#18,371
When COVID emerged in 2019 - sparking the first known coronavirus pandemic - we were actively following several other coronaviruses with pandemic potential, particularly MERS-CoV; which emerged from camels in 2012, and had infected > 2400 people in the previous 8 years.While less transmissible than SARS-CoV-2, MERS-CoV appears to be much deadlier (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.
For a number of years the Saudis reported MERS cases on a - more or less - daily basis. Reports were often belated, and gradually we began to see long periods (weeks and even months) with no updates at all (see 2018's The Saudi MOH Breaks Their Silence On MERS-CoV).
Since COVID emerged, however, reporting of MERS cases by Middle Eastern nations has plummeted sharply (see WHO chart above). Even before the pandemic, we'd seen estimates that the vast majority of MERS cases go undiagnosed (or unreported) in the Middle East (see EID Journal: Estimation of Severe MERS Cases in the Middle East, 2012–2016)
In a 2022 update, the WHO suggested that MERS cases are probably still occurring, but going unreported due to the pandemic.
While daily or even weekly reporting on MERS ceased 5 years ago, the WHO's EMRO still provided a detailed monthly summery of MERS reports, along with other Epidemic and pandemic-prone diseases.
As a result, the last EMRO monthly report on MERS-COV was published in May of 2024. Of course, it isn't just MERS-CoV (or the Middle East).The last update to EMRO's Epidemic and pandemic-prone diseases table of current outbreaks was January 27th, 2004. Many disease categories, however, have not been updated in years.
Yesterday the WHO published their (now) bi-annual update on MERS-CoV from Saudi Arabia, which describes 4 cases (2 fatal) from the past 6 months. I've only posted some excerpts, so follow the link to read it in its entirety.
I'll have a bit more after the break.
13 March 2025
Situation at a glance
This is the bi-annual update on the Middle East respiratory syndrome coronavirus (MERS-CoV) infections reported to the World Health Organization (WHO) from the Kingdom of Saudi Arabia (KSA). From 6 September 2024 to 28 February 2025, four laboratory-confirmed cases of MERS-CoV infection, including two deaths, were reported to WHO by the Ministry of Health of the KSA. One of the four cases was a secondary case exposed to the virus in a healthcare facility (nosocomial transmission). Close contacts of the four cases were followed up by the Ministry of Health. No additional secondary cases have been detected. The notification of these four cases does not alter the overall risk assessment, which remains moderate at both the global and regional levels. The reporting of these cases shows that the virus continues to pose a threat in countries where it is circulating in dromedary camels, particularly those in the Middle East.
Description of the situation
Between 6 September 2024 and 28 February 2025, the Ministry of Health (MoH) of the Kingdom of Saudi Arabia (KSA) reported four cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including two deaths, with the last case being reported on 4 February 2025. The cases were reported from the Hail (2), Riyadh (1) and the Eastern (1) Provinces of the KSA (Figure 1). Laboratory confirmation of the cases was performed by real-time polymerase chain reaction (RT-PCR) between 8 November 2024 and 4 February 2025.
All cases involved males aged between 27 and 78 years, and all presented with comorbidities. None were health workers, and from investigations only one was found to have indirect contact with dromedary camels (hosts of MERS-CoV) and their raw products (milk).
Two cases, with symptoms onset in November 2024, were identified within the same hospital. The first case was confirmed on 11 November through RT-PCR testing, and follow-up on close contacts revealed a secondary case that shared the same hospital room and developed symptoms subsequently. Neither of the two patients had direct or indirect contact with dromedary camels, including consumption of raw camel milk in the 14 days prior to the onset of symptoms.
Since the first report of MERS-CoV in KSA in 2012, a total 2618 laboratory-confirmed cases of MERS-CoV infection, with 945 associated deaths (CFR 36%), have been reported to WHO from 27 countries, across all six WHO regions. The majority of cases (2209; 84%), have been reported from KSA, including these newly reported cases. Since 2019, no MERS-CoV infections have been reported from countries outside the Middle East.
Figure 1. Geographical distribution of MERS-CoV infections between 6 September 2024 to 28 February 2025 by city and region, KSA (n=4).
(SNIP)
WHO Risk Assessment
The notification of these four additional cases does not change the overall risk assessment. 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, and that cases will continue to be exported to other countries by individuals who were exposed to the virus through contact with dromedaries or their products (consumption of raw camel milk), or in a healthcare setting. WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.
Admittedly, detecting MERS cases can be challenging, especially now, against the backdrop of COVID. A few past blogs include:
EID Journal: Sensitivity and Specificity Of MERS-CoV Antibody Testing
AJIC: Intermittent Positive Testing For MERS-CoV
JIDC: Atypical Presentation Of MERS-CoV In A Lebanese Patient
Evaluation of a Visual Triage for the Screening of MERS-CoV Patients
While the WHO diplomatically advises:
Based on the current situation and available information, WHO re-emphasizes the importance of strong surveillance by all Member States for acute respiratory infections, including MERS-CoV, and to carefully review and investigate any unusual patterns.
The reality is, the timely reporting of emerging infectious disease outbreaks has deteriorated badly all around the world (see Flying Blind In The Viral Storm).
It has now become `acceptable' for nations to routinely redact `sensitive' outbreak information, or to release information belatedly, assuming it gets released at all.
While these policies may provide some short-term political of economic benefits, they will quickly evaporate when the next global public health crisis inevitably emerges.
