether spread of the virus is being sustained through human contact or if an animal source is continually seeding the epidemic through ongoing transmission to humans, Van Kerkhove thinks it is both.

"I think we're seeing a combination of the two. There is certainly human-to-human transmission occurring, but we also continue to see a number of isolated cases reported without any epidemiologic links to other cases, indicating that there is likely non–human-to-human exposure occurring."

The CIDRAP article also noted, per the World Health Organization:
  • "Initial MERS symptoms typically include fever, cough, chills, sore throat, and muscle and joint pain, followed by dyspnea (shortness of breath).
  • At least a third of patients had gastrointestinal symptoms such as vomiting and diarrhea.
  • Many patients have been treated unsuccessfully with high-dose corticosteroids, and the WHO recommends against such treatment, with few exceptions.
  • No antibiotic or antiviral agents have been effective in treating severe MERS cases.
  • Unpublished data shows that MERS-CoV is closely related to coronaviruses found in hedgehogs (and various studies show it is related to coronaviruses in bats).
  • Genetic analyses suggest that the virus emerged in mid-2011".

MERS Infected Camels Quarantined

The MERS virus may be transmissible between humans and camels
Eight camels who are suspected of being infected with the MERS (Middle East Respiratory Syndrome) virus have been placed in quarantine, according to the Saudi Ministry of Agriculture.

Two teams have been formed to test the camels, consisting of members of the Saudi Ministries of Health and Agriculture.

According to this report, preliminary tests for the virus were positive and the camels will be held in isolation until further testing is completed. Results are expected in a few days.

The Minister of Health also confirmed that camels from the property of a man from Jeddah, who was recently diagnosed with MERS, have also tested positive in preliminary tests for the virus.

Tests on Saudi camels in August of this year did not show exposure to the virus, but antibodies to the virus were found in camels in Spain and Oman. Recently however, cases of active infection have been found in camels belonging to MERS patients in Saudi Arabia.

Image from dohanews.co

Qatar Confirms Ninth MERS Case

November 15, 2013

Nine cases of MERS have been confirmed in Qatar
In the second MERS announcement in a week, Qatar's Supreme Council of Health reported that a 61 year old foreign worker has tested positive for the MERS virus in that country. The report states he arrived in Qatar a few months ago to look for work.

This makes nine cases in the gulf country to date. Six of the previous victims are Qatari citizens, including three victims who died. Three are expatriates, as is the most recent victim.

The MERS virus was confirmed at the Helmud Medical Corporation laboratory. He is currently in intensive care and it is not known if he had prior contact with another MERS case. His contacts have been tested for the virus and preliminary results have been negative.

image from the nation.com

Wednesday, November 13, 2013

Kuwait Announces Second MERS Case

Health officials from at least thirteen countries
have currently reported MERS infections. 
In the second announcement within hours, the Kuwaiti Minister of Health is reporting another man has tested positive for the MERS (Middle East Respiratory Syndrome) virus in the gulf country.

The Kuwait News Agency reports that he is 52 years old and in stable condition. They reported he recently returned from 'an overseas trip.'

"The man was admitted to the Infectious Diseases Hospital and the necessary preventive measures were put in place pursuant to the guidelines of the World Health Organization (WHO)," said Dr. Mosaab Al-Saleh, who leads the Health Ministry's anti-epidemic unit.

He noted that this case is not related to the first MERS patient in Kuwait, who was announced earlier today and said that contacts of the first victim were all currently in good health. He promised to keep the public updated on new developments 'in a transparent way.'


Kuwait Reports First MERS Infection

November 13, 2013

Kuwait has reported the first MERS infection in that country. (Google Maps)
A man in Kuwait is in critical condition with the Middle East Respiratory Syndrome (MERS) virus, the Minister of Health announced today.

The latest victim is 47 years old and suffers from diabetes and high blood pressure. He is being isolated in intensive care, according to the Kuwait News Agency (KUNA).

Saying that Kuwait was 'fully capable to treat this disease', Dr Musab Al-Saleh, Disease Control Chief for the Health Ministry said and they would be following infection control guidelines by the World Health Organization and other international health agencies.

