ECDC Epidemiological Update On MERS-CoV

Credit ECDC - More than half of all known MERS Cases Reported in last 30 days

 

# 8553

 

With the end of the month upon us, it is a bit sobering to realize that we’ve just seen more MERS cases reported during the past 30 days than had been reported in the entire two years prior to April 1st. While it isn’t clear at this point whether this MERS outbreak has got `legs’ or not, this rapid increase in cases has caught just about everyone’s attention in the world of infectious diseases. 

 

Today the ECDC has posted an epidemiological update on the MERS coronavirus with a number of new graphics, excerpts which you find below.

 

Epidemiological update: Middle East respiratory syndrome coronavirus (MERS-CoV)

30 Apr 2014

​As of 30 April 2014, 424 cases of MERS-CoV have been reported globally, including 131 deaths. All cases have either occurred in the Middle East or have direct links to a primary case infected in the Middle East.

• Middle East
  Saudi Arabia: 342 cases / 105 deaths
  United Arab Emirates: 49 cases / 9 deaths
  Qatar: 7 cases / 4 deaths
  Jordan: 5 cases / 3 deaths
  Oman: 2 cases / 2 deaths
  Kuwait: 3 cases / 1 death
  Egypt: 1 case/ 0 deaths
• Europe
• UK: 4 cases / 3 deaths
  Germany: 2 cases / 1 death
  France: 2 cases / 1 death
  Italy: 1 case / 0 deaths
  Greece: 1 case/ 0 deaths
• Africa
  Tunisia: 3 cases / 1 death
• Asia
  Malaysia: 1 case / 1 death
  Philippines: 1 case / 0 deaths

The primary case for each chain was infected in the Middle East, and local secondary transmission following importation was reported from the United Kingdom, France, and Tunisia.

The number of reported cases increased markedly in April 2014 (Figure 1) with 217 cases and 38 deaths. Between March 2013 and March 2014 the monthly average number of reported cases was 15.

During April 2014, 217 cases were reported, as compared to the 207 cases reported from the beginning of the outbreak (March 2012) to 31 March 2014. Among these 217 cases, 179 (82%)  were reported by Saudi Arabia, 32 cases (15%) by the United Arab Emirates, 2 cases were reported by Jordan and one case each by Egypt, Greece, Malaysia and Philippines (Figure 4).

Healthcare workers have been more frequently reported during the month of April 2014 than previously. Since April 2012, 95 cases have been healthcare workers, of whom 62 (65%) were reported in April 2014. Seventy (74%) of the healthcare workers were reported from Saudi Arabia, twenty-three (24%) from the United Arab Emirates, and one each from Philippines and Jordan.

The cause of the rapid increase in cases in April is unknown. The Rapid Risk Assessment of 24 April considers the possible scenarios that might explain this, notably:

• More sensitive case detection through more active case finding and contact tracing or changes in testing algorithms,
• Increased zoonotic transmission with subsequent transmission in healthcare settings,
• Breakdown in infection control measures or otherwise increased transmission in the local healthcare setting,
• Change in the virus resulting in more effective human-to-human transmission, resulting in both nosocomial clusters, and increased numbers of asymptomatic community acquired cases, or
• False positive lab results.

On 26 April, Christian Drosten of Bonn University published a report in ProMed describing the preliminary results from sequence analysis of three viruses recovered from recent cases. These results suggest that the virus has not undergone major genetic changes compared to MERS/CoV sequenced earlier in the outbreak. The report also provide evidence against the hypothesis of a laboratory contamination causing this increase in reported cases.

ECDC continues to monitor information on the situation on MERS-CoV worldwide. In earlier Rapid Risk Assessments, ECDC concluded that the risk of importation of MERS-CoV to the EU was expected to continue and the risk of secondary transmission in the EU remains low. The assessment provided in the ECDC Rapid Risk Assessment on 24 April 2014 remains valid.

Read more on MERS-CoV

WHO: Antibiotic Resistance – Serious, World-Wide Threat

WHO Report 257 pg PDF

 

# 8552

 

For years we’ve heard dire warnings that our limited arsenal of antibiotics was in danger of being rendered useless against a growing army of resistant bacteria, and we could be facing a `post-antibiotic’ world.   Today, the World Health Organization released an in-depth report showing just how close we are to finally seeing that grim future realized.

 

First, an excerpt from the press release, and then some links to some other reportage on the situation, after which I’ll be back with a bit more.

 

 WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health

New WHO report provides the most comprehensive picture of antibiotic resistance to date, with data from 114 countries

News release

30 April 2014 | Geneva - A new report by WHO–its first to look at antimicrobial resistance, including antibiotic resistance, globally–reveals that this serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country. Antibiotic resistance–when bacteria change so antibiotics no longer work in people who need them to treat infections–is now a major threat to public health.

“Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill,” says Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security. “Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.”

Key findings of the report

The report, "Antimicrobial resistance: global report on surveillance", notes that resistance is occurring across many different infectious agents but the report focuses on antibiotic resistance in seven different bacteria responsible for common, serious diseases such as bloodstream infections (sepsis), diarrhoea, pneumonia, urinary tract infections and gonorrhoea. The results are cause for high concern, documenting resistance to antibiotics, especially “last resort” antibiotics, in all regions of the world.

Key findings from the report include:

• Resistance to the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, Klebsiella pneumoniae–carbapenem antibiotics–has spread to all regions of the world. K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients. In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K. pneumoniae infections.
• Resistance to one of the most widely used antibacterial medicines for the treatment of urinary tract infections caused by E. coli–fluoroquinolones–is very widespread. In the 1980s, when these drugs were first introduced, resistance was virtually zero. Today, there are countries in many parts of the world where this treatment is now ineffective in more than half of patients.
• Treatment failure to the last resort of treatment for gonorrhoea–third generation cephalosporins–has been confirmed in Austria, Australia, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden and the United Kingdom. More than 1 million people are infected with gonorrhoea around the world every day.
• Antibiotic resistance causes people to be sick for longer and increases the risk of death. For example, people with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64% more likely to die than people with a non-resistant form of the infection. Resistance also increases the cost of health care with lengthier stays in hospital and more intensive care required.

            (Continue . . .)

 

Some related articles on today’s announcement include:

 

• Maggie Fox at NBC news writes :  Drug-Resistant Bugs a Global Threat, WHO Says
• Kai Kupferschmidt writing for Science Insider has First Global Resistance Overview Paints Grim Picture
• And Yesterday Maryn Mckenna penned a piece for Wired.com  called NDM: “A Great Challenge for the Future of Healthcare”

 

 

In early 2012 World Health Director-General Margaret Chan expressed a dire warning about our dwindling antibiotic arsenal (see Chan: World Faces A `Post-Antibiotic Era’) – a sentiment echoed a year later by CDC Director Thomas Frieden during the release of a major US report on the threat (see McKenna On CDC Antibiotic Resistance Report).

