Saturday, December 21, 2013

Five New MERS Cases; Four in Saudi, One in UAE

MERS Corona Virus Info-graphic
from the Saudi Ministry of Health 
Five new cases of MERS have been reported, four in Riyadh, Saudi Arabia and one in Dubai, UAE.

According to the Saudi Minister of Health (MOH), the first two cases are both female and work in the health care field. They are asymptomatic (without symptoms) and are contacts with a previously confirmed MERS patient.

A 53 year old male is also reportedly infected with the MERS virus. He is suffering from pre-existing diseases and is in intensive care. The fourth Saudi victim has passed away. He was a 73 year old man who also had chronic medical problems.

The Saudi Ministry of Health currently reports 136 cases of MERS in the Kingdom and 56 deaths.

The Dubai Health Authority in the United Arab Emirates (UAE) announced another case of MERS in that country. Health officials report a 68 year old man had been admitted to the hospital intensive care unit with the virus. He suffers from diabetes and chronic kidney failure.

Earlier this month, a family in the UAE was found to be ill with MERS. That cluster included a Jordanian man, his pregnant wife and their eight year old son. The woman passed away shortly after giving birth by emergency cesarean section.

Prior to today's announcements, the World Health Organization had recognized 165 laboratory confirmed MERS infections worldwide with 71 deaths.

Hong Kong Man Tests Negative for MERS

A 67 year old man who had recently traveled from Qatar to Hong Kong and had been suspected of contracting MERS has tested negative for the virus, according to a spokesperson for the Centre for Health Protection (CHP) for Hong Kong.

The man had become ill while in Qatar and visited a private doctor upon returning to Hong Kong. He was hospitalized in isolation and in stable condition.

Officials stated they will maintain vigilance at public and private hospitals and that doctors are stationed at airports to watch for incoming passengers who may be infected with MERS.

"No human infection with this virus has been identified so far in Hong Kong" According to health officials, "We would like to reassure the public that the Government will be as transparent as possible in the dissemination of information on cases of Middle East Respiratory Syndrome. Whenever there is a suspected case, particularly involving patients with travel history to the Middle East, the CHP will release information to the public as soon as possible."

Thursday, December 19, 2013

Hong Kong Reports Possible MERS Infection in Visitor to Qatar

The man traveled from Qatar to Hong Kong on December 17
The Department of Health in Hong Kong announced today that they are investigating a suspected case of MERS in a returning visitor from Qatar.

The 67 year old man became ill on December 14 with cough and runny nose while in the Middle East and returned alone to Hong Kong on December 17.

On December 19th, he visited his private doctor and was transferred to Princess Margaret Hospital in Hong Kong where he is under isolation and in stable condition.

The man, who suffers from chronic medical conditions, reported no contact with animals while in Qatar.

The Hong Kong Centre for Health Protection (CHP) said they will continue surveillance at public and private hospitals and station doctors at airports to watch for suspected MERS infections in returning travelers.

According to the statement, "No human infection with this virus has been identified so far in Hong Kong...We would like to reassure the public that the Government will be as transparent as possible in the dissemination of information on cases of Middle East Respiratory Syndrome. Whenever there is a suspected case, particularly involving patients with travel history to the Middle East, the CHP will release information to the public as soon as possible."

MERS has been laboratory confirmed in 165 patients and claimed 71 lives since it was identified last year.

Tuesday, December 17, 2013

Two Additional MERS Infections in Saudi Arabia

The World Health Organization confirmed two additional cases of the MERS virus in Saudi Arabia today.

The newest cases both are women. One is a 51 year old from Jawf Province who became ill on November 20. She suffers from chronic medical conditions and is in intensive care in Riyadh. She reported no contact with animals.

The second infection was confirmed in an asymptomatic, 28 year old. The ex-pat health care worker had contact with a 37 year old man who passed away from MERS and was reported on November 21.

Saudi Arabia has been the hardest hit by the disease, accounting for 132 of 165 confirmed cases and 55 of 71 fatalities.

Saturday, December 14, 2013

MERS Rampant Among Camels in the Middle East

Locations where animal samples were taken relative to
human outbreaks of MERS in 2012 (
Eurosurvellience)
The evidence that the MERS virus is rampant in the dromedary camel population in the middle east continues to mount with the recent discovery of the virus in a majority of tested camels in Jordan and Saudi Arabia according to two articles in Eurosurvellience.

Samples were collected from camels, cattle, sheep, goats and chickens in areas where the disease has been found in humans, including Riyadh and Al Ahsa in the Saudi Kingdom and in Zarqa, Jordan where the first cluster was discovered in 2012.

100% of the camels tested in Jordan (11 of 11) and about 90% of camels tested in Saudi Arabia (280 of 310) tested positive for antibodies to MERS or a close form of the disease.

MERS antibodies had been found previously in camels form Spain, Oman, Egypt, Saudi Arabia and Qatar.

Some of the samples from Saudi camels may have been cross reactions with the bovine coronavirus (BCoV). Researchers caution that there appears to be a 'broad pattern of cross-reactivity' between these similar diseases and this should be considered when testing for the viruses.

It appears the camels in the area are exposed to the virus early in life. Researchers found that about 72% of young camels, under a year old, had been exposed to the disease and 95% of dromedary camels over a year old showed past exposure.

