Friday, January 11, 2019

WHO EMRO MERS-CoV Summary - December 2018


Despite declining numbers - much of which can be attributed to improved infection control in Saudi hospitals - MERS-CoV continues to be one of the zoonotic diseases we watch with particular interest for signs of further adaptation to humans.

Less than a year ago, in the WHO List Of Blueprint Priority Diseases, we saw MERS-CoV listed among the 8 disease threat in need of urgent accelerated research and development.
List of Blueprint priority diseases
The second annual review occurred 6-7 February, 2018. Experts consider that given their potential to cause a public health emergency and the absence of efficacious drugs and/or vaccines, there is an urgent need for accelerated research and development for*:
  • Crimean-Congo haemorrhagic fever (CCHF)
  • Ebola virus disease and Marburg virus disease
  • Lassa fever
  • Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS)
  • Nipah and henipaviral diseases
  • Rift Valley fever (RVF)
  • Zika
  • Disease X

And over the past 6 months we've seen a number of studies that have called into question our ability to identify mildly symptomatic, asymptomatic, or atypically presenting MERS infections in the community.  A few of those studies include:
J. Korean Med Sci: Atypical Presentation Of A MERS Case In A Returning Traveler From Kuwait

mBio: High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia

AJIC:Intermittent Positive Testing For MERS-CoV

JIDC: Atypical Presentation Of MERS-CoV In A Lebanese Patient

And in August - in Evaluation of a Visual Triage for the Screening of MERS-CoV Patients - we looked at what has been described as a serious flaw in Saudi Arabia's MERS surveillance program.

WHO's EMRO (Eastern Mediterranean Regional Office) has released their latest monthly summary of global MERS cases, showing 5 cases in December, all from Saudi Arabia.  One the cases is described as a secondary household contact.

Epidemic and pandemic-prone diseases
MERS situation update, December 2018
At the end of December 2018, a total of 2279 laboratory-confirmed cases of Middle East respiratory syndrome including 806 associated deaths (case–fatality rate: 35.3%) were reported globally; the majority of these cases were reported from Saudi Arabia (1901 cases, including 732 related deaths with a case–fatality rate of 38.5%).

During the month of December, a total of 5 laboratory-confirmed cases of MERS were reported globally (all from Saudi Arabia) with no associated death. There were no healthcare workers affected and most of the cases were primary cases. One of the cases was a secondary infection through household contact.
The demographic and epidemiological characteristics of reported cases, when compared during the same corresponding period of 2013 to 2018, do not show any significant difference or change. Owing to improved infection prevention and control practices in hospitals, the number of hospital-acquired cases of MERS has dropped significantly since 2015.
The age group 50–59 years continues to be at highest risk for acquiring infection of primary cases. The age group 30–39 years is most at risk for secondary cases. The number of deaths is higher in the age group 50–59 years for primary cases and 70–79 years for secondary cases.

Read the latest MERS update, December 2018

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