 

Inevitable conclusions backed up by a long list of reports and studies showing the inexorable erosion the effectiveness of our current antibiotics to deal with rapidly evolving bacteria.   Some of these reports I’ve covered in the past include:

 

EID Journal: Acquisition of Drug Resistant Genes Through International Travel

AAP/CDC: New Guidance On For Antibiotics For Children

The Lancet: Antibiotic Resistance - The Need For Global Solutions

UK CMO: Antimicrobial Resistance Poses `Catastrophic Threat’

MMWR Vital Signs: Carbapenem-Resistant Enterobacteriaceae (CRE)

And for a far more complete discussion of antimicrobial resistance issues, I can think of no better primer than Maryn McKenna’s book SUPERBUG: The Fatal Menace of MRSA.

Superbug (MRSA) Book

Meanwhile, Maryn’s SUPERBUG Blog, continues to provide the best day-to-day coverage of these issues, and I expect she’ll post something on today’s WHO report later today.

Saudi MOH Announces 16 New MERS Cases

 

# 8551

 

The short lull in MERS cases over the past 48 hours (only 6 reported) appears over, as once again KSA’s MOH has announced 16 new cases, spread across 7 regions of the country.

 

It is worth nothing that with each day, the formatting and quality of the reports coming from the MOH has improved.  Although posted mid-day (local time) on April 30th, this reported is dated April 29th.

 

Today’s report does not cite any healthcare workers, and at least some of today’s cases appear to be community acquired (symptomatic prior to hospitalization & having no contacts of a known case), rather than as the result of nosocomial infection.

 

Once again we are seeing a pronounced bias towards older male victims with comorbidities.

 

Daily Report on the Coronavirus (MERS-CoV) Situation: Tuesday, 29th April, 2014 (corresponding to 29th Jumada Al-Akhera, 1435H).

The total number of the confirmed cases over the past 24 hours:  16 cases

Overview of the Health Status of the Cases:

• Three cases haven’t developed any symptoms.
• Six stable cases, receiving the proper treatment.
• Seven cases in Intensive Care units.

Health Situation of the Cases in Detail:

A) In Riyadh:

1. A 75-year-old man, suffering from diabetes and hypertension with a prior history of a brain stroke. On 22/4/2014, he was transferred from a private hospital to a government hospital with lung problems. His symptoms increased on 24/4/2014 and he was moved to the ICU. 
2. A 76-year-old man, suffering from chronic heart problems. On 20/4/2014, he underwent a heart surgery at a government hospital. On 24/4/2014, he developed respiratory symptoms. Now, he is in the ICU. He has been in contact with a confirmed case.
3. A 62-year-old man, suffering from chronic heart problems and hypertension. He was admitted to a government hospital on 27/3/2014. He tested positive. He has been in contact with a confirmed case, but hasn’t developed any symptoms.
4. A 73-year-old man. He suffers from diabetes, hypertension, and nephritic syndrome. He was admitted to a government hospital on 20/4/2014 due to obstructive jaundice. Then, he displayed respiratory symptoms on 23/4/2014. Now, he is being treated in the ICU.
5. A 77-year-old man, suffering from diabetes and hypertension and a previous history of a brain stroke. He was admitted to a government hospital on 31/3/2014 after a bacterial infection. On 23/4/2014, he displayed respiratory symptoms. Now, he is in the ICU.
6. A 51-year-old woman. She was admitted to the governmental hospital on 27/4/2014 with respiratory syndromes. Her condition is stable. She has been in contact with a confirmed case.
7. A 41-year-old woman. She has mild respiratory symptoms and is in stable condition. She has been in contact with a confirmed case.

B) In Tabuk:

1. A 32-year-old man, suffering from diabetes and hypertension. He was admitted to the private hospital for one day on 17/4/2014 to control his diabetes. He was readmitted on 26/4/2014 with respiratory symptoms and discharged on 28/4/2014. Now, he is in the ICU at a private hospital. He has been in contact with a confirmed case.
2. A 46-year-old man. On 12/4/2014, he was admitted to a private hospital with respiratory symptoms. He was discharged on 17/4/2014. He was readmitted after an increase in respiratory symptoms on 26/4/2014. His condition is stable. He has been in contact with a confirmed case.

C) In Makkah:

1. A 29-year-old woman. She has been in contact with a confirmed case and does not have symptoms.

D) In Jeddah:

1. A 60-year-old man. He developed respiratory symptoms on 23/4/2014. He was admitted to a government hospital on 26/4/2014. Now, he is being treated in the ICU.
2. A 75-year-old woman. She developed respiratory symptoms on 21/4/2014 and was admitted to a government hospital on 26/4/2014. Now, she is being treated in the ICU.
3. A 70-year-old woman. She displayed respiratory symptoms on 1/4/2014. She was admitted to a government hospital on 27/4/2014. Her condition is stable.

E) In Najran:

1. A 68-year-old man, suffering from chronic heart problems and hypertension. He displayed respiratory symptoms on 20/4/2014. He was admitted to a government hospital on 25/4/2014 and left, of his own accord and responsibility, on 27/4/2014. His condition was stable.

F) In Hafr AlBatin:

1. A 30-year-old woman. She has been in contact with a confirmed case and does not have any symptoms.

G) In Madinah:

1. A 44-year-old man. He is suffering from heart disease, diabetes, and liver failure. He developed respiratory symptoms on 26/4/2014. Then, he was admitted to a government hospital on 27/4/2014. Now, his condition is stable. He was in contact with a confirmed case.

Within the same vein, there are two deaths among those cases that have been previously announced to be infected with the virus, as follows:

1. A 41-year-old man in Tabuk, may Allah have mercy upon him.

2. An 88-year-old man in Riyadh, may Allah have mercy upon him.

Sandman & Lanard On The Cochrane Tamiflu Report

 

# 8550

 

Somehow, with all of the MERS news coming out of the Middle East, I managed to miss a terrific piece of analysis by our favorite Risk Communications experts, Dr. Peter Sandman and Dr. Jody Lanard,  published last week on the The Peter M. Sandman Risk Communication Website.

 

Their website is a repository of invaluable risk management advice, that quite frankly should be second home for anyone involved in public relations or risk communications.

