Coronavirus – Credit CDC PHIL
# 7515
Overnight The Lancet published an analysis of 47 lab confirmed cases of MERS-CoV diagnosed in Saudi Arabia between September 2012 and June 15th 2013.
While the bulk of the study is behind a pay wall, we do have the abstract and several media reports quoting the corresponding author for this study; KSA Deputy Health Minister, Professor Ziad Memish.
Dr. Memish has been quoted by Reuters as stating that, "So far there is little to indicate that MERS will follow a similar path to SARS." At the same time, this new study concedes:
Major gaps in our knowledge of the epidemiology, community prevalence, and clinical spectrum of infection and disease need urgent definition
First stop, a link to the abstract, then a couple of links to media coverage.
Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study
Abdullah Assiri MD a b †, Jaffar A Al-Tawfiq FACP c †, Abdullah A Al-Rabeeah FRCS a, Fahad A Al-Rabiah MD d, Sami Al-Hajjar MD d, Ali Al-Barrak MD e, Hesham Flemban MD f, Wafa N Al-Nassir MD g, Hanan H Balkhy MD h, Rafat F Al-Hakeem MD a i, Hatem Q Makhdoom PhD j, Prof Alimuddin I Zumla FRCP a k l †, Prof Ziad A Memish FRCP a m n
Findings
47 individuals (46 adults, one child) with laboratory-confirmed MERS-CoV disease were identified; 36 (77%) were male (male:female ratio 3·3:1). 28 patients died, a 60% case-fatality rate. The case-fatality rate rose with increasing age.
Only two of the 47 cases were previously healthy; most patients (45 [96%]) had underlying comorbid medical disorders, including diabetes (32 [68%]), hypertension (16 [34%]), chronic cardiac disease (13 [28%]), and chronic renal disease (23 [49%]). Common symptoms at presentation were fever (46 [98%]), fever with chills or rigors (41 [87%]), cough (39 [83%]), shortness of breath (34 [72%]), and myalgia (15 [32%]). Gastrointestinal symptoms were also frequent, including diarrhoea (12 [26%]), vomiting (ten [21%]), and abdominal pain (eight [17%]).
All patients had abnormal findings on chest radiography, ranging from subtle to extensive unilateral and bilateral abnormalities. Laboratory analyses showed raised concentrations of lactate dehydrogenase (23 [49%]) and aspartate aminotransferase (seven [15%]) and thrombocytopenia (17 [36%]) and lymphopenia (16 [34%]).
A key finding is that 96% (45 of 47) of these cases had pre-existing medical conditions.
- diabetes (32 [68%])
- hypertension (16 [34%])
- chronic cardiac disease (13 [28%])
- chronic renal disease (23 [49%])
BBC coverage of this report includes extended comments by Professor Memish, where he compares the threat from MERS-CoV with that of SARS a decade ago.
Mers: New virus 'not following Sars' path'
By James Gallagher Health and science reporter, BBC News
<Excerpt>
The lead researcher and Deputy Minister for Public Health, Prof Ziad Memish, said: "Despite sharing some clinical similarities with Sars, there are also some important differences.
"In contrast to Sars, which was much more infectious especially in healthcare settings and affected the healthier and the younger age group, Mers appears to be more deadly, with 60% of patients with co-existing chronic illnesses dying, compared with the 1% toll of Sars.
"Although this high mortality rate with Mers is probably spurious due to the fact that we are only picking up severe cases and missing a significant number of milder or asymptomatic cases.
"So far there is little to indicate that Mers will follow a similar path to Sars."
In an accompanying article (Is MERS another SARS?), MERS researcher Professor Christian Drosten (see The Lancet: Virological Analysis Of A MERS-CoV Patient & Nature: Receptor For NCoV Found) - as reported in this Medscape article MERS and SARS: Similar Not Identical - is less sanguine in his analysis.
He notes that the incidence of diabetes among elderly male Saudis is fairly close to that reported among these cases, and that a high rate of chronic kidney disease and hypertension among patients is not unexpected, given that many of these cases were linked to nosocomial spread at a dialysis clinic.
Without broader community seroprevalence studies, Drosten argues that it is premature to regard this virus as primarily a threat to those with underlying disorders.
Complicating matters, since this study’s cut-off date in June, we’ve seen a growing number of asymptomatic cases reported among younger, presumably healthier, individuals.
This from the most recent ECDC Rapid Risk Assessment on MERS-COV.
Ten asymptomatic cases have been reported since 8 June, eight by Saudi Arabia and two by the United Arab Emirates (UAE). Six of these asymptomatic cases have been health care workers. All the new cases reported since the previous update have been reported by Saudi Arabia and UAE.
This broad range of clinical presentation (asymptomatic to severe, even fatal illness) leaves investigators unsure whether the 90+ cases that have so far been identified represent the bulk of the infected cases or are just the `tip of a much larger iceberg’.
Crucial questions for which answers, right now, are frustratingly few.