Kuwait shares a southern border with the Saudi Kingdom which has been especially hard hit by the virus.

The last two weeks have also seen cases of MERS reported in the countries of Spain, India and Oman for the first time. Travelers returning from the Hajj Pilgrimage in Saudi Arabia are being screened at airports around the world in an attempt to prevent the disease from breaking out of the Arabian Peninsula and becoming a pandemic.

In a report released by The Lancet, a group of European researchers called MERS "a slowly growing epidemic" and said that for every reported case there could be five to ten unreported cases.

They estimate the number of symptomatic cases to be close to one thousand, a fraction of the number officially confirmed by the World Health Organization (WHO).

According to the latest update on November 11, WHO has 'been informed' of only 155 cases of MERS worldwide, including 64 who have died. Most of the victims are located in Saudi Arabia or have recently traveled there.

The actual number of infected in the country may be difficult to know. An official from WHO recently admitted that Saudi 'surveillance strategy' involved testing for MERS only in patients who are critically ill with pneumonia-like symptoms and receiving intensive care treatment.

“I know that their surveillance strategy is focused on intensive care patients," said Dr. Anthony Mounts, a MERS expert for WHO.

MERS can cause symptoms similar to pneumonia with cough, fever and shortness of breath. It can also lead to kidney and renal failure and has shown to be especially lethal to the elderly or those who suffer from chronic diseases.

Scientists are working to locate the source of the virus and suspect an animal host. Clues have been found which suggest the disease evolved in bats and may be transmissible between humans and camels. However, the main form of transmission may now be human to human according to the Lancet study.

Tuesday, November 12, 2013

MERS: 'A Slowly Growing Epidemic'; Most Cases Unreported

MERS: "A slowly growing epidemic"
MERS is 'a slowly growing epidemic' and reserachers suspect that for every reported case, there could be five to ten more cases that are undetected, according to a report released in The Lancet.

The study estimates that  there have been 940 symptomatic cases so far and 62% of infections have been unreported. The World Health Organization (WHO) has officially confirmed only 155 cases to date.

"At the very least there probably have been double the number of infections," said Neil Ferguson of the MRC Centre for Outbreak Analysis at Imperial College. "But it's considerably more likely in my view that we've had maybe five to ten times more human infections than that. And symptomatic human infections."

The study compiled databases of confirmed and probable cases. They looked at epidemiological data including incubation periods and estimated transmission rates. A 1.0 transmission rate means each infected person infects one other person.

When infection control methods are used, the virus does not appear to be self-sustaining. However, when there are no efforts to limit exposure, the virus appears to have a transmissability rate of  0.8 - 1.3. This is significant because an epidemic can become self sustaining when it reaches approximately a 1.0 transmission rate.

How can so many cases be missed by health officials? Surveillance methods tend to focus on the victims who visit hospitals, so only the sickest of the infected are being counted.

According to this report, one of the problems faced by researchers is the scarcity of publicly available data. ”We would certainly be in a better position if there was fuller reporting.” Ferguson said.

In Saudi Arabia, 'ground-zero' for the disease and origin of the majority of cases, only the most seriously ill patients with pneumonia-like symptoms who require ICU treatment are even being tested for MERS. According to Dr. Anthony Mounts, MERS expert for the WHO, “I know that their surveillance strategy is focused on intensive care patients."

Contact testing of confirmed cases has shown the presence of asymptomatic infections, that is with mild or no symptoms and these carriers are capable of spreading the virus to others.

Researchers speculate that the main method of transmission may be person to person at this point, or there could still be an animal source which continues to infect humans, who then spread the virus to other humans.

Ferguson feels that if there was a sustained animal source there would be more sick animals. He believes, "we have a human-to-human epidemic, with limited efficiency of transmission compared to flu, and mild presentation in most or many cases, similar to flu.”