 

I’ve highlighted their work often in the past,including Sandman & Lanard: WHO, Pandemic Phases & Public Preparedness, Sandman: A Tale Of Two CDCs, Lanard: China’s Risk Communication On H7N9, and Referral: Sandman On The H5N1 Moratorium.

 

Their latest analysis centers on the  recent release of (and media hype surrounding) a recent Cochrane group analysis that found insufficient evidence to show whether Oseltamivir (Tamiflu ®)  and other NAI antivirals reduces influenza complications and transmission. 

 

I wrote about  this report earlier this month in  Revisiting Tamiflu Efficacy (Again) & The CDC Responds To The Cochrane Tamiflu Study, where I posited the preponderance of evidence supports the use of NAI antivirals for severe influenza.

 

Early last week Declan Butler, writing for the Journal Nature, wrote a piece called Tamiflu report comes under fire, for which Sandman & Lanard have supplied some quotes. Building on their emailed comments to Butler, they penned and posted a longer analysis on their website the following day.

 

Since it would do an injustice to the authors to try to excerpt highlights, I would simply suggest you follow the link below to read it in its entirety. 

 

Overstated Attack Hiding Behind Scientific Assessment: An April 2014 Cochrane Review Trashes the Usefulness of Influenza Antiviral Drugs

by Peter M. Sandman and Jody Lanard

(an April 15, 2014 email responding to Declan Butler of Nature)

Declan Butler’s April 22, 2014 article drew from this email.

Introductory Note

In early April 2014, the Cochrane Collective published two journal articles and a news release that went out of their way to understate the value of Tamiflu and Relenza, the two antiviral drugs used against influenza. When Nature reporter Declan Butler asked for our comment, we quickly sent back the short email posted below.

 

(Continue . . . )

 

The Sandman site is a treasure trove of risk communications information, and you could literally spend days just hitting the highlights. 

 

Highly recommended.

mBio: MERS-CoV Carriage By Dromedaries

 

# 8549

 

On a day when the new Saudi Minister of Health appears to be taking the MERS-Camel connection more seriously (see Crofsblog Saudi Arabia: Faqih urges avoidance of camel meat and milk), we get a new study appearing in the open-access journal mBio that further implicates camels as the source of the virus.

 

Researchers report recovering MERS-CoV from nasal swabs of dromedaries whose complete genetic sequences are indistinguishable from those found in humans.  Furthermore, they found that camels can be simultaneously infected with multiple strains of MERS.

 

The study, led by an international team from Columbia University , King Saud University, and the EcoHealth Alliance, found the MERS virus in 3/4ths of the camels they tested. 

 

Middle East Respiratory Syndrome Coronavirus Quasispecies That Include Homologues of Human Isolates Revealed through Whole-Genome Analysis and Virus Cultured from Dromedary Camels in Saudi Arabia

Thomas Briese^a, Nischay Mishra^a, Komal Jain^a, Iyad S. Zalmout^b, Omar J. Jabado^c, William B. Karesh^d, Peter Daszak^d, Osama B. Mohammed^b, Abdulaziz N. Alagaili^b,e, W. Ian Lipkin^a

ABSTRACT

Complete Middle East respiratory syndrome coronavirus (MERS-CoV) genome sequences were obtained from nasal swabs of dromedary camels sampled in the Kingdom of Saudi Arabia through direct analysis of nucleic acid extracts or following virus isolation in cell culture. Consensus dromedary MERS-CoV genome sequences were the same with either template source and identical to published human MERS-CoV sequences. However, in contrast to individual human cases, where only clonal genomic sequences are reported, detailed population analyses revealed the presence of more than one genomic variant in individual dromedaries. If humans are truly infected only with clonal virus populations, we must entertain a model for interspecies transmission of MERS-CoV wherein only specific genotypes are capable of passing bottleneck selection.

IMPORTANCE In most cases of Middle East respiratory syndrome (MERS), the route for human infection with the causative agent, MERS coronavirus (MERS-CoV), is unknown. Antibodies to and viral nucleic acids of MERS-CoV have been found in dromedaries, suggesting the possibility that they may serve as a reservoir or vector for human infection. However, neither whole viral genomic sequence nor infectious virus has been isolated from dromedaries or other animals in Saudi Arabia. Here, we report recovery of MERS-CoV from nasal swabs of dromedaries, demonstrate that MERS-CoV whole-genome consensus sequences from dromedaries and humans are indistinguishable, and show that dromedaries can be simultaneously infected with more than one MERS-CoV. Together with data indicating widespread dromedary infection in the Kingdom of Saudi Arabia, these findings support the plausibility of a role for dromedaries in human infection.

(Continue . . .)

 

 

In an accompanying press release, Columbia University's Mailman School of Public Health quotes authors Thomas Briese, Abdulaziz N. Alagaili, and Ian Lipkin  on the findings:

 

"The finding of infectious virus strengthens the argument that dromedary camels are reservoirs for MERS-CoV," says first author Thomas Briese, PhD, associate director of the Center for Infection and Immunity and associate professor of Epidemiology at the Mailman School. "The narrow range of MERS viruses in humans and a very broad range in camels may explain in part the why human disease is uncommon: because only a few genotypes are capable of cross species transmission," adds Dr. Briese.

"Given these new data, we are now investigating potential routes for human infection through exposure to camel milk or meat products," says co-author Abdulaziz N. Alagaili, PhD, director of the Mammals Research Chair at King Saud University. "This report builds on work published earlier this year when our team found that three-quarters of camels in Saudi Arabia carry MERS virus."

<SNIP>

"Although there is no evidence that MERS-CoV is becoming more transmissible, the recent increase in reported cases is a cause for concern," says senior author W. Ian Lipkin, MD, director of the Center for Infection and Immunity and the John Snow Professor of Epidemiology at the Mailman School. "It is essential that investigators commit to data and sample sharing so that this potential threat to global health is addressed by the entire biomedical research community."

 

Looks like its time for Ian Mackay to break out his smoking camel graphic again.

 

MERS: The Limitations Of Airport Screening

 

Scheduled airline traffic around the world, circa June 2009 – Credit Wikipedia

 

 

# 8548

 

As the graphic above illustrates, airline traffic is a very effective conduit for infectious disease, able to transport someone to nearly anyplace in the world in less than 24 hours.  The world’s airlines carry 2.6 billion passengers each year, on more than 17 million flights.

 

In 2003, we saw the SARS virus hop the Pacific on a flight taken by a 78-year-old woman who fell ill in Toronto after visiting Hong Kong, and before that outbreak was contained, 251 people in Canada had been infected, and 44 died (see SARS And Remembrance).

