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: maps, totals, sex, age and different populations

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Middle East respiratory syndrome coronavirus (MERS-CoV) by week and month...

To follow up yesterday's daily numbers chart, here we have the number of MERS-CoV detections by week (Chart 1) and by month (Chart 2). 

Not a lot of change from my last posts of these 18-June and 23-June - we are currently in our 5th straight day without any new detections being reported - and prior to this drought, there had been very few other detections for a while so we can now very clearly see the Jeddah-2014 (Kingdom of Saudi Arabia) major hospital-base outbreak peak's beginning and end.

We're also in the second half of Ramadan, putting us past the maximum likely incubation period for those visitors to the holy places that may have acquired MERS-CoV infection at the beginning go the month. A pretty good indication that MERS-CoV is not spreading among the community. It is still strange to me that a region that was yielding sporadic cases up until very recently, is now not yielding any such cases. Perhaps it's the improvements initiated under Dr Fakeih's watch, or maybe the hot, dry weather? It could be that camel contacts are reduced or that festivals are not as frequent in the extreme heat.  It would be great to see some scientific literature emerge on the Jeddah-2104 outbreak, on seroprevalence, on camel testing, gene/genome sequencing, studies of other animals or transmission investigations. Things have been very quiet on the publication front for some time now and we still know very little detail about the largest flurry of (known) cases to have occurred since 2012.

We'll wait and watch and see, I suppose.

MERS-CoV detections, worldwide (but mostly in the Kingdom of Saudi Arabia), by week.
Click on chart to enlarge.

MERS-CoV detections, worldwide (but mostly in the Kingdom of Saudi Arabia), by month.
Note the yellow star which highlights a 10-fold higher scale for 2014 y-axis (left-hand side) than in the 2013 numbers. Even 2014's puny June surpassed any month in 2013.
Click on chart to enlarge.

Snapdate: MERS-CoV by month..

An updated chart. 
[SNAPDATE'S are snap updates that don't have lots of detail and chat...although they almost always end up having lots of chat!]

Unfortunately there are 23 deaths I cannot assign to cases previously announced and so they are not shown in this chart. As the new CCC format continues and there is no WHO fill-in data to help out, this will be an ever-widening gap. One of several.

Into this gap, speculation and hand-waving will exist and thrive. As always. 

Previous caveats about the found113 remain in place too.[1]

The pattern of bad communication>change>good communication>change.... just keeps cycling on in MERSville. Why do we keep resetting-isn't that the question of the day?

MRS-CoV detection by month. Please note the difference in the y-axis scales; for 2014 data, it is set at 10x that of 21012 and 2013 (350 versus 35) to accommodate the much great number of cases - as indicated by the yellow star. 
Click on image to enlarge.

If the scales are not adjusted (h/t to @doctorsdilemma for reminding me that I need to keep things clear, even in a snapdate)...the outbreak's impact is more obvious, at the expense of having any real idea of the detail. Here's how that looks though just tt make the point more clear...

References...

1. Adding in the recent MERS-CoV cases by chart...we're back to 2013
   http://virologydownunder.blogspot.com.au/2014/06/adding-in-recent-mers-cov-cases-by.html

Snapdate: MERS-CoV detection by month...

We are living in the 2.17th year, or 113th week, since the first known MERS-CoV-related illness affected a 25-year old Jordanian.

April stands out as the biggest MERS-CoV detection month ever, with 286 cases either becoming ill, being hospitalised or being reported as positive. But don't be confused by the differing values on the axes in the chart below. For all that May looks like a smaller cousin of April, its tally has already outstripped every other month of 2012 or 2013. 

72 cases so fall into May. But the rate of cases this month is slower than in April (see previous post). 

The tally of detections announced officially through WHO (which remains in a galaxy far, far, far away when it comes to detail on April-May cases) and from various Ministries of Health brings my worldwide tally to 580 MERS-CoV detections listed of which ~166 people have died of MERS. I'm still awaiting detail from WHO or UAE on 4 MERS-CoV cases that I do not list.

38% of May's case have died compared to 13% of April's (where I'm able to assign fatal cases to a month).

Click on image to enlarge.

MERS-CoV cases and deaths by month and growing tallies: a look at the impact of 2 clusters on a "slowly growing epidemic"

The yellow star are to highlight that the 
y-axis (left-hand side values) in 2014
is set to a higher maximum value
than for 2012/2013.
Click on image to enlarge.

The 2 healthcare-associated clusters (paramedic cluster and Jeddah cluster) are the driving factors underpinning the case number spike in April. Cases in other regions are either linked or relatively few in number.

Click on image to enlarge.

With a dozen new cases noted by the United Arab Emirates (UAE) early this morning (my time) I've updated the case and epidemic curve chart below as well, again. This makes UAE the clear second place hotzone for MERS-CoV cases. 

Whether these cases, all asymptomatic, are liked to the paramedic cluster or just the result of enhanced testing (there was mention of contacts in the media release though) is unknown and awaits clarification as do more details on most of the recent 90 cases .

Click on image to enlarge.

And lastly for this post, a chart I last updated 18-Mar when there were fewer then 200 cases. Ahh the good old days. How a month and a couple of healthcare outbreaks change things. This shows the total cases, obviously driven by the Kingdom of Saudi Arabia, but adds on those from the UAE and Yemen as well. A very interesting feature here is the current proportion of fatal cases. The PFC sits at 32.7%; the lowest proportion of fatal cases in the history of MERS-CoV. Why? Because the denominator in that equation (total case numbers) has sky-rocketed without an accompanying rise in fatal cases. While some of the recent cases may yet succumb to severe MERS, the spike we've seen in cases without any disease or with only mild disease, who probably won't die, will offset that and the PFC looks to remain lowered. I would very much like someone to tell me whether these increased numbers of mild cases are due to a change in the approach to testing (contact me!) of people; more testing and less watching and waiting to see if contact and other become obviously sick. Either way - this is great to see.

So this last chart really hammers home one good reason to include asymptomatic cases in the tallies; we get to see the full spectrum of disease from MERS-CoV infection, including no disease at all. 

Knowing that gives us some much needed context when we see a headline that reads "killer virus spreads". 

Now if we just knew whether asymptomatic cases spread infectious virus either through occasional coughs or sneezes or by contaminating their environments. Baby steps.

H7N9 snapdate: H7N9 totals by month, 2013 vs 2014 to date

Click on image to enlarge.

January has so far tallied 1.6x more cases than the peak month of 2013 which was April. And those cases are still being reported.

But only 2 lab-confirmed cases were added to the list last night, perhaps things have started to slow at last? 

That is extrapolating a bit much from 1 night of reporting with low numbers, but let's wait and see what happens tonight (today for you guys up north!). Seems to be the mantra for this sort of stuff.