#18,331
Long before the SARS-CoV-2 virus emerged in China in 2019, we were watching another emerging coronavirus on the Arabian peninsula - MERS-CoV - which is endemic in camels and has, since 2012, spilled over over into humans numerous times, often with deadly effect.
While not nearly as transmissible as SARS-CoV-2, MERS-CoV appears to be much deadlier than COVID (35% CFR among known cases), although surveillance and reporting has been limited.
In 2017 we saw a study (see A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia) suggesting the virus didn't have all that far to evolve before it could pose a genuine global threat.
Since COVID emerged, reporting of MERS cases by Middle Eastern nations - which has often left a lot to be desired - has plummeted (see WHO EMRO Chart above).
Although we've not any large outbreaks in several years, last May we saw a report on three cases epidemiologically linked to exposures in a health-care facility in Riyadh, illustrating that under the right conditions the virus does spread from human-to-human.
Today the WHO is reporting on KSA's 5th case of 2024, which involves a 50-something male (with no known camel contact) who fell ill, briefly entered a Saudi hospital (where respiratory samples were taken), and then checked himself out and traveled to Pakistan before test results could be returned.
A close contact similarly traveled abroad right after exposure. It appears in both cases, based on investigations to date, that no additional transmission of the virus occurred.
Long-time readers will recall that in 2015, a single infected traveler to South Korea sparked a massive outbreak, which infected 185 people across 16 hospitals, and claimed 38 lives (see Superspreaders & The Korean MERS Epidemiological Report).
While the number of MERS-CoV cases reported over the past few years has fallen sharply, the virus continues to evolve (see Preprint: Ongoing Evolution of Middle East Respiratory Syndrome Coronavirus, Kingdom of Saudi Arabia, 2023-2024), and continued vigilance is required.
I've posted the link, and some excerpts, from today's WHO report. Follow the link to read it in its entirety.
Middle East respiratory syndrome coronavirus - Kingdom of Saudi Arabia
2 October 2024
Situation at a glance
The World Health Organization (WHO) was notified of one human case of Middle East respiratory syndrome coronavirus (MERS-CoV) on 5 September 2024, by the Ministry of Health of the Kingdom of Saudi Arabia (KSA). The case is a male from the Eastern Region of KSA aged between 50-55 years, with underlying health conditions. He had no history of contact with camels and was not a health care worker. The follow-up of close contacts has been completed, and no secondary cases have been detected. Since the beginning of the year, five cases including four deaths have been reported from KSA. The notification of this case does not change WHO’s overall risk assessment, which remains moderate at both the global and regional levels.
Description of the situation
On 5 September 2024, the Ministry of Health (MoH) of the Kingdom of Saudi Arabia (KSA) notified the World Health Organization (WHO) of one case of Middle East respiratory syndrome coronavirus (MERS-CoV).
The case, a man aged between 50-55 years residing in the Eastern Region of KSA, developed a fever, cough, shortness of breath, and palpitations on 28 August 2024. He was admitted as a cardiac case to a local hospital on 31 August and transferred to a medical complex on 1 September. From there he was discharged at his request the same day, against medical advice.
A nasopharyngeal swab taken on 1 September and tested at the National Public Health Laboratory as part of severe acute respiratory illness (SARI) sentinel surveillance, returned a positive result for MERS-CoV on 4 September through Real-Time Polymerase Chain Reaction (RT-PCR).
After the patient was discharged from the hospital and prior to receiving the laboratory results confirming MERS-CoV, he traveled to Pakistan on 2 September.
The patient is a non-healthcare worker with several co-morbidities. Following field investigation, there was no evidence of interaction with camels. In KSA, follow-up has been completed for one household member, 23 healthcare professionals, and two patients who had contact with the case, with no secondary cases reported. Among close contacts listed in KSA, one travelled from Saudi Arabia to South Asia on 4 September. Flight details and personal information were retrieved to initiate contact tracing and follow-up, and no secondary cases have been identified in connection with this high-risk contact.
Following the notification on 5 September 2024 from the International Health Regulations (IHR) National Focal Point (NFP) of KSA to the Pakistan IHR NFP regarding the patient’s travel and positive MERS-CoV results, the patient was located in Pakistan, and the health authorities proceeded to transfer the patient to a public hospital for strict isolation and management of existing comorbidities.A total of 41 nasopharyngeal samples, including repeat samples of the case and close contacts were collected and tested at the Pakistan National Institute for Health/National Reference Laboratory. The patient tested positive, albeit with a low viral load, while all contacts tested negative. Close contacts, including family members and healthcare workers were closely monitored for 14 days, and no secondary cases have been identified.
The patient was discharged on 13 September after receiving a negative test result for MERS-CoV, along with instructions to continue oral medication and to return for a follow-up appointment in five days. This follow-up was successfully completed on 19 September, confirming the patient's full recovery.
Since the beginning of the year, a total of five cases including four deaths have been reported from KSA, and this is the first case reported since the last Disease Outbreak News was published on 8 May 2024.(SNIP)WHO risk assessment
Since the first report of MERS-CoV in the Kingdom of Saudi Arabia (KSA) in 2012 until now, human infections have been reported in 27 countries, spanning all six WHO regions. The majority of MERS-CoV cases (2205; 84%), have been reported in KSA, including this newly reported case.
The notification of this case does not change the overall risk assessment. The new case reported is believed to have acquired MERS-CoV infection locally within KSA. However, the potential for international transmission is increased due to the fact that the individual visited Pakistan, while a high-risk contact traveled to South Asia within the 14-day follow-up period. Both individuals had arranged their travels prior to the occurrence of the event and before the test results of the case were obtained and disseminated.
WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East and/or other countries where MERS-CoV is circulating in dromedaries. In addition, cases will continue to be exported to other countries by individuals who were exposed to the virus through contact with dromedaries or their products (for example, consumption of raw camel milk), or in a health-care setting. Human-to-human transmission of MERS-CoV may occur if there are delays in identifying the infection, particularly in countries that are not well-acquainted with the disease, as well as slow triage of suspected cases and delays in the implementation of standard infection prevention and control measures.
WHO continues to monitor the epidemiological situation and conducts risk assessments based on the latest available information.
