Wednesday, 9 October 2013

MERS-CoV update...

Click to enlarge. Schematic of the MERS-CoV.
Feel free to use, please just cite 
Virology Down Under and Dr Ian M Mackay
No major jump in Middle East respiratory syndrome coronavirus (MERS-CoV) cases over the past 2 weeks. Great to see.

In parallel to this slow-down in new announcements, the World Health Organization's last few MERS Disease Outbreak News (DONs; 19th Sept20th Sept and 4th Oct) announcements have have given no specific detail but rather age ranges, date of onset ranges and comments in a general and format that is not linked to specific cases.

While the 3rd Emergency Committee convened by the Director-General under the International Health Regulations decreed September 25th that the conditions for a Public Health Emergency of International Concern (PHEIC) have not been met, it did conclude the following:

  • strengthening surveillance, especially in countries with pilgrims participating in Umrah and the Hajj;
  • continuing to increase awareness and effective risk communication concerning MERS-CoV, including with pilgrims;
  • supporting countries that are particularly vulnerable, especially in Sub-Saharan Africa taking into account the regional challenges;
  • increasing relevant diagnostic testing capacities;
  • continuing with investigative work, including identifying the source of the virus and relevant exposures through case control studies and other research; and
  • timely sharing of information in accordance with the International Health Regulations (2005) and ongoing active coordination with WHO.
The following press briefing by Dr Keiji Fukuda noted that:
  • cases have been found in 9 countries
  • no umrah visitors were infected
  • more cases in men than women (~59% male)
  • about a third of (so-called sporadic) cases occur in the community; acquired there via an unknown exposure.
    • older, male, underlying conditions have most severe outcomes
    • suspicion is that exposure is related to animals but how remains unknown
  • another group is person-to-person (family and hospital settings) that lead to clusters but no translation to community case spreads
  • we are seeing the emergence of a new virus, limited to the Middle East, but the full picture remains to be captured
  • we are seeing more mild cases as surveillance picks up but the disease should not be considered mild
  • overall levels of testing after umrah is variable and overall  testing in a number of countries at particular risk of infection is sub-optimal
  • an ideal level of surveillance should be sustained, not bankrupt the country or exhaust resources but identify whether infections are coming into a country or if infection trends are changing. The level of detail depends on the country.
  • WHO is, in general, providing all the information they have
My count seems to be 139 cases with 58 deaths among those giving a PFC of 41.7%. This included the reclassification of 2 "local" Italian cases as probable rather than laboratory confirmed. FluTrackers and I keep the continuous numbering system though, we just deduct 2 from the tally.
Click to enlarge. A map showing countries where cases have
been detected (orange) and those where local transmission
has occurred (red).

In context of global infectious diseases, that is not a large number of cases but it remains a high proportion of deaths. 

To tackle this high PFC, we really need to do something, on a research basis (so as not to bankrupt or over-tax already strained diagnostic services), that was not specifically listed above; test more well people prospectively. This will address how widespread the virus is among those who are not older, male and sick with comorbidities.

Seems like a job for local academic medical researchers - with some special government funding made available perhaps?