Monday, November 11, 2013

India Reports Possible MERS Infection in Hajj Pilgrim

Bangalore, India reports a possible MERS infection in returning Hajj pilgrim
A 42 year old woman in Bangalore, India has been diagnosed with the Middle East Respiratory Syndrome (MERS) virus, according to Health and Family Welfare Director, Geetha Nyama Goudar.

She had recently visited Saudi Arabia for the annual Hajj pilgrimage and may be the first case of MERS in India.

V.B. Patil, Health Commissioner said that District Health Officers had been "directed to deploy staff at the airports in their jurisdiction for screening."

The woman was coughing 'severely' on the plane and was sent by airport screeners to Rajiv Gandhi University of Chest Diseases where she was tested for MERS. Swab samples will be sent to the National Institute for Mental Health and Neuro Sciences for confirmation.

The woman was complaining of a sore throat and fever and was advised to be admitted to the hospital but refused.

Officials said she showed symptoms similar to those seen in the H1N1 virus but her condition was not serious. She was permitted to go home to Anantapur, but authorities have been advised to 'keep a check'.

According to Dr Ravi, Senior Pathologist at the National Influenza Surveillance Centre (NIMHANS), there have been "not more than ten" suspected cases of the rare MERS virus in India so far.

Ravi cautioned that "the incubation period of MERS-CoV is 12 days, it is likely that the infection is not detected when the pilgrims land."

Millions of visitors perform the Hajj pilgrimage every year, a trip which is required of all Muslims who are able to do so. The annual ritual brings visitors to the Saudi cities of Mecca and Medina from around the world.

Airport and health workers world wide are on alert for signs of respiratory distress in returning visitors from the Arabian Peninsula. Saudi Arabia has been hardest hit and suspected of harboring an unknown source of the virus.

To date, the World Health Organization has confirmed 153 cases of MERS worldwide including 64 deaths. 127 of those infections have occurred in Saudi Arabia and accounted of 53 of the fatalities.

Saudi Camel and Owner Test Positive for MERS

November 11, 2013

A Saudi camel and its owner have both tested positive for MERS
A camel has tested positive for the Middle East Respiratory Syndrome (MERS) virus, the Saudi government reported today. The camel was owned by a man who had also been proven to be infected with the virus.

This is the first case of infection discovered in camels. In August of this year, camels were shown to carry antibodies to the virus but no active infections were present.

Researchers are comparing the genetic structure of the virus found in the camel to those carried by humans. If it proves to be a perfect match, it could provide important clues to the source of the human infections which have baffled scientists.

According to the Saudi Health Ministry, if they are genetically identical, "this would be a first scientific discovery worldwide, and a door to identify the source of the virus,"

More research on the spread of this mysterious disease is needed as many of the infected had no contact with camels or other animals. 

It is known that MERS, like its cousin SARS, evolved in bats. Genetic research has shown that the virus has repeatedly infected humans from some unknown intermediary source.

Scientists suspect that Saudi Arabia may host an 'unknown reservoir' of the deadly corona virus which can cause symptoms similar to pneumonia in addition to renal failure. It has shown to be particularly dangerous to the elderly or those with underlying medical conditions.


Omani MERS Patient Dies in UAE

November 11, 2013

Health officials from Abu Dhabi, capital city of the UAE, have announced the death of the 75 year old Omani man from Middle East Respiratory Syndrome (MERS) who was reported ill earlier this week.

The man was visiting the country in October when he became sick with the virus. He was hospitalized and receiving treatment, but passed away on November 8.

Earlier this week, Oman reported the death of the first MERS victim in that country. He was a 68 year old man who was suffering from several pre-existing medical conditions. He experienced symptoms of fever, cough and shortness of breath for a week before succumbing to the disease.

The World Health Organization issued an update today and puts laboratory confirmed infection totals at 153 with 64 deaths. These numbers will likely rise as more reported cases are verified by the WHO.

