WHO EMRO MERS-CoV Summary - July, 2019

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Once a month the WHO's EMRO (Eastern Mediterranean Regional Office) provides a summary of MERS activity in the Middle East - and around the world - based on what is officially reported by individual Ministries of Health to the World Health Organization. 

In this summary WHO EMRO reports 9 new MERS Cases - all from Saudi Arabia - during the month of July.

While a significant decline over the numbers we were seeing last spring, over the past year 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 of 2018 - 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.

First the latest EMRO report, then I'll return with a bit more.

MERS situation update, July 2019
 

• At the end of July 2019, a total of 2458 laboratory-confirmed cases of Middle East respiratory syndrome (MERS), including 848 associated deaths (case-fatality rate: 34.49%) were reported globally; the majority of these cases were reported from Saudi Arabia (2067 cases, including 770 related deaths with a case–fatality rate of 37.25%).
• During the month of July, a total of 9 laboratory-confirmed cases of MERS were reported globally. All the 9 cases were reported from Saudi Arabia with 3 associated deaths. 2 of the cases reported had their the symptom onset in the previous month - June. There were no cluster of cases reported this month. One case had history of contact with camels and consumption of their raw milk while the exposure history of the other cases is still under investigation. Only one case reported this month was a female and one case reported was a non-national. No healthcare workers were a ffected this month.
• This month, Saudi Arabia has not reported any new cases related to the Al-Khafji city outbreak. The outbreak has presumed to have stopped due to the effective response measures taken by Saudi Arabia. There were no cluster of cases reported this month apart from one secondary case, a health care worker linked to a case reported in the previous month (May).
• The demographic and epidemiological characteristics of reported cases, when compared during the same corresponding period of 2014 to 2019, do not show any significant difference or change.
• The age group 50–59 years continues to be at the 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.

While MERS-CoV hasn't embarked on a world tour the way that SARS did 16 years ago, we've seen studies (see A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia) suggesting the virus doesn't have all that far to evolve before it could pose a genuine global threat.

Last year, 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

(SNIP)

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

All of which makes gaining a better understanding of how - and how well - the MERS coronavirus continues to spread in the community a high priority.