Friday, November 01, 2019

WHO DON Update: MERS-CoV In The United Arab Emirates

Fig. 2. Virological and serological evidence for MERS CoV in dromedary camels.

Credit Epidemiology and Infection, Volume 147


With the exception of a sizable outbreak in Oman (n=13) last winter (see March WHO update), we've only seen human MERS infections originating from Saudi Arabia in 2019.  
Yesterday, however, the World Health Organization published a report on a single MERS case - with onset last September - that was reported by the UAE MOH.
While this case - involving a farmer with recent camel (and sheep) contact -  is likely the result of a spillover from infected livestock, the question remains: Why are MERS cases so seldomly reported outside of Saudi Arabia?

We've looked repeatedly at the seroprevalence of MERS in dromedary camels (and other livestock) across the Middle East, Northern African, and parts of Asia (see here, here, and here) - and given the numbers - one would expect more spillover events to occur and be reported from outside of KSA.
Whether this is due to some subtle difference in the strains of MERS-CoV circulating that affect transmissibility, a lack of surveillance and testing in some regions, or some other factor (or factors), is unknown.
Excerpts from the WHO update below.  Follow the link to read it in its entirety.

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

Disease Outbreak News
31 October 2019

On 7 October 2019, the National IHR Focal Point of the United Arab Emirates (UAE) notified WHO of one laboratory-confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

The patient is a 44-year-old male non-national farmer from Al Ain city, Abu Dhabi region, UAE. He developed fever, runny nose, headache, vomiting, productive cough and shortness of breath on 25 September 2019, and was admitted to hospital on 29 September.
A nasopharyngeal aspirate was collected and tested positive for MERS-CoV by reverse-transcriptase polymerase chain reaction (RT-PCR) on 3 October at the Shiekh Khalifa Medical Center laboratory. The patient has underlying comorbidities including diabetes mellitus, hypertension and hyperlipidemia.
He has a history of close contact with dromedary camels and sheep at nearby farms during the 14 days prior to the onset of symptoms. He has no history of recent travel and has not been involved in the slaughtering of animals. As of 14 October, the patient is in stable condition and is currently in an intensive care unit (ICU).

This is the first case of MERS-CoV infection reported from UAE since May 2018. Since 2012, UAE has reported 88 cases (including the patient reported above) of MERS-CoV infection and 12 associated deaths.

Globally, from 2012 through 8 October 2019, a total of 2,470 laboratory-confirmed cases of infection with MERS-CoV have been reported to WHO, including 851 associated deaths. The global number reflects the total number of laboratory-confirmed cases reported to WHO under the International Health Regulations (IHR 2005) to date. The total number of deaths includes the deaths reported to WHO and through follow-up with Ministries of Health in affected member states.