Six countries have reported MERS infections or deaths just this week:

Nov 4: Saudi Arabia reports another death from the virus.
Nov 6: Spain reports a woman with MERS who has recently returned from the Hajj.
Nov 7: UAE Reports an Omni citizen is hospitalized with the virus.
Nov 7: Saudi Arabia reports two more infections with the MERS virus.
Nov 8: Qatar reports the eighth victim of the disease in that country.
Nov 10: Oman reports the death of the first MERS victim in that country.
Nov 10: Saudi Arabia reports another fatality in the KSA.
Nov 11: UAE reports death of visiting Omani citizen.
Nov 11: India reports a woman returning from the Hajj is diagnosed with MERS.

Sunday, November 10, 2013

Oman Reports First MERS Death as Toll Rises in Saudi Arabia

MERS corona virus
The Gulf country of Oman has reported its first fatality from the Middle East Respiratory Syndrome (MERS) virus and the Kingdom of Saudi Arabia has reported another death from this dangerous illness, which has sickened at least 154 and claimed 64 lives.

The Omani man was 68 years old and had several pre-existing medical conditions including diabetes, high blood pressure and heart failure.

The report states he had a 'seven-day history of fever, cough, expectoration and shortness of breath'.  He was receiving appropriate medical care, but his condition continued to deteriorate and on Saturday his lungs failed and he passed away, according to this article in Gulf News.

Oman’s Minister of Health, Dr Ahmad Bin Mohammad Al Saeedi said, "We have examined 129 cases over the last year and all tested negative for this virus. We have a strong surveillance system which has also been appreciated by the WHO" (World Health Organization).

The man was the first case of MERS in Oman and was publicly reported by health officials on October 30. Tests for the virus among contacts of the victim have so far proved negative.

Nearby Saudi Arabia is reporting another MERS death. No details on this case have been released, but the Saudi Kingdom has been the source of most of the infections and deaths. The Ministry of Health website states there have been 127 cases of MERS in the Saudi Kingdom and 53 fatalities.

Like influenza and SARS, the virus can cause pneumonia like symptoms including fever, cough and difficulty breathing. However, MERS can also lead to renal failure and has proven to be particularly lethal to those with underlying and chronic medical conditions.

Friday, November 8, 2013

Qatar Reports Eighth MERS Infection

MERS corona virus
A man from Qatar has been diagnosed with the Middle East Respiratory Syndrome (MERS), according to the Qatar Supreme Council of Health.

The man is a 46 year old who is reported to have chronic health problems. His close contacts were checked for the virus and all have tested negative.

The statement from the Kuwait News Agency (KUNA) says that Qatar has declared 'at least three' previous cases and the disease had been reported in 'several regional counties'. It also stated that a previously reported MERS patient had recovered after medical treatment.

The Center for Infectious Disease Research and Policy (CIDRAP) reports this is the eighth case of the virus in Qatar. If confirmed it could bring the total to 155 MERS infections worldwide, including 64 fatalities.

Qatar is the fourth country this week to report additional MERS infections. On November 7, Saudi Arabia reported two more cases. The UAE reported an Omani national was ill with the virus on November 6, the same day a woman was reported to be hospitalized with MERS in Spain.




Thursday, November 7, 2013

Saudi Officials Report Two More MERS Cases

Saudi Health Officials report two more MERS infections
Image from CNN
CIDRAP announced that Saudi health officials are reporting two more cases of the Middle East Respiratory Syndrome (MERS) in Saudi Arabia. They also confirmed the previously reported Omani man who is ill with the virus in the UAE capital of Abu Dhabi.

The statement, issued in Arabic from the Saudi Ministry of Health, states the first Saudi victim is a 72 year old man from Riyadh. He is in stable condition in ICU and suffers from pre-existing medical conditions.

The second case is a 42 year old man who was previously healthy. He is from the Jeddah region and is not believed to have traveled outside the area.

The previously reported case in UAE involves a 75 year old Omani man who became ill while in Abu Dhabi. The man is in ICU and raises the total MERS infections in UAE to eight. The country of Oman recently reported it's first case of the virus.

When confirmed by the World Health Organization, these new cases will bring the total MERS infections to 154 with 64 deaths worldwide.

According to the International Society of Travel Medicine's Philippe Parola, MD, PhD., testing of suspected cases is ongoing, with emphasis on returning Hajj travelers. Cases of influenza A have been reported in France and Canada, and many have tested positive for the H3N2 subtype.


