Wednesday, January 29, 2014

MERS Toll Rises; USA Funds Vaccine Research

The World Health Organization has confirmed two more MERS deaths, one in Saudi Arabia and one in Jordan.

The first case involves confirmation of MERS in a surgeon who was admitted to the hospital with cold-like symptoms on January 4 and passed away on January 14, according to WHO spokesmen Gregory Hartl.

The 54 year old doctor, who was from Bangladesh, is reported to have suffered from chronic illnesses but had no contact with animals or other MERS patients. Officials are continuing to investigate the source of his infection.

The second confirmed death involves a 48 year old man in Jordan who had recently traveled to the UK and became ill on December 29. He was hospitalized on January 9 with cough, fever, difficulty breathing and abdominal problems. His condition worsened and on January 16 he was placed on a ventilator. He passed away on January 23.

The man had reportedly had traveled to the United Kingdom for treatment of an unrelated illness from November 12 to December 25. He reportedly did not attend any large public gatherings in the last month or had contact with animals. However, he did receive two visitors from Kuwait from December 25 through 31.

Health officials are monitoring family members and health care workers and investigations are continuing in both the UK and Jordan, according to the WHO.

These reports raise the confirmed MERS totals to 180 with 77 deaths. The Saudi Ministry of Health reports 143 cases in Saudi Arabia, including 59 deaths.

USA Funds Vaccine Research; Fast Tracks Approval
Researchers at Fudan University in Shanghai have identified two tightly bound proteins that aid the virus in infecting healthy cells. According to Shibo Jiang, one of these proteins was re-created in the laboratory which prevents the virus from entering cells. This promising treatment is similar to one currently used in HIV-AIDS treatments.

Jiang is also working with the New York Blood Center in the United States on a vaccine which is based on a surface protein in the MERS virus. Ideally, both treatments could be used in a vaccine.

Developing a vaccine is an expensive and time consuming endeavor and many pharmaceutical companies are reluctant to invest money into developing a treatment for a disease which may not become widespread and therefore have little economic value.

The USA is stepping up to help fund this research with a $400,000 grant from the National Institutes of Health to the New York Blood Center to work on a vaccine. They were awarded the grant due to their previous experience in developing a vaccine for the similar SARS virus.

President Obama has declared MERS to be a threat to public health and national security. He has authorized the 'fast tracking' of approval for tests and treatments for the virus.

Progression of Illness in Intensive Care Units Studied
In other MERS news, The Annals of Internal Medicine released a study following the course of 12 confirmed MERS patients, including progression, treatment and outcomes in two intensive care units in in Riyadh and one in Al Hasa.

The study concludes that although mortality rates are high, the virus can be contained through infection control measures. The report cautions:
"...it is clear from the healthcare-associated cluster that human-to-human transmission does occur with unprotected exposure. Therefore, there is a concern that MERS-CoV may become highly infectious to humans with sustained human-to-human transmissibility. In such an event, along with the high pathogenicity of the virus, MERS-CoV will become a major public health threat worldwide."

Monday, January 20, 2014

WHO Issues MERS Update: 178 Cases; 76 Deaths

Confirmed MERS cases 2012 - 2013 by month (image from WHO)
The World Health Organization released a summary and literature update on January 20 which takes a detailed look at the current MERS outbreak and the most recent infections.

WHO has confirmed 178 cases of Middle East Respiratory Syndrome so far, which includes 76 fatalities.

Notable findings include two suspected cases in Spain have been classified as 'unconfirmed' and health care facilities are the source of more than half the MERS infections to date.

Since the last report issued on November 22, 2013, 21 additional cases of MERS have been confirmed, including seven deaths, or a 33% fatality rate. That is down from 39% in November's report and 45% in a September, 2013 report.

The most recent cases include 14 from Saudi Arabia with four fatalities, six cases from the UAE with two deaths and one fatality in Oman.

The median age of infection is 52 years, which has increased slightly from the November, 2013 report which put the median age at 51, which had similarly increased from the 50 years in the September report.

MERS has not been reported in any additional countries since the November report and continue to include Jordan, Kuwait, Oman, Qatar, Saudi Arabia and the UAE. In northern Africa, Tunisia and in Europe, France, Germany, Italy and the United Kingdom.

All victims outside the Arabian Peninsula have had a direct link to the Middle East, either through recent travel to the area or close contacts of recent visitors to the area.

Testing on two women from Spain who had recently returned from Hajj in Saudi Arabia is contradictory and those cases are considered unconfirmed. These are the only reported possible infections among Hajj visitors following the annual pilgrimage to Saudi Arabia which occurs in mid-October.

Confirmed MERS cases 2012 - 2013 by country (image from WHO)
Seven of the newest victims in Saudi Arabia are considered 'sporadic' or of unknown origin. The other seven KSA cases are considered 'secondary', that is exposed from another infected human. Six of the seven secondary cases are infected health care workers who are asymptomatic (without symptoms).

More than half the confirmed MERS cases to date have occurred in health care settings, either in workers, other patients or visitors.

WHO reports 32 health care workers have been infected. Most report mild or no symptoms and were discovered through routine contact testing of confirmed MERS patients. Seven suffered severe illness and four of those passed away.

WHO reminds health care professionals to use universal precautions and infection control measures, even if the disease has not been confirmed.  If MERS is suspected, the patient should be treated as potentially infected even if initial MERS testing shows negative results.

More evidence for MERS in camels was reported during the study period, with several ill animals in Qatar and previous signs of exposure to the virus in camels from Saudi Arabia, Egypt, Jordan, Oman, UAE and the Canary Islands.

Studies showed that a MERS-like virus has been circulating in the camel population since 2003 but has only recently become transmissible to humans. The method of exposure is still unknown.