As of December 2, the World Health Organization has confirmed 163 cases of MERS, including 71 deaths. However, recent studies show the disease is under reported and the majority of cases are not being diagnosed.

In the past, testing for the virus has focused only on the most severe patients. For example, in the Jordanian cluster described in the report, eleven probable cases were involved, but only the two fatalities in the group were tested and verified to have had MERS.

Approximately 40% of infections are considered 'sporadic' or index cases and these have occurred in Jordan, Oman, Kuwait, Qatar, UAE and Saudi Arabia.

The Jordanian study stated,
"Human to human transmission has been observed in healthcare and family settings. Various studies indicate that the observed MERS-CoV diversity in humans results from multiple independent introductions in the human population in the Middle East and the number of these sporadic, primary infections is still increasing."
Despite the findings of widespread MERS exposure in dromedarys, it is still unclear if camels are the reservoir which researchers suspect has repeatedly infected humans. Most victims have reported no contact with camels. "Neither the proximate animal source of human infection nor the natural reservoir of the virus is known," states the report. For now, the search for the origin of the illness continues.

Thursday, December 5, 2013

WHO Recommends No Changes to MERS Health Regulations

MERS: Not a Public Health Emergency
of International Concern
The World Health Organization held the fourth International Health Regulatons (IHR) Emergency Committee concerning the MERS-CoV by teleconference on December 4.

Members heard from representatives from the recently affected countries of Saudi Arabia, Kuwait, Oman, Qatar and Spain, as well as two 'expert advisers' specializing in camel diseases and crisis communications.

The WHO Secretariat updated members on new epidemiological information on progression of the disese and clusters and scientific evidence including detection of MERS in camels. State representatives presented information on recent cases in their countries.

The Saudi government was praised for its 'preparation, surveillance and management' of millions of visitors during the annual Hajj pilgrimage.

After some discussion, the Committee felt that, "Based on a risk assessment of current information, 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."

They concluded there was no reason to change their advice to the Secretary General regarding international health regulations. They reinforced previous advice regarding MERS testing, tracking and information sharing. They recommend,

  • "strengthening surveillance, including in countries with pilgrims;
  • continuing to increase awareness and effective risk communication concerning MERS-CoV;
  • 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;
  • timely sharing of information in accordance with the International Health Regulations (2005) and ongoing active coordination with WHO."


They also emphasized the need for,

  • "investigative studies, including international case-control, serological, environmental, and animal-human interface studies, to better understand risk factors and the epidemiology;
  • further review and strengthening of such tools as standardized case definitions and surveillance and further emphasis on infection control and prevention."

The committee suggested they may reconvene in March of 2014 unless serious developments require members to meet before then.

Monday, December 2, 2013

New Mother Dies of MERS in UAE Family Cluster

The MERS corona virus
In a tragic outcome, a 32 year old woman who was eight months pregnant and diagnosed with MERS has died in the UAE.

The Jordanian woman, who was in the last stage of her pregnancy and in critical condition, gave birth by emergency Cesarean Section, according to health officials in Abu Dhabi and the World Health Organization.

WHO reports the baby boy is doing well. The infant seems to be free of the virus for now, according to Gregory Hartl, head of Public Relations and Social Media for the World Health Organization, via Twitter.  But the WHO statement cautions, "Further investigations into close contacts of the family, the newborn baby, and healthcare workers are on-going."

First reported on November 29, Infectious Disease chief, Dr. Asim Malik at Mafraq Hospital in Abu Dhabi warned, “This is the first ever involving a pregnant woman so we do not know anything about the possible outcome."

She and her husband became ill with the virus around November 15 and were admitted to the hospital, according to the report issued on Friday. Earlier today, WHO had reported both parents were in critical condition.

The woman is the mother of an eight year old boy who was admitted to the hospital with the virus as reported earlier today. Authorities say his symptoms are mild and his illness was discovered through routine contact testing of the expectant couples' family.

The WHO reports that the source of the infection in this family cluster is unknown. They have not traveled recently and had no contact with animals or other MERS cases. Hartl tweeted, "There is still a big mystery around many MERS cases."

The WHO statement issued today reports 163 confirmed cases and 70 fatalities. These new numbers reflect two recent deaths in Qatar on November 19 and November 29, however, the statement does not include the tragic death of the young mother reported today.

WHO recommends those at severe risk of disease to avoid farms or barns where the disease is known to be present. For others, they suggest hand washing, avoiding contact with sick animals and general good hygiene practices.

According to the statement, recommendations regarding travel and trade restrictions have not changed. "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."

Eight Year Old Boy Diagnosed With MERS in UAE

December 2, 2013

Testing Lab at Mafraq Hospital in Abu Dhabi (image from zawya.com)
An eight year old Jordanian boy has been hospitalized in UAE after preliminary tests showed he was infected with the MERS virus, according to an announcement by health authorities in Abu Dhabi on Sunday.

His symptoms are mild and the disease was discovered through contact testing of the family members of a man who was diagnosed with MERS two days before.

He may be related to an expectant couple who were reported to be hospitalized with the virus on November 29.

On Friday, UAE health officials reported that a 38 year old Jordanian man was admitted to the hospital with breathing problems and found to be ill with MERS. His wife, who is eight months pregnant, was also diagnosed with the illness and has been hospitalized.