Ill Spanish MERS Victim Required Oxygen on Flight From Mecca

November 7, 2013

Eleven passengers plus airline staff will be tracked for exposure to the virus.
The Center for Infectious Disease Research and Policy (CIDRAP) has released more information on the Middle East Respiratory Syndrome (MERS) case which was reported yesterday in Spain.

It marks the first case of MERS in that country and the fifth European country to report laboratory confirmed infections with the corona virus. Previous cases have been reported in France, UK, Germany and Italy.

The European Center for Disease Control  (ECDC) reports that the woman is 61 years old and was in generally good health with no underlying medical problems when she arrived in Medina, Saudi Arabia for the Hajj pilgrimage on October 2.

She had no contact with animals as she visited the Saudi cities of Medina until October 10 and then traveled to Mecca on October 11. She developed a cough and fever on Oct 15 and visited a hospital emergency room in Mecca two weeks later on Oct 28 and 29.

Chest x-rays were taken and she was diagnosed with pneumonia. According to Spanish Health Ministry officials, she refused to be hospitalized in Saudi Arabia and instead, was hospitalized in Madrid when she returned to Spain on November 1.

The ECDC reports she was ill on the flight home and required oxygen while aboard. Eleven passengers who were seated within two rows of the woman on the plane from Mecca to Madrid have been identified and will be monitored for exposure to the virus.

Health officials from Spain are also tracking 14 family members, 18 health care workers and 7 patients from the hospital in Madrid and airline staff who had close contact with her en-route from Saudi Arabia.

According to the latest MERS update from the World Health Organization, dated November 4, 2013, "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."

The ECDC states that this imported case is the tenth in Europe and the thirteenth outside the Middle East, out of 151 confirmed cases including 64 deaths.

image from CNN: 6 Places Germs Breed in a Plane

Omani National is Eighth MERS Case in UAE

November 7, 2013

The MERS virus has been detected in an elderly Omani national who was visiting Abu Dhabi, according to The Health Authority Abu Dhabi (HAAD).

The report states the victim is 75 years old and was hospitalized after suffering respiratory problems in October and is currently in ICU in the capital city of the United Arab Emirates (UAE). It brings the total of confirmed infections in the country to eight.

Oman reported the first case of MERS in that country just last week. The statement said the victim was a man who was suffering from a 'chest infection' and in stable condition.

The report stresses that HAAD is coordinating with the Ministry of Health and is following all international guidelines and taken all measures as recommended by the World Health Organization. They feel there is no cause for concern as the situation is being monitored closely 'for the health and safety of everyone.'

Wednesday, November 6, 2013

MERS Virus Reported in Spain

Spain reports first MERS case
(from Google Maps)
The Spanish Ministry of Health is reporting the first verified case of Middle East Respiratory Syndrome (MERS) in that country.

The victim is a female who recently returned from the Hajj in Saudi Arabia. She is in stable condition in a hospital in Madrid, according to this article from the Center for Disease Control and Prevention (CIDRAP).

The woman began to exhibit symptoms before she left Saudi Arabia and was admitted to a hospital after returning to Spain. Verification of the MERS virus was performed by the Spanish National Microbiology Center.

Dr. Anthony Mounts of the World Health Organization stated that contacts of the woman, including possible fellow passengers on air flights, would be tracked for the illness.

Earlier this week the WHO spokesmen had expressed confidence that Hajj had not acted as a 'transmission event' which might have spread the virus to global pandemic levels. He now admits the threat still exists, remarking that, "I think it does give us pause,..I think it means that we really do have to wait a little while longer before we're sure we're out of danger."

Spain is the tenth country to have confirmed the virus and makes 151 cases so far, including 64 deaths. It is the fifth European country to report MERS infections, the others occurring in UK, Germany, France and Italy. Other outbreaks have occurred in Tunisia and on the Arabian Peninsula in the countries of Saudi Arabia, Oman, Qatar, UAE and Jordan.