 

So, whenever a virus threatens to spread globally one of the first visible actions taken by many governments is to impose some sort of airport, seaport, or border screening to prevent those who are infected from entering the country. 

 

Over the weekend we saw a declaration of an emergency in all of Egypt’s ports after a MERS case was detected coming in from Saudi Arabia - and quarantined - at the Cairo Airport last Friday.  Today, we are seeing media reports of two more `suspected cases’ being tested, but it is unknown if they are actually MERS cases.

 

Yesterday Malaysia announced an intensive airport screening program for passengers arriving in Kuala Lumpur  (see Visitors entering Malaysia to be screened for Coronavirus). 

 

While certainly reassuring to the public, and likely to pick up at least some symptomatic carriers of an emerging virus, studies to date indicate the effectiveness of airport screening to be pretty limited.

 

One of the big problems lies in the incubation period, that for many viral infections, allows a long `asymptomatic’ window during which someone can travel before showing symptoms. The incubation period of seasonal influenza runs 1 to 4 days (avg. 2 days), measles 7 to 21 days (avg. 14 days), MERS-CoV up to 15 days. 

 

Plenty of time for someone to pass through airport screening, and travel in-country for several days, before showing any outward symptoms of infection.

While we don’t know if asymptomatic carriers of the MERS virus are infectious, we do know that with influenza it is possible to pass on the virus while not showing signs of illness.  So even those who are infected, but never show signs of illness, may be capable of spreading the virus. 

 

In Japan: Quarantine At Ports Ineffective Against Pandemic Flu  I wrote about a study that suggests between asymptomatic or mild infections, and a silent incubation period of several days, there wasn’t much chance of long-term success.

For every person identified, and quarantined, by port authorities  - researchers estimate 14 others infected by the virus entered undetected.

And in 2009, during the initial outbreak of H1N1, we saw airline passengers taking fever-reducers to beat the airport scanners in order to get home (see Vietnam Discovers Passengers Beating Thermal Scanners).

 

All `holes’ in the screening process that would allow infected travelers to enter a country undetected.

 

Between the SARS outbreak of 2003 and the 2009 pandemic, we’ve a number of studies that have looked at just how effective airport screening is in a `real world situation’. 

• In December of 2009, in Travel-Associated H1N1 Influenza in Singapore, I wrote about a a study in the CDC’s  EID Journal  entitled: Epidemiology of travel-associated pandemic (H1N1) 2009 infection in 116 patients, Singapore that determined that airport thermal scanners detected only 12% of travel-associated flu, and that many travelers boarded flights despite already experiencing symptoms.
• In April of 2012, in EID Journal: Airport Screening For Pandemic Flu In New Zealand, we looked at a study that found that the screening methods used at New Zealand’s airport (which did not employ thermal scanners)  were inadequate to slow the entry of the 2009 pandemic flu into their country, detecting less than 6% of those infected.
• And in June of 2010  CIDRAP carried a piece on a study of thermal scanners in New Zealand in 2008 (before the pandemic) presented at 2010’s ICEID called Thermal scanners are poor flu predictors.

Last year, Helen Branswell reported on the value of airport screening in an article called:

 

Airport disease screening rarely worthwhile, study suggests

Helen Branswell, The Canadian Press
Published Wednesday, April 10, 2013 10:11AM EDT

TORONTO -- A new study suggest airport screening for disease control rarely makes sense, but if it's undertaken, it should be done at the source of the outbreak.

The researchers say the screening of passengers leaving via a few key airports near the epicentre of an outbreak is a better approach than having hundreds of airports around the world screen arriving passengers.

(Continue . . . )

 

Politically, and in terms of reassuring the public, the screening of passenger arriving at airports and other points of entry probably has some merit.  And it may provide valuable surveillance information as well.  But practically, as an effective way to keep an emerging virus out of a country, studies continue to show just how unlikely that outcome really is.

 

We simply possess no technological shield that would keep an emerging pandemic virus at bay. 

 

Making it desirable that – whenever possible – outbreaks of emerging viruses are quashed as quickly as possible at the source, before they can board an airplane and spread inexorably around the globe.

 

Saudi MOH Announces 6 More MERS Cases

 

 

# 8547

 

After issuing no report yesterday, today the Saudi MOH has announced 6 more cases of MERS infection, and has added another improvement to their reporting technique – a map and graphics showing today’s cases.

 

No Health Care workers are listed today for a change, and 4 of the 6 cases are described as showing no symptoms.  Five of the six are under the age of 40, and the cases are equally divided between genders.  

 

While a significant reduction in the number of cases we’ve seen reported over the past couple of weeks, we’ll have to see if this is the start of a trend, or a simply a short-lived blip in the reporting.

 

 

Health: Registration 6 cases of infection Corona

06/29/1435
Daily situation report cases of Corona virus that causes respiratory syndrome Middle East

Monday, 28 June 1435 e

•   A summary of the health status of the cases:

    4 cases without symptoms
    2 cases of stable and receiving treatment in the wing

• Details of the cases:

A. In the city of Riyadh:

Woman, aged 65 years, suffering from several chronic diseases, hypnotic government hospital in Riyadh for several months.

B. In the city of Tabuk:

The old man 39 years old suffering from chronic heart problems and asthma, on the date of 04.14.2014 to enter a private hospital in Riyadh. He was suffering from shortness of breath, and was admitted to the intensive care unit and was discharged from hospital on 18.04.2014. Enter again to the hospital on 23/04/2014 shortness of breath and high temperature has been diagnosed with pneumonia, and was discharged from hospital on 25.04.2014.

C. In the Holy City:

Woman, aged 18 years, mixing with a confirmed case and there are no symptoms.

D. In the province of Jeddah:

A man aged 42 years, Mkhalt of confirmed cases, they appeared to have respiratory symptoms on 22/04/2014 and was admitted to a government hospital on 23.04.2014 and in stable condition.

Woman, aged 38 years, mixing with a confirmed case does not have no symptoms.

A man aged 28 years, suffering from chronic kidney failure, developed symptoms of respiratory dated 04/23/2014, and was admitted to the government hospital on 04.25.2014 and in stable condition.

• Deaths:

Three of the patients enrolled previously, namely:

The case of the death of a man at the age of 79 years of cases recorded previously in Riyadh, may he rest in peace.

The case of the death of the old man of 61 cases recorded previously in Riyadh, may he rest in peace.

The case of the death of a man at the age of 56 years of cases recorded previously in Riyadh, may he rest in peace.

 

CIDRAP:Two MERS Antibody Studies

Photo Credit NIAID

 

 

# 8546

 

 

Last night CIDRAP News published a report by Lisa Schnirring on a pair of human antibody studies released yesterday looking at potential treatments for the MERS coronavirus.  The studies appear in Science Translational Medicine and PNAS, and Lisa does a terrific job summarizing them.