For more information, the article provides links to publications and literature providing guidance to care providers, preparedness and response in effected countries and detailed medical and case studies.

Friday, January 17, 2014

MERS Suspected in Death of Riyadh Doctor

Image from the Saudi MOH
In another suspected MERS case in the Saudi Kingdom, a 55 year old surgeon from Bangladesh who was working at Prince Salman Hospital in Riyadh, has died.

Dr. Mohammed Humayun Kabeer was admitted to the hospital for symptoms of the common cold on January 6.

His condition worsened and he was moved to the intensive care unit. Despite the best efforts by hospital staff, he passed away on January 15 due to multiple organ failure, just nine days after being admitted.

The body will be flown to Dhaka next week. The report did not specify if he had contact with MERS patients at the hospital where he worked.

If confirmed by the World Health Organization, this will bring the number of deaths due to the MERS virus in Saudi Arabia to 142 including 58 deaths.

Thursday, January 9, 2014

WHO Confirms Second Omani Death From MERS

MERS virus (image from the CDC)
The World Health Organization has confirmed the death of a previously reported Omani man on December 30 was due to the MERS virus.

This brings the total laboratory confirmed cases of MERS infections which are recognized by WHO to 178, which includes 75 deaths.

The man began to experience symptoms of cough, fever and shortness of breath on December 20 and was admitted to the hospital on December 24 in the Governorate of North Batinha in the Sultanate of Oman.

His symptoms worsened on December 28 and he was transferred to the intensive care unit where he was diagnosed with pneumonia. He passed away two days later.

The man, who was a heavy smoker, had been exposed to camels and farm animals daily and participated in camel race events.

Most of the confirmed MERS infections have originated in Saudi Arabia, accounting for 141 cases and 57 deaths, according to the Saudi Minister of Health website.

That means that currently 79% of cases have originated in KSA and 76% of the deaths. As infections continue to mount in other countries, especially the UAE and Qatar, those totals are down slightly from early November, 2013* when Saudi Arabia was the source of 84% of both infections and deaths from the virus.


*November 6, 2013: 84% cases (126/150)  / 84% fatalities  (54/64)
  January 9, 2014:   79% cases (141/178) / 76% fatalities (57/75)

Friday, January 3, 2014

New MERS Case in UAE; "Infections Increasing"

UAE is now second only to Saudi Arabia in MERS infections
The World Health Organization has been informed of another MERS case in the United Arab Emirates, raising the global confirmed cases to 177 with 74 deaths.

The UAE now ranks second only to Saudi Arabia in numbers of MERS infections. Previously, Qatar held that position.

The newest case involves a 33 year old man who works in the health care field and was in contact with a previously confirmed MERS patient.

The man has a history of asthma and kidney disease and developed symptoms on December 27. He was admitted to the hospital the next day suffering from bilateral pneumonia, acute renal failure and thrombocytopenia (low blood platelet count which can cause internal bleeding.) The man is currently in stable, but critical condition.

Dr. Salwan Ibrahim, Middle East Director for International SOS, whose website describes them as "the world’s leading medical and travel security services company," stated that MERS cannot be left just to government officials alone; that the private sector needed to take some responsibility to educate their workers on how to avoid the deadly virus, in this report by the Dubai Chronicle.

He said that information is the strongest weapon against MERS and everyone should remain vigilant and know how to protect themselves, including staying away from sick people, hand washing, covering coughs and sneezes and staying home when sick.

Dr Ibrahim cautioned that the virus mutates very quickly and seems to have become more contagious in the last few months as the numbers of new infections are increasing. He added, although much of the virus is still a mystery, experts now have better knowledge and technology to treat and contain the virus.

Wednesday, January 1, 2014

Oman Reports Second MERS Death

Oman reports their second MERS death.
The Ministry of Health for the Sultanate of Oman is reporting the second death in that country from the MERS virus.

The latest victim was a 59 year old man who was in the hospital and being treated for lung failure and pneumonia. He passed away on December 30.

The single previous case of MERS in Oman was a man admitted to the hospital in Nizwa in October and who died on November 10.

An Omani citizen who was visiting the Emirates in October became ill with the virus during his stay. He was hospitalized in Abu Dhabi, UAE and passed away on November 8.

The announcement stated that "The Ministry of Health is fully prepared to deal with these cases, and immediate action by the response team will take the actions required for each case."

Yesterday, the World Health Organization officially recognized an additional six cases of MERS, bringing the total laboratory confirmed infections to 176, including 74 deaths. Today's announcement of the recent Omani fatality is not included in the latest totals.

MERS Totals Rise; Kidneys May Hold Clue to Transmission

January 1, 2014

Corona virus
Health officials are monitoring two additional cases of MERS, one in Saudi Arabia and another in the UAE.

The Center for Infectious Disease Research and Policy, (CIDRAP) reports a 57 year old man is in intensive care in Riyadh. The man suffers from underlying medical conditions and has no travel history.

In the United Arab Emirates, a 59 year old asymptomatic woman is in isolation with the virus. Her husband, aged 68, previously died of MERS.

WHO has officially confirmed MERS caused the death of a 73 year old Saudi man who passed away on December 17. This brings the total laboratory confirmed cases to 176, which includes 74 fatalities.

In other MERS news, a report in Virology Journal by Christian Drosten looked closely at the link between MERS and renal failure, which is uncommon among corona viruses.

Researchers found that kidney epithelial cells reproduced almost a thousand times more virus than bronchial epithelial cells. This unusual trait of MERS is not yet understood.

Researchers recommend epidemiological studies analyze kidney problems associated with MERS and suggest that the virus may be shed with urine. This connection could explain the 'untraceable transmission chains' which continue to infect new victims from an unknown source. The study also suggests that MERS patients may benefit from early use of renoprotective treatments.