Wednesday, 16 April 2014

MERS and camels....urine drinking seems to be a very wide ranging thing...

A video of camel urine being collected by a band of merry (although somewhat coughy) men.

http://www.youtube.com/watch?v=fFk0rXkv0xc&feature=youtube_gdata_player

While the intended uses for camel urine extend from prolonging life to treating cancer to preventing hair loss (none of which have been proven effective in clinical studies as I understand it), consumption among tribes and others in the Kingdom of Saudi Arabia seems to be much more widespread than I, in my ignorance, had thought.

It still remains unclear whether MERS-CoV is actually shed in the urine from infected camels. This is strange to me given that there have now been quite a few camel studies, including those that used PCR-based (real-time reverse transcription PCR that is) methods quite capable of detecting infectious virus. There also seems to be plenty of opportunities to sample already collected urine by PCR. The camel testing focus has been mostly on respiratory secretions and faeces; urine gets missed off the list of samples to be tested. Why? I don't know. Hopefully that will change soon as the science catches up to the realities of lifestyle, however widespread or niche, that those practices may be.

What also really frustrates me is that because camel urine is consumed by drinking, the next step for many is that MERS-CoV must be infecting through the oral route. That does not necessarily track. Urination, defecation, coughing, sneezing, flushing a toilet, talking even breathing can create aerosols that can be inhaled. An aerosol being tiny droplets or floating "nuclei" (dried down droplet that remains airborne for much longer than the larger hydrated form). 

To me at least, this would seem to be to be a much more logical and probable way of acquiring the respiratory disease that is MERS on presentation. At least much more probable that swallowing and needing to inhale some of that into the airways. They may not be exclusive events; swallowing may create aerosols too, but I'm thinking more in terms of the most likely or frequent methods for acquiring a respiratory infection, which is what MERS seems to start off being. 

Keeping in mind that animal studies of hamsters have shown that drinking can result in airway infection by virus - but do we drink like a hamster in a cage? I don't know that we do and I remain very dubious of the relevance of those sorts of findings in humans.

Just some thoughts anyway.

Many thanks to all on Twitter who continue to educate me on camel-related practices in far-off lands. Pleas note that I do not intend to belittle any practice and I sincerely hope it doesn't come across that way. I'm seeking only to try and understand how MERS-CoV may spread, and by extrapolation, how other viruses may spread among animals and to people in the future. 

Spillover events like MERS-CoV infections and H5N1 and H7N9 and H10N8....are going to keep happening but hopefully the knowledge we acquire from each outbreak can speed up our efforts to track the source for the next one. Whatever that source may be. Ultimately, such work needs to be done by the country harbouring the infection though because, resource permitting, they can do it most quickly; so this sort of education is secondary to putting in place the infrastructure and people to accept that education.