 

Two MERS antibody studies may help quest for treatment

Lisa Schnirring | Staff Writer | CIDRAP News

|

Apr 28, 2014

Amid a surge of MERS-CoV (Middle East respiratory syndrome coronavirus) cases, two research teams today—one based at Harvard University and the other in China—said they have identified antibodies against the novel virus, the first of many steps toward developing a treatment against the disease.

 

The two teams used different search strategies and identified different types of antibodies, but their target was the same: preventing the spike-shaped protein on the surface of MERS-CoV from binding to receptors on the surface of cells that line human airways.

 

MERS-CoV causes a respiratory infection that can lead to severe pneumonia and kidney failure. The disease is fatal for more than 40% of patients infected, and so far there is no treatment or vaccine.

(Continue . . . )

 

Although promising, as Lisa explained, the identification of potentially useful antibodies against the MERS coronavirus is but the first step towards creating a usable therapy.  Over the past 5 years we’ve looked at several similar studies, including:

 

• In 2009 in Research: Monoclonal Antibodies Against Influenza researchers at the Dana-Farber Cancer Institute (Dana-Farber), Burnham Institute for Medical Research (Burnham) and the Centers for Disease Control and Prevention (CDC) announced the identification of human monoclonal antibodies (mAb) that work against a wide range of influenza viruses, including the H5N1 bird flu virus.
• Similarly, in 2010, in Monoclonal Antibodies Revisited, we looked a Korean company (Celltrion) working on Human Monoclonal Antibodies (moAb) that are designed to work against a wide variety of influenza viruses. 
• In 2011, we looked at NIH: Investigating A Potential Treatment For Hendra & Nipah Viruses which looked at using the human monoclonal antibody (hmAb) m102.4 to protect green monkeys against a Hendra Virus challenge. In 2009 research published in PLoS Pathogens  illustrated its protective effect against Nipah in ferrets.

 

These monoclonal antibodies would not work like a vaccine, which confer relatively long-term protection.  Rather, a single injection is expected to serve as a treatment, or to work as a temporary (several week) prophylaxis.

 

While a hugely promising field of research, the above examples show that isolating a candidate antibody is a long way from having a tested and approved therapy. 

 

We’ve seen  a great deal of optimism expressed by the Saudi government about rapidly developing a vaccine for the MERS coronavirus. While no doubt reassuring to the public, a vaccine is something that most scientist believe will take several years to develop (see Obstacles To A MERS Vaccine). 

 

Although a human antibody therapy might be brought to market sooner, no one should expect they will provide a near-term solution to the MERS problem either.

Egypt’s MOA Reacts To MERS-Camel Connection

Photo Credit Wikipedia

 

# 8545

 

Despite the mounting evidence showing that camels are carriers – and likely one of the vectors – of the MERS coronavirus, the Saudi Government has been slow to warm to the idea (see April 4th  Saudi MOA Spokesman: Camel Link Unproven, MERS-CoV Is MOH Problem  and April 14th Saudi Health Minister denies relation between camels, Mers). 

In neighboring Egypt, which only last week saw their first imported case of MERS from Saudi Arabia, we are seeing a much more proactive reaction (see Egypt Ramps Up MERS Surveillance At Local Ports), that according to a report today in Al Gareda, extends to their Ministry of Agriculture as well.

 

It appears that the Egyptian MOA plans to take blood samples from, and tighten the control on the importation and movement of,  `beauty’  (camels) throughout the nation.  This comes just a week after local authorities announced the results of an EID Journal study that found  MERS in  Egyptian camels (see Egyptian MOH Statement On MERS Threat).

 

 

Agriculture announces a State of emergency to prevent the spread of the «CK» with «Interior and defense»

Posted on Monday, April 28, 2014

The Gazette-the Ministry of agriculture and land reclamation, represented by the General Organization for veterinary services, to declare a State of emergency to A "situation", on Monday, after the Health Ministry announced the first case of "Corona".

 

It also decided to take precautionary measures and stricter control procedures in coordination with the ministries of Interior and defense, "on the border to prevent smuggling, in particular of the Sudan through" path ", and the use of satellite images to monitor the movement of animals in these areas.

 

The head of the Central Department of veterinary quarantine in the General Authority for veterinary services, Ministry of agriculture, Dr. Sayed GAD, today signed a protocol with the animal health Research Institute to withdraw samples of beauty from Sudan, Ethiopia and Djibouti, after the discovery of the virus "SK" in beauty, in addition to intensify border controls at the border to prevent smuggling.

 

GAD also stressed that cooperation with the animal health Research Institute to withdraw samples of beauty of Egypt from Sudan and Ethiopia to detect disease "SK" Rift Valley fever and check on the safety of beauty, and after entering the quarantine in the border areas before reaching the Egyptian markets.

 

Sayed GAD said that Egypt imported annually 120,000 head of beauty apply each stone and veterinary requirements, both from the country of origin or border, confirmed that it was tightening controls on Halaib and shalatin ports, especially as the main port for beauty, as well as create a quarry in hadrbh area near the Red Sea coast.

 

 

Given the recent political fallout in Saudi Arabia (including the removal of a long-serving Minister of Health) over their slow response to the MERS virus – Egypt -  which as seen more than its share of political instability in recent years, appears anxious to get out ahead of the virus.

Referral: VDU `Snapdate’ On H7N9 In China

Two Waves Over 14  months - Credit Dr. Ian Mackay VDU Blog

 

# 8543

 

 

We in Flublogia are very blessed by having not one – but two – graphically gifted (and prolific) infectious disease bloggers;  Maia Majumder on her Mens et Manus blog, and virologist Dr. Ian Mackay on his VDU Blog. 

 

As someone incapable of drawing a straight line with a ruler, I’m am a big fan and in awe of both of their talents.

While we’ve been focused on MERS the past few weeks, the H7N9 virus continues to percolate in Eastern China, and its threat has not diminished. Today Ian updates 8 (count’em, 8!) of his H7N9 graphics, all of which illustrate the progression of this upstart avian flu virus which has been in circulation now for a little over a year. 

 

Follow the link to read:

 

H7N9 Snapdate: some quick charts...

Monday, 28 April 2014

I don't have a lot of time tonight so this is just a quick post of some updated charts with a few summaries of some key features of the influenza A(H7N9) virus situation in south-eastern China. At writing it was at 432 detections with media reporting 128 deaths

(Continue  . . . . )

 

 

As always with Ian’s blog, go for the graphics . . . but stay for the expert commentary.  