This is the second report today of the MERS virus appearing among recent travelers to Saudi Arabia and occurring in countries where the virus had not been previously reported.

Earlier, local media reported 'at least five' unconfirmed cases of MERS in the country of Azerbaijan. All are recent visitors to Saudi Arabia for the annual Hajj.  (See 'Azerbaijan Reports Possible MERS Outbreak Among Returning Hajj Pilgrims', Nov. 6, 2013)

So far, The World Health Organization has confirmed 150 cases of MERS in eight countries with 64 fatalities. These totals do not reflect today's disturbing news from Azerbaijan or Spain.


Azerbaijan Reports Possible MERS Outbreak Among Returning Hajj Pilgrims

November 6, 2013

Azerbaijan reports possible MERS outbreak
(from Google Maps)
Local media in the country of Azerbaijan is reporting the hospitalization of 'at least five' suspected cases of the deadly Middle East Respiratory Syndrome (MERS) in that country.

The unconfirmed report states the suspected victims are hospitalized with 'acute respiratory diseases'. All are recently returned pilgrims from the Hajj in Saudi Arabia, the source of most of the previous MERS infections. 

The outbreak has not been verified as MERS yet, but if it proves to be true, this will be the first cluster linked to the Hajj, an annual journey performed by millions of Muslims. It could mark the tenth country where MERS has been found if verified by the World Health Organization.

A country of 95% Muslim, about 4,000 of the faithful made the trip this year. Azerbaijan is the largest country in the Caucasus, considered a crossroads between Asia and Europe. It lies between Russia to the north and Iran to the south.

So far, most of the cases of MERS have been linked to the country of Saudi Arabia, accounting for 126 of 150 laboratory confirmed infections and 54 of 64 deaths.

Health officials have been worried that Hajj pilgrims could carry the virus back to their home countries, allowing the deadly illness to break out of the Arabian Peninsula and become a global pandemic.

The Middle East Respiratory Syndrome is a corona virus which can cause severe respiratory disease, diarrhea and kidney failure. It appears to have a shockingly high mortality rate of nearly 50%. Most victims have had underlying medical conditions which may contribute to the high death rate.

Genetic testing recently confirmed that MERS evolved in bats and has repeatedly infected humans from an unknown intermediary source. The SARS virus, a cousin to MERS was recently proven to also have originated in bats. 

Monday, November 4, 2013

Saudi Kingdom Reports Another MERS Fatality

MERS corona virus from CDC
The World Health Organization is reporting another fatality from the mysterious Middle East Respiratory Syndrome (MERS) virus in the Kingdom of Saudi Arabia.

The most recent victim was a 56 year old woman from the Eastern region of the country. She had chronic medical conditions and been in contact with a previous MERS patient.

WHO has now confirmed 150 cases of MERS in nine countries, 64 have died. 126 cases have originated in Saudi Arabia with 54 deaths.

The deadly MERS virus is a corona virus, similar to SARS. Both are believed to have originated in bats and evolved to infect humans. SARS appears to be more contagious than MERS but the Middle East Repiratory Syndrome is more deadly.

Countries around the world are closely watching pilgrims returning from the Saudi cities of Mecca and Medina following the Hajj. One of the pillars of Islam, it is a journey that is made by millions of Muslims every year. So far, no cases of MERS have been reported among returning Hajj travelers.



Friday, November 1, 2013

WHO Confirms 149 MERS Infections in Nine Countries; 63 Deaths

WHO confirms 149 MERS cases in nine countries
The World Health Organization (WHO) has confirmed four previously reported cases of Middle East Respiratory Syndrome, including the first case in the country of Oman.

The 68 year old man from the Al Dahkliya region reportedly has not recently traveled outside the country. Research continues on identifying the source of the infection which has now struck nine countries, most infections originating in the Kingdom of Saudi Arabia.

Saudi Health Officials had reported three additional infections with the virus, including one fatality, earlier this week. WHO now has confirmed 149 cases of MERS with 63 deaths. The Saudi Ministry of Health website currently shows 125 cases and 53 fatalities in that country.