Thursday, March 15, 2018

WHO EMRO MERS-CoV Report - Feb 2018



With the Saudi MOH only issuing (usually belatedly) daily MERS reports for 16 of February's 28 days (see recap here), and disparities between their English and Arabic case lists (see Saudi MOH: Mismatching MERS Reports), we've been waiting for an update from the World Health Organization to try to sort out last month's numbers.
Amid incomplete data and rumors of more cases, the Saudi MOH reported either 14 MERS cases in February (English page total) or 16 cases (Arabic page total).
The last detailed WHO report was released on January 26th, and covered cases reported to them by the National IHR Focal Point of KSA between December 9th, 2017 and January 17th of this year.

But we also get a brief MERS-CoV summary (lacking individual case details) once each month from WHO's EMRO (Eastern Mediterranean Office), generally published around the 15th, covering the previous month.

We've EMRO's report for February, and not unexpectedly, the number of Saudi MERS Cases reported here are higher (n=23) than what was originally announced.  Additionally, we learn of a single (previously unannounced) case in Oman.

MERS situation update, February 2018

At the end of February 2018, a total of 2182 laboratory-confirmed cases of Middle East respiratory syndrome (MERS), including 779 associated deaths (case–fatality rate: 35.7%) were reported globally; the majority of these cases were reported from Saudi Arabia (1807 laboratory-confirmed cases, including 705 related deaths with a case–fatality rate of 39%).
During the month of February, 24 laboratory-confirmed cases of MERS were reported globally: 23 cases in Saudi Arabia including 5 associated deaths and one case reported in Oman. A cluster of nosocomial infection was detected on 5 March 2018 in a health-facility in Riyadh region. At least 3 secondary cases were reported in this cluster; investigation is ongoing to identify the index case as well as testing of all close contacts for identifying additional secondary cases.
The demographic and epidemiological characteristics of the cases reported in February 2018 do not show any significant difference compared with cases reported during the same period from 2012 to 2017. Owing to improved infection prevention and control practices in the hospitals, the number of hospital-acquired cases of MERS has dropped significantly in 2015, 2016 and 2017.
The age group of those aged 50–59 years continues to be the group at highest risk for acquiring infection as primary cases. For secondary cases, it is the age group of 30–39 years who are mostly at risk. The number of deaths is higher in the age group of 50–59 years for primary cases and 70–79 years for secondary cases.

As the epi curve chart at the top of this blog shows, even with these revised numbers, the level of MERS activity in Saudi Arabia if far below what we were seeing in 2014-2015.
A trend which has been attributed to better infection control in hospitals, resulting in fewer - and smaller - nosocomial outbreaks. 
While the spotty reporting of cases from KSA in recent weeks is disappointing - even at its best - surveillance can only be expected to pick up a fraction of the cases in the population (see EID Journal: Estimation of Severe MERS Cases in the Middle East, 2012–2016).
Although MERS-CoV remains a serious public health concern - and we've seen recent studies (see Study: A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia) suggesting the virus may have gotten a little better at transmitting in the community - so far we've seen no signs of any sustained or efficient transmission of the MERS virus outside of health care facilities.
That said, MERS continues to evolve, and as long as it continues to enter the human population via infected camels, will continue to pose a serious public health threat.

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