 

Highly recommended.

Saudi Schools Prepare For MERS

 

# 8542

 

Perhaps since it has been primarily perceived as a disease that affects older men, the Ministry of Education In Saudi Arabia has done little except proclaim that their schools are free of MERS, and that parents need not worry (see Director of Education Riyadh: Riyadh schools free from Corona).

While it is true that young people make up a small minority of symptomatic MERS cases, we are seeing an increasing number of pediatric cases reported of late, including the infection of a 16 year-old, and the death of a 9-month old, yesterday (cite).

 

Parents (and others) - worried and upset over the government’s initial slow response to this virus - have taken to twitter and other social media platforms demanding that schools either close or steps be taken to reduce the risks to their children.

 

Today, Arabic media is carrying reports indicating that the Ministry of Education is about to order schools to take specific steps to address the expanding MERS outbreak. Steps that include an isolation room, masks, gloves, and thermometers for every school.

 

This from Al Hasa Today.

 

 

Room "temporary detention" of suspects "Corona" school

April 28, 2014 

Sources revealed that the plan of the Ministry of Education for the prevention of HIV Corona include the allocation of a room in each school to wait for conditions until transported to their homes or to the hospital by the patient's condition.

The room will provide the expected processed in about 34 thousand schools all means of prevention and their gloves and masks while providing high detection device for the patient's temperature to detect suspected cases, according to the "economic".

The plan to be implemented by the ministry for HIV prevention training sessions aimed at schools, to provide them with the necessary information about the disease and its symptoms and how it is transmitted and detection, reporting, and prevention in cooperation with the Ministry of Health.

The sources said that the ministry will allocate a central operations room to answer questions employees of schools, students and parents.

The number of school administrators in some areas and cities raised letters to the departments of education, so as to cancel the program lineup morning (queue), and the abolition of the establishment of the noon prayer in schools for poor ventilation and protect against HIV infection.

The following is a statement from the Saudi Minister of Education – posted yesterday on the MOE website – that states that an `action plan’ is being readied for schools in the Kingdom.

 

Faisal directs an action plan for the prevention and awareness of disease Coruna

HRH Prince Khalid Al-Faisal, Minister of Education to work to take the necessary measures for the prevention of Corona virus in schools, and through the development of an action plan for the prevention of the disease in schools And put in place mechanisms to clear methodology implemented in coordination and integration with the Ministry of Health.

This came during a meeting today which was attended by His Excellency Acanutorhalld Sabti, Deputy Minister of Education, HE Sheikh Al Acanutorahmd Deputy Minister for the education of boys, and Acanutorslaman Monthly General Manager of School Health.

He also asserted the need to disseminate health education for employees of schools, students and the provision of supplies and the use of all available means, including social media, and work to improve the cleanliness and maintenance in schools and providing supplies to schools time and provide antiseptics  and disinfectants in all schools, and equip school clinics Bmstelzmadtha medical office.

And accept the conferees state of health of students and teachers and the level of preventive measures of infectious diseases in schools, and discussed the measures taken to maintain the health of students and employees of schools, has also asserted the importance of coordination with the Ministry of Health as a ministry of the National Committee for Infectious Diseases Dr / Solomon Monthly, general manager of school health , everyone has contoured note that there are no cases of school and thankfully which bodes reassured on the health situation in schools at the moment

Monday Morning MERS Recap & Referrals

MERS: Mortality & Comorbidity - @maiamajumder Mens et Manus blog

 

# 8541

 

It has been a very busy weekend on the MERS Coronavirus front, and so a brief recap of recent events (with links) and some referrals to what others have been writing,  to start your week off.

 

First, 26 new MERS cases were announced from Saudi Arabia (10 on Saturday and 16 on Sunday), with cases being reported now not only in Jeddah and Riyadh, but Mecca and Tabuk as well.  The WHO also release a GAR update on 7 UAE MERS cases on Saturday.

 

On Friday night Egypt announced their first imported MERS case, and in response, on Sunday we saw Egypt Ramps Up MERS Surveillance At Local Ports.  Meanwhile, as part of their response to the crisis, on Saturday the Saudi MOH Announced: Three Hospitals Assigned As MERS Treatment Centers. 

 

The `big story’ has come from the lab of Dr. Christian Drosten, in Bonn Germany, who has very rapidly sequenced three early samples of the MERS virus from the Jeddah outbreak, and compared it to others collected over the past two years.

 

On Friday, we saw preliminary analysis of the `spike protein’ region, which found no major changes that would account for increased transmissibility.  Yesterday, Dr. Drosten announced  a more complete analysis which looked at the full genome (see Drosten: Jeddah MERS Sequences Show No Significant Changes).

 

While `good news’ – in that it suggests the virus has not `mutated’ - this leaves open the question as to why the MERS virus has suddenly taken flight – at least in a couple of areas of Saudi Arabia and the UAE.

 

For some insight into what all of this means, Dr. Ian Mackay penned a pair of blogs over the weekend exploring these results:

 

If this is what MERS-CoV detections look like with more testing...what is the "normal" community level of virus?? [UPDATED]

MERS-CoV genomes remain stable amid Jeddah outbreak cases... [UPDATED]

 

Overnight Andrew Rambaut, on his epidemic: Molecular Epidemiology and Evolution of Viral Pathogens  website, took a look at the placement (and potential significance) of Drosten’s latest MERS sequences in the MERS phylogenetic tree in:

 

Initial hints about the origins of the April Jeddah MERS-CoV outbreak

 

Lastly, a referral to the growing body of work being produced by Maimuna (Maia) Majumder  - an Engineering Systems PhD student at MIT, MPH & epidemiologist – whose website Mens et Manus is rapidly becoming the place to go for some of the most innovative MERS and infectious disease related graphics and commentary on the web.

Maia began uploading her graphics on FluTrackers over the weekend, and her work is a terrific addition to Flublogia. You can follow her on twitter  @maiamajumder, and you’ll find a link to her site in my sidebar.   

 

Highly recommended.

Saudi MOH Announces 16 New MERS Cases & 8 Fatalities

*** UPDATED ***

 

# 8540

 

A week ago today the KSA case count stood at 244 cases, and 79 fatalities.  With today’s MOH statement, we’ve seen an increase of 95 cases, and 23 fatalities; almost as many cases in a week as was reported during the first 18 months after it was first detected in humans.

 

This morning’s announcement from Dr. Christian Drosten  – that his group had sequenced and compared 3 virus sample from Jeddah and found `no significant changes’ – means that epidemiologists are faced with a genuine puzzle as to what is behind this recent surge in cases.

