Monday, May 28, 2018

WHO: UAE MERS-CoV Case & IHR Concerns













#13,338



Although I don't find any formal announcement on the UAE Health Authority website, today the World Health Organization is reporting (see below) on a single UAE MERS case with illness onset on May 4th, although that isn't the only news of note provided by this WHO update.
As we've discussed frequently over the past few months, reporting on MERS cases out of Saudi Arabia suddenly became more erratic last January, with `daily MOH updates' often posted belatedly, days skipped entirely, or posted with conflicting details.
Although we've had some WHO EMRO monthly summaries (see here, here, and here), we've not seen a WHO DON report (with case line listing) out of Saudi Arabia since late January, making this the longest reporting gap by the WHO since the virus emerged in 2012.

While an updated line listing of MERS cases is included in today's update, no new Saudi Cases have been added since the middle of January (see screenshot below)



The total number of cases reported in today's update has increased by 64 since the January 26th report, which when you deduct the UAE and Oman cases, suggests an increase in Saudi Arabian of 62 MERS cases.
Details on those cases, however, remain curiously unavailable through the WHO DON reports.
First today's update, then I'll return with a bit more on the IHR and this dearth of data from KSA.

Middle East respiratory syndrome coronavirus (MERS-CoV) – United Arab Emirates

Disease outbreak news
28 May 2018

On 16 May 2018, the National IHR Focal Point of the United Arab Emirates (UAE) reported one (1) laboratory-confirmed case of Middle East Respiratory Syndrome (MERS-CoV) infection to WHO.


Details of the case

The case is a 78 year old, male national, residing in Gayathi, UAE. On 13 May 2018, the patient presented to a hospital in Abu Dhabi with fever, cough and shortness of breath, which began on 4 May 2018. A lower respiratory/nasopharyngeal sample was collected on 14 May 2018 and tested positive for MERS-CoV by reverse transcription polymerase chain reaction (RT-PCR) at the Sheikh Khalifa Medical Centre laboratory. He is currently in stable condition in hospital. The patient has hypertension and interstitial lung disease as underlying conditions. Investigation into the source of infection is ongoing. The patient reported recent travel to the Kingdom of Saudi Arabia and he owns a camel farm in UAE, which he visits on daily basis.

Globally, 2207 laboratory-confirmed cases of MERS-CoV, including 787 MERS associated deaths have occurred since September 2012. The global number reflects the total number of laboratory confirmed cases reported to WHO under IHR to date. The total number of deaths includes the deaths that WHO is aware of since 2012 through follow-up with affected member states. For more information, see link below.

    MERS-CoV case reported on 23 August 2017
    xls, 230kb

Public health response

Contacts of the confirmed patient have been identified and are being monitored for the appearance of symptoms for 14 days from the last exposure to the confirmed patient. The Communicable Disease Department in UAE is in coordination with the animal authorities to initiate camel testing at the patient’s farm in UAE.


(Continue . . . )
  
After three months of erratic reporting on the KSA Health Ministry website, the surveillance page - which appears to be under redesign - has become static, and all data after January 23rd 2018 is currently missing.


While the lack of daily MERS updates is disappointing, the Saudis are under no obligation to post them.  In recent years we've seen many other countries (China, Egypt, Indonesia, etc.) pull back from making detailed public announcements on infectious disease cases.
But under the terms of the 2005 IHR (International Health Regulations) - WHO member countries have agreed to develop mandated surveillance and testing systems, and to report certain disease outbreaks and public health events to WHO in a timely manner. 
Thirteen years after it was approved, fewer than half the countries of the world self-report having met the core requirements of the IHR. But even among those who have - timely reporting continues to be problematic for a variety of political, economic, and societal reasons.

http://www.euro.who.int/__data/assets/pdf_file/0011/242588/IHR-Factsheet.pdf

 
While public chastisement is rare in diplomatic circles, in the past few years we've seen signs of growing frustration over the lack of progress on the IHR, including:

Since the Saudis and the WHO have not publicly addressed the lack of reporting (publicly or through the IHR), we don't know what is behind this recent lack of case details in the WHO reports.  Hopefully those details will be released soon.

But the bigger picture is that the slow progress by many countries in reaching the core goals of the IHR, and the continued gaps in reporting, undermine our ability to detect and react to infectious disease threats around the world.
With the number of disease threats (natural and potentially man-made) facing the globe, this is not an enviable position to be in.
As the WHO IHR infographic above reminds us, `Until all sectors are on board with the IHR, no country is ready'.  

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