UAE’s Proximity to Saudi Arabia
# 8420
Last week (see WHO: Two MERS-CoV Updates From The UAE) we saw a report from the World Health Organization on two new MERS cases – one of which had been a contact of a previously reported case. Today, the WHO has published details on a new case – who reportedly had contact with animals, including camels - but no contact with previously known cases.
Middle East respiratory syndrome coronavirus (MERS-CoV) – update / 01/04/2014
01/04/2014
1 April 2014 - On 30 March 2014, the National IHR Focal Point of the United Arab Emirates (UAE) notified WHO of an additional laboratory-confirmed case of infection with Middle East respiratory syndrome coronavirus (MERS-CoV).
Details of the case provided to WHO are as follows:
A 64 year-old man from Abu Dhabi with underlying medical conditions. He became ill on 21 March, and was admitted to hospital on 25 March. His condition deteriorated and he was placed in intensive care. He passed away on 30 March. The patient had no reported contact with laboratory-confirmed cases, however did report having contact with animals, including camels. The patient also had a recent history of travel to Oman and to Saudi Arabia. Further epidemiological investigation in ongoing.
Globally, from September 2012 to date, WHO has been informed of a total of 207 laboratory-confirmed cases of infection with MERS-CoV, including 87 deaths.
Based on FluTrackers MERS Case Line Listing, this appears to be the 6th case reported out of the UAE in 2014, and the 30th case reported this year globally.
While secondary human-to-human transmission of the MERS coronavirus has been well demonstrated, evidence increasingly implicates camels as being the initial source of the virus (see CIDRAP NEWS report WHO sees camels as MERS source, but route uncertain).
Another study, published yesterday in the International Journal of Infectious Disease, looked at two clusters of MERS cases in Hafr Al-Batin district of Saudi Arabia, and found additional evidence of a camel connection.
A link and an excerpt follow:
Memish ZA, Cotten M, Watson SJ, Kellam P, Zumla A, Alhakeem RF, Assiri A, Rabeeah AAA, Al-Tawfiq JA,
International Journal of Infectious Diseases (2014), http://dx.doi.org/10.1016/j.ijid.2014.03.1372
Summary
The Middle East respiratory syndrome coronavirus (MERS-CoV) was first described in September 2012 and had caused a total of 191 cases of MERS-CoV infection with 82 deaths. Camels have been implicated as the reservoir of MERS-CoV, but the exact source and mode of transmission for most patients remain unknown.
During a 3 month period, June to August 2013, there were 12 positive MERS-CoV cases reported from the Hafr Al-Batin district in the north east region of the Kingdom of Saudi Arabia. In addition to the different regional camel festivals in neighboring countries, Hafr Al-Batin has the biggest camel market in the entire Kingdom and host an annual camel festival.
Thus, we conducted a detailed epidemiological, clinical and genomic study to ascertain common exposure and transmission patterns of all cases of MERS-CoV reported from Hafr Al-Batin.
The genetic data indicated that at least two of the infected contacts could not have been directly infected from the index patient and alternate source should be considered. Camels appear as the likely source but other animals have not been ruled out. More detailed case control studies with detailed case histories, epidemiological information and genomic analysis are being conducted to delineate the missing pieces in the transmission dynamics of MERS-CoV outbreak.