Today we have a fairly detailed, but nonetheless confusing update, which I’ve spent a fair amount of time trying to parse without a lot of success.   While the header states 16 new cases, there are only appear to be 9 detailed in the report; 2 in Riyadh, 6 in Tabuk, and 1 in Jeddah. Additionally, there are more cases listed on the charts than in the text. 

 

**** UPDATED *****

Minutes after I posted the MOH statement they released a revised statement which clears up much of the confusion. I’ve edited out the first version, and replaced it below with the new:

• Of note, 6 cases are listed as coming from a hospital in Tabuk, in Northwestern Saudi Arabia.  Over the past week there has been a fair amount of twitter `chatter’ concerning cases there, but this is the first confirmation I’ve seen.
• A bit unusually for MERS, 2 children in Riyadh are reported to have fall ill with the virus, and one has died.  Up until now, only about 4% of cases have been reported in children.
• And lastly, Health Care Workers once again make up a large percentage of the cases reported, with 7 HCWs listed in today’s update.

 

 

Daily situation report for coronavirus causing AIDS Middle East 

Thursday, may 27, 1433 h

• The total number of confirmed cases in 24 hours: 16

• The total number of deaths in 24 hours: 8 deaths (4 cases recorded in the past 24 hours, and 4 cases of the disease registered already)

Allocation of cases to the cities of the Kingdom  (note: Grandmother= Jeddah)

Summary of the health status of cases:

• 6 cases without symptoms

• 5 stable, receiving treatment on the wing

• One case in intensive care

• 4 deaths, may Allaah have mercy on them

• Distribution of cases at hospitals in the Kingdom:

• Details of the cases:

A. in Riyadh:

1. Saudi child aged 9 months, entered a military hospital in Riyadh on 4 April 2014 and was diagnosed with nephrotic syndrome, 7/4/2014 developed symptoms of respiratory and intensive care and his condition has evolved into a vital organ failure and examination of the Koruna and set positive, passed away may he rest in peace.

2. a Saudi citizen at the age of 16 years, entered the military hospital on 21 April 2014 with respiratory symptoms and stable condition.

B-in the city of Tabuk:

1. a Syrian national, aged 32 years, Prince Fahd Bin Sultan hospital, contacts of the confirmed case, has no symptoms.

2. an Egyptian doctor at the age of 37 years, Prince Fahd Bin Sultan hospital, contacts of the confirmed case, has no symptoms.

3. Philippine nurse nationality at the age of 26 years, Prince Fahd Bin Sultan hospital, mixing with a certain situation, and they have no symptoms.

4. Filipino nurse nationality at the age of 24 years, Prince Fahd Bin Sultan hospital, mixing with a certain situation, and they have no symptoms.

5. Philippine nurse nationality at the age of 46 years, Prince Fahd Bin Sultan hospital, mixing with a certain situation, and they have no symptoms.

6. nurse Filipino nationality at the age of 37 years, Prince Fahd Bin Sultan hospital, contacts of the confirmed case, has no symptoms.

-In Jeddah Governorate:

1. Philippine nurse nationality at the age of 42 years working in a military hospital in Jeddah, had respiratory symptoms on 20 April 2014 and entered the hospital on 22 April 2014 and in stable condition.

2. citizen aged 65 years, in a military hospital in Jeddah, had respiratory symptoms on 17 April 2014, was hospitalized on 19 April 2014 has had death God sheathe her mercy.

3. Yemeni resident aged 75 years, Irfan hospital, entered the hospital on 21 March 2014 with a clot in the brain, has respiratory symptoms on 21/4/2014 and receiving treatment in intensive care, we pray to God for him.

4. Indonesian resident 61-year-old, suffering from kidney failure and respiratory symptoms were introduced to King Fahd Hospital on 16 April 2014, had died in his mercy sheathe her.

5. Philippine nurse sex 54-year-old, the Emergency Department at King Fahd Hospital, she developed respiratory symptoms on 24 April 2014 and in stable condition.

6. citizen aged 65 years, and enter the respiratory symptoms in King Fahd Hospital on 25 April 2014 and in stable condition.

7. a Saudi citizen aged 59 years, King Fahd Hospital and sleep in the hospital for respiratory symptoms on 25 April 2014, and his condition was stable.

8. citizen at the age of 55 years, suffering from heart failure, the National Guard hospital in Riyadh on 18 April 2014, passed away may he rest in peace.

• Death of patients registered already:

1. If the death of a 78-year-old from previously recorded cases Riyadh, may he rest in peace.

2. If the death of a 69-year-old cases that were recorded earlier in Riyadh sheathe her God in his mercy.

3. If the death of the citizen at the age of 89 years of cases recorded earlier in Riyadh sheathe her God in his mercy.

4. If the death of a resident at the age of 68 years of cases recorded already in Jeddah may he rest in peace.

Egypt Ramps Up MERS Surveillance At Local Ports

 

 

# 8539

 

 

If there is a MERS-centric topic trending in the Arabic press this morning, it revolves around Egypt’s imported MERS case (see Crof’s Report from yesterday), and increased surveillance ordered at all ports of entry, particularly for those arriving from Saudi Arabia.

This morning, there are media reports of another suspected case being quarantined and tested at the Cairo airport, and of an `Emergency Declaration’ at all Egyptian ports of entry.

 

First, the report from the Cairo Airport – with the caveat that right now,  anyone arriving from Saudi Arabia who has a fever, or displays any signs of  illness – is probably going to be quickly quarantined and tested. Meaning,  we will likely see far more people tested than will actually prove positive for the virus.

 

«Stone airport» suspected injury to passengers «Corona»

Hussein wrote Khanki

Sunday, April 27th, 2014 13:40

Suspected quarantine management at Cairo airport on Sunday, in the Egyptian passengers, coming from Saudi Arabia, to be infected with a virus «Corona».

According to a source familiar with the passenger Abdel Moneim Suleiman, arrived on board a Saudi plane, coming from Jeddah, where the hair condition of fatigue.

With the signing of a medical examination, a doctor suspected in quarantine infected with HIV «Corona», is transferred to the passenger to a hospital diets, to conduct the necessary tests to follow up the case, and make sure negative infection.

 

In a related story, Al Bayan reports:

 

Egypt: declaration of emergency in all ports because of Corona

Date: April 27, 2014

The Ministry of Health in Egypt - after the discovery of the case of infection with the coronavirus - a state of emergency all Egypt ports.

Television's correspondent in the Egyptian Ministry of Health said the case of infection with Corona announced by the ministry today is a citizen of the Eastern Province was living in Saudi Arabia.

