Friday, April 25, 2014

Has MERS Reached a Pandemic 'Tipping Point'? WHO Raises Alarms; Saudi Totals Spike Again

April has seen a sharp increase in MERS infections. (image from CDC)
The World Health Organization is raising alarms about the sudden jump in the number of cases of Middle East Respiratory Syndrome (MERS) in Saudi Arabia and the UAE in the last few weeks, as health officials speculate whether the virus has reached a 'tipping point' where it could break out of the Middle East and become a global pandemic.

It took MERS two years, since it was first identified in April, 2012, to top 200 cases. Barely two weeks ago, WHO listed 211 infections and 88 deaths from the virus worldwide.

Saudi Arabia alone is currently reporting 313 cases and 93 deaths. The New York Times states there have been four deaths and 36 cases reported there in the last 24 hours, including a Turkish pilgrim who had visited Mecca.

As the number of cases grows, so do the countries where MERS has been found. Malaysia, the Philippines, Yemen and Greece have all reported their first infections and in all cases the victims had recently traveled to the Arabian Peninsula.

The United Arab Emirates has reported 45 cases and 7 deaths. Half (23) of those infections have occurred since April 1.

Jordan has reported an additional case involving a 25 year old man from Al Grayat City who had recently traveled to Saudi Arabia and had contact with camels and drank camel milk. This makes five cases and three deaths in that country.

WHO states that three quarters of the recent infections were secondary cases, that is, they caught the virus from another person. Most of these secondary infections have occurred in health care facilities, with the virus being passed to healthcare workers and other patients who were being treated for unrelated illnesses.

Most of the new cases have been been mild or asymptomatic (without symptoms) and secondary cases are less likely to spread the virus but health officials caution that much is still unknown about how MERS is transmitted or the route of infection.

WHO has offered to assist Saudi Arabia and the UAE in investigating the outbreaks and chain of transmission. They hope to determine if there is an 'evolving risk' that could be contributing to the uptick in infections.

According to Dr. Michael Osterholm of the Center for Disease Research and Policy (CIDRAP) via NPR, the disease may have "reached a tipping point and could be ready to spread out of the region." He cautioned that, "It took us over a year to get the first hundred cases of this viral infection, now in just the last two weeks, we've had a hundred cases. ... There's a major change occurring that cannot just be attributed to better case detection. Something's happening."

MERS is believed to be less contagious but more deadly than it's famous cousin SARS which sickened thousands worldwide and continues to circulate in some populations. The MERS virus has claimed the lives of 30 - 50% of victims, a staggeringly high mortality rate.

As concerns grow that the virus may have mutated to a form which is more easily transmissible among humans. Dr. Osterholm is worried we have may have already crossed that line. "When humans readily transmit [a virus] to humans, that's what will cause a worldwide outbreak," Osterholm says. "We are very concerned that ... with what we've seen over the last two weeks ... we may be at that point now."

Twelve New Cases Reported in Saudi Arabia Today
The alarming jump in infections in Saudi Arabia continues today with the announcement of 12 new MERS cases and two deaths from previously confirmed infections.

The statement includes details of the newest cases, six in hard-hit Jeddah, five in Riyadh and one from the holy city of Mecca.

Five of those infected are in area ICU units, six are in stable condition and one is asymptomatic (without symptoms).

Nine men and three women are included in today's announcement. Health care facilities continue to be the venue for many of the infections, with nearly half coming from that sector; One doctor, two nurses, a receptionist and a patient admitted for an unrelated illness were likely exposed to MERS at Saudi Hospitals.

The deaths were a 68 year old man from Mecca and a 72 year old woman from Riyadh.

The Saudi Ministry of Health has currently confirmed 313 MERS infections in the Kingdom and 92 deaths.

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