MERS by month, camel and mass gathering...

I haven't updated this figure in a long while but recently had the chance to add some new camel calving season data [1] and another festival to my earlier lists [2-4] - the Um Ragaiba festival.[6] 

The Um Ragaiba festival is purportedly the largest of the human|camel gatherings, located north of Riyadh and near Buraidah and Hafr Al-Batin - interestingly, are all sites of infamy among the tales told in MERSville.[5]

MERS-CoV detection in humans by month. Also showing spring and
summer seasons in the Kingdom of Saudi Arabia and some key
camel and festival dates.
Click on image to enlarge

The latest version of this figure highlights a few things to me:

1. I don't see a seasonality here which is not surprising. Most human cases are due to human error creating the circumstances by which health care related outbreaks take off. These happen at different times. It is hard to remove that very loud noise and see if a seasonality remains. A seasonality that is presumably due to times when there are more active camel infections increasing the risk of human infections through proximity and direct contact with infected hosts
2. The Kingdom of Saudi Arabia has at last taken the threat posed by MERS-CoV infected camels seriously. In 2015, two big festivals which had camel involvement, Janadriyah and Um Ragaiba were not held. Take note China and avian influenza
3. The bulk of human cases occur within a timeframe bracketed by camel calving season - so, keeping in mind what I said above, rather than season, perhaps we can agree that the period in which higher numbers of MERS-CoV cases occur, seems to be in the Arabian Peninsula's spring and summer - even if that outbreak is in South Korea! When virus activity rises at the source, so does the risk of death and significant economic and social impact beyond the borders of that source

Reference...

1. http://www.ncbi.nlm.nih.gov/pubmed/26256102
2. http://virologydownunder.blogspot.com.au/2014/01/a-date-with-middle-east-respiratory.html
3. http://virologydownunder.blogspot.com.au/2014/04/an-update-on-april-outbreak-of-mers-cov.html
4. http://virologydownunder.blogspot.com.au/2013/09/can-mers-cov-seasonality-tell-us.html
5. https://www.saudiaramcoworld.com/issue/200803/heads.high.htm
6. http://www.ncbi.nlm.nih.gov/pubmed/25714162

MERS-CoV snapdate...

MERS-CoV detections by month and year

As can be seen from the graph below, the peaks of MERS-CoV detection have been driven by humans and their infection prevention and control issues - but what maintains the virus in between those lapses? 

It seems clear that MERS-CoV is entrenched among camels in the Middle East and Africa but how is it getting to humans, and how is it dong that in such small numbers over such a wide area? These have been questions for 148 weeks. 

It's a good thing this infection transmits so poorly between humans.

Click on image to enlarge.

MERS-CoV by month, now with added camels and hospital outbreaks...

Weekly case tallies for 20012-4 (blue-surviving 
and fatal cases; red-fatal cases). Also indicated 
are the season in which camels give birth (I've
noted "birthdays" because it seems to be 1-year
old or older camels that are usually positive for
MERS-CoV. Past and future Hajj pilgrimage 
dates are also shown as is 1 of several
large camel events in the KSA.
Click on image to enlarge.

While the World Health Organization is yet to produce confirmed case data for the majority of the MERS-CoV outbreaks' biggest month, some of those data and extra information are being provided by the Kingdom of Saudi Arabia Ministry of Health v2.0. 

And it's very welcome and much appreciated. There still remain some vagaries and data gaps that make consistency an issue. But further information is not forthcoming so let look at some charts of what we have. 

For now, we can see in the daily graph, 4-days into May, that cases are still being announced but at what looks like a slower rate. We are seeing cases reported with a lag of approximately a week from when they became ill/were hospitalised (when those dates are present).

A plot of cases per day. Many (?most) are based on dates of reporting although
more dates of illness onset have emerged lately and I am working through them. This means that the specific peaks may chop and change a little as dates are assigned. Nonetheless, the trend seems to be one of decreasing numbers per day and
the cumulative average may be suggesting a peaked for this KSA outbreak.
Click on image to enlarge.

Middle East respiratory syndrome coronavirus (MERS-CoV) cases rise in march: Festival-related?

It's been nearly 3-weeks since my last update so I'm well overdue to look at what's changed.

Click on image to enlarge.

A quick post first up showing the accumulating cases by the region in which the person probably caught their infection and the week in which they became ill - or the week in which the case was publicly reported by a Ministry if no onset date was provided.

Why the recent uptick in cases; ~9 reported this month so far? 

There have been a few things going on in Riyadh (a city of 6 million, in which 10/11 most recent cases have been acquired) that might link people with camels (the likely intermediate or primary host of MERS-CoV in the region). 

I have listed a few other events listed that may also be pertinent for MERS-CoV acquisition &/or transmission, from whatever source, in a post 29-Jan [5]. To add to that there is this:

• The 17-day long 29th annual Janadriyah Festival kicked off Feb-12. It showcases the national heritage and culture of the Saudi lifestyle. Includes camel rides and racing [3,4] and is visited by millions of people from all over the Kingdom of Saudi Arabia (1.4mil by 26-Feb) [2][3]. But not just locals; tourists come from all other regions of the Arabian peninsula too, including the UAE which a "guest of honor" this year. Of note: the recent 68-year old male UAE MERS-CoV case had exposure to animals from his own farm and is not noted as having traveled.

References...

1. What's on in Riyadh
   http://www.expatarrivals.com/saudi-arabia/riyadh/whats-on-in-riyadh
2. Arab News story on Janadriyah festival 2014
   http://www.arabnews.com/news/531351
3. Janadriyah festival at Blue Abaya
   http://www.blueabaya.com/2014/02/guide-to-janadriyah-festival-2014.html
   and
   http://www.blueabaya.com/2013/04/top-ten-things-to-do-at-janadriyah.html
4. Camel racing at the Janadriyah Festival
   http://english.alarabiya.net/en/perspective/photo-gallery/2014/02/13/Riyadh-Camel-Race.html
5. A date with Middle East respiratory syndrome coronavirus (MERS-CoV)..
   http://virologydownunder.blogspot.com.au/2014/01/a-date-with-middle-east-respiratory.html