The Ministry of Health announced earlier today the discovery of the first cases of infection in the hospital admitted Corona Abbasid.

 

 

Meanwhile, the Egyptian Ministry of Health has posted details on the imported MERS case, first reported on Friday.

 

 

The Ministry of Health confirmed the first case of new koruna virus known as respiratory syndrome middle (MERS-cov).

The situation of a young 27-year-old civil engineer working in Saudi Arabia four years ago and lives in the city of Riyadh

-Suspected situation through quarantine team to Cairo International Airport and transferred directly to the ambulance to hospital abasiyya with preventive measures for infection control in the early morning hours of 25 April 2014.

Where the patient is booked in quarantine (quarantine) on arrival at the hospital, was taking a swab of nose and throat and spit sample sent to a central laboratory for examination.

-The result of a positive sample for virus koruna on 26/4/2014.

History of case:

The patient's symptoms began in Saudi Arabia on 22 April 2014, which was suffering from a high temperature, cough and pain in muscles and joints, fatigue and diarrhea.

-Frequency of patient care hospital in Riyadh, Saudi Arabia, and the situation at the hospital is reserved and analyses (blood, liver and kidney functions – chest), an x-ray showed pneumonia.

-Out-patient of the hospital and back to the Republic of Egypt Arabic to Cairo airport at 12: 30 am on 25 April 2014.

Clinical status of the patient:

-The corresponding patient by a hospital dietician abasiyya and chest specialist hospital released the Abbasid and reported that the patient has pneumonia right and the general situation stable.

Risk factors:

-Contacts of the case was confirmed by a Slovakian was reserved to a hospital in Jeddah, Saudi Arabia during the past 14 days.

Source: Media Center

Drosten: Jeddah MERS Sequences Show No Significant Changes

Credit Dr Ian Mackay  VDU Blog

 

 

# 8538

 

The sudden spike in MERS virus detections in Saudi Arabia and the UAE over the last month has sparked a good deal of concern that the MERS coronavirus might be evolving into a more human-adapted virus.  While not the only possible explanation for this increase - it would be the most worrisome - were it true.

 

On Friday (see Referral: VDU Blog On MERS-CoV Partial Spike Sequence Results),  Dr. Ian Mackay explained the early results of genetic testing performed by Christian Drosten’s lab in Germany  on MERS samples gathered from the recent Jeddah outbreak, which found no changes to the spike protein region of the virus.

 

A good sign that the virus was relatively unchanged, but as only a subset of MERS genome was examined, not definitive.

Yesterday evening news began to emerge that Dr. Drosten had fully sequenced three virus samples from the Jeddah outbreak, and that these samples showed `no significant changes’ compared to earlier samples sequenced. 

 

A finding that would appear to remove the `easiest’  explanation for these recent outbreaks from the top of the suspect list.

 

Dr. Ian Mackay posted a short announcement last night on his VDU blog, which he later updated, along with a second post where he discusses the ramifications of this finding, along with a small but important caveat (note: the `curve’ mentioned refers to his graphic at the top of this post).

 

If this is what MERS-CoV detections look like with more testing...what is the "normal" community level of virus?? [UPDATED]

For a virus that is chugging along without the aid of any new genetic changes, and perhaps showing up more often (a) because of enhanced testing and/or (b) because of a large-scale breakdown in infection prevention and control (IPC), this curve sure does depict the possibility that we had no idea how much MERS-CoV was transmitting among the population. Still a poor transmitter compared to an influenzavirus, because we have seen a few larger MERS-CoV studies than show few to no MERS-CoV positives, but still more people positive than we thought.

(Continue . . . )

 

Then `minor caveat’  here is that these three comparative samples came from early in the Jeddah outbreak, which doesn’t preclude the possibility that some evolutionary changes may have occurred since then. But the most likely explanation at this point would involve something other than an adaptation of the virus.

 

Dr. Drosten wrote a letter to ProMed Mail, outlining his findings, which appeared overnight.  A brief excerpt follows:

 

MERS-COV - EASTERN MEDITERRANEAN (42): SAUDI ARABIA, GENOME SEQUENCING, JEDDAH OUTBREAK

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Sat 26 Apr 2014
From: Christian Drosten <drosten@virology-bonn.de> [edited]

(EXCERPT)

We have sequenced near full genomes of 3 viruses from the early phase of the Jeddah outbreak. The samples were submitted to Jeddah regional laboratory on [3, 5 and 7 Apr 2014], and sent to Germany for external confirmatory testing on [14 Apr 2014] by KSA MOH in Riyadh. Two of the sequenced viruses were from patients treated in the major public hospital in which most cases of the Jeddah outbreak seem to have occurred. A 3rd sequence was from another health care facility in the city.

Genome sequences of all 3 viruses are highly similar to each other but not identical, and are highly similar to a large number of known MERS-CoV sequences (consult http://www.virology-bonn.de for a phylogeny; genome overview in Cotten 2014). There are no genome insertions or deletions suggestive of sudden major changes. The receptor-binding domain in the spike protein thought to influence the virus's ability to be transmitted or spread is 100 percent identical to the binding site in a large number of known MERS-CoV genome sequences. Based on genome comparison with other MERS-CoV strains there is no reason to assume that the sequenced viruses from Jeddah have acquired changes increasing their pandemic potential.

(Continue . . )

 

To this cavalcade of coverage we can add Helen Branswell’s excellent report for the Canadian Press:

MERS virus hasn't changed, not reason for surge in Saudi cases: expert

Helen Branswell / The Canadian Press
April 26, 2014 05:36 PM

A German coronavirus expert says the virus responsible for the MERS infection appears not to have changed.

Dr. Christian Drosten says based on what his laboratory has seen so far, this month's surge in MERS cases cannot be explained by mutations in the virus.

Drosten's lab at the University of Bonn has been looking at genetic sequences of RNA drawn from samples from 30 recent cases from Jidda, Saudi Arabia, where the largest increase in cases has occurred.

In an email, Drosten says the lab has sequenced three nearly full genomes and they see no signs of significant changes that could account for the increase in cases.

(Continue . . . )

 

As far as what the actual reason for the recent spike in MERS cases might be, it will likely require good old-fashioned gumshoe epidemiology to figure that out. 

An investigation that would include, but not be limited to: extensive contact tracing, broad viral (rRT-PCR) & serological testing, a review of infection control protocols, and a long-promised but never-delivered Case Control Study to determine what specific exposures are most likely to lead to infection.

Basic investigative steps that should have been implemented by Saudi Arabia well over a year ago, and that hopefully with a new Minister of Health in charge, will now get top priority.