SNAPDATE: MERS by the years...

When it comes to Middle East respiratory syndrome coronavirus (MERS-CoV) infections, the years  and the comorbidities - really do take a toll. 

The graph below helps to highlight how the median and average ages of MERS-CoV positive cases and deaths are distinct from the median age of the total Saudi Arabian population - among whom most MERS-CoV infections have been reported. ...although there is the issue of expatriate workers who also get infected - do they contribute to the Kingdom's median age?

Click on image to enlarge.

A place to be critical...

Around May/June 2015, the Middle East respiratory syndrome (MERS) coronavirus escaped its Arabian Peninsula bonds and exploded...still associated with the circumstances created under lax hospital conditions...into another part of the world entirely - South Korea.

About 20% of South Korean MERS cases were fatal. In contrast, nearly twice that proportion have died after MERS-CoV infection among 26 countries (36% fatal).[1] Meanwhile, a little over twice the SOuth Korea proportion of fatal cases occurs in the Kingdom of Saudi Arabia (KSA; 42%).[2] 

It is interesting to look at another possible measure of clinical impact - how often a MERS patient is publicly described via official channels as being in "critical" condition. I suspect that this term could be applied as arbitrarily as anything else used by humans, nonetheless, see the figure below.

Total MERS-CoV detections (mustard bars; left-hand axis)
and mentions of cases in "critical" condition (red bars; right-hand axis).
Taken from the MERS-CoV data visualizations page.[3]
Click on image to enlarge.

A few things:

• Sadly, you have to ignore the biggest peak - the Jeddah-2014 hospital outbreak (March to June) - as data during that time were rare and detail was mostly absent both from the KSA Ministry of Health and the World Health Organization
• If we look at the South Korea peak (May/June 2015) versus the most recent Riyadh outbreak (July/August 2015), there seem to be a lot more mentions of critical cases. There is also more red visible during the Eastern Region/Ar Riyadh region peak around January/February 2015. 

There may be little to conclude from observations such as this, but it is yet another interesting pattern to muse upon.  

Older males with comorbidities are heavily represented among MERS disease cases that present to hospitals (younger people among those with mild or no notable disease) and older  males and females with comorbidities among the fatal outcomes. A shared risk is that comorbidities are preyed upon by MERS-CoV.

Comorbidities include diabetes mellitus, cirrhosis and various lung, renal and cardiac conditions. All of these are diseases of concern among countries with abundant unhealthy food options, weight issues and ageing populations. Is your country one of those? Even familiar old viruses could re-emerge as threats to this subgroup as the years go by. In the meantime, emerging newly identified viruses create an atmosphere of concern.

MERS-CoV detections broken down by age bands and into total cases
(left hand graphs), and those with a fatal outcome (right-hand grpahs).
Taken from the MERS-CoV data visualizations page.[3]
Click on image to enlarge.

References..

1. http://www.who.int/csr/don/01-october-2015-mers-jordan/en/
2. http://www.moh.gov.sa/en/CCC/PressReleases/Pages/Statistics-2015-10-04-001.aspx
3. http://virologydownunder.blogspot.com.au/2014/08/mers-cov-daily-monthly-and-cumulative.html

Queensland influenza sees a shift in age...

Image adapted from Geoscience Australia,

The Australian Government.[3]

The media Down Under have been doing their thing this influenza season...

• Vaccine delay to cause horror flu season, say experts
• Qld sniffles through highest flu count
• CHART: Australia could be in for its worst flu season on record
• Flu cases tracking at record levels

...lots of inflammatory (pun intended) headlines to make us all fear just about everything and everyone. Blah.

Nonetheless, it is flu season down here - and hopefully you gave vaccination a try this year, or you got your annual shot. Top marks if so! If you can safely and pretty painlessly dodge a preventable disease, save yourself some misery, avoid making your kids sick - who will require time off to be looked after, not make Aunty Robyn crook as a dog and not put Grandad's ailing ticker under extra stress...why wouldn't you? 

VDU Figure 1. Figure 2 from the State of
Queensland (Queensland Health) report
found here.[1]Click on image to enlarge

Thanks to the excellent and publicly available wealth of data presented by the epidemiologists of the State of Queensland (Queensland Health), I talked about influenza in Queensland and the distribution of types (i.e. Flu A or B) and subtypes (e.g. H3N2 or H1N1) last year.[2]

In 2014, influenza A viruses were the big bad, but in 2015, as we can see in VDU Figure 1 (orange), influenza B viruses are ruling the mean streets.

VDU Figure 2. Appendix 1 from the State of
Queensland (Queensland Health) report
found here.[1]Click on image to enlarge

From the look of VDU Figure 2, the influenza season remains in full swing (hint-get that vaccination if you haven't already). 

VDU Figure 2 also shows that things are not tracking all that unusually for a Queensland influenza season when you compare this year to curves from the past 5 years. So I'd suggest taking those media headlines with a box of tissues!

However, something stood out to me when looking at the latest report so I went back and cut-and-pasted the age and sex graphs from the past few consecutive weeks to make VDU Figure 3. Sure enough, there was a particular spike in the 5-9 and 10-19 year old age bands (yellow arrows in graph boxed in red). Even allowing for changed y-axis scale in the first 4 graphs (dates are listed in each graph's legend) these 2 bands seem to have risen just in the past reporting week. 

Still, the overall pattern of rising case numbers, a dip in the 20-29 year old age band, then a rise before a consistent drop off is retained. Is this the result of school kids returning from school holidays on the 23rd of July, sharing their viruses, incubating an infection and becoming ill? If so - will we see a rise in parent - age age bands in the report after next's? Let's watch and see!

VDU Figure 3. Figure 4s from previous weeks of State of Queensland (Queensland Health) report found here.[4]
Images excised from PDFs and pasted together using 
Adobe Photoshop CC 2015.0.0
Click on image to enlarge

References....

1. https://www.health.qld.gov.au/ph/documents/cdb/influenza-qld-150802.pdf
2. http://virologydownunder.blogspot.com.au/2014/03/influenza-viruses-in-queensland.html
3. http://www-a.ga.gov.au/web_temp/1531782/61756.pdf
4. https://www.health.qld.gov.au/ph/cdb/sru_influenza.asp
5. http://education.qld.gov.au/public_media/calendar/holidays.html

Middle East respiratory syndrome coronavirus (MERS-CoV): Age and Sex [UPDATED]

THIS PAGE IS NO LONGER UPDATED

This data visualization has been added to the single
MERS-CoV page now be found at..
http://virologydownunder.blogspot.com.au/2014/07/middle-east-respiratory-syndrome_17.html

A new static page on which I will update the MERS-CoV numbers as they relate to the age and sex of the people laboratory confirmed as infected.

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